Bangladesh National Formulary (BDNF) 5th Version 2019 PDF

BDNF
BANGLADESH
NATIONAL
FORMULARY
2019
5
Published by
Directorate General of Drug Administration
Health Services Division
Ministry of Health and Family Welfare (MOHFW)
In Association with
Bangladesh Medical Association
Bangladesh Pharmaceutical Society
Bangladesh National Formulary
(BDNF)
2019
Published by
Ministry of Health and Family Welfare (MOHFW)
In Association with
BDNF 2019
An official publication about drugs and related items officially used in Bangladesh
for rapid reference and includes all the available information for prescribing and
dispensing.
Published by
Aushadh Bhaban, Mohakhali, Dhaka-1212, Bangladesh
In Association with
and
ISSN 1683-1314
5th
Edition
July, 2019
Computer Composed by
Md. Shahidul Islam Khan
Cover Design by
Md. Mehedi Hasan,
National Consultant, Essential Drugs and Medicines,
WHO Bangladesh
Printed by
--------------------
Caution
Bangladesh National Formulary (BDNF) is meant for academic and
professional use only. Any part of this book may not be used for any form of
advertisement, sales, publicity or business related to drug(s) mentioned in
the Formulary without the prior written permission of the publisher.
Acknowledgement
World Health Organization (WHO), Bangladesh
• Directorate General of Drug Administration
Aushadh Bhaban, Mohakhali,
Dhaka-1212, Bangladesh
Tel : 880-2-9880854, 9880964, 9880897, 9880803
E-mail : dgda.gov@gmail.com
Web : www.dgda.gov.bd
• Bangladesh Medical Association

• Bangladesh Pharmaceutical Society
Supported by:
CONTENTS
Preface i-ii
Committees iii-iv
Contributors v-vii
User’s Guide viii
Guidance on Prescribing ix-xv
Notes on drugs and preparations

1. Anti-Infective 1-90
2. Gastro-Intestinal System 91-121
3. Cardiovascular System 122-175
4. Respiratory System 176-194
5. Endocrine System 195-235
6. Obstetrics, Gynaecology and Genito Urinary-Tract Disorders 236-264
7. Central Nervous System 265-314
8. Anaesthesia 315-328
9. Musculoskeletal and Joint Diseases 329-353
10. Eye 354-386
11. Ear, Nose and Throat 387-402
12. Skin 403-442
13. Immunological Products and Vaccines 443-463
14. Malignant Diseases and Immunosuppression 464-493
15. Anaemias and Other Blood Disorders 494-508
16. Nutrition 509-534
17. Contrast Media 535-541
Appendices and Indices

Appendix-1 Treatment Guidelines 542-568
Appendix-1a Treatment Guidelines for Acute Watery Diarrhoea 542-545
Appendix-1b Treatment Guidelines for Tuberculosis 546-548
Appendix-1c Treatment Guidelines for Leprosy 549-550
Appendix-1d Treatment Guidelines for Dengue Infection 551-554
Appendix-1e Treatment Guidelines for Acute Respiratory Tract Infection 555-555
Appendix-1f Treatment Guidelines for Drug Addicts 555-558
Appendix-1g Treatment Guidelines for Burn Injury 559-561
Appendix-1h Treatment Guidelines for Malaria 562-562
Appendix-1i Treatment Guideline for Kala-azar 563-565
Appendix-1j Treatment Guidelines for Chikungunya 566-568
Appendix-2 Drug Interactions 569-643
Appendix-3 Liver Diseases 644-650
Appendix-4 Renal Impairment 651-659
Appendix-5 Pregnancy 660-699
Appendix-6 Breast-Feeding 700-705
Appendix-7 Poisoning 706-714
Appendix-8 Immunization Schedule 715-722
Appendix-9 Essential Drug List 723-734
Appendix-10 List of Over the Counter (OTC) Drugs 735
Appendix-11 List of Controlled Drugs 736
Appendix-12 Adverse Drug Reactions Monitoring (ADRM) and 737-747
Pharmacovigillance
Appendix-13 Pharmaceutical Abbreviations 748-751
Appendix-14 Medicinal Gases 752-757
Appendix-15 Nuclear Medicine and Radiopharmaceuticals 758-766
Appendix-16 Nuclear Parenteral Doses (for Adults and Children) of 767-770
Drugs for Medical Emergencies
Appendix-17 Drug and Food Interaction 771-772
Appendix-18 Side Effect of some common drugs 773-777
Appendix-19 Clinical Pathology and other Biomedical tablet 778-791
Appendix-20 List of thermolabile products with recommended 792-794
Storage Condition
Appendix-21 Access, Watch and Reserve groups of antibiotics 795-798
Dental Practitioners’ Formulary 799-824

Index of Pharmaceutical Manufacturers in Bangladesh 825-832
Abbreviations & Symbols Used in the Formulary 833-834
General Index 835-900
Reporting Form of Suspected Adverse Drug Reactions
COMMITTEES
Committees
CHIEF PATRON NATIONAL FORMULARY COMMITTEE
Mr. Zahid Maleque, MP
Honorable Minister Chairman
Ministry of Health & Family Welfare Professor Kanak Kanti Barua
Government of the People’s Republic Vice-chancellor, BSMMU, Dhaka
of Bangladesh
Member-Secretary
PATRONS Nayer Sultana
Md. Asadul Islam Director (cc)
Honorable Secretary Directorate General of Drug Administration
Ministry of Health & Family Welfare Members
Government of the People’s Republic Major General (Rtd.) Md. Abdul Ali Mia
of Bangladesh Ex-Consultant Physician General
Bangladesh Armed Forces Medical Services
ADVISORY COMMITTEE Dhaka
Chairman Additional Secretary

(Drugs Admin & Law)
Major General Md. Mustafizur Rahman Health Services Division
Exe-Director General Ministry of Health & Family Welfare
Directorate General of Drug Administration Bangladesh Secretariat, Dhaka
Dhaka
Professor A. K. M. Nurul Anwar
Co-Chairman Ex-Director General
Professor Md. Ismail Khan Directorate General of Health Services (DGHS)
Vice Chancellor
Chittagong Medical University Professor A.B.M Faruque
Chittagong Department of Pharmaceutical Technology
University of Dhaka
Members
Additional Secretary Dr. Mustafa Jalal Mohiuddin
(Drugs Admin & Law) President
Health Services Division Bangladesh Medical Association
Ministry of Health & Family Welfare
Bangladesh Secretariat, Dhaka Professor Rashid–E-Mahbub
Ex-President
Professor Nazmun Nahar Bangladesh Medical Association
EX-Director General
BIRDEM Hospital, Dhaka Professor Md. Zulfiqur Rahman Khan
Dean
President Faculty of Surgery, BSMMU, Dhaka
Bangladesh Medical & dental Council Professor A.F.M Saiful Islam
Ex-Director
President Center for Medical education, Dhaka
Bangladesh Private Practitioners Association
Professor Md. Abdur Rahman
Dean
M. Musaddek Hossain Faculty of Pharmacy
Vice-President University of Dhaka
Bangladesh Pharmacy Council
Professor Sania Tahmina
Director, CDC
Directorate General of Health Services (DGHS)
Dr. Firdausi Qadri
Emeritus Scientist & Acting Senior Director(IDD)
ICDDRB, Mohakhali, Dhaka
President
Bangladesh Pharmaceutical society
iii
COMMITTEES
EDITORIAL BOARD WORKING COMMITTEE

Adviser Chairperson
Professor DR. Md. Zohurul Haque Professor Dr. Afsana Karim
Professor of Pharmacology
Department of Pharmacology
Ex-Director
BIRDEM, Dhaka
Directorate of Drug Administration
Member-Secretary
Chief Editor
Mahbub Hossain
Professor Dr. Afsana Karim Superintendent of Drugs
Department of Pharmacology
BIRDEM, Dhaka
Members
Executive Editor
Sr. Assistant Secretary (Drug Admin)
Professor Sitesh Chandra Bachar Ministry of Health & Family Welfare
Professor of Pharmaceutical Technology
Bangladesh Secretariat, Dhaka
Faculty of Pharmacy
University of Dhaka
Professor Sitesh Chandra Bachar
Professor of Pharmaceutical Technology
Assistant Editor Faculty of Pharmacy
Dr. Mohammad Asaduzzaman University of Dhaka
Associate Professor
Clinical Pharmacy & Pharmacology Dept. Dr. A. K. Lutful Kabir
University of Dhaka
Associate Professor
Pharmaceutical Technology Dept.
Members University of Dhaka
Deputy Secretary (Drug Admin)
Health Services Division Nayer Sultana
Ministry of Health & Family Welfare Director (cc)
Bangladesh Secretariat, Dhaka Directorate General of Drug Administration
Brigadier General Dipak Kumar Paul Md. Razibul Habib

Chowdhury Superintendent of Drugs
Pharmacology Department Directorate General of Drug Administration
Dean
Medical Studies Faculty
BUP, Mirpur Cantonment, Dhaka
Professor A.K.M. Mosarrof Hossain
Pharmacology Department
Sylhet M A G Osmani Medical College, Sylhet
Professor Sultana Ferdousi

Chairman
Physiology Department
BSMMU, Dhaka
Professor Eliza Omar Eva

Pharmacology Department
Shahid Shohrawardi Medical College, Dhaka
Member-Secretary
Nayer Sultana
Director (cc)
iv
CONTRIBUTORS
Contributors
Ahmad Istiaque, Advisor, Aristopharma Ltd.
Ahmed Md. Jamal Uddin, Dr. Associate Professor, Department of Internal Medicine,
BIRDEM
Allo Akhtarun Nahar (Retd.) Chief Nutrition Officer, BIRDEM.
Amin Md. Ruhul, Director (C.C), Directorate General of Drug Administration
AraGulshan, Dr., Professor of Pharmacology, Medical College for Women, Uttara
Ara Iffat, Dr., Professor of Obstetrics & Gynecology, Dhaka Medical College
Azad Khan AbulKalam, Dr., Professor of Internal Medicine, Dhaka Medical College
Azam Md. Golam, Dr. Associate Professor, Department of GHPD, BIRDEM.
BacharSitesh Chandra, PhD, Professor of Pharmacy, University of Dhaka
Banu Layla Afroza, Dr., Professor of Pharmacology, Shikdar Medical College
BanuParvin Akhter, Dr., Chief Oncologist, Delta Medical College & Hospital
Barami A A Salim, Ex-Director, Directorate General of Drug Administration
Bari Tajul Islam Abdul, Dr.Infectious Disease Division, icddrb& Former Program
Manner, EPI, Bangladesh.
BasakSanchay, Sanofi Pasteur, Sanofi Bangladesh Limited.
Basher M Abul, Dr., Professor of Radiology & Imaging, BSMMU
Begum Bilkis, Professor & Chairman of Clinical Pharmacy and Pharmacology,
University of Dhaka
Begum Fatima, Dr., Associate Professor, National Institute of Nuclear Medicine &
Allied Science, Atomic Energy Commission
BegumFerdousi, Dr., Professor of Gynaecology& Obstetrics, BIRDEM
Begum Hosne Ara, Dr. Associate Professor, Department of Skin and VD, BIRDEM.
Begum Kohinur, Dr., Professor, Pharmacy Department, Asha University
Begum Masuda, Dr., Professor of Hematology, BSMMU
Begum Samsad, Dr., Assistant Professor of Dermatologist, Shaheed Suhrawardy
Medical College
Bhattacharya Pinaki, Dr., D16 Pharma & Biotech Ltd.
Bhuiyan M M Rahman, Dr., Professor of Gastroenterology
Chowdhury Ashesh Kumar, Prof. Immunology,BIRDEM.
Chowdhury Mohiul Islam, Dr. Infectious Disease Division, icddrb, Dhaka,
Bangladesh
Chowdhury Shah Abdur Rahman, Professor, Pharmacology.
Chowdhury ShameemMatin, Dr., Psychiatrist, Private Practitioner
Chowdhury Sk. Ferozuddin, Professor, Pharmacy Department, Jahangirnagar
University
DiptaTashmimFarhana, Prof. Transfusion Medicine &Clinical Haemato logy,
BIRDEM.
Faroque A.B.M., Professor of Pharmaceutical Technology, University of Dhaka
FatemaKaniz, Dr. Associate Professor, Department of Critical Care Medicine,
BIRDEM.
Ferdousi Sultana, Dr.Professor of Physiology, BSMMU
Ghani Abdul,Dr., Professor, Ex-Director, Directorate of Drug Administration
Habib Mansur, Dr., Professor of Neuromedicine, Dhaka Medical College
Haque Md. Zahurul, Dr., Professor of Pharmacology, Ex-Director, Directorate of Drug
Administration
Hasan Md. Mehedi, National Consultant - Essential Drug and Medicines, (WHO),
Bangladesh.
Hasnat Abul, Dr., Professor of Clinical Pharmacy & Pharmacology, University of
Dhaka
Hawlader Md. Mujibur Rahman, Dr., Professor of Conservative Dentistry and
Endodontics, BSMMU
Hossain Istiaque, Healthcare Pharmaceuticals Ltd.
Hossain Mahbub, Superintendent of Drugs, Directorate General of Drug
Administration
Hossain Md. Akter, Assistant Director, Directorate General of Drug Administration,
DGDA
Hossain Mohammad Delwar, Dr. Associate Professor Internal Medicine, BIRDEM.
Hossain Sayed Mashoor, Dr., RPGLC
v
CONTRIBUTORS
Hossain Sheikh Mohammed, Dr., Ophthalmologist, National Institute of Ophthalmology &

Hospital
Hossain Syed Emamul, Dr., Central Drug Addiction Treatment Center, Department of Narcotics
Control
Hossain Touhid Mohammad Saiful, Dr., Assistant Professor of Urology, BSMMU
Huq M Azizul, Glaxo Smithkline Bangladesh Ltd.
HyeHumayun K. M. A., Dr., Ex-Director, Directorate General of Health Services
Hye M. A., Dr., Professor, Ahsania Mission Cancer Hospital
Hye Md. Abdul, Dr., Professor of Anesthesiology, BSMMU
Iqbal Rowshan, Dr., BIRDEM
Islam AFM Saiful, Dr.,Professor,Department Pharmacology, Anwar Khan Modern Medical College
IslamK M H S Sirajul, Dr., Professor of Cardiology, BSMMU
Islam Md Mohid, Superintendent of Drug, Directorate General of Drug Administration
Islam Shahidul Professor, Microbiology, BIRDEM.
Jahan Mina Hoor, Ex. Assistant Director, Directorate of Drug Administration, DGDA.
Jaigirdar Md. Quamrul Hasan, Dr., Professor Dermatology, BSMMU
Jalil, Reza-ul,Dr., Professor of Pharmaceutical Technology, University of Dhaka
Kabir Abul Kamal Lutful, Assistant Professor of Pharmaceutical Technology, University of Dhaka
Kabir Enamul, Dr., Pathology Department, Sir Salimullah Medical College
Kabir Md. Zhangir, Dr., Professor of Urology, Lab Aid Hospital
Kalam Abul, Dr., Navana Pharmaceuticals Ltd.
Kalimuddin Md., Dr., Registrar, National Heart Foundation & Research Institute
Karim Afsana, Dr., Professor of Pharmacology, BIRDEM
Klara Tisocki, Dr., Regional Advisor, Essential Drugs and other Medicines (EDM), World Health
Organization (WHO), Regional Office for South East Asia, New Delhi, India
Kutubi Afroza, Dr., Assistant Professor of Obstetrics & Gynecology, Dhaka Medical College
Mazid M A, Dr., Professor of Pharmaceutical Chemistry, University of Dhaka
Misbahuddin Mir, Dr., Professor of Pharmacology, BSMMU
Mohamed Ramzy Ismail, Technical Officer, Essential Drugs and Medicines, WHO Bangladesh
MomtazAzmeri, Dr., Assistant Professor of Pharmacology, Delta Medical College
Moyeenuzzaman M., Dr., Professor of Physical Medicine, BSMMU
Muquit A. N. M. Abdul, ACI Ltd.
Noor Farah, Dr., Professor of Pharmacology, Dhaka Dental College
PodderUjjwal Kumar, Business Development & Regulatory Affairs, Novartis (BD) Ltd.
Qadri Firdausi, Dr., Director, Centre for Vaccine Science, ICDDR’B
Rahat-Uzzaman, Healthcare Pharmaceuticals Ltd.
Rahman Mafuzar, Dr., Ex. Professor of Radiology & Imaging, BIRDEM Hospital
Rahman Md. Habibur, Dr., Professor of Pharmaceutical Technology & Ex- Director, Directorate of
Drug Administration
Rahman Md. Mahbubur, Dr., Resident Psychiatrist, Central Drug Addiction Treatment Center,
Department of Narcotics Control
Rahman Md. Mojibur,Dr., Professor of Epidemiology
Rahman Md. Mostafizur, Novartis (Bd) Ltd.
Rahman Md. Sayedur, Dr., Professor of Pharmacology, BSMMU
Rahman S M Abdur, Dr. PhD,Professor of Clinical Pharmacy & Pharmacology, University of
Dhaka
Rahman Shah Ataur, Dr., Professor of Dermatology
Rahman Syed Mizanur, Dr., Radiology & Imaging Department, BSMMU
Rashid Harun-Al, Dr., Professor of Anaesthesiology, Holly Family & Red Crescent Hospital
Rashid K. M. Mahbubur, Marketing Manager, Glaxo SmithKline Bangladesh Ltd.
Rashid Md. Abdur, Dr., Professor of Pharmaceutical Chemistry, University of Dhaka
Reza Md. Selim, Dr., Professor of Pharmaceutical Technology, University of Dhaka
Rizvi Shahriar, Dr., Medical CDC, DGHS
Rouf Abu SharaShamsur, PhD, Professor of Pharmaceutical Technology, University of Dhaka
Roy Bhupati Kumar, Healthcare Pharmaceuticals Ltd.
Sattar Humayun, Dr., Professor of Microbiology, BSMMU
Sayeed Ashraf, Dr. Prof. Opthalmology, BIRDEM.
Shaheen Md. Shafiul Alam, Dr. Assistant Professor, Department of Anaesthesiology, BIRDEM.
Shaheen Nazma, Dr., Professor,Institute of Nutrition and Food Science, University of Dhaka
Siddiqi Umme Ruman, Dr, Zoonotic Disease Control Program, Communicable Disease Control
Unit, DGHS.
Siddiqua Aysha, Dr. Pharmacologist, Directorate General of Drug Administration
vi
CONTRIBUTORS
Sultana Nashid, Dr., Associate Professor of Pharmacology, Delta medical College

Sultana Nayer, Director (C.C), Directorate General of Drug Administration
Tahmeed Syed A B, Sanofi Pasteur
Uddin Md. Saleh, Dr., Professor of Ophthalmology
Umma Hani Kajol, UHFPO (C.C), Patnitala, Naogaon
Yusuf Abdullah Md, Dr., Assistant Professor, Department of Microbiology,
National Institute of Neurosciences Hospital.
Shafiullah Rajib hassan IBN, Dr., Medical Officer, Directorate General of Drug Administration
vii
User’s Guide
While compiling the Bangladesh National Formulary (BDNF), the Editorial Board has
tried to follow the style in which the British National Formulary (BNF) has been
arranged. This is because of the fact that the target users of the BDNF, i.e., the
physicians, pharmacists, dentists and other interested groups of Bangladesh, are
already used to making use of the BNF.
All the drugs (both locally manufactured and imported), which are registered with the
Directorate of Drug Administration up to 30th June, 2019 and are in current use in
Bangladesh, are included in the BDNF. Each of them is described individually. They
are first grouped into Chapters according to their pharmacological or physiological or
other medical category. This edition of the BDNF has such 17 Chapters. Each Chapter
is again sub-divided into Sections using numerical proceeds according to more distinct
co-relations between the items included in each Section. Each of these Sections
begins with a brief description of the subject matter, i.e., the drug or its group, which is
expected to be useful for the target users. Description of the drug is followed by brief
notes on its indications, side-effects, cautions, contra-indications, warnings, drug
interactions, doses, names of the proprietary preparations containing the said drug,
names of the manufacturers, the available dosage forms of the drug and their
strengths.
The opening Chapter of the BDNF includes a Guideline on Prescriptions, which

highlights various aspects of prescription writing, prescribing for children and the
elderly and prescribing in terminal illness. It also includes notes on the concept of
essential drugs and control of narcotics.
This issue of the BDNF also includes Chapters on Abbreviations used in the
Formulary, Dental Practitioners Formulary, Index of Manufacturers, Adverse Drug
Reactions Monitoring, a General Index and 21 Appendices.
For readers convenience the body of the text and index is composed in double
columns with no colours in the main captions, but the sub-heads and sub-sub-heads
in the body are printed in colours. Rulers are used above all sub-heads, thickness of
which are varied using black colour depending on the importance of the heads.
Separate superscript symbols are used to denote essential drugs (ED), controlled drugs
(CD)
, and imported drugs (I). Names of the microorganisms are printed in Italics. Names
of the generic drugs are printed in bold letters. Proprietary names are kept in bold
regular but the Company names are in Italics.
Indications, Cautions, Contra-indications, Side-effects, Interactions and Doses are

printed in regular and bold types. Generic items are printed in capital and bold letter.
It should be noted here that the price of the individual drug, which is sold and used in
Bangladesh is also mentioned in this issue.
viii
GUIDANCE ON PRESCRIBING
Guidance on Prescribing
GENERAL GUIDANCE
Appropriate prescribing implies the choice of medicines based on efficacy, safety,

suitability and cost relative to other drugs or treatments that may be available.
Medicines should be prescribed only when they are necessary. Taking time to explain
to patient (and relatives) the treatment options, as well as the rationale and potential
risks ofchosen treatment regimen encourages the patient to take the medicines as
prescribed. Successful therapy comprises much more than choosing an appropriate
drug; it requires knowledge, judgment, skill, wisdom, responsibility, and above all,
patient and doctor compliance.
COMPLIANCE
Patient compliance means adherence to a prescribedtreatment schedule. Patient

non-compliance is a major factor in therapeutic failure.
Reasons for patient non-compliance include: (a) poor patient-doctor relationship with
resultant failure to follow the instructions; (b) lack of adequate information about the
medications; (c) frequency and complexity of drug regimen; (d) forgetfulness; and (e)
fear or anxiety about drug reactions.
Discussing the rationale and possible adverse effects of treatment to the patient or
relatives improves compliance. Simplifying the regimen may also help. The patient
should know the nature of the disease and reasons for drug therapy including
expected benefits; how and when to take the medicine(s) with special instructions, if
any; how long a drug needs to be taken; what to do if a dose is missed; how to
recognize possible adverse effects; and when to report back to the doctor.
Doctor compliance is no less important and relates to his/her professional obligations

and responsibilities. A doctor should have full knowledge about the drugs he/she
prescribes, and be very careful and accurate in prescribing and telling the patients
what they need to know.
DRUG INFORMATION: ROLE OF BDNF
Most physicians recognize that they need unbiased drug information to choose from
the various medicines available in the market, which are often seductively promoted to
them by pharmaceutical companies.
Bangladesh National Formulary (BDNF) aims to provide prescribers, pharmacists, and
other healthcare professionals with up-to- date information about use of medicines.
It provides key information necessary for the selection, prescribing, dispensing and
administration of medicines, registered and approved by the Directorate General of
Drug Administration, Bangladesh.
Information on medicines provided in BDNF has been drawn from manufacturer’s
product literature, verified by professional experts with standard medical and
pharmaceutical literature like BNF, BP, USP, Martindale, and national guidelines.
Generic and International Non-proprietary Names (INN) where applicable have been
provided. Proprietary or brand names are as registered by the Drug Administration.
The doses mentioned areintended for general guidance only. The BDNF advocates
ix
caution that ‘prescription-only drugs’ and ‘controlled drugs’ need to be prescribed only
by a qualified and registered physician or dental surgeon.
ESSENTIAL DRUG CONCEPT: IMPORTANCE IN PRESCRIBING
The essential drugs (EDs) concept was first promoted in 1977 by World Health
Organization (WHO);encouraged each of the member countriesthe need to compile
and regularly update a list of a minimal number of appropriate (effective, safe, suitable
and least costly) drugs that will satisfy the healthcare needs of its majority population.
The Govt. should then ensure that the listed essential drugsbe available at all times, in
adequate amounts, in appropriate dosage forms and in affordable prices; and doctors
be encouraged to prescribe from the list of essential drugs. In 1977 WHO compiled its
first model list of essential drugs, updated regularlysince then, the most recent list
contains about 560 items.
The National Drug Policy (NDP) of 1982 was thefirst determined effort to implement
WHO concept of essential drugs in Bangladesh. Essential drugs have been marked by
symbol (ED) in BDNF. The essential drug list following NDP of 1982 have been revised
and updated in 2016 which contain 285 items (see Appendix-9).
Prescribing fromthe list of essential drugs is considered to be relatively effective and

safe and of acceptable quality and most cost-effective. .
PRESCRIPTION WRITING
Prescription shouldbe legible and dated containing the name, age and address of the
patient, and should be signed in ink by the prescriber.
The age of the patient should always be mentioned in cases of ‘prescription-only
drugs’ for children under 12 years.
A prescription ordering ‘controlled drugs’ must in addition specify the prescriber’s
address, the formulation and strength of the preparation, and the total quality of the
preparation to be supplied (or the number of dose units) in both words and figures. A
prescription ordering a ‘controlled drug’ should clearly mention that it can be
dispensed only once and it’s refilling is not permitted.
DRUG NAMES IN PRESCRIPTION
Names of drugs or medicinal products should be written clearly and not abbreviated.
Drugs prescribed may be either in non-proprietary (generic) or in proprietary (brand)
names.
There are growing awareness for using generic names in prescribing for obvious
advantages—uniformity, convenience, economy, and better comprehension.
Prescribing in non-proprietary (generic) names is also less taxing on the memory of
the prescriber.
However, when it is considered important to ensure consistency of a product in

respect of its quality or bioavailability, and when it is thought that the control over the
quality relative to other manufactured products may not be as rigorous as one would
expect, a doctor may opt to prescribe by proprietary names.
x
In the prescription, unit dose strength should be clearly stated
• Avoid unnecessary use of decimal point; e.g. 5 mg and not 5.0 mg.
• Quantities in grams should be written as 1 g or 1.2 g etc.
• Quantities less than 1 gram should always be written in milligrams; e.g. 500 mg
and not 0.5 g.
• Quantities less than 1 mg should be written in micrograms; e.g. 100 micrograms
and not as 0.1 mg
• Micrograms or nanograms should not generally be abbreviated, because it may
create confusion with milligrams.
• ml (for milliliter) should only be written and not cc (for cubic centimeter).
• When decimals are unavoidable for quantities less than one, a zero should be
written before the decimal; e.g. 0.5 g and not .5 g.
The quantity to be supplied may be specified in numbers or volume; it may also be

stated by indicating the number of days of treatment required.
The directions for use should preferably be in a language that is understood by the
patient and should be without any abbreviations.
PRESCRIBING FOR THE ELDERLY
Prescribing for elderly patients especially very old requires special consideration.They
are usually more vulnerable to adverse effects.Factors responsible include multiple
therapy (poly pharmacy) and alteration of pharmacokinetic or dynamic parameters.
Elderly patients often receive multiple drugs for their multiple diseases or symptoms,
which greatly increasethe risk of adverse effects and/or drug interactions. Elderly
patients’ medicines should be reviewed regularly and those that are not of benefit
should be stopped. Prophylactic medicines are inappropriate if they complicate
treatment or produce side-effects Non-pharmacological means are more appropriate
for symptoms like headache, sleeplessness, light-headedness particularly when
associated with social stress.
In the very old, manifestations of normal ageing may be mistaken for diseases,
leading to inappropriate prescribing. Age related muscle weakness, difficulty in
maintaining balance etc. are often confused with neurological diseases. Nervous
system of the elderly patients is more sensitive to many commonly used drugs like
opioids, benzodiazepines, anti-psychotics, anti-Parkinsondrugs which when used
need caution and regular monitoring.
Pharmacokinetic changes in the elderly can greatly reduce renal clearance and
markedly increase tissue concentration, resulting in slow excretion of drugs
particularly of nephrotoxic drugs. Acute illness can lead to rapid reduction in renal
clearance especially if accompanied by dehydration. Bleeding associated with aspirin
and other NSAIDs are more likely to have serious outcomes in elderly patients with
renal impairment or cardiac diseases.
Hepatic metabolism of lipid soluble drugs particularly with narrow therapeutic window
is reduced in elderly patients because of reduction in liver volume.
Very old patients may have difficulty in swallowing tablets or capsules and in case of
drugs like NSAIDs if left in the mouth may lead to ulceration Elderly patients should
therefore be advised to take tablets/capsules with enough fluid, and in upright position.
Liquid formulation if available may be preferable
Simple treatment regimen is always better for the elderly patients. Once or twice daily
preparation is preferable. Full instructions must be written on the prescription. It is also
xi
important to check the patient’s compliance by counting the remaining tablets or

capsules. Stopping a drug at the right time is as important as starting it.
PRESCRIBING FOR CHILDREN
Responses to drugs in neonates (first 1m), infants (up to1yr) and children(upto12yrs)
are not the same as in adults. The risk of adverse effects are more due to relative
deficiency of drug metabolizing enzymes, differing sensitivity of target organs,
inefficient renal filtration, and inadequate detoxifying systems. Special care should be
taken while prescribing for children and neonates.
Liquid preparations are particularly suitable for infants. Sugar-free liquid preparations
are preferable for long term treatment to avoid risk of dental caries. Many children are
able to swallow tablets or capsules and may prefer a solid dosage form. Whenever
possible, painful intramuscular injections should be avoided. Strength of the tablet or
capsule should be clearly mentioned in the prescription.
Inclusion of age of the child or infant in the prescription is a legal requirement while
ordering ‘prescription-only drugs’ for them; in fact it is advisable to mention the age
while prescribing any drug for children or infants
PRESCRIIBING IN PALLIATIVE CARE
Palliative care is the ‘total care’ needed for a terminally ill patient whose disease is not
responsive to any curative treatment. Aim of the ‘total care’ is to provide the best
quality of life for the patient and family. Control of pain and other symptoms,
management of complications, maintenance of nutrition, and psychological support of
the patient and familyare the main stay of the palliative care
For a total care plan, it is important to make careful assessment of symptoms and the
needs of the patient preferably by multidisciplinary team. Many patients wish to remain
and managed at home with their families, butshould be admitted in specialized
palliative care hospital if the family cannot cope.
While prescribing drugs, the number should be as few as possible. Oral administration
is the route of choice unless the symptoms are severe enough, in which case drugs
may be administered parentally.
Control of Common symptoms:
Pain: Non-opioids (paracetamol, NSAIDs) opioids (codeine, morphine) analgesics;

and adjuvant (antidepressants, antiepileptics) are used alone or in combination
according to type of pain and response.In mild cases, paracetamol may be enough.
Moderate pain may be treated by aspirin or other NSAIDs. In some cases, codeine
may be added for better relief. NSAIDs’ induced gastric upset may be relieved by PPIs
(ranitidine150 mg twice daily). If these measures fail, morphine (orally or parentally) is
the most useful analgesic. The dose should be adjusted carefully with assessment of
the pain.Laxatives should be prescribed to prevent morphine-induced constipation.
Bowel colic may be relieved by loperamide or hyoscinehydrobromide.Pain due to
muscle spasm usually responds toDiazepam. Pain due to nerve compression may be
reduced by dexamethasone.Patients with neuropathic pain may benefit from a trial of
a tricyclic antidepressant. An antiepileptic (gabapentine or pregabaline) may be added
or substituted if pain persists.
xii
Nausea and vomiting: may be due to disease itself, its treatment or concurrent
medical or surgical conditions. The cause should be identified before prescribing any
anti-emetic. Metoclopramide, anti-emetic with pro-kinetic action is the drug of choice.
Anti-emetic therapy should be reviewed every 24hrs and if necessary, a substitute
anti-emetic (haloperidol, cyclizine,levomepromazine) may be prescribed.
Hiccup: An antacid with an anti-flatulent may be prescribed. If this does not work
well, metoclopramide orally or i.m can be added. Alternately chlorpromazine may be
tried.
Dyspnea: Breathlessness at rest may be relieved by carefully titrated doses of

morphine, starting at 5mg every 4 hours. Diazepam 5-10 mg daily may be helpful. If
there is bronchospasm or partial obstruction, dexamethasone 4-8 mg daily may be
tried.
Anorexia: Anorexia may be due to a tumor or its complication, treatment by

radiotherapy or chemotherapy, oral ulceration, depression or anxiety. The approach
to treatment is by removing the cause if possible, alteration of diet and the use of
appetite stimulants. Prednisolone 10-30 mg daily or dexamethasone 2-4 mg daily
may improve appetite.
Dysphagia: Dysphagia may be due to a tumor itself, treatment, neurological damage

or concurrent illness or a combination of these factors. If patient cannot swallow a
solid diet, a liquid diet is advised. If liquid diet also cannot be taken, endo-esophageal
tube may be needed. Dexamethasone 8 mg daily may help. Dry mouth associated
with candidiasis can be treated with oral preparation of Nystatin or miconazole.
Convulsions: Convulsions are common in patients with cerebral tumor or uraemia.

Phenytoin or carbamazepine may be prescribed as prophylaxis. If oral medication is
not possible, Diazepamgiven as suppository (10-20 mg every 4-8 hours) or
Phenobarbitone injection (50-200 mg twice daily) is continued as prophylaxis.
PRESCRIBING CONTROLLED DRUGS
Narcotic and psychotropic drugs, which are under dual control of Directorate of Drug
Administration and Department of Narcotics Control (under The Narcotics Control Act,
1990; Act no. XX of 1990) and are permissible for use as medicinal products in
Bangladesh, are included as monographs in the BDNF. Such drugs are distinguished
throughout in the BDNF by the symbol [CD], meaning “Controlled Drugs”. A list of
controlled drugs is shown in Appendix-11.
Prescription requirements in respect of controlled drugs are as follows:
1. A registered medical practitioner or a dentist as per clause (m) and (e) of

section 2 of the Bangladesh Medical and Dental Council Act, 1980 (XVI of
1980) only shall prescribe any of the controlled drugs.
2. Prescription for controlled drugs must be written, signed and dated in
prescriber’s own handwriting; and specifies prescriber’s full address.
3. The prescription must state patient’s name and address, the total quantity
prescribed and the number of dose units in both words and figures.
4. It should be stated that the prescription is not refillable, and shall not be
dispensed more than once.
xiii
5. If a patient under care of a physicianbecomes an addict requiring treatment,

shall be referred to a narcotics addiction treatment/rehabilitation centre, and
as per section 17(2) of the Narcotics Control Act, 1990 shall inform the
Director General, Department of Narcotics Control, President’s Secretariat,
1 Segun Bagicha, GPO Box No. 3169, Dhaka-1000.
STORAGE AND DISPENSING OF CONTROLLED DRUGS
1. Controlled Drugs, especially A-Class and B-Class narcotics and psychotropic

drugs (see Appendix-11), should be stored in pharmacies and in hospitals or
health centers or clinics in a secured place under lock and key.
2. The name and address of the seller/dispenser and the date on which the
prescription is dispensed must be recorded on the prescription by the
pharmacist/dispenser.
3. The prescription for a controlled drug shall not be dispensed more than once
(see Section 13(3) of Narcotics Control Act, 1990).
4. It is recommended that pharmacies maintain a separate register for dispensing of
all A-Class and B-Class narcotics and psychotropic drugs (see Appendix-11),
wherein the name and address of both the prescriber and the patient, and name
and quantity of the drug dispensed along with the date of dispensing are
recorded.
5. A pharmacist is not allowed to dispense a controlled drug unless all the required
information is given on the prescription.
ADVERSE REACTIONS TO DRUGS
Any drug may produce unwanted or unexpected adverse reactions. Rapid detection,
management and reporting of adverse drug reaction is of utmost importance. Some
reactions like nausea, vomiting, headache, allergic rashes, convulsions etc. may
appear soon enough after the administration of a drug. Some other reactions like
malignancy, agranulocytosis, retinopathy, retroperitoneal fibrosis, etc. may appear
months or years after the exposure. Any suspicion of such an association should be
carefully investigated and reported.
When an infant is born with some congenital abnormality or there is an abortion of a
malformed fetus, doctors should consider whether this might be an adverse reaction to
a drug taken by the mother during pregnancy. Doctors should be particularly careful
and alert about adverse reactions to drugs in the elderly and in infants.
To prevent adverse drug reactions—
1. Do not prescribe a drug unless there is a good indication. If the patient is an

infant or an elderly or a pregnant woman, do not use a drug unless the need for it
is imperative.
2. Specially be careful in prescribing drugs for a person with previous history of
allergy or any adverse drug reactions.
3. Find out whether the patient is already taking some other medicines and avoid
possible drug interactions (see Appendix-2) while prescribing.
4. Age and hepatic or renal disease may alter metabolism and excretion of drugs,
so that much smaller doses may be needed to avoid adverse side effects.
xiv
5. Prescribe as few drugs as possible. Simplify the drug regimen and provide clear
instructions so that the patient (especially the elderly) has no difficulty in
understanding.
6. Whenever possible, use a familiar or established drug which is already included
in an official pharmacopoeia. Be especially careful in prescribing ‘new drugs’.
7. If serious adverse reactions are known to be associated with a drug, warn the
patient while prescribing it.
Reporting Adverse Drug Reactions:
Doctors working in public hospitals or health complexes or in private hospitals/clinics

or engaged in private practice have a special responsibility of reporting suspected
adverse reactions to any therapeutic agents including drugs, blood products, vaccines,
contrast medias, herbal products; and all cases of adverse reactions that were fatal,
life-threatening, hospitalization or prolongation of hospitalization, disability or
permanent damage, congenital anomaly/birth defect or any other serious issues.
Detection, management and reporting of adverse drug events (ADE), especially those
in respect of ‘new drugs’, is of vital importance.
There is an Adverse Drug Reactions Monitoring (ADRM) cell in the office of the
Directorate General of Drug Administration, which works in collaboration with WHO.
Details about the ADRM cell and a Yellow Card for ADE reporting to ADRM cell are
included at the end of the BDNF.
xv
Chapter 1
ANTI-INFECTIVES
Anti-infective Drug Therapyp 1
1.1 Antibacterial drugsp.3

1.1.1 Penicillins p.3
1.1.2 Cephalosporinsp.13
1.1.3 Other beta-lactamsp.29
1.1.3.1 Carbapenemsp.29
1.1.3.2 Monobactamp. 32
1.1.4 Aminoglycosidesp.32
1.1.5 Macrolidesp.35
1.1.6 Tetracyclinesp.40
1.1.7 Quinolones and fluoroquinolonesp.42
1.1.8 Sulfonamides and trimethoprimp.49
1.1.9 Metronidazole tinidazole and ornidazolep.50
1.1.10 Antimycobacterial drugsp.50
1.1.10.1 Anti-tuberculosis drugs p.51
1.1.10.2 Anti-leprosis drugsp.55
1.1.11 Drugs used in sexually transmitted diseases p.56
1.1.12 Other antibacterials p.57
1.2 Antifungal drugs p.62
1.2.1 Systemic antifungals for systemic fungal infectionsp.62
1.2.2 Systemic antifungals for mucocutaneous infectionsp.64
1.2.3 Topical antifungalsp.64
1.3 Antiprotozoal drugs p.66
1.3.1 Antimalarialsp.66
1.3.2 Amebicidesp.73
1.3.3 Trichommonocidesp.77
1.3.4 Antigiardial drugsp.77
1.3.5 Leishmeniacidesp.78
1.4 Antiviral drugs p.79
1.4.1 Drugs for herpes virus infectionsp.80
1.4.2 Drugs for viral hepatitisp.82
1.4.3 Drugs for influenza an respiratory syncytial virusp.84
1.4.4 Drugs for HIV infectionp.86
1.5 Anthelminticsp.94
1.5.1 Drugs for nematode infectionsp.94
1.5.2 Drugs for cestode infectionsp.99
1.6 Antimicrobial option for medically important organismp….
1. ANTI-INFECTIVE DRUGS ANTI-INFECTIVE DRUG THERAPY:

1.1 ANTIBACTERIALS Anti-infective (antimicrobial) drugs are
1.2 ANTIFUNGALS used for the treatment and prophylaxis of
1.3 ANTIPROTOZOALS infections. Nowadays, healthcare
1.4 ANTIVIRALS professionals are increasingly more
1.5 ANTHELMINTICS presented with scenarios in which
infecting microbes that are resistant to all
but a handful of antimicrobials Infections
secondary to drug-resistant pathogens
1. ANTI-INFECTIVES
continue to present therapeutic whether pregnant or breast-feeding or

challenges to clinicians. A number of the taking oral contraceptives.
historically most active antimicrobials Choice of appropriate route of
have undergone widespread administration, dosage formulation, and
susceptibility diminution. Particularly duration of therapy will depend on ability
problematic pathogens include gram- to tolerate drugs orally, site, type and
positive microbes such as severity of infection and kinetic
Staphylococcus aureus and consideration of drugs. Life threatening
Enterococcus species; extended- infections often require intravenous
spectrum, and metallobetalactamase- therapy. Painful intramuscular injections
producing Enterobacteriaceae; and should better be avoided in children. The
nonfermentative gram-negative species dose of an antibacterial will vary on such
such as Acinetobacter species and factors such as age, weight, renal and
Pseudomonas aeruginosa. hepatic functions and the severity of
SELECTING AN ANTIMICROBIAL: infection. Duration of therapy depends on
Ideally, the selection should base on nature of infection and the response to
identification of the causative organism(s) treatment. In most cases a 5-7 days
and their susceptibility to antimicrobials course is sufficient, and should not be
(Definitive therapy). In practice, however, unduly prolonged as the drugs are costly,
the choice often follows from clinical encourage resistance and may lead to
diagnosis defining as precisely as side-effects. In certain infections like
possible, the sites and nature of infection, chronic, it is necessary to continue
responsible pathogen(s) and known treatment for longer periods.
sensitivity to drugs (Empiric therapy). CHEMOPROPHYLAXIS: The basis of
Samples (blood, pus, urine, sputum, chemoprophylaxis is use of an
CSF, etc.) should be collected before antimicrobial agent in a healthy person to
starting any ‘blind’ antimicrobial therapy prevent infection but in practice it also
to confirm clinical diagnosis and drug includes suppression of existing infection.
sensitivity. Removing barriers such as The main categories of
draining an abscess, obstruction in chemoprophylaxis are: (i) prevention of
urinary or respiratory tract, etc. is infections like rheumatic fever, recurrent
important to facilitate entry of urinary tract infections, etc.; (ii)
antimicrobials to site(s) of infection. prevention of opportunistic infections like
Patients who receive Empiric bacterial endocarditis after dentistry or
antimicrobial therapy, to which the peritonitis after bowel surgery; (iii)
causative pathogen is resistant, suffer suppression of existing infection before
significantly. This underscores the overt diseases result e.g. tuberculosis,
importance of selecting an empiric malaria, animal bites, trauma; and (iv)
antimicrobial that possesses activity prevention of exacerbation of a chronic
against the range of suspected infection like bronchitis.
pathogens. One or more antimicrobials, Chemoprophylaxis in surgery is justified
suggested by knowledge of likely when risk of infection is high (such as
organism and its sensitivity pattern, is presence of large number of organisms
then judged by the drug’s specificity, in organs being operated or in colorectal
safety (risk-benefit ratio), kinetic and gynecological surgery); when risk of
considerations and cost effectiveness in infection is low but consequence of
respect to the patient factors to make the infection could be disastrous (e.g.
final choice. Factors related to patient insertion of prosthetic joints or valves
include history of drug allergy, renal and etc.); or when patient is
hepatic function, susceptibility to infection immunocompromised and is especially
(i.e. whether immunoco-mpromised), susceptible to infection. Antimicrobials
severity of illness, ability to tolerate should be selected on the basis of the
drugs, concomitant use of other drugs, knowledge of the likely pathogens at the
ethnic origin, age and sex; and if female,
2
1. ANTI-INFECTIVES
sites of surgery and their prevailing * - Watch group antibiotics

antimicrobial susceptibility. included in the EML/EMLc only
Antimicrobials should preferably be given for specific, limited indications
intravenously (IV) or intramuscularly (IM)
at the beginning of surgery and for no [W] - Watch group antibiotics
more than 72 hours.
COMBINATION THERAPY: In most [R] - Reserve group antibiotics
cases treatment with a single drug is [C] - Complementary list -
sufficient. But in some special cases, two
or more antimicrobials are indicated, for
signifies that the medicine(s)
example: (i) to prevent development of require(s) specialist diagnostic or
resistance in tuberculosis or leprosy; (ii) monitoring facilities, [Appendix-21]
to broaden antibacterial spectrum in case
of mixed infection e.g. peritonitis; (iii) to [OTC] - Over The Counter
obtain potentiation e.g. penicillin with
gentamicin.
1.1. ANTIBACTERIAL DRUGS
CONTROL OF ANTI MICROBIAL 1.1.1 PENICILLINS
RESISTANCE: Development of 1.1.2 CEPHALOSPORINS
resistance may be limited by avoidance 1.1.3 OTHER BETA-LACTAMS
of indiscriminate use of antimicrobial 1.1.3.1 CARBAPENEMS
drugs, controlling Access, Watch and 1.1.3.2 MONOBACTAM
Reserve classess antibiotics for rational 1.1.4 AMINOGLYCOSIDES
use, ensuring proper quality of 1.1.5 MACROLIDES
antimicrobial drugs, appropriate selection 1.1.6 TETRACYCLINES
of such drugs, constant monitoring of 1.1.7 QUINOLONES AND
resistance pattern in community, and FLUOROQUINOLONES
restricting use of newer antimicrobial 1.1.8 SULFONAMIDES AND
drugs as long as currently used drugs are TRIMETHOPRIM
effective. To assist in the development of 1.1.9 METRONIDAZOLE
tools for antibiotic stewardship at local, TINIDAZOLE AND ORNIDAZOLE
national and global levels and to reduce 1.1.10 ANTIMYCOBACTERIAL DRUGS
antimicrobial resistance, three different 1.1.10.1 ANTI-TUBERCULOSIS
categories were developed by WHO– DRUGS
ACCESS, WATCH and RESERVE 1.1.10.2 ANTI-LEPROSIS
groups. A publicly sponsored DRUGS
antimicrobial policy should incorporate 1.1.11 DRUGS USED IN SEXUALLY
prevention of indiscriminate use; TRANSMITTED DISEASES
appropriate combination to be used only 1.1.12 OTHER ANTIBACTERIALS
when essential; sensitivity pattern to be
monitored at the community level; 1.1.1. PENICILLINS
indiscriminate use of newer antimicrobial 1.1.1.1 NARROW-SPECTRUM
drugs to be restricted. ACCESS, WATCH PENICILLINS
and RESERVE groups classification is 1.1.1.2 BROAD-SPECTRUM
available in Appendix-21. PENICILLINS
1.1.1.3 EXTENDED SPECTRUM
Note: (ANTIPSEUDOMONAL)
[ED] - Essential Drug PENICILLINS
1.1.1.4 MECILLINAMS
[A] - Key Access Antibiotics
1.1.1.1 NARROW SPECTRUM
PENICILLINS
1.1.1.1.1 PENICILLINASE-SENSITIVE
3
1. ANTI-INFECTIVES
NARROW SPECTRUM necessary increase to 2.4 g daily or more

PENICILLINS according to severity of infections
1.1.1.1.2 PENICILLINASE-RESISTANT (single dose over 1.2 gIV route only);
NARROW SPECTRUM PREMATURE INFANT AND NEONATE,
PENICILLINS 50 mg/kg body weight daily in 2 divided
1.1.1.1.1 PENICILLINASE-SENSITIVE doses; in meningococcal meningitis, 100
NARROW SPECTRUM mg/kg daily in 2 divided doses; INFANT,
PENICILLINS 1-4 weeks, 75 mg/kg daily in 3 divided
doses. CHILD, 1 month to 12-years, 100
These penicillins are effective against mg/kg daily in 4 divided doses;
non-betalactamase (penicillinase) bacterial endocarditis, 7.2 g daily in 4-6
producing streptococci, meningococci, divided doses; meningococcal meningitis,
enterococci, pneumococci, staphylo- 2.4 g every 4-6 hours; CHILD, 1 month to
cocci, treponema pellidum, bacillus 12 years, 180-300 mg/kg daily in 4-6
anthracis, clostridium species, divided doses;
actinomyces and other gram positive
rods and non-betalactamase producing Proprietary Preparation
Pen G(Opsonin), Inj., 10 Lac IU, Tk. 16.74/vial.,
gram negative anaerobic organisms.
5 Lac IU, Tk. 11.29/vial
BENZYLPENICILLIN[A] BENZATHINE PENICILLIN[ED] [A]

(Penicillin G)
Benzathine penicillin has a very long
Indications:Streptococcal pharyngitis, duration of action (2-3 weeks). It is used
arthritis, meningitis, endocarditis; to provide a prolonged coverage of
meningococcal diseases; pneumococcal penicillin in rheumatic fever and is
pneumonia, meningitis; anthrax, syphilis, especially suitable for the treatment of
gonorrhea, actinomycosis, gas gangrene, all stages of syphilis.
carbuncle, to eliminate carrier state in Indications: Rheumatic fever, upper
diphtheria, with or without gentamicin for respiratory tract infections, gonococcal
listeria; surgical prophylaxis in limb infections and syphilis
amputation; intrapartum prophylaxis Contra-indications: Penicillin hyper
against group B streptococcal infection; sensitivity
prophylaxis against recurrence of Interactions: See Appendix -2
rheumatic fever and streptococcal Side-effects: See under Penicillins
infections Dose: Deep IM inj. (in the buttock):
Cautions:Dose reduction in renal rheumatic fever, ADULT, 600,000 units
impairment, (estimated GFR 10– per week or 12,00,000 units monthly;
50 ml/min/1.73 m2, use normal dose CHILD, 3 lac to 6 lac units;primary or
every 8–12 hours; estimated GFR less secondary syphilis, a total of 24 lac units
than 10 ml/min/1.73 m2 use normal dose (12 lac units in each buttock) once; larger
every 12 hours); doses and longer courses may be
Contraindications: Penicillin needed for late syphilis or neurosyphilis
hypersensitivity
Interactions:See Appendix-2 Proprietary Preparations
Side-effects:Urticaria, fever, joint pain, Benzapen(Square), Inj., 12 Lac Units/Vial, Tk.
rashes, angioedema, serum sickness like 28.04/vial.
reactions, neutropenia, hemolytic anemia G-Benzathine Penicillin (Gonoshasthaya),
and nephritis; diarrhea and antibiotic- Inj., 12 Lac Units / Vial, Tk. 22.00/Amp.; Inj., 6
associated colitis, neutropenia, Lac Units/Vial, Tk. 15.00/Amp.
thrombocytopenia, coagulation disorders
and CNS toxicity.
Dose: IM inj. or slow IV inj. or Infusion:
ADULT, 1.2 g daily in 4 divided doses, if
4
1. ANTI-INFECTIVES
PHENOXYMETHYL PENICILLIN [ED] [A] Procaine penicillin NOT suitable for

(Penicillin V) intravenous (IV) route
Dose: IM inj., 300,000 units with 100,000
Indications: Tonsillitis, otitis media, units of benzylpenicillin once every 12-24
erysipelas; prophylaxis in rheumatic fever hours;
and pneumococcal infection Primary syphilis, IM inj., procaine
Cautions, Contraindications: See penicillin 900 mg with benzylpenicillin
under benzylpenicillin sodium 180 mg daily for 10 days (14
Interactions: See Appendix -2 days for secondary or latent syphilis)
Dose :oral: ADULT, 500mg every 6
hours; CHILD, up to 1 year 62.5 mg Proprietary Preparations
Combipen(Acme), Inj., 4 LacTk. 14.05/Vial; 8
every 6 hours, 1-5 years 125 mg every
Lac Tk. 13.55/Vial
6 hours, 6-12 years 250 mg every 6 Pronapen(Renata), Inj.,8 Lac Tk. 9.10/Vial;Inj.,
hours 4 Lac, Tk. 14.05/Vial
Prophylaxis in rheumatic fever or
pneumococcal infection, 250 mg twice 1.1.1.1.2 PENICILLINASE-RESISTANT
daily; CHILD under 5 years 125 mg twice NARROW SPECTRUM PENICILLINS
daily
Cloxacillin, Dicloxacillin, Fucloxacillin,
Proprietary Preparations
Biopen(Biopharma), 125 mg/5 ml, Tk.
Nafcillin, Oxacillin comprise this group
18.28/50ml, Tk. 28.91/100ml.;Tab., 250 mg, Tk. of penicillins that are resistant to
2.28/Tab. inactivating activity of penicillinases and
G-Penicillin V(Gonoshasthaya), Susp., 125 exhibit antibacterial spectrum, similar to
mg/5 ml, Tk. 19.76/50 ml;Tab., 500 mg, Tk. those of narrow spectrum drugs.
2.00/Tab. Antibacterial activity against
Open(Opsonin),125 mg/5ml, Tk. betalactamases producing organisms
24.73/50ml.;Tab. , 250 mg , Tk. 2.28/Tab., 500
mg , Tk. 4.59/Tab.
also is achieved by combining enzyme
Oracyn-K(Sanofi), Suspn., 125 mg/5ml, Tk. inhibitors like clavulanic acid,
18.46/50 ml.,Tab. , 250mg, Tk. 2.30/Tab. tazobactam, sulbactam with penicillins
Pacin(Zenith), Tab. 2,50 mg, Tk. 2.16/Tab. not resistant to betalactamases.
Penco(Supreme), Tab. , 250 mg, Tk. As they are acid stable, they can be
1.45/Tab. given orally as well as by injection.
Penvik(Square), Suspn.,250 mg/5 ml, Tk. Flucloxacillin is better and well absorbed
58.64/100ml.;Tab.,250 mg, Tk. 2.30/Tab., 500
mg, Tk. 4.44/Tab.
from the gut than cloxacillin.
. Staphylococcus aureus strains resistant
PROCAINE PENICILLIN[ED] [A] to flucoxacillin have also arisen, and may
be treated by vancomycin or by
(Procaine benzylpenicillin) teicoplnin. Other alternatives may include
rifampicin and solium fusidate.
Procaine penicillin is a salt of procaine
and benzylpenicillin, which is poorly
soluble in water. It is used as CLOXACILLIN[ED] [A]
intramuscular (IM) depot injections, which
provide therapeutic tissue concentrations Indications: Same as that of
of penicillin for up to 24 hours. Flucloxacillin
Indications: Preferred choice for the Cautions: See under Flucloxacillin.
treatment of yaws and syphilis; Contraindications: See under Benzyl-
neurosyphilis requires special penicillin
consideration, penicillin sensitive all other Interactions:See underBenzylpenicillin.
infections (See under Benzylpenicillin) Side-effects: Seeunder Benzylpenicillin.
Caution, Contraindication and Side- Dose: oral:500 mg every 6 hours, at
effects: Same as in Benzylpenicillin; least 30 minutes before food; CHILD
5
1. ANTI-INFECTIVES
under 2 years, quarter of adult dose; 2- Cholestatic Jaundice may occur up to

10 years, half of adult dose several weeks after treatment with
By IM injection, 250 mg every 4-6 hours; flucloxacillin; in that case treatment with
CHILD under 2 years quarter of adult flucloxacillin should be stopped.
dose; 2-10 years half of adult dose Contraindications: See under Benzyl-
By slow IV injection or by intravenous penicillin
infusion, 500 mg over 3 to 4 minutes Side-effects: See under Benzyl-
every 4 to 6 hours; CHILD under 2 years penicillin; also hepatitis and cholestatic
quarter of adult dose; 2-10 years half of jaundice reported
adult dose Dose: By mouth, 250–500 mg every 6
All systemic doses may be doubled in hours, at least 30 minutes before food;
severe infections CHILD under 2 years, quarter of adult
dose; 2-10 years, half of adult dose
Proprietary Preparations By IM injection, 250-500 mg every 6
Clobex(Beximco), Cap., 500 mg, Tk. hours; CHILD under 2 years quarter adult
5.98/Cap.; Susp 125 mg/5ml, Tk.43.98/100 ml dose; 2-10 years half of adult dose
Cloxin(Opsonin), Suspn., 125 mg /5 ml, Tk. By slow IV injection or by IV infusion,
44.84/100 ml.;Cap., 500 mg , Tk. 5.92/Cap.;Inj.,
500 mg , Tk. 25.31/Vial
0.25-1 g every 6 hours; doses may be
Ficlox(Sanofi), Cap., 500mg, Tk. 5.98/Cap. doubled in severe infections. CHILD:
G-Cloxacillin(Gonoshasthaya), Suspn.,125 under 2 years 1/4th the adult dose; 2-10
mg/5 ml, Tk. 42.25/100 ml;Cap., 500 mg, Tk. years 1/2 of adult dose
4.50/Cap.;Inj., 500 mg/Vial, Tk. 20/Vial Endocarditis: 12 g daily in 6 divided
Loxa(Albion), Susp., 125 mg/5 ml, Tk. doses for 4 weeks
43.00/100 ml; Cap. 500 mg, Tk. 5.94/Cap. Osteomyelitis: up to 8 g daily in 3-4
Navaclo (Navana), Cap., 500 mg, Tk.
6.76/Cap.;Susp.,125 mg/5 ml,Tk. 43.33/100ml
divided doses
Sinaclox(Ibn Sina), Cap. , 500 mg, Tk.
5.75/Cap.; Suspn., 125 mg/5 ml, Tk. 43/100ml Proprietary Preparations
Tyclox(Astra Bio), Cap.,500 mg, Tk. 5.95/Cap.; Adflox(Team), Cap., 500 mg, Tk. 9/Cap.
Suspn.,125 mg/5 ml, Tk. 40/100 ml A-Flox(Acme), Cap.,250.00 mg,
Tk.5.66/Cap.,500.00 mg, Tk. 10.58/Cap.; Inj.,
250 mg/Vial, Tk. 35.25/Vial,; 500 mg/Vial, Tk.
DICLOXACILLIN[A] 45.30/Vial ,; suspn., 125 mg/5 ml, Tk.
Indications: Treatment of staphylococcal 61.61/100ml
infection resistant to benzylpenicillin Clox-F(Asiatic), Cap., 250 mg, Tk. 5/Cap.;
Side-effect and Cautions:Same as that 500mg, Tk. 10/Cap.;Suspn.,125 mg/5 ml, Tk.
of flucloxacillin 60/100ml,250 mg/5 ml, Tk. 110/100ml
FCX(G.A.Co), Suspn, 125 mg/5ml,
Dose: 125 to 250 mg every 6
Tk.60.00/100 ml
hours,CHILD: 12.5 to 25mg/kg daily Floxapen(General), Cap., 250mg,
individed doses. Doses may be Tk.5.78/Cap.; Tk. 10.57/Cap.; Suspn., 125
increased in severe infections mg/5 ml, Tk. 61.41/100ml
Dicloxacillin sodium has also been given Flubac(Popular), Cap. , 250 mg, Tk.5.77/Cap.;
parenterally 500 mg, Tk. 10.04/Cap.; Suspn., 250 mg/5 ml,
Tk. 110.42/100 ml.,125 mg/5 ml, Tk. 61.23/60
ml
GenericPreparation
Flubex(Beximco), Cap., 250 mg, Tk.5.50/Cap.;
Capsule, 500mg; 250 mg 500 mg, Tk. 10.50/Cap.; Suspn, 250 mg/5 ml,
Tk. 110/100 ml.,125mg/5 ml, Tk. 60.00/100 ml
FLUCLOXACILLIN[ED] [A] Fluc(Astra ), Cap. , 250 mg, Tk. 5.50/Cap.; 500
mg, Tk. 10.00/Cap.; Suspn., 125 mg/5 ml, Tk.
60.00/100ml
Indications: Beta-lactamase-producing Fluclox(ACI), Cap., 250mg, Tk.
staphylococci infections including otitis 5.79/Cap.,500mg, Tk. 10.57/Cap.; Inj.,
externa; adjunct in pneumonia, impetigo, 250mg/Vial, Tk. 35.24/Vial,500mg/Vial, Tk.
cellulitis, osteomyelitis and in 45.28/Vial,; Susp. , 125mg/5ml, Tk.
staphylococcal endocarditis 61.41/100ml,250mg/5ml, Tk. 110.74/100ml
Cautions: See under Benzylpenicillin Flucloxin(Eskayef), Cap, 250mg , Tk.
5.77/Cap.; 500mg , Tk. 10.50/Cap.;Inj,
6
1. ANTI-INFECTIVES
500mg/vial, Tk. 45.28/Vial,; Susp.;125 mg/5 Staflu(Alco), Cap.,250 mg,Tk. 5.79/Cap.; 500
ml, Tk. 61.00/100ml mg, Tk. 10.57/Cap.;Suspn.,125 mg / 5ml, Tk.
Flucocin(Euro), Cap., 500 mg, Tk. 10.52/Cap. 65.20/100ml.; 250 mg / 5ml, Tk. 110.75/100ml
Flucopen(Somatec), Cap., 250 mg, Tk. Stafoxin(Aristo), Cap., 250 mg, Tk. 5.50/Cap.;
5.53/Cap.; 500 mg, Tk. 10.03/Cap.; Suspn., 500 mg, Tk. 10.00/Tab.; suspn.,125 mg/5 ml,
125 mg/5 ml, Tk. 60.23/100ml Tk. 60.00/100ml
FLU-K(Kemiko), Cap., 250 mg, Tk. 6.65/Cap.; Stapkil(Pacific), Suspn.,125mg/5ml, Tk.
500 mg, Tk. 10.53/Cap. 46/100ml.; Cap.,250 mg,Tk. 5.50/Cap.,500 mg,
Flupen(Drug Intl), Cap., 250mg, Tk. 5.05/Cap., Tk. 10.00/Cap.
500mg, Tk. 10.55/Cap.;Suspn, 125mg/5ml, Tk.
60.20/100ml,; 1.1.1.2 BROAD SPECTRUM
Flurif, (Sharif), Cap.,500 mg, Tk. 10.52/Cap.
Flustar(Renata), suspn., 125 mg/5 ml, Tk. PENICILLINS
60.00/100ml 1.1.1.2.1 PENICILLINASE-SENSITIVE
Flux(Opsonin), Cap., 250 mg , Tk. 5.77/Cap.; BROAD SPECTRUM
500 mg, Tk. 10.57/Cap.; Suspn., 125 mg/5 ml, PENICILLINS
Tk. 61.42/100 ml , Tk. 110.42/100 ml ,; Inj., 500 1.1.1.2.2 PENICILLINASE-RESISTANT
mg/Vial , Tk. 45.30/Vial
BROAD SPECTRUM
Fluxi(Ziska), Suspn., 125 mg/5 ml, Tk.
60.00/100ml PENICILLINS
Fluxicap(Ziska), Cap. , 250 mg, Tk. 4.60/Cap.;
500 mg, Tk. 10.00/Cap Broad-spectrum penicillins (Ampicillin,
Flxzen(Zenith), Cap, 250 mg, Tk. 5.02/Cap.; Amoxicillin, Bacampicillin) retain the
500 mg , Tk. 8.03/Cap .; Suspn., 125 mg/5 ml, antibacterial activity of narrow spectrum
Tk. 60.23/100ml
Fucil(Nipa), Cap, 500 mg , Tk. 10.00/Cap.;
with additional bactericidal activity
Susp., 125 mg/5ml , Tk. 60.00/100ml against E. coli, H. influenzae, Salmonella
Fulcin(Supreme), Cap, 250 mg, Tk. 5.50/Cap.; species, Listeria monocytogenes
500 mg, Tk. 10.50/Cap.; suspn., 125 mg/5 ml, andHelicobacter pylori.
Tk. 60.00/100ml
Halopen(Nipro JMI), Susp., 125 mg/5 ml, Tk. 1.1.1.2.1 PENICILLINASE-SENSITIVE
60.41 Tk /100 ml; Cap., 250 mg, Tk. 5.55 Tk
BROAD SPECTRUM
/Cap.; 500 mg, Tk.10.03/Ta
Inclox(Incepta), Cap,250 mg, Tk. 5.50/Cap.; PENICILLINS
500 mg, Tk. 10.00/Cap. These drugs are subjected to the
Isoclox(Globe), Cap., 250 mg,Tk. 5.50/Cap.; destruction by the penicillinase produced
500 mg, Tk. 10.00/Cap.;Suspn.,125 mg /5 ml, by organisms Ampicillinis particularly
Tk. 60.00/100ml valuable for the treatment of respiratory
Monaclox-F(Amico), Cap., 250mg , TK.
tract infections (RTI) by mixed organisms
5.50/Cap.; 500mg , TK. 10.00/Cap.; Suspn.,
125mg/5ml, TK. 65.00/100ml that include Haemophilus influenzae.
Murein(One Pharma), Cap.,500 mg ,Tk. Amoxicillin It is a derivative of ampicillin
10.00/Cap. and has the same antibacterial spectrum.
Orgaflu (Organic), Cap.,250 mg,Tk. 5.58/Cap. Orally given it is better absorbed than
; 500 mg, Tk. 10.53/Cap. ampicillin and produces higher plasma
Phylopen(Square), Cap.,250 mg, Tk. and tissue concentrations. Besides, its
5.54/Cap.,500 mg, Tk. 10.57/Cap.; Inj., 500
absorption is not affected by the
mg, Tk. 45.30/Vial ; Suspn.,125 mg/5 ml, Tk.
60.4/100ml,; 250 mg/5 ml, Tk. 110.75/100ml presence of food in the stomach.
Revistar(Biopharma), Cap., 250 mg, Tk.
5.52/Cap; 500 mg, Tk. 10.04/Cap.; suspn., 125 AMOXICILLIN[A]
mg/5 ml, Tk. 60.23/100ml
Silox(Silva), Cap., 250mg,Tk. 5.77/Cap.
(Amoxycillin)
,500mg, Tk. 10.03/Cap.
Sinaflox(Ibn Sina), Cap., 250mg, Tk. 5.60/Cap. Indications: As under Ampicillin; also
,500mg, Tk. 10.50/Cap.; suspn., 125 mg/5 ml, endocarditis prophylaxis, meningococcal
Tk. 65.00/100ml disease and adjunct in listeria meningitis
Skilox(Healthcare), Cap., 250mg , Tk. Cautions, Contra-indications, Side-
10.00/Cap.; 500mg ,Tk. 16.66/Cap.; suspn., effects: See under Ampicillin.
125 mg/5 ml, Tk. 62.00/100 ml
7
1. ANTI-INFECTIVES
Dose: oral: ADULT 250 mg every 8 Fimoxyl(Sanofi), Cap., 250mg, Tk. 3.61/Cap.;
hours, doubled in severe infections; 500mg, Tk. 6.76/Cap.; Inj., 250mg, Tk.
CHILD up to 10 years, 125 mg every 8 19.19/Vial; 500mg, Tk. 26.29/Vial; Paed. drop,
125mg/1.25ml, Tk. 30.20/15ml; Susp.,
hours, doubled in severe infections 125mg/5ml, Tk. 47.46/100ml; 250mg/5ml, Tk.
Severe or recurrent purulent respiratory 68.26/100ml; Tab., 250 mg, Tk. 3.48/Tab.;
infection, 3 g every 12 hours 500mg, Tk. 6.02/Tab.
Short course oral therapy Genamox(General), Cap., 250mg, Tk.
Dental abscess, 3 g repeated after 8 3.61/Cap. ; 500mg, Tk. 6.76/Cap,; Pead. drop.,
hours. UTI 3 g repeated after 10-12 125 mg/1.25 ml, Tk. 30.11/15ml.; Suspn., 125
hours. Otitis media: CHILD 3-10 years, mg/5 ml , Tk. 47.45/100ml
Hi-mox(Hudson), Cap., 250mg, Tk.3.50/Cap.
750 mg twice daily for two days Kamoxy(Kemiko), Cap., 250 mg, Tk.
IM inj.: 500 mg every 8 hours; CHILD, 3.60/Cap. ,500 mg, Tk. 6.78/Cap. ;Suspn. ;125
50-100 mg/kg daily in divided doses mg / 5ml.; Tk. 47.60/100ml,;
IV inj. or infusion; 500 mg every 8 hours Loxyl(Asiatic), Cap., 250mg ,
increased to 1 g every 6 hours; CHILD, Tk.3.61/Cap.;Suspn.;125gm/5ml, Tk.
50-100 mg/kg daily in divided doses 47.46/100ml
Meningitis (if necessary, in combination Loxyl(Asiatic), Cap.; 500 mg , Tk. 6.76/Cap.
Monamox(Amico), Cap., 250mg , TK.
with another antibiotic), by IV infusion, 2g 3.00/Cap.; 500mg , TK. 6.00/Cap.; Paed.drop.
every 4 hours for 5 days in 125mg/1.25ml, TK. 28.00/15ml,;
meningococcal disease or for 10-14 days Mox(Astra Bio), Cap. , 250 mg, Tk. 3.60
in listerial meningitis /Cap.,500 mg, Tk. 6.00/Cap. ; Suspn., 125
mg/5 ml, Tk. 47.00/100ml,; Paed. drop, 125
Proprietary Preparations mg/1.25 ml, Tk. 30.00/15ml
Admox(Team), Cap.,500 mg, Tk. 6.79/Cap.; Moxacil(Square), Cap., 250 mg, Tk.
Suspn., 125mg/5ml, Tk. 47.60/100ml, ; 3.61/Cap., 500 mg, Tk. 6.79/Cap. ; Tab. , 250
Amocin(Pacific), Cap., 250 mg, Tk. 3.30/Cap. mg, Tk. 3.50/Tab. ;Inj., 500 mg/vial, Tk.
; 500 mg, Tk. 6.70/Cap. ; Suspn., 125mg/5ml, 32.88/Vial,; Paed. drop, 125 mg/1.25 ml, Tk.
Tk. 40.00/100ml 30.2/15ml,; Suspn. , 125 mg/5 ml, Tk.
Amotid(Biopharma), Cap., 250mg , Tk. 47.61/100ml,; 250 mg/5 ml, Tk. 65.45/100ml,;
3.61/Cap.; 500mg , Tk. 6.02/Cap.; Paed. Moxapen(Nipa), Cap. , 500 mg, Tk. 6.00/Cap.
drop, 125 mg/1.25 ml, Tk. 30.11/15ml.; Suspn., Moxarif(Sharif), Cap. , 500 mg, Tk. 6.00/Cap.
125 mg/5 ml, Tk. 46.17/100ml,; Moxico(Supreme), Cap, 500 mg, Tk.
Amoxizen(Zenith), Cap, 250 mg,Tk. 3.52/Cap. 6.00/Cap.,250 mg, Tk. 3.60/Cap.;Suspn,
;500 mg, Tk. 6.11/Cap. 250g/5ml, Tk. 65.00/100ml., 125 mg/5ml, Tk.
Amx(Nipro JMI), Cap., 250mg, Tk. 3.60/Cap.; 47.00/100ml
500mg, Tk. 6.78 /Cap.; Susp., 125mg/5ml, Tk. Mimox(Albion), Cap. , 250 mg, Tk. 3.54; Susp.,
47.61 /100 ml ; 250mg/5ml 78.0 125 mg/5 ml, Tk. 46.00/100ml
Aristomox(Aristo), Cap., 250mg , TK. Moxin(Opsonin),Tab. , 250 mg , Tk. 3.48/Tab.;
3.50/Cap, 500mg , Tk. 6.75/Cap.; Suspn., Cap., 500 mg , Tk. 6.74/Cap.; Inj.,250 mg ,
125mg/5ml Tk. 45.00/100ml Tk. 19.07/Vial., 500 mg, Tk. 26.17/Vial.;
Avlomox(ACI),Cap,250mg , TK. 3.45/Cap.; Suspn., 125mg/5ml , Tk. 47.61/100ml,;
500mg , TK. 6.12/Cap. ; Inj, 500mg , TK. Paed.drop 125mg /1.25 ml, Tk. 30.20/15
32.10/Vial,;Suspn TK. 125 mg/5 ml, Orgamox(Organic), Cap., 250 mg, Tk.
TK.46.18/100ml.;250mg/5ml, TK. 3.54/Cap.; 500mg , Tk. 6.76/Cap.
65.45/100ml.;Tk.49.73/60ml .; Paed. drop, Sapox(Alco), Cap., 500 mg, Tk. 6.78/Cap.;
125mg/1.25ml, TK. 30.29/15ml Paed drop., 125 mg / 1.25ml, Tk. 30.29/15ml,;
Bactamox(Renata), Tab., 250 mg, Tk. Suspn.; 125 mg / 5ml, Tk. 47.61/100ml , 250
3.38/Tab.; 500 mg, Tk. 5.81/Tab.; paed. drop. mg / 5ml, Tk. 69.21/100ml
125 mg/1.25 ml, Tk. 28.32/15ml,; Suspn. , 125 Sinamox(Ibn Sina), Cap., 250 mg, Tk.
mg/5 ml, Tk. 45.52/100ml 3.60/Cap.; 500 mg, Tk. 6.75Cap. ; Pead.
Demoxil(Drug Intl), Tab , 250mg, Tk. drops. 125 mg/1.25 ml.;Tk.30.00/15ml.;
3.52/Tab. , 500mg, Tk. 6.27/Tab. Suspn., Suspn., 125 mg/5 ml, Tk. 47.46/100ml.;
250mg/5ml, Tk. 65.20/100ml,125mg/5ml, Tk. 250mg/5ml, Tk. 69.00/100ml
47.15/100ml SK-Mox(Eskayef), Cap, 250 mg, Tk. 3.55/Cap.;
Fimox(Popular), Cap., 250,Tk. 3.62/Cap. ; 500 mg, Tk. 6.09/Cap. ; Suspn., 250 mg/5 ml,
500mg, Tk. 6.78/Cap. ; Suspn.;125mg/5ml, Tk. Tk. 68.20/100ml.; Suspn.,125 mg/5 ml, Tk.
47.60/60 ml.; Paed. drops,125 mg/1.25 ml,Tk. 47.60/100ml,; paed drop., 125 mg/1.25 ml, Tk.
30.28/10 ml 30.20/15ml
8
1. ANTI-INFECTIVES
Tycil(Beximco), Cap., 500 mg, Tk.

6.79/Cap.,250 mg, Tk. 3.62/Cap; Suspn., 250
1.1.1.2.2 PENICILLINASE-RESISTANT
mg/5 ml, Tk. 65.45/100 ml
Tymox(Somatec),Suspn.,125 mg/5 ml, Tk. BROAD SPECTRUM
47.14/100ml,; Paed. drop, 125 mg/1.25 ml, PENICILLINS
Tk. 30.20/15ml,;Cap., 500 mg, Tk. 6.04/Cap.
Ultramox(Globe), Cap., 250 mg, Tk. 3.50/Cap., CO-AMOXICLAV[A]
500 mg, Tk. 6.07/Cap.; Suspn., 125 mg /5 ml,
Tk. 47.29/100 ml
Co-amoxiclav is a combined preparation
AMPICILLIN[ED] [A] of Amoxicillin (as the trihydrate or as the
sodium salt) and betalactamase inhibitor
Clavulanic acid (as potassium
Indications: UTI, otitis media, sinusitis,
clavulanate).
chronic bronchitis, Haemophilus
Indications: Infections due to beta-
influenzae infections, invasive
lactamase producing strains including
salmonellosis, meningococcal disease,
RTI, genitourinary and abdominal
listerial meningitis, H pylori infection,
infections, cellulitis, animal bites, severe
prophylaxis and treatment of endocarditis
dental infection with spreading cellulitis.
Cautions: Allergy to penicillin, renal
Cautions: See under Ampicillin; in
impairment requires dose reduction,
hepatic impairment and in pregnancy.
erythematous rashes common in
CHOLESTATIC JAUNDICE has been
glandular fever and chronic lymphatic
identified as an adverse reaction
leukemia
occurring either during, or shortly after,
Contra-indications: Penicillin
the use of co-amoxiclav. An
hypersensitivity
epidemiological study has shown that the
Interactions: See Appendix-2
risk of acute liver toxicity was about 6
Side-effects: Nausea, vomiting,
times greater with co-amoxiclav than with
diarrhea; rarely rashes (discontinue
amoxicillin
treatment), antibiotic-associated colitis
Contraindications: Hypersensitivity,
Dose: ORAL: 0.25-1g every 6 hours, at
history of penicillin or co-amoxiclav
least 30 minutes before food; CHILD
associated jaundice; hepatic dysfunction
under 10 years, ½ ADULT dose
Side-effects: See under Ampicillin,
By IM or IV injection or infusion, 500 mg
alsohepatitis, cholestatic jaundice,
every 4-6 hours; CHILD under 10 years,
erythema multiforme, toxic epidermal
½ of adult dose.
necrolysis, exfoliative dermatitis,
UTI 500 mg every 8 hours
vasculitis, dizziness, headache,
Meningitis (if necessary, in combination
convulsions (particularly with high doses
with another antibiotic), by intravenous
or in renal impairment); superficial
infusion 2 g every 4 hours for 5 days in
staining of teeth with suspension,
meningococcal disease or for 10-14 days
phlebitis at injection site; see also
in listerial meningitis
cautions above.
Dose: oral: Amoxicillin, 250mg every 8
hours, doubled in severe infections;
Ampexin(Opsonin), Inj., 250 mg/vial,
Tk.17.89/Vial; 500 mg/vial, Tk. 24.00/Vial CHILD up to 10 years, 125 mg every 8
Pen-A(Reneta), Inj., 500 mg/vial, Tk. 20.43/Vial hours, doubled in severe infections;
Acmecilin(Acme), Cap., 250 mg, Tk. severe or recurrent purulent respiratory
3.34/Cap.; Susp., 125 gm/5 ml, Tk. 39.71/100 infection, 3 g every 12 hours
ml; Inj., 250mg/Vial, Tk. 19.43 /Vial; 500 Severe dental infections, expressed as
mg/vial, Tk. 27.32 /Vial amoxicillin, 250 mg every 8 hours for 5
Ampexin(Opsonin), Inj., 250 mg/vial,
days.
Tk.17.89/Vial; 500 mg/vial, Tk. 24.00/Vial
Ampirex(Jayson), Cap., 250 mg, Tk 2.04.;Inj., By IV injection over 3-4 minutes or by IV
500 mg/vial, Tk. 22.49/Vial.; Susp., 125mg/5ml, infusion, expressed as amoxicillin, 1 g
Tk.33.89/100 ml every 8 hours increased to 1 g every 6
9
1. ANTI-INFECTIVES
hours in more serious infections; Ultraclav(Globe), Tab., 500 mg + 125 mg, Tk.
INFANTS up to 3 months 25 mg/kg every 25.00Tab.
8 hours (every 12 hours in the perinatal
period and in premature infants); CHILD 1.1.1.3 EXTENDED SPECTRUM
3 months-12 years, 25 mg/kg every 8 (ANTIPSEUDOMONAL) PENICILLINS
hours increased to 25 mg/kg every 6 This group consists of extended-
hours in more serious infections; surgical spectrum drugs that exhibit the
prophylaxis, 1 g at induction; for high risk antimicrobial activity of broad-spectrum
procedures (e.g. colorectal surgery) a penicillins and also are effective against
further 2-3 doses may be given every 8 Psuedomonus aeruginosa,Klebsiella
hours in first 24 hours (longer if pneumonia, Proteus sp. and Bacteroids
significantly increased risk of infection) fragilis. The Carboxypenicillin,
Ticarcillin, is principally indicated for
Proprietary Preparations serious infections due to P aeruginosa
Augment(Eskayef), Inj.,1 gm + 200 mg,Tk. and also has activity against certain other
275.00/vial.; suspn 125 mg + 31.25 mg/5 ml, Gram-negative bacilli including Proteus
Tk. 175.00/100ml.; Tab, 875 mg + 125 mg, Tk.
spp. and B fragilis. The ureidopenicillin,
30.00/Tab.,250 mg + 125 mg, Tk.
20.00/Tab.,500 mg + 125 mg, Tk. 25.00/Tab piperacillin is more active than ticarcillin
Avloclav(ACI), Tab., 250mg +125mg, TK. against Ps. aeruginosa.
25.00/Tab.; 875mg + 125mg , TK. 45/Tab.;
500mg + 125mg , TK. 32.00/Tab. ; Suspn.,
125mg + 31.25mg / 5ml , TK.220.00/100ml ,
400mg + 57.5mg /5ml , TK. 195.00/50ml. ;Inj.,
1gm + 200mg , TK. 300.00/vial; 500mg
PIPERICILLIN WITH TAZOBACTAM[A*]
+100mg , Tk.150/vial
Clamox(Opsonin), Inj.1 gm + 200 mg, Tk. Indications: P. aeruginosa infections,
276.05/ vial;500 mg + 100 mg ,Tk. 140.53/ surgical prophylaxis, also see under
vial,;Suspn,125 mg + 31.25 mg /5 ml, Tk. Dose
151.02/100 ml.;Tab. 250 mg + 125 mg Tk.
Cautions: See under Benzyl penicillin
16.56/Tab., 875 mg + 125 mg, Tk.
25.10/Tab.,500 mg + 125 mg , Tk. 20.14/Tab
Contra-indications:See under Benzyl
Demoxiclave(Drug Intl), Suspn.,125mg+ penicillin
31.25mg/5ml, Tk. 150.45/100ml., 400mg+ Side-effects: See under Benzyl
57.5mg/5ml, Tk. 90.30/35ml,; Tab., 250mg+ penicillin; also nausea, vomiting,
125mg, Tk. 16.05/Tab. ; 500mg+ 125mg, Tk. diarrhea, less commonly stomatitis,
24.10/Tab.;Inj., 1gm+ 200mg, Tk. dyspepsia, constipation, jaundice,
300.90/vial.,500mg+ 100mg, Tk. 150.45/Vial,
hypotension, headache, insomnia; rarely
Fimoxyclav(Sanofi), Inj., 500mg+100mg/Vial,
Tk. 150.45/Vial; 1gm+200mg, Tk. 300.90 /Vial; abdominal pain, hepatitis, edema; very
Tab., 250mg + 125mg, Tk. 25.08 Tk/Tab.; rarely hypoglycemia, hypokalemia,
500mg+125mg,Tk. 32.10 Tk/Tab.; pancytopenia, Stevens-Johnson
875mg+125mg, Tk. 45.13Tab.; Susp., syndrome, toxic epidermal necrolysis.
400mg+57.5mg/5ml, Tk. 245.74/50 ml; Dose: Lower respiratory tract,urinary
125mg+31.25mg/5ml, Tk.245.74/100 ml tract, intra-abdominal, and skin
Moxaclav (Square), Inj.,1gm + 200 mg, Tk.
infections, and septicemia: ADULT and
300.00/vial., 500 mg + 100 mg , Tk.
150.00/vial.; Suspn. ,125 mg + 31.25 mg/5 ml,
CHILD over 12 years, byIV inj. over 3-5
Tk. 175.53/100ml., Tk. 135.92/60ml,400 mg + minutes or byIV infusion: 100-150 mg/kg
57.5 mg/5 ml , Tk. 90.61/35ml.; Tab. , 250 mg daily in divided doses, or increased to
+ 125 mg, Tk. 25.00/Tab., 500 mg + 125 mg, 200-300 mg/kg daily in severe infections
Tk. 32.00/Tab. ,875 mg + 125 mg, Tk. and at least 16 g daily in life-threatening
45.00/Tab. infections. NEONATES IV injection over
Tyclav(Beximco), Inj., 1g + 200mg, Tk.
3-5 minutes or IV infusion, aged up to 7
300.00/vial, 500mg + 100mg, Tk. 150.00/vial,;
Suspn., 125mg + 31.25mg/5ml, Tk. days or over 7 days but under 20 kg, 150
220.00/100ml., 400mg + 57.5mg/5ml, Tk. mg/kg daily in 3 divided doses, aged over
230.00/50ml,;Tab. 500mg + 125mg, Tk. 7 days and over 20 kg, 300 mg/kg/d in 3-
32.00/Tab., 250mg + 125mg, Tk. 25.00/Tab., 4 divided doses; CHILD 1 month-12
875mg + 125mg, Tk. 45.00/Tab.; years: 100-200 mg/kg daily in 3-4 divided
10
1. ANTI-INFECTIVES
doses, increased to 200-300 mg/kg daily ADULT and CHILD over 40 kg, 400 mg
in 3-4 divided doses for severe infections; every 6-8 hours; UTI, CHILD under 40
surgical prophylaxis: 2 g just before kg, 20-40 mg/kg daily in 3-4 divided
surgery followed by at least 2 doses of 2 doses
g at 4/6 hours intervals within 24 hours of Note: Tablets should be swallowed
surgery. whole with plenty of fluid during meals
while sitting or standing
Brodactam(Sanofi), IV., Infusion., 4g + Proprietary Preparations
0.5g,/vial Tk. 1003.01/Vial Alexid(Aristo), Tab., 200mg, Tk. 15/Tab.
Megacilin(Popular), IV., Infusion4 gm + 0.5 Emcil(Square), Tab., 200 mg, Tk.15.05/Tab.
gm/vial, Tk. 1003.77Vial Pivicil(General), Tab.,200 mg, Tk.12.09/Tab.,
Tazocilin(Square), IV., Infusion4 gm + 0.5 V-cillin(Asiatic), Tab., 200mg, Tk. 12/Tab
gm/vial, Tk. 1003.01/Vial
Tazopen(Renata), IV., Infusion 2gm +
0.25gm/vial, Tk. 550.00/Vial; 4 gm + 0.5 1.1.2 CEPHALOSPORINS
gm/vial, Tk. 1000.00/Vial 1.1.2.1 FIRST-GENERATION DRUGS
Tazosyn(ACI), IV., Infusion4 gm + 0.5 gm/vial, 1.1.2.2 SECOND-GENERATION
Tk. 1003.01/Vial; 2gm + 0.25gm/vial , Tk. DRUGS
601.80/Vial 1.1.2.3 THIRD-GENERATION DRUGS
1.1.2.4 FOURTH-GENERATION
1.1.1.4 MECILLINAMS[A] DRUGS
PIVMECILLINAM HYDROCHLORIDE[A] Cephalosporins are broad-spectrum,

bactericidal antibiotics and are classified
Pivmecillinam has significant activity into "generations" on the basis of general
against many Gram-negative bacteria features of antimicrobial activity.
including E. coli,Klebsiella, Enterobacter Of the first generation, Cefazolin is more
and Salmonellae. It is not active against susceptible to hydrolysis by
Pseudomonas aeruginosa or betalactamase from S. aureus than is
Enterococci. Pivmecillinam is hydrolyzed cephalothin. Second generation
to mecillinam, which is the active drug. Cefoxitin and cefuroxime and third
Indications: Acute uncomplicated generation drugs are more resistant than
cystitis, chronic or recurrent bacteriuria, first generation agents to betalactamases
UTI produced by gram-negative bacteria.
Cautions: See under Benzylpenicillin; Third generation drugs are susceptible to
liver and renal function tests required in hydrolysis by chromosomally encoded
long term use; pregnancy; avoid in acute type 1 beta-lactamases induced by
porphyria treatment of infections due to aerobic
Contraindications: See under gram-negative bacilli with second- or
Benzylpenicillin: also carnitine deficiency, third-generation drugs and/or imipenem.
esophageal strictures, gastrointestinal Fourth generation agents such as
obstruction; not recommended for infants cefipime, are poor inducers of type 1
under 3 months beta-lactamases and are less susceptible
Interactions: See Appendix-2 than third generation drugs to hydrolysis
Side-effects: See under Benzyl- by type 1 beta-lactamases.
penicillin; also nausea, vomiting, Cautions:. Great caution should be
dyspepsia; and reduced serum and total taken before administration of a
body carnitine (during repeated or long cephalosporin in patients who have had a
term use) recent severe, immediate reaction to
Dose : oral:acute uncomplicated cystitis, penicillin, impaired renal function,
ADULT and CHILD over 40 kg, initially pregnancy and breast-feeding.
400 mg then 200 mg every 8 hours for 3 Side-effects: Anaphylaxis,
days; chronic or recurrent bacteriuria, bronchospasm, and urticaria are seen.
11
1. ANTI-INFECTIVES
Cephalosporins are potentially Adora(Incepta), Paed. drops, 125 mg/1.25 ml,

nephrotoxic drugs. Gastrointestinal upset Tk. 50.00/15ml; Suspn. 125 mg/5 ml, Tk.
in the form of diarrhea can result after 90.00/100m, 5gm/100ml, Tk. 120.00/100ml;
Tk.60/60ml; Cap., 500mg, Tk. 18/Cap.
cephalosporins and may be more Arocef(Eskayef), Cap, 500mg , Tk. 15.00/Cap.;
frequent with cefoperazone and 500mg , Tk. 15.00/Cap.; Suspn. , 125 mg/5
cefpiramide because of their greater ml, Tk. 70.00/100ml,; Paed. drops, 125
biliary excretion. mg/1.25 ml, Tk. 50.00/15ml
Bexen(Nipro JMI), Cap. 500 mg, Tk.
12.07/Cap.; Suspn. 125 mg/5 ml Tk. 70.26/100
1.1.2.1.1 FIRST-GENERATION
ml
CEPHALOSPORINS Cedril(ACI), Suspn., 125 mg/5 ml, TK.
70.47/100ml,; Cap., 500mg, TK. 12.09/Tab.
First generation drugs (cefadroxil, Ficef(UniMed) Cap. 500 mg Tk. 12.00/Cap;
cephalexin, cphradine etc.) are very Paed. drops 125 mg/5 ml, Tk. 50.00/15 ml;
active against gram-positive cocci Suspn. 125 mg/5 ml Tk. 70.20/100 ml
Fodexil(Square), Cap., 500 mg, Tk.
including pneumococci, streptococci and
15.05/Cap. ; Tab. , 1 gm, Tk. 25.00/Tab.
staphylococci and have modest activity Licef(Asiatic), Suspn, 125 mg/5 ml, Tk.
against gram-negative microorganisms. 82.00/100ml,
Most oral cavity microbes, except Sefanid(Drug Intl), Suspn., 125mg/5ml, Tk.
B.fragilis group are sensitive. Activity 70.25/100ml,; Cap., 500mg, Tk. 12.05/Cap.
against Moraxella catarrhalis, E. coli, K. Trubid(Opsonin), Suspn., 125 mg/5 ml, Tk.
pneumonia and P. mirabilis is good. They 70.26/ 100 ml,; Tk. 50.19/ 60 ml,; Cap, 500
mg, Tk. 15.00/Cap.
are not effective against enterococci,
Twicef(Acme), Suspn.,250mg/5ml , Tk.
methicillin-resistant S. aureus and S. 120.82/100ml,; ., 125 mg/5 ml, Tk.
epidermidis, P.aeruginosa. 70.47/100ml,; Cap., 500 mg , Tk. 12.09/Cap.;
Paed. drops, 125 mg/1.25 ml, Tk. 50.20/15ml
CEFADROXIL[A]
CEFOPERAZONE[A]
Indications: Urinary tract infections,
minor polymicrobial infections, i.e. Indication: Used in the treatment of
cellulites, soft tissue abscess, ottitis susceptible infection especially those due
media, sinusitis to Pseudomonus spp. It is slightly less
Cautions:See notes above active against some Entrobactecae.
Contra-indications: Hypersensitivity, Cautions:See notes above; not
porphyria recommended for the treatment of
Interactions:See Appendix-2 meningitis because of its poor
Side-effects: Diarrhea, nausea and penetration into the C. S. F.
vomiting, abdominal discomfort, Contraindications and Side-effects:
headache, rashes, pruritus, urticaria, See under Cefadroxil
serum-sickness like reactions with rash, Interaction:See Appendix -2
fever and arthalgia and anaphylaxis, Dose and Administration: The usual
erythema multiforme, toxic epidermal dose is 2 to 4 g daily in two divided dose.
necrolysis, hepatic enzymes In severe infections up to 12g daily in two
disturbances, transient hepatitis and to four divided dose may be given. In
cholestatic jaundice; general the dose should not exceed 4g
Dose: : Oral l: patients weighing > 40 kg: daily in patient with liver disease or biliary
0.5-1 g twice daily; CHILD < 1 year 25 obstruction or 1 to 2g daily in those both
mg/kg daily in 2-3 divided doses; 1-6 liver and kidney impairments; if higher
years 250 mg twice daily; > 6 years 500 dose are used plasma concentration of
mg twice daily cefoperazone should be monitored
Proprietary Preparations Proprietary Preparations

Adocil(Kemiko), Suspn., 125 mg / 5ml, Tk. Cefopen(Square), Inj., 1 gm, Tk. 250.00/Vial,;
80.24/100ml; Cap. 500 mg, Tk. 12.00/Cap. 500mg, Tk.150.00/Vial
12
1. ANTI-INFECTIVES
CEPHALEXIN [ED][A] minutes orIV infusion 0.5-1 g every 6

(Cefalexin) hours for mild to moderate infections; for
severe infections increased to 8 g daily;
Indications: Prophylaxis of recurrent CHILD 50-100 mg/kg daily in 4 divided
UTI; also see under cefadroxil doses; in surgical prophylaxis: 1-2 g by
Cautions, Contraindications and Side- deep IM inj. or byIV inj. over 5 minutes.
effects: See notes above and under
cefadroxil Proprietary Preparations
Adecef(Supreme), Cap, 500mg, Tk.
12.50/Cap. ; Paed. drops, 125 mg/1.25 ml, Tk.
Dose: oral: ADULT 250-500 mg every 8- 50.00/15ml,; Suspn, 125mg / 5ml, Tk.
12 hours for mild to moderate infections; 80.25/100ml.; 250 mg/5 ml, Tk. 120.00/100ml
for severe infections increased to 1-1.5 g Ancef(UniMed), Cap,250mg, Tk. 6.50/Cap. ;
every 6-8 hours, as prophylactic in 500mg, Tk. 12.50/Cap. ; Paed. drops, 125
recurrent urinary tract infections, 125 mg mg/1.25 ml, Tk. 50.00/15ml,; Suspn,
at night; CHILD 25 mg/kg daily in 2-3 250mg/5ml, Tk. 120.00/100ml.; 125mg/5ml,
Tk. 85.00/100ml
divided doses, doubled for severe
Avlosef(ACI), Cap., 250mg , TK. 8.02/Cap. ;
infections, max. 100 mg/kg daily in 500mg , TK. 15.05/Cap.;Inj, 1gm/vial,TK.
divided doses;under 1 year, 125 mg 95.29/Vial,; 500mg/vial , TK. 65.20/ Vial,;
every 12 hours; 1-5 years, 125 mg every Paed. drops, 125mg/1.25ml, TK. 65.20/15ml ,;
8 hours; 6-12 years, 250mg every 8 Suspn, 125mg / 5ml , TK. 90.27/100ml
hours ,250mg/5ml TK. 135.41/100ml ,TK. 80.54/60ml
Bactokil(Virgo), Cap., 250 mg, Tk.
156.00/Cap. ; 500 mg, Tk. 262.50/Cap. ;
Suspn., 125mg / 5ml, Tk. 80.00/100ml
Acelex(Acme), Cap., 250.00 mg, Tk.
Belocef(Amico), Cap., 250mg , Tki. 6.50/Cap.;
6.65/Cap.; 500.00 mg , Tk. 12.58/Cap. ;
500mg , TK. 12.50/Cap.; Paed. drops,
Paed.drop., 125mg/1.25 ml, Tk. 42.66/15ml.;
125mg/1.25ml, Tk. 50.00/15ml,; Suspn,
Suspn., 125 mg/5 ml, Tk. 77.52/100ml
125mg/5ml, TK. 80.00/100ml
Avloxin(ACI), Susp. , 125mg/5ml, Tk..
Betasef(Alco), Cap., 250 mg, Tk. 8.00/Cap. ;
69.47/100ml,; Cap., 500mg , TK. 10.57/Cap
500 mg, Tk. 15.00/Cap.; Paeed.drops 125
Ceporex(GSK), Cap., 500 mg, Tk. 12.73/Cap.;
mg/1.25 ml, Tk. 65.00/15ml,; Suspn250mg/5ml
Suspn., 125 mg/5 ml, Tk. 84.27/100ml
Tk. 90.00/100ml ,250 mg / 5 ml, Tk.
Lexin(Astra Bio), Cap. , 250 mg, Tk.
120.35/100ml
6.60/Cap.; 500 mg, Tk. 12.73/Cap.; Suspn.,
Cefadin(Ziska), Cap. , 500 mg, Tk. 12.00/Cap.;
125 mg/5 ml, Tk. 77.52/100 ml
Inj., 1g/vial, Tk. 80.00/ Vial,; 500 mg, Tk.
Neorex(Eskayef), Cap, 500mg, Tk. 12.50/Cap.;
50.00/ Vial ,; Suspn, 125 mg/5 ml, Tk.
250mg, Tk. 6.60/Cap.; 500mg, Tk.12.50/Cap.;
80.00/100ml
Suspn, 125mg/5ml, Tk. 83.50/100ml
Ceflin(Nipa), Cap., 500 mg, Tk. 12.66/Cap.;
Nufex(General), Suspn, 125 mg/5 ml, Tk.
Suspn, 125 mg/5ml, Tk. 80.00/100ml
78.52/100ml; Cap., 500mg, Tk. 9.06/Cap.
Cephid(Zenith), Cap., 250mg, Tk. 6.52/Cap. ;
500 mg, Tk. 12.55/Cap.; Suspn, 125 mg/5 ml,
CEPHRADINE CILASTATIN[W] Tk. 80.30/100ml
Cephracap(Euro), Cap., 500mg, Tk.
Indications: Surgical prophylaxis, also 15.00/Cap.
Cephran (Opsonin), Cap. , 500 mg , Tk.
see under cefadroxil 15.05/Cap. ; Inj, 500 mg/vial , Tk. 54.20/Via,; 1
Cautions, Contraindications and Side- gm/vial, Tk. 80.30/Vial,; Paed. drops, 125
effects: See notes above and under mg/1.25 ml, Tk. 65.00/15ml
cefadroxil Dicef(Drug Intl), Cap., 250mg, Tk. 7.05/Cap. ;
Interactions: See Appendix-2 500mg, Tk. 13.05/Cap.; Paed. drops,
Dose: oral: ADULT 250-500 mg every 6 125mg/1.25ml, Tk. 50.20/15ml,; Suspn,
125mg/5ml, Tk. 81.25/100ml,; 250mg/5ml, Tk.
hours or 0.5-1 g every 12 hours for mild
120.40/100ml
to moderate infections; for severe Eusef(Globe), Cap., 500 mg, Tk. 12.00/Cap. ;
infections increased to 1 g every 6 hours; Inj, 1 gm/vial, Tk. 80.00/ Vial,500 mg/vial, Tk.
CHILD 25-50 mg/kg daily in 2-4 divided 50.00/ Vial.; Paed. drop, 125 mg/1.25 ml, Tk.
doses; deep IM inj. orIV inj. over 3-5
13
1. ANTI-INFECTIVES
50.00/15ml,; Suspn, 125 mg /5 ml, Tk. mg/1.25 ml, Suspn, 125 mg/5 ml, Tk.
80.00/100ml,; 250 mg /5 ml, Tk. 140.00/100ml 80.00/100 ml
Extracef(Aristo), Cap., 250mg , Tk. 6.50/Cap.; Sicef(Silva), Cap.,500mg, Tk. 12.55/Cap. ;
500mg , TK. 15.00/Cap. ; Paed. drops, 125 Suspn.,125 mg/5 ml, Tk. 80.30/100ml
mg/1.25 ml, Tk. 62.00/15ml,Suspn, 125mg / Sinaceph(Ibn Sina), Cap., 250 mg, Tk.
5ml , Tk. 90.00/100ml,; 250 mg/5 ml, Tk. 6.80/Cap. ;500 mg, Tk. 15.00/Cap. ; Inj., 500
125.00/60ml, mg/vial, Tk. 55.00/ Vial,; 1 gm/vial, Tk. 85.00/
Gigacef(Pacific), Cap.,500 mg, Tk. 15.00/Cap. Vial,; Paed. drops, 125 mg/1.25
; Paed. drops, 125 mg/1.25 ml, Tk. 46.00/15ml ml,Tk.55.00/15ml,;Suspn, 125 mg/5 ml, Tk.
,; Suspn, 125mg/5ml, Tk. 64.00/100ml 95.00/100ml,
Intracef(Beximco), Cap., 250mg , Tk. SK Cef(Eskayef), Inj, 1gm/vial, Tk. 80.00/
6.50/Cap.; 500mg, Tk.12.50/cap ,;Paed. drop, Vial,; 500mg/vial, Tk. 50.00/ Vial,; Cap,
125 mg/1.25 ml, Tk., 50.00/15ml,; Suspn, 250mg , Tk. 8.00/Cap. ,500mg , Tk. 15.00/Cap.
125mg/5ml, Tk. 80.00/100ml,; 250mg/5ml, Tk. ,Paed. drops, 125 mg/1.25 ml, Tk. 65.00/15ml
120.00/100ml ,; Suspn, 250 mg/5 ml, Tk. 140.00/100ml,; 125
Lebac(Square), Cap.,250 mg, Tk. 8.03/Cap. ; mg/5 ml, Tk. 90.00/100ml,Tk. 80.00/60ml
500 mg, Tk. 15.05/Cap. ; Inj, 1 gm/vial, Tk. Supracef(Biopharma), Cap., 250mg , Tk.
95.29/Vial ,; Inj, 500 mg/vial, Tk. 65.19/Vial,; 6.52/Cap.; 500mg , Tk. 12.05/Cap. ; Paed.
Paed. drop, 125 mg/1.25 ml, Tk. 65.19/15ml,; drops, 125 mg/1.25 ml, Tk. 50.19/15ml,;
Suspn, 125 mg/5 ml, Tk. 90.27/100ml,; 250 Suspn, 250 mg/ 5ml, Tk. 120.45/100ml; 125
mg/5 ml, Tk. 135.4/100ml mg/5 ml, Tk. 80.30/100ml
Polycef(Renata), Cap., 250 mg, Tk. 6.52/Cap. Tydin(Somatec), Cap., 500 mg, Tk. 14.68/cap.
; 500 mg, Tk. 12.54/Cap. ; Inj,1 gm/vial,Tk.; ; Paed. drops, 125 mg/1.25 ml, Tk.
90.00/ Vial.;250mg/vial, Tk. 38.10/ Vial,500 50.00/15ml.; Suspn., 125mg/5 ml, Tk.
mg/vial, Tk. 65.00/ Vial.; Paed. drop, 125 82.00/100ml; 250 mg/5 ml, Tk. 120.46/100ml
mg/1.25 ml, Tk. 62.00/15ml.; Suspn, 125 mg/5 Vecef(Asiatic), Cap., 500mg , Tk. 12.50/Cap. ;
ml, Tk. 90.00/100ml,; 250 mg/5 ml, Tk. Inj., 1gm/vial , Tk. 80.00/Vial,; 500mg/vial , Tk.
132.00/100ml 50.00/ Vial,; Paed. drops, 125 mg/1.25 ml, Tk.
Procef(Incepta), Cap. , 500 mg, Tk. 50.00/15ml.; Suspn, 125 mg/5 ml, Tk.
12.50/Cap. ; 250 mg, Tk. 6.50/Cap. ; Inj, 1 80.00/100ml; 250mg/5ml, Tk. 120.00/100ml
gm/vial, Tk. 80.00/ Vial,; 500 mg/vial, Tk. 50.00/ Velogen(General), Cap. , 250mg, Tk.
Vial ,; Paed. drops, 125 mg/1.25 ml, Tk. 6.54/Cap.;500mg, Tk. 12.59/Cap. ; Paed.
50.00/15ml,; Suspn, 250 mg/5 ml, Tk. drops, 125 mg/1.25 ml, Tk. 50.34/15ml,;
120.00/100ml,; 125 mg/5 ml, Tk. 80.00/100ml Suspn, 125 mg/5 ml, Tk. 82.56/100ml
Rocef(Healthcare), Cap.,250mg , Tk. Velox(Kemiko), Cap., 250 mg, Tk. 7.02/Cap.;
6,50/Cap. ; 500mg , Tk. 12.50/Cap. ; Suspn, 500 mg, Tk. 13.04/Cap.;Paed.drop,125
125mg/5ml , Tk. 95.00/100 ml,; 250mg/5ml , mg/1.25 ml,Tk. 50.15/15ml;125 mg / 5 ml,Tk.
Tk. 140.00/100 ml 80.24/100ml
Roxicef(Popular), Cap., 500 mg, Tk. Zecef(GACO), Cap.,500 mg,Tk. 12.54/Cap.;
12.55/Cap. ;Suspn, 250 mg/5 ml, Tk. Suspn.,125 mg/5ml, Tk. 80.24/100 ml
120.45/200 ml,; 125mg / 5ml, Tk. 80.30/100 ml
Sefin(Orion), Cap., 250 mg, Tk. 6.55/Cap. ;
1.1.2.1.2 SECOND-GENERATION
500 mg, Tk. 12.59/Cap. ; Inj, 1 gm/vial, Tk.
80.55/ Vial,; 500 mg/vial, Tk. 35.23/ Vial,; CEPHALOSPORINS
Paed. drop, 125 mg/1.25 ml, Tk. 50.35/15ml,;
Suspn, 250 mg/5ml, Tk. 120.81/100ml, Tk. Compared to first generation, second
60.42/50ml,; 125mg / 5ml , Tk. 80.55/100ml,; generation cephalosporins are more
Cap., 250mg, Tk. 6.50/Cap. 500mg , Tk. active against gram-negative
12.50/Cap.
microorganisms but such activity is less
Sefrad(Sanofi), Cap., 250mg, Tk. 10.03/Cap. ;
500mg, Tk. 16.05/Cap. ; Inj., 500mg/vial, Tk. than third generation agents. A subset of
60.18/Vial,; Paed. drops, 100mg/ml, Tk. second generation i.e. Cefoxitin,
65.20/15 ml,; Suspn, 125 mg/ 5 ml, Tk. Cefotetan and Cefmetazole also is active
95.29/100 ml.,250 mg/5 ml, Tk.130.39/100 ml,; against B. fragilis.
Sefril(Acme), Cap. , 250mg., Tk. 8.03/Cap.
,500 mg., Tk. 15.04/Cap. ; Inj.,1 gm/vial, Tk.
90.27/ Vial ,500mg/vial, Tk. 65.19/ Vial.; Paed.
drops, 125 mg/1.25 ml, Tk. 62.19/15ml.,
Suspn, 125mg / 5ml , Tk. 90.27/100ml,; 250
mg/5 ml, Tk. 120.82/100ml
Sefty(Astra Bio), Cap. , 250 mg, Tk. 6.50/Cap.,
500 mg, Tk. 15.00/Cap. ; Paed.drop, 125
14
1. ANTI-INFECTIVES
CEFACLOR [A] 125.00/15ml,; Suspn., 125 mg/5 ml, Tk.

180.00/100ml
Xclor(Orion), Suspn., 125 mg/5ml , Tk.
Indications: Sinusitis, otitis and lower 190.57/100ml
respiratory infections caused by beta-
lactamase producing H. influenza or B. CEFOXITIN[A]
catarrhalis, also see under cefadroxil
Cautions: Penicillin hypersensitivity,
Indications: As prophylactic against
pregnancy, breast-feeding, renal
intestinal anerobes in colorectal surgery,
impairment; false positive urinary glucose
mixed anerobic infections, i.e. peritonitis,
test and false positive Coombs’ test
diverculitis, infections due to facultative
Contraindications and Side-effects:
gram-negative bacteria, i.e. pelvic
See under cefadroxil
inflammatory disease, diabetic foot
Interactions: See appendix-2
infection; also see under Cefadroxil
Dose: oral:ADULT 250 mg every 8 hour
Cautions, Contra-indications, Side-
for mild to moderate infections; for severe
effects:See notes above and under
infections increased to 500 mg every 8
cefadroxil
hour up to a max. of 4 g daily in 3 divided
Interactions:See Appendix-2
doses; CHILD > 1 month, 20 mg/kg daily
(probenecid reduces the renal clearance
in 3 divided doses for mild to moderate
of Cefoxitin)
infections; for severe infections increased
Dose :By deep IM or slow IV inj. or IV
to 40 mg/kg every 8 hour up to a max. of
infusion 1-2 g every 6-8 hours for mild to
1 g daily in 3 divided doses
moderate infections; increased up to 12 g
daily in 3-4 divided doses for severe
Abaclor(ACI), Cap.;250 mg, Tk.
infections; CHILD recommended routeIV;
21.14/Cap.;500 mg, TK. 40.27/Tab. ;375 mg, up to 1 week, 20-40 mg/kg every 12
Tk. 30.09/Tab.; Paed. drops, 125mg/1.25ml, hours, 1-4 weeks 20-40 mg/kg every 8
Tk. 125.85/15 ml,; Susp., 125 mg/5 ml, TK. hours in mild to moderate infections,
201.35/100 ml increased to 200 mg/kg daily in 3-4
Alclor(Acme), Paed. drop, 100mg/ ml, Tk. divided doses up to a max.of 12 g daily in
125.37/15ml.; Suspn.,125 mg/5 ml, Tk. severe infections; surgical prophylaxis:
190.58/100ml;Cap.,500 mg, Tk. 40.12/Cap.
Ceflon(Eskayef), Cap.,250mg, Tk. 16.00/Cap. ;
by deep IM or slowIV inj. orIV infusion 2
500 mg , Tk. 30.00/Cap.; Suspn.,125 mg/5 ml, g, 30-60 minutes before surgery,
Tk. 200.00/100ml,; Paed. drop, 125 mg/1.25 repeated every 6 hours for 24 hours;
ml, Tk. 125.00/15ml CHILD 30-40 mg/kg 30-60 minutes
Cfl(Sharif), Paed. drops, 125 mg/1.25 ml, Tk. before surgery, repeated every 6 hours
125.37/15ml ,;Suspn.,125 mg/5 ml, Tk. for 24 hours (second and third doses
190.58/100ml every 8-12 hours in neonates);
Clobac(Opsonin), Suspn.,125 mg /5 ml, Tk.
180.68/100 ml,; 500 mg /5 m, Tk.
inuncomplicated UTI, Cefoxitin 1 g twice
125.47/15ml,; 125mg/5ml, Tk. 175/100ml daily has been given intramuscularly
Clocef(Amico), Cap., 500mg, Tk. 22/Cap.
Clorocef(Ibn Sina), Suspn., 125mg/5ml, Tk. Proprietary Preparations
205.00/100ml,; Pead. drop, 125 mg/1.25 ml, Cefot(ACI), Inj., 1gm /vial, Tk. 132.40/ Vial,
Tk. 130.00/15ml 500mg/vial, Tk. 76.23/ Vial, 250mg/vial, Tk.
Efaclor(Astra Bio), Suspn., 125 mg/5 ml, Tk. 50.15/ Vial,2gm/vial,Tk. 250.75/ Vial
180.00/100 ml Cefotax(Renata), Inj., 250 mg/vial,Tk. 75.00/
Loracef(Square), Cap., 500 mg,Tk. Vial,500 mg/vial, Tk. 180.00/ Vial,1 gm/vial, Tk.
38.26/Cap.; Paed. drops, 125 mg/1.25 ml, Tk. 100.00/Vial
125.85/15ml,;Suspn., 125 mg/5 ml, Tk. Cefotime(Incepta), Inj., 1 gm/vial, Tk. 132.00/
191.3/100ml Vial,; 250 mg/vial, Tk. 50.00/ Vial,; 500 mg/vial,
Oticef(Alco), Paed. drops, 125 mg / 1.25 ml, Tk. 76.00/ Vial
Tk. 125.38/15ml ,; Suspn., Tk. 200.60/100ml Ceftax(Opsonin), Inj.,
Cap., 500 mg, Tk. 40.12/Cap. 1 gm/vial, Tk. 132.50/ Vial,250 mg/vial , Tk.
Oticlor(Incepta), Cap., 500 mg, Tk. 40.00/Cap. 50.19/ Vial,500 mg/vial , Tk. 76.29/ Vial
; Paed. drops, 125 mg/1.25 ml, Tk.
15
1. ANTI-INFECTIVES
Maxcef(Square), Inj., 1 gm/vial, Tk. 140.42/ single dose; CHILD > 3 months, 125 mg
Vial,250 mg/vial, Tk. 70.21/ Vial,500 mg/vial, twice daily, can be doubled in CHILD > 2
Tk. 90.27/ Vial years with otitis media; Lyme disease:
Taxceph(Ibn Sina), Inj.,1 gm/vial, Tk. 140.00/
Vial,250mg/vial, Tk. 52.00/ Vial,500mg/vial, Tk.
ADULT and CHILD > 12 years, 500 mg
76.00/ Vial twice daily for 20 days; by IM inj. orIV inj.
Taxim(Acme), Inj., 1 gm/vial, Tk. 150.44/ Vial or infusion, 750 mg every 6-8 hours for
,250 mg/vial, Tk. 75.22/ Vial.,500 mg/Vial, Tk. mild to moderate infections;increased to
100.30/ Vial 1.5 g every 6-8 hours for severe
Torped(Orion), Inj., 1 gm/vial, Tk. 130.88/ infections, single doses over 750 mgIV
Vial, 250 mg/vial, Tk. 50.35/ Vial , 500 mg/vial, only; CHILD 60-mg/kg daily (range 30-
Tk. 75.50/ Vial
100 mg/kg daily) in 3-4 divided doses; for
gonorrhea, 1.5 g as a single dose by IM
CEFPROZIL[A] inj; surgical prophylaxis, 1.5 g byIV inj. at
induction of anesthesia, may be
Indications: Upper Respiratory tract supplemented with 750 mg IM inj. 8 and
infection, Skin and Soft tissue infections 16 hours later in abdominal, pelvic and
Cautions: See notes above orthopedic operations or followed by 750
Contra-indications, Side-effects: See mg by IM inj. every 8 hours for further 24-
under Cefadroxil 48 hours in cardiac, pulmonary,
Dose: URTI and Skin and Soft tissue esophageal and vascular surgery
infections, 500 mg once daily usually for
10 days; CHILD 6 months – 12 years; 20 Proprietary Preparations
mg/kg (Max 500 mg) once daily. Acute Adetil(Supreme), suspn, 125mg/5ml,
exacerbations of chronic bronchitis, 500 Tk.198.00/70ml,;Tab.,250mg, Tk. 25.00/Tab.;
mg every 12 hours usually for 10 days. 500mg, Tk. 45.00/Tab.
Otitis media, CHILD 6 months-12 years, Axet(Orion), Inj , 750mg/vial, Tk. 125.85/Vial
,;250 mg/vial, Tk. 60.41/Vial,;Tab.,125mg, Tk.
20 mg/kg (max 500 mg) every 12 hours
15.10/Tab., 250 mg, Tk. 25.18/Tab.,500 mg,
Tk. 45.30/Tab. ;suspn., 125mg/5ml, Tk.
Proprietary Preparations 216.46/70ml
Cefozil(Popular), Tab., 250mg, Tk. 30.11/Tab.; Axetil(Alco), suspn., 125mg/5ml, Tk.
500mg, Tk. 55.21/Tab.; Susp., 125 mg/5 ml, 190.57/70ml ,;Tab.,125 mg, Tk.
Tk.230.87/50 ml 12.04/Tab.,500 mg, Tk. 45.14/Tab,250 mg,Tk.
25.08/Tab.
Axicef(UniMed), suspn, 125mg/5ml, Tk.
CEFUROXIME[A*] 200.00/70ml,;Inj.,500mg/vial, Tk.
45.00/Vial,;Tab , 250mg, Tk. 25.00/Tab.
Axim(Aristo), Inj., 750mg/vial , Tk. 125.00/Vial,
Indications: Surgical prophylaxis, Lyme 1.5g/vial, Tk. 200.00/vial,; Tab., 125mg ,Tk.
disease, community acquired pneumonia 15.00/Tab.; 250mg , Tk. 25.00/Tab,; 500mg ,
especially where beta-lactamase Tk. 45.00/Tab. Susp., 125 mg/5 ml, Tk.
producing H influenza or K pneumonia is 225.00/70 ml;
a consideration, gonorrhea, also see C-2(Astra Bio), Tab. , 250 mg, Tk. 25.00/Tab. ;
under cefadroxil 500 mg, Tk. 45.00/Tab. ;suspn, 125mg/5ml, Tk.
198.00/5ml
Cautions: See notes above; also Cefobac(Popular), Tab. , 250mg, Tk.
pregnancy, breast-feeding and renal 25.09/Tab.,500mg, Tk. 45.17/Tab.;Inj.,750
impairment (Appendix-4) mg/vial, Tk. 125.47/Vial,1.5 gm/vial, Tk.
Interactions: See Appendix-2 200.75/Vial
Contraindications and Side-effects: Cefotil(Square), Inj.,750 mg/vial, Tk.
See under cefadroxil 125.85/Vial .,1.5 gm/vial, Tk. 201.35/vial
.;Tab.,500 mg, Tk. 45.29/Tab,250 mg, Tk.
Dose: Oral :as cefuroxime axetil, 250 mg
25.17/Tab. ; suspn, 125mg/5ml, Tk.
twice daily for mild to moderate 199.34/70ml,;
infections, increased to 500 mg twice Cefunix(Virgo), Tab. , 250mg, Tk.
daily for severe infections and for 25.00/Tab.,500mg , Tk. 40.00/Tab.
pneumonia; for urinary tract infections Cefurim(Somatec), suspn, 125mg/5ml, Tk.,
125 mg twice daily, doubled in 200.00/70ml,;Tab.,500 mg , Tk. 45.17/Tab.,250
pyelonephritis; for gonorrhea, 1 g as a mg, Tk. 25.10/Tab.
16
1. ANTI-INFECTIVES
Cerox(ACI), Inj., 1.5gm, TK. 201.35/vial,; 250 250.94/50ml.;Inj.,750mg/vial ,Tk. 125.00/Vial,;

mg, TK. 55.38/vial,; 750mg,TK. Tab., 500 mg, Tk. 45.17/Tab.
126.12/vial,;suspn, 125mg/5ml, TK. Orextil(Monico), Tab., 500mg, Tk.
199.35/70ml .;250mg/5ml , 45.00/Tab.;250 mg, Tk. 25.00/Tab.
Tk.250.75/50mlTab., 250mg, TK. 25.17/Tab. , Primocef(Novo ), Inj.,1.5 gm/vial, Tk.
500mg, TK. 45.31/Tab. 125mg, TK. 200.00/vial,;750 mg/vial, Tk. 125.00/vial,;Tab.,
15.11/Tab. 250 mg, Tk. 25.00/Tab.; 500 mg, Tk.
Ceroxime(Asiatic), Tab., 125mg , Tk. 45.00/Tab.; suspn, 125mg/5ml, Tk.
15.00/Tab.; Inj., 750mg/vial , Tk. 125.00/vial,; 198.00/70ml
suspn, 125mg/5ml, Tk. 198.00/70ml,; Probac(Silva),suspn, 125mg/5ml, Tk.
Tab.,250mg , Tk. 25.00/Tab.,; 500mg , Tk. 198.74/70ml ,;Tab.,250mg,Tk. 25.10/Tab.
45.00/Tab. Rofurox(Radiant), Tab., 250mg, Tk.
Famicef(Acme),Tab. , 250 mg , Tk. 25.17/Tab. 40.00/Tab., 500mg , Tk. 60.00/Tab.;suspn,
,500 mg , Tk. 45.29/Tab.; Inj1.5 gm/vial, Tk. 125mg/5ml, Tk. 325.00/70
201.35/vial ,750 mg/vial, Tk. 120.82/vial,; Roxicil(Pharmacil), Inj.,750mg/vial ,Tk.
suspn, 250 mg/5 ml , Tk. 186.25/35ml,Tk. 170.51/Vial ,;Tab, 250mg ,Tk.
199.34/70ml. 30.09/Tab.;500mg , Tk. 50.15/Tab.
Furex(Drug Intl), Inj.,1.5gm/vial, Tk. Roxcef(Nipro JMI), Tab., 250 mg, Tk.
200.65/vial, 750mg/vial, Tk. 125.40/vial,; 25.08/Tab.; 500mg, Tk. 45.14/Tab.
Suspn.,125mg/5ml, Tk. 225.75/70ml,; Tab., Inj.,750 mg/vial,Tk.125.00/vial ,1gm/viai
250mg, Tk. 25.10/Tab. ; 500mg, Tk. 45.15/Tab. Tk.200.00/vial
Furocef(Renata), Inj.,1.5 gm,/vial Tk. Secomax(General),Tab., 250mg, Tk.
200.75/vial,; 750mg/vial, Tk. 125.47/vial, 25.16/Tab., 500mg, Tk. 45.31/Tab.; suspn.,
250mg/vial, Tk. 55.21/vial 250mg/5ml, Tk. 201.35/70ml
;Suspn, 125mg/5ml, Tk. 198.75/70ml. ; Sefur(Opsonin), suspn, 250mg/5ml, Tk.
250mg/5ml ,Tk,250.00/50ml.;Tab.,125 mg, Tk. 250.94/ 50 ml.,
15.06/Tab., 250 mg, Tk. 25.09/Tab. 500mg, Inj., 1.5 gm /vial, Tk. 200.75/vial, Inj.,750
Tk. 45.17/Tab. , mg/vial, Tk. 125.47/Vial,; Tab. , 125 mg , Tk.
Furoget(Getwell), Suspn., 125mg/5ml, Tk. 15.06/Tab. ,250 mg , Tk. 25.16/Tab. ,500 mg ,
195.00/70ml ,; Tab. ,500mg,Tk. 44.00/Tab. Tk. 45.30/Tab.
;250mg, Tk. 24.00/Tab. Sefurox(Sanofi), Inj.,1.5g/vial, Tk. 200.60/Vial,
Furotil(Healthcare), Inj.,1.5gm/vial, Tk. Inj., 750mg/vial, Tk. 125.85/Vial.;suspn,
275.00/vial, 750mg/vial, Tk. 175.00/vial.; suspn, 125mg/5ml, Tk. 199.34/Vial,; Tab.,500mg, Tk.
125mg/5ml, Tk. 200.00/70ml. ;Tab., 125mg , 45.31/Tab.,250mg, Tk. 25.17/Tab.;
Tk. 15.00/Tab.,250mg , Tk. 25.00/Tab., 500mg Segorin(Pacific), Tab. , 250 mg,Tk. 25.00/Tab.
, Tk. 45.00/Tab. , 125 mg, Tk. 15.00/Tab. , 500 mg, Tk.
Furotixol(Sharif), suspn, 125 mg /5 ml , Tk. 45.00/Tab. ;suspn,125mg/5ml, Tk.
198.59/70ml ,;Tab.,250 mg, Tk. 25.09/Tab. 150.00/70ml .
500 mg, Tk. 45.13/Tab. Sharpkil(One Pharma),Tab., 250 mg, Tk.
Kfore(Kemiko), Tab., 250 mg, Tk. 25.07/Tab. 25.00/Tab.,500 mg, Tk. 45.00/Tab.
, 500 mg, Tk. 45.13/Tab. Turbocef(Beximco), Inj., 750mg/vial, Tk.
Kilbac(Incepta), suspn., 125mg/5ml, Tk. 125.00/vial,; 1.5gm/vial, Tk. 200.00/vial,; suspn,
198.00/70ml.; ;250mg/5ml, Tk250.00/50ml 250mg/5ml, Tk. 240.00/Susp.;Tab., 250mg, Tk.
Inj.,1.5 gm/vial, Tk. 200.00/vial,; 250 mg/vial, 25.00/Tab.; 500mg, Tk. 45.00/Tab.
Tk. 55.00/vial,; 750 mg/vial, Tk. 125.00/vial Uroxime(Euro), suspn, 125mg/5ml,
,;Tab., 125 mg, Tk. 15.00/Tab.;250 mg, Tk. Tk.198.00/70ml ,;Tab., 301.25mg, Tk.
25.00/Tab. , 500 mg, Tk. 45.00/Tab. 25.00/Tab.;500mg,Tk. 45.00/Tab.
Kilmax(Eskayef), Inj., 750mg/vial, Tk. Vexotil(Organic), Tab.,250 mg, Tk.
125.00/Vial,; 1.5gm/vial ,Tk. 200.00/vial, 250mg 25.08/Tab.,500 mg,Tk. 45.13/Tab.
/vial, Tk. 55.00/vial.; ;suspn,125mg/5ml, Tk. ;suspn,125mg/5ml, Tk. 198.60/70ml
198.00/70ml,;250mg/5ml Tk.250.00/50mlTab, Xefrim(Beacon), suspn, 125mg/5ml, Tk.
125mg , Tk. 15.00/Tab.,250mg , Tk. 199.35/70ml,; Tab. , 250mg , Tk. 25.08/Tab.
25.00/Tab.,500mg, Tk. 45.00/Tab Ximetil(Globe), Inj. ,1.5 gm/vial, Tk.
Lepath(Amico), Tab., 250mg , TK. 22.00/Tab. 200.00/vial,; 750 mg,/vial Tk. 125.00/Vial,;
Merocef(Ibn Sina), suspn, 125mg/5ml, Tk. Tab. , 250 mg, Tk. 25.00/Tab.;500 mg, Tk.
200.00/70ml,; Inj., 750 mg/vial, Tk. 45.00/Tab.; suspn., 125mg/5ml,
130.00/vial,; Tab.,500 mg, Tk. 46.00/Tab. ; Tk.198.00/70ml
250mg, Tk. 26.00/Tab. Xitil(Ziska), suspn, 125mg/5ml, Tk.
Mextil(Biopharma), suspn, 125mg/5ml, Tk. 198.00/70ml,;Tab.250 mg, Tk. 25.00/Tab.,500
200.75/70ml,;250mg/5ml mg, Tk. 45.00/Tab.
17
1. ANTI-INFECTIVES
Zenifor(Zenith), suspn, 125mg/5ml, Tk. 48.00/Tab.;Suspn., 125 mg + 31.25 mg/5 ml,

198.00/50ml,;Tab., 500 mg, Tk. 45.00/Tab. Tk. 250.00/70ml
Zinnat(GSK), Tab. , 250 mg, Tk. 30.00/Tab., Kefuclav(Eskayef), Suspn., 125 mg + 31.25
500 mg, Tk. 55.00/Tab mg/5 ml, Tk. 250.00/70ml,; Tab, 500 mg +
125 mg, Tk. 50.00/Tab.; 250 mg +62.5 mg, Tk.
Cefuroxime + Clavulanic Acid 30.00/Tab.; 250mg+ 62.50mg, Tk. 30.00/Tab.;
Axeclav(Alco), Suspn. 125 mg + 31.25 mg/5 500mg + 125mg, Tk. 50.00/Tab.; 500mg +
ml, Tk. 250.00/70ml ,; Tab., 500 mg + 125 125mg, Tk. 50.00/Tab.; 250mg+ 62.50mg, Tk.
mg, Tk. 50.00/Tab. ,250 mg +62.5 mg, Tk. 30.00/Tab.
30.00/Tab. Mexclav(Biopharma), Tab., 250mg+ 62.50mg,
Axim(Aristo), Suspn., 125 mg + 31.25 Tk. 30.00/Tab.; 500mg + 125mg, Tk.
mg/5ml,Tk.250.00/70ml,; 125 mg + 31.25 mg/5 50.00/Tab.
ml, Tk. 225.00/70mlTab., 250 mg +62.5 mg, Rofuclav(Radiant), Tab. , 250mg+ 62.50mg,
Tk. 30.00/Tab. ; 500 mg + 125 mg, Tk. Tk., 50.00/Tab.; 500 mg + 125 mg, Tk.
50.00/Tab. 0.00/Tab.; 500 mg + 125 mg, Tk. 50.00/Tab.
Ceclav(Sharif), Tab., 500 mg+ 125mg, Tk. Secoclav(General), Tab. , 500mg + 125mg,
50.00/Tab. ; 250 mg+ 62.5 mg, Tk.30.00/Tab. Tk. 50.00/Tab.; 250mg + 62.50mg, Tk.
Cefaclav(Incepta), Suspn. , 125 mg + 31.25 30.00/Tab.
mg/5 ml, Tk. 250.00/70ml,; Tab.,500 mg+ Sefur(Opsonin),Suspn.,125 mg + 31.25 mg/5
125mg, Tk. 50.00/Tab.,250 mg+ 62.5 mg, Tk. ml, Tk.198.75/70 ml
18.00/Tab.; 250 mg+ 62.5 mg, Tk. Sharpkil(One Pharma), Tab., 250 mg + 62.5
30.00/Tab.,500 mg+ 125mg, Tk. 50.00/Tab. mg, Tk. 30.00/Tab.; 500 mg+ 125 mg, Tk.
Cefobac(Popular), Suspn. 125 mg + 31.25 50.00/Tab.
mg/5 ml, Tk. 198.75/70 ml Xiclav(Ziska), Suspn., 125 mg + 31.25 mg/5
Cefotil(Square), Suspn.,125 mg + 31.25 mg/5 ml, Tk. 250.00/70 ml,; Tab, 250 mg + 62.5 mg,
ml, Tk. 250.00/70ml,;Tab. , 250 mg + 62.5 mg Tk. 300.00/Tab.; 500 mg + 125 mg, Tk.
, Tk. 30.10/Tab. ; 500 mg + 125 mg , Tk. 400.00/Tab.
50.15/Tab. Ximeclav(Globe), Suspn. 125 mg + 31.25
Cefurim(Somatec), Tab., 250 mg + 62.50 mg , mg/5 ml, Tk. 250.00/Vial,; Tab. , 250 mg +
Tk. 30.00/Tab.; Suspn. , 125 mg + 31.25 62.5 mg, Tk. 30.00/Tab.; 500 mg + 125 mg,
mg/5 ml, Tk. 250.00/70ml,; Tab., 500 mg + Tk. 50.00/Tab.
125 mg, Tk. 50.00/Tab.
Cerox(ACI), Tab., 125mg + 31.25mg , Tk.
1.1.2.3 THIRD-GENERATION
21.06/Tab. ; 500mg + 125mg, TK. 50.15/Tab.
; 125 mg + 31.25 mg/5 ml, Tk. CEPHALOSPORINS
225.00/70ml,;Suspn., 125 mg + 31.25 mg/5 ml,
TK. 250.75/70ml Third generation agents (Cefotaxime,
Clavurox(Popular), Tab., 500mg + 125mg, Tk. Ceftriaxone, Ceftibuten etc.) generally
50.00/Tab.; suspn.,125 mg + 31.25 mg/5 ml, are less active than first generation drugs
Tk. 250.00/70 ml
against gram-positive cocci, but they are
Clavusef(Opsonin), Suspn., 125 mg + 31.25
mg/5 ml, Tk. 252.75/70 ml,; Tab. , 125 mg + much more active against the
31.25 mg , Tk. 18.05/Tab.; 250 mg + 62.5 Enterobacteriaceae, including beta-
mg ,Tk. 30.10/Tab.,; 500 mg + 125 mg , Tk. lactamase producing strains. Among third
50.15/Tab. generation drugs ceftazidime and
Cloavurox(Popular), Tab.,250 mg + 62.5 mg cefoperazone also are effective in P.
, Tk. 30.00/Tab. aeruginosa infection but are less active
Co-Axet(Orion), Tab.,250 mg+ 62.5 mg, Tk.
than other third generation agents
30.09/Tab.; 500 mg +125 mg,Tk. 50.15/Tab.
Famiclav(Acme), Suspn. , 125 mg + 31.25 against gram-positive cocci.
mg/5 ml, Tk. 252.00/70ml,; Tab. , 250 mg +
62.50 mg , Tk. 30.00/Tab. ; 500 mg + 125 mg CEFDINIR[W]
, Tk. 50.00/Tab.
Fuclav, (Drug Intl), Suspn. 125 mg + 31.25
mg/5 ml, Tk. 250.75/70ml,; 125mg+ 31.25mg, Indications: Gonorrhea, otitis media,
Tk. 18.10/Tab. ; 250mg+ 62.50mg, Tk. pharyngitis, lower RTI such as bronchitis
30.10/Tab. ; 500mg+ 125mg, Tk. 50.20/Tab. and UTI
Furoclav(Renata), Tab. , 250mg+ 62.50mg, Caution: Renal Impairment
Tk. 30.00/Tab. ; 500 mg + 125 mg , Tk. Side effects:See under Cefadroxil
50.00/Tab. Interactions:See Appendix-2
Furoget(Getwell), Tab. , 250mg +2.50 mg, Dose: Oral:ADULT, 600 mg daily as a
Tk. 28.00/Tab. ; 500mg + 125mg, Tk.
single dose on in two divided doses
18
1. ANTI-INFECTIVES
CHILD may be given 14 mg/kg body CEFIXIME [A*][W]
weight daily
Indications:Sinusitis, otitis media, skin
Proprietary Preparations and soft tissue infections caused by
Cednir(Eskayef), Cap, 300mg , Tk.
Enterobacteriaceae and betalactamase
40.00/Cap.;Suspn., 125 mg/5 ml, Tk.
160.00/30ml producing H. influenzae, Morexella
Cefexta(UniMed),Suspn., 125 mg/5 ml, Tk. catarrhalis and N. gonorrhea
225.00/60ml,;Cap., 300mg, Tk. 57.00/Cap.; Cautions, Contra-indicationsandSide-
Suspn., 250 mg/5 ml, Tk. 210.00/30ml effects: See notes above and under
Efdinir(Incepta), Cap.,300 mg, Tk. cefadroxil
45.00/Cap.;Suspn.,125 mg/5 ml, Tk. Interactions: See Appendix -2
175.00/60ml
Dose: Oral: ADULT and CHILD > 10
years: 200-400 mg twice/once daily;
CEFDITOREN[W] CHILD > 6 months: 8 mg/kg daily in 1-2
divided doses
Indications: Sinusitis, otitis media, skin
and soft tissue infections caused by Proprietary Preparations
Enterobacteriaceae and betalactamase Adexim(Supreme), Cap, 200mg,
producing H. influenzae, Morexella Tk.30.00/Cap.; Suspn., 100 mg/5 ml,
catarrhalis and N. gonorrhea Tk.160.00/50ml
Cautions: See notes above; also Afix(Aristo), Suspn., 200 mg/5 ml,
Tk.195.00/30ml, Tk. 280.00/50ml,;100 mg/5 ml,
carnitine deficiency Tk. 195.00/50ml,Tk.120.00/30ml Tk. Cap.,
Contra-indications: See under 400mg , Tk. 50.00/Cap. ; 200mg , Tk.
Cefadroxil 3.00/Cap. ; Tab. , 200mg , Tk.
Interactions:See Appendix -2 35.00/Tab.;400mg , Tk. 50.00/Tab.
Side-effects:See under Cefadroxil Afixime(Asiatic), Cap., 200mg , Tk. 30.00/Cap.
Dose: Oral: ADULT and CHILD > 10 , 400mg , Tk. 50.00/Cap.; Suspn., 100 mg/5
years: 200-400 mg twice daily; in patients ml, 130.00/37.5ml,Tk. 210.00/50ml
Bestcef(Biopharma), Cap., 200mg , Tk.
with renal insufficiency: creatinine 35.00/Cap. ;400mg , Tk. 50.19/Cap. ;Suspn,
clearance (CC) < 30ml/min, 200 mg once 100mg /5ml, Tk. 130.49/37.5ml,Tk.
daily, CC 30-49 ml/min, 200 mg twice 210.00/50ml
daily Bioxim(Sharif), Cap. , 400 mg, Tk.
50.14/Cap.,200 mg, Tk. 30.10/Cap. Suspn.,
Proprietary Preparations 100 mg/5 ml, Tk. 120.37/30ml, Tk.
Cefditor(Orion), Tab., 200mg, Tk.100.30/Tab. 175.00/50ml , Tk. 280.00/50ml ,;
Ceftoren(ACI), Tab., 200mg, Tk. 150.00/Tab. C-3(Astra Bio), Cap., 400 mg, Tk. 50.00/Cap. ;
200 mg, Tk. 35.00/Cap. , Tk. 30.00/Cap. ;
Suspn., 100 mg/5 ml, Tk. 195.00/5ml
CEFETAMET PIVOXIL HCl[W] Cebex(Novo), Suspn., 100 mg/5 ml, Tk.
195.00/50ml,; Cap., 200 mg, Tk. 35.00/Cap.,
This member of third-generation 400 mg, Tk. 50.00/Cap.
cephalosporins has therapeutic profile Cef-3(Square), Cap., 200 mg, Tk. 35.11/Cap.,
400 mg, Tk. 50.35/Cap.;paed.drop, 125
similar to that of cefixime. However, it
mg/1.25ml, Tk. 100.3/21ml,; Suspn., 100 mg/5
may precipitate carnitine deficiency. ml, Tk. 135.4/30ml,Tk. 210.63/50ml,Tk.
The usual administration is per oral in a 250/75ml,; 200 mg/5 ml, Tk. 280.85/50ml,;
dose of 500 mg twice daily. Tab., 200 mg, Tk. 35.11/Tab.
Cefcil(Pharmacil), Cap., 200mg , Tk.
Proprietary Preparation 34.10/Cap.; Suspn., 100 mg/5 ml, Tk.
Tenafet(Incepta),Tab.,250mg,Tk.20/Tab;500m 200.60/50ml
g,Tk.35/Tab.;Susp.,250mg/5ml,Tk.120/50 ml Ceficap(Euro), Suspn., 100 mg/5 ml, Tk.
195/50ml. ; Cap., 224mg, Tk. 35.00/Cap.
,400mg, Tk. 50.00/Cap.
Cefiget(Getwell), Suspn., 100 mg/5 ml, Tk.
205.00/50ml,Tk. 245.00/100ml ,Tk.
19
1. ANTI-INFECTIVES
90.00/20ml,; Cap., 400mg, Tk. 49.00/Cap., 135.51/30ml, Tk. 155.58/40ml,Tk.

200mg, Tk. 34.00/Cap 195.74/50ml,Tk. 225.00/70ml ,; Tab. , 400 mg,
Cefim, (ACI), Cap., 200mg, TK. 35.11/Cap. , Tk. 50.00/Tab. ; 200 mg, Tk. 35.00/Tab. ;
400mg, TK. 50.34/Cap. ; Paed. drops, 125 Cap., 200 mg, Tk. 35.00/Cap.; 400 mg, Tk.
mg/1.25ml, TK. 100.00/21ml; Suspn., 200 mg/5 50.00/Cap
ml, TK. 300.90/50ml ,;Suspn.,100 mg/5 ml, Orgaxim(Organic), Cap., 200mg, Tk.
TK. 241.62/75ml ,; TK. 130.39/30ml ,TK. 30.10/Cap. ;500mg , Tk. 50.15/Cap. ; Suspn.,
210.63/50ml ,; Tab., 200 mg, TK. 30.90/Tab. ; 100 mg/50ml, Tk. 195.59/5ml, Tk. 240.72/75ml
400mg, TK. 50.15/Tab. Prexim(Ziska), Cap. , 400 mg, Tk. 45.00/Cap.
Cefix(Globe), Cap., 200 mg, Tk. 35.00/Cap.; 200 mg, Tk. 30.00/Cap. ,; Suspn., 100 mg/5 ml,
400 mg, Tk. 50.00/Cap. ; Suspn., 100 mg /5 ml, Tk. 120.00/30ml,Tk. 195.00/50ml,;
Tk. 195.00/50ml, Rofixim(Radiant), Cap. , 500mg, Tk.
Cefixim(Ibn Sina), Cap., 200 mg, Tk. 45.00/Cap. ,400mg, Tk. 65.00/Cap. ;
35.00/Cap. ; Paed.drop, 125mg/1.25ml, Tk. Suspn.,100 mg/5 ml, Tk. 250.00/50ml,
100.00/21ml,; Suspn, 100mg /5ml, Tk. 200mg/5 ml, Tk. 395.00/50ml,
180.00/40ml,Tk. 130.00/30ml,Tk. 210.00/50ml,; Roxim(Eskayef), Cap 200mg , Tk. 30.00/Cap.
200mg /5ml, Tk. 280.00/50ml,; Cap., 400 mg, ,400mg , Tk. 50.00/Cap. Suspn, 200 mg/5 ml,
Tk. 55.00/Cap. ; Tk. 320.00/37.5ml, Tk.320/60ml; 100 mg/5 ml,
Ceftid(Opsonin), Cap. , 400 mg. Tk. Tk. 135.00/30ml,Tk.195.00/50ml
50.35/Cap.,200 mg , Tk. 35.11/Cap. ;; Paed Paed. drop, 125 mg/1.25ml, Tk. 85.00/15ml,;
drops, 125mg/1.25ml, Tk. 98.00/21ml,;Suspn., Tab., 200mg, Tk. 30.00/Tab., 400mg , Tk.
100 mg/5 ml, Tk. 210.63/50 ml ,Tk.130.49/ 37.5 50.00/Tab.
ml.,Tk. 321.21/ 50 ml; Tab. , 400 mg , Tk. Saver(Alco), Suspn., 100 mg / 5 ml, Tk.
50.19/Tab.; 200 mg , Tk. 35.00/Tab.; 120.36/30ml , Tk. 150.45/40ml ,Tk.
Cexime(GSK), Cap. , 200 mg, Tk. 35.11/Cap. 195.59/50ml ,; Cap., 200 mg, Tk. 30.09/Cap.
; 400 mg, Tk . 50.15/Cap. ;100 mg/5 ml, Tk. ; 400 mg, Tk. 50.15/Cap.
200.00/50ml Starcef(Beacon), Cap., 400mg , Tk.
Denvar(Healthcare), Cap., 200mg , Tk. 50.00/Cap. ; 200mg , Tk. 35.11/Cap. ;
35.00/Cap. ,400mg, Tk. 50.00/Cap. ;Suspn., Suspn., 100 mg/5 ml, Tk. 196.33/50ml
200mg/5ml , Tk. 320.00/50 ml,; 225.00/37.5 ml Supraxim(Silva), Cap. , 200mg, Tk.
,; 100mg/5ml, Tk. 145.00/30 ml ,Tk. 210.00/50 35.00/Cap.; Suspn., 100 mg/5 ml, Tk.
ml 200.00/50ml ,Tk. 140.00/30ml
Emixef(Incepta), Suspn., 200 mg/5 ml, Tk. T-cef(Drug Intl), Cap , 400mg, Tk. 50.20/Cap.;
280.00/50ml,; Suspn., 100 mg/5 ml, Tk. 200mg, Tk. 30.10/Cap. ; Suspn., 200mg/5ml,
130.00/30ml, Tk. 170.00/40ml, Tk. Tk. 280.85/50ml,; 100mg/5ml, Tk.
195.00/50ml.; Cap, 200 mg, Tk. 35.00/Cap. 135.45/30ml,; 195.60/50ml,; Paed.drops,
; 400 mg, Tk. 50.00/Cap. 125mg/1.25ml, Tk. 100.30/21ml
Erafix(Virgo), Cap. , 200 mg, Tk. 36.00/Cap. Tgocef(Somatec), Suspn., 100 mg/5 ml, Tk.
Fix-A(Acme), Cap., 200 mg, Tk. 35.00/Cap. ; 130.00/30ml,;Tk. 195.00/50ml,; Cap., 200 mg,
400 mg, Tk. 50.35/Cap.; Suspn., 100 mg/5 ml, Tk. 35.00/Cap. ; 400 mg, Tk. 50.00/Cap.
Tk. 210.63/50ml ,Tk. 130.88/37.5ml ,Tk. Tocef(General), Suspn., 100 mg/5 ml, Tk.
240.72/75ml ,.;200mg/5ml,Tk. 280.84/50ml,; 130.88/37.5ml, 196.33/50ml,; 200 mg/5 ml, Tk.
Paed.drops, 125 mg/1.25ml, Tk.100.30/21ml 280.00/50ml,; Cap., 200mg, Tk. 35.00/Cap. ;
Gen-3(Amico), Cap., 200mg , 30.00/Cap.; 400mg, Tk. 50.34/Cap.
Suspn., 100mg/5ml , TK. 175.00/50ml Trifix(Pacific), Suspn., 200 mg/5 ml, Tk.
G-FIX(G.A.Co), Cap., 200 mg, Tk. 35.11/Cap.; 240.00/50ml ,; Cap., 200 mg, Tk. 35.00/Cap. ;
400 mg, Tk. 48.00/Cap., Suspn., 100 mg/5ml, 400 mg, Tk. 50.00/Cap.
Tk. 195.59/50 ml Triocef(Nipa), Cap., 200 mg, Tk. 30.00/Cap. ;
Kefim(Kemiko), Cap., 400 mg, Tk. 55.16/Cap. Suspn., 100 mg/5 ml, Tk. 135.00/37.5ml, Tk.
; 200 mg, Tk. 30.09/Cap.,Suspn., 100 mg/5 ml, 195.00/50ml
Tk. 130.39/37.5ml , Tk. 195.59/50ml Triocim(Beximco), Cap., 200mg, Tk.
Kuracef(Sanofi), Suspn., 100 mg/5 ml, Tk. 35.00/Cap.; 400mg, Tk. 50.00/Cap. ; Suspn.,
135.00/30 ml,Tk. 215.00/50 ml,; Tab., 200mg, 100mg/5ml, Tk. 210.00/50ml,; 200 mg/5 ml, Tk.
Tk. 40.00/Tab.; 400mg, Tk. 55.00/Tab. 320.00/50ml
Odacef(UniMed), Cap., 200mg, Tk. Truso(Orion), Cap., Tk. 35.11/Cap. ; Suspn.,
30.00/Cap. ;400mg, Tk. 50.00/Cap. ; Suspn., 200 mg/5 ml, Tk. 280.84/50ml,; 100 mg/5 ml,
100 mg/5 ml, Tk. 195.00/50ml,Tk. 120.00/30ml Tk. 130.89/37.5ml,; Tk. 195.59/50ml Paed.
Onefix(One Pharma), Cap. , 200 mg, Tk. drops, 125 mg/1.25ml, Tk. 80.24/15ml
34.99/Cap. ; 400 mg , Tk. 49.99/Cap. ; Suspn., Zemicef(Popular), Cap. , 200mg, Tk.
100 mg/5 ml, Tk. 135.00/30ml,Tk. 195.00/50ml 35/Cap.;Suspn, 200 mg/5 ml, 100mg/5 ml, Tk.
Orcef(Renata), Suspn., 200 mg/5 ml, Tk. 120.45/30ml, Tk.150.57/40ml, Tk.195.74/50ml
280.00/50 ml,;Suspn., 100 mg/5 ml, Tk.
20
1. ANTI-INFECTIVES
[W] [W]
CEFOTAXIME CEFPODOXIME
Indications: As part of 3-drug Indications: Upper respiratory-tract

combination with vancomycin and infections, particularly those that are
Ampicillin in meningitis due to H. recurrent and resistant to other
influenzae,penicillin-sensitiveS. antibiotics; lower respiratory-tract
pneumonia, N. meningitidisand gram- infections including bronchitis and
negative enteric bacteria, gonorrhea, pneumonia; skin and soft tissue
Hemophilus epiglottitis; also see under infections; uncomplicated UTI and
cefadroxil gonorrhea; also effective against
Cautions, Contraindications: Side- penicillin-resistant strains of
effects: Streptococcus pneumonia
Interactions: See Appendix-2 Caution, Contraindications and Side-
Side-effects: Rare events of cardiac effects: See notes above and under
arrhythmias after rapid inj. also see under cefadroxil
cefadroxil Interactions:See Appendix -2
Dose :By IM or slow IV inj. or IV infusion Dose: Oral:as cefpodoxime proxetil:
1 g every 12 hours for mild to moderate upper respiratory-tract infections (in
infections; increased to 8 g daily in 4 pharyngitis and tonsillitis only in
divided doses for severe meningitis, up to infections which are recurrent, chronic, or
a max. of 12 g daily in 3-4 divided doses; resistant to other antibacterial), 100 mg
CHILD 100-150 mg/kg/day in 2 to 4 twice daily, 200 mg twice daily in
divided doses in mild to moderate sinusitis; lower respiratory tract infections
infections, increased to 200 mg/kg daily including bronchitis and pneumonia, 100-
in severe infections; NEONATES 50 200 mg twice daily; skin and soft tissue
mg/kg/day in 2 to 4 divided doses for mild infections, 200 mg twice daily;
to moderate infections; increased to 150- uncomplicated urinary-tract infections,
200 mg/kg/day 4 divided doses for 100-200 mg twice daily; uncomplicated
severe infections; for gonorrhea, a single gonorrhea, 200 mg as a single dose;
dose of 500 mg CHILD 15 days-6 months 4 mg/kg every
12 hours; 6 months-2 years 40 mg every
Proprietary Preparations 12 hours; 3-8 years 80 mg every 12
Cefot(ACI), Inj.,1gm/vial,Tk. 132.40/ Vial, 500 hours; > 9 years 100 mg every 12 hours
mg/vial, Tk. 76.23/ Vial, 250mg, Tk. 50.15/
Vial, 2gm, Tk. 250.75/Vial Proprietary Preparations
Cefotax(Renata), Inj., 250 mg/vial, Tk. 75.00/
Cefdox(ACI), Suspn, 40 mg/5 ml, Tk.
Vial, 500 mg, Tk. 180.00/Vial, 1 gm/vial, Tk.
98.67/50ml,80 mg/5 ml, Tk. 176.19/50ml;
100.00/Vial, Tab., 200mg, TK. 42.29/Tab. ; Cap., 100mg ,
Cefotime(Incepta), Inj., 1 gm/vial, Tk. 132.00/ Tk. 22.13/Cap.,200mg, Tk. 25.00/Cap. ; Paed.
Vial, 250 mg/vial, Tk. 50.00/ Vial,500 mg/vial, drops20 mg/ml, Tk. 60.41/15ml
Tk. 76.00/ Vial Cefipod(Asiatic), Suspn, 40 mg/5 ml, Tk.
Ceftax(Opsonin), Inj., 1 gm/vial, Tk. 132.50/
195.00/100ml,80 mg/5 ml, Tk. 175.00/50ml,;
Vial,250 mg/vial , Tk. 50.19/Vial, 500 mg/vial ,
Cap., 100mg , Tk. 14.00/Cap. ; Paed. drops,
Tk. 76.29/ Vial 20 mg/ml, Tk. 60.00/15ml
Maxcef(Square), Inj., 1 gm/vial, Tk.
Cefobid(UniMed), Cap.,200mg, Tk.
140.42/Vial. ,250 mg/vial,Tk. 70.21/Vial,500
42.00/Cap.; Suspn, 40mg/5ml, Tk. 98.00/50ml
mg/vial, Tk. 90.27/ Vial
Cefodim(Pacific), Cap. , 100 mg, Tk.
Taxceph(Ibn Sina), Inj.,1 gm/vial, Tk.
22.00/Cap. ; 200 mg, Tk. 40.00/Cap. ; Suspn,
140.00/Vial, 250mg/vial, Tk. 52.00/ Vial,500mg,
40mg/5ml, Tk. 80.00/50ml
Tk. 76.00/ Vial Cefokid(Euro), Suspn, 80 mg/5 ml, Tk.
Taxim(Acme), Inj., 1 gm/vial, Tk. 150.44/Vial , 98.00/50ml
250 mg/vial, Tk. 75.22/ Vial,500 mg/Vial, Tk. Cefomin(Popular), Tab. , 100mg, Tk.
100.30/ Vial 20.08/Tab.; 200.00mg, Tk. 38.14/Tab. Suspn,
Torped(Orion), Inj.,1 gm/vial, Tk. 130.88/
40mg/5 ml, Tk. 96.36/50ml
Vial, 250 mg/vial, Tk. 50.35/ Vial ,; 500 mg/vial,
Tk. 75.50/ Vial
21
1. ANTI-INFECTIVES
Ceforan(Drug Intl), Tab., 200mg, Tk. Vanprox(Square), Paed. drops, 20 mg/ml, Tk.
28.10/Tab. ; 100mg, Tk. 17.05/Tab. ; Suspn, 60.4/15ml,; Suspn, 40 mg/5 ml, Tk.
40mg/5ml, Tk. 120.40/100ml, Tk. 98.65/50ml,; Cap., 200 mg, Tk. 42.29/Cap.
75.25/50ml,80mg/5ml, Tk. 175.55/50ml Vercef(Beximco), Paed. drops, 20 mg/ml, Tk.
Cefpod(Zenith), Tab., 100 mg , Tk. 22.00/Tab. 60.00/15ml,; Suspn, 40mg/5ml, Tk.
Cepdoxim(Alco), Cap., 100 mg, Tk. 98.00/50ml,; 80mg/5ml, Tk. 175.00/50ml
20.06/Cap.; 200 mg, Tk. 30.09/Cap. Susp., Victorin(Novo Health), Cap., 200 mg, Tk.
40 mg/ 5ml, Tk. 175.53/100ml ,; Tk. 40.00/Cap. ; Paed. drops, 20 mg/ml, Tk.
90.27/50ml ,; 60.00/15ml,:Suspn, 40mg/5ml, Tk. 98.00/50ml
CP(Acme), Tab., 200 mg, Tk. 42.29/Tab. ; Ximeprox(Incepta), Paed. drops, 20 mg/ml,
Suspn, 40 mg/5 ml, Tk. 98.65/50ml,; 80mg/5 Tk. 60.00/15ml,: Suspn, 40 mg/ 5ml, Tk.
ml, Tk. 175.52/50ml,; Paed. drops, 120 175.00/50ml,; Tk. 195.00/100ml,; 80 mg/5 ml,
mg/1.25ml, Tk. 60.40/15ml Tk. 98.00/50ml,; Tab., 100 mg, Tk. 17.00/Tab.
Desbac(General), Cap., 100mg, Tk. ; 200 mg, Tk. 28.00/Tab.
22.13/Cap.; Suspn, 40 mg/5ml, Tk. 98.67/50ml Zedoxim(Globe), Cap., 100 mg, Tk.
Dofixim(Ibn Sina), Cap.,100mg, Tk. 20.00/Cap. , 200 mg, Tk. 40.00/Cap. ;
168.00/Cap.; Suspn, 40 mg/ 5ml, Tk. Paed.drop , 20 mg/ml, Tk. 60.00/Vial,; Suspn,
100.00/50ml 40 mg/5 ml, Tk. 95.00/50 ml;
DxProxil(Monico), Suspn, 40mg/5ml, Tk.
98.00/50ml Cefpodoxime + Clavulanic Acid
Emiprox(Virgo), Suspn., 40 mg/5 ml, Tk. Clavuran(Drug Intl), Tab., 100mg+ 62.5mg, Tk.
90.00/50ml, 80 mg/5 ml, Tk. 170.00/50ml 22.10/Tab.; 200mg+ 125mg, Tk. 35.15/Tab.
Instina(Ziska), Suspn., 40 mg/5 ml, Tk. Combocef(ACI), Tab., 200mg +125mg Tk.
98.00/50ml 50.15/Tab.; 100mg + 62.5mg, Tk. 30.09/Tab.
Kidcef(Beacon),Suspn., 40mg/5ml, Tk. Duo(Incepta), Tab, 100mg+ 62.5mg, Tk.
98.67/50ml 25.00/Tab.; 200 mg + 125 mg, Tk. 40.00/Tab.
Leprox(Amico), Suspn., 40mg/5ml, TK. Xtabac(Opsonin), Tab. , 200 mg + 125 mg ,
98.00/50ml,; 80mg/5ml, TK. 175.00/50ml Tk. 35.00/Tab.; 100 mg + 62.50 mg, Tk.
Neoprox(Somatec), Suspn., 40 mg/5 ml, Tk. 20.00/Tab.
98.37/50ml,; Paed. drops, 20 mg/ml, Tk.
60.23/15ml
CEFTAZIDIME[W]
Pedicef(Orion), Paed. drops , 20mg/ml, Tk.
60.39/15ml,; Suspn., 40mg/5ml, Tk.
98.66/50ml,;80mg/5ml, Tk. 176.19/50ml Indications: With an aminoglycoside
Podo(Kemiko)Suspn., 40 mg / 5ml, Tk. treatment of choice for Pseudomonus
98.29/50ml meningitis, surgical prophylaxis, also see
Rovantin(Opsonin), Suspn, 40 mg /5 ml, Tk. under Cefixime
98.66/50ml,80 mg /5 ml, Tk. 175.66/50ml,20
mg /5 ml, Tk. 60.42/5ml,; Tab., 100 mg , Tk.
14.05/Tab., 200 mg , Tk. 25.09/Tab. effects:See notes above and under
Roxetil(Healthcare), Cap., 100mg , Tk. cefadroxil
352.00/Cap. , 200mg, Tk. 504.00/Cap. ; Interactions:See Appendix-2
Suspn, 40mg/5ml, Tk. 95.00/50 ml Dose:IM or slow IV inj. or IV infusion: 1 g
Sarelox(Sanofi), Suspn., 80mg/ml, Tk. every 8 hours for mild to moderate
98.67/50 ml infections, increased to 2 g every 8-12
Starin(Eskayef), Suspn., 40 mg/ 5ml, Tk.
hours for severe infections, single dose
98.00/50ml, 80 mg/5 ml, Tk. 150/50ml,; Cap,
100mg , Tk. 22.00/Cap. , 200mg , Tk. over 1 gIV route only, up to a max. of 3 g
40.00/Cap.; Paed. drops , 20mg/ml, Tk. daily; CHILD up to 2 months 25-60 mg/kg
60.00/15ml daily in 2 divided doses, > 2 months 30-
Taxetil(Aristo), Suspn, 80 mg/5 ml, Tk. 100 mg/kg daily in 2-3 divided doses; up
175.00/50ml,; 40 mg/5 ml, Tk. 99.00/50ml, Tk. to 150 mg/kg daily in 3 divided doses
195.00/100ml,; Cap., 100mg , Tk. 22.00/Cap.; (max. 6 g daily ) if immunocompromised
200mg , Tk. 40.00/Cap.; Paed. drops, 20
or meningitis;IV route recommended for
mg/ml, Tk. 62.00/15ml
Trioclav(Eskayef), Tab, 200mg, Tk. children; urinary tract and less serious
40.00/Tab.; 200mg , Tk. 40.00/Tab. infections: 0.5-1 g every 12 hours;
Trucef(Renata), Paed. drops, 20 mg/ml, Tk. Pseudomonal lung infection in cystic
60.23/15ml,; Suspn, 40 mg/ 5ml, Tk. fibrosis: ADULT with normal renal
98.37/50ml,; 80 mg/ 5ml, Tk. 175.66/50ml function 100-150 mg/kg daily in 3 divided
doses; CHILD up to 150 mg/kg daily
(max. 6 g daily) in 3 divided doses;IV
22
1. ANTI-INFECTIVES
route recommended for children; surgical CEFTIBUTEN [W]
prophylaxis, prostatic surgery, 1 g at

induction of anesthesia repeated if Ceftibuten is an oral 3rd generation
necessary when catheter removed cephalosporin used similarly to cefixime
in the treatment of urinary tract infection
Proprietary Preparations and respiratory tract infection.
Asizime(Asiatic), Inj , 1gm/vial, Tk.
Indications:See under Cefixime
240.00/Vial, Inj , 250mg/vial , Tk. 85.00/
Vial,500mg/vial , Tk. 130.00/ Vial Cautions, Contra-indications, Side-
Cefazid(Renata), Inj, 1 gm/vial, Tk. effects: See notes above and under
240.00/Vial,250 mg/vial, Tk. 85.00/ Vial,500 cefadroxil
mg/vial, Tk. 130.00/ Vial Interactions: See Appendix-2
Ceftazim(Aristo), Inj , 1g/vial, Tk. Dose: Oral: ADULT and CHILD > 10
240.00/Vial,250mg/vial , Tk. 85.00/ years: 400 mg once daily; CHILD > 6
Vial,500mg/vial , Tk. 130.00/Vial
months: 8 mg/kg once daily
Lesero(Ziska), Inj , 1g/vial, Tk. 215.00/
Vial,500 mg/vial, Tk. 115.00/Vial ,250 mg/vial,
Tk. 70.00/ Vial Proprietary Preparations
Maxidim(Beximco), Inj , 250mg/vial, Tk. 85.00/ Butibac(Drug Intl), Cap., 400 mg, Tk.
Vial,; 500mg/vial, Tk. 130.00/ Vial,1gm/vial, Tk. 120.00/Cap. ; Suspn., 90 mg/5 ml, Tk.
240.00/ Vial 480.00/60ml
Serozid(Opsonin), Inj , 500 mg/vial , Tk. Buticef(Ibn Sina), Suspn., 90 mg/5 ml, Tk.
130.39/ Vial,1 gm/vial, Tk. 240.00/ Vial ,250 480.00/60ml ,; Cap., 400 mg, Tk. 1200.00/Cap.
mg/vial , Tk. 85.00/ Vial Cebumax(General), Cap. , 400 mg, Tk.
Sidobac(Incepta), Inj , 1 gm/vial, Tk. 215.00/ 120.00/Cap.;Suspn., 90 mg/5 ml, Tk.
Vial , 250 mg/vial, Tk. 70.00/ Vial,500 mg/vial, 480.00/60ml
Tk. 115.00/ Vial Cebuten(Renata), Cap., 400 mg, Tk.
Tazicef(Novo Health), Inj , 250 mg/vial, Tk. 120.00/Cap. ; 400 mg, Tk. 120.00/Cap.
70.00/ Vial ,1.0 gm/vial, Tk. 215.00/ Vial,500 Cefamax(Incepta), Suspn., 90 mg/5 ml, Tk.
mg/vial, Tk. 115.00/ Vial 480.00/60ml,; Cap. , 400 mg, Tk. 120.00/Cap.
Tazid(Square), Inj , 1 gm/vial, Tk. 240.72/ Cefaten(Eskayef), Cap. , 400 mg, Tk.
Vial,; 250 mg/vial, Tk. 85.26/ Vial,500 mg/vial, 120.00/Cap., 400 mg, Suspn., 90 mg/5 ml, Tk.l
Tk. 130.39/ Vial 465.00/60ml., 90 mg/5 ml, Tk. 775.00/100ml
Tazimax(Eskayef), Inj, 1gm, Tk. 240.00/ Vial,; Cefteria(ACI), Suspn., 90 mg/5 ml, TK.
250mg , Tk. 85.00/ Vial,1gm/vial, Tk. 481.00/60ml ,90 mg/5 ml, TK. 802.00/120ml
240.00/Vial,250mg/vial, Tk. 85.00/ Vial ,;Cap., 400 mg, TK. 120.00/Cap.
Tizime(Globe), Inj , 1 gm/vial, Tk. 210.00/Vial,; Ceftiben(Square), Cap., 400 mg, Tk.
250 mg/vial,Tk. 70.00/Vial,500 mg/vial, Tk. 120.00/Cap. ; Suspn., 90 mg/5 ml, Tk.
115.00/Vial 480.00/60ml
Trizidim(Acme), Inj , 250 mg/vial, Tk. 70.47/ Inbuten(Pharmacil), Cap. , 400 mg, Tk.
Vial,; 1 gm, Tk. 216.45/ Vial,500 mg, Tk. 120.00/Cap,; Suspn., 90 mg/5 ml, Tk.
115.78/ Vial 480.00/60 ml
Trum(Drug Intl), Inj , 1gm, Tk. 225.70/ Vial,; Logibac(Acme), Suspn., 90 mg/5 ml, Tk.
250mg/vial, Tk. 70.25/ Vial,; 500mg/vial, Tk. 480.00/60ml,; Cap., 400 mg, Tk. 120.00/Cap.
120.40/ Vial Maxbuten(Sanofi), Suspn., 180mg/ml, Tk.
Zidicef(Popular), Inj , 1 gm/vial, Tk. 215.81/ 800.00/60ml,90 mg/5 ml, Tk. 480.00/60ml,;
Vial,; 250mg/vial, Tk. 70.26/ Vial,; 500 mg/vial, Tab., 400mg, Tk. 120.00/Tab.;
Tk.115.43/ Vial,2 gm, Tk. 361.36/ Vial Oditen(Opsonin), Cap., 400 mg, Tk.
Zidim(Orion), Inj, 500 mg, Tk. 115.78/ Vial , 1 120.37/Cap.;Suspn., 90 mg/5 ml, Tk. 481.44/60
gm/vial, Tk. 216.45/Vial,250 mg/vial, Tk. 70.48/ ml ,Tk. 800.00/120 ml
Vial Roin(Ziska), Cap. , 400 mg, Tk. 120.00/Cap. ;
Zidimax(Biopharma), Inj , 250mg/vial , Tk. Suspn., 90 mg/5 ml, Tk. 400.00/60ml
70.00/ Vial,500mg/vial ,Tk. 115.00/ Vial Tibucef(Globe), Suspn., 90 mg/5 ml, Tk.
Zitum(ACI), Inj , 250mg/vial,Tk. 70.47/ 465.00/60 ml,; Cap., 400 mg, Tk. 120.00/Cap.
Vial,500mg/vial, Tk. 115.78/ Vial,1gm/vial,Tk. Zoventa(Healthcare),Suspn.,180mg/5ml, Tk.
226.53/ Vial 800.00/60 ml ,90mg/5ml ,Tk. 480.00/60
ml,Cap.,200 mg ;Cap Tk. 70.00/Cap.,400
mg,Tk. 120.00/Cap.
23
1. ANTI-INFECTIVES
CEFTRIAXONE[W] , Tk. 100.00/vial,Inj., IV 2g/vial, Tk.

300.00/vial,1g/vial, Tk. 200.00/vial,500mg/vial ,
Tk. 130.00/vial, 250mg/vial , Tk. 100.00/vial
Indications: Surgical prophylaxis; also Axosin(Ibn Sina), Inj., IM 1g/vial, Tk.
see under Cefotaxime 180.00/vial,; 500mg/vial, Tk.
Cautions: See notes above ; also 120.46/vial,250mg/vial , Tk. 90.00/vial,; Inj., IV
hepatic impairment, in premature 2g/vial, Tk. 290.00/vial,; 1g/vial, Tk.
neonates may displace bilirubin from 180.00/vial,; 500mg/vial , Tk. 120.46/vial,
250mg/vial , Tk. 90.00/vial
binding sites of albumin
Cefaz(Astra Bio), Inj., IM 1g/vial,
Contra-indications: Neonates with 250mg/vial,Tk. 100.00/vial,; Inj., IV 2g/vial, Tk.
jaundice, hypoalbuminemia, acidosis or 300.00/vial, 1g/vial, Tk. 190.00/vial,;
impaired bilirubin binding; also see under Cefone(Sharif), Inj., IM
Cefadroxil 500mg/vial,Tk.120.37/vial,;250mg/vial , Tk.
Interactions:See Appendix -2 90.28/vial,; Inj., IV 2g/vial, Tk.
Side-effects:See under Cefadroxil; also 200.79/vial,1g/vial, Tk. 180.58/vial,;
Ceftizone(Renata),Inj., IM 1g/vial, Tk.
pancreatitis, rarely prolongation of
200.75/vial,; 500mg/vial , Tk. 140.53/vial,;
prothrombin time 250mg/vial , Tk. 100.38/vial,; Inj., IV 2g,Tk.
Dose: By IM or slow IV inj. over at least 341.28/vial,; Tk. 500mg/vial , Tk. 140.53/vial,;
2-4 minutes orIV infusion 1 g daily for 250mg/vial , Tk. 100.38/vial,;
mild to moderate infections, increased to Ceftobac(Organic), Inj., IM 1g/vial, Tk.
2-4 g daily for severe infections; INFANT 160.00/vial,; 500mg/vial , Tk. 120.00/vial,; Inj.,
and CHILD 20-50 mg/kg daily in mild to IV 2g/vial, Tk. 300.00/vial,;
Ceftrix(Novo Healthcare), Inj., IM 1g/vial, TK.
moderate infections, up to 80 mg/kg daily
191.29/Vial,;500mg/vial ,Tk.
in severe infections; doses of 50 mg/kg 130.39/vial,;250mg/vial, Tk. 100.30/vial; Inj., IV
and over byIV infusion only; NEONATES 2gm/vial, Tk. 302.04/Vial,;1g/vial, Tk.
byIV infusion over 60 minutes, 20-50 191.29/Vial,Inj., 500mg/vial, Tk. 130.39/vial.;
mg/kg daily up to a max. of 50 mg/kg 250mg/vial, Tk. 100.30/Vial,;
daily; uncomplicated gonorrhea: by deep Ceftron(Square), Inj., IM., 1g/100vial, Tk.
IM inj. of 250 mg as a single dose; 190.58/Vial,; 500mg/vial, Tk. 130.39/vial,;
250mg/vial , Tk. 100.30/vial; Inj., IV 2gm/vial,
surgical prophylaxis: by deep IM inj. orIV
Tk. 302.04/Vial,; 1g/vial, Tk. 190.58/Vial,;
inj. over at least 2-4 minutes, 1 g a single 500mg/vial, Tk. 130.39/vial.,250mg/vial,TK.
dose; colorectal surgery deep IM inj. or 100.30/Vial,;
inj. over at least 2-4 minutes or by IV Cetaxone(Euro), Inj., IM 1g/vial, TK.
infusion, 2 g as a single dose; IM doses 190.00/Vial,; 500mg , TK. 130.00/vial,; 250mg
over 1 g should be divided between more , TK. 100.30/vial
than one site Inj., IV 2gm/vial,TK. 300.00/Vial,; 1g/vial, TK.
190.00/Vial,; 500mg/vial, TK.
130.00/vial,250mg/via, TK. 100.30/Vial,;
Proprietary Preparations Dicephin(Drug Intl),Inj., IM,; 1g/vial, TK.
Aciphin(ACI), Inj., IM 1g/vial, Tk. 191.29/Vial, 190.60/Vial,; 500mg/vial , Tk. 130.45/vial,;
500mg/vial , Tk. 130.39/vial, 250mg , Tk. 250mg/vial , Tk. 100.30/vial ,; Inj., IV
100.30/vial ,Inj., IV 2gm/vial, TK. 302.04/Vial, 2gm/vial,Tk. 301.00/Vial,; 1g/vial, Tk.
1g/vial, Tk. 191.29/Vial,; 500mg/vial, Tk. 190.60/Vial,; 500mg/vial, Tk.
130.39/vial, 250mg/vial, Tk. 100.30/Vial,; 130.45/vial.,250mg/vial, Tk. 100.30/Vial,;
Arixon(Beximco), Inj., IM Enocef(Sanofi),
1g/vial,Tk.190.00/vial,500mg/vial, Tk. Inj., IM 1g/vial, Tk. 201.35/Vial,
130.00/vial; 250mg/vial, Tk. 100.00/vial,;Inj.,IV Exephin(Incepta), IM Inj. , 1 gm/vial, Tk.
2g/vial, Tk. 300.00/vial, 1g/vial,; Tk. 190.00/vial,; 250 mg/vial, Tk. 100.00/vial,; 500
190.00/vial,;500mg/vial, Tk. mg/vial, Tk. 130.00/vial.;Inj.,IV.,2 gm/vial, Tk.
300.00/vial.;250mg/vial , Tk. 100.00/vial 300.00/vial,; 1 gm/vial, Tk. 190.00/Vial,; 250
Asixone(Asiatic), Inj., IM 1g/vial, Tk. mg/vial, Tk. 100/vial ; 500 mg/vial, Tk.
190.00/vial,; 500mg/vial , Tk. 130.00/vial
130.00/vial.;250mg/vial , Tk. 100.00/vial,; Inj., Imacef(General),Inj., IM 1g/vial, Tk.
IV 2g/vial, Tk. 300.00/vial,; 1g/vial, Tk. 190.00/Vial,; 500mg , Tk. 130.00/vial,; Inj., IV
190.00/vial,; 500mg/vial , Tk. 130.00/vial,; 2gm, Tk. 302.04/Vial,;1g/vial, Tk. 161.08/Vial,;
250mg/vial , Tk. 100.00/vial,; 500mg/vial, Tk.130.00/vial
Axon(Aristo),Inj., IM 1g/vial, Tk. Infecef(Alco), Inj.,IM 1g, Tk. 190.57/Vial,;
200/vial,500mg/vial , Tk. 130.00/vial,250mg/vial 500mg , Tk. 130.39/vial,;250mg, Tk.
24
1. ANTI-INFECTIVES
100.39/vial; Inj., IV 2gm,Tk. , 300.90/Vial,; Trizon(Acme), IM Inj., 1 g/Vial,Tk. 190.58/vial;

1g/vial, Tk. 190.57/Vial,; 500mg/vial, Tk. 250 mg/Vial, Tk. 100.30/vial,; 500 mg/Vial, Tk.
130.39/vial.,250mg/vial, TK. 100.30/Vial,; 130.39/vial,; 1 g/Vial, Tk.
Maxzon(One Pharma), IM Inj. , 250 mg/vial, 190.58/vial,;IV.Inj.,2gm/vial, Tk. 300.90/vial,;
Tk. 100.00/vial,; 500 mg/vial , Tk. 130.00/vial,; 250 mg/vial, Tk. 100.30/vial ; 500 mg/vial, Tk.
Inj.,IV., 1 gm/vial, Tk.1190.00/vial,; 2 gm/vial , 130.39/vial
Tk. 300.00/vial Vertex(Orion), IM Inj , 1 gm/vial, Tk.
Odatrix(UniMed), Inj.,IM 1g/vial, TK. 190.21/Vial,; 250 mg/vial, Tk. 100.3/Vial,;
160.00/Vial,; 500mg/vial , TK. 120.00/vial,; 500 mg/vial, Tk. 130.39/Vial,; IV.Inj.,2
Inj., IV 2gm/vial,TK. 300.00/Vial,; 1g/vial, TK. gm/vial, Tk. 302.04/Vial ,; 1 gm/vial, Tk.
160.00/Vial,; 190.21/Vial,; 250 mg/vial, Tk. 100.30/Vial.
Oricef(Healthcare), IM Inj. , 1gm/vial , Tk. 500 mg/vial, Tk. 130.39/Vial
320.00/vial,; 250mg/vial , Tk. 130.00/vial,; Winner(Biopharma), IM Inj. , 1 gm/vial, Tk.
500mg/vial , Tk. 200.00/vial; IVInj., 1gm/vial , 180.68/vial,; 500mg/vial , Tk. 120.45/vial,;
Tk. 320.00/vial,; 250mg/vial, Tk. 130.00/vial,; IV.Inj.,500mg/vial , Tk.120.45/vial,; 1 gm/vial,
2gm/vial, Tk. 490.00/vial,; 500mg/vial , Tk. Tk. 180.68/vial,; 2gm/vial, Tk. 300.00/vial
200.00/vial
Orizone(Pharmacil), IV Inj. , 1 gm/vial, Tk.
1.1.2.2 FOURTH-GENERATION
290.87/Vial ,; 2gm/vial, Tk. 501.05/Vial ,;
500mg , Tk. 200.60/Vial CEPHALOSPORINS[R]
Perix(Monico),
Inj., IM 250mg/vial, TK. 90.00/Vial,; Fourth generation drugs have an
Rit(Kemiko), Inj., IM 1g/vial, TK. 190.58/Vial,; extended spectrum of activity compared
500mg/vial, TK. 120.35/vial ,250mg/vial, TK. to third generation and have increased
95.29/vial,Inj., IVInj.,2g/vial, TK. 300.00/Vial,;
stability against betalactamases. They
Inj., 1g/vial, TK. 190.58/Vial,; Inj., 500mg/vial,
TK. 120.35/vial., 250mg/vial, TK. 95.29/vial are considered to be particularly useful in
Rofecin(Radiant), IM Inj. 250mg, Tk. infections caused by aerobic gram-
150.45/vial,; 1 gm/vial, Tk. 361.08/vial,; negative organisms resistant to third
500mg, Tk. 220.66/vial,; Inj.,IV. 500mg/vial, Tk. generation cephalosporins.
220.66/vial,; 2.0g/vial , Tk. 682.05/vial,; 1
gm/vial, Tk. 361.08/vial,; 250mg, Tk.
150.45/vial
CEFEPIME[R]
Traxef(Beacon), Inj., 1gm , Tk. 320.96/vial
Traxon(Opsonin), IM. Inj. , 1gm/vial , Tk. Indications: Drug of choice for the
190.00/vial,; 250 mg/vial , Tk. 100.00/vial,; empirical treatment of nosocomial
500 mg/vial, Tk. 130.00/vial,; IV.Inj., 500 infections, i.e. nosocomial isolates of
mg/Vial , Tk. 130.00/vial ,; 1gm/Vial , Tk. enterobacter, citrobacter and serratia;
190.58/vil,; 250 mg/Vial , Tk. 100.00/vial2
gm/vial , Tk. 302.03/vial,;
also see under Cefixime
Tribac(Globe), IM Inj. , 1 gm/vial, Tk. Cautions, Contra-indications, Side-
180.00/Vial,; 250 mg/vial, Tk. 90.00/Vial,; 500 effects:See notes above and under
mg/Vial, Tk. 120.00/Vial,;IV.Inj., 2 gm/vial, Tk. cefadroxil
300.00/Vial,; 1 gm/vial, Tk. 180.00/Vial,; 250 Interactions:See Appendix-2
mg/vial, Tk. 90.00/Vial,; 500 mg/vial, Tk. Dose:By slow IV inj. over at least 2-4
120.00/Vial
minutes orIV infusion 0.5-1 g 12 hourly
Triject(Eskayef), IM.,Inj, 1 gm/vial, Tk.
190.00/Vial,; 500mg/vial, Tk. 130.00/Vial ,;
for mild to moderate infections; increased
250mg/vial, Tk. 100.00/Vial,; 500mg/vial, Tk. to 2 g daily every 12 hours for severe
130.00/Vial,; IV .Inj., 2 gm/vial, Tk. infections; INFANT and CHILD 75-120
300.00/Vial,; 250mg/vial, Tk. 100.00/Vial,; 1 mg/kg/day in 2-3 divided doses
gm/vial, Tk. 190.00/Vial,; 500mg/vial, Tk.
130.00/Vial,; 250mg/vial, Tk. 100.00/vial Proprietary Preparations
Triphin(Ziska), IM Inj. , 1 gm/Vial, Tk. Ceftipime(Renata), Inj, 1 gm/vial, Tk. 552.08/
160.00/vial,; 250 mg/Vial, Tk. 80.00/vial,; 500 Vial; 2 gm/vial, Tk. 1104.15/ Vial, 500 mg, Tk.
mg/Vial, Tk. 120.00/vial.;IV, Inj. , 2 gm/vial, Tk. 301.13/ Vial
250.00/vial,; 1 gm/vial, Tk. 160.00/vial,; 250 Efepime(Ziska), Inj, 1 g/vial, Tk. 550.00/Vial, 2
mg/vial, Tk. 80.00/vial,; 500 mg/vial, Tk. g/vial, Tk. 1100.00/Vial, 500 mg/vial, Tk.
120.00/vial 300.00/ Vial
25
1. ANTI-INFECTIVES
Forgen(Aristo), Inj, 1 gm/vial, Tk. 550.00/ Vial, Proprietary Preparation

2gm/vial , Tk. 1100.00/ Vial,500mg/vial , Tk. Force(Square), IV Inj. 1 gm/Vial, Tk.
300.00/ Vial 401.51/Vial
Gen-4(Ibn Sina), Inj, 500 mg/vial, Tk. 555.00/
Vial,2gm/vial, Tk. 1010.00/ Vial,500mg, Tk.
305.00/Vial 1.1.3 OTHER BETA-LACTUMS
Magnova , (Orion), Inj, 1mg/vial , Tk. 551.65/ 1.1.3.1 CARBAPENEMS[W]
Vial,2 gm/vial , Tk. 1103.31/ Vial ,500mg , Tk. 1.1.3.2 MONOBACTAM[W]
300.90/ Vial
Maxpime(Square), Inj, 1 gm/vial, Tk. 551.65/
Vial,500 mg, Tk. 300.90/ Vial,2gm/vial , Tk. Besides Penicillins and
1100.00/ Vial Cephalosporins, Carbapenems
Pime(ACI), Inj, 1gm/vial, Tk. 553.73/ Vial,; (Doripenem, Ertapenem, Imipenem,
2gm/vial, Tk. 1107.47/ Vial,; 500mg, Tk. Meropenem) and monobactam
302.04/ Vial (Aztreonam) are important therapeutic
Superpime(Acme), Inj, 1 gm/vial, Tk. 551.64/
agents with a beta lactam structure. They
Vial, 2 gm/vial, Tk. 1103.31/ Vial, 500 mg/vial ,
Tk. 300.90/ Vial are bactericidal and act by inhibiting cell
Tetracef(Beximco), Inj, 1gm/vial, Tk. 550.00/ wall synthesis of susceptible organisms.
Vial, 500mg, Tk. 300/Vial
Tupime(Kemiko), Inj, 1 gm/vial, Tk. 551.65/Vial 1.1.3.1. CARBAPENEMS[W]
Ultrapime(Incepta), Inj, 1 gm/vial, Tk. 550.00/
Vial, 500 mg, Tk. 300.00/ Vial
Unipim(Drug Intl), Inj, 1gm/vial, Tk. 501.50/ The carbapenems have wide spectrum of
Vial, 500mg, Tk. 301.10/ Vial activity, being active against many
Winnipime(Sanofi), Inj, 1g/vial, Tk. 551.65/ aerobic and anaerobic gram-positive and
Vial ,2g/vial, Tk. 1103.31/ Vial gram-negative organisms, including
Xenim(Opsonin), Inj., 1 gm/vial, Tk. 552.08/ Listeria,Pseudomonas and most
Vial,; 500 mg/vial , Tk. 301.13/ Vial Enterobacteriaceae.Carbapenems are
Ximepime(Globe), Inj., 1 gm/vial, 550.00/ Vial,;
2 gm/vial, 1100.00/ Vial,; 500 mg/vial ,
resistant to wide spectrum of
300.00/Vial,; 1gm/vial , Tk. 550.00/ Vial, betalactamases.
2gm/vial , Tk. 1100.00/ Vial, 500mg , Tk.
300.00/ Vial DORIPENEM[W]
Zopime(Healthcare), Inj., 1gm/vial , Tk.
550.00/ Vial, 500mg/vial, Tk. 300.00/ Vial
Doripenem is the newest of the
carbapenems with a broad spectrum and
CEFPIROME[R]
enhanced gram-negative antimicrobial
activity particularly against P aeruginosa.
Indications: infections due to sensitive institutional susceptibility patterns and
Gram positive and Gram-negative cost may be the 2 factors that will carry
bacteria the most weight in prescribing decisions.
Cautions, Contra-indications, Side- Indications: Treatment of complicated
effects: See notes above and under intra-abdominal infections and
cefadroxil complicated urinary tract infections,
Interactions:See Appendix -2 including pyelonephritis;
Dose:IV inj. or infusion: complicated Cautions: Hypersensitivity to beta
upper and lower UTI, Skin and Soft lactams, pregnancy, CNS disorders,
tissue infections, 1 g every 12 hours, renal impairment
increased to 2 g every 12 hours in very Contra-indications: Hypersensitivity;
severe infections; Interactions: See Appendix-2
Lower Respiratory Tract Infection, 1-2 g Side-effects:See under Cefadroxil, also
every 12 hours; seizures, convulsions, confusion and
Severe infections including bacteremia mental disturbances
and septicemia and infections in Dose: Complicated Intra-abdominal
neutropenic patients, 2 g every 12 hours Infection:500 mg IV infusion over 1 hour
CHILD less than 12 years not 8 hourly x 5-14 days,at least 3 days IV,
recommended may switch to an appropriate oral
26
1. ANTI-INFECTIVES
treatment if clinical improvement Noted; Cautions: Hypersensitivity to other beta-

Complicated UTI lactams, pregnancy, CNS disorders,
500 mg IV infusion over 1 hour 8 hourly x renal impairment
10 days can be extended up to 14 days if Contra-indications: Hypersensitivity to
concurrent bacteremia; treatment of imipenem or cilastatin, breast-feeding
bronchopulmonary infection in patients Interactions: See Appendix -2
with cystic fibrosis who are colonized with Side-effects:See under Cefadroxil, also
P aeruginosa seizures, convulsions, confusion and
mental disturbances, increases in serum
Proprietary Preparations creatinine and blood urea, tooth or
Dionem(Opsonin), Inj., 500 mg , Tk. tongue discoloration, red coloration of
2000.00/Vial urine in children
Doriject(Popular), Inj., 500 mg Tk. Dose:Deep IM inj.: 500-750 mg 12
2000.00/Vial
Dorinem(ACI), Inj., 500 mg, Tk. 2006.02/Vial
hourly; gonococcal urethritis or cervicitis,
Doripen(Eskayef), Inj., 500 mg, Tk. 500 mg a single dose;IV infusion, 1-2 g
2000.00/Vial, 250 mg, Tk. 1300.00/Vial, daily in 3-4 divided doses, may be
Perinem(Drug Intl), Inj., 500 mg, Tk. increased to 50 mg/kg up to a max. of 4 g
2000.00/Vial daily; CHILD > 3 months, 60 mg/kg/day
in 4 divided doses; surgical
ERTAPENEM[W] prophylaxis:IV infusion: 1 g at induction
Ertapenem is considered a narrower of anesthesia repeated after 3 hours,
spectrum agent, as it has limited activity supplemented in colorectal, cardiac
against certain pathogens of concern surgery by doses of 500 mg 8 and 16
such as P aeruginosa. hours after induction
Indications:Infection againstP
aeruginosa. Proprietary Preparations
Cautions: Hypersensitivity to other beta- Cispenam(Incepta), Inj., 250 mg+250 mg, Tk.
650.00/Vial, 500 mg+ 500 mg , Tk. 1195/Vial.
lactams, pregnancy, CNS disorders,
Imbac(Popular), Inj. , 500 mg + 500 mg , Tk.
renal impairment 1199.51/Vial
Interactions: See Appendix-2 Iminem(ACI), Inj., 500 mg + 500 mg , Tk.
Side-effects:See under Cefadroxil 1203.12/Vial ,; 250 mg + 250 mg , Tk.
Dose :1 gram IV or IM once daily for 5 to 650.00/Vial
14 days Iropen(Renata),Inj., 500 mg + 500 mg , Tk.
1295.00/Vial
Maxipen(Opsonin), Inj., 500 mg + 500 mg ,
Proprietary Preparation
Tk. 1295.00/Vial
Etropen(Techno)Inj.,1 gm/vial,Tk.3400/vial
MEROPENEM[W]
IMIPENEM WITH CILASTATIN[W]
Indications: Aerobic and anaerobic
Indications: Drug of choice for infections
Gram-positive and Gram-negative
caused by cephalosporin-resistant
infections, septicemia; see also notes
nosocomial bacteria, such as Citrobacter
above
freundii and Enterobacter spp; good
Cautions: Hypersensitivity to beta-
choice for empiric treatment of serious
lactam antibiotics; hepatic impairment
infections in hospitalized patients who
(Appendix-3); renal impairment
have recently received other beta-lactam
(appendix-4); pregnancy (appendix-5);
drugs, urinary tract and lower respiratory
and breast-feeding(appendix-6);
infections, septicemia particularly of renal
origin, intraabdominal and gynecological
Contra indications: Hypersensitivity to
infections, skin, soft-tissue, bone and
meropenem.
joint infections, surgical prophylaxis; also
Side-effects: Gastrointestinal
see Notes above
disturbances such as nausea, vomiting,
27
1. ANTI-INFECTIVES
diarrhoea, abdominal pain; disturbance of Merocon(Beacon), Inj. , 1 gm/vial , Tk.

liver function tests; hypersensitivity 1303.91/Vial ,; 500 mg, Tk. 702.11/Vial
reaction such as skin rash, pruritus, Meroject(Eskayef), Inj, 500mg, Tk.
700.00/Vial,; 1 gm/vial, Tk. 1300.00/Vial. ;
urticaria, thrombocytopenia, positive 500mg/vial, Tk. 700.00/Vial,; 1gm/vial , Tk.
Coombs test; eosinophilia, neutropenia, 1300.00/Vial.
leucopenia; headache, paraesthesia; Meromax(Orion), Inj. , 500 mg/vial, Tk.
also reported convulsion, Steven- 654.41/Vial,; 1 gm/vial, Tk. 1208.07/Vial
Johnson syndrome and toxic epidermal Meronix(Novo Health), Inj. , 1gm/vial, Tk.
necrolysis; local reactions including pain 1300.00/Vial ,; 500 mg/vial, Tk. 700.00/Vial
and thrombophlebitis at injection site Meropen(Renata), Inj. , 1 gm/vial, Tk.
1300.00/Vial. ,; 250 mg/Vial, Tk. 400.00/Vial,;
Dose:By intravenous injection over 3 to 500 mg/vial, Tk. 700.00/Vial
5minutes or by intravenousinfusion over Merotrax(Ibn Sina), Inj. , 1gm/vial, Tk.
15 to 30minutes in a usual dose of 0.5 to 1300.00/Vial,; 500mg, Tk. 700.00/Vial
1g every 8 hours; dose may be doubled Neopenem(Healthcare), Inj, 1gm/vial, Tk.
in hospital-acquired pneumonia, 1350.00/Vial,; 250mg/vial , Tk. 450.00/Vial,;
peritonitis, septicemia and infections in 500mg/vial, Tk. 750.00/Vial
neutropenic patients. 2g every 8 hours Penomer(Beximco), Inj. , 500mg/vial, Tk.
700.00/Vial,; 1gm/vial, Tk. 1300.00/Vial
for meningitis; dose of up to2 g every Ronem(Opsonin), Inj. , 500 mg/vial , Tk.
8hours also been used in cystic fibrosis. 700.00/Vial,; 1 gm/vial, Tk. 1300.00/Vial
Dose should be reduced in patients with Ropenem(Drug Intl), Inj. , 1gm/vial, Tk.
renal impairment; CHILD over 3 months 1003.00/Vial,; 500mg, Tk. 503.15/Vial
of age and weighing less than of 50kg, Specbac(Square), Inj. , 1 gm/vial, Tk.
10-20mg/kg every 8 hours (not 1300.00/Vial. ; 250 mg/vial, Tk. 400.00/Vial;
recommended for infection in 500 mg/vial, Tk. 700.00/Vial
Merocil(Pharmacil), IV Inj.,1 gm/Vial, Tk.
neutropenia) 1594.78/Vial ; 500mg/Vial, Tk. 852.56/Vial
For meningitis, 2g every 8 hours; CHILD
3 months to 12 years 40mg/kg every 8
1.1.3.2 MONOBACTAM[W]
hours; over 50 kg body weight adult dose
Exacerbations of chronic lower
respiratory-tract infection in cystic AZTREONAM[W]
fibrosis, up to 2g every 8 hours; CHILD 4-
18 years 25-40mg/kg every 8 hours Indications: Gram negative infections
caused by Pseudomonas
Proprietary Preparations aeruginosa,Hemophilus influenzae,
Aronem(ACI), Inj. , 1gm, Tk. 1208.14/Vial,; Neisseria meningitides and N. gonorrhea
500mg, TK. 654.41/Vial Cautions: Hepatic impairment, breast-
Aropen(Aristo), Inj. , 1gm, Tk. 1200.00/Vial
feeding; penicillins- and/or
Betanem (Kemiko), Inj. , 1 gm/vial, Tk.
1250.00/Vial,; 500 mg/vial, Tk. 700.00/Vial
cephalosporins-allergic patients tolerate
Carbanem(Sanofi), Inj. , 1gm/vial, Tk. aztreonam without reaction
1303.91/Vial,; 500mg, Tk. 702.11/Vial Contra-indications: Aztreonam
Fulspec(Acme), Inj. , 250 mg/vial, Tk. hypersensitivity; pregnancy
400.00/Vial,; 1 gm/vial, Tk. 1208.15/Vial,; Interactions:See Appendix-2
500.00 mg/vial, Tk. 654.42/Vial Side-effects: Nausea, vomiting,
Intrapen(General), Inj., 1 gm/vial, Tk.
diarrhea, abdominal cramps, mouth
1303.90/Vial,; 500 mg, Tk. 702.11/Vial
I-Penam(Incepta), Inj. , 1gm/vial, Tk. ulcers, altered taste, jaundice and
1300.00/Vial ,; 500 mg, Tk. 700.00/Vial hepatitis, blood disorders including
Menem(Astra Bio), Inj. , 1 gm/vial, Tk. thrombocytopenia and neutropenia,
1300.00/Vial,; 500 mg/vial, Tk. 700.00/Vial urticaria and rashes
Mepen(Biopharma), Inj. , 1gm/vial, Tk. Dose:Deep IM or slow IV inj. over at
1200.00/Vial,; 500mg/vial , Tk. 650.00/Vial least 2-4 minutes or IV infusion: 1 g every
Merobac(Popular), Inj. , 1gm/vial, Tk.
8 hours for mild to moderate infections;
1204.53/Vial,; 750 mg, Tk. 652.45/Vial
Merocar(Globe), Inj. , 1 gm/vial, Tk.
increased to 2 g every 6-8 hours for
1200.00/Vial,; 500 mg, Tk. 650.00/Vial severe infections; CHILD > 1 week, IV inj.
or infusion: 30 mg/kg every 6-8 hours,
28
1. ANTI-INFECTIVES
increased for severe infections in child > essential (if given, serum concentration
2 years, to 50 mg/kg every 6-8 hours up must be monitored).
to a max. of 8 g/day; for urinary tract Side-effects: All aminoglycosides are
infections, 0.5-1 g 8-12 hourly; for ototoxic and nephrotoxic. Ototoxicity is
gonorrhea or cystitis, 1 g by IM inj. as a largely irreversible Concurrent use of
single dose frusemide, ethacrynic acidpotentiates
ototoxicity. Cochlear toxicity initiates as a
Proprietary Preparations high-pitched tinnitus followed by auditory
Atreon(Square), Inj., 500 mg/Vial, Tk. impairment. Vestibular toxicity starts as
300/Vial;2 gm/Vial, Tk. 650/Vial;1 gm/vial, Tk. moderately intense headache which is
450/Vial rapidly followed by an acute stage of
Azonam(Incepta), Inj., 1 gm/Vial, Tk. 400/Vial
nausea, vomiting and difficulty with
equilibrium. All aminoglycosides are
1.1.4. AMINOGLYCOSIDES[A] capable of affecting both cochlear and
(See also section 12 and 10) vestibular function. Tobramycin affects
both functions, whereas Amikacin,
These drugs are primarily active against Neomycin and kanamycin primarily
aerobic, gram-negative bacilli. Because affect auditory function and streptomycin
of limited spectrum compared with other and gentamicin are primarily
aminoglycosides, Kanamycin and vestibulotoxic. Nephrotoxicity of
Streptomycin are not recommended for aminoglycosides is almost always
infections caused by P. aeruginosa and reversible and starts as a defect in renal
Serratia. Streptomycin is active against concentrating ability, mild proteinuria and
Mycobacterium tuberculosis, for which it appearance of hyaline and granular casts
is now entirely reserved. Gentamicin in urine. Most common significant finding
and Tobramycin exhibit similar activity is mild rise in serum creatinine. The most
but against P. aeruginosa and some important result of nephrotoxicity is the
strains of Proteus species Tobramycin is reduced excretion of drug which, in turn,
considered to be superior. predisposes to ototoxicity. Other
Aminoglycosides have limited activity potentially nephrotoxic drugs such as
against gram-positive bacteria. S. aureus Amphotericin B, Vancomycin,
and Strep. viridans appear to be sensitive Cisplatin, Cyclosporine, Cephalothin
while other gram-positive organisms and aggravate aminoglycosides induced
anaerobes are resistant. nephrotoxicity. In very high doses, these
Cautions:Patients with renal impairment drugs can produce curare-like
may require earlier and more frequent neuromuscular blockade and may cause
concentration measurement. Patients respiratory paralysis.
with creatinine clearance value less than
80-100 ml/min. needs dose adjustment. AMIKACIN[A] [C]
Monitoring for ototoxicity by careful
audiometric examination also is required
Indications: Preferred choice for initial
in patients receiving high dosed and/or
treatment of serious nosocomial gram-
prolonged courses of aminogly-
negative bacillary infections resistant to
cosides.Cautions are also required in
gentamicin and tobramycin; also see
pregnancy and in nursing mothers.
under Gentamicin
Use of aminoglycosides in second and
third trimesters of pregnancy carries the
effects:See notes above
risk of auditory or vestibular nerve
Dose:IM or slow IV inj. or IV infusion, 15
damage. Streptomycin has the
mg/kg daily divided doses every 12 hours
greatestrisk and with Gentamicin and
Tobramycin the risk is probably very
small but should not be used unless Amibac(Popular), Inj., 100 mg/2 ml, Tk.
16.06/2 ml,; 500 mg/2ml, Tk. 48.18/2 ml
29
1. ANTI-INFECTIVES
Amikin(Incepta), Inj., 100 mg/2 ml, Tk. Gentabac(Popular), Inj., 80 mg /2 ml, Tk.
16.00/2m l,500 mg/2 ml, Tk. 48.00/2 ml 10.15/Amp; 20 mg /2 ml, Tk. 6.07/Amp
Amistar(Square), Inj.,100 mg/2 ml, Tk. Gentanix(Novo Health), Inj.,80 mg/2 ml, Tk.
16.05/2 ml, 500 mg/2 ml, Tk. 48.14/2 ml 10.00/Amp
Kacin(ACI), Inj., 100mg/2ml, Tk. 16.11/2 ml,; Gentin(Opsonin), Inj. 20 mg /2 ml, Tk. 6.08/ 2
500mg/2ml, Tk. 48.32/2ml ml /Amp,; Inj., 80 mg/2 ml, Tk. 14/2ml amp
Mikacin(Aristo), Inj., 500mg/2ml, Tk. 45.00/2 Intamycin (Incepta), Inj. , 80 mg/2 ml, Tk.
ml,; 100mg/2ml Tk. 15.00/2 ml 10.00/Amp., 20 mg /2 ml, Tk. 6.00/Amp
Psudonil(Drug Intl), Inj.,100mg/2ml, Tk. Optimycin (Aristo) Inj. , 80 mg/2 ml, Tk.
16.05/2 ml,; 250mg/2ml, Tk. 30.10/2 ml,; 14.00/Amp.
500mg/2ml, Tk. 45.15/2 ml Invigen (Beximco), Inj. (IV. infusion).
80mg/100ml
GENTAMICIN[ED] [A] Tk.47.22/100ml
G-Gentamycin(Gonoshasthaya) Inj. , 80
Indications: Urinary tract infections, mg/2 ml, Tk. 12.00/Amp.,
bacteremia, infected burns, osteomyelitis,
sepsis, pneumonia, peritonitis, biliary
tract infections, acute pyelonephritis or NEOMYCIN SULPHATE[ED] [A]
prostatitis, otitis, meningitis, ocular
infections caused by susceptible Indications: Bowel sterilization before
organisms (see notes above); with an surgery, with polymyxins for bladder
antipseudomonal penicillin for sepsis in irrigation to prevent bacteremia and
granulocytopenic patients, concurrently bacteriuria associated with the use of
with penicillin G for bacterial endocarditis indwelling catheters, infections
due to viridans streptococci or associated with burns, wounds, ulcers,
enterococci; in combination with nafcillin dermatoses caused by susceptible
in selected cases of staphylococcal organisms, as an adjunct to the therapy
endocarditis; in combination with a of hepatic coma
penicillin and/or metronidazole for Cautions:Too toxic for systemic use;
surgical chemoprophylaxis, and in because severe renal insufficiency may
undiagnosed serious infections develop in the late stages of hepatic
Cautions: See notes above coma, great cautions should be taken
Contra-indications: Myasthenia gravis; when neomycin is utilized as an adjunct
also see notes above and should be stopped if there is
Side-effects See notes above;also ototoxicity or evidence of renal injury;
hypomagnesaemia on prolonged therapy also see notes above
Dose:IM or slow IV inj. over at least 3 Contra-indications:Intestinal
minutes, initially 2 mg/kg, then 3-5 mg/kg obstruction; also see notes above
daily in divided doses every 8 hours, or Side-effects: See notes above; also
as once-daily dose by IV infusion, 5 increased salivation, stomatitis
mg/kg given over 30-60 minutes; CHILD Interactions: See Appendix-2
up to 2 weeks 3 mg/kg every 12 hours; 2 Dose:Oral: Preoperative bowel
weeks-12 years 2 mg/kg every 8 hours; sterilization, 1 g every 4 hours, for 2-3
by intrathecal inj.1-10 mg daily; ear and days; hepatic coma, up to 4 g daily in
eye infections, 3-4 drops 3-4 times daily divided doses usually for max.14 days
Note: one-hour (“peak”) concentration Side-effects: Increased salivation,
should not exceed 10 mg/litre (5 mg/litre stomatitis; see also under
in endocarditis); pre-dose (“trough”) Aminoglycosides
concentration should be less than 2
mg/litre (less than 1mg /litre in Proprietary Preparations
endocarditis) See section 12.2.&10.2.(for skin and eye
preparation)
Genacyn(Square), Inj., 80 mg /2 ml, Tk.
10.18/Amp; 20 mg /2 ml, Tk. 6.11/Amp
30
1. ANTI-INFECTIVES
[ED] [A]
STREPTOMYCIN
Indications: Tuberculosis in combination See section10.2.1(For Eye preparation
with other drugs; plague, tularemia, only)
adjunct to doxycycline in brucellosis,
enterococci endocarditis 1.1.5 MACROLIDES
effects: See notes above AZITHROMYCIN[W]
Dose:Deep IM inj. or IV inj. ADULT Indications:Same as that of
tuberculosis, 15 mg/kg/d, CHILD 20-40 Clarithromycin
mg/kg/d, not to exceed 1-1.5 g/d; for Cautions, Contra-indications, Side-
intermittent supervised therapy 1-1.5 g effects:See under Erythromycin;also
twice or thrice weekly; bacterial anorexia, dyspepsia, photosensitivity,
endocarditis, 0.5 g twice daily; the dose interstitial nephritis, acute renal failure,
is reduced in those under 50kg or those asthenia, paraesthesia, convulsions,
over 40 years or those with renal Stevens-Johnson syndrome, toxic
impairment epidermal necrolysis and taste
Note: one-hour (“peak”) concentration disturbances
should not exceed 40mg/litre; pre-dose Interactions: See Appendix -2
(“trough”) concentration should be less Dose: Oral &IV: ADULT should be given
than 5 mg/litre (less than 1 mg/litre in 1 hour before or 2 hours after meal when
renal impairment or in those over 50 administered orally, 500 mg on first day,
years of age) then 250 mg/d for days 2 through 5;
uncomplicated genital chlamydial
Generic Preparation infections and non-gonococcal urethritis:
Injection,1gm/vial 1 g as a single dose; M. avium-
intracellulare infection in AIDSpatients,
TOBRAMYCIN[A] for treatment 500 mg daily and for
prevention 1200 mg once weekly;CHILD
Indications: See under Gentamicin 10 mg/kg (max. 500 mg) on first day,
Cautions: See notes above; For then 5 mg/kg (max. 250 mg) for days 2
inhalation treatment: other inhaled drugs through 5
should be given before,
Contraindications, Side- effects: See Proprietary Preparations
notes above Acos(Radiant), Suspn., 200ml/5ml, Tk.
Interactions: See Appendix-2 175.53/30ml,; Tab.,500mg, Tk. 55.17/Tab.
Dose:IM or slow IV inj. over 3-5 minutes Adiz(Euro), Cap., 250 mg, Tk. 25.00/Cap. ,
500 mg, Tk. 35.00/Cap.
or IV infusion, 5-6 mg/kg daily in divided Asizith(Asiatic), Suspn., 200ml/5ml,, Tk.
doses every 8 hours; NEONATES 2 130.00/30ml,Tk. 85.00/15ml,; Tab., 250mg ,
mg/kg every 12 hours; CHILD > 1 week Tk. 20.00/Tab., 500mg , Tk. 35.00/Tab.
2-2.5 mg/kg every 8 hours; for chronic AZ(Aristo), Suspn., 200ml/5ml, Tk.
pulmonary Pseudomonas aeruginosa 100.00/15ml, Cap., 500mg , Tk. 35.00/Cap.;
infection in cystic fibrosis patients, by Tab. , 250mg , Tk. 25.00/Tab. ,500mg , Tk.
inhalation of nebulized solution, ADULT 35.00/Tab.
Azalid(Orion), Tab. ,500 mg, Tk. 35.11/Tab. ;
& CHILD over 6 years, 300 mg every 12 Cap., 500 mg, Tk. 25.00/Cap. ; Susp,
hours for 28 days, courses repeated after 200ml/5ml, Tk. 85.58/15ml,, Tk. 130.88/35ml
28-day interval Azaltic(Nipro JMI), Susp., 200mg/5ml , Tk.
Note: one-hour (“peak”) concentration 85.00/15ml; Tk. 130.39/35 ml; Tab., 500 mg,
should not exceed 10 mg/litre; pre-dose Tk. 35.00/Tab.
(“trough”) concentration should be less Azasite(Sharif), Suspn., 200 mg/5 ml, Tk.
than 2 mg/litre 85.26/20ml , Tk. 130.39/35ml , Tk. 185.56/50ml
,; Tab. 500 mg, Tk. 35.11/Tab.
31
1. ANTI-INFECTIVES
Azicin(Opsonin), Cap.,500 mg,Tk. 135.00/35ml , Tk. 90.00/15ml ,; Tk.

30.00/Cap.,250 mg ,Tk. 20.08/Cap. ; Suspn., 115.78/25ml,; Tab. , 500mg, Tk. 34.00/Tab.
200 mg /5 ml, Tk. 100.00/20 ml , Tk. 140.00/35 Maczith(Biopharma), Cap., 250mg, Tk.
ml ,; Tab. , 250 mg , Tk. 25.00/Tab., 500 mg, 25.00/Cap.; Suspn., 200gm/5ml, Tk.
Tk. 35.11/Tab.; Sachet1 gm, Tk. 80.00/sachet 160.00/35ml,Tk. 95.00/15ml,Tk.
Aziget(Getwell), Suspn, 200 mg/5 ml, Tk. 180.00/50ml,Tab., 500mg , Tk. 35.00/Tab.
140.00/35ml , Tk. 185.00/50ml , Tk. 85.00/15ml ,250mg Tk. 25.09/Tab.
, Tab., 500mg, Tk. 34.00/Tab.; Odaz(UniMed), Suspn, 200mg/5m, Tk.
Azikil(One Pharma), Suspn., 200 mg/5ml, Tk. 100.00/15ml,Tk. 150.00/30ml
100.00/20ml,Tk. 140.00/35ml, Tk. Odazyth(ACI), Inj.,500mg/vial. Tk. 251.69/vial,
185.00/50ml,Tab., 500 mg, Tk. 35.00/Tab. Suspn.,200mg/5ml, Tk.250.75/75ml ,Tk.
Azimex(Drug Intl), Suspn., 200mg/5ml, Tk. 186.26/50ml,Tk. 85.58/15ml , Tk. 130.88/30ml
130.45/30ml,Tk. 185.55/50ml, Tk. 90.30/15ml,; Tab., 500mg, Tk. 35.11/Tab. ; Cap., 250mg,
Tab., 250mg, Tk. 25.10/Tab. ;500mg, Tk. Tk. 25.08/Cap
35.15/Tab. Orgazith(Organic), Cap., 250 mg, Tk.
Azimon(Monico), Suspn., 200mg/5ml, Tk. 20.06/Cap.,Susp.,200 mg / 5ml,Tk. 85.26/20ml,
90.0015ml.; Tab., 500mg, Tk. 35.00/Tab. Tk. 130.39/35ml , Tk. 185.56/50ml,
Azin(Acme), Cap , 250.00 mg, Tk. 25.08/Cap.; Respazit(Somatec), Suspn., 200 mg / 5 ml, Tk.
Tab. , 500.00 mg, Tk. 35.11/Tab.;Suspn., 200 140.00/35ml,Tk. 185.00/50ml,; Cap., 250 mg,
mg/5ml,, Tk. 140.42/30ml,Tk. 185.56/50ml, Tk. Tk. 25.00/Cap.; Tab., 500 mg, Tk. 35.00/Tab.
95.29/15ml Romycin(Ibn Sina), Suspn., 200 mg / 5 ml, Tk.
Azinaaf(Naafco), Suspn., 200mg/5ml, Tk. 140.00/35ml,Tk. 190.00/50ml,Tk.
130.00/35ml,; Tab.,500 mg, 33.00/Tab. 90.00/15ml,;Cap., 500mgTk. 35.00/Cap.; Tab.,
Azithral(Globex), Tab., 500mg,Tk. 12.00/Tab.; 250mgTk. 2500/Tab.
Cap, 250 mg, Tk. 20.00/Cap. Rozith(Healthcare), Inj.,, 500 mg/vial,, Tk.
Azithro(Astra Bio), Tab. ,250 mg, Tk. 460.00/Ivial.; Suspn.,200mg /5ml ,Tk. 95.00/
20.00/Tab. ; 500 mg, Tk. 15ml, Tk. 185.00/50ml.; Tab., 250mg , Tk.
30.00/Tab.,Tk.35.00/Tab .; Suspn., 200 mg/5 25.00/Tab.,500mg , Tk. 35.00/Tab.
ml, Tk. 140.00/25ml SB-Azit(Sunman-Bardem), Tab., 500 mg, Tk.
Azithrocin(Beximco), Inj., 500 mg/vial,. 35.00/Tab.
460.00/vial ; Suspn., 200mg / 5ml, Tk. Simpli(Beacon), Inj.,, 500 mg/vial, Tk.
185.00/50,Tk. 85.00/15ml,Tk. 130.00/30mlTab., 461.38/vial. ;Suspn., 200 mg / 5 ml,Tk.
250mg , Tk. 25.00/Tab., 500mg, Tk. 85.57/20ml; Tab, 500mg , Tk. 35.11/Tab.
30.00/Tab.; Cap., 250mg , Tk. 25.00/Cap Telide(Team), Suspn., 200mg/5ml, Tk.
Azithrogen(Biogen), Tab.,500mg, Tk. 135.00/35ml, Tk. 180.00/50ml, Tk. 83.00/15ml
30.00/Tab. ,:Tab., 500 mg, Tk. 33.00/Tab.
Azithromax(Ziska), Suspn., 200 mg/5 ml, Tk. Thromax(Novo Health), Suspn., 200mg/5ml
130.00/35ml,Tk. 185.00/50ml, Tk. 85.00/15ml,; Tk. 120.00/25ml,; Tab., 250 mg, Tk.
Tab. , 500 mg, Tk. 300.00/Tab. 20.00/Tab.; 500 mg, Tk. 35.00/Tab.
Azix(Amico), Suspn., 200gm/5ml, TK. 85.00/ Virzith(Virgo), Suspn., 200mg/5ml, Tk.
15ml ,; Tab., 500mg, TK. 30.00 /Tab. 130.00/30ml, Tk. 180.00/50ml,Tk. 90.00/15ml,;
Azmin(Modern), Suspn., 200gm/5ml Tk. Tab. , 500mg, Tk. 36.00/Tab.
130.00/35ml,Tk. 85.00/15ml,Tab., 524.05 mg , Xolide(Radiant), Cap. , 250mg , Tk.
Tk. 35.00/Tab. 27.08/Cap. ; 500mg , Tk . 40.12/Cap.
Azomac(General), Pead. drop,Tk. 85.57/15ml Zemycin(GACO), Suspn., 200mg/5ml, Tk.
,; Susp., 200gm/5ml,, Tk. 100.30/20ml,Tk. 85.26/15 ml,Tk. 128.00/35 ml,Tk. 172.00/50
185.55/50ml,; Tk. 130.88/35ml, Tk. ml,; Tab., 500 mg, Tk. 30.09/Tab.
140.43/35ml,Tab., 500mg, Tk. 35.00/Tab. Zenicin(Zenith), Suspn., 200mg/5ml, Tk.
Azro(Nipa), Suspn, 200 mg/5ml, Tk. 126.00/30ml, Tk. 180.00/50ml, Tk.
85.00/15ml,Tk. 130.00/30ml, Tk. 180.00/50ml, 80.00/15ml,Tab., 500 mg , Tk. 30.00/Tab.
Tab., 500 mg, Tk. 30.00/Tab. Zibac(Popular), Tab. , 500mg, Tk. 35.00/Tab.;
Curazith(Sanofi), Suspn., 200gm/5ml, Tk. 250mg, Tk. 20.08/Tab.,Inj.,, 500 mg/vial, Tk.
85.26/15ml,Tab., 500mg,Tk. 35.11/Tab.; 250.94/vial, ; Suspn., 200mg/5ml, Tk.
250mg, Tk. 20.06/Tab. 100.00/20ml,
Demacro(Decent), Suspn., 200gm/5ml,, Tk. Zimax(Square), Suspn., 200mg/5ml, Tk.
85.00/15ml,; Tab., 500mg, Tk. 30.00/Tab. 85.58/15ml,; Tab. , 500 mg, Tk. 35.11/Tab.;
Macazi(Pacific), Tab., 500 mg, Tk. 35.00/Tab. 500 mg, Tk. 35.11/Tab.; Cap. , 250 mg, Tk.
;Suspn.,200mg/5ml, Tk. 118.00/35ml , Tk. 25.08/Cap. ; Inj., 500 mg/vial, Tk. 461.38/vial
64.00/15ml Zinex(Alco), Suspn., 200 mg / 5ml, Tk.
Macrozith(Silva), Cap., 250mg, Tk. 130.39/30ml ; Tk. 185.56/50ml , Tk.
20.08/Cap. ; Suspn., 200gm/5ml Tk. 85.26/15ml ;Tab., 250 mg, Tk. 20.06/Tab.;
500 mg, Tk. 35.00/Tab.
32
1. ANTI-INFECTIVES
Zita(Kemiko), Suspn., 200 mg / 5 ml, Tk. proximal vein, 500 mg twice daily, CHILD
130.39/30ml , Tk. 185.56/50ml , Tk. 85.26/15ml not recommended.
,Tab., 500 mg, Tk. 35.00/Tab.
Zithracin(Supreme), Tab., 500mg, Tk.
35.00/Tab.; Suspn., 200 mg / 5 ml, Tk.
85.25/15ml , Claricin(Acme), Tab. , 250 mg., Tk.
Zithrin(Renata), Cap., 250mg , Tk. 25.17/Tab.; 500 mg., Tk. 40.27/Tab.; Suspn.,
20.00/Cap.; Suspn., 200 mg / 5 ml, Tk. 125 mg/5 ml, Tk. 395.00/60ml
Clarin(Drug Intl), Tab., 250mg, Tk. 25.10/Tab.;
125.00/30ml,Tk. 130.00/35ml,Tk.
500mg, Tk. 40.15/Tab.
80.30/15ml,Tk. 85.32/20ml,Tk.
Clarith(Ibn Sina), Suspn., 125 mg/5 ml, Tk.
185.00/50ml,:Tab., 250mg , Tk. 25.00/Tab.,
350.00/70ml,; Tab., 250 mg, Tk. 30.00/Tab.
500mg, Tk. 35.00/Tab.; Inj.,, 500 mg/vial, Tk.
460.00/vial. Clarox(Renata), Tab. 250mg, Tk. 25.00/Tab.;
500mg Tk. 40.00/Tab.
Zithrox(Eskayef), Suspn., 200 mg / 5 ml, Tk.
96.00/15ml,Tk. 90.00/20ml,Tk. Klabex(Opsonin), Tab. , 500 mg , Tk.
40.00/Tab.
186.00/50ml,130.00/30ml,Tk. 140.00/35ml;
Klabid(UniMed), Tab , 250mg, Tk. 30.00/Tab.;
Tab, 250mg , Tk. 25.00/Tab.; 500mg, Tk.
35.00/Tab.; Suspn., 200 mg / 5 ml,Tk. 500mg, Tk. 50.00/Tab.; ER Tab., 500 mg, Tk.
140.00/35ml,; Tk. 186.00/50ml,; 65.00/Tab.
Zycin(Globe), Suspn., 200 mg/5 ml, Tk. Klaricid(I)(Abbott), Inj.500mg/vial Tk.623.73
130.00/30ml,; Tk. 185.00/50ml, 85.00/15ml,; Klarix(Incepta), Suspn, 125 mg/5 ml, Tk.
340.00/60ml,; Tab., 250mgTk. 25.00/Tab.,
Tab. , 500 mg, Tk. 35.00/Tab
500mg Tk. 40.00/Tab.
Macrobid(General), Tab. , 500mg, Tk.
CLARITHROMYCIN[W] 50.34/Tab.
Remac(Square), Suspn.,125 mg/5 ml, Tk.
Indications: Eradication of H. pylori, first- 395/60ml,;Tab 500 mg, Tk. 40.27/Tab.
line therapy for prophylaxis and treatment
of disseminated infection caused by M. ERYTHROMYCIN[ED] [W]
avium-intracellulare in AIDS patients and
for treatment of pulmonary infections in Indications: Mycoplasma pneumonia
non-HIV-infected patients, toxoplasmosis infections, campylobacter enteritis, first
encephalitis; also see under line drug for chlamydial urogenital
Erythromycin infections in pregnant women, chlamydial
Cautions: See under Erythromycin; dose pneumonia, diphtheria, pertussis,
reduction required in renal impairment legionnaires’ disease, acne vulgaris
Contra-indications:See under (topical erythromycin preparations are
Erythromycin used to treat acne); effective alternative
Interactions: See Appendix-2 to penicillins in hypersensitive patients for
Side-effects: See under Erythromycin, pharyngitis, scarlet fever, erysipelas and
also reported headache, taste cellulitis due to S. pyogenes, for tetanus
disturbances, tooth and tongue and for prophylaxis against recurrences
discoloration, stomatitis, glossitis, of rheumatic fever
hepatitis and Stevens-Johnson Cautions: Hepatic and renal impairment;
syndrome; on IV infusion, local concomitant therapy with pimozide or
tenderness, phlebitis; less commonly , terfenadine should be avoided; porphyria;
arthralgia and myalgia; rarely tinnitus; in patients with a predisposition to QT
very rarely, dizziness, insomnia, interval prolongation; small amount
nightmare, paraesthesia, convulsions, secreted into breast milk, potential
hypoglycemia, renal failure problems for nursing infant: modification
Dose: Oral : ADULT & CHILD > 12 of bowel flora,
years, 250 mg every 12 hours, increased Contra-indications: Liver disease
in severe infections to 500 mg every 12 hypersensitivity
hours; CHILD < 12 years, 7.5 mg/kg Interactions: See Appendix-2
twice daily; by IV infusion into larger Side-effects: Nausea, vomiting,
abdominal discomfort, diarrhea, antibiotic
33
1. ANTI-INFECTIVES
associated colitis, hypersensitivity Erymex(Ibn Sina), Suspn, 125 mg/5 ml, Tk.
reactions including urticaria, rashes, 84.50/100ml,; Tab.,500mg, Tk. 10.25/Tab.
cholestatic jaundice and other reactions, Erythin(ACI), Suspn., 125 mg /5 ml, Tk.
60.41/60ml,Tk. 61.47/100ml.;Tab., 500mg, Tk.
reversible hearing loss after large doses, 8.06/Tab.
chest pain and arrhythmias including Ertyhrox(Renata), Suspn., 125 mg /5 ml, Tk.
prolongation of QT interval and 69.32/100ml,; Tab. , 250 mg, Tk.
ventricular tachycardia 5.15/Tab., 500 mg, Tk. 10.30/Tab.
Dose Oral ADULT & CHILD > 8 years, Eryzen(Zenith), Suspn., 125 mg /5 ml, Tk.
250-500 mg every 6 hours or 0.5-1 g 57.02/100ml,; Tab., 250 mg, Tk. 4.38/Tab.,500
every 12 hours, up to 4 g daily in severe mg, Tk. 8.66/Tab.
Etrocin(Beximco), Suspn., 125 mg /5 ml, Tk.
infections; CHILD up to 2 years, 125 mg 84.75/100ml,; Tab., 500mg, Tk. 9.03/Tab.
every 6 hours, 2-8 years, 250 mg every 6 Firmac(Incepta), Suspn., 125 mg /5 ml, Tk.
hours, doses doubled for severe 60.00/100ml
infections; early syphilis, 500 mg 4 times Mac(Orion), Suspn., 125 mg /5 ml, Tk.
daily for 14 days; uncomplicated genital 60.46/100ml,Tk. 103.71/100ml,Tk. 74.49/70ml
chlamydia, non-gonococcal urethritis, Macas(Asiatic), Suspn., 125 mg /5 ml, Tk.
500 mg twice daily for 14 days; by 56.85/100ml,; Tab., 500mg , Tk. 8.12/Tab.
Macery(Pacific), Suspn., 125 mg /5 ml, Tk.
IVinfusion: ADULT & CHILD in severe 46.00/100ml .; Tab., 250 mg, Tk. 5.00/Tab.,500
infections, 50 mg/kg daily by continuous mg, Tk. 10.00/Tab.
infusion or in divided doses every 6 Macro(Astra Bio), Suspn., 125 mg /5 ml, Tk.
hours; for mild infections when oral 60.00/100ml
therapy not possible, 25 mg/kg daily Priocin(Eskayef), Suspn., 125 mg/5 ml , Tk.
61.42/100ml.; Tab., 500mg , Tk. 7.00/Tab.
Proprietary Preparations Throcin(Globe), Tab. , 500 mg, Tk. 8.00/Tab.;
Acryth(Monico), Suspn., 125 mg /5 ml, Tk. Suspn., 125 mg /5 ml, Tk. 56.00/100 ml
60.00/100ml G-Erythromycin(Gonoshasthaya), Tab., 500
mg, Tk.15.00/Tab.
Adethro(Supreme), Suspn., 125 mg /5 ml, Tk.
Ero(Hudson), Susp., 125mg/5ml, Tk.60.00/100
60.00/100ml,; Tab., 500gm, Tk. 8.00/Tab.
ml
A-Mycin(Aristo), Paed. drops, 50 mg/1.25 ml,
Tk. 60.00/25ml,; Suspn., 125 mg /5 ml, Tk. Erocin(Acme), Susp., 125 mg/5 ml, Tk.
84.75/100ml,; 125 mg /5 ml, Tk. 69.32/100 ml ; Tab., 250 mg, Tk. 5.16/Tab.
100.00/50ml,Tab., 250mg , Tk. 5.15/Tab. ; ;500 mg, Tk. 10.32/Tab.
500mg , Tk. 9.00/Tab. Erom(Kemiko), Susp., 125 mg/5 ml, Tk.
Azmin(Modern), Tab., 500 mg, Tk. 35.00/Tab.; 60/100 ml ;Tab., 250 mg, Tk. 4.85/Tab. ; 500
Suspn., 250 mg /5 ml, Tk. mg, Tk. 8.60/Tab.
Eromac(General), Susp.,125 mg/5 ml,Tk.
130.00/35mi.,Tk.85.00/15ml
61.23/100 ml
Erixin(Amico), Suspn., 125 mg /5 ml, TK.
Eryrox DS(Navana), Susp, 125 mg/5 ml, Tk.
60.00/100ml
Ermac(Opsonin), Suspn., 125 mg /5 ml, Tk. 60.22/100 ml
84.74/100 ml Erythromycin DS(Albion), Susp., 125 mg/5 ml,
Tk. 60.00/100 ml; DSTab., 500 mg, Tk.
Eromycin(Square), Paed. drops, 200 mg/5 ml,
7.50/Tab.
Tk. 60.4/60ml,; Suspn., 125 mg /5 ml, Tk.
Macrocin(Sanofi), Tab., 250 mg, Tk. 4.88/Tab.;
69.53/100ml,; Tab. , 250 mg, Tk. 5.18/Tab.500
mg, Tk. 10.35/Tab. Tab., 500 mg, Tk. 8.66/Tab.; Susp., 125 mg/5
Eronix(Ziska), Suspn., 125 mg /5 ml, Tk. ml, Tk. 61.00/100 ml ;
60.00/100ml
Erosa(Biopharma), Suspn., 125 mg /5 ml, Tk. ROXITHROMYCIN[W]
67.00/100ml,; Tab., 250mg , Tk. 4.52/Tab.;
500mg , Tk. 8.03/Tab.
Indications: As for erythromycin
Erosite(Sharif), Suspn., 125 mg /5 ml, Tk.
69.32/100ml Cautions: As for erythromycin
Errin(Radiant), Suspn., 125 mg /5 ml, Tk. Interactions: See Appendix -2
60.18/100 ml Contra indication: Liver disease
Ery(Alco), Suspn., 125 mg /5 ml, Tk. Side-effects: Gastrointestinal distur-
69.53/100ml,; Tab., 250 mg, Tk. 5.17/Tab. bances, Increase in liver enzyme values
; 500 mg, Tk. 10.33/Tab. and hepatitis; rashes and other
Erybac(Drug Intl), Suspn., 125 mg /5 ml, Tk.
hypersensitivity reactions; headache,
60.20/100 ml,; Tab., 250mg, Tk.
4.05/Tab.;500mg, Tk. 8.05/Tab.
34
1. ANTI-INFECTIVES
dizziness, weakness, reversible 1.1.6 TETRACYCLINES[A]

pancreatitis, eosinophilia (See also section 12.2,10)
Dose:By mouth, ADULT 150mg twice
daily, or sometimes 300mg once daily, They are broad-spectrum bacteriostatic
before meals, in the treatment of antibiotics with activity against wide
susceptible infections. CHILD up to 40kg range of aerobic and anaerobic gram-
bodyweight, a dose of 5-8mg per kg daily positive and gram-negative bacteria,
before meals may be used rickettsiae, chlamydia, legionella,
mycoplasma, atypical mycobacteria, and
Proprietary Preparations spirochaetes and against some protozoa.
A-Rox(Ambee), Susp., 50 mg/5 ml, Tk. But their use has decreased because of
45.17/50ml; Tab., 150 mg, Tk. 6.53/Tab; 300
mg, Tk. 11.04/Tab
increasing emergence of resistance. In
Pedilid(Incepta), Susp., 50mg/5 ml, Tk. general, they are more active against
50.00/50 ml; Tab., 150 mg, Tk. 7.00/Tab.; 300 gram-positive than gram-negative
mg, Tk. 14.00/Tab. organisms.
Rocky(Amico ), Susp., 50 mg/5 ml , Tk. These drugs distribute widely into
40.00/50 ml; Tab. 150 mg, Tk. 7.00/Tab.; 300 prostate, bone marrow, bone, dentine,
mg, Tk. 12.00/Tab. enamel of unerupted teeth and
Rolid(Globe), Tab., 300 mg, Tk. 14.00/Tab;
150 mg, Tk. 7.00/Tab.; Susp., 50 mg/5 ml, Tk.
reticuloendothelial cells of liver.
45.00/50 ml Penetration into CSF, synovial fluid,
Rotomycin(Kemiko), Tab. , 300 mg, Tk. mucosa of maxillary sinus, and fetal
14.00/Tab. circulation is excellent. Relatively high
Roxcin(Alco), Tab. , 150 mg, Tk. 7.00/Tab. ; concentrations also are found in breast
300 mg, Tk. 14.00/Tab.; Susp., 50 mg/5 ml Tk. milk. Primary route of elimination of these
50.00/50 ml drugs except that of doxycycline, is the
Ryth(Navana), Tab., 150 mg, Tk. 7.03/Tab.;
300 mg, Tk. 14.05/Tab.;Susp., 50 mg/5 ml ,
kidney.
Tk. 50.19/50 ml;Tk. 100.38/100 ml Cautions: Gastrointestinal distress,
nausea and vomiting can be minimized
by giving these drugs with food but
SPIRAMYCIN[W]
should not be ingested with dairy
products, antacids containing Calcium,
Spiramycin is a macrolide antibiotic with Aluminum, Zinc, Magnesium or
actions similar to those of erythromycin. Silicate, Vitamins with iron, Sucralfate,
Indications: Respiratory tract infections, Bismuth subsalicylate,
genital infections, skin and soft tissue Cholestyramine and Colestipol;
infections caused by streptococci, unused supplies of these antibiotics
pneumococci and meningococci, should be discarded.
diphtheria, prophylaxis of fetus against Contra-indications: Preganant patients
transmission of maternal toxoplasmosis and to patients with renal insufficiency
in pregnancy (doxycycline may be given). Neither they
Caution: Breast-feeding are recommended for lactating mother
Contra-indications: known hypersen- and for treatment of common infections in
sitivity to macrolides children under the age of 8 years.
Side-effects: Nausea, vomiting, Side-effects: Epigastric burning and
diarrhea, allergic skin reactions distress, abdominal discomfort, nausea,
Dose: Oral: ADULTS 6 to 9 million vomiting and diarrhea may occur.
IU/day in 2 to 3 divided doses. CHILD Esophagitis, esophageal ulcers and
weighing more than 20kg, 0.15 million IU pancreatitis have been reported.
per kg body weight per day, to be divided Photosensitivity particularly with
into 2 to 3 doses. demeclocycline and doxycycline also is
seen. Children may develop permanent
Proprietary Preparation brown discoloration of teeth. This risk is
Rovamycin(Sanofi),Tab.,Tk.20.00/Tab.
highest when tetracycline is given to
35
1. ANTI-INFECTIVES
neonates, babies prior to first dentition Impedox(ACI), Cap, 100mg, Tk. 2.17/Cap.
and to pregnant mothers. Fanconi Monadox(Amico), Cap., 100 mg, Tk. 2.50/Cap.
syndrome, has been Therapy with Oriodox(Orion), Cap., 100 mg, Tk. 2.12/Cap.
Unidox(Globe), Cap., 100 mg, Tk. 2.50/Cap.
tetracyclines may lead to the
superinfections that result in intestinal
functional disturbances, anal pruritus, OXYTETRACYCLINE[ED] [A]
vaginal or oral candidiasis or enterocolitis
with shock and death. Indications: See under Tetracycline
Pseudomembranous colitis due to an Cautions: See notes above; also
overgrowth of toxin producing C. difficile porphyria
is particularly relevant. Contra-indications, Side-effects:See
notes above
DOXYCYCLINE[ED] [A] Dose: Oral: 250-500 mg every 6 hours;
acne, 500 mg twice daily for 4-6 months,
up to 2 years or longer in severe cases
Indications: Chronic prostatitis, sinusitis,
malaria treatment and prophylaxis, pelvic
inflammatory disease (with metroni- Oxecylin(Acme), Cap., 250 mg, Tk. 2/Cap.
dazole); brucellosis (with rifampicin), Renamycin(Renata), Cap., 250mg,Tk. 2/Cap.
adjunct to gingival scaling and root Teramycin(Ziska), Tab. , 500 mg, Tk. 3/Tab.
planning for periodonititis; also see under
tetracycline (except eye infections) TETRACYCLINE[ED] [A]
Cautions, Contra-indications: See
notes above
Indications:Mycoplasma pneumonia,
chlamydial pneumonia,
Side-effects: See notes above; also
lymphogranuloma venereum, trachoma,
vestibular reactions including anorexia,
rickettsial infections (epidemic typhus,
dizziness, tinnitus and vertigo
Dose :Oral : 200 mg on first day, then scrub typhus, rickettsial pox, Q fever),
uncomplicated gonococcal infections,
100 mg daily; severe infections including
syphilis, brucellosis, exacerbations of
refractory urinary tract infections, 200 mg
daily; early syphilis, 200 mg daily in 1-2 chronic bronchitis, acne, actinomycosis,
lyme disease, tularemia, cholera, eye
divided doses for 14 days; late latent
infections (conjunctivitis, blepharitis)
syphilis, 100-200 mg twice daily for 28
days; uncomplicated genital chlamydia, Cautions, Contra-indications: See
notes above; also hepatic impairment
non-gonococcal urethritis, 100 mg twice
Side-effects: See notesabove
daily for 7 days; by IV infusion: 200 mg in
one or two infusions on first day followed Interactions: See Appendix-2
Dose:Oral: 250 mg every 6 hours for
by 100-200 mg on subsequent days
mild to moderate infections, increased in
Proprietary Preparations severe infections to 500 mg every 6-8
Asidox(Asiatic), Cap., 100mg, Tk. 2/Cap. hours; primary, secondary, or early latent
Dopac(Pacific), Cap., 100 mg, Tk. 2/Cap. syphilis, 500 mg every 6 hours for 14
Dox P(Astra Bio), Cap., 100mg,Tk.2/Cap. days; non-gonococcal urethritis, 500 mg
Doxicap(Renata), Cap. , 100 mg, Tk. every 6 hours for 7-14 days (21 days if
2.20/Cap. ; 50 mg, Tk. 1.42/Cap. failure or relapse after first course); acne,
Doxicline(Ziska), Cap.,100 mg, Tk.2.00/Cap. 500 mg twice daily for 4-6 months, up to
Doxico(Supreme), Cap.,100mg, Tk.2.15/Cap.
2 years or longer in severe cases;
Doxigen(General),Cap.,100 mg, Tk.2.16/Cap.
Doxin(Opsonin), Cap. , 100 mg, Tk. topical: 1% solution, 2-4 drops 4-6 hourly,
2.21/Cap.; 50 mg, Tk. 1.43/Cap. every hourly in severe cases
Doxizen(Zenith), Cap., 100 mg, Tk. 2.16/Cap.
Doxy(Acme), Cap. , 100 mg, Tk. 2.20/Cap. Proprietary Preparations
Doxycycline(Popular), Cap., 100 mg, Tk. Tetclin(Pacific), Cap. , 250 mg, Tk. 1.00/Cap.
2.00/Cap. Tetramycin(Asiatic), Cap., 250mg, Tk.
Doxysina(Ibn Sina), Cap., 100 mg, Tk. 1.30/Cap.
2.03/Cap.
36
1. ANTI-INFECTIVES
Tetrasina(Ibn Sina), Cap. , 250mg, Tk. are contra-indicated in patients with

1.75/Cap. ; 500 mg, Tk. 3.30/Cap. history of tendon disorders related to
Tetrax(Square), Cap., 500 mg, Tk. 2.29/Cap. quinolones. In presence of epilepsy and
Titacin(Supreme),Cap, 500mg, Tk. 2.00/Cap.;
Tab., 250 mg, Tk. 1.30/ Tab
myasthenia gravis cautious
A-Tetra(Acme),Tab.,500 mg, Tk. administration is required. These drugs
2.29/Tab.;Cap., 500mg, Tk. 2.03/Cap. should be withdrawn if psychiatric,
G-Tetracycline(Gonoshasthaya), Cap., 250 neurological, tendinitis or hypersensitivity
mg, Tk.1.00/Cap.; reactions occur.
Jmycin(Jayson), Cap., 250 mg, Tk. 1.31/Cap. Side-effects: Gastrointestinal upset in
Monatrex(Amico), Cap., 250 mg, Tk. the form of mild nausea, vomiting, and/or
1.20/Cap.; DS Cap., 500 mg, Tk. 2.00/Cap.
Tetracycline-H(Hudson), Cap. 250 mg, Tk.
abdominal discomfort, rarely diarrhea
1.00/Cap. and antibiotic-associated colitis. Central
nervous system side effects including
1.1.7.1. QUINOLONES AND headache, dizziness have been reported,
FLUOROQUINOLONES(See photosensitivity with lomefloxacin and
section 10.2,11.1) pefloxacin. Reversible arthopathy and
joint swelling have developed in children
receiving fluoroquinolones. Tendinitis, a
The older agents are 4-quinolones rare complication seen in adults. Risk of
(Nalidixic acid, Cinoxacin) with retinal detachment.
narrower spectrum of antimicrobial
activity and the newer drugs are
fluorinated analogs with broad spectrum CIPROFLOXACIN[ED] [A*][W]
of activity and much wider tissue
distribution.The quinolones are effective Indications: Urinary tract infections,
against enteric gram-negative bacilli; P. pseudomonal lower respiratory infections
aeruginosa is resistant. Fluorinated except pneumococcal pneumonia,
analogs have greatly improved enteric fever, shigellosis, gonorrhea,
antibacterial activity against many gram- chancroid, prostatitis, septicemia, bone,
positive and gram-negative organisms. joints and soft tissue infections, traveler's
Fluoroquinolones also are active against diarrhea, superficial bacterial infections of
agents of atypical pneumonia like eye caused by sensitive organisms,
mycoplasmas, Chlamydia and second line drug for legionellosis, with an
intracellular pathogens, such as anti-anaerobic (clindamycin or
legionella and some mycobacteria. metronidazole) for pelvic inflammatory
Resistance to one fluoroquinolone disease, part of multidrug therapy for
usually confers cross-resistance to all multidrug-resistant tuberculosis, with
other members of this class. amoxicillin-clavulanate as an oral empiric
Cautions and Contra-indications: Dose therapy for fever in low-risk patients with
adjustment in patients with creatinine granulocytopenia secondary to cancer
clearance less than 50 ml/min. is chemotherapy, eradication of
required for cinoxacin, norfloxacin, meningococci from carriers, surgical
ciprofloxacin, ofloxacin, enoxacin and prophylaxis and prophylaxis of infection
lomefloxacin but not for nalidixic acid, in neutropenic patients
trovafloxacin and pefloxacin. Cautions Cautions and Contra-indications:
are required in pregnancy, nursing Excessive alkalinity of urine should be
mother and the non-renally cleared avoided, adequate fluid intake required to
fluoroquinolones in patients with hepatic avoid crystalluria, performance of skilled
failure. These drugs are not generally tasks like driving may be impaired
recommended for use in prepubertal (effects enhanced by alcohol); also see
children, although in some cases the notes above
benefits may outweigh the risks and Side-effects: See notes above; also
requires careful assessment. Quinolones flatulence, dysphagia, hyperglycemia,
alerted prothrombin concentration,
37
1. ANTI-INFECTIVES
vasculitis, erythema nodosum, petechiae, Cilocin(Pacific), Suspn, 250mg/5ml, Tk.

hemorrhagic bullae, tinnitus, 100.00/60ml,; Tab., 500 mg, Tk. 12.00/Tab. ,;
tenosynovitis, tachycardia, edema, 500 mg, Tk. 8.00/Tab.
CIP(Asiatic), Tab., 500mg , Tk. 14.00/Tab.,
syncope, hot flushes and sweating; pain 750mg , Tk. 18.00/Tab.
and phlebitis at injection site Cipcin(Biopharma), Inj.,(IV.Infusion),
Interactions: See Appendix-2 0.20%,, Tk. 140.00/100ml,; Suspn, 250 mg/5
Dose: Oral: Urinary-tract infections, 250- ml, Tk. 100.00/60ml,; Tab., 750 mg , Tk.
500 mg twice daily; 100 mg twice daily 18.07/Tab., 250 mg , Tk. 8.53/Tab., 500 mg ,
for 3 days in acute uncomplicated cystitis Tk. 15.06/Tab.
in women; chronic prostatitis, 500 mg Ciprin(Nipa), Tab. , 500 mg, Tk. 12.00/Tab.
Cipro(Acme), Inj.,(IV.Infusion), 0.20%,,, Tk.
twice daily for 28 days; gonorrhea, 500 146.94/100ml,; Suspn, 250 mg/5 ml, Tk.
mg as a single dose; pseudomonal lower 100.30/60ml,; Tab, 250 mg., Tk. 8.56/Tab.;
respiratory-tract infection in cystic 500.00 mg , Tk. 14.06/Tab.; 750 mg, Tk.
fibrosis, 750 mg twice daily; most other 18.11/Tab
infections, 500-750 mg twice daily; Ciprobey(Sharif), Suspn, 250 mg/5 ml, Tk.
surgical prophylaxis, 750 mg 60-90 90.28/60ml,; Tab., 500 mg, Tk. 14.04/Tab.
minutes before procedure; CHILD (not Ciprocin(Square), Inj.,(IV.Infusion), , 0.20%,,
Tk. 146/100ml,; Suspn, 250 mg/5 ml, Tk.
recommended but where benefit 100.3/60ml,; Tab, 250 mg, Tk. 8.56/Tab.; 500
outweighs risk), 5-17 years, up to 20 mg, Tk. 15.05/Tab.; 750 mg, Tk. 18.12/Tab.
mg/kg twice daily, max. 1.5 g daily; IV Cipronaaf(Naafco), Tab. , 500 mg, Tk.
infusion, over 30-60 minutes; 200-400 14.00/Tab.
mg twice daily; pseudomonal lower Cipronil(Silva), Suspn, 250 mg/5 ml, Tk.
respiratory tract infection in cystic 95.00/60ml,; Tab., 500mg, Tk. 14.05/Tab.
fibrosis, 400 mg twice daily; CHILD 5-17 Ciprox(Opsonin), Suspn, 125 mg/5 ml, Tk.
90.34/60 ml; 250 mg/5 ml, Tk. 100.00/60ml,;
years, up to 10 mg/kg 3 times daily, max. Tab.XR,1 gm , Tk. 20.14/Tab.,; 250 mg , Tk.
1.2 g daily; urinary-tract infections, 100 8.53/Tab.; 500 mg , Tk. 15.05/Tab.; 750 mg ,
mg twice daily; gonorrhea, 100 mg as a Tk. 18.13/Tab.
single dose; Ciproxy (Opso Saline), Inj., (IV Infusion),
IV infusion: over 30-60 minutes, 200– 0.20%,Tk. 52.83/100 ml
400mg twice daily. Ciprozen(Zenith), Suspn, 250 mg/5 ml, Tk.
75.25/60ml,;Tab., 250 mg, Tk. 8.03/Tab.; 500
mg, Tk. 14.06/Tab.
Proprietary Preparations Ciprozid(Drug Intl), Suspn, 250mg/5ml, Tk.
Adecin(Supreme), Suspn, 250 mg/5 ml, Tk.
90.30/60ml,; Tab., 250mg, Tk. 8.05/Tab.;
90.25/100ml,; Tab. , 500 mg, Tk. 14.00/Tab. 500mg, Tk. 15.05/Tab.; 1000mg, Tk.
Amiflox(Amico), Tab., 250 mg, Tk. 6.00/Tab.;
20.10/Tab.; 750mg, Tk. 16.05/Tab.
Tab., 500 mg, TK. 14.00/Tab.; Suspn, 250
Cipwell(Getwell), Suspn, 250 mg/5 ml, Tk.
mg/5 ml, TK. 85.00/60ml
95.00/60ml,; Tab., 500mg, Tk. 14.00/Tab.
Ancipro(UniMed), Tab , 250mg, Tk. 8.50/Tab. Civox(Popular), Tab. , 500mg, Tk. 14.05/Tab.;
, 500mg, Tk. 14.00/Tab. ; 750mg, Tk. Inj.,(IV.Infusion), , 0.20%,, Tk.
18.00/Tab. 100.38/100ml,; Suspn, 250 mg/5 ml, Tk.
Aprocin(Aristo), Suspn.,250mg/5ml,Tk. 90.34/60 ml,; Tk. 90.34/60 ml
100/60ml; Tab., 500mg , Tk. 14.00/Tab. ;
Dumaflox(Alco), Suspn, 250 mg/5 ml, Tk.
750mg , Tk. 18.00/Tab.
100.00/60ml,; Tab., 250 mg, Tk. 7.52/Tab.;
Bactin(Ibn Sina), Inj.,(IV.Infusion), 0.20%,, 500 mg, Tk. 10.03/Tab. ; 750 mg, Tk.
Tk. 145.00/100ml,; Suspn, 250 mg/5 ml, Tk.
12.04/Tab.
110.00/60ml,; Tab.,250 mg, Tk. 8.54/Tab. ;
Fiprox(Sanofi), Tab. , 500mg, Tk. 14.09/Tab.
500 mg, Tk. 15.00/Tab. ; 750 mg, Tk.
Flontin(Renata), Inj.,(IV.Infusion), 0.20%,,
18.06/Tab.
Tk. 145.54/100ml,; Suspn, 250 mg/5 ml, Tk.
Beuflox(Incepta), Inj.,(IV.Infusion), , 0.20%,,,
100.00/60ml; 250 mg, Tk. 8.53/Tab.; 750 mg,
Tk. 47.85/100ml,; Tab., 250 mg, Tk. 8.00/Tab. Tk. 18.06/Tab.; 500 mg, Tk. 15.00/Tab.
,250 mg, Tk. 8.50/Tab.; 500 mg, Tk. Floxabid(ACI), Inj.,(IV.Infusion), , 0.20%, Tk.
15.00/Tab.; 750 mg, Tk. 18.00/Tab.; Suspn, 146.44/100ml; Tab., 100mg, Tk. 20.13/Tab.;
250 mg/5 ml , Tk. 100.00/60ml,; 250mg, Tk. 8.56/Tab.; 500mg, Tk. 15.05/Tab.;
Cero(G.A.Co), Tab., 500 mg, Tk. 14.05/Tab.
750mg, Tk. 18.12/Tab.; Suspn, 250 mg/5 ml,
Cibact(Euro), Suspn, 250 mg/5 ml, Tk.
Tk. 100.30/60ml
100.00/60ml,; Tab., 500 mg, Tk. 14.00/Tab.
Floxy(Team), Tab., 500 mg, Tk. 13.00/Tab.
Ciflocin(Astra Bio), Tab. , 500 mg, Tk.
12.00/Tab.;
38
1. ANTI-INFECTIVES
Geflox(General), Inj.,(IV.Infusion), , 0.20%, history of prolongation of the QT interval,

Tk. 70.21/100ml,; Suspn, 250 mg/5 ml, Tk. patients with uncorrected electrolyte
100.00/60ml,; Tab., 500mg , Tk. 14.09/Tab.; disorders, and patients receiving Class IA
250mg, Tk. 8.52/Tab.
Glaxipro(GSK), Tab. , 500 mg, Tk. 15.00/Tab
or III antiarrhythmic agents;safety and
Kapron(Globe), Inj.,(IV.Infusion), , 0.20%,Tk. efficacy has not been evaluated in
90.00/100ml; Suspn, 250 mg/5 ml, Tk. pregnant or lactating women or in
90.00/60ml,; Tab., 250 mg, Tk. 8.00/Tab.; 500 individuals <18 years of age
mg, Tk. 15.00/Tab.; 750 mg, Tk. 18.00/Tab.; Side-effects: See notes above
Libracin(Libra ), Inj.,(IV.Infusion), , 0.20%,, Interactions: See Appendix-2
Tk. 70.48/100ml Dose: Oral: Treatment of mild-to-
Maprocin(Orion), Suspn, 250 mg/5 ml, Tk.
90.61/60ml,; Tab., 500 mg, Tk. 15.00/Tab.;
moderate Cap, 320 mg once daily for 7
750mg, Tk. 18.16/Tab. days
Monipro(Monico), Suspn, 250 mg/5 ml, Tk. Note: For patients with creatinine
90.00/60ml; Tab., 500mg, Tk. 14.00/Tab. clearance <40 mL/min, the dose should
Neofloxin(Beximco), Inj.,(IV.Infusion), , be adjusted to 160 mg daily.
0.20%,,, Tk. 146.50/100ml,; Suspn, 250 mg/5 Gemifloxacin can be taken with or
ml, 100.0027/60ml,; sachet.,Tk. without food and should be swallowed
11.9966/Schet,; 250 mg/5 ml, Tk. Tab.,
250mg, Tk. 8.50/Tab.; 500mg, Tk. 15.00/Tab.;
whole with a liberal amount of liquid.
750mg, Tk. 18.00/Tab.
Ocimax(One Pharma), Suspn, 250 mg/5ml, Proprietary Preparations
Tk.99.99/60ml,; Tab., 500 mg, Tk. 13.99/Tab. Asiflocin(Asiatic), Tab., 320 mg, Tk.
Orcipro(Organic),Tab., 500 mg,Tk. 14.05/Tab 65.00/Tab.
Procin(Kemiko), Suspn, 250 mg/5 ml, Tk. Facticin(Square), Tab., 320 mg, Tk.
90.27/60ml,; Tab., 250 mg, Tk. 8.52/Tab.; 500 65.19/Tab.
mg, Tk. 14.05/Tab.; 750 mg, Tk. 18.00/Tab. Factiq(Monico), Tab., 320 mg, Tk. 65.00/Tab.
Q-Nol(Decent), Tab., 500mg, Tk. 11.00/Tab. Flogem(Opsonin), Tab., 320 mg, Tk.
Quinox(Eskayef), Suspn, 250 mg/5 ml, Tk. 65.25/Tab.
100.00/100ml,; Tab, 500 ng, Tk. 15.00/Tab.; Gefcin(Biopharma), Tab., 320 mg, Tk.
250mg, Tk. 8.50/Tab.; 750mg , Tk. 18.00/Tab 65.20/Tab.
Quintor(Ziska), Suspn, 250 mg/5 ml, Tk. Geloxin(Euro), Tab., 320 mg, Tk. 65.00/Tab.
60.00/60ml,; 500 mg, Tk. 10.00/Tab. Gemicin(Healthcare), Cap, 320 mg, Tk.
Rocipro(Healthcare), Tab., 500mg, Tk. 65.00/Cap.
14.00/Tab. Gemif(Beacon), Tab., 320 mg, Tk. 65.20/Tab.
Tyflox(Somatec), Suspn, 250 mg/5 ml, Tk. Gemiflox(Popular), Tab., 320 mg, Tk.
100.00/60ml; Tab., 500 mg, Tk. 14.00/Tab. 65.25/Tab.
Virflox(Virgo), Suspn, 250 mg/5 ml, Tk. Geminox(Eskayef), Tab., 320 mg, Tk.
90.00/60ml; Tab., 500 mg, Tk. 700.00/Tab. 65.00/Tab.; 320 mg, Tk. 65.00/Tab.
Winbac(Radiant), Tab. , 500mg, Tk. Gemitab(Ibn Sina), Tab. ,320 mg, Tk.
16.05/Tab. 350.00/Tab.
Xbac(Beacon), Inj.,(IV.Infusion), 200 mg/100 Geoflox(Sharif), Tab., 320 mg, Tk. 65.19/Tab.
ml, Tk. 145.99/Infusion,; Suspn, 250 mg/5 ml, Kmi(kemiko), Tab., 320 mg, Tk. 65.00/Tab.
Tk. 90.60/60ml,; Tab., 500mg , Tk. 14.09/Tab.; Orasquin(Incepta), Tab. , 320 mg, Tk.
750mg , Tk. 18.11/Tab. 65.00/Tab.
Xirocip(Novo Healthcare), IVInfusion,0.2%, Tk. Toplon(Renata), Tab., 320 mg, Tk. 65.00/Tab.
70.00/100ml,; 0.4%, Tk. 120.00/100ml; Suspn, Xemi(Orion), Tab., 320 mg, Tk. 50.15/Tab.
250 mg/5 ml, Tk. 90.00/60ml; Tab., 1000 mg,
Tk. 25.00/Tab.; 500 mg, Tk. 14.00/Tab. LEVOFLOXACIN[W]
GEMIFLOXACIN[W] Indications: See under dose

Cautions: See notes above; renal
Indications:Treatment of community- impairment; may impair performance of
acquired pneumonia (CAP) due to skilled tasks, history of psychiatric illness
multidrug-resistant Streptococcus Interactions : See Appendix-2
pneumoniae Side-effects: See notes above; also
Cautions and Contra-indications: asthenia, anxiety, tachycardia,
Should be avoided in patients with a hypotension, hypoglycemia, pneumonitis,
39
1. ANTI-INFECTIVES
local reactions and transient hypotension Levora(Somatec), Tab., 500 mg, Tk.
reported with infusion 14.05/Tab.
Dose:Oral :acute sinusitis, 500mg daily Levosina(Ibn Sina)Tab. ,500mg, Tk.
15.50/Tab.; 750 mg, Tk. 21.00/Tab.
for 10-14 days Levox(Opsonin), Suspn, 125 mg/5 ml, Tk.
Exacerbation of chronic bronchitis, 250- 75.28/100 ml; Tab., 250 mg, Tk. 8.03/Tab. ;
500mg daily for 7-10 days 750 mg , Tk. 20.08/Tab.; 500 mg , Tk.
Community-acquired pneumonia, 500mg 15.10/Tab.; Inj.,(IV.Infusion), 0.5%,
once or twice daily for 7-14 days Tk.100.38/100 ml;
Complicated UTIs, 250mg daily for 7-10 Levoxin(Incepta), Suspn., 125 mg/5 ml, Tk.
days 80.00/100ml,; Tab., 250 mg, Tk. 8.00/Tab.
; 500 mg, Tk. 15.00/Tab. ; 750 mg, Tk.
Skin and soft tissue infections, 250 mg 20.00/Tab. ; IV.Infusion 0.5%,,Tk.
daily or 500mg once or twice daily for 7- 100.00/100ml
14 daysby intravenous infusion (over at .Lexazen(Zenith), Tab. , 250 mg, Tk.
least 60 minutes for 500mg), community- 8.03/Tab.; 500 mg, Tk. 14.06/Tab.
acquired pneumonia, 500mg once or Lexvo(Modern), Tab. , 500 mg, Tk. 15.00/Tab.
twice daily Lezon(Euro), Tab., 500 mg, Tk. 15.00/Tab.
Complicated UTIs, 250mg daily, Lifcin(Biopharma), Inj.,(IV.Infusion),
0.5%,,Tk. 100.00/100ml,: Suspn., 125 mg/5 ml,
increased in severe infections Tk. 75.28/100ml,; Tab., 500 mg, Tk.
Skin and soft tissue infections, 500mg 15.06/Tab.
twice daily Lin(Kemiko), Tab., 250 mg, Tk. 10.00/Tab. ;
500 mg, Tk. 15.05/Tab.
Proprietary Preparations Livacin(G.A.Co), Tab., 500 mg, Tk.15.00/Tab.
Adelev(Supreme), Tab. , 250mg, Tk. Locin(Globe), Tab., 250 mg, Tk. 11.00/Tab. ;
8.00/Tab.; 500mg, Tk. 15.00/Tab. 500 mg, Tk. 14.00/Tab.
Asilee(Asiatic),Tab., 500mg , Tk. 15.00/Tab. Lovicin(Nipa), Tab., 500 mg , Tk. 15.00/Tab.
Corbic(Novo Health), Tab. , 500 mg, Tk. Orgalev, (Organic), Tab. , 500 mg, Tk.
15.00/Tab. 15.05/Tab.
Evo(Beximco), Inj.,(IV.Infusion), 0.5%, Tk. Orlev(Orion), Tab, 500 mg, Tk. 15.10/Tab.
100.00/100ml,; Tab., 500mg, Tk. 16.00/Tab.; Ovel(Aristo), Tab., 500mg, Tk. 15.00/Tab.
750mg, Tk. 20.00/Tab.; 250mg , Tk. 9.00/Tab. Quilev(Monico), Tab., 500mg, Tk. 15.00/Tab.
Flovo(Decent), Tab., 500mg, Tk. 15.00/Tab. Quixin(Beacon), Tab. , 500mg , Tk. 15.10/Tab.
Floxaget(Getwell), Tab. , 500mg, Tk. Resquin(Healthcare), Tab., 250mg , Tk.
15.00/Tab. 8.00/Tab.; 500mg, Tk.15.00/Tab.; 750mg, Tk.
Genolev(General), Tab., 250mg, Tk. 20.00/Tab.
8.05/Tab.; 500mg, Tk. 15.11/Tab. Trevox(Square), Suspn., 125 mg/5 ml, Tk.
Leflox(ACI), Tab., 500mg, Tk. 15.11/Tab. ; 80.24/100ml,; Inj.,(IV.Infusion), 0.5%,Tk.
750mg, Tk. 20.13/Tab. 100.3/100ml,; Tab. , 500 mg, Tk. 15.10/Tab. ;
Leo(Acme), Inj.,(IV.Infusion), 0.5%, Tk. 750 mg, Tk. 20.13/Tab.
100.30/100ml,; Tab. , 250.00 mg , Tk. Xenolev(Virgo), Tab. , 500mg , Tk. 15.00/Tab.
8.07/Tab. ; 500 mg, Tk. 15.10/Tab. ; 750 mg ,
Tk. 20.13/Tab. LOMEFLOXACIN HYDROCHLORIDE[W]
Leoflox(Alco), Tab. , 500 mg, Tk. 15.05/Tab. ;
250 mg, Tk. 7.02/Tab.
Levin(Amico), Tab., 500mg , TK. 14.00/Tab. Indications: See under Ciprofloxacin
Levo(Astra Bio), Tab. , 500 mg, Tk. 15.00/Tab. Cautions: See under Ciprofloxacin
Levobac(Popular), Tab. , 500 mg, Tk. Contra-indications: See under
15.06/Tab.; 750 mg, Tk. 20.08/Tab.; I Ciprofloxacin
Inj.,(IV.Infusion), 0.5%,, Tk. 100.38/100ml,; Side-effects: See notes above
Levoflox(Drug Intl), Tab., 500mg, Tk.
Dose:Oral: 400 mg once/twice daily;
15.05/Tab.; 750mg, Tk. 20.10/Tab.
Levoking(Renata), Tab. , 250 mg, Tk. topical for Eye infections: see under
8.03/Tab. ; 500 mg, Tk. 15.06/Tab. ; 750 mg, Ciprofloxacin
Tk. 20.07/Tab. Note. evening administration may
Levolo(Pacific), Tab., 500 mg, Tk. 15.00/Tab. minimize the phototoxicity reactions
Levomax(Eskayef), Suspn, 125 mg/5 ml, Tk.
90.00/5ml, 250mg/5ml, Tk. 130.00/5ml ; Tab, Proprietary Preparations
750mg , Tk. 20.00/Tab.; 500mg, Tk. Lomeflox(Aristo), Tab., 400mg, Tk. 15/Tab.
15.00/Tab.; 750mg, Tk. 20.00/Tab.; Mexlo(Square), Tab., 400 mg, Tk. 15.10/Tab.
Levonix(Ziska), Tab. , 500 mg, Tk. 14.00/Tab. Omeflox(ACI)Tab., 400 mg, Tk. 15.11/Tab.
40
1. ANTI-INFECTIVES
MOXIFLOXACIN [W] [C] 2 weeks, false positive urinary glucose

test
Indications: Sinusitis, community- Side-effects:See notes above; also
acquired pneumonia, complicated skin reported weakness, increased
and soft-tissue infections not responding intracranial pressure, cranial nerve palsy,
to other antibacterials toxic psychosis, metabolic acidosis
Cautions: See notes above; also Dose:oral: 1 g every 6 hours for 7 days,
conditions predisposing to arrhythmias reduced to 500 mg every 6 hours in
including myocardial ischemia chronic therapy; CHILD > 3 months max.
Contra-indications: See notes 50 mg/kg daily in divided doses, reduced
above;also electrolyte disturbances, in prolonged therapy to 30 mg/kg daily
heart failure with reduced left ventricular
ejection fraction Proprietary Preparations
Dixicon(Jayson), Susp., 300 mg/5 ml, Tk.
30.45/50 ml
Side effect: See notes above;; also Nalid(Square), Susp., 300 mg/5 ml, Tk.
flatulence, gastritis; amnesia; very rarely, 41.74/50 ml; Tab. 500 mg, Tk. 4.87/Tab.
rhabdomyolysis, potentially life- Naligram(Acme), Susp., 300 mg/5 ml, Tk.
threatening hepatic failure 41.73/50 ml; 300 mg/5 ml, Tk. 86.10/100
Dose: Oral, IV infusion, over 60 minutes, ml;Tab., 500 mg, Tk.4.87/Tab.
400mg once daily Nalidex (Ambee), Susp., 300mg/5ml, Tk.
30.46/50 ml; Tab., 500 mg, Tk. 4.07/Tab.
Cubimox(Acme), Tab. , 400 mg, Tk. OFLOXACIN[W]
40.00/Tab
Flomox(Opso Saline), Inj.(IV Infusion), 400 Indications:See under Ciprofloxacin
mg/250 ml, Tk. 90.23/250 ml Cautions:See under Ciprofloxacin
Iventi(Square), Inj.(IV Infusion), 400
mg/250ml, Tk. 350/250ml Vial,; Tab. , 400 mg,
Contra-indications: See under
Tk. 40.00/Tab. Ciprofloxacin
Lomeflox (Aristo), Tab., 400 mg, Interactions:See Appendix-2
Tk.15.00/Tab. Side-effects:See notes above; also eye
Maxiflox(ACI), Tab., 400 mg, Tk. 40.00/Tab. irritation; hot flushes; change in blood
Mexlo (Square), Tk. 70.21/5ml,; Tab. , 400 mg sugar; myopathy, rhabdomyolysis
, Tk. 15.10/Tab. Dose:Oral: for mild to moderate
Moxibac(Popular), Inj.(IV Infusion), 400
mg/250ml, Tk. 350.00/250 ml Vial,; Tab. ,
infections, 200-400 mg twice daily for 7-
400mg, Tk. 70.00/Tab. 10 days, may be increased to 400-800
Moxiflox(Alco), Tab. , 400 mg, Tk. 50.15/Tab. mg twice daily in severe cases; for
Moxilocin(Opsonin), Tab. 400 mg, Tk.40/Tab. uncomplicated gonorrhea, 400 mg as a
Moxquin(Incepta), Tab. 400 mg, Tk. 40/Tab. single dose; for PID & chronic prostatitis
Omeflox(ACI), Tab., 400 mg, Tk. 15.11/Tab. therapy with ofloxacin needs to be
Optimox(Aristo), Tab., 400 mg, Tk. 40.00/Tab.; continued for 14 & 28 days respectively;
Respamox(Somatec), Tab. 400mg, Tk.
40.00/Tab.
IV infusion: over at least 30 minutes 200-
(For Eye preparation see section 10.2) 400 mg twice daily in mild to moderate
infections, for severe or complicated
infections, dose may be increased to 400
NALIDIXIC ACID[ED] [W]
mg twice daily
Indications: urinary tract infections, Proprietary Preparations
shigellosis Flocet(Opsonin), Tab. , 200 mg, Tk.
Cautions & Contra-indications:See 12.05/Tab.; 400 mg, Tk. 22.08/Tab.;
notes above; also porphyria; monitoring Inj.(IVInfusion)0.2%, Tk. 120.37/100ml
of blood count, renal and hepatic Oflacin(Drug Intl), Tab., 200mg, Tk.
functions required if given for more than 12.05/Tab.; 400mg, Tk. 20.10/Tab.
Rutix(Square), Tab. , 200 mg, Tk. 12.09/Tab. ;
400 mg, Tk. 22.14/Tab.
41
1. ANTI-INFECTIVES
Cautions: All sulfonamides and their

PEFLOXACIN MESYLATE[W] derivatives, including carbonic anhydrase
inhibitors, thiazides, frusemide,
Indications: See under Ciprofloxacin bumetanide, torsemide, diazoxide, and
Cautions, Contra-indications:See sulfonylurea hypoglycemic drugs, are
under Ciprofloxacin; also hepatic cross-allergic. Plenty of fluid is to be
impairment taken and monitoring of blood count is
Side-effects: See notes above; required in prolonged therapy. Hepatic
Dose:Oral & IV infusion 400 mg twice function monitoring also is required in
daily AIDS patients receiving co-trimoxazole.
Interactions: See Appendix -2 Dose adjustment is needed in renal
insufficiency and therapy with
Proprietary Preparations sulfonamides and/or trimethoprim in
Nobac(Ibn Sina), Tab., 400mg, Tk.12/Tab. pregnancy and in breast-feeding requires
Peflox(Drug Intl), Tab., 400mg, Tk.11.05/Tab. careful assessment of risks in the baby.
Sulfonamides and cotrimoxazole are not
SPARFLOXACIN[W] recommended for use in infants below 6
weeks except for treatment or
Indications: See under Ciprofloxacin; prophylaxis of pneumocystis pneumonia.
also for respiratory infections caused by Side-effects: Fever, skin rashes,
S. pneumonia exfoliative dermatitis, photosensitivity,
Cautions, Contra-indications:See urticaria, nausea, vomiting, diarrhea,
under Ciprofloxacin; also hepatic crystalluria, various types of nephrosis
impairment and allergic nephritis. Stevens-Johnson
Interactions:See Appendix-2 syndrome and toxic epidermal necrolysis,
Side-effects: See notes above;also although rare, is a particularly serious
cardiac rhythm disturbances and and potentially fatal type of reaction
prolongation of QT interval are in reports associated with use of sulfonamides.
Dose: Oral 200-400 mg once daily Hemolytic anemia, particularly in
glucose-6-phosphate-dehydrogenase
Proprietary Preparations deficient patients, aplastic anemia,
Aciflox(ACI), Tab., 200mg, TK. 12.00/Tab. granulocytopenia, thrombocytopenia, or
Asaf(Asiatic), Tab., 200mg , Tk. 18.75/Tab. leukemoid reactions also are reported
Floxipar(Acme), Tab., 200.00 mg., Tk. after sulfonamides therapy; risk of
15.61/Tab. kernicterus in newborns if taken near the
Omniflox(Aristo), Tab., 200mg , Tk. 18/Tab. end of pregnancy.
Parlox(Eskayef), Tab., 200 mg, Tk. 15/Tab. Trimethoprim may produce megalo-
Quinoflox(Healthcare), Tab., 200mg, Tk.
150.00/Tab.
blastic anemia, leucopenia and
Saga(Square), Tab. , 200 mg, Tk. 15.05/Tab. granulocytopenia. Nausea and vomiting,
Salocin(Kemiko), Tab., 200 mg, Tk. 17/Tab. drug fever, vasculitis, renal damage and
Spar(Globe), Tab. , 200 mg, Tk. 20.00/Tab. central nervous system disturbances
Sparflox(Alco), Tab. , 200 mg, Tk. 16.05/Tab. occasionally occur.
Sparlin(Beximco),Tab.,200mg, Tk. 15.06/Tab.
Sparonex(Drug Intl), Tab., 200mg, Tk.
18.10/Tab.
CO-TRIMOXAZOLE[ED] [A]
1.1.8 SULPHONAMIDES Indications: Urinary tract infections,

ANDTRIMETHOPRIM [A] acute exacerbation of chronic bronchitis,
typhoid fever, shigellosis, pneumocystis
carinii pneumonia, acute otitis media in
A few of them are used topically such as
children, toxoplasmosis, nocardiasis
in eye infections and in infected wound
Cautions: Monitoring of blood counts is
and burn injury. In combination with
required in prolonged therapy; adequate
trimethoprim as Co-trimoxazole,
fluid intake is to be maintained; also see
notes above
42
1. ANTI-INFECTIVES
Contra-indication: Porphyria Tk.19.60/50ml; Tab., 400 mg + 80 mg, Tk.

Interactions: See Appendix-2 1.20/Tab.
Side-effects:See notes above; Megatrim(Beximco), Suspn., 200 mg+ 40 mg
/5 ml., Tk. 22.17/60ml,; Tab., 800mg + 160mg,
Dose Oral: ADULT 480-960 mg every 12 Tk. 2.65.00/Tab.
hours; CHILD 6 weeks-5 months 120 mg M-Trim(Modern), Suspn., 200 mg+ 40 mg /5
every 12 hours; 6 months-5 years 240 ml., Tk. 23.96/60ml,; Tab., 800 mg+160 mg. ,
mg every 12 hours; 6-12 years, 480 mg Tk. 2.65/Tab.
every 12 hours; Octrim(Orion), Suspn., 200 mg+ 40 mg /5 ml.,
By IV infusion: ADULT 960 mg every 12 Tk. 21.08/60ml
hours increased to 1.44 g every 12 hours Ptrim(Astra Bio), Suspn., 200 mg+ 40 mg /5
ml., Tk. 22.00/60ml,; Tab., 80 mg + 160 mg,
in severe infections; CHILD 36 mg/kg Tk. 2.50/Tab.
daily in 2 divided doses increased to 54 Septra(Asiatic), Suspn., 200 mg+ 40 mg /5 ml.,
mg/kg daily in severe infections; Tk., 21.57/60ml,; Tab., 400mg + 80mg , Tk.
pneumocystis carinii infections: for 1.49/Tab. ; 800mg+160mg, Tk. 2.03/Tab.
treatment oral or IV infusion, ADULT & Sinatrim(Ibn Sina), Suspn., 200 mg+ 40 mg /5
CHILD over 4 weeks 120 mg/kg daily in ml., Tk. 22.00/60ml,; Tab., 800mg + 160mg,
2-4 divided doses for 14 days, for Tk. 210.00/Tab.
Sulphatrim(Amico), Suspn., 200 mg+ 40 mg/5
prophylaxis: Oral: ADULT 960 mg once ml., TK. 22.10/60ml,; Tab., 400 mg + 80mg ,
daily or 960 mg on alternate days or 960 TK. 1.49/Tab. ; 800mg + 160mg , TK.
mg twice daily on alternate days; CHILD 2.50/Tab.; 100 mg + 20mg , TK. 0.58/Tab.
6 weeks-5 months 120 mg twice daily on Triprim(Supreme), Cap. , 400mg +80mg, Tk.
3 consecutive days or 7 days/week; 6 1.48/Cap. ; Suspn., 200 mg+ 40 mg /5 ml., Tk.
months-5 years 240 mg 6-12 years 480 21.00/60ml,; Tab., 800mg + 160mg , Tk.
mg 2.00/Tab.
Jasotrim(Jayson), Susp., 200 mg + 40 mg/5
ml , Tk. 21.61/60 ml; Tab., 400 mg + 80 mg,
Proprietary Preparations Tk. 1.49/Tab.
Actrim(Globe), Suspn., 200 mg+ 40 mg /5 ml.,
Tk.22.00/60ml
Actrim-DS(Globe),Tab., 800 mg + 160 mg, Tk. 1.1.9 METRONIDAZOLE, TINIDAZOLE
2.00/Tab. AND ORDINAZOLE
Alcot(Pacific), Suspn., 200 mg+ 40 mg /5 ml., See section 1.3.2
Tk. 20.00/60ml ,; Tab., 400 mg + 80 mg, Tk.
1.00/Tab. ; 400 mg + 80 mg, Tk. 2.00/Tab.
1.1.10ANTI-MYCOBACTERIAL DRUGS
Avlotrin(ACI), Suspn., 200 mg+ 40 mg /5 ml., 1.1.10.1 ANTI-TUBERCULOSIS DRUGS
TK. 22.21/60ml ,; Tab., 400mg +80mg , TK. 1.1.10.2ANTI-LEPROSY DRUGS
1.5/Tab. ; 800mg + 160mg , TK. 2.01/Tab.
Biotrim(Biopharma), Suspn., 200 mg+ 40 mg
/5 ml., Tk. 21.56/60ml,; Tab., 800mg + 160mg 1.1.10.1ANTI-TUBERCULOSIS DRUGS
, Tk. 2.01/Tab. FIRST LINE DRUGS
Cosat(Eskayef), Suspn., 200 mg+ 40 mg /5 ETHAMBUTOL HYDROCHLORIDE[ED]
ml., Tk. 22.07/60ml, Tab., 800 mg + 160 mg ,
Tk. 2.55/
Cotrazen(Zenith), Suspn., 200 mg+ 40 mg /5 Ethambutol is effective against most
ml., Tk. 21.36/60ml,; Tab., 400 mg + 80 mg, strains of M tuberculosis and M kansasii
Tk. 1.40/Tab.; 800 mg + 160 mg, Tk. 2.02/Tab. and good number of strains of M. avium
Cotrim(Square), Suspn., 200 mg+ 40 mg /5 complex. No other bacteria are sensitive
ml., Tk. 21.64/60ml,; Tab. , 400 mg + 80 mg, to ethambutol. Cleared by both renal and
Tk. 1.49/Tab. ,Tab, 800 mg + 160 mg, Tk.
2.04/Tab.
nonrenal routes, renal being more
Co-trimoxazole(Popular), Tab. , 400mg + prominent.
80mg , Tk. 1.48/Tab. Indications: Tuberculosis in combination
Cots (Opsonin), Suspn., 200 mg+40mg/5 ml., with other drug (see under chemotherapy
Tk. 22.14./60 ml for tuberculosis)
Gentrim(General), Tab. , 400mg + 80mg, Tk. Cautions: Dose reduction required in
1.49/Tab. renal impairment, also monitoring of
G-Cotrimoxazole(Gonoshasthaya), Susp, 200
mg+40 mg/5 ml, Tk. 28.00/100 ml;
plasma concentration if creatinine
43
1. ANTI-INFECTIVES
clearance less than 30 ml/min; tests of Contra-indications: Drug induced liver

visual acquity and red-green disease
discrimination prior to therapy and routine Interactions: See Appendix-2
ophthalmological monitoring during Side-effects: Rash, fever, jaundice,
therapy recommended, patients should peripheral neuritis leading to numbness,
be warned to report any visual change; tingling of the feet particularly in slow
cautions for elderly, young children and acetylators, diabetic, HIV infected and
pregnant patients malnourished or anemic patients; allergic
Contra-indications: Optic neuritis, poor reactions including hepatitis, skin
vision eruptions and morbilliform eruptions,
Interactions: See Appendix-2 maculopapular, purpuric and urticarial
Side-effects: Optic neuritis leading to rashes; hematological reactions like
loss of red/green discrimination ability, agranulocytosis, eosinophilia,
pruritus, joint pain, GIT upset, abdominal thrombocytopenia, hemolytic anemia;
pain, malaise, headache, dizziness, convulsions, insomnia, muscle twitching,
mental confusion, disorientation, ataxia, paraesthesia, stupor, toxic
hallucination; numbness and tingling of encephalopathy; optic neuritis and
fingers due to peripheral neuritis atrophy
infrequently; rarely anaphylaxis, Dose: Oral or IM inj: treatment and
thrombocytopenia and leucopenia prophylaxis, ADULT 300 mg once daily;
Dose: Oral: ADULT & CHILD > 12 years CHILD 10-20 mg/kg (max. 300 mg) once
15 mg/kg once daily; for recurrent cases, daily; for intermittent supervised therapy,
25 mg/kg/d for 60 days then 15 mg/kg/d; 10 mg/kg thrice or 15 mg twice weekly;
CHILD 6-12 years, 10-15 mg/kg/d; for pyridoxine, 15-50 mg/d particularly in
intermittent supervised therapy, ADULT high risk patients for peripheral
& CHILD > 12 years, 30 mg/kg thrice neuropathy
weekly or 50 mg/kg twice weekly (not
recommended for children under 5 years) Proprietary Preparations
Rifampicin + Isoniazid
Proprietary Preparations Rimactazid(Novartis), Tab. , 300 mg + 150
(For Combined Preparations of mg, Tk. 8.37/Tab. ;150 mg+ 75 mg, Tk.
4.00/Tab.;, 450 mg + 300 mg, Tk. 11.71/Tab.
Ethambutol, see under Isoniazid) Isoniazid + Thiacetazone
Rifampicin+Isoniazid+Pyrazinamide
ISONIAZID[ED]
Rifampicin+Isoniazid+Pyrazinamide+
Ethambutol HCl
Isoniazid is effective selectively against
Rimstar 4-FDC(Novartis), Tab. , 150 mg +75
M. tuberculosis and M. kansasii. Hepatic mg + 400 mg + 275 mg, Tk. 10.00/Tab.
clearance by genetically determined
acetylation is the principal mode of
RIFAMPICIN[ED]
isoniazid elimination.
Indications: Tuberculosis in combination
with other drug (see under Rifampicin exerts broad-spectrum
chemotherapy for tuberculosis) antibacterial effect and is effective
Cautions: Monthly evaluation of patients against most gram-positive as well as
for symptoms of hepatitis has been many gram-negative organisms. S.
advised, one-third to one-half of normal aureus, coagulase-negative
dose is recommended in moderate to staphylococci, E. coli, Pseudomonus,
severe hepatic insufficiency; other indole-positive and indole-negative
conditions that require cautious therapy Proteus, and Klebsiella, N. meningitidis,
with isoniazid are epilepsy, history of H. influenzae are particularly susceptible.
psychosis, alcohol dependence, Of the mycobacteria, M. tuberculosis, M.
malnutrition, diabetes mellitus, slow kansasii, M. scrofulaceum, M.
acetylator status, porphyria, pregnancy, intracellulare are sensitive, while M.
breast-feeding and HIV infection fortuitum is highly resistant.
44
1. ANTI-INFECTIVES
After absorption from gastrointestinal supervised therapy, 600 mg twice or

tract, it is eliminated rapidly in the bile thrice weekly;
and exhibits an entrohepatic recycling. Leprosy, supervised therapy of 600 mg
Rifampicin is a potent inducer of hepatic once in a month, 450 mg for patients
drug metabolizing enzymes and weighing less than 35 kg; Brucellosis,
eliminates principally in feces. legionnaires disease and serious
Indications: Treatment of tuberculosis in staphylococcal infections, in combination
combination with other drug (see under with other drugs, orally or by IV infusion,
chemotherapy for tuberculosis), an 0.6-1.2g daily in 2-4 divided dose
alternative to isoniazid as prophylactic in
close contacts to a case of isoniazid- Proprietary Preparations
resistant tuberculosis provided that the (For Combined Preparations of
index case is susceptible to this drug; Rifampicin, see under Isoniazid)
Leprosy, brucellosis, hemophilus
influenzae infection, legionnaires PYRAZINAMIDE[ED]
disease, prophylaxis of meningococcal
meningitis; in combination with This is an important front-line anti-
ceftriaxone or vancomycin for treatment tuberculosis drug and is used in
of meningitis caused by penicillin- combination with isoniazid and rifampicin
resistant strains of pneumococci, in in short-course, 6 months regimen as a
combined therapy against serious 'sterilizing' agent active against residual
staphylococcal infections such as intracellular organisms responsible for
osteomyelitis and prosthetic valve relapse. Pyrazinamide produces
endocarditis selective bactericidal effect against M.
Cautions: Patients with hepatic tuberculosis, but not effective against M.
impairment need hepatic function and bovis.
blood counts monitoring, alcoholism, The drug is taken up by macrophages
during concomitant use of oral and is converted to active pyrazinoic acid
contraceptives, patients should be by mycobacterial pyrazinamidase. The
advised to useadditional means of drug eliminates principally by renal route.
contraception, pregnancy, breast- Indications: Treatment of tuberculosis in
feeding, porphyria; patients should be combination with other drugsin
warned about harmless orange-red color combinationwith ciprofloxacin or ofloxacin
to urine, feces, saliva, sputum, tears, and as prophylactic in close contacts to a
sweat case of multidrug-resistant tuberculosis
Contra-indications: Jaundice, liver provided that the index case is
damage susceptible to these drugs
Interactions: See Appendix-2 Cautions: Hepatic insufficiency,
Side-effects: Gastrointestinal symptoms monitoring of liver function is advised;
including anorexia, nausea, vomiting, therapy should be stopped if there is
diarrhea; cholestatic jaundice and evidence of hepatotoxicity (elevation of
occasionally hepatitis; light-chain plasma alanine and aspartate
proteinuria commonly and acute renal aminotransferases are the earliest
failure rarely, thrombocytopenic purpura, features of drug hepatotoxicity); diabetes,
urticaria, rashes; a flu-like syndrome gout
characterized by fever, chills, myalgias, Contra-indications: Liver damage,
anemia, and sometimes associated with porphyria
acute tubular necrosis Interactions: See Appendix-2
Dose: Tuberculosis treatment and Side-effects: Most serious is the
prophylaxis, ADULT < 50 kg, 450 mg hepatotoxicity; liver tenderness,
once daily, 50 kg and over 600mg once hepatomegaly, jaundice and fulminating
daily or as 10 mg/kg/d; CHILD 10 mg/kg liver failure that can be fatal;
(max. 600 mg) daily; for intermittent hyperuricemia and gouty arthritis occur
45
1. ANTI-INFECTIVES
uniformly and not considered to be a Side-effects: Hearing loss, tinnitus,

reason to halt therapy; also anorexia, transient proteinuria, cylindruria,
nausea and vomiting, dysuria, occasional electrolyte disturbances and nitrogen
mild fever, malaise retention, severe renal failure,urticaria
Dose Oral: Treatment and prophylaxis, and rashes; leukocytosis or leucopenia
ADULT & CHILD 15-30 mg/kg daily as a rarely thrombocytopenia; change in liver
single dose, max. 2 g/d; for intermittent function tests, neuromuscular block after
supervised therapy, 35-40 mg/kg twice or large doses, pain and induration at
thrice weekly, max. 3 g/occasion injection site
Dose:Deep IM inj. 15-30 mg/kg/d or up
Proprietary Preparations to 1 g daily for 2-4 months then 1 g, 2-3
(For Combined Preparations of times weekly
Pyrazinamide, see under Isoniazid)
Generic Preparation
STREPTOMYCIN[ED] [C] Capsule, 250mg
See section 1.1.4
THIACETAZONE CYCLOSERINE
Thiacetazone is bacteriostatic against This drug is inhibitory to many gram-

many strains of M tuberculosis and M positive and gram-negative organisms
leprae. Thiacetazone containing but is used exclusively to treat
regimens are less effective than the tuberculosis caused by strains of M.
short-course regimens recommended by tuberculosis resistant to first-line drugs.
WHO, but are used with isoniazid in long- The drug has adequate oral
term regimens principally because of its bioavailability and achieves antibacterial
low cost. WHO does not recommend its concentrations in many tissues including
use in leprosy. central nervous system and CSF.
Dose:See standard treatment Indications: In combination with other,
Guidelines(Appendix-1) drugs, tuberculosis resistant to first-line
Cautions: Dose reduction is necessary
Generic Preparation in renal impairment; monitoring of blood
Isoniazid 300 mg + Thiacetazone 150 mg counts, renal and hepatic function;
Tablet pregnancy and breast-feeding;
neurological toxicities are common above
SECOND LINE ANTI-TUBERCULOSIS the dose of 0.75 g/d
DRUGS: Contra-indications: Severe renal
impairment, epilepsy, depression,
porphyria
AMIKACIN[C] Interactions: See Appendix-2
See under Aminoglycosides (Sec1.1.4. ) Side-effects: Most serious toxicities are
peripheral neuropathy and central
CAPREOMYCIN nervous system dysfunction including
headache, dizziness, vertigo,
Indications: In combination with other drowsiness, tremor, convulsions,
drugs for tuberculosis resistant to first- confusion, depression, and psychotic
line drugs reactions, (dose reduction & pyridoxine
Cautions: Renal, hepatic, or auditory 150 mg/d are recommended); rashes,
impairment, monitoring of renal, hepatic, allergic dermatitis megaloblastic anemia;
auditory, vestibular function and changes in liver function tests; heart
electrolytes are advised; pregnancy failure at high doses reported
(teratogenic in animals) and breast- Dose: Oral: Initially 250 mg every 12
feeding hours for 2 weeks, then increased to
Interactions: See Appendix-2 maximum 500 mg every 12 hours; CHILD
46
1. ANTI-INFECTIVES
initially 10 mg/kg daily adjusted according impairment); gastric ulcer; G6PD

to blood concentration and response deficiency; pregnancy, breast-feeding
Generic Preparation Side-effects: GI disturbances including
Capsule,250 mg nausea, vomiting, abdominal pain, gastric
irritation and ulcer; hypersensitivity
ETHIONAMIDE reactions including skin rashes, arthalgia,
lymphadenopathy, syndrome like
Ethionamide has selective infectious mononucleosis; hemolytic
antimycobacterial activity including M anemia
tuberculosis, M kansasii, M leprae and Dose: Oral tuberculosis: ADULT, 12 g
some strains of M avium complex. daily in 3 divided doses; ulcerative colitis:
Indications: In combination with other 2 g once daily
drugs for tuberculosis resistant to first-
line drugs or when first line drugs cannot RIFABUTIN
be given because of toxicity; alternative
to Clofazimine in regimens for leprosy It exerts antibacterial activity similar to
Cautions: Hepatic impairment (should that of rifampicin. It is both a substrate
not be used in severe impairment), and inducer of cytochrome P 450
monitoring of hepatic function before and enzymes.
during treatment; unsafe in porphyria; Indications: See under Dose
psychiatric disorders; monitoring of blood Cautions: See under rifampicin
glucose, thyroid function and of visual Contra-indications: jaundice, liver
acquity damage (not recommended for use in
Interactions: See Appendix-2 children)
Side-effects: GI disturbances, mental Interactions: See Appendix -2
disturbances including anxiety, Side-effects:Nausea, vomiting;
depression, psychotic disorders; leucopenia, thrombocytopenia, anemia,
headache, dizziness, postural raised liver enzymes, jaundice, uveitis
hypotension; hepatotoxicity; following high doses or administration
hypersensitivity reactions including with drugs which raise plasma
thrombocytopenia, purpura, alopecia, concentration; arthalgia, myalgia,
dermatitis influenzae-like syndrome, dyspnea; also
Dose: Oral resistant tuberculosis: hypersensitivity reactions including fever,
ADULT, 15-20 mg/kg daily (max. 1 g rash, eosinophilia, bronchospasm; urine,
daily); CHILD, 10-20 mg/kg (max. 750 saliva and other body secretions colored
mg) daily; in single or divided doses orange-red;
Dose: Oral: prophylaxis of
Generic Preparation mycobacterium avium complex infections
Tablet,250mg in HIV-infected patients, 300 mg daily as
a single dose; treatment of non-
PARA-AMINOSALICYLIC ACID tuberculous mycobacterial disease, in
combination with clarithromycin and
This is bacteriostatic against M ethambutol, 450-600 mg daily as a single
tuberculosis, while other mycobacteria dose;
are usually resistant. alternative to rifampicin for treatment of
Indications: in combination with other tuberculosis in HIV-infected patients (as it
drugs for tuberculosis resistant to first- as less interactions than rifampicin with
line drugs or when first line drugs cannot indinavir and nelfinavir), 150-450 mg
be given; ulcerative colitis daily as a single dose for at least 6
Cautions: Renal and hepatic impairment months; for preventive therapy of
(should not be used in severe tuberculosis, either alone, in a 6-month
regimen or with pyrazinamide in a 2-
47
1. ANTI-INFECTIVES
month regimen, 150-450 mg daily as a portion of drug is excreted in feces.

single dose; treatment of pulmonary Clofazimine is stored widely in
tuberculosis, 150-450 mg daily as a reticuloendothelial tissues and skin.
single dose for 6 months Indications: Leprosy in combination with
other drug, chronic skin ulcers (Buruli
Generic Preparation ulcer) produced by M. ulcerans,
Capsule, 150 mg prophylaxis against erythema nodosum
leprosum
CHEMOTHERAPY OF TUBERCULOSIS Cautions: Hepatic and renal impairment;
Mycobacteria are slowly growing pregnancy and breast-feeding; may
organisms, can remain dormant for long discolor soft lenses; best to avoid if
time and a substantial proportion reside persistent abdominal pain and diarrhea
within macrophages inaccessible to Interactions: See Appendix-2
many drugs and can rapidly develop Side-effects: Nausea, vomiting
resistance to any single drug. As such, (hospitalize if persistent), abdominal pain;
combinations of drugs are employed to headache; tiredness; brownish-black
overcome these obstacles and to prevent discoloration of lesions and skin including
emergence of resistance. Another areas exposed to light, reversible hair
problem, to prevent disease relapse, discoloration; dry skin; red discoloration
required therapy is of long duration which of feces, urine and other body fluids; also
most patients fail to comply. To rash; pruritus, acne-like eruptions,
overcome this problem, supervised short- anorexia, eosinophilic enteritis, bowel
course therapy with intermittent obstruction, dry eyes, dimmed vision,
administration of drugs has been macular and subepithelial corneal
formulated and adopted by many national pigmentation; elevated blood sugar,
anti-tuberculosis programmes. weight loss, spinal infarction,
Followings are recommended regimens lymphadenopathy
for treatment and prophylaxis of Dose: Oral: leprosy, 50-100 mg daily, in
tuberculosis: lepromatous lepra reactions, dose
increased to 300 mg daily for maximum
of 3 months
1.1.10.2 DRUGS FOR LEPROSY
(See Appendix-1c) Generic Preparation
Capsule, 50mg
Leprosy is a slowly progressive chronic
infectious granulomatous disease caused
DAPSONE[ED]
by Mycobacterium leprae affecting mostly
the skin and peripheral nerves resulting Like sulfonamides, it acts by inhibiting
in anaesthetic hypopigmented patches in microbial folate synthesis; well absorbed
skin, and sometimes trophic changes after oral administration and widely
producing deformities in certain other distributed throughout body fluids and
tissues notably oral/nasal mucosa, the tissues and tends to accumulate in skin,
eye, muscle and bone. Multidrug muscle, liver, and kidney. Dapsone is
treatment (MDT) for leprosy as principally cleared through kidney after
recommended by the Bangladesh acetylation.
National TB and Leprosy Control Indications: Leprosy, treatment and
Programme is shown in Appendix-1 prophylaxis of pneumocystis carinii
pneumonia, dermatitis herpetiformis
Cautions: Dose adjustment required in
CLOFAZIMINE[ED]
renal failure, cardiac or pulmonary
disease; anemia; hemolysis in G-6PD
Clofazimine is active against both deficient patients, during long-term
dapsone-sensitive and dapsone-resistant treatment, patients and their attendants
bacilli and against M. intracellulare. should be told how to recognize signs of
Variable absorption from gut and a major blood disorders; they should be advised
48
1. ANTI-INFECTIVES
to get admission into hospitals if gonorrhoea, Haemophilus ducreyi and

symptoms such as fever, sore throat, Chlamydia trachomatis; though AIDS
rash, mouth ulcers, purpura, bruising or caused by the human immunodeficiency
bleeding develop; breast-feeding, virus (HIV) is not yet a very common STD
pregnancy; best to avoid in porphyria; in Bangladesh, there are special reasons
Contraindications: Blood dyscrasia, for awareness against this new global
hypersensitivity to dapsone menace. Syphilis and gonorrhoea being
Interactions: See Appendix-2 the two most prevalent STDs, the drug
Side-effects: Dose-related and not treatments regimens for these two
common at dose used for leprosy, diseases are described.
hemolysis in G-6PD deficient patients,
methemoglobinemias rather common; 1.1.12 OTHER ANTIBACTERIALS
neuropathy, allergic dermatitis anorexia,
nausea, vomiting, pruritus, tachycardia,
CHLORAMPHENICOL[ED] [OTC] [A]
headache, insomnia, psychosis during
therapy of lepromatous leprosy; (See section 10.2 & 11.1.1)
erythema nodosum leprosum often
develops Chloramphenicol was found to have a
Dose: Oral: leprosy, 100 mg daily or 1-2 serious (often fatal) bone marrow
mg/kg daily, depression However, it is still the drug of
choice for enteric fever when other
Generic Preparation antibiotics are resistant. For H. influenzae
Tablet, 100mg infections, especially meningitis,
emergence of ampicillin resistant strains
led to a reappraisal of the use of
RIFAMPICIN[ED]
chloramphenicol.
see under Drugs for tuberculosis Indications: Severe rickettsial infections
such as typhus or rocky mountain fever
1.1.11 DRUGS USED IN SEXUALLY in children, alternative to a beta-lactam
TRANSMITTED DISEASES for bacterial meningitis due to penicillin-
resistant strain of pneumo- or meningo-
Sexually transmitted diseases (STDs) are coccus and in penicillin-allergic patients,
a group of communicable diseases that alternative to tetracyclines for acute and
are transmitted predominantly by sexual chronic brucellosis, eye and ear
contact and caused by a wide range of infections caused by susceptible
bacterial, viral, protozoal and fungal organisms
agents, and also by different Cautions: Dose must be reduced in
ectoparasites. hepatic impairment, in newborns less
The highest incidence of STDs is than a week old and in premature infants;
observed in 2024 years age group. repeated courses & prolonged treatment
Certain socio-demographic factors such are not recommended; periodic blood
as population explosion, rapid counts and monitoring of plasma
urbanization and industrialization, rural to concentration (in neonates) are required
urban migration, prostitution, broken Contra-indications: Pregnancy, breast-
homes, sexual disharmony, social feeding, porphyria
disruption and alcoholism undoubtedly Interactions: See Appendix-2
contribute towards the increase of STDs Side-effects: Blood dyscrasia such as
in a developing country like Bangladesh. leucopenia, thrombocytopenia, dose-
Over 20 pathogens have been found to related reversible suppression of red-cell
spread commonly by sexual contact. The production, idiosyncratic irreversible
most common of these pathogens with aplastic anemia; also peripheral neuritis,
usual clinical manifestations are optic neuritis; erythema multiforme;
Treponema pallidum, Neisseria nausea, vomiting, diarrhea, grey baby
49
1. ANTI-INFECTIVES
syndrome (abdominal distension, pallid 4 divided doses; severe infections, at

cyanosis, circulatory collapse) usually least 300 mg daily regardless of weight
after excessive doses in neonates with
immature hepatic function Proprietary Preparations
Dose: Oral IV inj. or infusion: ADULT & Anobac(Globe), Cap., 300 mg, Tk. 15.00/Cap.
CHILD, 50-100 mg/kg/d in 4 divided Asiclin(Asiatic), Cap., 150mg , Tk. 8.00/Cap.
doses; INFANTS < 2 weeks, 25 mg/kg/d ,300mg , Tk. 15.00/Cap.; Inj., 300mg /2ml, Tk.
39.00/2ml, 600mg/4ml, Tk. 69.00/4ml
in 4 divided doses; topical (as 0.5% Cinamycin(Ibn Sina), Cap. , 150mg, Tk.
solution and 1% ointment); 2-3 drops/in 8/Cap.; 300mg, Tk. 15/Cap.;Inj., 300mg/2ml,
thin layer 2-3 times or more Tk. 200.00/2ml.; 600mg/4ml , Tk. 350.00/4ml
Cleocin(Healthcare), Cap., 150mg, Tk.
Proprietary Preparation 300.00/Cap.; 300mg , Tk;. 448.00/Cap.
Chloramphenicol(Hudson), Cap., 250mg, Cleodin(General), Cap., 150mg, Tk.
Tk.2.50/Cap. 6.00/Cap.; 300mg, Tk. 15.04/Cap.; Inj.,
300mg/2ml, Tk. 40.12/2ml,600mg/4ml, Tk.
(See also section 10.2&11.1., For skin 70.21/4ml
Climycin(Square), Cap, 150 mg, Tk.
and ENT preparation) 8.06/Cap.300 mg, Tk. 15.10/Cap.
Clinacyn(Beximco), Cap., 150mg, Tk.
CLINDAMYCIN 8.00/Cap.; 300mg, Tk. 15.00/Cap.
Clincin (Navana), Cap., 150 mg, Tk.
8.00/Cap.; 300mg, Tk. 15.00/Cap.;Syrup, 75
Indications: Severe anaerobic infection
mg/5 ml, Tk. 250/100 ml
caused by bacteroids and other Clinda(Astra Bio), Cap. , 150 mg, Tk.
anaerobes, septic abortion, pelvic 8.00/Cap.; 300 mg, Tk. 15.00/Cap.
abscesses, with an aminoglycosides or Clindabac(Popular), Cap.,150 mg, Tk.
cephalosporin to treat penetrating wound 8.00/Cap.; 300 mg, Tk. 15.00/Cap.
of gut, with primaquine as an alternative Clindacin(Incepta), Cap. ,150 mg, Tk.
to co-trimoxazole in pneumocystis 8.00/Cap., 300 mg, Tk. 15.00/Cap.;
Inj.,300mg/2ml, Tk. 40.00/2ml. ; 600mg/4ml,
pneumonia in AIDS patients and with
TK.. 70.00/4ml.; Suspn., 75 mg /5 ml, Tk.
pyrimethamine in AIDS-related 280.00/100 ml
toxoplasma encephalitis; topically in Clindamet(Somatec), Cap., 150 mg, Tk.
acne. 8.00/Cap.; 300 mg, Tk. 15.00/Cap.
Cautions: Should be discontinued if Clindaver (Veritas), Cap., 300 mg, Tk.
there is diarrhea or colitis, requires 15.00/Cap.
monitoring of renal and hepatic functions Clindax(Opsonin), Inj., 300 mg/2 ml, Tk. 40.15/
2 ml, 600 mg/4 ml, Tk.70.26/4ml,;Cap.,150 mg,
in prolonged therapy and in neonates
Tk. 8.03/ Cap., 300 mg , Tk. 15.06/Cap.;
and infants; renal or hepatic impairment, Suspn., 75 mg /5 ml, Tk. 250.94/ 100 ml
pregnancy and breast-feeding Clinex(Aristo), Cap., 150mg , Tk. 8.00/Cap.;
Contra-indications: Diarrheal states 300mg, Tk.15.00/cap
Interactions: See Appendix-2 Daclin(ACI), Cap.,150mg, Tk.
Side-effects: Diarrhea, nausea, 8.02/Cap.,300mg, Tk.15.05/Cap
vomiting, pseudomembranous colitis, Dalacin(Drug Intl), Cap.,300mg, Tk.
15.05/Cap.; Inj.,300mg/2ml, Tk. 40.15/2ml. ;
impaired liver function, jaundice,
600mg/4ml, Tk. 70.25/4ml.
neutropenia, eosinophilia, Endamycin(Euro), Cap., 150mg, Tk.
agranulocytosis, thrombocytopenia, rash, 15.00/Cap.; 300mg, Tk. 8.00/Cap.
urticaria, erythema multiforme, exfoliative Fortior(Pharmacil), Cap.,300mg, Tk.
and vesiculobullous dermatitis 22.00/cap.
Dose: Oral: 150-300 mg every 6 hours; Linacin(Sharif), Cap. , 150 mg , Tk. 8.03/Cap.;
up to 500 mg every 6 hours in severe 300 mg , Tk. 15.04/Cap.
Lincocin(Acme), Cap. ,300 mg , Tk.
infections; CHILD 10-20 mg/kg/d in 4
15.04/Cap.
divided doses; deep IM inj. or IV infusion: Lindamax(Eskayef), Cap, 150mg, Tk.
0.6-2.7 g daily in 2-4 divided doses; life- 8.00/Cap.; 300mg , Tk. 15.00/Cap. ;
threatening infection, up to 4.8 g daily; Maxclin(Alco), Tab., 150 mg, Tk. 8.00/Tab.;
CHILD > 1 month, 15-40 mg/kg daily in 3- 300 mg,Tk. 15.00/Tab.
50
1. ANTI-INFECTIVES
Qcin (Renata), Inj., 300 mg/2 ml, Tk. 40.00/2 FOSFOMYCIN [R][C]
ml; 600 mg/4 ml, Tk. 70.00/4 ml;Cap. 150 mg,
Tk. 8.00/Cap.; 300 mg, Tk. 15.00/Cap.
Xindal (Orion), Cap., 150 mg, Tk. 8.00/Cap.; Indications: Uncomplicated urinary tract
300 mg, Tk. 15.00/Cap. infections (acute cystitis) in women due
to susceptible strains of Escherichia coli
LINEZOLID[C] and Enterococcus faecalis
Cautions:Breast
Indications: Pneumonia, complicated feeding,Pregnancy,Renal Impairmen
skin and soft tissue infections caused by Contra-indications: Patients with severe
Gram- positive bacteria including those renal insufficiency (CLcr<10ml/min),
due to vancomycin-resistant enterococci patients undergoing haemodialysis
and methicillin resistant S aureus Interactions:Concomitant administration
Cautions: Blood count including platelet of metoclopramide has been shown to
count requires weekly monitoring; if lower serum and urinary concentrations
significant myelosuppression, treatment and should be avoided.
should be stopped; visual function Side-effects: Headache dizziness
monitoring is required in long dyspepsia vulvovaginitisdizziness
therapy(more than 28 days), patients Dose: Oral: ADULT: Uncomplicated
should be warned to report symptoms of lower urinary tract infections: one sachet
visual impairment immediately; history of (3g)
seizures, hepatic impairment, renal Child:not recomeded under the age of12
impairment, pregnancy; tyramine–rich Year
foods Note: Fosfomycin is for oral
Interactions: See Appendix -2 administration and should be taken on an
Contra-indications: Breast-feeding; empty stomach, either 1 hour before or at
patients using MAO-inhibitor drugs least 2 hours after meals and preferably
Side-effects: Diarrhea, nausea, and before bedtime after emptying the
vomiting, metallic taste, dizziness and bladder. The contents of a sachet should
abnormal liver function test; reversible be dissolved in a glass of water and
myelosuppression including anemia; taken immediately after its preparation.
leucopenia, pancytopenia, and in
particular, thrombocytopenia has been Proprietary Preparation
Fosamin(Beximco), Granules for Oral Solution,
reported 3mg, Tk. 350.00/sachet
Dose: Oral or IV infusion over 30-120
minutes: ADULTover 18 years600mg
NITROFURANTOIN[ED] [A] [C]
every 12 hours for 10-14 days
Proprietary Preparations Indications: For long-term suppression

Arlin(Beximco), Inj., 600 mg/300 ml, Tk. and treatment of uncomplicated lower
450.00/ Vial,; Suspn., 100mg/5ml, Tk. urinary tract infections
280.00/100ml,; Tab., 400mg , Tk. 60.00/Tab.; Cautions: Hepatic insufficiency; elderly
600mg , Tk. 85.0003/Tab. patients (risk of acute pulmonary
Ezolid(ACI), Tab., 400mg, Tk. 60.00/Tab. ; reactions); anemia; diabetes mellitus;
600mg, Tk. 85.00/Tab.
electrolyte imbalance; vitamin B and
Linexil(Opsonin), Inj., 600 mg/300 ml, Tk.
451.36/ Vial,; Suspn., 100 mg /5 ml, Tk. folate deficiency; pulmonary disease;
280.00/100 ml. urine may be colored yellow or brown;
Linzolid(Incepta), Inj., 600 mg/300 ml, Tk. Contra-indications: Known
450.00/ Vial,; Suspn. 100 mg/5 ml, Tk. hypersensitivity, renal impairment,
280.00/100 ml; Tab., 400 mg, Tk. 60.00/Tab.; pregnancy (at term) and breast-feeding;
600 mg, Tk. 85.00/Tab. infants less than 3 months old, G6PD
deficiency; acute porphyria
51
1. ANTI-INFECTIVES
Side-effects: Diarrhea, nausea, and dyspnea, headache, depression,

vomiting; neurological disturbances dizziness, muscle spasm, rash,
including dizziness, headache, vertigo, pruritus;less commonly anorexia, taste
nystagmus, benign intracranial disturbances, dry mouth, peripheral
hypertension, severe and sometimes edema, sleep disturbances, anxiety,
irreversible peripheral polyneuropathy; memory impairment, convulsions,
hypersensitivity reactions including skin hypoesthesia, paraesthesia, antibiotic-
rashes, urticaria, pruritus, fever, associated colitis, influenza-like
erythema multiforme, Steven-Johnson symptoms, dysuria, polyuria, glycosuria,
syndrome, exfoliative dermatitis, polymenorrhoea, blood disorders,
pancreatitis, blood disorders (including hyperkalemia; rarely blood pressure
agranulocytosis, thrombocytopenia, and changes, constipation
aplastic anemia); acute pulmonary Dose: Oral: travellers' diarrhea not
sensitivity reactions characterized by associated with fever, bloody diarrhea,
sudden onset of fever, chills, blood or leucocytes in the stool, or 8 or
eosinophilia, cough, chest pain , more unformed stools in the previous 24
dyspnea, pleural effusion, chronic hours: ADULT over 18 years, 200 mg
symptoms include interstitial pneumonitis every 8 hours for 3 days; reduction in
and pulmonary fibrosis recurrence of hepatic encephalopathy,
Dose: Oral: acute uncomplicated ADULT over 18 years, 550 mg twice daily
infection, ADULT, 50 mg every 6 hours
with food for 7 days (3 days usually Proprietary Preparations
adequate in women); CHILD, over 3 Aximin(Acme), Tab., 200 mg , Tk. 20.07/Tab.,
months, 750 micrograms/kg every 6 550 mg , Tk. 45.13/Tab.
hours; severe chronic recurrent infection, Efaxim(Square), Tab., 200 mg, Tk.
20.00/Tab., 550 mg, Tk. 45.00/Tab.
100 mg every 6 hours with food for 7 Faxan(Drug Intl), Tab., 200mg, Tk. 20.10/Tab.,
days (dose reduced or discontinued if 550mg, Tk. 40.15/Tab.
severe nausea); prophylaxis, 50–100 mg Henlix(ACI), Tab., 200mg, Tk. 25.00/Tab.,
at night; CHILD over 3 months, 1 mg/kg 550mg, Tk. 45.00/Tab.
at night Hepatab(Ibn Sina), Tab., 200mg, Tk.
20.00/Tab., 550mg, Tk. 50.00/Tab.
Proprietary Preparations Hepaximin(Aristo), Tab., 200mg , Tk.
20.00/Tab., 550mg , Tk. 45.00/Tab.
Nintoin(Incepta), Suspn., 25 mg/5 ml, Tk.
Rifabac(Popular), Tab. , 200mg, Tk.
80.00/100ml.; Cap., 100 mg, Tk. 20.00/Cap. ;
100 mg, Tk. 4.00/Cap. ; Tab. , 100 mg, Tk. 25.00/Tab., 550mg, Tk. 65.00/Tab.
6.00/Tab. Rifacol(Sharif), Tab. , 200 mg, Tk.
Nitrofur, (ACI), Suspn, 25mg/5ml, Tk. 20.07/Tab., 550 mg, Tk. 45.13/Tab.
80.00/100ml Rifagut(Opsonin), Tab. , 200 mg, Tk.
Ofuran(Pacific), Tab. , 100 mg, Tk. 20/Tab. 20.06/Tab., 550 mg, Tk. 45.00/Tab., 200 mg,
Tk. 20.00/Tab.
Rantoin(Drug Intl), Tab., 100mg, Tk. 6/Tab.
Rifagyl(Globe), Tab. , 550 mg, Tk. 45.00/Tab.
Urobak(Opsonin), suspn.,, 25 mg/5 ml, Tk.
Rifamax(Incepta), Tab. , 200 mg, Tk.
60.00/ 100 ml ,; Tab, 100 mg , Tk. 6.00/Tab.
Urocure(Square), Cap. , 100 mg, Tk. 25.00/Tab., 550 mg, Tk. 65.00/Tab.
Rifaxin(Ziska), Tab. , 200 mg, Tk. 20.00/Tab.,
20.06/Cap. ; Suspn. , 25 mg/5 ml, Tk.
550 mg, Tk. 45.00/Tab.
80.24/100ml
Rixmin(Astra Bio), Tab. , 200 mg, Tk. 20/Tab.
Xifamin(Nipro JMI), Tab., 200 mg, Tk.20/Tab.
RIFAXIMIN
SODIUM FUSIDATE
Indications: See under Dose
Caution: Hepatic impairment Fusidic acid and its salts are effective
Contra-indications: hypersen-sitivity; against Staphylococci, notably Staph.
intestinal obstruction; pregnancy and aureus and Staph. epidermidis including
breast-feeding methicillin-resistant strains. Neisseria B.
Interactions: See Appendix -2 fragilis and many clostridialare used
Side-effects: Nausea, vomiting, mainly in the treatment of staphylococcal
abdominal pain, flatulence, diarrhea,
52
1. ANTI-INFECTIVES
infection They have been used in the prophylaxis in orthopedic surgery at risk
treatment of abscess including brain of infection with Gram-positive organisms
abscess, in bones and joint infections, Cautions: Blood count, kidney and liver
and topically in the treatment of in eye function tests required; vancomycin
infections and infections of the skin (see sensitivity; monitoring of auditory function
also section 10.2&12.2) if other nephrotoxic or neurotoxic drugs
Indications: See notes above given; pregnancy
Cautions: Liver function tests required Interactions: See Appendix -2
Side-effects: Nausea, vomiting, Side-effects: Rush, pruritus; rarely,
abdominal pain, reversible jaundice, nausea, vomiting, diarrhea, dizziness,
especially after rapid intravenous bronchospasm, mild hearing loss,
injection or infusion; altered liver function vestibular disorders; renal failure,
tests; neutropenia, eosinophilia, urticaria, Stevens-Johnson syndrome, toxic
rash, thrombophlebitis epidermal necrolysis
Interactions: See Appendix-2 Dose: Loading dose of 6mg/kg IV 12hrly
Dose: See section 10.2.&12.2 for 3doses, them maintenance dose of
6mg/kg IV once daily. Insevere
Proprietary Preparations infections, higher doses have been used;
Facid (Eskayef),Tab, 250mg, Tk. 65.00/Tab 12mg/kg IV 12hrly for 3 doses, then
Fusidin Leo(I) (Leo),Tab.111.02/Tab 12mg/kg daily.
(See section 10.2. for Eye and12.2 for Skin IV inj. or infusion, ADULT > 70 kg body
preparation)
weight, initially 400 mg 12 hourly for 3
doses, then (may be given by IM inj.) 400
SPECTINOMYCIN[A] mg once daily; CHILD over 2 months, IV
inj. or infusion, initially 10 mg/kg (max.
This is a narrow-spectrum bacteriostatic 400 mg) 12 hourly for 3 doses, then 6
antibiotic structurally related to mg/kg (max. 200 mg) once daily
aminoglycosides and is effective against
a number of gram-negative organisms Proprietary Preparations
but is inferior to other drugs to which Targocid(I) (Gruppo), Inj., 200 mg/Vial, Tk.
such organisms are susceptible. 872.08/Vial; 400 mg/Vial, Tk. 1568.62/Vial
Indications: Recommended as Tergocin (Incepta),Inj.,200mg/vial,Tk.1600/vial
alternative treatment for uncomplicated
gonococcal infection in patients who are TIGECYCLINE[R]
intolerant or allergic to beta-lactam drugs
and fluoroquinolones Tigecycline should be reserved for the
Cautions: Renal and hepatic impairment treatment of complicated skin and soft-
Interactions: See Appendix-2 tissue infections and complicated
Side-effects: Nausea, dizziness, abdominal infections caused by multiple-
urticaria, fever; rarely nephrotoxicity and antibacterial resistant organisms when
anemia other antibacterials cannot be used; it is
Dose: deep IM inj. a single dose of 2 g or not recommended for the treatment of
40 mg/kg foot infections in patients with diabetes.
Indications: See notes above
Proprietary Preparation Cautions: Cholestasis; dose reduction in
Tinobac (Incepta), Inj., 2 gm/vial, Tk. hepatic impairment; also see under
250.00/Vial tetracyclines
Contra-indications: hypersensitivity to
TEICOPLANIN[W] Tetracyclines
Interactions: See Appendix -2
Indications: Treatment of serious Gram- Side-effects: Nausea, vomiting,
positive infection including endocarditis, abdominal pain, dyspepsia, diarrhea,
dialysis-associated peritonitis; anorexia, bilirubinaemia, dizziness,
53
1. ANTI-INFECTIVES
headache, hypoglycaemia, prolonged interstitial nephritis; blood disorders

prothrombin time, prolonged activated including neutropenia (usually after
partial thromboplastin time, rash, pruritus, receiving dose of 25g); rarely
and injection-site reactions; less agranulocytosis; and thrombocytopenia;
commonly pancreatitis, cholestatic nausea; eosinophilia; anaphylaxis,
jaundice, and hypoproteinaemia; also rashes including, exfoliative dermatitis;
reported, antibiotic-associated colitis, and toxic epidermal necrolysis; phlebitis;
hepatic failure, thrombocytopenia, on rapid infusion, severe hypotension
Stevens-Johnson syndrome (including shock and cardiac arrest);
Dose: IV infusion:ADULT, over 18 years, wheezing, dyspnea; urticaria, pruritus
initially 100 mg, then 50 mg every 12 Dose: Oral: in antibiotic associated
hours for 5–14 days; initially 100 mg colitis, 125mg every 6 hours for 7 to
then 25 mg every 12 hours in 10days; dose may be increased if
severehepatic impairment infection is severe or fails to respond.
CHILD, 5mg/kg every 6 hours, over 5
Proprietary Preparations years half adult dose; By intravenous
Widebac(Incepta),IV. Infusion, 50 mg/vial, Tk. infusion, 500mg over at least 60 minutes
600.00/vial every 12 hours, ELDERLY, over 65
Tygacil(I)(Wyeth) ,IV. Infusion 50 mg/Vial, Tk. years, IV. Infusion 500mg every 12 hours
4120/Vial
or 1g once daily; NEONATE up to
1week,15mg/kg initially then 10mg/kg
VANCOMYCIN[W] every 12 hours; INFANT 1-4weeks,
15mg/kg initially then 10mg/kg every 8
Indications: For the treatment of serious hours; CHILD over 1month, 10mg/kg
Staphylococcal or other Gram-positive every 6 hours
infections where other drugs such as the
pencillins cannot be used because of Note: plasma concentration monitoring
resistance or patient intolerance. It is required; pre-dose concentration should
used in the prophylaxis and treatment of be 5-10mg/L
endocarditis by intravenous route; (added
to dialysis fluid and used for the Proprietary Preparations
treatment of peritonitis associated with Covan(Renata),IV. Infusion, 1 gm/Vial, Tk.
continuous ambulatory, peritoneal 480.00/vial; 500 mg/vial, Tk. 250.00/vial
dialysis, antibiotic associated colitis Vancard(Techno), IV. Infusion., 1 gm/Vial, Tk.
Cautions: Hypersensitive to it; should 850.00/Vial; 500 mg/Vial, Tk. 470.00/Vial
Vancobac(Popular), IV. Infusion 1 gm/vial, Tk.
not be given intramuscularly; avoid rapid
552.08/vial; 500mg/vial, Tk. 321.21/vial
infusion; rotate infusion site; renal Vancomin(Opsonin), IV. Infusion Vial, 500
impairment; elderly; avoid if history of mg/Vial , Tk. 250.94/vial; 1 gm/Vial, Tk.
deafness; all patients require plasma 481.81/vial
vancomycin measurement (after 3 or 4 Vanmycin(Incepta), IV. Infusion 1 gm/Vial, Tk.
doses if renal function normal, earlier if 480.00/vial; 500 mg/vial, Tk. 250.00/vial
renal impair-ment), blood counts,
urinalysis, and renal functions test; 1.2 ANTIFUNGALS
monitor auditory function in elderly or if (See section 12.2&10.2)
renal impairment; pregnancy and breast 1.2.1 FOR SYSTEMIC FUNGAL
feeding; systemic absorption may follow INFECTIONS
oral administration especially in 1.2.2 FOR MUCOCUTANEOUS
inflammatory bowel disorders or INFECTIONS
following multiple doses 1.2.3 TOPICAL ANTIFUNGALS
Side-effects: Ototoxicity (discontinue if
tinnitus occurs); flushing of the upper
body (“red man” syndrome); nephro-
toxicity including renal failure and
54
1. ANTI-INFECTIVES
1.2.1 FOR SYSTEMICFUNGAL thrombophlebitis at injection site;

INFECTIONS encephalopathy rarely
AMPHOTERICIN B(See section 1.3.5) Dose:By slow IV infusion, 0.5-1 mg/kg/d,

is an amphoteric polyene macrolide continued to a total dose of 1-2 g;
nearly insoluble lele in water and exhibits Oral: intestinal candidiasis, 100-200 mg
broad-spectrum fungicidal activity. The every 6 hours; INFANT and CHILD 100
drug is effective against clinically mg 4 times daily, oral and perioral
significant yeasts, including C. albicans infections, Amphotericin 10 mg lozenges,
and Cryptococcus neoformans, the 1 lozenge to dissolve slowly in the mouth
organisms causing endemic mycoses 4 times daily for 10-15 days or 100 mg
including Histoplasma capsulatum, suspension placed in the mouth after
Blastomyces dermatitidis and food and retain near lesions 4 times daily
Coccidioides immitis and the pathogenic for 14 days, therapy should be continued
molds, such as Aspergillus fumigatus and for 48 hours after lesions have resolved.
mucor. It has limited activity against the
protozoa L. braziliensis and Naegleria Proprietary Preparation
Tericin(Beacon), Inj., 50mg, Tk. 15045.11/Vial
fowleri.
Indications: Drug of choice for initial
induction regiment for life-threatening FLUCONAZOLE[ED]
mycotic infections such as severe fungal
pneumonia, cryptococcal meningitis, Indications: See under Dose
sepsis syndrome, for empiric therapy Cautions: Renal insufficiency, in
incancer patients with neutropenia, severeform dose interval should be
mycotic corneal ulcers and keratitis, increased from 24 to 48 or 72 hours;
fungal arthritis, candiduria. breast-feeding; monitoring of liver
Cautions: Renal impairment; hepatic function is required in prolonged and or
and renal-function tests, blood counts, high dose therapy, drug should be
and plasma electrolyte monitoring stopped if evidence of hepatic necrosis
required, if any abnormality therapy Contra-indications: Pregnancy, severe
should be discontinued; pregnancy and liver disease, acute porphyria
breast-feeding; when given parenterally, Interactions: See Appendix-2
toxicity common (close supervision Side-effects: Nausea, abdominal
necessary and test dose required); rapid discomfort, diarrhea, and flatulence,
infusion (risk of arrhythmias) and occasionally abnormalities of liver
concurrent corticosteroids therapy need enzymes, rarely rash, angioedema,
to be avoided anaphylaxis, Stevens-Johnson syndrome
Contra-indications: Hypersensitivity and fixed drug eruption; skeletal and
Interactions: See Appendix -2 cardiac deformities in infants born to
Side-effects: when given parenterally, women taking high doses during
anorexia, nausea and vomiting, diarrhea, pregnancy has also been reported
epigastric pain; febrile reactions, Dose: Candidiasis: oropharyngeal
headache, muscle and joint pain; candidiasis, orally, 200 mg on the first
anemia; disturbances in renal function day then 100 mg daily for 2 weeks;
with renal tubular acidosis, hypokalemia esophageal candidiasis, orally, 100-200
and hypomagnesemia; cardiovascular mg daily; vaginal candidiasis and
toxicity including arrhythmias; blood candidial balantitis, orally, 150 mg as a
disorders; neurological disorders single dose; deep candidiasis in allogenic
including hearing loss, diplopia, bone marrow transplant recipients and
convulsions, peripheral neuropathy, candidemia in non-immunocompromised
abnormal liver function; rash, patients, orally, 400 mg daily; CHILD oral
anaphylactoid reactions; pain and or IV infusion, 3-6 mg/kg on first day then
3 mg/kg daily, every 72 hours in
55
1. ANTI-INFECTIVES
NEONATE up to 2 weeks old, every 48 and hair loss; rhabdomyolysis is also

hours in NEONATE 2-4 weeks old; Tinea reported
pedis, corporis, cruris, pityriasis Dose: Oral : oropharyngeal candidiasis,
versicolor, and dermal candidiasis, orally, 100 mg daily, 200 mg daily in AIDS or
50 mg daily for 2-4 weeks for up to 6 neutropenia for 15 days; vulvovaginal
weeks in tinea pedis; cryptococcosis candidiasis, 200 mg twice daily for 1 day;
including meningitis, oral or IV infusion, pityriasis versicolor, 200 mg daily for 7
400 mg daily for initial 8 weeks, then 200 days; tinea corporis and tinea cruris, 100
mg daily; CHILD 6-12 mg/kg daily, every mg/d for 15 days or 200 mg/d for 7 days;
72 hours in NEONATE up to 2 weeks old, tinea pedis and manuum, 100 mg daily
every 48 hours in NEOANTE 2-4 weeks for 30 days or 200 mg twice daily for 7
old, max. 400 mg daily; prevention of days; onychomycosis, 200 mg daily for 3
relapse of cryptococcal meningitis in months; histoplasmosis, 200 mg 1-2
AIDS patients after completion of primary times daily; systemic aspergillosis,
therapy, 100-200 mg daily; candidiasis and cryptococcosis including
coccidioidomycosis including meningitis, cryptococcal meningitis, histoplasmosis
oral or by IV infusion, 200-400 mg daily; where other antifungal drugs
prevention offungalinfections in inappropriate or ineffective, 200 mg once
immunocompromised patients following daily, IV infusion: 200 mg every 12 hours
cytotoxic chemotherapy or radiotherapy, for 2 days, then 200 mg once daily for
oral or by IV infusion, 50-400 mg daily max. 12 days; maintenance in AIDS
adjusted according to risk; CHILD patients to prevent relapse of underlying
according to extent and duration of fungal infection and prophylaxis in
neutropenia, 3-12 mg/kg daily, every 72 neutropenia when standard therapy
hours in NEONATE up to 2 weeks old, inappropriate, 200 mg once daily
every 48 hours in NEONATE 2-4 weeks
old, max. 400 mg daily Proprietary Preparations
Itra(Square), Cap., 100 mg, Tk. 15.10/Cap.
Proprietary Preparations Trec(Team), Cap., 100 mg, Tk. 14/Cap.
See section 12.2 Iconal(Kemiko), Cap., 100mg, Tk. 15.04/Cap.
ITRACONAZOLE KETOCONAZOLE
This is a synthetic triazole having Indications: Systemic mycoses, serious

mechanism and antifungal spectrum of chronic resistant mucocutaneous
activity similar to those of fluconazole. candidiasis, serious mycoses of gut not
Indications: See under Dose responsive to other therapy, chronic
Cautions: Absorption is impaired in vaginal candidiasis not responsive to
AIDS patients, neutropenia and when other therapy, dermatophytes infections
gastric acidity is reduced; the drug should not responsive to other therapy excluding
be administered at least two hours after infection of the toe nails, prophylaxis of
antacid or a full meal; monitoring of liver mycoses in patients with reduced
function in prolonged therapy, dose immune responses
adjustment in renal impairment, liver Cautions: See notes above;liver function
disease, risk of heart failure with high tests before, during and after treatment;
dose, drug should be discontinued if porphyria
peripheral neuropathy; Contra-indications: Hepatic impairment,
Contra-indications: Severe hepatic pregnancy, breast-feeding
impairment, acute porphyria; pregnancy Interactions: See Appendix-2
Interactions: See Appendix-2 Side-effects: Nausea, anorexia,
Side- effects: See under fluconazole; vomiting, rashes, pruritus, hepatitis;
also heart failure, hypertriglyceridemia, gynaecomastia, decreased libido in
hypertension, peripheral neuropathy; in males, at high doses azospermia has
prolonged therapy hypokalemia, edema, been reported; also hypertension, fluid
56
1. ANTI-INFECTIVES
retention, asymptomatic elevation of ECHINOCANDINS

aminotransferase
Dose: Oral: ADULT 200 mg once daily, The echinocandin antifungals include
increased to 400 mg if required; CHILD Anidulafungin,Caspofungin and
3.3-6.6 mg/kg daily; duration of therapy: Micafungin. They are only active against
5 days for candida vulvovaginitis, 2 Aspergillus spp. and Candida spp.;
weeks for candida esophagitis and 6-12 however, anidulafungin and micafungin
months for deep mycoses; prophylaxis are not used for the treatment of
and maintenance treatment in aspergillosis. Echinocandins are not
immunosuppressed patients, 200 mg effective against fungal infections of the
daily CNS. For the role of echinocandin
antifungals in the prevention and
Proprietary Preparations systemic treatment of fungal infections
Ketocon(Opsonin), Tab., Tk. 8.06/Tab.
KetofunAmico), Tab., TK. 8.30/Tab.
(See section12.2.for skin preparation) ANIDULAFUNGIN
VORICONAZOLE Indications: Oesophageal candidiasis,

Candidemia and other complicated
Indications: Invasive aspergillosis, Candida infections.
invasive fluconazole-resistant Candida Side-effects: Nausea, Vomiting,
spp. Including C krusei, serious infection Hypomagnesaemia, Hypokalemia and
caused by Scedosporium spp., Fusarium Headche.
spp. Dose: For candidemia, 200mg IV on day
Cautions: Monitoring of hepatic and 1, followed by 100mg IV daily. For
renal function and skin cancer oesophageal candidiasis, 100mg IV on
surveillance required; also see notes day 1, followed by 50mg IV daily.
above CHILDREN: Age> 28 days, 1.5-3mg/kg
Contraindications: Acute porphyria loading dose, then 0.75-1.5mg/kg/ day
Interactions: See Appendix-2 (once daily).
diarrhea, jaundice, edema, hypotension, Proprietary Preparations
Eraxis(I)(Pharmacia&Upjohn),Inj.,100ml/vial Tk.
chest pain, respiratory distress 11245.25/vial.
syndrome, headache, dizziness, anxiety,
hallucination, paraesthesia, tremor,
CAPSOFUNGIN
hypoglycemia, hematuria, blood
disorders, acute renal failure,
hypokalemia, visual disturbances; less Indications: 1st line of drug for
commonly, hepatitis, cholecystitis, candidemia, candidal intra-abdominal
pancreatitis, arrhythmias, ataxia, abscesses, peritonitis and pleural spaces
nystagmus, adrenocortical insufficiency; infections; Oesophageal candidiasis;
Dose: Oral: ADULT and CHILD over 12 Empiric therapy for febrile, neutropenic
years, body-weight over 40 kg, 400 mg patients; Invasive aspergillosis in patients
12 hourly for 2 doses then reduced to refractory to or intolerant of other
200 mg; body-weight under 40 kg, 200 therapics.
mg 12 hourly for 2 doses then reduced to Cautions: As it is metabolized in liver, so
100 mg; IV infusion: 6 mg/kg 12 hourly reduce dose to 35mg/day IV in moderate
for 2 doses then reduced to 4 mg/kg hepatic insufficiency. Interactions include
Cyclosporine (Hepatic toxicity) and
Generic Preparation tacrolimus (Drug level Monitoring)
Tablet, 200mg; 50mg; Syrup, 200mg/5ml Side-effects: Pruritus at infusion site;
and headache, Fever, Chills, Vomiting
and Diarrhoea associated with infusion.
57
1. ANTI-INFECTIVES
Dose: 70mg IV on 1st day, followed by

50mg IV daily. TERBINAFINE
CHILD: 70mg/m2 IV on 1stday, followed
by 50mg/m2 IV daily (max dose Indications: Fungal infections of the skin
70mg/day) and nails; ringworm infections including
tinea pedis, cruris and corporis
Proprietary Preparations Cautions: Pregnant and breast-feeding
Cancidas(I)(MSD), IV. Infusion, 50mg/Vial Tk.
women; hepatic and renal impairment;
16640.48/vial, 70mg/vial Tk.16640.48/vial
psoriasis, autoimmune disease
Contra-indications: Hypersensitivity
1.2.2FOR MUCOCUTANEOUS Interactions:See Appendix-2
INFECTIONS Side-effects: Gastrointestinal distress,
(see section 12.2.2) mild abdominal pain, skin reactions (rash,
GRISEOFULVIN[ED] urticaria), headache; rarely
hepatotoxicity, severe neutropenia,
This is a narrow-spectrum fungistatic Stevens-Johnson syndrome or toxic
drug given orally and is the choice of epidermal necrolysis may occur; very
treatment for extensive and intractable rarely, psychiatric disturbance, blood
fungal infections disorders
Indications: Fungal infections of skin, Dose: Oral: onychomycosis of nails, 250
hair, nails and scalp where topical mg daily for 3 months; duration of oral
therapy is inappropriate or failed therapy for ringworm infections is 2-6
Cautions: May impair performance of weeks with local application of cream
skilled tasks, aggravation of systemic twice daily
lupus erythematosus; breast-feeding,
pregnancy should be avoided during Proprietary Preparations
therapy and for 1 month after treatment, Infud(General), Tab.250mg, Tk. 50.00/Tab.
men should not father children within 6 Mycofin(Eskayef), Tab, 250mg, Tk. 40/Tab.
months of treatment Mycofree(Drug Intl), Tab., 250mg, Tk. 25/Tab.
Skinabin(ACI), Tab., 250mg, Tk. 40.27/Tab.
Contra-indications: Severe liver
Telfin(UniMed), Tab., 250mg, Tk. 50.00/Tab.
disease, lupus erythematosus rashes,
(See section12.2 for skin preparation)
mental confusion, peripheral neutritis,
headache, nausea, vomiting, vertigo,
gastric discomfort, augmentation of 1.2.3 TOPICAL ANTIFUNGALS
alcohol effects, transient macular edema (See section12.2)
Side-effects: Hepatotoxicity, Superficial fungal infections including
photosensitivity, urticaria, erythematous dermatophytosis (ringworm), candidiasis,
rashes, mental confusion, peripheral tinea versicolor, piedra, tinea nigra and
neuritis, headache, nausea, vomiting, fungal keratitis are treated successfully
vertigo, gastric discomfort, augmentation by topical antifungals with or without
of alcohol effects, transient macular concomitant administration of systemic
edema antifungal drugs. Topical administration
Dose: Oral: 500 mg daily, in divided of antifungal is usually not successful for
doses or as a single dose, in severe mycoses of the nails (onychomycosis)
infection dose may be doubled; CHILD and hair (tinea capitis) and not
10 mg/kg daily in divided doses or as a recommended for subcutaneous
single dose mycoses (sporotrichosis and
chromomycosis). Besides the type of
Proprietary Preparations lesion and mechanism of drug’s action,
Fulcinex(ACI), Suspn, 2.5gm/100ml, Tk. viscosity, hydrophobicity and acidity of
23.49/60ml; Tab., 500mg, Tk. 5.60/Tab. the formulation are important
Grisovin FP(GSK), Tab., 500mg, Tk. 5.88/Tab determinants of the efficacy of topical
Grisozen(Zenith),Tab., 500 mg, Tk. 6.68/Tab. agents in superficial mycoses. Because
58
1. ANTI-INFECTIVES
of thepoor penetration of the topical 1.3 ANTIPROTOZOAL DRUGS

drugs into hyperkeratotic lesions, 1.3.1 ANTIMALARIALS
removal of the thick keratin is a useful 1.3.2 AMEBICIDES
adjunct to therapy. 1.3.3 TRICHOMMONOCIDES
(See section 12.2.2) 1.3.4 ANTIGIARDIAL DRUGS
1.3.5 LEISHMENIACIDES
CLOTRIMAZOLE[ED]
(See section 12.2.2& 6.2.2) 1.3.1 ANTIMALARIA DRUGS
ECONAZOLE CHEMOTHERAPY OF MALARIA

(See section 12.2.2& 6.2.2) (see also Appendix-1h)
MICONAZOLE[ED] Chemoprophylaxis: As no antimalarial

drug kills sporozoites, which initiate
(See section 12.2.2) infection in humans, it is not truly
possible to prevent infection. Drugs can
NYSTATIN[ED] only prevent the development of
(See section 12.2.2 & 6.2.2) symptomatic malaria either by clinical
suppression (keeping the parasite count
Indications: Candidiasis of mouth, in blood below threshold level of clinical
esophagus or intestinal tract, vaginal attack) or by causal prophylaxis
candidiasis, skin infection, perineal (destroying pre-erythrocytic intrahepatic
pruritus forms of parasites).
Cautions: If irritation or sensitization Prophylaxis for infections with
develops, treatment should be chloroquine-sensitive P. falciparum P.
discontinued, pregnancy vivax. P. malariae, and P. ovale.
Interactions: See Appendix-2 ADULT 500 mg of chloroquine phosphate
Side-effects: Nausea, vomiting, (300 mg of base) weekly starting one
diarrhea, local irritation or burning week before entering an endemic area
sensation may occur and continuing until 4 weeks after
Dose:oral: Intestinal candidiasis 500,000 leaving; CHILD, 8.3 mg/kg of chloroquine
units every 6 hours, doubled in severe phosphate (5 mg base per kg) taken
infections; CHILD 100,000 units every 6 orally by the same schedule; in pregnant
hour; prophylaxis, 1 million units once women chloroquine be maintained in
daily; NEONATE 100,000 units once adult dose until delivery;
daily Prophylaxis for infections with
chloroquine-resistant or multidrug-
Proprietary Preparations resistant strains ofP.
See section 12.2.2 & 6.2.2 falciparum:Regimens:
ADULT & CHILD > 45 kg body weight:
TIOCONAZOLE mefloquine 250 mg tablet weekly starting
1 week before entering an endemic area
(See section 12.2.2 & 6.2.2) and ending 4 weeks after leaving;
Tioconazole, an imidazole, is used for the pediatric doses taken by the same
treatment of Candida vulvovaginitis. A schedule are, CHILD weighing 5-9 kg
single 4.6 g dose of ointment containing 31.25 mg, 10-19 kg 62.5 mg, 20-30 kg
6.5% drug is given at bedtime. 125 mg; and for those weighing 31-45 kg
187.5 mg; OR
ADULT doxycycline 100 mg daily; CHILD
over 8 years of age, the dosage is 2
mg/kg given once daily, increasing up to
59
1. ANTI-INFECTIVES
the daily adult dose. Prophylaxis with mefloquine 15 mg/kg (or 25 mg/kg) to
doxycycline should begin 1 day before affect a radical cure
travel to an endemic area and end 4
weeks after leaving. Generic Preparation
Note: doxycycline use for malaria Injection 80 mg/ml
prophylaxis should not exceed 4 months;
it should not be given to children less ARTEMETHER PLUS LUMEFANTRINE
than 8 years of age or to pregnant (Tablet, artemether 20 mg with
women lumefantrine 120 mg)
ARTEMISININS Indications: Treatment of acute

uncomplicated malaria due to
Artemisinin has three major Plasmodium falciparum mixed infections
semisynthetic derivatives in clinical use, including P. falciparum in areas with
Dihydroartemisinin, Artemether and significant drug resistance.
Artesunate.The short plasma t1/2 of Cautions: ECG required before and
these drugs often leads to treatment during treatment in cardiac disorder
failure when artimisinins are used as including bradycardia, heart failure,
monotherapy. Combining an artemisinin history of arrhythmias, QT interval
derivative with a longer–lasting partner prolongation, electrolyte disturbances,
drug ensures sustained antimalarial concomitant administration of drugs that
activity. prolonged QT interval; patients unable to
take food require monitoring (greater risk
ARTEMETHER[ED] of recrudescence); severe renal
impairment or hepatic impairment, avoid
This lipid soluble analog of artemisinin is in acute porphyria; dizziness may affect
a potent blood schizontocides against all performance of skilled tasks (e.g.
human malaria parasites but not effective driving); pregnancy, breast-feeding.
against dormant hepatic forms. Contra-indications: Family history of
Artemether also exhibit antiparasitic sudden death, congenital prolongation of
activity against several other protozoa QT interval,history of arrhythmias, of
including Leishmania major and clinically relevant bradycardia, and of
Toxoplasma gondii and against congestive heart failure accompanied by
schistosomes, but not used clinically to reduced left ventricular ejection fraction
treat these infections Interactions: See Appendix-2
Indications: Treatment of severe malaria Side-effects: Abdominal pain, anorexia,
including infections due to chloroquine diarrhea, nausea and vomiting,
and multidrug-resistant strains of P. headache, dizziness, sleep disorders;
falciparum. palpitations, arthralgia, myalgia; cough,
Cautions: Cardiac diseases asthenia, fatigue; pruritus,
Contra-indications: First trimester of rash.Dose:oral: treatment of
pregnancy uncomplicated falciparum malaria,
Interactions: See Appendix -2 ADULT & CHILD > 12 years and body
Side-effects: Headache, nausea, weight > 35 kg, initially 4 tablets followed
vomiting, abdominal pain, dizziness, by 5 doses of 4 tablets each after 8, 24,
tinnitus, neutropenia, elevated liver 36, 48 and 60 hours (total 24 tablets over
enzyme values; cardiotoxicity (after high 60 hours); CHILD body-weight 10-14 kg
dose). initially 1 tablet followed by 5 doses of 1
Dose: Treatment of P.falciparum malaria tablet each after 8, 24, 36, 48 and 60
(in areas of quinine resistance), by IM inj. hours (total 6 tablets over 60 hours);
ADULT & CHILD > 6 month, loading body-weight 15-24 kg initially 2 tablets
dose of 3.2 mg/kg daily until patient can followed by 5 doses of 2 tablet each after
tolerate oral medication or to maximum 7 8, 24, 36, 48 and 60 hours (total 12
days; this is followed by a single dose of tablets over 60 hours); body-weight 25-
60
1. ANTI-INFECTIVES
34 kg, initially 3 tablets followed by 5 CHLOROQUINE [ED]
doses of 3 tablet each after 8, 24, 36, 48

and 60 hours (total 18 tablets over 60 Indications: Chemoprophylaxis and
hours) treatment of malariarheumatoid arthritis,
lupus erythematosus, adjunct to
Proprietary Preparations metronidazole in extra-intestinal
Artemet(Incepta),Tab. , 20 mg +120 mg, Tk.
amebiasis
20.00/Tab.
Lumertam(Square), Tab, 20 mg + 120 mg, Tk. Cautions: Impaired renal and hepatic
20.13/Tab. functions(avoid concurrent therapy with
Coavlon(ACI), Tab., 20mg+120mg, Tk. hepatotoxic drugs); neurologic or
20.14/Tab. hepatologic disorders, G6PD deficiency;
Arexel(Jayson), Tab. 20 mg + 120 mg, Tk. may aggravate myasthenia gravis,
17.06/Tab. psoriasis.
Contra-indications: Psoriasis,
ARTESUNATE[ED] porphyria, retinal or visual field
abnormalities, myopathy
This water-soluble analog of artemisinin Interactions: See Appendix -2
is useful for oral, IV, IM and rectal Side-effects: Pruritus, anorexia, malaise,
administration. The drug exhibits similar headache, nausea, vomiting, abdominal
pharmacological profile like that of pain, diarrhea, blurring of vision, rashes,
artemether (see above). urticaria; rarely psychotic episodes,
Indications: Treatment of uncomplicated convulsions, depigmentation and loss of
P. falciparum malaria in areas of multiple- hair, impaired hearing, hemolysis in G-
drug resistance 6PD deficient patients, agranulocytosis,
Cautions: Risk of recurrence if used exfoliative dermatitis, hypotension, QRS
alone in non-immune patients; also see widening and T wave abnormalities in
under artemether ECG; long-term administration of high
Contra-indications: First trimester of doses for rheumatologic diseases can
pregnancy. result in irreversible ototoxicity,
Interactions: See Appendix-2 retinopathy, myopathy and peripheral
Side-effects: Headache, nausea, neuropathy; large IM inj. or rapid IV
vomiting, abdominal pain, diarrhea, infusion can cause severe hypotension
dizziness, tinnitus, neutropenia, elevated and respiratory and cardiac arrest
liver enzyme values; ECG abnormalities, Dose: Oral: Treatment of non-falciparum
including prolongation of QT interval; malaria, ADULT initialdose of 620 mg of
temporary suppression of reticulocyte base thena single dose of 310 mg of
response.and induction of black-water base after 6 to 8 hours then a single dose
fever, of 310 mg of base daily for 2
Dose:Oral: treatment of uncomplicated days(approximate total cumulative dose
P. falciparum malaria (in an areas of of 25 mg/kg of base);
multiple-drug resistance), ADULT & CHILD initial dose of 10 mg base/kg then
CHILD > 6 months, 4 mg/kg daily for 3 a single dose of 5 mg base /kg after 6-8
days; a single dose of mefloquine 15 hours followed by single dose of 5 mg
mg/kg (or 25 mg/kg,) is given on day 2 or base/kg daily for 2 days; rheumatic
3 to affect a radical cure; if artesunate disease, 150 mg base daily, max. 2.5 mg
used alone, treatment should be base/kg daily; CHILD up to 3 mg base/kg
continued for 7 days daily; Prophylaxis of malaria, started 1
week before entering endemic area and
Proprietary Preparation continued for 4 weeks after leaving,
Artex(Jayson), Tab. 50 mg, Tk. 12.05/Tab. 310 mg once weekly; child up to 6 weeks
body-weight under 4.5 kg, 25 mg once
weekly; 6 weeks–6 months body-weight
4.5–8 kg, 50 mg once weekly; 6 months–
61
1. ANTI-INFECTIVES
1 year body-weight 8–11 kg, 75 mg once sleep disorders; neuropsychiatric

weekly; 1–3 years body-weight 11–15 kg, reactions like depression, (suicidal
100 mg once weekly; 3–4 years body- ideation and suicide reported), confusion,
weight 15–16.5 kg, 125 mg once weekly; acute psychosis or seizures; tinnitus,
4–8 years body-weight 16.5–25 kg, vestibular disorders, visual disturbances,
150 mg once weekly (or 155 mg once circulatory disorders, bradycardia,
weekly if tablets used); 8–13 years body- cardiac conduction disorders, muscle
weight 25–45 kg, 225 mg once weekly weakness, myalgia, arthralgia, rash,
(or 232.5 mg once weekly if tablets urticaria, pruritus, alopecia, asthenia,
used); over 13 years, body-weight over malaise, fatigue, fever, loss of appetite,
45 kg, adult dose leucopenia or leukocytosis,
thrombocytopenia. Side effects may
Proprietary Preparations occur and persist up to several months
Avloquin(ACI), Syrup 80mg/5mlml, Tk. after discontinuation
14.91/60ml; Tab., 250mg, Tk. 1.22/Tab Dose : Oral: prophylaxis starting 2–3
Clit(Hudson), Syrup, 125mg/5ml, Tk.12.00/60 weeks before entering endemic area and
ml; Tab., 250mg, Tk.1.20/Tab.
Jasochlor(Jayson), Tab. , 250 mg, Tk.
continued for 4 weeks after leaving:
1.21/Tab.; Syrup, 80 mg/5 ml, Tk.14.87/60ml ADULT and CHILD body-weight over
Quinolex(Globe), Syrup, 80 mg / 5 ml, Tk. 45 kg, 250 mg once weekly; body-weight
20/60 ml,; Tab. , 250 mg, Tk. 1/Tab. 5–16 kg, 62.5 mg once weekly; body-
Supraquin(Supreme), Syrup, 80mg/5ml,, Tk. weight 16–25 kg, 125 mg once weekly;
14.00/60ml,; Tab., 250 mg, Tk. 14.40/Tab. body-weight 25–45 kg, 187.5 mg once
Zenoquine(Zenith), Syrup, 80mg/5ml, , Tk. weekly; for treatment, ADULT & CHILD
14.65/60ml,; Tab., 150 mg+ 250mg, Tk.
1.30/Tab.
20 mg base/kg (max. 1.5 g) as a single or
preferably in 2 divided doses 6-8 hours
apart daily for 3 days; also see Notes
MEFLOQUINE[ED]
above
Indications: Prophylaxis of malaria in Proprietary Preparations
areas where there is a high risk of Meflon(ACI), Tab., 250 mg, Tk. 39.61/Tab.
chloroquine-resistant falciparum malaria; Larimef(Healthcare), Tab., 250 mg , Tk.
Cautions: Severe hepatic and renal 39.60/Tab.
impairment; traumatic brain injury; may
impair fine motor skills like airplane PRIMAQUINE[ED]
piloting or car driving ( may occur and
persist up to several months after Indications:Radical cure of P. vivax and
stopping the drug); patient counseling to P. ovale malaria; with clindamycin an
discontinue mefloquine and to seek alternative to co-trimoxazole for
immediate medical attention if pneumocystis carinii infection.
neuropsychiatric symptoms appear Cautions:Pregnancy (risk of neonatal
Contra-indications: Should not be used hemolysis and methemoglobinemias in
for treatment if it has been used for third trimester); breast-feeding, G-6PD
prophylaxis; epilepsy, psychiatric deficiency (See notes above), diseases
disorders and history thereof including associated with granulocytopenia i.e.
depression or convulsions (for rheumatoid arthritis, lupus erythematosus
prophylaxis); cardiac arrhythmia and Contra-indications:Hemolytic anemia
conduction defects; hypersensitivity to Interactions:See Appendix-2
quinine; also not recommended for use in Side-effects:Anorexia, nausea, vomiting,
first trimester of pregnancy and in jaundice, less commonly, mild diarrhea,
children weighing less than 5 kg and / or methemoglobinemias, hemolytic anemia
< 3 months especially in G6PD deficiency,
Interactions: See Appendix -2 agranulocytosis, cardiac arrhythmia
Side-effects:: Nausea, vomiting, Dose: Oral: ADULT 15 mg daily for 14-
diarrhea, abdominal pain, dizziness, loss 21 days following a course of
of balance, headache, somnolence,
62
1. ANTI-INFECTIVES
chloroquine; CHILD, over 6 months of Cautions: See under Pyrimethamine and

age: (specialist advice should be sought under Co-trimoxazole; not recommended
for children under 6 months of age); in P. for prophylaxis because of severe side-
vivax infection, 500 micrograms/kg (max. effects on long-term use; possible
30 mg) daily for 14 days, and for P. teratogenic risk in first
ovale, 250 micrograms/kg (max. 15 mg) trimester (pyrimethamine a folate
daily for 14 days; antagonist); in third trimester risk of
PREGNENCY: the radical cure with neonatal hemolysis and
primaquine should be postponed until the methemoglobinemias; discontinue if
pregnancy is over; instead chloroquine cough or shortness of breath
should be continued at a dose of 310 mg Contra-indications: See under Co-
each week during the pregnancy trimoxazole; sulfonamide allergy
Proprietary Preparations Side-effects: See under Pyrimethamine
Jasoprim (Jayson), Tab.,15mg, Tk.1.26/Tab and under Co-trimoxazole (section
Kanaprim(Globe), Tab. , 15 mg, Tk. 0.62/Tab. 1.1.8.); pulmonary infiltrates (e.g.
P-Phos, (Hudson), Tab., 15mg, Tk. 0.62/Tab. eosinophilic or allergic alveolitis) reported
Remaquin(ACI), Tab., 15mg, Tk. 1.51/Tab.
Dose: Oral:ADULT, pyrimethamine
75 mg with sulfadoxine 1.5 g as a single
PYRIMETHAMINE[ED] dose together with, or after, a course of
quinine: CHILD, up to 4 years and body-
Indications: with sulfadoxine for weight over 5 kg, pyrimethamine 12.5 mg
treatment of Falciparum malaria with (or with sulfadoxine 250 mg; 5–6 years,
following) quinine; with sulfadiazine for pyrimethamine 25 mg with sulfadoxine
treatment of toxoplasmosis in 500 mg; 7–9 years, pyrimethamine
immunocompromised patients; 37.5 mg with sulfadoxine 750 mg; 10–14
Cautions: Renal or hepatic insufficiency, years, pyrimethamine 50 mg with
folate supplements required in sulfadoxine 1 g; 14–18 years,
pregnancy, breast-feeding blood count pyrimethamine 75mg with sulfadoxine
monitoring required in prolonged therapy; 1.5g
history of seizures (avoid large loading
doses) Proprietary Preparations
Interactions: See Appendix-2 Malacide(Square), Tab., 500 mg+25 mg, Tk.
Side-effects: Depression of 4.43/Tab.
hematopoiesis with prolonged treatment; Sulfamin(Jayson), Tab., 500 mg+25 mg, Tk.
nausea, vomiting, diarrhea; headache, 4.43/Tab.
dizziness, rashes; less commonly fever,
abnormal skin pigmentation; very QUININE[ED]
rarely colic, buccal ulceration,
convulsions Indications: First-line drug for treatment
Dose: See Pyrimethamine with of severe, uncomplicated falciparum
Sulfadoxine below malaria in an area with documented
chloroquine-resistant malaria, with
Proprietary Preparations clindamycin first-line therapy for babesial
See under Pyrimethamine with infections; nocturnal leg cramps
Sulfadoxinebelow Cautions: Great cautions required in
patients with underlying cardiac
PYRIMETHAMINE WITH abnormalities (including atrial fibrillation,
SULFADOXINE[ED] conduction defects, heart block), elderly,
monitor ECG during parenteral treatment;
Indications: Adjunct to quinine in the monitor blood glucose and electrolyte
treatment of P.falciparum malaria during parenteral treatment; G6PD
deficiency; renal and hepatic insufficiency
63
1. ANTI-INFECTIVES
require dose adjustment, therapy should pyrimethamine 75 mg with sulfadoxine

be discontinued if signs of cinchonism, 1.5 g; IVquinine 20 mg/kg infuse over 4
hemolysis or hypersensitivity; high doses hours, then10 mg/kg infuse over 4 hours,
are teratogenic in first trimester; but in every 8-12 hourly followed by oral
malaria benefit of treatment considered quinine;
to outweighs risk In nocturnal leg cramps: 200–300 mg
Contra-indications: Visual and auditory of quinine salt at bedtime for at least 4
problems; hemoglobinuria; myasthenia weeks, if improvement, continue
gravis
Interactions: See Appendix-2 Proprietary Preparations
Side-effects: Cinchonism, including Albiquin(Albion), Tab., 300 mg, Tk. 6.40/Tab.
tinnitus, headache, nausea, dizziness, Aloquin(Alco), Tab., 300 mg, Tk.3.40/Tab.
flushing and visual disturbances, Jasoquin(Jayson), Inj., 300 mg/5 ml, Tk.
20.59/Amp. Tab., 300 mg, Tk.6.42/Tab.
abdominal pain, blindness;
hypersensitivity reactions including
rashes, angioneurotic edema, 1.3.2 ANTIAMEBIC DRUGS
bronchospasm; hematologic
abnormalities like hemolysis particularly METRONIDAZOLE[ED] [OTC] [A]
in G-6PD deficient patients, leucopenia,
agranulocytosis, thrombocytopenia; may Metronidazole is effective against
cause hypoglycemia, severe hypotension tropozoites of E. histolytica, G. lamblia,T.
and ECG abnormalities like QT vaginalis, all anaerobic cocci and both
prolongation after rapid IV infusion, rarely anaerobic gram-negative bacilli, including
black water fever that includes marked Bacteroides species, and anaerobic
hemolysis and hemoglobinuria spore-forming gram-positive bacilli. Non-
Dose:treatment of falciparum malaria: sporulating gram-positive bacilli, aerobic
Oral: ADULT,600 mg of quinine salt and facultative anaerobic bacteria as well
every 8 hours for 5–7 days together with as the cysts of E. histolytica are not
or followed by either doxycycline 200 mg sensitive. The drug is completely and
once daily for 7 daysor clindamycin 450 promptly absorbed after oral intake and
mg every 8 hours for 7 days;if the with the exception of placenta,
parasite is likely to be sensitive, penetrates well into body tissues and
pyrimethamine 75 mg with sulfadoxine fluids, including CSF, vaginal secretions,
1.5 g as a single dose (instead of either seminal fluids, and saliva and breast
clindamycin or doxycycline) together milk. It is eliminated in the urine largely
with, or after, a course of quinine 600 mg as metabolites.
every 8 hours for 7 days; CHILD, Indications: See under Dose
10 mg/kg (of quinine salt, max. 600 mg) Cautions: Disulfiram-like reaction with
every 8 hours for 7 days together with or alcohol, repeated therapy requires
followed by leukocyte count before, during and after
Clindamycin 7–13 mg/kg (max. 450 mg) each course of treatment; pregnancy,
every 8 hours for 7 days or in children lactation; great caution in patients with
over 12 years, doxycycline 200 mg once central nervous system disease, drug
daily for 7 days should be withdrawn if numbness or
or if the parasite is likely to be paraesthesia of the extremities occur
sensitive, pyrimethamine with sulfadoxine Contra-indications: First trimester
as a single dose: up to 4 years and pregnancy
body-weight over 5 kg, pyrimethamine Interactions: See Appendix-2
12.5 mg with sulfadoxine 250 mg; 5–6 Side-effects: Dry mouth, metallic taste,
years, pyrimethamine 25 mg with furred tongue, stomatitis, nausea,
sulfadoxine 500 mg; 7–9 years, diarrhea, rashes; headache, dizziness,
pyrimethamine 37.5 mg with sulfadoxine ataxia, erythema multiforme, darkening of
750 mg; 10–14 years, pyrimethamine urine, pruritus, urticaria, angioedema,
50 mg with sulfadoxine 1 g; 14–18 years, anaphylaxis, abnormal liver function
64
1. ANTI-INFECTIVES
tests, hepatitis, jaundice, Proprietary Preparations

thrombocytopenia, aplastic anemia, Amodis(Square), Suspn, 200 mg/5ml, Tk.
myalgia, arthralgia, peripheral 29.89/60ml,; Tab. , 500 mg, Tk. 1.91/Tab. ;
neuropathy in prolonged treatment, 400 mg, Tk. 1.27/Tab. Inj.,( IV Infusion), 500
mg/100 ml, Tk. 53.56/Vial,;
ataxia and transient epileptic seizures Amotrex(ACI), Inj.,( IV Infusion),, 500 mg/100
with high doses; dysuria, cystitis and a ml, TK. 85.26/ Vial;Suspn, 200 mg/5ml, TK.
sense of pelvic pressure also have been 29.9/60ml ,; Tab., 200mg, TK. 0.69/Tab. ;
reported 400mg, TK. 1.27/Tab. ; 800mg, TK. 2.02/Tab.
Dose:Urogenital trichomoniasis, oral: Anzole(Monico), Suspn, 200 mg/5ml, Tk.
ADULT 2 g as a single dose or 250 mg 25.00/60ml,; Tab., 400mg, Tk. 1.14/Tab.
thrice daily or 375 mg twice daily for 7 Benmet(Pacific), Tab.,400 mg, Tk. 1.26/Tab.
Biozyl(Biopharma), Inj.,( IV Infusion),, 500
days; CHILD 1-3 years 50 mg every 8 mg/100 ml, Tk. 75.00/100ml Vial,; Suspen, 200
hours; 3-7 years 100 mg twice daily, 7-10 mg/5ml, Tk. 25.09/60ml,; Tab., 400mg , Tk.
years 100 mg thrice daily; amebiasis, 1.00/Tab.
oral: ADULT 500-750 mg thrice daily for Decagyl(Decent), Tab., 400mg, Tk. 1.00/Tab.
10 days; CHILD 35-50 mg/kg/d in three Dirozyl(Acme), Supp., 500mg., Tk.
divided doses for 10 days; giardiasis, 12.09/Supp,
oral: ADULT 250 mg thrice daily for 5 Filmet(Beximco), Suspn, 200 mg/5ml, Tk.
29.89/60ml,; Tab., 400mg, Tk. 1.52/Tab.;
days; CHILD, 15 mg/kg thrice daily for 5 200mg, Tk. 0.68/Tab.; 800mg, Tk. 2.01/Tab.;
days; anaerobic infections, IV infusion: Inj.,( IV Infusion),, 500 mg/100 ml, Tk.
ADULT 15 mg/ kg followed 6 hours later 54.00/Vial
by 7.5 mg/kg every 6 hours for 7-10 Flagyl(Sanofi), Suspn. , 40mg/ml, Tk.
days; CHILD 7.5 mg/kg every 8 hours; 29.89/Suspn. ; Tab., 200mg, Tk. 0.67/Tab.;
orally, ADULT 800 mg initially then 400- 400mg, Tk. 1.58/Tab.
500 mg every 8 hours; CHILD 7.5 mg/kg Flamyd(Incepta), Suspn, 200 mg/5ml, Tk.
29.50/60ml,; Tab, 400 mg, Tk.
every 8 hours;rectally, 1g every 8 hours 1.05/Tab.; 500mg, Tk. 1.92/Tab.; Vaginal Gel,
for 3 days, then 1g every 12 hours for 7- 750mg/100gm, Tk. 50.00/30gm,; Inj.,( IV
10 days; leg ulcers and pressure sores, Infusion), 500 mg/100 ml, Tk. 53.40/100ml Vial
orally: 400 mg every 8 hours for 7 days; Gly(Astra Bio), Suspn, 200 mg/5ml, Tk.
bacterial vaginosis, orally: 400-500 mg 25.00/5ml
twice daily for 5-7 days or 2 g as a single Kemet(Kemiko), Tab., 400 mg, Tk. 1.26/Tab.
dose: pelvic inflammatory disease, orally, Librazol(Libra), Inj.,( IV Infusion),, 500 mg/100
ml, Tk. 49.90/100ml Vial
400 mg twice daily for 14 days; acute M-Dazole(Modern), Tab., 400 mg, Tk.
ulcerative gingivitis, orally: ADULT 200- 1.20/Tab.
250 mg every 8 hours for 3 days; CHILD Mecozol(Amico), Suspn, 200 mg/5ml, TK.
1-3 years, 50 mg every 8 hours for 3 25.00/60ml,; Tab., 400mg, TK. 1.50/Tab.
days; 3-7 years, 100 mg every 12 hours; Menilet(Alco), Tab. , 400 mg, Tk. 1.57/Tab.
7-10 years, 100 mg every 8 hours; acute Menol(Supreme), Suspn, 200 mg/5ml, Tk.
dental infections, oral: 200 mg every 8 25.75/60ml,; Tab., 400 mg, Tk. 1.14/Tab.
Metco(Eskayef), Inj.,( IV Infusion),, 500 mg/100
hours for 3-7 days; Helicobacter pylori ml, Tk. 60.18/ 100ml Vial,; , Suspn, 200
eradication, oral: 400 mg twice/thrice mg/5ml, Tk. 29.89/60ml,; Tab., 400mg, Tk.
daily; 1.26/Tab.;
surgical prophylaxis, oral: 400 mg every Metfil(Bristol), Tab. , 400mg , Tk. 1.00/Tab.
8 hours started 24 hours before surgery, Metonid(Popular), Tab. , 400mg, Tk.
then continued postoperatively by IV 1.14/Tab.; Inj.,( IV Infusion), 500 mg/100 ml,
infusion or by rectum until oral Tk. 52.95/100ml Vial
Metrion(General), Inj.,( IV Infusion),, 500
administration can be resumed; CHILD mg/100 ml, Tk. 80.24/100ml Vial,; Tab. ,
7.5 mg/kg every 8 hours; through rectum: 400mg, Tk. 1.14/Tab.; Suspn, 200 mg/5ml,
1 g every 8 hours; CHILD 5-10 years, Tk.25.76/60ml
500 mg every 8 hours; IV infusion: 500 Metro(Ziska), Suspn, 200 mg/5ml, Tk.
mg shortly before surgery then every 8 25.00/60ml,; Tab, 400 mg, Tk. 1.05/Tab.
hours until oral administration can be Metrobac(Ziska), Inj.,( IV Infusion), 500
started; CHILD 7.5 mg/kg every 8 hours mg/100 ml, Tk. 53.00/100 ml Vial
65
1. ANTI-INFECTIVES
Metromax(Novo ), Tab. , 250 mg, Tk. Xynor(Beximco), Tab., 500 mg, Tk. 6.50/Tab.
0.78/Tab.; 500 mg, Tk. 1.35/Tab.;IVInfusion,
500 mg/100 ml, Tk. 52.00/100ml Val SECNIDAZOLE
Metrozen(Zenith), Suspn, 200 mg/5ml, Tk.
21.44/60 ml,; Tab., 400 mg, Tk. 1.07/Tab. Indications: Amebiasis, and has also
Metryl(Opsonin), Inj.,( IV Infusion),, 500 mg , been tried in giardiasis, and
Tk. 53.57/100 ml Vial,; Tab., 200 mg , trichomoniasis.
Tk.0.67/Tab. ; 400 mg , Tk. 1.27/Tab. ; 500 mg Cautions, Contraindications & Side-
, Tk. 1.91/Tab. ; Suspen, 200 mg/5ml, Tk. effect: See under Metronidazole
29.59/ 60 ml,; Dose: Oral: Giardiasis: ADULT, single
Metsina(Ibn Sina), Inj.,( IV Infusion),, 500
dose of 2g; CHILD, 30mg/kg; invasive
mg/100 ml, Tk. 75.00/100ml Vial,; Tab., 400
mg, Tk. 155.00/Tab. hepatic amebiasis ADULT, 1.5g single
Mez iv(Renata), Inj.,( IV Infusion),, 500 dose or in divided doses for 5 days
mg/100 ml, Tk. 70.00/100 ml Vial
Micogyl(Globe), Tab. , 400 mg, Tk. 1.20/Tab.; Proprietary Preparations
IVInfusion, 500 mg/100 ml, Tk. 53.41/100 ml Pronil(Acme), Tab., 1 gm., Tk. 16.11/Tab., 500
Vial mg., Tk. 8.66/Tab.
Nidazyl(Orion), Suspn, 200 mg/5ml, Tk. Secnid(Square), Tab., 1 gm, Tk. 20.06/Tab.
29.89/60ml,; Tab. , 400 mg, Tk. 1.05/Tab. Secnidal(Sanofi), Tab., 1 gm, Tk. 25.46/Tab.
Strazyl(Asiatic), Suspn., 4gm/100ml, Tk. Secnizol(Incepta), Tab., 1 gm, Tk. 16.00/Tab.
24.84/60ml,; Tab., 200mg, Tk. 0.66/Tab. ; Sezol (ACI), Tab., 1 gm, Tk. 17.05/Tab.
400mg , Tk. 1.02/Tab.
TINIDAZOLE
ORNIDAZOLE Indications: See under Dose
Cautions: See under Metronidazole;
Indications: Treatment of susceptible also avoid breast-feeding during and for
protozoal infections and treatment and 3 days after stopping treatment
prophylaxis of anaerobic bacterial Contra-indications: Acute porphyria;
infections also see under Metronidazole
Cautions: See under metronidazole; Interactions: See Appendix-2
also blood dyscrasia; doses should be Side-effects: See under Metronidazole
reduced in patients with severe liver Dose: Oral: intestinal amebiasis: ADULT
disease and CHILD 12-18 years, 2 g daily in a
Interactions: See Appendix-2 single dose for 3 days, CHILD, 1 month-
Side-effects: See under metronidazole 12 years, 50-60 mg/kg (max. 2 g) once
Dose: IV infusion:severe amoebic daily for 3 days; hepatic amebiasis:
dysentery and amoebic liver abscess: 0.5 ADULT and CHILD 12-18 years, 1.5-2 g
to 1 gm initially, followed by 500mg every once daily for 3-6 days, CHILD, 1 month-
12 hours for 3 to 6 days; 12 years, 50–60 mg/kg (max. 2 g) once
Oral:amebiasis: ADULT: 500mg twice daily for 5 days; giardiasis and
daily for 5-10 days; CHILD :25 mg/kg trichomoniasis, , ADULT and CHILD 12-
daily 500mg as a single dose 5-10 18 years, 2 g as a single dose (repeat
days;giardiasis, ADULT:1 or 1.5 g as a once if required) , CHILD 1 month–12
single daily dose for 1 or 2 days; CHILD years single dose of 50–75 mg/kg (max.
:500mg as a single dose;trichomoniasis, 2 g) (repeat once if necessary)
a single dose of 1.5 g or 1 gm together anaerobic infections, oral: treatment, 2 g
with 500 mg vaginally; 5 day course of initially then 1 g daily for minimum 5-6
500 mg twice daily are also used, (sexual days; prophylaxis 2 g as a single dose;
partners should be treated concomitantly) by slow IV infusion: treatment, 800 mg
daily, prophylaxis, 1600 mg as a single
Proprietary Preparations dose;
OR-500(Zenith), Tab. 500 mg, Tk. 6.52/Tab. bacterial vaginosis and acute ulcerative
Ornid(Drug Intl), Tab., 500 mg, Tk. 7.05/Tab. gingivitis, 2 g as a single dose;
Ornil(Opsonin), Tab., 500 mg, Tk. 7.00/Tab.
Ornizol(Alco), Tab., 500 mg, Tk. 6.02/Tab.
abdominal surgery prophylaxis, a single 2
Robic(Square), Tab., 500 mg, Tk. 7.02/Tab. g dose approximately 12 hours before
Troniz(UniMed), Tab , 500 mg, Tk. 6.50/Tab. surgery; CHILD 50-60 mg/kg/d.
66
1. ANTI-INFECTIVES
Proprietary Preparations Nidor(Pharmasia), Susp., 100 mg/ 5 ml, Tk.

Tinizol DS(Beacon), Tab. , 1 gm, Tk. 5.72/Tab. 50.00/60 ml; Tab., 500 mg, Tk. 10.04/Tab.
T-Zol(Popular), Tab. , 500 mg, Tk. 2.77/Tab.; 1 Nidozox(Acme), Suspn, 100 mg/5 ml, Tk.
gm, Tk. 5.75/Tab. 40.12/30ml,; Tab., 500.00 mg, Tk. 10.07/Tab.
Nitalet(Amulet), Tab., 500 mg, Tk. 10.00/Tab.
Nitanid(Drug Intl), Suspn, 100 mg/5 ml, Tk.
1.3.3.DRUGS FOR TRICHOMONIASIS 50.20/60ml,; Tab., 500mg, Tk. 10.05/Tab.
Nitasis(Navana), Susp., 100 mg/ 5 ml, Tk.
1.3.4 ANTIGIARDIAL DRUGS 35.00/30 ml, Tk. 10.00/Tab.
Nitasol(Ibn Sina), Suspn, 100 mg/5 ml, Tk.
36.00/30ml,; Tk. 50.00/60ml,; Tab.,500mg, Tk.
Giardiasis, caused by the flagellated 132.00/Tab.
protozoan Giardia lamblia, can be Nitax(Delta), Tab., 500 mg, Tk. 8.00/Tab.
successfully treated by metronidazole Nitaxen(Leon), Susp., 100 mg/ 5 ml, Tk.
and related nitroimidazoles like tinidazole 35.00/30 ml; 500 mg, Tk. 10.00/Tab.
and scenidazole. Other than these, Nitaxide(Beximco), Tab., 500mg, Tk.
10.00/Tab.;Suspn, 100 mg/5 ml, Tk.
paromomycin and nitazoxanide are also
35.00/30ml,;Tk. 50.00/60ml
used for clinical cure. Nitazet(Organic), Tab. , 500 mg, Tk.
10.03/Tab. ; Suspn, 100 mg/5 ml, Tk.
NITAZOXANIDE 35.11/30ml , 100 mg/5 ml, Tk. 50.15/60ml
Nitazox(Incepta), Suspn, 100 mg/5 ml, Tk.
50.00/60ml,; Tk. 1.167/30ml,; Tab.,Tk.
Indications: Treatment of G intestinalis 10.00/Tab.
infections and treatment of diarrhea Nitide(Nipro JMI), Susp., 100 mg/ 5 ml, Tk.
caused by cryptosporidia 35.00/30 ml; Tk. 50.00/60 ml; Tab., 500mg , Tk.
Cautions:Pregnancy, breast-feeding; 10.00/Tab.
greenish discoloration of urine Nitoxin(Aristo), Suspn, 100 mg/5 ml, Tk.
Interactions:See Appendix-2 36.00/30ml, Tk. 50.00/60ml,; Tab., 500mg , Tk.
Side-effects: GI disturbances: 10.00/Tab.
Nixar(Sharif), Susp., 100 mg/ 5 ml, Tk.
abdominal pain, nausea, vomiting, 35.00/30 ml; Tab. 500 mg, Tk. 10.00/Tab.
iarrhea; headache; rarely, fever, malaise, Nizox(Somatec), Suspn, 100 mg/5 ml, Tk.
pruritus, dizziness, rhinitis 35.00/30ml,; Tab., 500 mg, Tk. 10.03/Tab.
Dose: Oral: ADULT, 500 mg twice daily Ntz(Asiatic), Suspn, 100 mg/5 ml, Tk.
for 3 days; CHILD, 12-47 months, 100 35.00/30ml,Tk. 50.00/60ml
mg twice daily for 3 days; 4-11 years, Proxa-A(Ad-din), Tab., 500 mg, Tk. 9.00/Tab.;
200 mg twice daily for 3 days Susp. , 100 mg/5 ml, Tk. 35/30 ml
Tazonid(Popular), Suspn, 100 mg/5 ml, Tk.
32.12/30mll
Proprietary Preparations Tazox(Novo Health), Suspn, 100 mg/5 ml, Tk.
Adnix(Alco), Suspn, 100 mg/5 ml, Tk. 35.00/30ml,; Tab. , 500 mg, Tk. 10.00/Tab.
35.11/30ml ,; Tab. , 500 mg, Tk. 10.03/Tab. Toza(Eskayef), Suspn, 100 mg/5 ml, Tk.
Albizox(Albion), Susp., 100 mg/ 5 ml, Tk. 35.00/30ml,; Tk. 50.00/60ml,; Tab, 500mg, Tk.
50.00/60 ml 10.00/Tab.; Tk. 10.00/Tab.
Alinix(Healthcare), Suspn, 100 mg/5 ml, Tk. Xanide(Globe), Suspn, 100 mg/5 ml, Tk.
35.00/30 ml,; Tk. 50.00/60 ml ,; Tab., 500mg , 35.00/30 ml,; Tk. 50.00/60 ml,; Tab. , 500 mg,
Tk. 300.00/Tab. 10.00/Tab
Antizoa(RAK), Susp., 100 mg/ 5 ml, Tk. Xanita(Renata), Suspn, 100 mg/5 ml, Tk.
35.00/30 ml; Tab. 500 mg, Tk. 10.00/Tab. 40.00/30ml,; Tk. 58.00/60ml,; Tab. , 500mg,
Atinid(Biopharma), Suspn, 100 mg/5 ml, Tk. Tk. 10.04/Tab.
35.13/30ml,; Tk. 50.19/60 ml,; Tab., 500 mg, Zoana(Orion),Suspn, 100 mg/5 ml, Tk.
Tk. 10.04/Tab. 50.24/62ml,; Tk. 35.24/32ml,; Tab. , 500mg,
Dianide(General), Tab. 500mg, Tk. Tk. 10.07/Tab.
10.07/Tab.; Suspn, 100 mg/5 ml, Tk. Zonan(MST), Susp. , 100 mg/5 ml, Tk. 35/30
50.34/60ml,; Tk. 35.25/30ml ml; Tk.50/60 ml ; Tab., 500 mg, Tk. 10/Tab.
Diar(ACI), Suspn, 100 mg/5 ml, Tk. Zox(Square), Tab. , 500 mg, Tk. 10.07/Tab.;
35.24/30ml ,; Tk. 50.34/60ml ,; Tab., 500mg, Suspn, 100 mg/5 ml, Tk.35.24/30gm; Tk. .
Tk. 10.07/Tab. 50.35/60 ml
Nicud, (Monico), Suspn, 100 mg/5 ml, Tk.
35.00/30ml
67
1. ANTI-INFECTIVES
Zoxan(Opsonin), Suspn, 100 mg/5 ml, Tk. treatment; predisposition to QT interval

50.19/ 60 ml ,; Tk. 35.13/30 ml,; Tab., 500 mg, prolongation, concomitant use with drugs
Tk. 10.07/Tab. that prolong the QT interval
Zoxanid(Silva), Tab., 500mg, Tk. 10.04/Tab.;
Suspn, 100 mg/5 ml, Tk. 35.13/ 30 ml; Tk.
Contra-indication: Significant renal
50.19/60ml impairment
1.3.5 DRUGS FOR LEISHMANIASIS Side-effects: Anorexia, nausea,
vomiting, abdominal pain; ECG changes;
(See section 1.2) headache, lethargy, myalgia; raised liver
The classic therapy for all species of enzymes; coughing and substernal pain;
Leishmania is pentavalent antimony rarely anaphylaxis; and also reported,
(sodium antimony gluconate, sodium fever, sweating, flashing, vertigo,
stibogluconate). As an alternative, bleeding from nose and gum, jaundice,
Liposomal amphotericin B is a highly rash; pain and thrombosis on IV
effective agent for visceral leishmaniasis administration, intramuscular injection
and currently drug of choice in antimony- also painful
resistant disease. Pentamidine isetionate Dose:Visceral leishmaniasis: IM or IV inj.
can be also used in antimony-resistant (injection should be filtered immediately
leishmaniasis. Other drugs include before administration using a filter of
Paromomycin, parenterally for visceral 5 microns or less), ADULT and CHILD,
disease and topical formulation for 20 mg/kg/d for 28 days; cutaneous
cutaneous form, and the orally active leishmaniasis: except L. aethiopica, L.
agent Miltefosine, both for visceral and braziliensis, L. amazonensis, by
cutaneous diseases. intralesional inj. ADULT and CHILD 100-
300 mg into base of lesion, repeated if
SODIUM STIBOGLUCONATE[ED] required, once or twice at intervals of 1-2
days; by IM inj. ADULT and CHILD 10-20
This pentavalent antimonial is effective mg/kg daily until a few days after clinical
against cutaneous as well as visceral cure and negative slit-skin smear; in
leishmaniasis (kala-azar). It is rapidly cutaneous lesion due to, L. braziliensis
absorbed after parenteral (IM or IV inj.) and L. amazonensis, dose is 20 mg/kg
administration and exhibits two phase- daily; mucocutaneous leishmaniasis due
elimination, i.e. with short (about 2 hours) to L. braziliensis: IM inj. ADULT and
and long (> 24 hours) half-life. CHILD 20 mg/kg daily until negative slit-
Indications: Leishmaniasis skin smear or for at least 4 weeks; if
Cautions: Renal and hepatic relapse or unresponsive treatment with
impairment, pregnancy; protein-rich diet pentamidine isetionate or amphotericin-B
should be provided through out treatment
period, iron and other nutritional Generic Preparation
deficiencies and intercurrent infections Injection, 100mg/ml
required to be corrected; monitoring of
cardiac, renal and hepatic functions, MILTEFOSIN
dose reduction or withdrawal of therapy if Indications: Visceral and cutaneous
any abnormality; IV injections must be leishmaniasis
given slowly over 5 minutes (to reduce Cautions: Pregnancy and breastfeeding
the risk of local thrombosis) and stopped Side-effects:Nausea and vomiting,
if coughing or substernal pain; treatment Contra-indication: Pregnancy
of mucocutaneous leishmaniasis may Dose: ADULT- >25kg: 100mg/day, twice
induce severe inflammation around the a day, for 28days;<25kg: 50mg/day,
lesions (may be life-threatening if twice a day, for 28 days.
pharyngeal or tracheal involvement, may
require corticosteroid); heart disease Proprietary Preparation
(withdraw if conduction disturbance- Miltefos(Popular), Cap., 10mg, Tk. 60.23/Tab.;
occurs); monitor ECG before and during 50mg , Tk. 160.60/Tab.
68
1. ANTI-INFECTIVES
primary or recurrent genital herpes

1.4 ANTIVIRAL DRUGS infection requires administration of
1.4.1 DRUGS FOR HERPES VIRUS systemic antiviral drug. Treatment should
INFECTIONS start as early as possible and usually
1.4.2 DRUGS FOR VIRAL HEPATITIS within 5 days of the appearance.
1.4.3 DRUGS FOR INFLUENZA AND Varicella-zoster infection (chicken pox) in
RESPIRATORY SYNCTIAL healthy children between 1 month and 12
VIRUS years is usually mild and does not require
1.4.4 DRUGS FOR HIV INFECTION treatment.
Antiviral agents, similar to the ACICLOVIR

antibacterials, are most active when (Acyclovir)
viruses are replicating.Antiviral drugs
inhibit virus replication in different ways: Indications: Herpes simplex
by directly acting on virus-specific encephalitis, primary and recurrent
proteins and by modulating host genital herpes, herpes simplex skin
immune system. The first category infections, including initial and recurrent
drugs are: Aciclovir, Cidofovir, labial and genital herpes (as a cream),
Famciclovir, Idoxuridine, Valaciclovir, disseminated varicella-zoster in
Adefovir Dipivoxil, Entecavir, immunocompromised patients, neonatal
Telbivudine, Tenofovir Disoproxil, herpes simplex infection
Amantadine, Rimantadine, Cautions: Maintain adequate hydration;
Oseltamivir, zanamavir, Lamivudine, renal impairment requires dose
Zidovudine, Didanosine, Zalcitabine, reduction; pregnancy, breast-feeding,the
Stavudine, Ganciclovir, Tribavirine. ophthalmic ointment causes a mild
The second category includes transient stinging sensation and a diffuse
Interferons and Inosinepranobex. superficial punctate keratopathy which
clears when the drug is stopped
1.4.1 DRUGS FOR HERPES Interactions: See Appendix-2
VIRUSINFECTIONS Side-effects: Rashes, gastrointestinal
1.4.1.1 DRUGS FOR HERPES disturbances; rises in bilirubin and liver
enzymes, increases in blood urea and
SIMPLEXAND VARICELLA-
ZOSTER creatinine, decreases in hematological
1.4.1.2 DRUGS FOR indices, headache, neurological
reactions, dizziness; also confusion,
CYTOMEGALOVIRUS
hallucinations, agitation, tremors,
1.4.1.1 DRUGS FOR HERPES somnolence, psychosis, convulsions and
SIMPLEX AND coma; extravasation of intravenous
VARICELLA-ZOSTER infusion fluid may cause severe local
INFECTIONS inflammation sometimes leading to
ulceration
Herpes Infection of the mouth, lips and Dose:By mouth Herpes simplex
eye is generally associated with herpes (treatment) 200 mg (400 mg in the
virus serotype 1 (HSV-1) and genital immunocompromised or if absorption is
infection is most often associated with impaired) 5 times daily, usually for 5
HSV-2 and also with HSV-1. Mild days; CHILD under 2 years, half of adult
infection of the eye (ocular herpes) and dose, over 2 years, adult dose
of the lips (herpes labialis) in Herpes simplex (prevention or
immunocompetent individuals is treated recurrence) 200mg 4 times daily or
with a topical antiviral whereas severe 400mg twice daily possibly reduced to
infection, neonatal herpes, infection in 200 mg 2 or 3 times daily and interrupted
immunocompromised individuals, and every 6-12 months
69
1. ANTI-INFECTIVES
Herpes simplex (prophylaxis) in the Xovir(Beacon), Inj.( IV, Infusion),

immunocompromised, 200-400mg 4 250mg/100mlml ,Tk. 401.2/vial.; 500mg/100ml ,
times daily; CHILD under 2 years, half of Tk. 702.11/vial.
adult dose, over 2 years, adult dose;
VALACICLOVIR
Varicella and herpes zoster (treatment)
ADULTS 800mg 5 times daily for 7 days;
CHILD 20 mg/kg (max. 800 mg) 4 times Indications:See under acyclovir; also
daily; 2-5 years 400mg 4 times daily over prevention of cytomegalovirus (CMV)
6 years, 800 mg 4 times daily disease following solid organ
By intravenous infusion (treatment of transplantation when valganciclovir or
herpes simplex in the immunocom- ganciclovir cannot be used
promised, severe initial genital herpes, Cautions, Contra-indications:See
and varicella-zoster) 5mg/kg every 8 under acyclovir
hours usually for 5 days, doubled to 10 Interactions:See Appendix-2
mg/kg every 8 hours in varicella-zoster in Side-effects: See under acyclovir;
the immunocompromised and in simplex neurological reactions more frequent in
encephalitis (usually given for 10 days in high doses
encephalitis); prophylaxis of herpes Dose: Oral:Herpes simplex (treatment)
simplex in the immunocompromised, 500 mg twice daily for 5 days (1 g twice
5mg/kg every 8 hours daily in immunocompromised or HIV
NEONATE: up to 3 months, herpes patients); CHILD under 2 years, half of
simplex, 10mg/kg every 8 hours usually adult dose, over 2 years, adult dose
for ten days; CHILD 3 months-12 years; Herpes labialis, treatment, ADULT and
herpes simplex or varicella-zoster, 250 CHILD over 12 years, 2 g 12 hourly
mg/m2 every 8 hours usually for 5 days, Herpes simplex, suppression, 500 mg
doubled to 500 mg/m2 every 8 hours for daily in 1-2 divided doses in
varicella-zoster in the immunocom- immunocompromised or HIV
promised and in simplex encephalitis patients,500mg twice daily; herpes zoster
(given for 10 days in encephalitis) treatment, 1 g three times daily for 7 days
(See sec.10.2.3&12.2.3.) Prevention of CMV disease following
solid organ transplantation, 2 g 4 times
Proprietary Preparations daily usually for 90 days
Acerux(Opsonin),;Inj.( IV, Infusion), 250
mg/100 ml, Tk. 400.00/100 ml; 500 mg/100 ml, Proprietary Preparations
Tk. 700.00/100 ml;Suspn 200 mg /5ml, Tk. Alaclov(ACI), Tab., 500mg , Tk. 40.15/Tab.
125.47/70 ml; Tab. , 200 mg, Tk. 14.05/Tab.; Revira(Square), Tab., 1 gm, Tk.75.00/Tab.,
400 mg , Tk. 22.00/Tab. 500 mg , Tk. 40.15/Tab.
Acyvir(Aristo), Inj.( IV, Infusion), 250mg/100 Valovir(Incepta), Tab., 1 mg, Tk. 75.00/Tab;
ml, Tk. 400.00/Vial, 500 mg/100 ml, Tk. 500 mg, Tk. 40.00/Tab.
700.00/Vial
Novirax(Drug Intl), Tk. 40.15/Tab.; 200mg, Tk. 1.4.1.2 DRUGS FOR
14.05/Tab.; 400mg, Tk. 22.10/Tab.
.
CYTOMEGALOVIRUS
Simplovir(Incepta), Inj.( IV, Infusion),, (CMV) INFECTIONS
250mg/100 mlTk. 400.00/vial;500 mg/100 ml, GANCICLOVIR
Tk. 700.00/Vial;Tk. 1000.00/100ml;Tab. Tk. (See section 10.2.3)
22.00/Tab. ,Tk. 14.00/Tab.
Viroxi(Eskayef), Tab., 200mg, Tk. 14.00/Tab.
Virunil(Globe), Inj.( IV, Infusion), 250 Indications: life-threatening or sight-
mg/100ml,Tk. 400.00/Vial; 500 mg/100ml, Tk. threatening CMV infections in
700.00/Vial immunocompromised patients only;
Virux(Square), Inj.( IV, Infusion), 250 prevention of CMV disease during
mg/100ml, Tk. 401.20/vial.; 500 mg/100ml, immunosuppressive therapy following
Tk.702.11/vial.;Suspn, 200 mg/5 ml, organ transplantation; local treatment of
Tk.125.85/70ml;Tab., 200
CMV retinitis; congenital cytomegalovirus
mg,Tk.14.1/Tab.;Tab. , 400 mg, Tk. 22.14/Tab.
infection of the CNS
70
1. ANTI-INFECTIVES
Cautions: history of cytopenia; (See section 10.2.3 for Eye preparation)

radiotherapy; ensure adequate hydration
during intravenous administration; infuse 1.4.2.1 DRUGS FOR VIRAL
into vein with adequate flow preferably HEPATITIS
using plastic cannula; children, renal Use of drugs for treatment and/or
insufficiency,potential carcinogen and prophylaxis of viral heapatitis demands
teratogen advice of a specialist. The management
Contra-indications: Hypersensitivity to of acute viral hepatitis is largely
valganciclovir, ganciclovir, aciclovir, or symptomatic. Chronic hepatitis is maily
valaciclovir; abnormally low hemoglobin, due to infections caused by hepatitis B
neutrophil, or platelet counts; pregnancy, (HVB) and hepatitis C (HCV) viruses and
breast-feeding (until 72 hours after last a number of drugs are available for
dose) treating those infections.
Interactions: See Appendix -2 Treatment of Chronic hepatitis: In
Side-effects: Leucopenia, contrast to hepatitis C which is supposed
thrombocytopenia; GI disturbances, to be curable in all affected individual,
hepatic dysfunction, peripheral hepatitis B is capable of establishing
neuropathy, depression, anxiety, lifelong chronic infection in ~10% of
confusion, anorexia, night sweats; patients. Blood is the main source of
myalgia, arthralgia; macular edema, infection and spread may follow
retinal detachment, vitreous floaters, transfusion of infected blood or blood
pruritus,disturbances in hearing and products or result from injections with
vision, and alopecia contaminated needle (most common
Dose: IV infusion: initially 5 mg/kg every among parenteral drug abusers who
12 hours for 14–21 days for treatment or share needles). Products such as
for 7–14 days for prevention; albumin solution and gammaglobulins,
maintenance (for patients at risk of which are pasteurized, are wholly free of
relapse of retinitis) 6 mg/kg daily on 5 risk.Patients with chronic HBV may
days per week or 5 mg/kg daily until develop active hepatitis that can lead to
adequate recovery of immunity; if retinitis fibrosis and cirrhosis and all such
progresses initial induction treatment individuals have a greatly increased
may be repeated; Maintenance treatment incidence of hepatocellular carcinoma.
in AIDS patients where retinitis stable Interferon (IFN) alone or in combination
(following at least 3 weeks of intravenous with ribavirin can cure patients with
ganciclovir), oral: 1g 3 times daily with chronic infection but is associated with
food or 500mg 6 times daily with food in high rates of side effects, often leading to
renal impairment; CHILD, 1 month–18 premature treatment withdrawal. Drugs
years initially (induction) 5 mg/kg every like entecavir, adefovir dipivoxil,
12 hours for 14–21 days for treatment or lamivudine, and telbivudine and tenofovir
for 7–14 days for prevention; disoproxil with potent anti-HBV activity
maintenance (for patients at risk of are much better tolerated than IFN-
relapse of retinitis), 6 mg/kg daily on 5 containing regimens but are not usually
days per weekor 5 mg/kg daily until curative. Tenofovir disoproxil or its
adequate recovery of immunity; if retinitis combination with either emtricitabine or
progresses initial induction treatment lamivudine may be used with other
may be repeated; antiretrovirals in patients who require
Congenital cytomegalovirus infection of treatment for both HIV and chronic
the CNS:IV infusion: NEONATE, 6 mg/kg hepatitis B.
every 12 hours for 6 weeks
Cymevene(I) (Roche), IV infusion) 500mg/Vial,
Tk. 3,981.00/Vial
71
1. ANTI-INFECTIVES
ADEFOVIR DIPIVOXIL
Indication: Chronic hepatitis B infection Virodacla (Incepta), Tab., 60 mg, Tk.400/Tab.
Dakovir(Beximco), Tab., 60mg, Tk. 300/Tab.
with either compensated liver disease Dakla (Healthcare), Tab., 60mg, Tk. 400/Tab.
with evidence of viral replication and Daclavir (Beacon),Tab., 60mg, Tk.400/Tab.
histologically documented active liver
inflammation and fibrosis or decomposed
ENTECAVIR
liver disease
Cautions: Monitor renal function in every Indications: Treatment of chronic HBV
3 months, more frequently in renal infection with active viral replication and
Impairment and in patient receiving either evidence of persistence elevations
nephrotoxic drugs ; monitor liver function in serum aminotransferases or
and viral and serological markers for histologically active disease
hepatitis B every 6 months; discontinue if Caution: Monitoring of hepatic function
deterioration in liver function, hepatic every 3 months and viral and serological
steatosis, progressive hepatomegaly or markers for HBV infection every 3-6
unexplained lactic acidosis; pregnancy months during treatment (monitoring
Contraindication: Breast feeding continued for at least 1 year after
Side-effects: Abdominal pain, nausea, discontinuation), therapy discontinue if
vomiting, dyspepsia, flatulence, detoriation in liver function, hepatic
diarrhoea, asthenia, headache, renal steatosis, progressive hepatomegaly or
failure; hypophosphatemia unexplained lactic acidosis; dose
Dose: ADULT over 18 years, 10mg/day reduction if GFR < 50 ml/min/1.732;
pregnancy and breast-feeding
Proprietary Preparations Interactions: See Appendix-2
Antiva(Square), Tab. 10 mg, Tk. 35.14/Tab. Side-effects: headache, fatigue,
Adfovir(Sun), Tab. 10 mg, Tk. 25.17/Tab. dizziness, nausea, vomiting, dyspepsia,
Infovir(Incepta), Tab. 10 mg, Tk. 35.00/Tab. diarrhea, raised serum amylase and
Rezoven(Beximco),Tab.,10mg, Tk. 35.00/Tab lipase; less commonly,
thrombocytopenia, rash, alopecia
DACLATASVIR Dose: Oral: adult over 18 years: not
Indications: In combination with previously treated with nucleoside
Sofosbuvir for the treatment of chronic analogue, 500 micrograms once daily,
hepatitis C virus (HCV) infection in lamivudine-resistant chronic hepatitis B,
adults. 1 mg once daily
Caution
&Contraindications:Hypersensitivity to Proprietary Preparations
the active substance or to any of the Barcavir(Incepta), Tab., 1mg, Tk.90/Tab.;500
excipients,should not be used during mcg, Tk. 48.00/Tab.
Cavir(Square), Tab., 1 mg, Tk. 90.27/Tab.; 500
pregnancy or in women of childbearing mcg,Tk. 48.14/Tab.
,breast feeding Contraindicated in Caviral(Beacon), Tab., 500 mcg, Tk.
combination with medicinal products that 60.18/Tab.
strongly induce CYP3A4 and P-gp, Encavir(Popular), Tab., 0.5 mg, Tk.
Side-effects: Weakness, tiredness, 65.25/Tab.; 1 mg Tk. 120.45/Tab.
headache, nausea, skin rash, Entavir(Drug Intl), Tab. , 500 mcg , Tk.
diarrhea.Sleep disturbances, anemian 45.15/Tab.; 1mg, Tk. 90.30/Tab.
Entavir(Opsonin), Tab., 1 mg, Tk.
combination with sofosbuvir- fatigue, 79.47/Tab.; 0.5 mg, Tk. 42.38/Tab.
headache, and nausea Enteca(Renata), Tab, 500 mcg , Tk.
Dosage :The recommended dose of 48.00/Tab.
Daclatasvir is 60 mg once daily, to be Enviral(Opsonin), Tab., 500 mcg, Tk.
taken orally with or without meals. 48.18/Tab.; 1 mg , Tk. 90.34/Tab.
Daclatasvir must be administered in Genevir(General), Tab., 1mg, Tk. 90.27/Tab.;
combination with other medicinal 500 mcg, Tk. 48.14/Tab.
Tecavir(Aristo), Tab., 1mg, Tk. 90.00/Tab.; 500
products.Consult product literature
mcg, Tk. 3.00/Tab.
72
1. ANTI-INFECTIVES
Tecavir(Aristo), Tab., 0.5 mg, Tk. 48.00/Tab.; 1 Proprietary Preparations

mg, Tk. 90.00/Tab. Buviren(Renata), Tab. , 400mg, Tk. 600/Tab.
Teviral(ACI), Tab., 500 mcg , Tk. 3.00/Tab.; Hopetavir(Incepta), Tab., 400mg, Tk.
1mg , Tk. 100.30/Tab .; Syrup, 5mg/100ml, 600.00/Tab.
Tk. 220.00/70ml,; Hopso(Drug Intl), Tab. , 400mg, Tk.
Teviral(ACI), Tab., 5mg, Tk. 48.18/Tab.; 1 450.00/Tab.
mg,Tk. 90/Tab. Sofo(Aristopharma), Tab., 400mg , Tk.
Vir(Acme), Tab. , 500 mcg, Tk. 48.14/Tab. 600.00/Tab.
Virenta(Eskayef), Tab, 500 mcg, Tk. Sofomax(ACI), Tab., 400mg , Tk. 700.00/Tab.
48.00/Tab. Soforal(Beacon), Tab. , 400mg , Tk.
600.00/Tab.
SOFOSBUVIR Sofovir(Beximco), Tab., 400mg, Tk.
350.00/Tab.
Indications: For the treatment of
Sovalvir(Healthcare), Tab., 400mg, Tk.
chronichepatitis C (CHC) infection as a 6031.97/Tab.
component of a combination antiviral Soventa(Eskayef), Tab, 400mg, Tk.
treatment regimen 600.00/Tab.
Caution: Not recommended for Suvirux(Square), Tab. , 400 mg, Tk.
administration as monotherapy; special 600.00/Tab.
monitoring required in liver problems
Sofosbuvir400mg and Velpatasvir100mg
,current or previous infection with the
Fixvel(Beacon), Tab., Tk.1000.00/Tab.
hepatitis B virus,kidney problems ,blood Panovir(Incepta), Tab., Tk.1000.00/Tab.
tests is must before, during and after
your treatment with Sofosbuvir
INTERFERONS (IFNs)
Contra-indications: When used in
combination with peginterferon
alfa/ribavirin or ribavirin alone, all INTERFERON ALFA
contraindications to peginterferon alfa
and/or ribavirin also apply to its Indications: IFN alfa-2a and alfa 2b:
combination therapy.Because ribavirin chronic hepatitis B and chronic hepatitis
may cause birth defects and fetal death, C ideally in combination with ribavirin;
Sofosbuvir 400mg tablet in combination chronic myelogenous and hairy cell
with peginterferon alfa/ribavirin or leukemia, follicular lymphoma, adjunct to
ribavirin is contraindicated in pregnancey surgery in malignant melanoma;
and in men whose female partners are IFN alfa-2a: AIDS-related Kaposi’s
pregnant.avoid inbreast feeding. sarcoma, progressive cutaneous T-cell
Side-effects: Most common adverse lymphoma
events observed with it in in combination IFN alfa-2b: lymph or liver metastases of
with peginterferon alfa and ribavirin were carcinoid tumor, maintenance of
fatigue, headache, nausea, insomnia and remission in multiple myeloma
anemia;anxiety,blurred vision , memory Cautions: See notes above; monitoring
loss, loss of concentration,weight loss , of lipid profile
stomach discomfort, constipation, dry Contra-indications: Avoid injections
mouth, indigestion, acid reflux ,hair loss containing benzyl alcohol in neonates
andryskin,back pain, muscle spasms , Interactions: See Appendix-2
chest pain, feelingweak,nasopharyngitis. Side-effects: Influenza like syndrome
Dose: For Adults and Paediatric fatigue and depression which disappear
Population is one 400 mg tablet, taken on lowering the dose; other effects are
orally, once daily with food. anorexia, convulsions, hypotension,
Consideration should be given to hypertension, cardiac dysrhythmias and
potentially extending the duration of bone marrow depression; also reported
therapy according to different genotypes nephrotoxicity, hepatotoxicity and severe
of CHC beyond 12 weeks and up to 24 hypertriglyceridemia
weeks ; Dose: See section 14.2.4.
73
1. ANTI-INFECTIVES
Hepatitis B: IFN-2b, 5-10 mU in Caution: Dose adjustment required in

ADULTand 6 mU/m2 in CHILD thrice renal insufficiency; pregnancy, breast-
weekly for 4-6 weeks,Hepatitis C: 3 mU feeding; also see notes above
thrice weekly Interactions:See Appendix-2
Dose: prevention of influenza (should be
Proprietary Preparations started within 48 hours of exposure):
See section14.2.4 ADULT and CHILD over 13 years, 75 mg
once daily for 10 days for post-exposure
1.4.2.2 DRUGS FOR INFLUENZA prophylaxis and for upto 6 weeks during
AND RESPIRATORY an endemic;
SYNCYTIAL VIRUS Treatment of influenza: ADULT and
CHILD over 13 years, 75 mg 12 hourly
for 5 days
AMANTADINE HYDROCHLORIDE
Indications: Prevention and treatment of G-Oseltamivir(Gonoshasthaya), Susp, 30
influenza A virus infections, Parkinson's mg/25ml, Tk. 350.00/25 ml; Cap. 75 mg,
disease Tk.75.00/Cap.
Cautions: Renal and hepatic Oselta(Popular), Cap., 75 mg, Tk. 150.57/Cap.
insufficiency, congestive heart failure, Pandeflu(ACI), Cap., 75 mg, Tk. 151.02/Cap.
Tamiflu(I)(Roche)Cap., 75 mg, Tk.
confused or hallucinatory states, elderly,
199.85/Cap.
gradual withdrawal required in
Parkinson's disease
Contra-indications: Pregnancy, breast- RIBAVIRIN
feeding, epilepsy, gastric ulceration, and
severe renal impairment Indications: Sever respiratory syncytial
Side-effects: anorexia, nausea, virus bronchiolitis in infants and children;
nervousness, difficulty in concentrating, in combination with peginterferon alfa or
light headedness, hallucination, interferon alfa for chronic hepatitis B and
dizziness, convulsions, blurred vision, C in patients without liver dcompensation
edema and who have fibrosis or high
Dose: Oral: Influenza A, ADULT & inflammatory activity or for relapse
CHILD > 10 years, treatment 100 mg following previous response to interferon
daily for 4-5 days; prophylaxis, 100 mg alfa
daily usually for 6 weeks or with influenza Cautions: For inhalation therapy:
vaccination for 2-3 weeks after pregnancy should be excluded before
vaccination; Parkinson's disease, 100 treatment, effective contraception
mg/d initially then increased after 1 week essential during treatment and for 6
to 100 mg twice daily (max. 400 mg/d), months after treatment in women and in
ELDERLY 100 mg daily men;
Contra-indications: Pregnancy, breast-
Proprietary Preparation feeding; Specific contraindications for
Amantril (ACI), Cap., 100mg, Tk.10.00/Cap. oral treatment: Severe cardiac disease,
Altrip (NIPRO JMI), Tab., 6.25 mg, Tk. haemoglobinopathies; severe debilitating
35.08/Tab. medical conditions; severe hepatic
dysfunction or decompensated cirrhosis;
OSELTAMIVIR[ED autoimmune disease ,history of severe
psychiatric condition
Because of the need of metabolism into Interactions: See Appendix -2
active form, which may not be proper in Side-effects: Specific for inhalation
children particularly in neonates, this therapy: Worsening respiration, bacterial
drug is not recommended for use under 1 pneumonia and pneumothorax reported;
year of age unless there is a pandemic. rarely non-specific anemia and hemolysis
Indications: See under Dose. Dose:Respiratory syncytial virus
bronchitis in infants and children: by
74
1. ANTI-INFECTIVES
aerosol inhalation or nebulization of a usual risk factors for cardiovascular

solution containing 20mg/ml for 12-18 disease should be taken into account
hours for at least 3 days, maximum 7 before starting antiretroviral therapy and
days; chronic hepatitis C (in combination patients should be advised about lifestyle
with interferon alfa or peginterferon alfa): changes to reduce their cardiovascular
ADULT over 18 years body weight under risk; plasma lipids and blood glucose
75 kg,400mg in morning and 600mg in should be measured before starting
the evening;body-weight 75 kg and antiretroviral therapy, after 3–6 months of
over,600mg twice daily treatment, and then annually; reports of
osteonecrosis in patients with advanced
Proprietary Preparations HIV disease or following long-term
Celbarin(Incepta), Cap., 200 mg, Tk. 35/Cap. exposure to combination ART;
Chrocee(ACI), Cap., 200 mg, TK. 35.00/Cap. improvement in immune function as a
Copeg(Beacon), Cap., 200 mg, Tk. 35/Cap. result of antiretroviral treatment may
Opegus(Drug Intl), Cap., 200 mg, Tk. 25/Cap.
Rivarin(Healthcare),Cap.,200 mg,Tk. 35/Cap.
provoke a marked inflammatory reaction
Viracin(Beximco), Cap., 200 mg, Tk. against residual opportunistic organisms;
35.00/Cap. these reactions may occur within the first
few weeks or months of initiating
1.4.4 DRUGS FOR HUMAN treatment; reports of autoimmune
IMMUNODEFICIENCY VIRUS disorders (such as Graves’ disease)
(HIV) INFECTION many months after initiation of treatment.
1.4.4.1 NUCLEOSIDE AND
NUCLEOTIDE REVERSE 1.4.4.1 NUCLEOSIDE AND
TRANSCRIPTASE INHIBITORS NUCLEOTIDE REVERSE
1.4.4.2 NON-NUCLEOSIDE REVERSE TRANSCRIPTASE
TRANSCRIPTASE INHIBITORS INHIBITORS
1.4.4.3 PROTEASE INHIBITOR
1.4.4.4 INTEGRASE INHIBITORS ABACAVIR[ED]
1.4.4.5 ENTRY INHIBITORS
Indications: Treatment of HIV-infection
Currently available drugs provide in combination with other antiretroviral
suppressive therapy for HIV infection drugs
rather than a curative one. The goal of Cautions: Potentially fatal
therapy is to reduce plasma viral load hypersensitivity syndrome mostly linked
through suppression of replication as with HLA-B*5701 allele; test for that allele
much as possible for as long as possible before use; counsel patient about how to
and expected outcome of initial therapy recognize hypersensitivity and to seek
in a previously untreated patient is an immediate medical attention if symptoms
undetectable viral load (plasma HIV RNA develop ; heavily loaded HIV-infection (>
<50 copies /ml) within 24 weeks of 100 000 copies/ml); patients with chronic
treatment initiation. hepatic B and C, hepatic impairment,
Cautions: Metabolic effects associated lactic acidosis; patients at high risk of
with antiretroviral treatment include fat cardiovascular disease; alcoholic
redistribution, insulin resistance, and patients;
dyslipidemia; (collectively termed Contraindications: History of
lipodystrophy syndrome); fat hypersensitivity
redistribution (with loss of subcutaneous Interactions: See Appendix-2
fat, increased abdominal fat, ‘buffalo Side-effects: Fatal hypersensitivity
hump’ and breast enlargement) is characterized by fever, rash, abdominal
associated with regimens containing pain and other GI complaints, cough,
protease inhibitors and nucleoside phengitis, dyspnea, sore throat, acute
reverse transcriptase inhibitors; the respiratory distress syndrome, myalgia,
75
1. ANTI-INFECTIVES
headache, paraesthesia, mouth TENOFOVIR DISOPROXIL[ED

ulceration, edema, hypotension, renal
failure; rarely myolysis Indications: HIV infection in combination
Dose: Oral: ADULT, 600 mg in 1-2 with other antiretroviral drugs; chronic
doses; CHILD, 3 months-12 years, 8 hepatitis B infection with either
mg/kg 12 hourly adjusted to body weight compensated liver disease or
(max. 600 mg ) decompensated liver disease
Cautions : See notes above; also test
Generic Preparations renal function and serum phosphate
(Tablet, Abacavir 300 mg+ Lamivudine 150 mg
before treatment, then every 4 weeks
+ Zidovudine 300 mg)
(more frequently if at increased risk of
renal impairment) for 1 year and then
LAMIVUDINE[ED] every 3 months, interrupt treatment if
renal function deteriorates or serum
Indications: HIV infection in combination phosphate decreases; concomitant or
with at least two other antiretroviral recent use of nephrotoxic drugs; for use
drugs, chronic hepatitis B infection in chronic hepatitis B, monitor liver
Cautions: Pregnancy, breast-feeding, function tests every 3 months and viral
renal and hepatic impairment; monitoring markers for hepatitis B every 3–6 months
of hepatic function is required, drug during treatment (continue monitoring for
should be discontinued if deterioration, at least 1 year after discontinuation,
hepatic steatosis, hepatomegaly or recurrent hepatitis may occur on
unexplained lactic acidosis discontinuation): If a dose is more than
Contraindications: Breast-feeding 12 hours late, the missed dose should
Side-effects: Tiredness, respiratory tract not be taken and the next dose should be
infections, throat discomfort, headache, taken at the normal time
abdominal discomfort, nausea, vomiting, Interactions: See Appendix -2
diarrhea, hypersensitivity reactions, Side-effects: See notes above; also
peripheral neuropathy, lactic acidosis, hypophosphatemia; rarely renal failure,
raised liver enzymes and serum amylase proximal renal tubulopathy, nephrogenic
Dose:oral: HIV infection in combination diabetes insipidus; reduced bone density
with other antiretroviral drugs, 150 mg Dose: Oral: ADULT, over 18 years,
every 12 hours or 300 mg once daily; 245 mg once daily; CHILD 2–18 years:HIV
INFANT < 1 month 2 mg/kg twice daily; infection in combination with other ARDs
CHILD 3 months-12 years 4 mg/kg every when first-line NRTIs cannot be used
12 hours; max. 300 mg daily; chronic because of resistance or contra-
hepatitis B, ADULT 100 mg daily indications,
CHILD 2–18 years, 6.5 mg/kg (max.
Proprietary Preparations 245 mg) oncedaily or Body-weight 17–22
Lamivudine kg 123 mg once dailybody-weight 22–28
Hepavir(Square), Tab.,100 mg, Tk. 25.17/Tab.
Lamidin(Eskayef), Tab.,100mg, Tk. 25.30/Tab.
kg 163 mg once daily; body- weight 28–
Lamivir(Incepta), Tab.,100 mg, Tk. 25.00/Tab. 35 kg 204 mg once daily; body-
Viradin(Healthcare), Tab., 100mg, Tk. weightover 35 kg 245 mg once
25.00/Tab. dailyChronic hepatitis B infection with
Lamivudine + Zidovudine compensatedliver disease (with evidence
Diavix(Beximco), Tab.150 mg + 300 mg, Tk. of viral replication,and histology of active
45.00/Tab. liver inflammation or fibrosis): Child 12–
Lamivudine + Zidovudine + Nevirapine
Triovix(Beximco), Tab.150 mg + 300 mg + 200
18 years, body-weight > 35kg 245 mg
mg, Tk. 70.00/Tab. once daily
Becovir(Beacon), Tab., 300mg, Tk 85.26/Tab.
Foviral(ACI), Tab., 300mg, Tk. 85.26/Tab.
Proxivir(Square), Tab., 300mg, Tk. 85.26/Tab.
76
1. ANTI-INFECTIVES
Tenoviral(Opsonin), Tab., 300mg, Tk. hypersensitivity reactions, pigmentation

85.26/Tab. of nails, skin and mucosa
Tenvira(Aristo), Tab., 300mg, Tk. 85.00/Tab. Dose: Oral: ADULT 500-600 mg daily in
T-fovir(Drug Intl), Tab., 300mg, Tk. 85.30/Tab.
Vironil(UniMed), Tab., 300mg, Tk. 95.00/Tab.
2-3 divided doses; INFANT < 4 weeks 4
Xynovir(Incepta), Tab., 300mg, Tk. 85.00/Tab. mg/kg twice daily; CHILD > 3 months
180-360 mg/m2 daily in 3-4 divided
TENOFOVIR ALAFENAMIDE doses; max. 200 mg every 6 hours;
patients temporarily unable to take
zidovudine by mouth, by IV infusion over
Hepatitis B virus (HBV) nucleoside
1 hour 1-2 mg/kg every 4 hours
analog reverse transcriptase inhibitor.
(approximating to 1.5-3 mg/kg every 4
Indications: Chronic hepatitis B virus
hours by mouth) usually for not more
infection in adults with compensated liver
than 2 weeks; CHILD 80-160 mg/m2
disease.
every 6 hours (120 mg/m2 every 6 hours
Cautions & Side-effect: See under
approximates to 180 mg/m2 every 6
Tenofovir disoproxil
hours by mouth); prevention of maternal-
Dose: 25 mg (one tablet) taken orally
fetal HIV transmission, oral, between 14
once with food
and 34 weeks of gestation, 100 mg 5
times daily, IV during labor, 2 mg/kg over
Tafecta (Beacon), Tab. 25mg, Tk. 160.00/Tab. 1 hour, then 1 mg/kg/h by continuous
infusion, followed by syrup to neonate
from birth through 6 weeks of age, 2
ZIDOVUDINE[ED]
mg/kg every 6 hours
Indications: HIV infection in combination Proprietary Preparation
with other antiretroviral drugs, alone for (For co-formulation with abacavir and
prevention of maternal-fetal HIV lamivudine see under abacavir and that with
transmission; AIDS or AIDS-related lamivudine see under lamivudine)
complex, to reduce the frequency of
opportunistic infections and for ZALCITABINE
prolonging survival
Cautions: See under lamivudine; also Indications: Advanced HIV infection in
hematological disorders, vitamin B12 combination with other antiretroviral
deficiency; associated with higher risk of drugs
lipoatrophy Cautions: Peripheral neuropathy
Contra-indications: Abnormally low pancreatitis (monitor serum amylase in
neutrophil counts or hemoglobin those with history of elevated serum
concentration, neonates with amylase); cardiomyopathy, history of
hyperbilirubinemia requiring treatment congestive cardiac failure; hepatotoxicity
other than phototherapy, or with raised (potentially life threatening lactic acidosis
transaminase with hepatomegaly reported); pregnancy
Interactions: See Appendix-2 (women of childbearing age should use
Side-effects: Anemia, leucopenia, effective contraception during treatment);
neutropenia, nausea, vomiting, abdomi- renal impairment
nal discomfort, diarrhea, taste PERIPHERAL NEUROPATHY:
disturbance, pancreatitis, liver disorders discontinue immediately if peripheral
including fatty change and raised bilirubin neuropathy develops characterized by
and liver enzyme, chest pain, dyspnea, numbness and burning dysaesthesia
cough, influenza-like symptoms, possibly followed by sharp shooting pains
headache, fever, neuropathy, or severe continuous burning and
convulsions, dizziness, anxiety, potentially irreversible pain; extreme
depression, asthenia, myopathy, caution and close monitoring required in
pancytopenia, thrombocytopenia, those at risk of peripheral neuropathy
77
1. ANTI-INFECTIVES
(especially those with low CD4 cell count Side-effects: Rash, usually in the first 2
for whom risk is greater) weeks; Stevens-Johnson syndrome;
PANCREATITIS: discontinue headache, dizziness, insomnia, abnormal
permanently if clinical pancreatitis dreams, fatigue, impaired concentration
develops; suspend if raised serum (administration at bed time in the first 2-4
amylase associated with glucose weeks reduces CNS effects); nausea,
intolerance rising triglyceride, decreasing less frequently vomiting, diarrhea,
serum calcium or other signs of hepatitis, depression, anxiety, psychosis,
impending pancreatitis until pancreatitis amnesia, ataxia, stupor, vertigo, also
excluded reported raised serum cholesterol,
Contraindications: Peripheral elevated liver enzymes (especially if
neuropathy; breast-feeding seropositive for hepatitis B and C),
Interactions: See Appendix-2 pancreatitis
Side-effects: Peripheral neuropathy Dose: Oral: HIV infection in combination
(discontinue immediately); oral ulcers, with other antiretroviral drugs, ADULT
nausea, vomiting, dysphagia, anorexia, 600 mg once daily; CHILD, 3-18 years:
diarrhoea, abdominal pain, constipation; body weight 13-15 kg 200 mg once daily;
pharyngitis; headache, dizziness; body weight 15-20 kg 250 mg once daily;
myalgia, arthralgia; rash, pruritus, body weight 20-25 kg 300 mg once daily;
sweating, weight loss, fatigue, fever, body weight 25-32 kg 350 mg once daily;
rigors, chest pain, anemia, leucopenia, body weight 33-40 kg 400 mg once daily;
neutropenia, thrombocytopenia, body weight 40 kg and over adult dose
disorders of liver function; less frequently
pancreatitis, esophageal jaundice and Proprietary Preparations
hepatocellular damage; Avifanz(Beximco), Tab. 600 mg, Tk. 140/Tab.
Dose: 750 micrograms 3 times daily; Delfavir(Delta), Tab. 600 mg, Tk. 50 /Tab
ELDERLY and CHILD under 13 years, Adiva(Sqaure), Tab. 600 mg Tk.201.35/Tab.
not recommended (safety and efficacy
not established) NEVIRAPINE[ED
Generic Preparation Indications: HIV infection in combination

Tablet, 75 micrograms; 750 microgarms with other antiretroviral drugs; prevention
of maternal-fetal HIV transmission
1.4.4.2 NON-NUCLEOSIDE Cautions: Hepatic impairment (chronic
REVERSETRANSCRIPTASE hepatitis B or C); severe renal
INHIBITORS impairment; pregnancy and breast-
feeding; high CD4 cell count;close liver
EFAVIRENZ[ED] function monitoring required during first
18 weeks; monitor before treatment then
every 2 weeks for 2 months then after 1
Indications: HIV infection in combination month and then regularly; monitor closely
with other antiretroviral drugs for skin reactions during first 18 weeks
Cautions: See notes above; also hepatic discontinue permanently if abnormalities
impairment; severe renal impairment; in liver function tests accompanied by
pregnancy and breast-feeding; elderly; hypersensitivity reaction;
history of mental illness or substance Counseling:Patients should be told how
abuse; patient on other hepatotoxic drug to recognize hypersensitivity reactions
needs monitoring of liver function; and advised to discontinue treatment and
discontinue if severe rash with blistering, seek immediate medical attention if
desquamation, mucosal involvement or severe skin reaction, hypersensitivity
fever; reactions, or symptoms of hepatitis
Contra-indications: Porphyria, develop
pregnancy Contra-indications: Acute porphyria;
Interactions: See Appendix-2 post-exposure prophylaxis
78
1. ANTI-INFECTIVES
Interactions: See Appendix-2 1.4.4.3 PROTEASE INHIBITORS

Side-effects: Rash including Stevens-
Johnson syndrome and rarely, toxic
INDINAVIR[ED]
epidermal necrolysis; hepatitis and
jaundice reported; nausea, vomiting,
abdominal pain, diarrhea, headache, Indications: HIV infection in combination
drowsiness, fatigue, fever; with nucleoside reverse transcriptase
hypersensitivity reactions (may involve inhibitors and usually with low-dose
hepatic reactions and rash) anaphylaxis, ritonavir
angioedema, urticaria, also reported Cautions: Hepatic impairment; adequate
Dose: Oral: HIV infection in combination hydration, at least 2 L daily to reduce risk
with other antiretroviral drugs, ADULT, of nephrolithiasis (more frequent in
200 mg once daily of ‘immediate-release’ children; may require interruption or
preparation for first 14 days then (if no discontinuation) ; solubility decreases at
rash present) 200 mg twice daily of higher pH, antacids or other buffering
‘immediate-release’ preparation or agents should not be taken at the same
400 mg once daily of modified-release time;
preparation; CHILD, 1 month–3 hemophilia; pregnancy and breast-
years 150–200 mg/m2 (max. 200 mg) feeding;
once daily of ‘immediate-release’ Interactions: See Appendix-2
preparation for first 14 days, then (if no Side-effects: Nausea, vomiting,
rash present) 150–200 mg/m2 (max. diarrhea, abdominal discomfort,
200 mg) twice daily or 300– dyspepsia, flatulence pancreatitis, dry
400 mg/m2 (max. 400 mg) once daily of mouth, taste disturbances; headache,
‘immediate-release’ preparation; 3–18 dizziness, insomnia; myalgia, myositis,
years 150–200 mg/m2 (max. 200 mg) rhabdomyolysis, asthenia, paraesthesia;
once daily of ‘immediate-release’ hyperglycemia: anaphylactoid reactions,
preparation for first 14 days, then (if no rash (including Stevens-Johnson
rash present after initial dose syndrome), pruritus, dry skin,
titration)150–200 mg/m2 (max. 200 mg) hyperpigmentation, alopecia, paronychia;
twice daily of ‘immediate-release’ interstitial nephritis, nephrolithiasis,
preparationprevention of maternal-fetal dysuria, hematuria, crystalluria,
HIV transmission, 200 mg orally as a proteinuria, pyuria (in children), hepatitis,
single dose to the woman at onset of transient hyperbilirubinemia; blood
labor followed by a 2 mg/kg oral dose to disorders including neutropenia,
the neonate within 3 days after delivery hemolytic anemia; lipodystrophy
Note: Initial dose titration using Dose: Oral: HIV infection, in combination
‘immediate-release’ preparation should with two NRTIs and low-dose ritonavir
not exceed 28 days; if rash not resolved booster, ADULT, indinavir 800 mg and
within 28 days, alternative treatment ritonavir 100 mg both twice daily; in
should be sought; If a dose is more than combination with two NRTIs but without
8 hours late with the ‘immediate-release’ ritonavir booster ADULT, 800 mg every 8
preparation (or more than 12 hours late hours; CHILD & ADOLESCENT 4-17
with the modified-release preparation), years 500 mg/m2 every 8 hours
the missed dose should not be taken and (maximum 800 mg every 8 hours);
the next dose should be taken at the CHILD < 4 years safety and efficacy not
usual time established
Proprietary Preparation Generic Preparation

(For co-formulation with lamivudine and Capsule, 200 mg,
zidovudine see under lamivudine)
79
1. ANTI-INFECTIVES
NELFINAVIR[ED] fraction, electrolyte disturbances,

concomitant use of drugs that prolong QT
Indications: HIV infection in combination or PR interval);
with other antiretroviral drugs Interactions: See Appendix-2
Cautions: See notes above; also hepatic Side-effects: Diarrhea, buccal and
and renal impairment, diabetes mellitus, mucosal ulceration, abdominal
hemophilia, pregnancy and breast- discomfort, nausea, vomiting, headache,
feeding peripheral neuropathy, paraesthesia,
Interactions: See Appendix -2 dizziness, insomnia, mood changes,
Side-effects: Diarrhea, nausea, ataxia, musculoskeletal pain, asthenia;
vomiting, flatulence, abdominal pain; fever, pruritus, rash and other skin
rash; reports of elevated creatinine eruptions, rarely Stevens-Johnson
kinase, hepatitis and pancreatitis, syndrome; other rare adverse effects
neutropenia, hypersensitivity reactions include thrombocytopenia and blood
including bronchospasm, fever, pruritus disorders, seizures, liver damage,
and facial edema, lipodystrophy and pancreatitis and nephrolithiasis, elevated
metabolic effects creatinine kinase, raised liver enzymes
Dose : Oral: HIV infection in combination and neutropenia, when used in
with other antiretroviral drugs, ADULT combination therapy, lipodystrophy and
1.25 g twice daily or 750 mg 3 times metabolic effects
daily; CHILD, 3-13 years, initially 50- Dose: Oral:HIV infection in combination
55mg/kg twice daily (max 1.25g twice with nucleoside reverse transcriptase
daily) or 25-30mg/kg 3 times daily inhibitors and with low-dose ritonavir
(max.750 mg 3 times daily) booster, ADULT, previously treated with
ART, saquinavir 1 g and ritonavir 100 mg
Proprietary Preparation both twice daily and not previously
Avifix(Beximco), Tab. 250 mg, Tk. 45.00/Tab treated with ART, 500 mg 12 hourly for 7
days then 1 g 12 hourly ; without
SAQUINAVIR ritonavir booster, ADULT 1.2 g every 8
hours after meal; CHILD < 16 years
safety and efficacy not established
Indications: HIV infection in combination
with other antiretroviral drugs and usually
Generic Preparation
with low-dose ritonavir Tablet, 500 mg
Cautions: See notes above; also monitor
ECG before starting treatment and then
1.4.4.4 INTEGRASE INHIBITORS
on day 3 or 4 of treatment, discontinue if
QT interval over 480 milliseconds, if QT HIV-retrovirus DNA remains in the host
interval more than 20 milliseconds above cell nucleus for a prolonged period of
baseline, or if prolongation of PR interval, inactivity or latency because of its ability
patients should be told how to recognize of chromosomal integration through
signs of arrhythmia and advised to seek activity of the viral integrase enzyme.
medical attention if symptoms such as Raltegravir inhibits this enzyme and
palpitation or syncope develop; prevents the formation of covalent bonds
concomitant use of garlic reduces between host and virus DNA.
plasma concentration; hepatic and renal
impairment; diabetes mellitus; RALTEGRAVIR
hemophilia; pregnancy and breast-
feeding; Indications: HIV infection in combination
Contra-indications: Severe hepatic with other antiretroviral drugs
impairment; predisposition to cardiac Cautions: Myopathy or rhabdomyolysis;
arrhythmias (including congenital QT chronic hepatitis B or C; psychiatric
prolongation, bradycardia, history of illness; discontinue if severe rash or rash
symptomatic arrhythmias, heart failure with fever, malaise, arthralgia, myalgia,
with reduced left ventricular ejection blistering, mouth ulceration,
80
1. ANTI-INFECTIVES
conjunctivitis, angioedema, hepatitis, or

eosinophilia; severe hepatic impairment, ENFUVIRTIDE
pregnancy, breast-feeding
Interactions: See Appendix -2 Indications: HIV infection in combination
Side-effects: GI disturbances, with other antiretroviral drugs for resistant
abdominal pain, flatulence, hypertrigly- infection or for patients intolerant to other
ceridemia, dizziness, headache, antiretroviral regimens
depression, insomnia, abnormal dreams, Cautions: Discontinue immediately if any
hyperactivity, asthenia, rash (including signs or symptoms of systemic
Stevens-Johnson syndrome); less hypersensitivity develop and do not
commonly, gastritis, hepatitis, rechallenge; patients should be told how
pancreatitis, dry mouth, taste to recognize signs of hypersensitivity,
disturbances, pain on swallowing, peptic and advised to discontinue treatment and
ulcer, constipation, rectal bleeding, seek immediate medical attention if
lipodystrophy, palpitation, ventricular symptoms develop; hepatic impairment,
extrasystoles, bradycardia, hypertension, chronic hepatitis B or C; pregnancy and
flushing, chest pain, edema, dysphonia, breast-feeding
epistaxis, nasal congestion, drowsiness, Interactions: See Appendix-2
anxiety, appetite changes, confusion, Side-effects Injection-site reactions;
impaired memory and attention, suicidal pancreatitis, gastro-esophageal reflux
ideation, pyrexia, chills, carpal tunnel disease, anorexia, weight loss;
syndrome, tremor, peripheral neuropathy, hypertriglyceridemia; peripheral
erectile dysfunction, gynaecomastia, neuropathy, asthenia, tremor, anxiety,
menopausal symptoms, osteopenia, nightmares, impaired concentration,
renal failure, nocturia, polydipsia, vertigo; pneumonia, sinusitis, influenza-
anemia, thrombocytopenia, neutropenia, like illness; diabetes mellitus; hematuria;
arthralgia, myalgia, rhabdomyolysis, renal calculi, lymphadenopathy; myalgia;
visual disturbances, tinnitus, gingivitis, conjunctivitis; dry skin, acne, erythema,
glossitis, acne, pruritus, hyperhidrosis, skin papilloma; less
dry skin, skin papilloma, alopecia; commonly hypersensitivity reactions,
Dose: Oral: ADULT, 400 mg twice including rash, fever, nausea, vomiting,
daily; CHILD, 2–18 years:(in combination chills, rigors, low blood pressure,
with other antiretroviral drugs for HIV respiratory distress, glomerulonephritis,
infection resistant to multiple and raised liver enzymes reported;
antiretrovirals): body-weight 12– Dose: Subcutaneous injection:
14 kg 75 mg twice daily; body-weight 14– reconstitute with 1.1 mL water for
20 kg 100 mg twice daily; body-weight Injections and allow to stand (for up to 45
20–28 kg 150 mg twice daily; body- minutes) to dissolve; do not shake or
weight 28–40 kg 200 mg twice daily; invert vial;
body-weight over 40 kg 300 mg twice ADULT, 90 mg twice daily; CHILD, 6–16
daily years 2 mg/kg (max. 90 mg) twice daily,
16–18 years 90 mg twice daily
Generic Preparation
Tablet, 400 mg
Generic Preparation
Injection, 90 mg/ml
1.4.4.5 ENTRY INHIBITORS
Entry inhibitor drugs prevent entry into MARAVIROC
host cell of the retrovirus in two different
ways: inhibiting fusion of viral cell Indications: HIV infected adults in
membranes mediated by gp41 and CD4 combination with other antiretroviral
interactions (enfuvirtide) and blocking drugs previously treated with
host cell CCR5 receptor to block binding antiretrovirals who have base line
of viral gp 120 (maraviroc).
81
1. ANTI-INFECTIVES
evidence of predominantly CCR5-tropic 1.5.1.2 DRUGS FOR HOOKWORMS

virus (ANCYLOSTOMIASIS,
Cautions: Cardiovascular disease; NECATORIASIS)
hepatic impairment, chronic hepatitis B or
C; pregnancy, breast-feeding Hookworms (Ancylostomiasis) are
Interactions: See Appendix -2 located in the upper small intestine and
Side-effects: GI disturbances; suck blood from their point of attachment;
depression, insomnia, malaise, anemia may thereby be produced.
headache, anemia, rash; less commonly, Effective treatment needs not only
seizures, renal failure, proteinuria, expulsion of the worms but treatment of
myositis; rarely hepatitis, angina, the anemia. Albendazole is the drug of
pancytopenia, granulocytopenia, first choice against both species and
Stevens-Johnson syndrome, toxic mebendazole is the next.Dog and cat
epidermal necrolysis; also reported hookworm larvae may enter human skin
hypersensitivity reactions including rash, where they produce slowly extending
fever, eosinophilia, and hepatic reactions; itching tracks usually on the foot
Dose: Oral: ADULT,over 18 years, (cutaneous larva migrans or creeping
300 mg twice daily eruption). Single tracks can be treated
with topical thiabendazole andmultiple
GenericPreparation infections respond to oral
Tablet, 150 mg, ivermectin,albendazole or thiabendazole
1.5 ANTHELMINTICS 1.5.1.3 DRUGS FOR THREADWORMS/

1.5.1 DRUGS FOR NEMATODE PINWORMS
INFECTIONS
1.5.2 DRUGS FOR CESTODE The adult threadworms do not live for
INFECTIONS longer than 6 weeks. Adult female worms
1.5.1 DRUGS FOR NEMATODE lay ova on the perianal skin which causes
INFECTIONS pruritus; scratching the area then leads to
1.5.1.1 ASCARICIDES : DRUGS FOR ova being transmitted on fingers to the
COMMON ROUNDWORMS mouth, often via food eaten with
1.5.1.2 DRUGS FOR HOOKWORMS unwashed hands. Pruritus in the perianal,
(ANCYLOSTOMIASIS, perineal region can be severe, scratching
NECATORIASIS) may cause secondary infection.
1.5.1.3 DRUGS FOR Mebendazoleis the drug of choice.
THREADWORMS/ Albendazole and pyrantel pamoate also
PINWORMS(ENTEROBIASIS) are highly effective.
1.5.1.4 DRUGS FOR DWARF
THREAD-WORMS 1.5.1.4DRUGS FOR DWARF
(STRONGYLOIDIASIS) THREAD-WORMS
1.5.1.5 DRUGS FOR WHIPWORMS (STRONGYLOIDIASIS)
(TRICHURIASIS)
1.5.1.6 DRUGS FOR LYMPHATIC Strongyloides stercoralis also called
FILARIASIS(WUCHERIA Drawf threadworm is capable to complete
INFECTIONS) its life-cycle within human host. It lives in
1.5.1.1 ASCARICIDES: DRUGS FOR the gut and produce larvae, which
COMMON ROUNDWORMS penetrate the gut wall and invade the
tissues, setting up a cycle of auto-
The preferred agents are the infection. Ivermectin is the treatment of
benzimidazoles, mebendazole and choice for chronic Strongyloides
albendazole and the board-spectrum infection. Albendazoleis an alternative.
drug pyrantel pamoate. Levamisol is an
alternate choice.
82
1. ANTI-INFECTIVES
1.5.1.5 DRUGS FOR WHIPWORMS treatment in inoperable cases, ADULT >

(TRICHURIASIS) 60 kg, 800 mg daily in divided doses for
28 days followed by 14 tablet-free days,
Although rarely causes serious may be given up to 3 cycles; for alveolar
complication heavy Trichuris burdens in echinococcosiscaused by E
children can lead to colitis, dysentery multilocularis, above drug treatment
syndrome and rectal prolapse. needs to be continued for months or
Mebendazole and albendazole are the years; neurocysticercosis , ADULT > 60
most effective drugs. kg 800 mg daily in 2 divided doses for 8-
30 days, ADULT < 60 kg 15 mg/kg, max.
800 mg/d in 2 divided doses for 8-30
ALBENDAZOLE[ED] [OTC]
days; cutaneous larva migrans, 400 mg
as a single dose; intestinal capillariasis,
Albendazole, a broad-spectrum 200-400 mg twice daily for 10 days;
benzimidazole carbamate has trichinosis, 200-400 mg twice daily for 15
antihelminthic activity similar to that of days; Strongyloides stercoralis, as an
mebendazole (see also under alternative to ivermectin, 400 mg twice
mebendazole) and is more effective daily for 3 days, repeated after 3 weeks if
against strongyloidiasis, cystic hydatid necessary
disease caused by Echinococcus
granulosus and neurocysticercosis Proprietary Preparations
caused by larval forms of Taenia solium. Aben(Team), 400 mg, Tab. Tk. 4.50/Tab.
Certain microsporidial species that cause Abentel(Aristo), Tab., 400mg , Tk. 5.00/Tab.
intestinal infections in AIDS patients Adze(Kemiko), Tab., 400 mg, Tk. 4.01/Tab.
respond partially or completely. The drug AH(Drug Intl),Suspn.,200mg/5ml, 20.10/10ml ,;
also has some efficacy against anaerobic Tab., 400mg, Tk. 5.05/Tab.
Alarm(Decent), Tab., 400mg, Tk. 4.00/Tab.
protozoa such as Trichomonus vaginalis
AlbamaxDS(Ziska), Tab., 400 mg, Tk.
and Giardia lamblia 4.00/Tab.
Indications: See under Dose Alben (Eskayef), Suspn, 200mg/5
Cautions: liver disease; monitoring of ml,Tk.20.00/10ml.;Tab.,400 mg, Tk. 5.00/Tab.;
liver function and for bone marrow Albendol(Globex), Suspn., 200mg/ 5 ml,
toxicities required in prolong use; in Tk.15.00/10mlTab., 400mg, Tk. 3.50/Tab
neurocysticercosis sought neurologist / Albezen(Zenith), 400 mg , Tab. , Tk. 3.01/Tab.
neurosurgeon advice Alda(Supreme), Suspn., 200mg/ 5 ml,
Tk.15.00/10ml,; Tab., 400 mg, Tk. 4.00/Tab.
Contra-indications: pregnancy Aldex(G.A co), Suspn., 200 mg/5ml, Tk.
Interactions: See Appendix-2 15.05/10 ml .; Tab., 400 mg, Tk. 4.02/Tab.
Side-effects: Gastrointestinal AL-DS(Globe), Tab., 400 mg, Tk. 5.00/Tab.
disturbances, headache, dizziness, Almex(Square), Suspn., 200 mg/5 ml , Tk.
changes in liver enzymes 20/10ml.; Tab., 400 mg, Tk. 5.02/Tab.
Dose: Oral: roundworm & hookworm Alphin(Beximco), Tab., 400mg , Tk. 5.00/Tab.
Alzed(General), Tab, 400mg, Tk. 3.32/Tab.
infections: ADULT & CHILD > 2 years
Anbendazole(Popular), Tab., 400mg, Tk.
400 mg as a single dose; threadworm 4.01/Tab.
infections 400 mg as a single dose for 3 Asiben(Asiatic), Suspn., 200mg/5ml, Tk.
days, repeated after 3 weeks if 14.00/10ml .;Tab., 400mg , Tk. 3.80/Tab.
necessary; echinococcus granulosus Azole(Biopharma), Tab., 400mg, Tk. 4.02/Tab.;
(cystic hydatid disease): adjunct in Suspn., 200mg/5ml, Tk. 18.00/10ml
surgical treatment:pre-surgery, 800 mg Ben-A(Acme),Tab. , 400.00 mg., Tk. 5.01/Tab.;
Suspn., 200mg/5ml, Tk. 20.07/10ml
daily in divided doses for 28 days
Benda(Bristol), Tab. , 400mg , Tk. 175.00/Tab.
followed by 14 tablet-free days, cycle Benfast(Novo Healthcare), Tab., 200 mg, Tk.
repeated once before surgery; post- 2.00/Tab.; , 400 mg, Tk. 4.00/Tab.
surgery, 800 mg daily in divided doses Chuben(Alco), Tab., 400 mg, Tk. 3.86/Tab.
for 28 days followed by 14 tablet-free Estazol(Ibn Sina), Suspn., 200mg/5ml, Tk.
days, cycle repeated once; as primary 20.00/10ml,; Tab.,Tk. 200.00/Tab.
83
1. ANTI-INFECTIVES
Helben(Modern), Tab. , 400 mg., Tk. 5.00/Tab. Johnson syndrome and toxic epidermal
Parnil DS(Euro), Tab., 400mg, Tk. 5.00/Tab. necrolysis
Sintel(ACI), Tab., 400mg, Tk. 5.02/Tab. ; Dose: Oral:pinworms/ threadworms
Tab.,(dispersible) 400mg, Tk. 6.02/Tab.;
Suspn., 200mg/5ml, Tk. 20.06/10ml ,
(enterobiasis), ADULT & CHILD >6
Verben(Astra Bio), Suspn., 200 mg/5 ml, Tk. months, 100 mg as a single dose; repeat
15.00 /5ml .; Tab. , 400 mg, Tk. 4.00/Tab. dose at 2 and 4 weeks if necessary ;
Vermid(Somatec), Tab., 400 mg, Tk. 5.00/Tab. roundworm (Ascaris lumbricoides),
Vermin DS(Nipa), Tab., 400 mg, Tk. 4.50/Tab. hookworm (Ankylostoma duodenale,
Zoben(Amico), Tab., 400mg , TK. 4.50/Tab.; Necator americanus), whipworm
Suspn., 200 mg/5 ml,, TK. 20.00/10ml (Trichuris trichiura) and Trichostrogylus
infections, ADULT & CHILD > 2 years,
LEVAMISOLE[ED] 100 mg twice daily for 3 days or 500 mg
as a single dose, may be repeated in 2-3
Indications: Ascariasis, hookworm and weeks, CHILD<< 2 years single dose
mixed ascariasis with hookworm administration not allowed; intestinal
infections, as an adjunct with fluorouracil capillariasis, 400 mg/d in divided doses
after surgical resection in patients with for 21 or more days; trichinosis, 600 mg
Dukes stage C colon cancer initially, increasing stepwise over 3 days
Cautions: Pregnancy, concomitant to 1200-1500 mg daily in 3 divided doses
alcohol for 10 days
Contra-indications: Severe liver and
kidney disease, breast-feeding Proprietary Preparations
Interactions: See Appendix-2 Bendex(G.A.Co), Tab., 100 mg, Tk. 1.15/Tab.;
Side-effects: Abdominal pain, nausea, 500 mg, Tk. 3.50/Tab.
vomiting, headache, dizziness, Misole(Albion), Susp., 100 mg/5 ml, Tk.
14.83/30ml
disulfiram-like adverse effects when
Panamox(Jayson), Tab., 100 mg, Tk. 0.74/
taken concomitantly with alcohol Tab.; Susp., 100 mg/5 ml, Tk.14.75/30 ml
Dose: Oral: ADULT & CHILD > 12 years Solas(Opsonin), Tab. 100 mg, Tk. 1.15/Tab. ;
2.5 mg/kg, CHILD 5-12 years 80 mg and Suspn 100 mg/5ml, Tk. 18.25/ 30 ml
1-4 years 40 mg as a single dose, in Vermizol(Zenith), Tab. 100 mg, Tk. 0.74/Tab.
severe hookworm infection second dose
in 3-7 day PYRANTEL PAMOATE
Indications: Roundworm (Ascaris
Proprietary Preparations lumbricoides), pinworm (Enterobius
Asitrax(Asiatic), Syrup, 40 mg/5ml, Tk. vermicularis), hookworm (Ankylostoma
12.00/30ml,; Tk. 8.00/15ml
Biotrex(Biopharma), Syrup, 40 mg/5ml, Tk.
duodenale), trichostrongyliasis and
15.00/30ml trichinosis infections
Etrax(ACI), Syrup, 40mg/5ml, Tk. 24.07/30ml ,; Cautions: Impaired liver function,
Tab., 40mg, Tk. 1.00/Tab. pregnancy, lactation
Helmisole(G.A.Co), Syrup, 40 mg/5ml, Tk. Interactions: See Appendix -2
15.05/30 ml,; Tab., 40 mg, Tk. 0.41/Tab. Side-effects: Anorexia, nausea,
Neotrax(Acme), Syrup, 40 mg/5ml, Tk. vomiting, abdominal pain, headache,
24.00/30ml,; Tk. 70.47/460ml,; Tab.;40mg ,
Tk. 0.43/Tab.
dizziness, drowsiness, insomnia, rashes
Vermicom(Opsonin), Syrup, Tk. 9.28/ 30 ml and raised SGOT levels
Dose: Oral: 10 mg/kg in a single dose(for
MEBENDAZOLE[ED] [OTC] hookworm same dose is repeated on 3
successive days and for trichinosis
Indications: See under Dose treatment for 5 days)
Cautions: Pregnancy, lactation
Interactions: See Appendix -2 Proprietary Preparations
Side-effects: Rarely abdominal pain, Delentin(Renata), Suspn., 50mg/ml, Tk.
diarrhea; rarelyhepatitis, convulsions, 16.05/10 ml
dizziness, neutropenia, urticaria, Melphin(Beximco), Suspn., 50mg/ml, Tk.
alopecia, rash including Stevens- 16.00/10 ml
84
1. ANTI-INFECTIVES
Minisol(Albion), Susp., 50 mg/ml, Tk. 12.00/30 Proprietory Preparation

ml Carbamazine(Amico), Tab., 100mg , Tk.
1.30/Tab.
1.5.1.6 DRUGS FOR LYMPHATIC Filazine(Hudson), Tab. 100 mg, Tk. 1.30/Tab.
Lafil(Supreme), Tab, 100mg, Tk. 1.00/Tab.
FILARIASIS
(WUCHERIA INFECTIONS)
IVERMECTIN
In lymphatic filariasis (LF) host reaction
to the adult worm initially causes It has efficacy in ascariasis,
lymphatic inflammation that can progress strogyloidosis, cutaneous larva migrans
through stages of lymphatic obstruction and lymphatic filariasis. Pinworm and
and secondary attacks of bacterial whipworm infections are variably
cellulitis leading to lymphedema responsive and hookworm infection is
manifested by hydrocele and unresponsive.
elephantiasis. Global program Indications: See under Dose
recommends that all at-risk individuals be Cautions, Contra-indications:
treated once yearly orally with two drug Pregnancy; mass treatment withheld
combination: Diethylcarbamazine (DEC) from pregnant women, children < 15 kg
and Albendazole (most countries) or body weight and in the seriously ill
DEC and ivermectin (parts of sub- Interactions: See Appendix -2
Saharan Africa, Yemen). Side-effects:In LF therapy, Mazzotti-like
reaction to dying microfilariae: usually
DIETHYL CARBAMAZINE[ED] mild itching and swollen, tender lymph
nodes; rarely, rarely abdominal pain,
diarrhea; rarelysevere reactions including
Indications: Lymphatic filariasis, high fever, tachycardia, hypotension,
treatment and prophylaxis of loiasis in prostration, dizziness, headache,
temporary residents in endemic areas, arthralgia, myalgia, diarrhea, edema and
visceral larva migrans in patients with high parasite burdens,
Cautions: in heavy infections there may encephalopathies; mild ocular irritation,
be febrile reaction, and in heavy Loa loa somnolence, transient eosinophilia,
infection there is a small risk of raised liver enzymes also are reported
encephalopathy, in such case treatment Dose: Oral: control of LF( in combination
must be given under careful in-patient with albendazole 400 mg), 200
supervision and stopped at the first sign micrograms/kg as a single annual dose
of cerebral involvement; renal impairment for at least 5 years; treatment
requires dose reduction, cardiac of:onchocerciasi (O volvulus), ascariasis,
disorders trichuriasis,enterobiasis, strogyloidiasis,
Contra-indications: Pregnancy, infants, ADULT & CHILD ≥ 5 years, 150-
elderly, debilitated patients 200microgm/kg, single dose; cutaneous
Interactions: See Appendix -2 larva migrans, 200 micrograms/kg single
Side-effects: Fever, headache, dose; treatment of hyperkeratotic
anorexia, malaise, urticaria, vomiting, scabies,200 micrograms/kg in
asthmatic attacks following the first dose combination with topical drugs
are due to products of destruction of the
parasite, microencephalitis, reversible ProprietaryPreparations
proteinuria Ivactin(Aristo), Tab., 3mg, Tk. 6.00/Tab.
Dose: Oral:1 mg/kg on the first day, then Scabo(Delta), Tab., 6 mg, Tk. 5.00/Tab.
increased gradually > 3 days to 6 mg/kg
daily in divided doses and maintained for
21 days; loiasis prophylaxis, 300 mg
weekly for as long as exposure occurs
1.5.2 DRUGS FOR CESTODE
INFECTIONS
85
1. ANTI-INFECTIVES
1.5.2.1 DRUGS FOR TAPEWORMS 1.5.2.2 DRUGS FOR HYDATID

(TAENIASIS: BEEF AND DISEASE (ECHINOCOCCOSIS)
PORKTAPEWORMS)
1.5.2.2 DRUGS FOR HYDATID Echinococcus granulosus produces
DISEASE unilocular, slowly growing cyst usually in
1.5.2.1 DRUGS FOR TAPEWORMS liver and lung whereas E multilocularis
causes multilocular invasive cysts also in
Beef tapeworm (Taenia saginata) rarely the same organs. The disease may
produces serious infection and is remain asymptomatic: cysts are
preventable by cooking beef at 600 C for frequently found on routine chest X-rays.
> 5 minutes. Praziquantel is the first Rupture of a cyst is associated with
choice whereas niclosomide stands next. formation of localized or generalized
Taenia solium or pork tapeworm causes secondary echinococcosis.
two types of infections: the intestinal form Asymptomatic patients do not always
caused by the adult worm and the far require treatment. Surgical treatment
more dangerous systemic form of remains the method of choice in many
cysticercosis, which usually co-exist, situations. Albendazole is used in
caused by the invasive larval form of the conjunction with surgery to reduce the
parasite. Invasion of the brain is common risk of recurrence or as primary treatment
and dangerous: epilepsy, meningitis and in inoperable cases. Alveolar
raised intracranial pressure may ensue. echinococcosis due to E. multilocularis is
Albendazole is choice of treatment for usually fatal if untreated. Surgical
cysticercosis (treatment of removal with albendazole cover is the
neurocysticercosis demands supports of treatment of choice, but where effective
neurologist/neurosurgeon), and surgery is impossible, repeated cycles of
niclosomide is preferred for intestinal albendazole (for a year or more) may
infection. help. Careful monitoring of liver function
is particularly important during drug
treatment
1.6 ANTIMICROBIAL OPTIONS FOR MEDICALLY IMPORTANT ORGANISMS

Organism Category of isolates Name of antibiotic
Staphylococcus aureus Penicillin sensitive isolates Penicillin G

Amoxicillin
Cephalexin
Penicillin resistant isolates Cloxacillin
Flucloxacillin
Clindamycin
Erythromycin
MRSA Clindamycin
Vancomycin
Linezolid
Daptomycin
Tetracycline
Cotrimoxazole
D test positive (clindamycin Cloxacillin
resistance) Flucloxacillin
Vancomycin
(according to c/s)
86
1. ANTI-INFECTIVES
Staphylococcus Penicillin sensitive isolates Penicillin G

epidermidis Amoxicillin
Cephalexin
MRSE Vancomycin plus
aminoglyside
Streptococcus pyogenes All isolates are penicillin Penicillin G
(Group A) sensitive Amoxicillin
Ampicillin
Streptococcus agalactiae Penicillin G
(Group B) Ampicillin
Enterococcus faecalis Penicillin sensitive Penicillin
Ampicillin
High level gentamycin Penicillin plus
resistant (HLGRE) aminoglycoside or
Vancomycin plus
aminoglycoside
Vancomycin resistant Linezolid
Quinopristin-dalfopristin
daptomycin
Streptococcus Penicillin sensitive strain Penicillin G
pneumoniae Erythromycin
Penicillin resistant strain Ceftriaxone
Levofloxacin
Vancomycin
Streptococci viridians Penicillin G with or
group without aminoglycosides
Neisseria meningitidis Penicillin G
Ceftriaxone/cefotaxime
Chloramphenical
Neisseria gonorrhoeae Penicillin sensitive Cefixime
Ceftriaxone
Spectinomycin
Neisseria gonorrhoeae Penicillin resistant (PPNG) Ciprofloxacin

Quinolone resistant Spectinomycin
Bacillus anthracis Penicillin G
Corynebacterium Penicillin G
diphtheriae Erythromycin
Listeria monocytogenes Cotrimoxazole
Ampicillin with or without
gentamycin
Escherichia coli Non beta lactamase Ampicillin
Amoxyclav
Cephalosporin
Cotrimoxazole
87
1. ANTI-INFECTIVES
ESBLs Aminoglycoside
Carbapenem
Cotrimoxazole
Nitrofurantoin (UTI)
Ciprofloxacine
Tigecycline
Piperacillin-Tazobactum
(choice according to c/s
report)
Salmonella typhi Nalidixic acid sensitive Quinolone
Ampicillin
Azithromycin
Nalidixic acid resistant Ceftriaxone
Cefixime
Azithromycin
(choice according to c/s)
Shigella sp. Ciprofloxacin
Vibrio cholerae Tetracycline
Haemophilus spp Amoxicillin, Co-
amoxiclav
Cephalosporin,
Ciprofloxacin, Macrolid
Helicobacter pylori Amoxicillin
Metronidazole
Bismuth
Campylobacter jejuni Erythromycin
Klebsiella spp Non beta lactamase Cephalosporins
Enterobacter spp Aminoglycosides
Serratia spp Quinolones
Proteus spp
Morganella spp
Providenciaspp
Klebsiella spp ESBLs Aminoglycoside
Enterobacter spp Carbapenem
Serratia spp Cotrimoxazole
Proteus sp Nitrofurantoin (UTI)
Morganella spp Quinolones
Providenciaspp (choice according to c/s
report)
Pseudomonas Piperacillin-tazobactam
aeruginosa Ceftazidime, cefepime
Quinolones
Carbapenem
Aztreonam
(choice according to c/s
report)
Burkholderia Ceftazidime
pseudomallei Carbapenem
Cotrimoxazole
Amoxyclav
Leginella Azithromycin,
Levofloxacin,
doxycycline
88
1. ANTI-INFECTIVES
Chlamydia trachomatis Azythromycin,

doxycycline
Rickettsia Tetracycline
Treponema pallidum Penicillin, Doxycyclin
Nocardia Cotrimoxazole
Mycoplasma Erythromycin,
Tetracyclin
Bacteroides Metronidazole,
Coamoxyclav
Clindamycin
Carbapenem
Clostridium tetani Penicillin
Clostidium difficile Metronidazole
Vancomycin
Actinomyces PenicillinG
Herpes Simplex Virus Acyclovir
Varicella Zoster Virus No antiviral therapy
needed
Cytomegalovirus Gancyclovir
Human papilloma virus Podophyllin
Liquid Nitrogen
Alpha interferon
Influenza virus Oseltamivir
Zanamivir
Hepatitis B virus Pegylated α-IFN
Lumivudin
Hepatitis C virus Pegylated α-IFN
Plus ribavirin
HIV virus Zidovudin
Lamivudin
Nevirapine
Indinavir
Dermatophytes Miconazole
Clotrimazole
Histoplasma capsulatum Itraconazole
Amphotericin B
Coccidioides immitis Itraconazole
Amphotericin B
Blastomyces dermatitidis Itraconazole
Candida albicans Topical nystatin or
clotrimazole
Fluconazole
Ketoconazole
Amphotericin B
Cryptococcus Amphotericin B plus
neoformans flucytosine
Aspergillus sp Amphotericin B
Mucor &Rhizopus sp Amphotericin B
Entamoeba histolytica Metronidazole
Tinidazole
Ornidazole
89
1. ANTI-INFECTIVES
Secnidazole
Diloxanide furate
Giardia lamblia Metronidazole
Nitozoxanide
Trichomonas vaginalis Metronidazole
Plasmodium sp. Chloroqine sensitive strain Chloroquine phosphate
Chloroqine resistant strain Artemether

Artemether with
lumefantrine
Artesunate
Quinine
Mefloquine
Toxoplasma gondii Sulfadiazine plus
pyrimethamine
Pneumocystis jiroveci Cotrimoxazole
Leishmania donvani Sodium stibogluconate
Liposomal Amphotericin
B
Miltefosin
Echinococcus Albendazole
Taenia sp Praziquantel
Schistosoma Praziquantel
Ascaris lumbricoides Mebendazole
Pyrantel pamoat
Hook worm Mebendazole
Pyrantel pamoat
Pinworm Mebendazole
Pyrantel pamoat
Strongyloides stercoralis Ivermectin
Trichuris trichiura Mebendazole
Wuchereria bancrofti Diethylcarbamazine
Dracunculus medinensis Thiabendazole
Metronidazole
Onchocerca volvulus Ivermectin
90
Chapter 2
GASTRO-INTESTINAL SYSTEM
2.1 Drugs for Dyspepsia and gastrooesophegal refluxp.91
2.1.1 Aluminium and magnesium containing antacids p.92
2.1.2 Compound antacid preparations p.93
2.2 Antispasmodics and other drugs altering gut motility p.94
2.3 Ulcer-healing drugs p.100
2.3.1 H2 receptor antagonistsp.100
2.3.2 Selective antimuscarinics p.103
2.3.3 Proton pump inhibitors p. 103
2.3.4 Chelates and complexes p.110
2.3.5 Prostaglandin analogues p.110
2.3.6 Drugs for eradication of H. pylori p. 111
2.4 Drugs for acute diarrhoea p. 111
2.5 Drugs for chronic diarrhoeap.113
2.6 Laxatives p. 115
2.6.1 Bulk forming laxatives p. 115
2.6.2 Stimulant laxatives p. 116
2.6.3 Faecal softeners p. 116
2.6.4 Osmotic laxatives p. 117
2.7 Preparations for haemorrhoids p. 119
2.7.1 Soothing haemorrhoidal preparations p. 119
2.7.2. Compound haemorrhoidal preparations with corticosteroids p. 119
2.7.3 Rectal sclerosants p. 120
2.7.4 Other Preparations p. 120
2.8 Drugs affecting intestinal secretions p. 120
2.8.1 Drugs acting on gall bladder p. 120
2.8.2 Pancreatin p. 121
2.1 DRUGS FOR DISPEPSIA AND without complications can bemanaged

GASTRO-OESOPHEGAL initially by changing the frequency
REFLUX andvolume of feed. A thickened
formulafeed can be used upon advice of
Pregnant woman with gastro- a dietitian. If necessary, a
oesophageal reflux is managed by suitablealginate-containing preparation
dietary and lifestyle changes; if no can be used instead ofthickened feeds.
improvement of symptoms, an antacid Older children with reflux may be
(section 2.1.1) or an alginatemay be managed by life-style changes; if
given. If this is ineffective, necessary by treatment with an
ranitidine(section 2.3.1)may be advised. alginatecontainingpreparation.
However, omeprazole (section2.3.3) is Non-resposive children to the above
reserved for women with severe or measures or whohave problems such as
complicatedreflux disease.Domperidone respiratory disorders or
can be added with caution suspectedoesophagitis need to be
Children withgastro-oesophageal reflux referred to hospital; anH2-receptor
disease is commonin infancy. However, antagonist (section 2.3.1) may be tried
most symptoms resolve withouttreatment toreduce acid secretion. If the
between 12 and 18 months of age. oesophagitis is resistant toH2-receptor
Infants withmild or moderate reflux antagonists, the proton pump inhibitor
91
2. GASTRO-INTESTINAL SYSTEM
omeprazole(section 2.3.3) can be salts cause constipation; so mixtures of

advised. these two preserve normal bowel
Hepatic and renal impairment: function. Some of these preparations
Patients with fluid retention should avoid contain high concentration of sodium
antacids containing large amounts of and should not be given to patients on
sodium. sodium restricted diet.
Interactions: Antacids should preferably
not be taken at the same time as other PREPARATIONS CONTAINING
drugs since they may impair absorption. MIXUTURES OF ALUMINIUM
It may also damage enteric coatings HYDROXIDE AND MAGNESIUM
designed to prevent dissolution in the HYDROXIDE[ED][OTC]
stomach.
2.1.1 ALUMINIUM-AND MAGNESIUM- Alimag(Asiatic), Tab. Tk. 0.52/Tab.
CONTAINING ANTACIDS Alucil-S(Opsonin),Susp.Tk.
2.1.2 COMPOUND ANTACID 56.39/200mlTab.Tk. 1.50/Tab.
PREPARATIONS Antacid(Popular), Tab. Tk. 0.53/Tab.
Antameal(Alco), Tab. Tk. 0.50/Tab.
Antanil(Ibn Sina), Susp.Tk. 33/200 ml Tab.
Antacids are basic compounds, which Tk. 0.52/Tab.
neutralize hydrochloric acid in the gastric Apcocid(Supreme), Tab. Tk. 0.50/Tab.
secretions; they often relieve symptoms Apedrox(APC), Susp. Tk. 30/200ml
of gastrointestinal disorders associated Biocid(Biopharma), Tab. Tk. 0.50/Tab.
with gastric hyperacidity such as ulcer Biocid MH(Biopharma),Susp.Tk.32.42/200 ml
Cytocid(Central), Susp. Tk.32/200 ml
dyspepsia, non-erosive gastro- Entacyd(Square), Susp. Tk. 55/200 ml Tab.
oesophegal reflux disease and peptic Tk. 0.80/Tab.
ulcer Antacids, sometimes also used in G-Antacid MH(Gonoshasthaya), Tab.
functional (non-ulcer) dyspepsia but the Tk.0.53/Tab
evidence of benefit is uncertain. They Gascon(Popular), Tab. Tk. 1.20/Tab.
are best given usually between meals Jpdrox(Jayson), Susp. Tk. 57/200 ml;
and at bedtime when symptoms occur or Tab. Tk. 0.73/Tab.
Lactameal(Beximco), Tab. Tk.
are expected. Liquid preparations are 0.53/Tab.;Susp. Tk. 33.00/200 ml
more effective than solids and relatively Magnogel(Amico ), Tab. Tk. 0.52/Tab.; Susp.
insoluble antacids are longer acting. Tk.32.00/200 ml
Presence of foods in the stomach can Oxecone(Acme), Susp.Tk. 57.33/200 ml;Tab.
prolong the neutralizing activity. Antacids Tk. 0.73/Tab.
may interact with many other drugs Sugel(Pacific), Susp. Tk. 24.06/200 ml; Tab.
affecting the rate and extent of their Tk. 0.38/Tab.
absorption (see Appendix-2). For this
reason, antacids should preferably not MAGNESIUM TRISILICATE
be taken at the same time with other
drugs. Indications: used as an antacid in dose
upto 2 g by mouth; usually in combi-
2.1.1 ALUMINIUM AND MAGNESIUM nation with aluminium-containing
CONTAINING ANTACIDS antacids.
Cautions:see notes above; patients with
Salts of Aluminium (Aluminium impaired renal functions.
hydroxide gel) and Magnesium Contraindications:see notes above
(Magnesium hydroxide, Magnesium Interactions: see Appendix-2
trisilicate and Magnesium carbonate), Side-effects:diarrhea.
being relatively insoluble in water, are
long-acting and are suitable for use as Proprietary Preparation
Mixtures of 250mg of Dried
antacid. Magnesium-containing antacids Aluminium Hydroxide Gel and
tend to cause diarrhoea and aluminium 500mg of Magnesium Trisilicate
92
G-Antacid(Gonoshasthaya), Susp. Marlox Plus(Incepta), Tab.Tk. 3.00/Tab.;

Tk.32.00/200ml;Tab. Tk. 0.53/Tab. Susp., Tk. 100.00/200 ml
Novelta(Orion), Tab.Tk. 3.00/Tab.; Tk.
65.00/100 ml; Tk. 100.00/200 ml
2.1.2 COMPOUND ANTACID,
Oxecone-MS(Acme), Susp.Tk.100.00/200 ml
SIMETHICONEAND ALGINATE
PREPARATIONS
ALUMINIUM -AND MAGNESIUM-
CONTAINING ANTACIDS WITH
Compound preparations have no clear ADDITIONAL INGREDIENTS
advantages over simpler preparations;
their neutralising capacity may be the
Simethicone whichacts as a defoaming
same. Complexes containing both
agent has been combined with an
aluminium and magnesium such as
antacid formulation to relieve flatulence.
magaldratehydrotalcite and almasilate
have been used.
ALGINATES
MAGALDRATE
Alginate an anionic polysaccharide is
obtained from brown algae.
Magaldrate (Aluminium Magnesium
Alginatescontaining antacids form a
Hydroxide Sulfate) is a synthetic
viscous gel (raft) that floats on the
combination of aluminium and
surface of stomach contents which
magnesium hydroxides and sulphates. It
impedes reflux and protects
reacts initially rapidly with acid and
oesophageal mucosa from acid attack.
releases aluminium hydroxide, which
Compound antacid preparations contain
then reacts more slowly to provide
alginic acid or sodium alginates with
sustained neutralizing action. Magaldrate
sodium bicarbonate/potassium
may be given in doses of up to 2 g by
bicarbonate, calcium carbonate. Some
mouth.
compounds preparations also contain
alginate/alginic acid with dried aluminium
Marlox(Incepta), Tab. , 400 mg, Tk.
hydroxide, magnesium trisilicate and
1.00/Tab.; Susp. 400 mg/5 ml,Tk. 50.00/200 sodium bicarbonate.
ml
Oxecone(Acme), Suspn. 400 mg/5 ml, Tk. Proprietary Preparations
54.36/200ml; Tab. , 400 mg , Tk. 1.00/Tab. Sodium Alginate + Potassium Bicarbonate
Magacil(Opsonin), Tab., 400 mg, Tk. Algicid(Incepta), Susp., 500 mg + 100 mg
0.75/Tab.; Susp., 400 mg/5 ml , Tk. /5ml, Tk. 125.00/200 ml ;Tab. , 500 mg + 100
37.74/200ml mg, Tk. 3.50/Tab.
Magaplus(Kemiko), Susp., 400 mg/5 ml, Tk. Algicon(Leon), Tab. , 500 mg + 100 mg, Tk.
54.20/200 ml 3.00/Tab. ;Susp., 500 mg + 100 mg /5ml,Tk.
125.00/200 ml
Magaldrate 480mg + Simethicone20mg/Tab Asynta(Square), Susp., 500 mg + 100 mg/5
Magaldrate 480mg + Simethicone20mg/5ml ml, Tk. 125.00/200 ml
suspension Gastrocon(Unimed), Tab., 500 mg+100 mg,
Avlocid MS(ACI), Tab., , Tk. 3.00/Tab.; Tk. 4.50/Tab.;Susp., 500mg+100 mg/5ml, Tk.
Susp., Tk. 100.00/200 ml 155.00/200 ml
Digecid Plus(Beximco), Tk. 2.00/Tab.; Susp., Viscocid(Beximco), Susp. 500 mg+100 mg
Tk. 110.00/200 ml /5ml, Tk. 150.00/200 ml
Gastid(Eskayef), Tab., Tk. 3.00/Tab.; Susp.,
Tk. 100.00/200 ml SIMETHICONE
Magacil Plus(Opsonin), Susp.Tk.75.19/200ml
Magalrat Plus(Ibn Sina), Tab., Tk. 3.00/Tab.; (Activated Dimethicone)
Susp., Tk. 100.00/200 ml
Maganta Plus(Square), Tab., Tk. 3.00/Tab.; Simethicone which is also known as
Susp., Tk. 100.00/200 ml Activated Dimethicone has been used
Magaplus-X(Kemiko),Susp.Tk. 55.00/100 ml; for the relief of the painful symptomos of
Tk. 100.00/200 ml excess gas in the digestive tract. Such
gas is frequently caused by excessive
93
swallowing of air while eating foods that

disagree, and this may also lead to 2.2 ANTISPASMODICS AND
indigestion. It has also been used in OTHER DRUGS ALTERING
infantile colic but evidence of benefit is GUT MOTILITY
uncertain.
Indications: flatulence, Abdominal Gastrointestinal pain and discomfort may
distension, gas and windy colic. be due to spasm of the smooth muscles
Simethicone drops are particularly indi- which may be associated with dyspepsia
cated in infantile colic irritable bowel syndrome or diverticular
Cautions; Contraindications; Side- disease. Antispasmodic drugs may be
effects: Simethicone is an inert subst- useful as adjunctive treatment and are of
ance and no adverse effects have been two types: a) antimuscarinics; and b)
reported after oral administration direct smooth muscle relaxant.
Proprietary Preparations ANTIMUSCARINICS

Aeropac(Amico), Paed. drops, 67 mg/ml, Tk.
25.00/15 ml (See also section 8.1.2)
Bloatstop(Acme), Emulsion, 1 gm/100 ml, Tk. The antimuscarinics reduce intestinal
70.00/100 ml spasm, motility and gastric secretions,
Flacol(Square), Paed. drops, 67 mg/ml,, Tk. and may be useful in some forms of
30.11/15 ml ;Tab. , 40mg, Tk.1.50/Tab. dyspepsia, irritable bowel syndrome and
Flatulex(Opsonin), Paed. drops, 67 mg/ml,, 67
diverticular disease. Antimuscarinics
mg/ml, Tk. 22.64/15 ml
Flatunil(Acme), Paed. drops, 67 mg/ml, 67 used in gastrointestinal muscle spasm
mg/ml, Tk. 30.00/15 ml include the tertiary amines Atropine
Gasnil(Eskayef), Paed. drops 67 mg/ml, Tk. sulphate,Dicycloverine hydrochloride
30.00/15 ml and Oxyphencyclimine hydrochloride
Lefoam(Incepta), Paed. drops, 67 mg/ml, Tk. Trimebutine is a drug with
30.00/15 ml antimuscarinic and opioid agonist effects
Neodrop(Beximco), Paed. drops, 67 mg/ml,
quarternary ammonium compounds
Tk. 30.00/15 ml
Pedicon(Orion), Paed. drops, 67 mg/ml, Tk. Hyoscine butylbromide Propantheline
25.09/10 ml;Paed. drops, 67 mg/ml, Tk. bromide,oxyphenonium bromide,and
30.11/15 ml Tiemonium methylsulphate.
Semecon(Drug Int.), Paed.drops, 67 mg/ml, Dicycloverine hydrochloride has much
Tk. 35.00/15 ml less antimuscarinic action than atropine
Simecol(Alco), Paed. drops, 67 mg/ml, Tk. and may also have some direct action on
28.00/15 ml
smooth muscle. Hyoscine butylbromide
Simet(ACI), Paed. drops, 67 mg/ml, Tk.
30.11/15 ml is advised as a gastro-intestinal
antispasmodic, but it is poorly absorbed.
Aluminium hydroxide and magnesium Quaternary ammonium compounds are
hydroxide with simethicone less lipid soluble and so are less likely to
Antacid MAX(Beximco), Tab. Tk. 2/Tab. cross the blood-brain barrier; they are
Antanil Plus(Ibn Sina), Susp.Tk. 65/200 ml; also less well absorbed. Although central
Tab., Tk. 1.50/Tab.
atropine like side-effects, such as
Avlocid Plus(ACI), Tab. Tk. 2/Tab. ;Susp.,
Tk. 75/200 ml confusion, are thereby reduced,
BIocid Plus(Biopharma), Susp. Tk. peripheral atropine-like side-effects still
75/200ml;Tab. Tk. 2/Tab. remain common. The elderly are
Entacyd Plus(Square), Susp.Tk. 75/200 ml; particularly susceptible to glaucoma and
Tab. Tk. 2.00/Tab. urinary retention.
Flatameal DS(Beximco), Susp. Tk. 75/200 ml Antimuscarinics are contraindicated in
Kdrox Plus(Kemiko), Tab. Tk. 2/Tab.
myasthenia gravis (but may be used to
Makcid Plus(Maks), Susp. Tk. 64/200 ml
Oxecone-S(Acme), Susp.Tk. 75/200 ml;Tab., decrease muscarinic side-effects of
Tk. 2.00/Tab. anticholinesterases), pyloric stenosis,
Peptacid(Amico),Tab.,Tk.1/Tab.;Tk.55/200 ml paralytic ileus, toxic megacolon,and
Recocid Plus(Rephco), Susp., Tk. 75/200 ml; prostatic enlargement. It should be used
Tab. Tk. 2/Tab.
94
with caution in children and in the Dose: 10–20 mg 3 times daily; INFANT
elderly; in Down’s syndrome, reflux 6–24 months 5–10mg3–4 times daily, 15
oesophagitis, diarrhoea, conditions minutes before feeds;
associated with cardiac insufficiency and CHILD 2–12years 10mg 3 times daily
tachycardia, hypertension,ulcerative
colitis,autonomic neuropathy, acute Proprietary Preparations
myocardial infarction, pyrexia, individuals Abdorin(Opsonin), Syrup, 10 mg /5 ml, Tk.
susceptible toangle-closure glaucoma. 30.11/50 ml,; Tab. , 10 mg, Tk. 2.01/Tab.
Side-effects of antimuscarinic drug Colicon(Square), Syrup, 10 mg/5 ml, Tk.
30.2/50ml,; Tab., 10 mg, Tk. 2.01/Tab.
(especially with high doses) include Cyclopan(Incepta), Inj. , 20 mg/2 ml, Tk.
constipation, transient bradycardia 8.00/2ml,; Syrup, 10 mg/5 ml, Tk. 30.00/50ml,;
(followed by tachycardia, palpitations Tab, 10 mg, Tk. 2.00/Tab.
and arrhythmias), reduced bronchial Dirin(Alco), Tab. , 10 mg, Tk. 2.01/Tab.;
secretions, urinary retention, dilatation of Syrup, 10 mg / 5ml, Tk. 40.12/50ml
the pupils with loss of accommodation, Diverin(ACI), Syrup, 10mg/5ml, Tk. 30.2/50ml
photophobia, dryness of the mouth and ,; Tab., 10mg, Tk. 2.02/Tab.; 20mg, Tk.
3.52/Tab.
skin, occasional confusion (particularly in Ibspa(Pacific), Tab., 10mg/5 ml, Tk.
the elderly), nausea, vomiting and 25.00/50ml,; 10 mg, Tk. 2.00/Tab.
giddiness. Loverin(Beximco), Tab., 10mg, Tk. 2.01/Tab.
Robentyl(Healthcare), Syrup, 50ml , Tk.
ATROPINE SULPHATE[ED] 40.00/Syrup,; 10mg , Tk. 200.00/Tab.
Cyclovin(Somatec), Tab. , 10 mg, Tk.
2.01/Tab.; 10 mg/5 ml, Tk. 30.11/50 ml
Indications: Aid in peptic ulcer Eraspa(MST), Tab. 10 mg, Tk. 2/Tab.
treatment, gastrointestinal spasm, renal Spalax(Navana), Syrup, 10 mg/5 ml, Tk.
and biliary coilc, pre-medication (see 30.11/50 ml
sec. 8.1.3)
Cautions; Contraindications; Side- HYOSCINE BUTYLBROMIDE[ED]
Interactions: See Appendix-2 Indications: symptomatic relief of
Dose: See section 8.1.2 gastro-intestinal, biliary or genitourinary
colic (spasmodic pain) and irritable
Proprietary Preparations bowel syndrome; dysmenorrhoea; as
Atropine(Chemist), Inj.,1mg/ml, Tk. 2.52/1ml antispasmodic in endoscopy and
Amp
Atropine-Jayson(Jayson), Inj. 0.6 mg/1ml, Tk.
radiological procedures of gut; as an
5.00/1 ml Amp. adjunct in the treatment of peptic ulcer..
G-Atropine(Gonoshasthaya), Inj.0.6 mg/1ml, Cautions; Contraindications; Side-
Tk. 3.01/1ml Amp. effects:see notes above
Interactions: see Appendix-2
DICYCLOVERINE HYDROCHLORIDE Dose:by mouth, 10-20 mg 4 times daily;
(Dicyclomine hydrochloride) CHILD 6-12 years, 10 mg 3 times daily.
By intramuscular or intravenous injection
Indications: Symptomatic relief of (acute spasm), 20 mg, repeated after 30
gastro-intestinal disorders characterised minutes if necessary. CHILD not
by smooth muscle spasm recommended
Side effects: See notes above
Cautions:See notes above Proprietary Preparations
Asipan(Asiatic), Tab., 20mg , Tk. 3.00/Tab.
Contra-indications:See notes above;
Buscon(Ibn Sina), Tab., 10 mg, Tk.
also infants under 6 months 3.00/Tab.; Inj., 20mg/ml, Tk. 29.50/ml Amp
Pregnancy:Use only if essential Butapan(Sanofi), Tab., 10mg, Tk. 6.90/Tab.;
Breast-feeding: Should be avoided, 20mg, Tk. 13.64/Tab.
present in milk; apnoeareported in infant Colik(ACI), Tab., 10mg, Tk.6.90/Tab.; 20mg,
Tk. 6.72/Tab., Inj., 20 mg/ml, Tk. 29.90/Amp,
Eziride(Opsonin), Tab. 150 mcg , Tk.
5.00/Tab.
95
Hybucin(Supreme), Tab. 10 mg, Tk. 3.40/Tab. TIEMONIUM METHYLSULPHATE

Hybut(Amico), Tab., 10mg, Tk. 3.43/Tab.
Hysomide(Opsonin), Inj., 20 mg/ml, Tk.
29.90/Amp,; Tab. , 10 mg, Tk. 6.90/Tab.; 20 Indications: symptomatic relief of
mg , Tk. 13.64/Tab. gastrointestinal, biliary, renal and
Spanil(Beximco), Tab., 10mg, Tk. 6.90/Tab. genitourinary colic
Spasmozen (Zenith), Tab. 10 mg , Tk. Cautions;Contraindications; Side-
3.44/Tab. effects: see notes above.
Typan(Astra Biopharma), Tab. , 10 mg, Tk.
Interactions: see Appendix-2
3.43/Tab.
Altapan(Albion), Tab., 10 mg, Tk.1.80/Tab. Dose:by mouth 100-300 mg daily in
Asipan(Asiatic), Tab., 20 mg, Tk. 3.00/Tab. divided doses; by intramuscular or slow
Butapan(Sanofi), Tab., 10 mg, Tk. 3.42/Tab.; intravenous injection, 10 mg 2-3 times
20 mg, Tk. 6.00/Tab.;Inj., 20 mg/ml , daily
Tk.7.89/Amp.
Butason(Hudson), Tab., 10mg, Tk.1.75/Tab. Proprietary Preparations
Colipan(Medimet), Inj., 1 mg/ml, Tk.7.85/1 ml Algin(Renata), Inj., 5 mg/2 ml, Tk. 25.00/2 ml
Amp.; Tab., 10mg, Tk.3.00/Tab.; 20mg, Amp., Tab. , 50 mg, Tk. 6.00/Tab., Syrup,
Tk.5.65/Tab. 10mg/5 ml, Tk. 90.00/100ml
G-Hyoscine(Gonoshasthaya), Tab. 10 mg, Aspasom (Kemiko), Tab., 50 mg, Tk.
Tk.3.35/Tab.; Inj., 20 mg/ml, Tk.7.75/Amp. 5.00/Tab., Syrup, 10mg/5 ml, Tk. 90.00/100ml
Spasmoson(Jayson), Tab., 10 mg, Tk. Dysma(Rangs), Tab., 50 mg, Tk. 5/Tab.
3.40/Tab.; Inj., 20 mg/ml, Tk. 7.88/Amp. Emogin(Somatec), Tab., 50 mg, Tk.
5.00/Tab.
OXYPHENONIUM BROMIDE Emonium(Beximco), Inj., 5 mg/2 ml, Tk.
75.00/2ml Amp., Tab., 50mg, Tk. 5.00/Tab.
Monivis(Organic), Tab. , 50 mg, Tk.
Indications: symptomatic relief of 6.02/Tab.
gastro-intestinal, biliary or genitourinary Norvis(Square), Inj., 5 mg/2 ml, Tk. 25.00/2
colic; as an adjunct in the treatment of ml Amp., Syrup, 10mg/5 ml, Tk. 87.26/100ml;
peptic ulcer. Tab. , 50 mg, Tk. 6.02/Tab.
Cautions; Contraindications; Side- Onium(Orion), Syrup, 10mg/5 ml, Tk.
effects:see notes above 50.15/50ml; 10mg/5 ml, Tk. 85.26/100ml; Tab.
, 50 mg, Tk. 6.02/Tab., Inj, 5 mg/2 ml, Tk.
Interactions: see Appendix-2 25.08/2 ml Amp.
Dose:by mouth, 5-10 mg 3 times daily Panium(Navana), Tab., 50 mg, Tk.
5.00/Tab.;Inj., 5 mg/2 ml, Tk. 20.00/amp.
Proprietary Preparations Previp(Genera), Tab. , 50 mg, Tk. 4.02/Tab.
Antrenex(Opsonin), Tab., 5 mg, Tk. 1.25/Tab. Relvis(Biopharma), Inj. , 5 mg/2 ml, Tk.
Antrenyl(Novartis), Tab., 5 mg, Tk. 4.00/Tab. 15.00/2 ml Amp., Tab., 50mg, Tk. 5.00/Tab.
A-Spasm(Acme), Tab., 5 mg, Tk. 1.44/Tab. Spadyl(SMC Enterprise), Tab., 50 mg, Tk.
Isonil(Amico), Tab., 5 mg, Tk. 1.41/Tab. 5.00/Tab.
Spanium(Ziska), Inj., 5 mg/2 ml, Tk. 15/2ml
Amp.; 50 mg, Tk. 4/Tab.
PROPANTHELINE BROMIDE
Spason(Astra Biopharma), Tab. , 50 mg,
Spazin (Euro), Tab., 50mg, Tk. 5.00/Tab.
Indications: symptomatic relief of Tiemo (Alco), Tab. , 50 mg, Tk. 4.01/Tab.
gastrointestinal colic, as an adjunct in Tienum(Chemist), Inj. , 2 ml, Tk. 15/2 ml Amp;
the treatment of peptic ulcer; adult Tab. , 50 mg, Tk. 4/Tab.
enuresis and urinary incontinence Timem(Silva), Tab. , 50mg, Tk. 4.02/Tab.
Timoben(Benham), Tab., 50 mg, Tk. 5/Tab.
Cautions; Contra indications; Side-
Timonac(Julpher), Inj., 5 mg/2 ml , Tk.
effects: see notes above 20.00/amp.;Tab., 50 mg, Tk. 6.00/Tab.
Interactions: see Appendix-2 Timonate(Pacific), Inj. , 5 mg/2 ml, Tk. 25.00/2
Dose: 15 mg 3 times daily 1 hour before ml Amp; Tab., 50 mg, Tk. 6.00/Tab.
meals and 30 mg at night, max. 120mg Timonil(Popular), Tab. , 50 mg, Tk.
daily CHILD not recommended 4.02/Tab., Inj, 5 mg/2 ml, Tk. 15.06/2 ml amp.
Timothy(Eskayef), Inj. , 5 mg/2 ml, Tk. 15.00/2
ml Amp., Tab, 50 mg, Tk. 4.00/Tab., 50 mg,
Tk. 4.00/Tab.
Prokind(Beacon), Tab. 15 mg, Tk. 8.02/Tab.
96
Timozin(Incepta), Tab. , 50 mg, Tk. Dose:200 mg 3 times daily before

6.00/Tab., Inj., 5 mg/2 ml, Tk. 15.00/2 ml Amp. meals.
Tinilux(Sharif), Tab. 50mg, Tk. 6.00/Tab.,
50mg, Tk. 6.00/Tab.
Tinimet (Rephco), Inj.,5 mg/2 ml,Tk.20/amp.;
5mg/2ml, Tk. 25/amp.;Tab., 50 mg, Tk. 5/Tab. Timotor(Square), Tab.,100 mg, Tk. 5.01/Tab.
Tinium(Acme), Inj., 5 mg/2 ml, Tk. 20.07/2 ml Trimotil(Incepta), Tab.,100 mg, Tk. 5.00/Tab.
Amp., Tab., 50 mg, Tk. 6.00/Tab.
Tino(Delta), Tab. , 50 mg, Tk. 4.00/Tab. OTHER ANTISPASMODICS
Tispa(Concord), Tab. , 50 mg, Tk. 5.00/Tab.
Titos(Novo Health), Tab. , 50 mg, Tk.
Alverine, drotaverine, Mebeverine,
5.00/Tab.
Tium(Ad-din), Tab., 50 mg, Tk. 3.50/Tab. and peppermint oil are believed to
Tivis(Beacon), Tab. , 50 mg, Tk. 5.00/Tab.; directly relax intestinal smooth muscle
Inj., 5 mg/2 ml, Tk. 16.00/amp. and may relieve spasm and pain in
Tivis(Beacon), Tab. , 50mg , Tk. 5.04/Tab., irritable bowel syndrome and diverticular
Inj., 5 mg/2 ml, Tk. 16.05/2 ml Amp. disease. They have no serious adverse
Tynium(ACI), Tab., 50mg , Tk. 6.02/Tab., Inj., effects but like all antispasmodics should
5 mg/2 ml, Tk. 15.11/2ml amp., Syrup,
be avoided in paralytic ileus.
10mg/5 ml, Tk. 56.17/50ml; 10mg/5 ml, Tk.
85.26/100ml
Veralgin(Aristo), Inj. , 5 mg/2 ml, Tk. 25.00/2 ALVERINE CITRATE
ml Amp., 50mg , Tk. 6.00/Tab.
Visarin(Pharmasia), Tab., 50 mg, Tk. 4/Tab.
Indications:as an adjunct in gastro-
Viscer(Techno), Inj., 5 mg/2 ml, Tk. 12/amp.
Visceral(Ibn Sina), Tab., 50mg, Tk. 8.00/Tab., intestinal disorderscharacterised by
Inj. , 5 mg/2 ml, Tk. 160.00/2 ml Amp. smooth muscle spasm; dysmenorrhoea
Visegin(UniMed), Tab.,50mg,Tk. 5/Tab. Contra-indications: paralytic
Viset(Healthcare), Syrup, 10mg/5 ml, Tk. ileus,breast-feeding
55.00/Syrup., 10mg/5 ml, Tk. 90.00/Syrup; Caution: pregnancy,
Tab., 50mg, Tk. 7.00/Tab., Inj. , 5 mg/2 ml, Tk. Side-effects: nausea; dyspnoea;
250.00/2 ml Amp
headache, dizziness;pruritus, rash;
Visnil(Nipro JMI),Tab., 50 mg, Tk. 4/Tab.
Visnor(Apex), Inj., 5 mg/2 ml, Tk. 15.00/amp;
hepatitis also reported
Tab., 50 mg, Tk. 4.00/Tab. Dose:ADULT and CHILD over 12 years,
Visonium(Drug Intl), Inj., 5 mg/2 ml, Tk. 60–120mg 1–3 timesdaily.
25.02/2 ml Amp.; Tab., 50mg, Tk. 5.00/Tab.
Vispazin(Globe), Suspn., 10mg/5 ml, Tk. Proprietary Preparations
90.00/100ml; Inj. , 5 mg/2 ml, Tk. 15.00/2 ml Alve(Orion), Tab., 60 mg, Tk. 5.01/Tab.
Amp.; Tab. , 50 mg, Tk. 5.00/Tab. Alverate(Ibn Sina), Tab., 60mg, Tk. 5.02/Tab.
Visral(Opsonin), Supp, 20 mg , Tk. Dismonal(Opsonin), Tab., 60 mg, Tk.
8.00/Supp., Syrup, 10mg/5 ml, Tk. 5.00/Tab.
80.00/100ml; Tab. , 50 mg , Tk. 6.00/Tab., Pelverin(Popular), Tab., 60mg, Tk. 5.02/Tab.
Inj., 5 mg /2 ml, Tk. 15.10/2ml Amp. Spasverin(Beacon), Tab. , 60mg , Tk.
Xelcom(Radiant), Tab. , 50mg, Tk. 5.02/Tab.
8.00/Tab., Inj, 5 mg/2 ml, Tk. 35.00/2 ml Amp
Zeum(Novartis), Tab., 50 mg, Tk. 6.50/Tab.
DROTAVERINE HYDROCHLORIDE
TRIMEBUTINE MALEATE
Indications: as an antispasmodic in
gastro-intestinal colic,biliary and
Indication: Irritable bowel Syndrome genitourinary colic; tenesmus in
Cautions:Pregnancy,breast dysentery; dysmenorrhoea
feeding,children Cautions and Contraindications:
Contraindication: Should not be taken pregnancy and lactation; impairment of
by anyone who is allergic to trimebutine liver or kidney (Appendix 3 & 4)
Side effects: Abdominal Interactions: see Appendix-2
pain,constipation,diarrhoea,dry Side-effects: flushing, perspiration,
mouth,fatigue, foul taste, headaches, hot palpitation and vertigo are reported
or cold sensations,indigestion nausea, Dose:by mouth 40-80 mg 3 times daily.
rash
97
by subcutaneous or intramuscular Mevin(Square), Tab., 135 mg, Tk. 6.02/Tab.;

injection, 40-80 mg up to three times Cap., 200 mg, Tk.10.03/Cap.
daily Rostil(Beximco), SR Cap., 200 mg, Tk.
10.00/Cap.; Tab., 135 mg, Tk. 7.00/Tab.
by slow intravenous injection in acute Veripel(Beacon), Cap., 200mg , Tk. 9.03/Cap.
renal colic, 40-80 mg Veron(Eskayef), Tab., 135 mg, Tk. 6.00/Tab.;
135 mg, Tk. 6.08/Tab.
Dot(Acme), Tab. , 40 mg, Tk. 1.76/Tab.; Inj.,
OTHER DRUGS ALTERING GUT
40 mg./2 ml, Tk. 7.04/2ml
Dotarin(Popular), Tab., 40 mg, Tk. 1.76/Tab.; MOTILITY
Inj., 40mg/2ml, Tk. 7.03/Amp. (See sectio section 7.8)
Dover(Nipa), Tab. 40 mg, Tk. 1.75/Tab. Gut smooth muscle exhibits intrinsic
Drotapan(Incepta), Tab. 40 mg, Tk. 1.75/Tab. motor activity which is modified by
Drovin(ACI), Inj., 40mg/2ml, Tk.10.07/2ml; autonomic innervation, local reflexes and
Tab., 40 mg, Tk. 1.77/Tab.
gut hormones to produce peristalsis.
Espa(Square), Inj., 40 mg/2 ml, Tk. 7.02/Amp.,
40 mg, Tk.1.75/Tab. Prokinetic drugs which include
N-Aspa(Albion), Tab., 40 mg, Tk. 1.81/Tab. domperidone and metoclopramide
No-Spa(Ambee), Tab., 40 mg, Tk. 1.82/Tab., stimulate the motility of the gut by acting
Inj. 40 mg/2 ml, Tk. 7.98/2 ml amp. at various points within this complex
Rova(Kemiko), Tab., 40 mg, Tk. 2.00/Tab. system to enhance gut movement.
Span(Opsonin), Tab. , 40 mg, Tk. 1.76/Tab.
Tav(Organic), Tab., 40 mg, Tk. 1.76/Tab.
Taverin(Beximco), Tab.,40 mg, Tk. 2.20/Tab. APREPITANT
MEBEVERINE HYDROCHLORIDE It is an antiemetic drug mediates its

effect by blocking the neurokinin 1 (NK1)
Indications: as an adjunct in the receptor.
treatment of symptomatic relief of Indications:as an adjunct to
gastrointestinal colic, irritable bowel dexamethasone and a 5HT3-receptor
syndrome antagonist in preventing nausea and
Cautions; Contraindications :paralytic vomitingassociated with moderately and
ileus, pregnancy and breast-feeding, highly emetogenicchemotherapy
porphyria; should be used with care in Cautions:should not be used
patients with cardiac disorder, hepatic or concurrently with pimozide, terfenadine,
renal insufficiency astemizole, or cisapride. Taking
Interactions: see Appendix-2 aprepitant with these medications could
Side-effects: anorexia, dizziness, result in serious or life-threatening
headache, insomnia, tachycardia have problems
been reported Contra-indications: acute porphyria ,
Dose: ADULT and CHILD above 12 hepatic impairment;pregnancy;breast-
years 135 mg 3 times daily, prefeably 20 feeding, child under 18 years of age.
mins before meals Side-effects: hiccups, dyspepsia,
diarrhoea, constipation, anorexia;
Proprietary Preparations asthenia, headache, dizziness; less
A-Meb(Acme),Tab. 135 mg., Tk. 6.01/Tab. commonly weight changes, dry mouth,
Evarin(Delta),Tab. 135 mg, Tk. 6.00/Tab. colitis, flatulence, stomatitis, abdominal
Iriban(Incepta), Tab., 200 mg, Tk. pain, duodenal ulcer, taste disturbance,
10.00/Tab.; 135 mg, Tk. 6.00/Tab. oedema, bradycardia, palpitations,
Irisyn(Ibn Sina), Tab., 135 mg, Tk. 7.00/Tab. cough, euphoria, anxiety, confusion,
Mave(Opsonin), Cap. , 200 mg , Tk. drowsiness, thirst, abnormal dreams,
10.07/Cap.; Tab., 135 mg, Tk. 7.00/Tab.
chills, hyperglycaemia, polyuria,
Mebeverine(Albion), Tab.,135 mg,Tk. 6/Tab.
Mebiz(Sun), SR Cap., 200 mg, Tk.10/Cap. anaemia, dysuria, haematuria,
Mespa (Ambee), Tab. 135 mg, Tk. 6.02/Tab. hyponatraemia,neutropenia, myalgia,
Meverine(Drug Intl), Tab., 135 mg, Tk. conjunctivitis, pharyngitis, sneezing,
6.05/Tab.; Cap., 200 mg, Tk. 10.05/Cap. tinnitus, sweating, pruritus,rash, acne,
98
photosensitivity, and flushing; dyspnoea, Dedom(Decent), Suspn. , 5mg/5ml, Tk.

insomnia, visual disturbances, 28.00/60 ml,; Tab., 10mg, Tk. 1.90/Tab.
dysarthria, urticaria, and Stevens- Deflux(Beximco), Dispersible Tab., 10mg, Tk.
2.50/Tab.; Paed Drops, 5mg/5ml,; Suspn.,
Johnson syndrome also reported. 5mg/5ml, Tk. 38.00/100ml,; Tab., 10mg, Tk.
Dose: ADULT over 18 years 125 mg 1 2.50/Tab.
hour before chemotherapy, then 80mg Doma(Pacific), Suspn. , 5 mg/5 ml, Tk.
daily as a single dose for the next 2 40/100ml ,; 5 mg/5 ml, Tk. 25/60ml ,; Tab., 10
days; consult product literature for dose mg, Tk. 3.00/Tab.
of concomitant corticosteroid and 5HT3- Dometic(One Pharma), Tab., 10 mg , Tk.
receptor antagonist. 2.00/Tab.
Domidon(Ziska), Suspn., 5 mg/5 ml, Tk.
28/60ml,; Tab., 10 mg, Tk. 2/Tab.
Proprietary Preparations Domilin(General), Suspn, 5mg/5ml, Tk.
Emend(Opsonin), Cap., 40 mg , Tk. 40.27/100ml,; Tab., 10mg, Tk. 2.01/Tab.
45.13/Cap. Domilux(Popular), Tab., 10 mg, Tk. 2.00/Tab.;
Emestop (Incepta), Cap., 40 mg, Tk. Suspn., 5mg/5ml,Tk. 35/ 60ml
50.00/Cap. ; 125 mg, Tk. 150.00/Cap. Domin(Opsonin), Supp, 15 mg , Tk.
5.02/15gm,; Suspn., 5mg/5ml, Tk. 28.11/60
DOMPERIDONE ml; Tab., 10 mg, Tk. 2.50/Tab.; Supp, 30 mg ,
Tk. 8.03/ 30 mg ,; Suspn., 5mg/5ml, Tk.
20.08/15 ml
Indications:nausea and vomiting Dominaaf(Naafco), Sunpn., 5 mg/5 ml, Tk.
associated with Levodopa therapy and 30.00/60ml,; Tab., 10 mg, Tk. 2/Tab.
Bromocriptine, functional dyspepsia, Dominat(Nipa), Tab., 10 mg, Tk.2/Tab.
acute Migraine attack Domiren(Renata), Paed. Drops, 5mg/5ml, Tk.
Cautions:renal impairment, pregnancy 25.00/15 ml; Suspn., 5mg/5ml, Tk.
and breast-feeding; not recommended 35.00/Suspn; 5mg/5ml, Tk. 38.00/Suspn.;
Tab., 10 mg, Tk. 2/Tab.
for routine prophylaxis of postoperative
Domperon(Astra Bio, Suspn., 5 mg/5 ml, Tk.
vomiting or for chronic administration 28.00/60 ml,; Tab, 10 mg, Tk. 2.00/Tab.
Interactions:see Appendix-2 Dompi(Alco), Suspn., 5mg / 5ml, Tk.
Side-effects:raised prolactin concen- 40.12/60ml ,; Tab. , 10 mg, Tk. 2.01/Tab.;
trations (possible galactorrhoea and 10mg, Tk. 2.25/Tab.
gynaecomastia), reduced libido reported; Don-A(Acme), Paed Drops, 5mg/5ml, Tk.
rashes and other allergic reactions; 20.13/15ml,; 5mg/5ml, Tk. 25.17/30ml,; Supp,
15 mg., Tk. 5.03/Supp,; 30 mg., Tk.
acute dystonic reactions reported
8.07/Supp,; 5mg/5ml, Tk. 35.11/60ml,; Tab. ,
Dose: 10-20 mg 3 times daily according 10 mg, Tk. 2.01/Tab.
to the requirement. CHILD: Not recomm- Dopadon(Ibn Sina), Paed. Drops, 5mg/5ml,
ended except nausea and vomiting after Tk. 25.00/15ml,; Suspn., 5mg/5ml, Tk.
cytotoxic therapy, 200-400 micrograms/ 30.00/60ml,; Tab., 10mg, Tk. 2.50/Tab.
kg every 4-8 hours Dysnov(UniMed), Tab , 10mg, Tk. 2.50/Tab.;
Paed Drop, 5mg/5ml, Tk. 20.00/15ml,; Suspn.,
5mg/5ml, Tk. 38.00/100ml
Edone(Zenith), Suspn.; 5mg/5ml, Tk.
Adegut(Supreme), Suspn.,100mg/100ml, Tk.
28.11/60ml,; 5mg/5ml, Tk. 38.14/100ml,; Tab.,
28/60ml,; Tab., 10mg, Tk. 2.00/Tab.
10 mg, Tk. 2.01/Tab.; 10 mg, Tk. 5.00/Tab.
Anet (Kemiko), Tab.,10 mg, Tk. 2/Tab.
Efodio(Radiant), Tab. , 10mg, Tk. 4.00/Tab.
Apidone(Team), Suspn., 5mg/5 ml, Tk.
Egut(Euro), Syrup, 5mg/5ml, Tk.
33.00/60ml,; Tab., 10 mg, Tk. 2.20/Tab.
35.00/100ml; Tab., 10 mg, Tk. 2.5/Tab.
Apuldon(Aristo), Paed Drops, 5mg/5ml, Tk.
Emidom(Somatec), Suspn., 5mg/5ml, Tk.
25.00/15ml,30ml,; Supp, 15mg , Tk.
28.11/60ml,; Tab., 10 mg, Tk. 2.50/Tab.
6.00/Supp,; 30mg, Tk. 9.00/Supp,; Suspn.,
Esogut(Biopharma), Paed Drops, 5mg/5ml,
5mg/5ml, Tk. 35.00/60ml,; Tab. , 10mg, Tk.
Tk. 25.00/15ml,; Suspn., 5mg/5ml, Tk.
2.50/Tab.
28.11/60ml,; Tab., 10mg, Tk. 2.50/Tab.
Atidon(Asiatic), Suspn., 5mg/5ml, Tk.
Loridon(Modern), Suspn., 5mg/5ml, Tk.
28.00/60ml,; Tab., 10 mg, Tk. 2.00/Tab.
20.00/15ml,; 5mg/5ml, Tk. 28.00/60ml,; Tab. ,
Bpdon(Bristol), Tab.,10mg, Tk.100/Tab
10 mg , Tk. 2.50/Tab.
Cosy(Orion), Tab., 10 mg, Tk. 2.50/Tab.;
Motifast(Square), Dispersible Tab., 10mg, Tk.
Syrup, 5mg/5ml, Tk. 28.19/60ml,; Syrup,
2.51/Tab.
5mg/5ml, Tk. 38.26/100ml
99
Motigen(Novo Health), Tab. ,10mg, Tk. Metocol(Opsonin), Syrup, 5mg/5ml,

2.00/Tab.; Suspn, 5mg/5ml, Tk. 38.00/100ml Tk.15.83/100 ml; 5mg/5ml,
Motigut(Square), Paed. Drops, 5mg/5ml, Tk. Tk.10.65/15 ml
25.08/15ml,; Suspn. , 5 mg/5 ml, Tk. Migen(Albion), Syrup, 100 mg/100 ml, Tk.
35.11/60ml,; Tab., 10 mg, Tk. 2.51/Tab. 13.70/100 ml
Motinorm(Sharif), Tab., 10 mg, Tk.2.00/Tab. Motilon(Sanofi), Tab. 10mg,
Motistat(Globex), Suspn.,5mg/5ml, Tk. Tk. 0.34/Tab.
40.12/60ml,; Tab., 10 mg, Tk. 2.00/Tab. Nutramid(Acme), Tab., 10 mg,
Noburn(Beacon), Tab.,10mg, Tk. 2.01/Tab. Tk. 0.34/Tab.; Syrup, 100 mg/100 ml, Tk.
Nudon (Organic), Tab., 10 mg, Tk. 2.00/Tab. 10.65/60 ml
Omidon(Incepta), Paed. Drops, 5mg/5ml, Tk.
25.00/15ml,; Suspn., 5mg/5ml, Tk.
2.3 ULCER HEALING DURGS
35.00/60ml,; Tab. , 10mg, Tk. 2.00/Tab.;
Suspn., 5mg/5ml, Tk. 38.00/100ml,; Tab., 10
mg, Tk. 2.00/Tab. 2.3.1 H2 RECEPTOR ANTAGONISTS
Paridon(Drug Intl), Tab., 10mg, Tk. 2.05/Tab.; 2.3.2 SELECTIVE ANTIMUSCARINICS
Suspn, 5mg/5ml, Tk. 32.10/100ml 2.3.3 PROTON PUMP INHIBITORS
Perion(Globe), Suspn., 5 mg /5 ml, Tk.
2.3.4 CHELATES AND COMPLEXES
30.00/60 ml,; 5 mg /5 ml, Tk. 38.00/100 ml,;
Tab, 10 mg, Tk. 2.00/Tab. 2.3.5 PROSTAGLAND INALOGUES
Ridon(Eskayef), Sachet, 10mg , Tk. 2.3.6 DRUGS FOR ERADICATION OF
6.00/Sachet,; Syrup, 5mg/5ml, Tk. HELICOBACTER PYLORI
20.00/15ml,; 5mg/5ml, Tk. 30.00/60ml,; Tab,
10 mg, Tk. 2.50/Tab.
Sagdon(Nuvista), Tab., 10 mg, Tk. 2.00/Tab. 2.3.1 H2 -RECEPTOR ANTAGONISTS
Sandom(Sanofi), Suspn., 5mg/5ml, Tk.
28.18/Vial.; Tab,10mg, Tk. 2.02/Tab.; Paed H2-receptor antagonists reduce gastric
Drop, 5mg/ml, Tk. 20.13/Vial. acid (both basal and food stimulated)
Vave(ACI), Suspn., 5mg/5ml, Tk. 35.11/60ml
,; 5mg/5ml, Tk. 40.12/100ml,; Tab., 10mg , and pepsin output as a result of H2-
Tk. 5.02/Tab.; Paed Drops, 5mg /ml, Tk. receptor blockade. They have been used
25.08/15ml ,; Tab., 10mg , Tk. 2.50/Tab. in peptic ulcer, gastrointestinal reflux
Virdon(Virgo), Paed Drops, 5mg/5ml, Tk. diseases and in selected cases of
20.00/15ml,; Suspn. , 5mg/5ml, Tk. persistent dyspepsia. High doses of H2-
28.00/60ml,; Tab., 10 mg, Tk.200/Tab. receptor antagonists have been used in
Vomino(Monico), Tab., 10mg, Tk. 2.00/Tab.; the Zollinger-Ellison syndrome, though a
Suspn., 5mg/5ml, Tk. 28.00/60ml
Xepadon(Amico), Paed Drop, 5mg/ml,
proton pump inhibitor (see sec 2.3.3) is
Tk.18.00/15ml,; Suspn., 5mg/5ml, Tk. now preferred.
25.00/60ml,; Tab., 10mg , Tk. 2.00/Tab.
FAMOTIDINE
METOCLOPRAMIDE
HYDROCHLORIDE[ED) Indications:see under Dose
(See section 7.8) Cautions:see under ranitidine; does not
inhibit hepatic microsomal drug
Indications: See notes above and see metabolism
section7.8 Side-effects:see under ranitidine; dry
Cautions andSide-effects: See mouth and anorexia also reported
section7.8 Dose: benign gastric and duodenal
Interactions: See Appendix-2 ulceration; 20 mg twice daily or 40 mg at
Dose:By mouth 10 mg 3 times daily; night for 4-8 weeks; maintenance 20 mg
IM/IV10 mg 3 times daily over 1-2 at night. In Zollinger-Ellison syndrome,
minutes. CHILD 1-5 mg 3 times daily. 20 mg every 6 hours (higher dose in
those who have previously been
Proprietary Preparations receiving another H2-antagonist)
Maxocol(Medimet), Syrup, 5mg/5ml,
Tk.15.77/100ml; Tab.,10mg, Tk.0.34/Tab. Proprietary Preparations
Meclid(Jayson), Inj., 10 mg/2 ml,Tk. 3.55/2 ml Famodin(Acme), Tab. 20.00 mg., Tk.
Amp. 2.00/Tab.; 40 mg., Tk. 4.01/Tab.
100
Famotack(Square), Tab. 20 mg, Tk. arrhythmias) and in cardiovascular

2.00/Tab.; 20mg, Tk. 2.05/Tab. impairment, does not significantly inhibit
Famotid(Drug Intl), Tab., 40mg, Tk. 4.05/Tab. hepatic micro-somal drug metabolism.
Famotidine(Albion), Tab., 20 mg,
Tk.1.50/Tab.; 40 mg, Tk. 3/Tab.
Side-effects:altered bowel habit,
Novatac(ACI), Tab.,40mg, Tk. 4.13/Tab.; dizziness, rash, tiredness; occasionally,
20mg, Tk. 2.27/Tab. gynaecomastia (cimetidine only, and
Servipep(Novartis), Tab., 20 mg, Tk. 4/Tab.; usually only in high dosage), reversible
40 mg, Tk. 6/Tab. confusional states, reversible liver
Yamadin(Beximco), Tab., 20 mg, Tk. damage, headache; rare reports of
1.90/Tab.; Tab., 40 mg, Tk. 3.82/Tab. breast swelling and tenderness in men;
bradycardia, AV block and asystole.
NIZATIDINE Dose:by mouth, 150 mg twice daily
(morning and night), or for patients with
Indications:see under Dose gastric and duodenal ulceration; 300 mg
Cautions: also avoid rapid intravenous as a single daily dose at night for 4 to 8
injection (risk of arrhythmias and weeks, up to 6 weeks in chronic episodic
postural hypotension); dyspepsia, and up to 8 to 12 weeks in
hepatic impairment reflux oesophagitis and NSAID
Interactions:see Appendix-2(histamine associated ulceration; Zollinger-Ellison
H2-antagonists) and notes above synd-rome, 150 mg 3 times daily,
Pregnancy: avoid unless essential increased if necessary to 6 g daily in
Breast-feeding: amount too small to be divided doses.
harmful For maintenance, 150 mg at
Side-effects:see notes above; also night.CHILD, 8-18 years, up to 150 mg
sweating; rarely nausea, fever, twice daily. Gastric acid reduction
vasculitis, hyperuricaemia (prophylaxis of acid aspiration) in
Dose: benign gastric, duodenal or obstetrics, by mouth, 150 mg at onset of
NSAID-associated ulceration, treatment, labour, then every 6 hours.
300 mg in the evening or 150 mg twice By intramuscular injection, 50 mg every
daily for 4–8 weeks; maintenance, 6-8 hours.
150mg at night By slow intravenous injection, 50 mg
Gastro-oesophageal reflux disease, diluted to 20 ml and given over at least 2
150–300 mg twice daily for up to 12 minutes; may be repeated every 6-8
weeks. CHILD not recommended hours.
Renal impairment: use half normal By intravenous injection, 25 mg/hour for
dose if eGFR 20–50 mL/minute/1.73m2; 2 hours; may be repeated every 6-8
use one-quarter normal dose if eGFR hours.
less than 20 mL/minute/1.73m2 Surgical procedures, by intramuscular or
slow intravenous injection, 50 mg 45-60
Generic Preparation minutes before induction (intravenous
Capsule, 150mg injection diluted to 20 ml and given over
at least 2 minutes), or by mouth, 150 mg
RANITIDINE[ED][OTC] 2 hours before induction, and also, when
possible on the preceding evening.
Indications: benign gastric and
duodenal ulceration stomal ulcer, reflux Proprietary Preparations
Aceptin-R(Asiatic), Inj., 50 mg/2 ml, Tk.
oesophagitis, Zollinger-Ellison synd-
10.00/2 ml Amp; Tab., 150 mg, Tk. 2.00/Tab.
rome, other conditions where reduction Acin(Biopharma), Syrup, 75 mg/5 ml, Tk.
of gastric acidity is beneficial.(see notes 45.17/100ml; Tab., 150 mg, Tk. 2.50/Tab.
above) Alin(Rephco), Tab.,150 mg, Tk. 2.50/Tab.
Cautions:renal and hapatic impairment Amurun (Amulet),Tab.,150 mg, Tk. 2/Tab.
(reduce dose); pregnancy and breast- Anitid(Team), Tab., 150 mg, Tk. 2.00/Tab.
feeding. Avoid intravenous injection in
high dosage (may rarely cause
101
Antac(Ambee), Syrup, 75mg/5ml, Tk Ranidin(Acme), Inj., 50 mg/2 ml, Tk. 10.03/2

40.15/100 ml; Tab., 150 mg, Tk. 1.81/Tab.; ml Amp; Syrup, 75 mg/5 ml, Tk. 45.29/100ml;
Inj. , 50 mg / 2 ml , Tk. 5.32/2ml Amp Tab., 300 mg , Tk. 4.03/Tab., 50 mg , Tk.
Asinar(Sanofi), Tab., 150mg, Tk. 2.51/Tab. 2.51/Tab.
Astac(Astra Bio), Tab. , 150 mg, Tk. 2.00/Tab. Ranison(Jayson), Inj., 50 mg/1 ml , Tk.
Bentid(Benham), Tab.,150 mg, 10.00/Amp.;Tab. ,150 mg, Tk.1.73/Tab.
Tk.2.00/Tab.;150 mg, Tk.2.00/Tab. Ranisyn(MST), Tab., 150 mg, Tk. 2.10/Tab.
Bristol Neoset(Bristol), Tab. , 150mg , Tk. Ranitid(Opsonin), Syrup, 75 mg/5 ml, Tk.
1.500/Tab. 50.15/100 ml; Inj., 50 mg/2 ml, Tk. 10.00/2 ml
Duran(Techno), Tab., 300 mg , Tk.4.00/Tab.; Amp; Tab. , 150 mg , Tk. 2.51/Tab., 150 mg ,
Syrup, 75 mg/5 ml, Tk. 40/100 ml.; IVInfusion, Tk. 2.51/Tab., 300 mg , Tk. 4.02/Tab.
50 mg/100 ml, Tk. 60.00/100 ml Ranitidine(Albion), Syrup, 75 mg/5 ml, Tk.
Eucon(Pacific), Inj., 50 mg/2 ml, Tk. 10.00/2 40.00/100ml; Tk. 70.00/200ml .;Tab., 150 mg,
ml Amp.; Tab., 150 mg, Tk. 1.90/Tab. Tk.2.00/Tab.
Gastab(Nipro JMI), Syrup, 75 mg/5 ml, Tk. Ranitidine-R(Doctor TIMS), Tab. , 150 mg,
45.17/100 ml; Tab., 150 mg, Tk. 2.00/Tab. Tk.2.50/Tab.
Gastroloc(Beacon), Tab. , 150mg , Tk. Ranitor(Popular), Tab. , 150 mg, Tk. 2.00/Tab.
2.00/Tab. Ranix(Chemist), Inj.,50mg/ 2 ml, Tk. 25.00/2
Gepin(General), Tab. , 150mg, Tk. 2.01/Tab., ml Amp.
Syrup, 75 mg/5 ml, Tk. 50.00/100ml; 75 mg/5 Rantec(Medimet), Tab., 150mg, Tk.2.00/Tab.;
ml, Tk. 95.00/200ml; Inj., 50 mg/2 ml, Tk. 300mg, Tk.3.50/Tab.
10.00/2ml Amp Ranul(Apex), Tab., 150 mg, Tk. 1.00/Tab.
G-Ranitidine(Gonoshasthaya), Tab.,150 mg, Ravia(Pharmasia), Tab.,150 mg, Tk.1.00/Tab.
Tk. 1.40/Tab. Recodin(Concord),Tab.,150 mg, Tk.1.50/Tab.
Hi-Tac(Hudson), Tab., 150mg, Tk.2.00/Tab. Reetac-R(Navana),Tab.,150 mg, Tk.1.50/Tab.
Inran(Monico), Inj., 50 mg/2 ml, Tk. 6.00/2 ml Renete(Euro), Tab., 150 mg, Tk. 2.50/Tab.
Amp; Tab., 150mg, Tk. 2.00/Tab. Resectin(SMC Enterprise), Tab. , 150 mg,
Inseac(Ibn Sina), Syrup, 75 mg/5 ml, Tk. Tk. 2.50/Tab.
55.00/100ml; Tab., 300 mg, Tk. 4.00/Tab, 100 Rhine(Healthcare), Tab., 150mg , Tk.
mg, Tk. 2.50/Tab. 3.00/Tab.
Libret(Libra),Inj.,(IV Infusion), 50 mg/100 ml, Sutac(Supreme), Tab. , 150 mg, Tk.
Tk. 55.21/100 ml 2.00/Tab.
Lumeran(Aristo), Tab., 150mg, Tk. 2.00/Tab. Tinadin(Delta),Tab.150mg,Tk.2.00 /Tab.
Neoceptin(Beximco), Inj., 50 mg/2 ml, Tk. Ulcar(Drug Intl), Tab., 150mg, Tk. 2.55/Tab.,
10.00/2 ml Amp; Infusion, 0.05%, Tk. 300mg, Tk. 8.05/Tab.
101.00/100 ml; Syrup, 75 mg/5 ml, Tk. Ultradin(Globe), Tab. , 150 mg, Tk. 2.50/Tab.
50.00/100ml; Tab., 150mg, Tk. 2.50/Tab. Unitac(G.A.Co), Tab., 150 mg, Tk. 1.81/Tab.
Neotack(Square), Inj., 50 mg/2 ml, Tk. Veridin(Veritas), Tab., 150 mg, Tk.2.50/Tab.
10.03/2ml Amp; Syrup, 75 mg/5 ml, Virdin(Virgo), Tab. , 150 mg , Tk. 2.00/Tab.
Tk.50.15/100ml; 150 mg, Tk.2.51/Tab. Wintack(White Horse), Tab., 150 mg,
Neotin(Nipa), Tab., 150mg, Tk. 2.50/Tab. Tk.2.00/Tab.
Normacid(Kemiko), Tab., 150 mg, Tk. Xantid(ACI), Inj., 50 mg/2 ml, Tk. 7.55/2ml
2.51/Tab., Inj., 50 mg/2 ml, Tk. 6.02/2 ml Amp; Tab., 150mg, Tk. 2.51/Tab., 300mg, Tk.
Amp., Syrup, 75 mg/5 ml, Tk. 45.13/100ml 4.03/Tab., 150 mg, Tk. 1.51/Tab.
Norma-H(Renata), Tab.,150 mg, Tk.2.50/Tab. Zantac(GSK), Tab.,150 mg, Tk.4.07/Tab
Off-H(Organic), Tab.,150mg, Tk.2.51/Tab. Zenidine(Zenith), Tab.,150mg,Tk. 2/Tab.
Ortac(Orion), Inj., 50 mg/2 ml, Tk. 6.04/2ml Zenil(Rangs), Tab., 150mg, Tk. 2/Tab.
Amp; Tab., Tk. 2.01/Tab. Zodin(Somatec), Syrup, 75 mg/5 ml, Tk.
Peptil H(Eskayef), Inj., 50 mg/2 ml, Tk. 6.00/2 40.15/100ml; Tab., 150mg, Tk. 2.01/Tab.
ml Amp; 50 mg/2 ml, Tk. 6.00/2 ml Amp; Liq, Zorep(Amico), Tab., 150mg, Tk. 2/Tab.
100ml, Tk. 45.00/100ml; Tab., 150mg , Tk.
1.80/Tab., 150mg , Tk. 2.00/Tab., 150mg, Tk.
2.00/Tab., Liq, 100ml, Tk. 45.00/100ml
Peptosol(Opso Saline), IV Infusion, 50
mg/100 ml, Tk. 26.41/100 ml 2.3.2 SELECTIVE
Protec-R(Globex),Tab.,150mg,Tk.1/Tab. ANTIMUSCARINICS
Ranbex(Novo),Tab.,150mg,Tk. 1.25/Tab.
Rani (Alco), Tab., 150 mg, Tk. 2.01/Tab. M1 selective antimuscarinic pirenzepine
Ranid(Ziska),Tab.,150mg, Tk. 1.20/Tab.
blocks cholinergic stimulation of gastric
Ranidin(Acme), Inj., 50 mg/1 ml , Tk. 10/Amp.;
Syrup, 75 mg/5 ml, Tk. 45.16/100 ml.; Tab., acid secretion but has some anticholi-
150 mg, Tk.2.01/Tab.; 300 mg , Tk.4.01/Tab. nergic adverse effects. It had been tried
102
in the treatment of peptic ulcer but has Proprietary Preparation

now been discontinued. Delanix(Incepta), Cap., 30 mg, Tk. 9.00/Tab.;
60 mg, Tk. 16.00/Cap.
Desopra(Alco), Cap. , 30 mg, Tk. 10.00/cap.
2.3.3 PROTON PUMP INHIBITORS Dexilant(Ziska), Cap. 30 mg, Tk. 9/Cap.;
60mg, Tk. 16/Cap.
These include Omeprazole, Dexlan(Ibn Sina), Cap. , 60 mg, Tk.
Lansoprazole, Pantoprazole, 18.00/Cap.; 30 mg, Tk. 10.00/Cap.
Rabeprazole and Esmoprazole. They Dexogut(Popular), Cap. , 31.500mg, Tk.
10.00/Cap.; 63.00mg, Tk. 18.00/Cap.
produce profound and sustained
inhibition of gastric acid secretion by
blocking the hydrogen-potassium- LANSOPRAZOLE
adenosine triphosphate enzyme system
(the ‘proton pump’) of the gastric parietal Indications: Gastric ulcer, duodenal
cell. They are effective short-term ulcer, reflux oesophagitis Zollinger-
treatments for gastric and duodenal Ellison syndrome; also used in
ulcers. The response is rapid and conjunction with other drugs in triple
sustained (a single daily dose of therapy for eradication of H. pylori
omeprazole is sufficient to provide Cautions:See notes above;avoid in
effective suppression of gastric acid for a pregnancy and breast-feeding
24 hour period), and thus promotes Interactions:See Appendix-2
better compliance than with other anti Side-effects:See notes above
ulcer drugs. Lansoprazole and Dose: Benign gastric ulcer 30 mg daily
pantoprazole appear to be comparable in the morning before breakfast for a
with omeprazole in efficacy. period of 4 to 8 weeks. For gastric or
Cautions: Proton pump inhibitors should duodenal ulcer associated with H. pyloroi
be used with caution in patients with liver in triple therapy for eradication of H.
disease, in pregancy and in breast- pylori, see section 2.3.6
feeding; they may musk the symptoms of
gastric cancer. Proprietary Preparations
Side-effects: These include Enso(Kemiko), Cap. , 15 mg, Tk. 3.01/Cap. ;
gastrointestinal disturbances (nausea, 30 mg, Tk. 5.02/Cap.
Lanozole(Medimet), Cap., 30 mg,
vomiting, diarrhoea flatulence, abdomi- Tk.5.00/Cap.; 5 mg, Tk.3.00/Cap.
nal pain), hypersensitivity reactions Lansec(Drug Intl), Cap., 30mg, Tk. 6.05/Cap.;
(rash, urticaria, pruritus, angiooedema); 15 mg, Tk. 3.55/Cap.
occasional headache, malaise, muscle Lansina(Ibn Sina), Cap. , 30 mg, Tk.
and joint pain, blurred vision and dry 6.00/Cap.
mouth. Lanso(Square), Cap. , 30 mg, Tk.6.04/Cap.
Lansocon(Biopharma), Cap. , 30 mg, Tk.
6.00/Cap.
DEXLANSOPRAZOLE Lansodin(Acme), Cap. , 15 mg , Tk.
3.52/Cap. ; 30 mg, Tk. 6.04/Cap.
Indications: acid reflux, heartburn, Lansoprazole(Albion), Cap. , 15 mg, Tk.
difficulty swallowing, persistent cough, 3.50/Cap. ;30 mg, Tk. 6.00/Cap.
Lansopril(Amico), Cap. , 30 mg, TK.
stomach ulcers(occasional use)
5.00/Cap.
Cautions :See notes above;liver Lansoprol(Ziska), Cap. , 30 mg, Tk.
disease, bone fracture, shoulder pain, 80.00/Cap.
elderly Lantid(Opsonin), Cap. , 15 mg, Tk. 3.01/Cap.
Side effects: See notes above; diarrhea, ; 30 mg , Tk. 5.02/Cap.
a low magnesium level, persistent Lanz(ACI), Cap., 15mg, Tk.3.03/Cap.; 30mg,
muscle spasms, seizures, abdominal or Tk. 5.04/Cap.
Lap(Ambee), Cap. , 30 mg, Tk. 5.01/Cap
stomach pain, cramping, fever
Lasocon(Biopharma), Cap. , 30 mg, Tk.
Dose: 30 mg/60 mg once daily with or 6.00/Cap.
without food Protolon(Beximco), Cap. , 30mg, Tk.
6.00/Cap.
103
Zoton(General), Cap. , 30mg, Tk. 6.04/Cap. Esmosec(Techno), Tab., 20 mg, Tk. 5/Tab.;
40 mg, Tk. 8/Tab.
Esmotac(G.A.Co), Tab., 20 mg , Tk.
ESOMEPRAZOLE
4.02/Tab.; 40 mg , Tk. 7.03/Tab.
ESO(Asiatic), Tab., 40 mg, TK. 8.00/Tab.; 20
Indications: listed in dosage mg , Tk. 5.00/Tab.
Caution:see notes above; exclude Esobest(Sharif), Tab. , 40 mg, Tk.
gastric malignancy before treatment; 8.00/Tab.; 20 mg, Tk. 10.00/Tab.; Cap, 20
severe hepatic impairment mg , Tk. 7.00/Cap.; 40 mg , Tk. 10.00/Cap.
Esocon(Biopharma), Cap., 40 mg, Tk.
Interactions:see Appendix-2
9.50/Cap.; 20 mg, Tk. 7.00/Cap.; Inj,
Side-effects: headache, abdominal 40mg/Vial, Tk. 65.00/Vial
pain, diarrhoea, nausea, vomiting, Esofour(Albion), Cap., 20 mg, Tk. 6/Cap.;
pruritus, dizziness 20mg, Tk. 6/Cap. Tab., 20 mg, Tk. 5/Tab.;
Dose: erosive reflux esophagitis: 20-40 40mg, Tk. 7/Tab.
mg once daily for 4-8 weeks; mainte- Esogap(Euro), Inj. , 40 mg/Vial, Tk.
nance, 20 mg once daily 100.00/Vial,; Tab., 20 mg, Tk. 5.00/Tab.; 450
mg, Tk. 8.00/Tab.
Symptomatic gastro-esophageal reflux:
Esoge(Organic), Cap. , 20 mg, Tk.
20 mg once daily for 4 weeks 6.50/Cap. ; 40 mg, Tk. 8.03/Cap.
Triple therapy for eradication of H. pylori Esoking(Globex), Cap., 20 mg, Tk. 6.00/Cap.
20 mg twice daily (with 1 g amoxycillin Esolin(Rephco), Tab. 40 mg, Tk. 8.00/Tab. ;
twice daily and 500mg calrithromycin 20 mg, Tk. 4.00/Tab.
twice daily for 7 days Esolok(Ibn Sina), Inj. , 40 mg/vial, Tk.
100.00/Inj.; Cap., 20 mg, Tk. 7.00/Cap.; 40
mg, Tk. 8.00/Cap. Tab., 20 mg, Tk. 5.00/Tab.
; 40 mg, Tk. 8.00/Tab.
Alton(General), Tab. , 20 mg, Tk. 5.01/Tab;
Esomenta(Julpher), Cap., 20 mg, Tk.
40 mg, Tk. 8.03/Tab.Inj., 40mg/Vial, Tk.
7.00/Cap.;Cap., 40 mg, Tk. 10.0/Cap.
100.30/Vial,;
Esomep(ACI), Inj., 40mg, Tk. 90.27/40mg,;
Asector(Novo Healthcare), Cap., 20 mg, Tk.
Cap., 20 mg, Tk. 7.02/Cap.; 40mg, Tk.
7.00/cap.; 40 mg, Tk. 9.00/Cap.; Inj. , 40
9.03/Cap.; Tab., 20mg, Tk. 5.02/Tab.; 40mg,
mg/Vial, Tk. 90.00/Vial
Tk. 8.02/Tab.
Asozit(White Horse), Cap., 20 mg, Tk. 7/Cap.
Esomium(SMC Enterprise), Cap., 40 mg, Tk.
Curacid(Rangs), Cap., 20mg, Tk. 6.00/Cap.;
9.00/Cap.; 20 mg, Tk. 6.00/Cap.
40mg, Tk. 9.00/Cap.
Esomo(Amulet), Cap., 20 mg, Tk. 6.00/Cap.;
Ema(Globe), Cap., 20 mg, Tk. 7.00/Cap.; 40
40 mg, Tk. 8.00/Cap.
mg, Tk. 3.00/Cap.; Inj. , 40 mg/vial, Tk.
Esonaaf(Naafco), Cap., 20 mg, Tk. 2.00/Cap.
3.00/Inj.; Tab. , 20 mg, Tk. 4.75/Tab.; 40 mg,
Esonix(Incepta), Cap., 20 mg, Tk.
Tk. 8.00/Tab.
7.00/Cap.; 40 mg, Tk. 9.00/Cap.; Inj., 40
Emep(Aristopharma), Cap. , 20 mg, Tk.
mg/Vial, Tk. 70.00/Vial,; 40 mg/Vial, Tk.
7.00/Cap.; 40 mg, Tk. 9.00/Cap.; Injection, 40
90.00/Vial,; Powder for Suspn. , 20
mg/Vial, Tk. 90.00/Vial,; Tab., 20mg , Tk.
mg/Sachet, Tk. 7.00/Sachet,; Tab, 20 mg, Tk.
5.00/Tab.
5.00/Tab.; 40 mg, Tk. 8.00/Tab.
Epa(Zenith), Tab., 20 mg, Tk. 4.01/Tab.
Esopra(Alco), Cap., 20 mg, Tk. 6.02/Cap.;
Epizol(Nipa), Cap. , 20 mg, Tk. 7.00/Cap.; 40
40 mg, Tk. 9.03/Cap.; Tab, 20 mg, Tk.
mg, Tk. 9.00/Cap.
4.01/Tab.; 40 mg, Tk. 7.02/Tab.
Eprazol(Labaid), Cap., 20 mg, Tk. 7/Cap.
Esoprex(Beacon), Cap., 40mg , Tk.
E-Proton(Doctor TIMS), Cap., 20 mg, Tk.
9.03/Cap.; 20mg , Tk. 7.02/Cap.; Inj.,
7.00/Cap.
40mg/Vial;, Tk. 100.30/Vial,;
Erazole(Kemiko), Cap. , 40 mg, Tk.
. Esoprol(Ziska), Cap., 20mg, Tk. 5.00/Cap;
10.03/Cap.; 20 mg, Tk. 7.02/Cap .; Tab., 20
40mg, Tk. 8.00/Cap.
mg, Tk. 5.02/Tab.; 40 mg, Tk. 8.03/Tab.
Esoral(Eskayef), Cap. , 20mg , Tk. 7.00/Cap.;
Escap(Sanofi), Cap., 40mg, Tk. 12.00/Cap.;
Inj. , 40mg , Tk. 90.00/Inj. ; Tab, 20mg, Tk.
20mg, Tk. 8.00/Cap.
10.00/Tab.; 20mg , Tk. 5.00/Tab.; 20mg, Tk.
Eslo(Bristol), Cap., 20mg , Tk. 390.00/Cap .;
5.00/Tab.; 20mg, Tk. 5.00/Tab.; 20mg , Tk.
Tab, 40mg , Tk. 335.00/Tab.; 20mg , Tk.
10.00/Tab.; 20mg , Tk. 4.01/Tab.; 20mg , Tk.
225.00/Tab.; 20mg , Tk. 450.00/Tab.
5.00/Tab.; 40mg , Tk. 14.00/Tab.; 40mg, Tk.
Esmax(Concord), Cap., 20 mg, Tk. 6/Cap.;
7.00/Tab.; 40mg , Tk. 8.00/Tab.;
40mg, Tk. 8/Cap; Tab., 20 mg, Tk. 5/Tab.
Esorant(Supreme), Cap, 20mg, Tk.
Esmogel(Biogen), Cap., 20mg , Tk. 6.50/Cap.
6.00/Cap.; 40mg, Tk. 8.00/Cap.
104
Esotac(Navana), Tab., 40 mg, Tk. Prazia(Amico), Cap., 20mg , TK. 7.00/Cap.;

7.03/Tab.;Cap., 20 mg, Tk. 6.00/Cap. 40 mg, 40mg , TK. 10.00/Cap.; Tab., 20mg, TK.
Tk. 8.00/Cap. 5.00/Tab.; 40mg , TK. 8.00/Tab.
Esotem(Team), Cap., 40 mg, Tk. 9.00/Cap. ; Progut(Popular), Cap. , 20mg , Tk. 7.00/Cap.
20 mg, Tk. 6.50/cap. ; , 40 mg, Tk. 9.00/Cap.; Powder for Suspn.,
Esotid(Opsonin), Cap. , 20 mg , Tk. 20 mg/Sachet,; Tab. , 20 mg, Tk. 5.00/Tab.;
6.04/Cap.; Tab, 20 mg , Tk. 5.03/Tab.; Cap., Inj., (Popular), Inj. , 40 mg/Vial, Tk. 90.00/Vial
40 mg , Tk. 9.06/Cap. Tab. , 40 mg , Tk. Pronex(Drug Intl), Tab., 20mg, Tk. 5.05/Tab.;
8.00/Tab.; Vial, 40 mg , Tk. 90.27/ 40 mg 40mg, Tk. 8.05/Tab.; Cap., 20mg, Tk.
Esotor(Nipro JMI), Tab. , 20 mg, Tk. 5.00/Tab. 6.00/Cap.; 40mg, Tk. 8.00/Cap.; Inj., 40mg,
; 40 mg, Tk. 8.00/Tab. Tk. 90.30/Inj.;
Esover(Veritas), Cap. , 20 mg, Tk. SB-Emec(Sunman-Bardem), Cap., 20 mg,
7.00/Cap.;40 mg, Tk. 9.00/Cap. Tk. 7.00/Cap.; 40 mg, Tk. 9.00/Cap.
Esovir(Virgo), Cap., 20 mg, Tk. 700.00/Cap. Sergel(Healthcare), Cap., 20mg , Tk.
Esoz(Astra Biopharma), Cap. , 20 mg, Tk. 700.00/Cap.; 40mg , Tk. 500.00/Cap.; Tab.,
7.00/Cap.; 40 mg, Tk. 8.00/Cap.; Tab. , 20 20mg, Tk. 210.00/Tab.; Inj, 40mg , Tk.
mg, Tk. 5.00/Tab. 40 mg, Tk. 8.03/Tab.. 100.00/Inj. ; 40mg/Vial, Tk. 100.00/Vial,; Tab.,
Esprazo(Pacific), Cap., 20 mg, Tk. 7.00/Cap. 40mg , Tk. 270.00/Tab.
Exium(Radiant), Cap., 20mg , Tk. 10.00/Cap.; Sompraz(Sun), Tab. , 20 mg, Tk. 6.00/Tab;40
40mg , Tk. 14.00/Cap.; 20mg , Tk. 8.50/Cap.; mg, Tk. 9.00/Tab..;
40 mg, Tk. 12.00/Cap. ; Inj., 40mg/Vial, Tk. Somprazol(Sharif), Cap. , 20 mg, Tk.
120.00/Vial. 6.00/Cap. ; 40 mg, Tk. 9.00/Cap.
Exmart(MST), Tab., 20 mg, Tk. 5/Cap.; 40
mg, TK. 8/Tab. Esomeprazole + Naproxen
Exome(Chemist), Tab., 20 mg, Tk. 5.00/Tab. Anaflex(ACI), Tab., 20mg+375mg, TK.
Exor(Orion), Inj, 40 mg, Tk. 100.30/Inj.; Cap., 8.02/Tab.; 20 mg + 500 mg, TK. 10.03/Tab.
20 mg, Tk. 7.00/Cap.; 40 mg, Tk. 10.00/Cap. Demovo(Delta), Tab. , 20 mg + 375 mg, Tk.
EZ(Modern), Cap. , 20 mg, Tk. 7.00/Cap. 8.00/Tab. ; 20 mg + 500 mg, Tk. 10/Tab.
Gerdo(Nuvista), Cap., 20 mg, Tk. 7.02/Cap. Dinovo(Beximco), Tab., 375mg + 20mg, Tk.
iMAX(Delta), Cap. , 20 mg, Tk. 5.00/Cap. 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.
Maxima(Acme), Cap., 40 mg , Tk. Emaprox(Globe), Tab. , 375 mg + 20 mg, Tk.
10.00/Cap.; 20 mg , Tk. 7.00/Cap.; Inj., 40 mg, 3.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.
Tk. 90.27/Inj.; Tab., 20 mg, Tk. 5.00/Tab.; 40 Emaprox(Globe), Tab.,20 mg + 375 mg, Tk.
mg, Tk. 8.00/Tab. 8.00/Tab.; 20 mg + 500 mg , Tk. 10.00/Tab.
Maxpro(Renata), Cap., 20 mg, Tk. Esona(Navana), Tab., 20 mg + 375 mg, Tk.
7.00/Cap.; 40 mg, Tk. 10.00/Cap.; Tab., 20 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.
mg, Tk. 5.00/Tab.; 40 mg, Tk. 8.00/Tab.; Inj., Eso-Plus(Asiatic), Tab., 500mg + 20mg, Tk.
40 mg/vial, Tk. 90.00/Inj. 10.00/Tab.; ., 20 mg + 375mg, Tk. 8.00/Tab.
Naspro(Popular), Tab. , 20 mg, Tk. Esoxen (Organic), Tab, 20 mg + 375mg, mg,
10.00/Tab.; 40 mg, Tk. 8.00/Tab. Tk. 8.03/Tab.; 20 mg + 500 mg, Tk.
Neptor(Novartis), Cap. , 20 mg, Tk. 10.03/Tab.
8.00/Cap.; Cap., 40 mg, Tk. 12.00/Cap. Inflect (Kemiko), Tab., 20 mg + 375mg, mg,
Nexcap(UniMed), Cap., 20mg , Tk. 7.00/Cap.; Tk. 8.02/Tab.; 20 mg + 500 mg Tk. 10.03/Tab.
40mg, Tk. 9.00/Cap. Locin(Globe ), Tab., 20 mg + 375 mg, Tk.
Nexcap(Unimed), Cap. , 20 mg, Tk. 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.
7.00/Cap.; 40 mg, Tk. 9.00/Cap. Nameso(Opsonin), Tab, 20 mg + 375mg,, Tk.
Nexe(Apex ), Tab. , 20 mg, Tk. 5.00/Tab.; 40 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.
mg, Tk. 8.00/Tab.; Cap., 20 mg, Tk. 6.00/Cap. Napexa (UniMed), Tab , 20 mg + 375mg, Tk.
Nexum(Square), Cap, 20 mg, Tk. 7.02/Cap.; 12.00/Tab.; 20 mg + 500 mg, Tk. 16.00/Tab.
40 mg, Tk. 10.03/Cap.; Inj., 40 mg/vial, Tk. Napren ES(Alco), Tab. , 20 mg + 375 mg, Tk.
90.27/Inj.; Tab. , 20 mg , Tk. 10.00/Tab. ; 40 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.
mg , Tk. 14.00/Tab. ; 40 mg, Tk. 8.07/Tab. Napreso(Euro), Tab., 20 mg + 500 mg, Tk.
Nuloc(Monico), Tab., 20mg, Tk. 5.00/Tab.; 10.00/Tab.
40mg, Tk. 90.00/Tab. Napro-A Plus(Acme), Tab20 mg + 375mg,,
Onepro(One Pharma), Cap., 20 mg, Tk. Tk. 8.03/Tab.; 20 mg + 500 mg mg, Tk.
6.99/Cap.; 40 mg, Tk. 9.00/Cap.; Tab., 20 mg, 10.03/Tab.
Tk. 5.00/Tab.; 40 mg, Tk. 7.99/Tab. Naproflex(Somatec), Tab., 20 mg + 375mg,,
Opton(Beximco), Cap., 20mg, Tk. 7.00/Cap. ; Tk. 8.00/Tab.; 375 mg + 20 mg, Tk. 10.00/Tab.
40mg, Tk. 10.00/Cap.; Inj., 40mg, Tk. Naprosyn Plus(Radiant), Tab., 20 mg +
110.00/Inj.; Tab., 40mg, Tk. 8.00/Tab.; 20mg, 375mg,, Tk. 16.05/Tab.; 20 mg + 500 mg, Tk.
Tk. 5.00/Tab. 20.06/Tab.
105
Naprotec(Sharif), Tab., 20 mg + 375mg, mg, Benign gastric or duodenal ulcer

Tk. 8.03/Tab.; 500mg + 20 mg, Tk. 10.30/Tab. associated with H. pylori, see section
Naprox Plus(Eskayef), Tab, 20 mg + 500 mg, 2.3.6 for eradication therapy.
Tk. 10.00/Tab.; 20 mg + 375mg,, Tk.
8.00/Tab.
Zollinger-Ellison syndrome, initially 60
Naproxen(Zenith), Tab, 20 mg + 375mg,, Tk. mg once daily; usual range 20-120 mg
8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.; daily (above 80 mg in 2 divided doses).
(Bristol), Tab. , 20 mg + 500 mg, Tk. Erosive reflux oesophagitis, 20 mg daily
10.00/Tab. for 4 weeks, followed by a further 4
Naproxen Plus(Albion), Tab., 20 mg + 500 weeks if not fully healed; 40 mg daily has
mg, Tk. 6.89/Tab. been given for 8 weeks in reflux
Naproxzia(Amico), Tab., 500mg + 20mg, Tk.
10.00/Tab.
oesophagitis refractory to other
Naprozol(General), Tab. , 20 mg + 375 mg, treatment.
Tk. 8.00/Tab.;Tab. , 20 mg + 500 mg, Tk.
10.00/Tab. Proprietary Preparations
Napsec(Drug Intl), Tab., 20 mg + 375mg,, Tk. Anasec(Novo Healthcare), Cap., 40 mg, Tk.
8.05/Tab.; 20 mg + 500 mg Tk. 10.05/Tab. 7.00/Cap.; 20 mg, Tk. 5.00/Cap.; Inj.,
Napxon(Ziska), Tab. ,20 mg + 375mg, mg, Tk. 40mg/Vial, Tk. 70.00/Vial
256.00/Tab.; 500 mg + 20 mg, Tk. 320.00/Tab. Aspra(Apex), Cap. , 20 mg, Tk. 4.00/Cap.;
Nasopain(Julpher ), Tab., 20 mg + 375 mg, AU-20(Decent), Cap., 20mg, Tk. 4.50/Cap.
Tk. 10.0/Tab.; 20 mg + 500 mg, Tk. 12.0/Tab. Cosec(Drug Intl), Cap., 20mg, Tk. 5.05/Cap. ;
Neso(Aristopharma), Tab., 20 mg + 375mg, , 40mg, Tk. 8.05/Cap.; Inj., 40mg/Vial, Tk.
Tk. 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab. 90.30/Vial
Nesotem(Team), Tab .20 mg + 500 mg mg, Curacid(Rangs), Cap., 20mg, Tk. 6.00/Cap.;
Tk. 9.50/Tab.; 20 mg + 375mg, Tk. 7.50/Tab. 40mg, Tk. 9.00/Cap.
Novoxen(Orion), Tab. ,20 mg + 375mg,, Tk. Deu(Monico), Cap., 20mg, Tk. 5.00/Cap.; Inj.,
8.02/Tab.; 20 mg + 500 mg Tk. 15.03/Tab. 40mg/Vial, Tk. 80.00/Vial
Nupralgin(Ibn Sina), Tab. 20 mg + 500 mg, Ema(Globe), Cap., 20 mg, Tk. 7.00/Cap; 40
Tk. 300.00/Tab.; 20 mg + 375mg,, Tk. mg, Tk. 9.00/Cap.; Tab., 20 mg, k. 4.75/Tab.;
80.00/Tab. 40 mg, Tk. 8.00/Tab.; IV Inj., 40 mg/vial, Tk.
Progesic(Incepta), Tab. 20 mg + 375mg,, Tk. 80.00/Vial
8.00/.Tab.; 20 mg + 500 mg, Tk. 10.00/Tab. Esoprol(Ziska), Cap., 20mg, Tk. 5.00/Cap;
Progut-N(Popular ), Tab. , 20 mg + 375 mg, 40mg, Tk. 8.00/Cap.
Tk. 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab. Eupi(Pharmasia), Inj., 40 mg/vial, Tk.
Ranoxen Plus(Rangs), Tab., 20 mg + 500 mg, 80.00/Vial; Cap., 20 mg, Tk. 5.00/Cap.
Tk. 10.00/Tab. Exmart(MST), Tab., 20 mg, Tk. 5/Cap.; 40
Solivo(Healthcare), Tab., 20 mg + 375mg,, Tk. mg, Tk. 8/Tab.
390.00/Tab.; 20 mg + 500 mg, Tk. 450.00/Tab. Exome(Chemist), Tab., 20 mg, Tk. 5.00/Tab.
Twist(Chemist), Tab., 20 mg + 500 mg, Tk. Gap(Euro), Inj., 40mg/Vial, Tk. 9.00/Vial;
10.00/Tab. Cap., 20 mg, Tk. 5.00/Cap.; 40mg, Tk.
Xenap(Astra Biopharma), Tab. , 20 mg + 500 8.00/Cap.
mg,; 375mg + 20mg, TK. 8.02/Tab. G-Omeprazole(Gonoshasthaya), Cap.,20mg,
Xenole(Square), Tab. ,20 mg + 375mg,, Tk. Tk 3.00/Cap. ;Inj., 40 mg/vial, Tk. 65.00/Vial
8.03/Tab.; 20 mg + 500 mg Tk.10.03/Tab. Healer(Amico), Cap., 20mg , TK. 4.00/Cap.;
Inhibita(Delta), Cap., 20 mg, Tk. 4.00/Cap.; 40
mg, Tk. 7.00/Cap.
OMEPRAZOLE[ED][OTC]
Inpro(Biopharma), Cap., 20 mg, Tk.
5.00/Cap.; 40 mg , Tk.7.03/Cap.; Inj., 40
Indications:See notes above mg/vial, Tk. 70.00/Vial
Cautions:See notes above; exclude Inpro(Biopharma), Cap., 20mg, Tk. 5.00/Cap.;
malignancy. 40mg , Tk. 7.03/Cap.; Inj., 40mg/Vial, Tk.
Interactions:See Appendix-2 70.00/Vial
I-Proton(Doctor TIMS), Cap., 20 mg, Tk.
Side-effects: See notes above
5.00/Cap.
Dose: Benign gastric and duodenal Losectil(Eskayef), Tab., 20mg , Tk. 4.00/Tab.;
ulcers, 20 mg once daily for 4 weeks in 10mg, Tk. 2.00/Cap.; 40mg , Tk. 7.00/Cap. ;
duodenal ulceration or 8 weeks in gastric Inj, 40mg/vial , Tk. 90.00/Vial; Powder
ulceration; in severe cases increase to forSuspn., 20mg/Sachet , Tk. 5.00/Sachet;
40 mg daily; long term use not 40mg/Sachet , Tk. 8.00/Sachet; Cap, 20mg,
recommended Tk. 4.99/Cap.; 40mg , Tk. 7.00/Cap. ; Inj. ,
40mg/Vial, Tk. 90.00/Vial
106
Losek(Bristol), Cap., 20mg , Tk. 3.50/Cap.; Omitac(G.A.Co), Cap., 20 mg, Tk. 5.00/Cap.
40mg, Tk. 7.00/Cap. Omitin(Nipa), Cap., 40 mg, Tk. 7.00/Cap.; 20
Lotil(Albion), Cap., 20 mg, Tk. 2.95/Cap.; 40 mg, Tk. 4.00/Cap.
mg, Tk. 4.00/ Tab. Omizit(White Horse), Cap., 20 mg, Tk.
Neopra(Supreme), Cap, 20mg, Tk. 5.00/Cap.; 4.00/Cap.
Norain(GSK), Cap., 20 mg, Tk. 5.01/Cap. Omsec(Techno), Cap. , 20 mg, Tk. 4.00/Cap.;
Nuprazol(Nuvista), Cap. , 20 mg, Tk. Inj., 40 mg/vial, Tk. 70.00/Vial
5.00/Cap. OP(Globe), Cap., 20 mg, Tk. 4.75/Cap.; 40
O-20(Asiatic), Cap., 20 mg , Tk. mg, Tk. 8.00/Cap.; Inj. , 40 mg/vial,
5.00/Cap.;40mg , Tk. 7.00/Cap. Tk.70.00/Vial
Ome(Somatec), Cap., 20 mg, Tk. 5.00/Cap.; OP max(Concord), Cap., 20 mg, Tk.
40 mg, Tk. 8.00/Cap. 4.00/Cap.; Cap. , 40 mg, Tk. 7.00/Cap.
Omeben(Benham), Cap. , 20 mg, Tk.5/Cap. Opal(Healthcare), Cap., 20mg , Tk.
Omecron(Nipro JMI), Cap., 20 mg, Tk. 10.00/Cap.; 40mg , Tk. 8.00/Cap.; Inj.,
6.00/Cap.; 40 mg, Tk. 8.00/Cap. 40mg/Vial, Tk. 95.00/Vial
Omegut(Popular), Cap., 20mg, Tk. 5.00/Tab.; Opezen(Zenith), Cap., 20 mg,; 40 mg, Tk.
40 mg, Tk. 7.03/Cap.; Inj., 40mg/Vial, Tk. 7.02/Cap.; Tk. 4.01/Cap.; Powder forSuspn.,
80.00/Vial 20mg/Sachet, Tk. 5.00/Sachet
Omelet(Amulet), Cap., 40 mg, Tk. 7.00/Cap.; Peptral(Labaid), Cap., 20 mg, Tk. 5.00/Cap.
Cap., 20 mg, Tk. 5.00/Cap. Piazol(Globex), Cap., 20 mg, Tk. 4.00/Cap.
Omelock(One Pharma), Cap., 20 mg, Tk. PPI(Acme), Inj., 40mg/Vial, Tk. 90.00/Vial; 20
5.00/Cap.; 40 mg , Tk. 7.99/Cap. mg, Tk. 5.01/Cap.; 40mg, Tk. 8.03/Cap.
Omenaaf(Naafco), Cap., 20 mg, Tk. Prazo(Pacific), Cap., 40 mg, Tk. 7.00/Cap.; 20
5.00/Cap.; 40 mg, Tk. 8.00/Cap. mg, Tk. 5.00/Cap. ; Tab., 20 mg, Tk. 2.50/Tab.
Omenix(Incepta), Inj., 40 mg/vial, Tk. Prazole(Renata), Cap., 20 mg, Tk. 4.02/Cap.
90.00/Vial; Suspn., 40 mg, Tk. 10.00/Sachet; Prazomax(SMC Enterprise), Cap., 20 mg, Tk.
Cap. , 20 mg, Tk. 5.00/Cap.; 20mg/Sachet , 4.00/Cap; 40 mg, Tk. 6.00/Cap.
Tk. 6.00/Sachet Prazover(Veritas), Cap., 20 mg, Tk. 5/Cap.
Omenta(Junphar), Cap., 20 mg, Tk.5.0/Cap.; Prazple(Renata), Cap., 20 mg, Tk. 5.00/Cap.
Inj., 40 mg/vial, Tk. 90.00/Vial Presec(UniMed), Cap., 20mg, Tk. 4.00/Cap.;
Omep(Arist), Inj., 40mg/Vial, Tk. 80.00/Vial; 40 mg, Tk. 7.00/Cap.
Cap., 10mg , Tk. 2.00/Cap.; 20mg , Tk. Prevas(General), Cap., 20mg; 40mg, Tk.
5.00/Cap.; 40mg , Tk. 7.00/Cap. 8.00/Cap.; Tk. 5.00/Cap. ; Inj., 40mg/Vial, Tk.
Omepra (Alco), Cap., 20mg, Tk. 4.01/Cap. ; 80.24/Vial
40 mg, Tk. 7.02/Cap. Probitor(Novartis), Cap., 20 mg, Tk 7.00/Cap.;
Omeprazole(APC), Cap., 20 mg, Tk. 40 mg, Tk. 10.00/Cap.
2.50/Cap. Procap(Orion), Inj , 40 mg/vial, Tk. 90.27/Vial;
Omeprol(Ziska), Cap., 20 mg, Tk. 4.00/Cap.; Cap., 20 mg, Tk. 5.01/Cap.; 40mg, Tk.
40 mg, Tk. 6.12/Cap.; Inj., 40mg/Vial, Tk. 8.02/Cap.
70.00/Vial Proceptins(Beximco), Cap., 20mg, Tk.
Omesil(Silva), Cap., 20mg, Tk. 5.02/Cap.; 40 5.00/Cap.; Cap., 40mg, Tk. 8.00/Cap.; Inj.,
mg, Tk. 7.02/Cap. 40mg/Vial, Tk. 100.00/Vial
Ometac(Navana), Cap., 20 mg, Tk. 4.02/Cap.; Prolok(Ibn Sina), Cap. , 20mg, Tk.
40 mg, Tk. 6.02/Cap. 5.00/Cap.; Inj., 40mg/Vial, Tk. 90.00/Vial;
Ometem(Team), Cap., 20 mg, Tk. 4.75/Cap.; 40mg, Tk. 240.00/Cap.
40 mg, Tk. 7.50/Cap. Promezol(Sharif), Cap. , 20 mg,
Ometid(Opsonin), Cap., 20 mg, Tk. 5.02/Cap.; Tk.5.00/Cap.; 40 mg, Tk. 8.00/Cap.
40 mg , Tk. 7.03/Cap.; Inj., 40mg/Vial, Tk. Prosectil(Pharmacil), Cap. , 20 mg, Tk.
90.27/Vial 5.00/Cap.; Inj., 40 mg/vial, Tk. 90.00/Vial
Ometor(Astra Bio), Cap., 20 mg, Tk. Regerd(Organic), Cap. , 20 mg, Tk.
4.00/Cap.; 40 mg, Tk. 8.00/Cap.; Inj. , 40 5.00/Cap.;40 mg , Tk. 7.00/Cap.
mg/vial, Tk. 80.00/Vial Rome(Rephco), Cap. , 20 mg, Tk. 5.00/Cap.
Ometor(Astra),Cap., 20 mg, Tk. 4.00/Cap. Seclo(Square), Inj.,40mg/Vial, Tk. 80.24/Vial;
Omevir(Virgo), Cap., 20 mg, Tk. 5.00/Cap. Tab. , 20 mg, Tk. 5.02/Tab. ; 40 mg, Tk.
Omex(Kemiko), Cap., 20 mg, Tk. 5.02/Cap; 7.00/Tab. ; Cap., 20 mg, Tk. 5.02/Cap.; Cap.,
40 mg, Tk. 7.02/Cap.; Inj., 40mg/Vial, Tk. 40 mg, Tk. 8.03/Cap.
87.00/Vial Seclogen(Biogen), Cap., 20 mg, Tk.
Omex(Kemiko), Cap., 20 mg, Tk. 5.00/Cap.; 5.00/Cap.
40 mg, Tk. 7.00/Cap. Stosec(Opso Saline), Inj., 40 mg/vial, Tk.
Omidex(Modern), Cap., 20 mg. , Tk. 5.00Cap. 52.83/Vial
Omirex(Jayson), Cap., 20 mg, Tk. Xeldrin(ACI), Cap., 10mg, Tk. 2.02/Cap;
5.00/Cap.;Cap., 40 mg, Tk. 8.00/Cap. Cap., 20mg, Tk. 5.02/Cap.; Cap., 40mg, Tk.
107
8.02/Cap; Inj., 40mg/Vial, Tk. 80.24/Vial; Tab., Panprazo(Pacific), Tab. , 20 mg, Tk.
20mg, Tk. 4.03/Tab.; 4.00/Tab.
Xelopes(Beacon), Cap., 20mg , Tk. 5.02/Cap.; Panpro(Biopharma), Tab., 40mg, Tk.
40mg , Tk. 7.02/Cap.; Inj., 40mg/Vial, Tk. 6.00/Tab., Inj., 40mg/Vial, Tk. 70.00/ Vial,
90.27/Vial 20mg, Tk. 5.00/Tab.
Xerosec(Sanofi), Cap., 10 mg, Tk. 2.51/Cap.; Pansec(Drug Intl), Tab., 20mg, Tk. 5.05/Tab.,
20 mg, Tk.5.00/Cap.; 40 mg, Tk.8.00/Cap. Tab., 40mg, Tk. 7.05/Tab., Inj., 40mg/Vial, Tk.
Zilon(Radiant), Cap. ,20 mg, Tk.5.00/Cap.;40 90.30/ Vial,
mg, Tk. 7.50/Cap. Pansec(Drug Intl), Tab., 20mg, Tk.5.00/Tab.;
40 mg, Tk. 7.00/Tab.; Inj., 40 mg/Vial, Tk.
90.00/Vial
PANTOPRAZOLE
Pansiv(MST), Tab., 20 mg, Tk. 4/Tab.; 40 mg,
Tk. 6/Tab.
Indications: for suppression of acid Pansos(Nipro JMI), Tab., 20mg, Tk.
secretion in gastric or duodenal ulcer, 3.00/Tab.; 40 mg , Tk. 5.00/Tab.
reflux oesophagitis Zollinger-Ellison Pantac(Navana), Tab., 20 mg, Tk. 4.00/Tab.;
syndrome; prophylaxis against acid 40 mg, Tk. 6.00/Tab.
Pantex(ACI), Inj., 40mg/Vial, Tk. 70.47/ Vial,
aspiration syndrome during indcution of
Cap., 20mg, Tk. 4.01/Cap., 40mg, Tk.
anaesthesia. In conjunction with other 6.02/Cap., Tab., 20mg, Tk. 5.02/Tab., 40mg,
drugs, for the eradication of H. pylori Tk. 7.02/Tab.
Interactions: see Appendix-2 Pantid(Opsonin), Inj., 40 mg/Vial , Tk.
Side-effects:see notes above 90.27/Vial, Tab, 20 mg , Tk. 5.02/Tab., 40 mg ,
Dose:by mouth in benign gastric ulcer or Tk. 7.02/Tab.
gastroesophageal reflux disease, 40 mg Pantium(Radiant), Tab, 40mg , Tk.
10.03/Tab., 20mg , Tk. 7.02/Tab.
daily in the morning for 4 weeks,
Panto(Somatec), Tab., 20 mg, Tk. 4.00/Tab.,
followed by further 4 weeks if not fully 40 mg, Tk. 6.00/Tab.
healed. Pantoaid(Novo Health), Tab. , 20 mg, Tk.
Duodenal ulcer or gastritis associated 5.00/Tab.
with H. pylori, 40 mg twice daily (with Pantobex(Beximco), Inj., 40mg/Vial, Tk.
clarithromycin 250mg twice daily and 110.00/ Vial, Tab., 20mg, Tk. 5.00/Tab., 40mg,
metronidazole 400mg twice daily) for 7 Tk. 7.00/Tab.
Pantochem(Chemist), Tab., 20 mg, Tk.
days.CHILD not recommended.
3.00/Tab.; 40 mg, Tk. 5.00/Tab.
Pantodac(Ziska), Tab. , 20 mg, Tk. 4.00/Tab.,
Proprietary Preparations 40 mg, Tk. 6.00/Tab.
Aup(Decent), Tab. 20mg, Tk. 3.00/Tab; Pantogen(General), Tab. , 20mg, Tk.
40mg, Tk. 5.00/Tab. 5.01/Tab., 40mg, Tk. 7.03/Tab.
Europan(Globe), Inj.40 mg/Vial, Tk. 70.00/ Pantogut(Popular), Tab. ,20mg , Tk.
Vial; Tab.20 mg, Tk. 4.00/Tab.; 40 mg, Tk. 5.00/Tab.; 40 mg, Tk. 7.00/Tab.,Inj., 40
6.00/Tab. mg/Vial, Tk. 70.26/ Vial
Exipro(Leon), Tab., 20 mg, Tk. 4.00/Tab.; 40 Pantolok(Ibn Sina), Inj., 40mg/Vial, Tk. 80.00/
mg, Tk. 6.00/Tab. Vial, Tab., 20mg, Tk. 5.00/Tab., 40mg, Tk.
Neopanta(Supreme), Tab., 20mg, 7.00/Tab.
Tk,.4.00/Tab., 40mg, Tk. 6.00/Tab. Pantomax(Pharmacil), Inj. , 40mg/Vial , Tk.
Nixpan(Ad-din), Tab., 20 mg, Tk. 3.00/Tab.; 90.27/Vial
40 mg, Tk. 5.00/Tab. Panton(Bristol Tab, 20mg , Tk. 3.00/Tab.,
P-20 & 40(Asiatic), Tab., 20mg , Tk. 4.00/Tab., 40mg , Tk. 5.00/Tab.
40mg , Tk. 6.00/Tab. Pantonix(Incepta), Inj., 40 mg/Vial, Tk. 90.00/
Pagerd(Organic), Tab, 20 mg, Tk. 4.02/Tab., Vial, Tab, Tk. 5.00/Tab, Tk. 7.00/Tab.
40 mg, Tk. 6.02/Tab. Pantopra(Alco), Tab. , 40mg, Tk. 5.02/Tab.,
Panfast(Monico), Inj., 40mg/Vial, Tk. 20mg, Tk. 3.01/Tab.
90.00/Vial Pantoprazole(Albion), Tab., 20 mg, Tk.
Panoral(Eskayef), Tab, 20 mg, Tk. 5.00/Tab., 3.00/Tab.; 40 mg, Tk. 5.00/Tab.
20 mg, Tk. 5.00/Tab., 40 mg, Tk. 7.00/Tab., 40 Pantoprox(SMC Enterprise), Tab. , 20 mg,
mg, Tk. 7.00/Tab. Tk. 5.00/Tab.
Panotem(Team), Tab., 40 mg, Tk. 6.50/Tab., Pantosec(Techno), Inj., 40 mg/Vial, Tk.
20 mg, Tk. 4.50/Tab. 70.00/Vial
Panoz(Astra Biop), Tab. , 20 mg, Tk. Pantosil(Silva), Tab., 40mg, Tk. 5.01/Tab.,
4.00/Tab., 40 mg, Tk. 7.00/Tab. 20mg, Tk. 4.50/Tab.
108
Pantover(Veritas), Tab., 20 mg, Tk. Dose: erosive or ulcerative gastroesop-

4.00/Tab.; Inj., 40 mg/Vial, Tk. 70.00/Vial hageal reflux disease, 20 mg daily for 4-
Pantozol(G.A.Co), Tab., 20 mg , Tk. 8 weeks; may be extended for further 8
3.01/Tab., 40 mg , Tk. 5.02/Tab.
Pantrol(Apex), Tab., 20 mg, Tk. 3.00/Tab.
weeks if necessary; maintenance, 20 mg
Panzer(Sun), Tab., 20 mg, Tk. 4.00/Tab.; 40 daily.
mg, Tk. 6.00/Tab. Duodenal ulcer, 20mg daily for 4 weeks.
Panzol(Amico), Tab., 20mg , TK. 3.50/Tab., Pathological hypersecretory conditions
40mg , TK. 5.50/Tab. including Zollinger-Ellison syndrome,
Patanix(Nipa), Tab. , 20 mg, Tk. 4.60/Tab. initially 60 mg once daily, may be
Pentosa(Pharmasia), Tab., 20 mg, Tk. increased to 100-120 mg daily.
4.00/Tab.; 40 mg, Tk. 6.00/Tab.
P-Lock(One Pharma), Tab, 20 mg, Tk.
5.00/Tab., 40 mg, Tk. 6.99/Tab. Proprietary Preparations
Pramax(Concord), Tab., 20 mg, Tk. Acifix(Beximco), Tab., 20mg , Tk. 5.00/Tab.
4.00/Tab.; 40 mg, Tk. 6.00/Tab. Finix(Opsonin), Tab., 20 mg , Tk. 5.03/Tab.
Prazolin(Rephco), Tab., 20 mg, Tk. Nexrab(UniMed), Tab., Tk. 8.00/Tab.
4.00/Tab.; 40 mg, Tk. 6.00/Tab. Paricel(ACI), Cap., 20mg, Tk. 8.00/Cap.,
Pregel(Healthcare), Tab., 40mg, Tk. Tab., 20mg, Tk. 5.04/Tab., 10mg, Tk.
7.00/Tab., 20mg , Tk.5.00/Tab., Inj, 3.51/Tab.
40mg/Vial, Tk. 90.00/Vial, Profast(Renata), Tab. , 20mg Tk. 5.00/Tab.
Protium(UniMed), Tab , 20mg, Tk. 5.00/Tab., Prompton(Radiant), Cap. , 20mg , Tk.
40mg, Tk. 9.00/Tab. 8.02/cap.
Protocid(Acme), Inj., 40 mg/Vial, Tk. 90.00/ R- 20(Asiatic), Tab., 20mg , Tk. 5.00/Tab.
Vial, Tab, 20 mg, Tk. 5.00/Tab., Tab, 40 mg , Rabe(Aristopharma), Tab., 20mg , Tk.
Tk. 7.00/Tab. 5.00/Tab.
Protoloc(Beacon), Tab., 20mg , Tk. .00/Tab., Rabeca(Square), Tab. , 20 mg, Tk. 5.02/Tab.
40mg , Tk. 7.00/Tab. Rabecon(Biopharma), Tab., 20mg, Tk.
Proton(Aristo), Inj., 40mg/Vial,Tk. 80.00/ Vial, 5.00/Tab.
Tab. 45.10g+ 40mg , Tk. 7.00/Tab. Rabemax(General), Tab. , 20mg, Tk.5.00/Tab.
Protonil(Renata), Tab., 20mg, Tk. 4.00/Tab., Rabepes(Beacon), Cap., 20mg , Tk.
40mg, Tk. 6.00/Tab. 8.00/Cap., Tab., 20mg, Tk. 5.02/Tab.
Proton-P(Aristo), Tab., 20mg , Tk. 5.00/Tab. Rabepra(Euro), Tab., 20mg, Tk. 5.00/Tab.
Protozin(Euro), Tab., 20mg, Tk. 5.00/Tab., Rabesec(Drug Intl), Tab., 20mg, Tk. 5.05/Tab.
40mg, Tk. 7.00/Tab. Rabetem(Team), Tab., 20 mg, Tk. 4.50/Tab.
Pz(Modern), Tab., 20 mg, Tk. 4.00/Tab., 45.10 Rabifast(Eskayef), Tab., 20 mg., Tk.
mg, Tk. 6.00/Tab. 5.00/Tab., 20mg, Tk. 5.00/Tab., 20 mg., Tk.
Topra(Jayson), Tab., 20 mg, Tk.3.00/Tab.; 40 5.00/Tab., 20mg, Tk. 5.00/Tab.
mg, Tk.5.02/Tab. Rabigut(Popular), Tab., 20mg, Tk. 5/Tab.
Trupan(Square), Inj. , 40 mg/vial, Tk.80.24/ Rabipep(Organic), Tab.,20 mg, Tk. 5/Tab.
Vial, Tab, 20 mg, Tk.5.02/Tab., 40 mg, Rabizol(Acme), Tab., 20.00 mg, Tk. 5.01/Tab.
Tk.7.02/Tab. Rabonac(Sharif), Tab., 20 mg, Tk. 5.01/Tab.
Zenopan(Zenith), Tab. , 20 mg, Tk. 5.00/Tab. Rabprazo(Pacific), Tab., 20 mg, Tk. 5/Tab.
Zopan(Kemiko), Tab., 20 mg, Tk. 4.01/Tab., Rasonix(Incepta), Cap., 20 mg, Tk. 3.50/Cap.,
40 mg, Tk. 6.02/Tab. 30 mg, Tk. 8.00/Cap., Tab., 20mg, Tk.
5.00/Tab.,
Rasoz(Astra Biopharma), Tab., 20 mg, Tk.
RABEPRAZOLE SODIUM 5.00/Tab.
Razole(Kemiko), Tab., 20 mg, Tk. 5.00/Tab.
Indications: listed in dose Respite(Sanofi), Tab. , 20mg, Tk. 6.02/Tab.
Cautions: see notes above;exclude RP-20(Globe), Tab., 20 mg, Tk. 5.00/Tab.
Xorel(Ibn Sina), Cap. , 20mg, Tk. 4.00/Cap.,
gastric malignancy before starting
Tab., 20mg, Tk. 3.00/Tab.
treatment
Contra-indications:pregnancy and
breast-feedings 2.3.4 CHELATES AND COMPLEXES
Interactions:see Appendix-2
Side-effects: chest pain, neck rigidity, Tripotassium dicitratobismuthate is a
Hypertension, Abnormal ECG, GI bismuth chelate, which promotes healing
diturbances, anxiety, insomnia. of gastric and duodenal ulcers. It may
act by coating the ulcer or by stimulating
bicarbonate secretion. As it is also likely
109
to adhere to food rather than to the top Cautions: conditions where hypoten-
the surface of the ulcer, patients should sion might precipitate severe complica-
be advised to avoid large food, antacids, tions (e.g. cerebrovascular disease,
and large quantities of milk when taking cardiovascular disease)
bismuth chelate. Contraindications: pregnancy or
Sucralfate is a complex of aluminium planning pregnancy (increases uterine
hydroxide and sulphated sucrose and tone). Should not be used in women of
has minimal antacid properties. It has child-bearing age unless the patient
been used for gastric and duodenal requires NSAID therapy and is at high
ulcers and may act by protecting the risk of NSAID induced ulceration; patient
mucosa from acid pepsin attack. Long must be advised of the risks of taking
term use needs further assessment misoprostol if pregnant
because some aluminium may be Interactions:see Appendix-2
absorbed. Side-effects: diarrhoea (may be severe,
reduced by giving single dose not
SUCRALFATE exceeding 200 micrograms and by
avoiding magnesium containing
Indications: palliative treatment of antacids); also reported: abdominal pain,
benign gastric and duodenal ulceration; dyspepsia, flatulence, nausea and
chronic gastritis vomiting, abnormal vaginal bleeding
Cautions: renal disease (including intermenstrual bleeding,
Interactions:see Appendix-2; antacids menorrhagia, and post menopausal
should not be taken half an hour before bleeding)
or after a dose Dose: benign gastric and duodenal
Side-effects: constipation; gastric dis- ulceration, 800 micrograms daily (in 2-4
comfort reported. divided doses) with breakfast (or main
Dose: 2g twice daily (on rising and at meals) and at bedtime; treatment should
bedtime) or 1g 4 times daily 1 hour be continued for at least 4 weeks and
before meals and at bedtime, taken for 4 may be continued for up to 8 weeks if
weeks or in resistant casees up to 8 required. Prophylaxis of NSAID induced
weeks; max. 8g daily. peptic ulcer, 200 micrograms 2-4 times
daily according to condition of patient.
Antepsin(Kemiko), Tab., 1000 mg, Tk. Proprietary Preparations
5.52/Tab. Cytomis(Incepta), Tab., 200 mcg, Tk.
Gastalfet(Beximco), Tab., 1000 mg, Tk. 15.00/Tab.
6.00/Tab., 500 mg, Tk. 4.02/Tab. G-Misoprostol(Gonoshasthaya), Tab., 200
Ulsec(Asiatic), Tab., 1000 mg , Tk. 5.50/Tab. mcg, Tk.10.00 /Tab.
Indula(Renata), Tab., 200 mcg, Tk. 15.00/Tab.
Isovent(Square), Tab., 200 mcg, Tk.
2.3.5 PROSTAGALNDIN 15.10/Tab. ; 600 mcg, Tk. 40.13/Tab.
ANALOGUES Misoclear(Acme), Tab., 200 mcg, Tk.
15.04/Tab.
Misoprostol, a synthetic analogue of Misoclear(Acme), Tab., 200 mcg, Tk.
15.00/Tab.
prostaglandin E1 (alprostadil) inhibits
Misopa(Beximco), Tab., 200mcg, Tk.
gastric acid secretion promoting healing 15.00/Tab.
of gastric and duodenal ulcer. It can Misopil(General), Tab., 200mcg, Tk.
protect against NSAID associated gastric 15.00/Tab.
ulcers but not dyspepsia. Misoprostol(Amico), Tab., 200mcg, Tk.
15.00/Tab.
Misotab(Euro), Tab., 200mcg, Tk. 15.00/Tab.
MISOPROSTOL[ED]
Misotec(Sharif), Tab., 200 mcg, Tk.
15.04/Tab.
Indications:see notes above and under Misotol(Ziska), Tab., 200 mcg, Tk. 15.00/Tab.
dose
110
2.3.6 DRUGS FOR ERADICATION

OF HELICOBACTER PYLORI Pantoprazole 40mg twice daily+
Clarithromycin 500mg twice daily+
Amoxycillin 1g twice daily
The causal role of H. pylori in gastric and
duodenal ulcer is now widely accepted. Ranitidine bismuth citrate 400 mg twice daily +
Long-term healing of gastric and Clarithromycin 500mg twice daily +
duodenal ulcers can be achieved by Amoxicillin 1 g twice daily
eradicating H. pylori, and after such
eradication the incidence of relapse TRIPLE THERAPY COMBINED
decreases. Studies have shown that with PREPARATIONS
H. pylori eradication only 5-10% patients
experienced relapse within a year Proprietary Preparations
compared to 85% of patients who do not Lansoprazole 30 mg + Clarithromycin 500 mg
have H. pylori eradication, and the benifit + Amoxycillin 1 g
appeared to continue for about 7 years. H.Pylori (Acme), Cap. , Tk. 55.16/Cap.
Helicon kit (General), Cap., Tk. 55.37/Cap
It is recommended that the presence of Pylopac(Beximco), Tab., Tk.45.00/blister strip
H. pylori be confirmed before starting Pylotrip (Square), Cap. , Tk. 55.16/Cap.
eradication treatment.
One week’s triple therapy containing a Omeprazole 20 mg + Clarithromycin 500mg +
proton pump inhibitor (omeprazole) and Metronidazole 500mg
clarithromycin with either metronidazole Neo Kit(Beximco), Tab. Tk.55.00/ blister strip
or amoxicillin produces eradication in Amoxicillin + Clarithromycin + Rabeprazole
Sodium
over 90% of patients. Clarithromycin Pylocure (Opsonin), Kit, Tk. 55.36/Tab.
may be substituted with both metroni- Esomeperazole 20mg Cap. 1pc+Amoxacillin
dazole and amoxicillin. Ranitidine or 50mg tab 2 pcs. + Clarithoromycin 500mg tab.
bismuth chelate may be used in place of Maxpro (Renata), Tk. 13.75/Kit
omeprazole. Two weeks’ triple therapy
regimen may give higher eradication rate
but adverse effects are common and 2.4 DRUGS FOR ACUTE
compliance is poor. DIARRHOEA
Recommended regimens for H. pylori Diarrhoea is characterized by increased

eradication (7-day course) volume and frequency of liquid stools. It
is commonly associated with infection,
Omeprazole 20 mg twice daily +
but may result from accumulation of non-
Clarithromycin 500 mg twice daily +
Amoxicillin 1 g twice daily absorbed osmotically active solute in gut
such as in lactose deficiency, or when
Lansoprazole 30 mg twice daily + intestinal motility or morphology is
Clarithromycin 500 mg twice daily + altered. Diarrhoea is a symptom of
Amoxicillin 1 g twice daily gastroenteritis and of most intestinal
infections. The first line of treatment in
Omeprazole 20 mg twice daily +
acute diarrhoea is oral rehydration
Metronidazole 400 mg twice daily therapy (ORT).
Lansoprazole 30 mg twice daily + ORAL REHYDRATION SALTS[ED] [OTC]

Metronidazole 400 mg twice daily
Each sachet of the proprietary
Lansoprazole 30 mg twice daily+ preparations contains: sodium chloride
Metronidazole 400 mg twice daily+ 1.75 g, potassium chloride 0.75 g,
Amoxicillin 1 g twice daily trisodium citrate dihydrate 1.45 g and
anhydrous dextrose 10 g. This is the
Omeprazole 20 mg twice daily + WHO approved formulation for ORS.
Metronidazole 400 mg thrice daily +
Amoxicillin 500 mg thrice daily
111
Contents of one sachet are dissolved in Cholera Saline (Opsosaline), IVInfusion

500 ml of drinking water for ready use. Tk.69.94/500ml; Tk. 91.72/1000ml
Dianak(Orion), IVInfusion Tk.49.78/500ml Tk.
65.50/1000 ml
Proprietary Preparations Diasol(Libra), IVInfusion TK. 52.60 /500ml;
ACI ORS(ACI), ORS, Tk. 5.00/Sachet; TK. Tk. 65.74/100ml
4.60/Sachet Koloride(Beximco), IVInfusion Tk.
Asaline(Apex), ORS, Tk. 4.58/Sachet 70.14/500ml; Tk. 91.99/1000ml
Easy ORS(Central), ORS, Tk. 4.58/Sachet
Kolosal (Popular), IV Infusion, Tk.
G-ORS(Gonoshasthaya), ORS, Tk 4/Sachet
70.14/500ml, Tk. 92.00/1000ml
K-SALINE FRUITY(Kemiko), ORS, Tk.
5.00/Sachet
K-SALINE N (Kemiko), ORS, Tk. 4.58/Sachet CEREAL BASED ORS
Naafco ORS(Naafco), ORS, Tk.5.00/Sachet
Neorice ORS(Eskayef), ORS, Tk. 12.00/ It contains sodium chloride 3.5 g, pota-
Sachet
ssium chloride 1.5 g, sodium bicarbonate
Neosaline(Eskayef), ORS, Tk. 5.00/ Sachet;
Tk. 5.00/Sachet; Tk. 5.00/Sachet; Tk. 2.5 g and 50 g boiled rice powder to be
5.00/Sachet dissolved in 1 litre of boiled drinking
O Fruity(Zenith), ORS, Tk. 4.58/Sachet water.
O Saline(Zenith),ORS, Tk. 3.44/Sachet; Tk.
3.22/Sachet Proprietary Preparations
OR Saline(Popular), ORS, Tk. 5.00/ Sachet Easy ORS Plus Saline(Central), ORS, Tk.
Oralsaline(Albion),ORS, Tk. 5/Sachet 12.00/Sachet
Oralsaline Sweety(Albion) ORS,Tk. 5/Sachet Rice ORS(Square), ORS, Tk. 10/500 ml
Orasol(Sonear), ORS, Tk. 3.20/Sachet Sachet ;Tk. 6.00/250mlSachet
ORS(Popular), ORS, Tk. 4.58/Sachet Rice Saline(General), ORS, Tk.
Rice ORS(General), ORS, Tk. 10.00/Sachet; 15/500mlSache,Tk. 9.00/250mlSachet
Tk. 15.05/Sachet; Tk. 9.03/Sachet; Tk. Neorice(Eskayef), ORS, Tk. 12.00/Sachet
17.00/Sachet
R-Saline(Rephco), ORS, Tk. 3.20/Sachet
R-Saline N(Rephco), ORS, Tk. 4.50/Sachet ANTIDIARRHOEAL DRUGS WHICH
Saline(Renata), ORS, Tk. 5.00/Sachet REDUCE MOTILITY
Saline R(Renata), ORS, Tk. 4.58/Sachet
SOS(Supreme), ORS, Tk. 4.58/Sachet
LOPERAMIDE HYDROCHLORIDE
SOS(Supreme), ORS, Tk. 5.00/Sachet; Tk.
5.00/Sachet
SOS Plus Mango(Supreme), ORS, Tk. Indications: acute diarrhoea in adults
5.00/Sachet and children over 4 years (see notes
Super (Amico), ORS, TK. 4.60/Sachet above); chronic diarrhoea in adults only
Super Saline(Amico), ORS, Tk. 4.57/Sachet Side-effects: occasional rashes
Unisaline(Ibn Sina), ORS, Tk. 5.00/Sachet;
Tk. 5.00/Sachet; Tk. 5.00/Sachet; Tk.
Dose: acute diarrhoea, 4 mg initially
5.00/Sachet followed by 2 mg after each loose stool
Unisaline Fruity(Ibn Sina), ORS, Tk. for up to 5 days; usual dose 6-8 mg
5.00/Sachet daily, max. 16 mg daily; CHILD 4-8 years
Virgos(Virgo), ORS, Tk. 4.58/Sachet 1 mg 4 times daily for up to 3 days only,
Zenith(Zenith), ORS, Tk. 5.00/Sachet 9-12 years 2 mg 4 times daily for up to 5
Zeosaline(Sharif), ORS, Tk. 4.58/Sachet days
Ziska(Ziska), ORS, Tk. 5.00/ Sachet
Chronic diarrhoea in adults, initially, 4-8
mg daily in divided doses, subsequently
IV REHYDRATION THERAPY adjusted according to response and
given in 2 divided doses for maintenance
Cholera Saline: Proprietary Preparations
Usual strength for IV infusion, potassium Imotil(Square), Cap., 2 mg, Tk.1/Cap.
chloride 0.1% sodium chloride 0.5% ;and Lopamid(Acme), Cap., 2 mg, Tk. 1/Cap.
sodium acetate 0.393% Loperin, (Opsonin), Cap., 2 mg, Tk. 1/Cap.
Cholenak (Square), IV Infusion, Tk. Nomotil(Ziska), Cap, 2mg, Tk.0.60/Cap.
92/1000ml; , Tk. 70.15/500ml
112
RACECADOTRIL which increase stool bulk, if necessary.

In some patients there may be important
Indications: is used in the treatment of psychological aggravating factors, which
diarrhoea. It is used, when fluid and respond to reassurance. Anti-diarrhoeal
dietary measures are not sufficiently drugs such as loperamide may some-
effective to control diarrhoea. times be necessary but prolonged use
CautionsandContraindications: may aggravate the condition. Anti-
hypersensitivity to the spasmodics may relieve the pain.
Racecadotril,blood in INFLAMMATORY BOWEL DISEASES
stools,breastfeeding,diarrhea,pregnance, Chronic inflammatory bowel diseases
Renal insufficiencySevere liver or kidney include ulcerative colitis and Crohn’s
diseaseUncontrolled vomiting disease. Drug treatment consists of
Side Effects:nausea, headache aminosalicylates (sulphasalazine,
,angioedema,rashes, Pain,Swelling of mesalazine, balsalazine, olsalazine)
the eyelid, Skin redness,Vomiting, and corticosteroids (hydrocortisone,
Constipation, Chronic diarrhoea budes-onide and prednisolone).
Dose: In infant less than 9 kg:one 10 mg Maintenance of nutrition is important.
sachet 3 times daily. Severe chronic active disease may
In infant from 9 kg to 13: kg two 10 mg require surgery.
sachets 3 times daily MALABSORPTION SYNDROME :
individual conditions need specific
Proprietary Preparations treatment and also general nutritional
Racetril(Incepta), Cap.,100 mg, Tk. 6.00/Cap., consideration. Thus coeliac disease
Suspn.,10 mg, Tk. 7.00/Suspn., 30 mg, Tk. (gluten enteropathy) usually needs a
10.00/Suspn. gluten free diet and pancreatic
Racedot(Square), Cap., 100 mg, Tk.8.03/Cap. insufficiency needs pancreatin supple-
Rehydril(Ibn Sina), Cap., 100mg, Tk. ments.
195.00/Cap.
ULCERATIVE COLITIS : for acute mild
Radola(ACI), Cap.,100mg,Tk. 6.00/Cap.
to moderate diseases affecting rectum or
sigmoid colon, topical corticosteroid
2.5 DRUGS FOR CHRONIC treatment such as prednisolone enemas
DIARRHOEAS or suppositories will induce remission;
foam preparations are especially useful
Chronic diarrhoea may be associated where patients have difficulty retaining
with underlying diseases and therefore liquid enemas. More extensive diseases
symptomatic relief is less appropriate may be treated with an aminosalicylate
than treatment of disease itself. Where but may require oral corticosteroid
the disease process responsible for treatment. Severe extensive or fulminant
chronic diarrhoea can not be disease may need hospital admission,
satisfactorily suppressed, symptomatic intravenous corticosteroid administration,
relief with antimotility drugs such as intravenous fluid and electrolyte
loperamide or diphenoxylate with replacement and/or blood transfusion,
atropine may be appropriate. Bulk parenteral nutrition and antibiotics.
laxatives such as ispaghula (Isop gul), Corticosteroids are unsuitable for
methylcellulose bran etc. have also been maintenance treatment because of side-
used for symptomatic treatment because effects. Sulphasalazine mesalazine
of their absorptive capacity. Opioids with and olsalazine all have value in preven-
a central action (e.g. codeine) are better ting relapse and choice is related in part
avoided because of the risk of to their different side-effects. In resistant
dependence. cases azathioprine(see section 14.2.1)
IRRITABLE BOWEL SYNDROME: This 2 mg/kg daily, given under close
can present with pain, constipation, or supervision may be helpful.
diarrhoea, all of which may benefit from Laxatives are required to facilitate bowel
a high fibre diet with bran or other agents movement when proctitis is present but a
113
high fibre diet and bulk forming drugs Antispasmodics may provide
such as methylcellulose or ispaghula symptommatic relief when colic is a
(Isop gul) are more useful in adjusting problem. Antibiotics should be used only
faecal consistency. when the diverticula in the intestinal wall
Symptoms of mild ulcerative colitis may become infected. Antidiarrhoeal drugs
be relieved with antidiarrhoeal drugs which slow the intestinal motility (e.g.
such as codeine or loperamide but they codeine, diphen-oxylate and loperamide)
should be used with caution in severe could possibly exacerbate the symptoms
cases as paralytic ileus and toxic of diverticular disease and are therefore
megacolon may be precipitated. For contra-indicated.
similar reasons antispasmodics should
not be used in ulcerative colitis. AMINOSALICYLATES
CROHN’S DISEASE: Treatment
particularly of colonic diseases is similar
MESALAZINE
to that for ulcerative colitis. In small
bowel disease sulphasalazine is of
doubtful value. Oral corticosteroids (e.g. Indications: maintenance of remission
prednisolone) suppress inflammation, in ulcerative colitis
and metronidazole may be beneficial Cautions: elderly, renal impairment,
possibly through antibacterial activity. pregnancy and breast-feeding; avoid
Other antibacterials should be given if administration with lactulose.
specifically indicated and for managing Contraindications: salicylate hypersen-
bacterial overgrowth in the small bowel. sitivity; severe renal impairment.
Infliximab, a monoclonal antibody Side-effects: nausea, diarrhoea, and
inhibiting pro-inflammatory cytokines, abdominal pain; headache; exacerbation
and TNF-alpha has recently been of symptoms of colitis; rarely reversible
indicated for severe Crohn’s disease pancreatitis; reversible myocarditis also
refractory to corticosteroids, but may be reported
associated with development of Dose: by mouth, 1.2-2.4 g daily in
extrapulmonary tuberculosis. divided doses.
In both colitis and Crohn’s disease
general nutritional care and appropriate Proprietary Preparations
Canasa(Drug Intl), Tab., 400mg, Tk. 5/Tab.
supplements are essential. Mesagut(Aristo), Tab., 400mg, Tk. 7.60/Tab.
Cholestyramine and aluminium Pentasa(I)(Feering),Sachet,1gm,Tk.69.19/Sac
hydroxide mixture, bind unabsorbed bile het,2gm,Tk.131/Sachet
salts and provide symptomatic relief of
diarrhoea following ileal disease or SULPHASALAZINE[ED]
resection, in bacterial colonisation of the
small bowel and in post-vagotomy
Indications: induction and maintenance
diarrhoea.
of remission in ulcerative colitis;
PSEUDOMEMBRANOUS COLITIS: This
treatment of active Crohn’s disease
is due to colonisation of the colon with
Cautions: pregnancy; hepatic and renal
Clostridium difficile that may develop
disease, glucose 6-phosphate
after antibiotic therapy. Ampicillin,
dehydrogenase (G6PD) deficiency
clindamycin and lincomycin have been
including breast-feeding of affected
implicated most frequently but few
infants; slow acetylator status; withdraw
antibiotics are free of this side-effect. It is
treatment if blood disorders,
usually of acute onset, but may run a
hypersensitivity reactions, or other
chronic course. Oral vancomycin or
serious disorders occur; upper
metronidazole has been advocated as
gastrointestinal side-effects are common
specific treatment.
with doses over 4g daily; blood counts,
DIVERTICULAR DISEASE: This is
liver function, and rheumatoid arthritis,
treated with a high fibre diet, bran
see section 9.1.3
supplements and bulk forming laxatives.
114
Contraindications: salicylate and effect may take some days to develop.

sulphonamide hypersensitivity; porphyria They are useful in the management of
Interactions:see Appendix-2 patients with colostomy, ileostomy,
Side-effects: nausea, vomiting, haemorrhoids, anal fissure, chronic
epigastric discomfort, headache, rashes; diarrhoea associated with diverticular
occasionally, fever, minor haemato- disease, irritable bowel syndrome, and
logical abnormalities such as Heinz body ulcerative colitis. Adequate fluid intake
anaemia, reversible neutropenia, folate must be maintained to avoid intestinal
deficiency; reversible azospermia; rarely: obstruction.
pancreatitis, exacerbation of colitis, Methylcelluloseispaghula (Isop gul),
thrombo-cytopenia, agranulo-cytosis, and sterculia are useful in patients who
Steven’s-Johnson syndrome, neuroto- cannot tolerate bran. Methylcellulose
xicity, photo-sensitisation, lupus erythe- also acts as a faecal softener.
matosus like syndrome, and pneu-
monitis; proteinuria and crystalluria; ISPAGHULA HUSK
urine may be orange coloured; soft (Isop Gul husk or ‘bhushi’)
contact lenses may be stained
Dose:by mouth, acute attack 1-2 g 4 Indications:See notes above
times daily (but see Cautions) until Cautions: adequate fluid intake should
remission occurs (if necessary, be maintained to avoid intestinal
corticosteroids may also be given), obstruction; ulcerative colitis.
reducing to a maintenance dose of 500 Contraindications: Intestinal obstruct-
mg 4 times daily; CHILD over 2 years, tion, colonic atony, faecal impaction
acute attack 40-60 mg/kg daily, Side-effects: Flatulence, rarely abdo-
maintenance dose 20-30 mg/kg daily. minal distension
By rectum, as suppositories, alone or in Dose: ADULT 3.5g in water twice daily
conjunction with oral treatment 0.5-1 g preferably after meals; CHILD over 6
morning and night after a bowel years half the adult dose
movement. As an enema, 3 g at night, COUNSELING: Preparations that swell
retained for at least 1 hour. in contact with liquid should always be
carefully swallowed with water and
Proprietary Preparations should not be taken immediately before
Reumazin(Aristo), Tab., 500 mg, Tk.
going to bed
5.20/Tab.
Salazine(Opsonin), Suppository, 500 mg , Tk.
10.00/Supp.; Tab., 500 mg, Tk. 5.23/Tab. Proprietary Preparation
Sulfacol(Drug Intl), Tab., 500 mg, Tk. Albi-Tasty Ispaghul(Albion), Powder 3.5 gm,
5.05/Tab. Tk. 4.00/Sachet
Sulfazin(Popular), Tab., 500 mg, Tk. Fiberlax(Incepta), Effervescent Granules Tk.
5.22/Tab. 400.00/20 gm Container
Zulfidin(UniMed), Tab, 500 mg , Tk. 7.00/Tab Ispergul(Square), Powder, 0, Tk. 395/120gm
Container
2.6 LAXATIVES
LUBIPROSTONE
2.6.1 Bulk forming drugs
2.6.2 Stimulant laxatives Indications: chronic constipation in
2.6.3 Faecal softeners adults, irritable bowel syndrome
2.6.4 Osmotic laxatives Side effects:nausea, diarrhea,
headache,flatulence
Contraindications: liver and kidney
2.6.1 BULK FORMING LAXATIVES disease; chronic diarrhea, bowel
obstruction,diarrhea-predominant IBS
These relieve constipation by increasing Dose:25 microgram twice daily to treat
faecal mass which stimulates peristalsis, constipation; 8 microgram twice daily to
but patients should be told that the full
115
treat IBS in women 18 years of age and Cautions;Contraindications and Side-

older effects: See notes on stimulant laxatives
Proprietary Preparation Proprietary Preparation

Lubistone(Incepta), Cap. , 8 mcg, Tk. Laxenna(GSK),Tab. 12mg, Tk. 1.25/Tab.
15.00/Cap. ; 24 mcg, Tk. 40.00/Cap.
Lubilax(Beacon), Cap., 24 mcg, Tk. SALINE LAXATIVE
40.12/Cap.; 8 mcg, Tk. 15.05/Cap
METHYL CELLULOSE Fleetenema(I)(CBFleet)Tk.214.24/133ml.,
Tk,214.24/66ml
Indications: see notes above
Cautions; Contraindications; Side- 2.6.3 FAECAL SOFTENERS
effects; Counseling:see under
Ispaghula Husk
Liquid paraffin the classical lubricating
Dose: 800-1600g twice daily with at
agent, has disadvantages (see below).
least 300 ml water
Bulk laxatives, non-ionic surfactant
“wetting” agents e.g. docusate sodium,
Celulose(Acme), Tk.0.82/Tab.
and glycerol suppositories also have
softening properties. Such drugs are
useful in the management of
2.6.2 STIMULANT LAXATIVES
haemorrhoids and anal fissure.
Enemas containing 130 ml of arachis oil
BISACODYL (ground-nut oil) would lubricate and
soften impacted faeces and promote
Indications: see under Dose; tablets act bowel movement. For children above 6
in 10-12 hours; suppositories act in 20- years, the dose has to be reduced in
60 minutes proportion to body-weight; not recomm-
Cautions; Contraindications; Side- ended for children under 6 years.
effects: see notes on stimulant
laxatives; tablets, griping; suppositories, LIQUID PARAFFIN
local irritation
Interactions:see Appendix-2 Indication: constipation
Dose:By mouth for constipation, 10 mg Cautions: avoid prolonged use; should
at night; occasionally necessary to not be taken immediately before going to
increase to 15-20 mg; CHILD 5 mg bed
By rectal suppositories, for constipation Side-effects: anal seepage of paraffin
10 mg in the morning; CHILD 5 mg. and consequent anal irritation after
Before radiological procedures and prolonged use, granulomatous reactions
surgery, 10 mg by mouth at bedtime for caused by absorption of small quantities
2 days before examination, and if of liquid paraffin (especially from the
necessary, a 10 mg suppository 1 hour emulsion), lipoid pneumonia, and
before examination. interference with the absorption of
fatsoluble vitamins
Proprietary Preparations Dose:by mouth 10-30 ml of the oral
Bisacodyl(Albion), Tab. , 5 mg, Tk. 0.70/Tab.
emulsion (see below) as required
Duralax(Opsonin), Tab., 5 mg, Tk. 0.71/Tab.
Generic Preparation
SENNA[ED]
Liquid Paraffin Oral Emulsion BP, Oral
Emulsion, contains liquid paraffin 5 ml,
Indications: Constipation; bowel evacu- vanillin 5 mg, chloroform 0.025 ml,
ation before abdominal radiological pro- benzoic acid solution 0.2 ml,
cedures, endoscopy, and surgery; acts
in 8-12 hours.
116
methylcellulose-20 200 mg, saccharin Side-effects: Flatulence, cramps, and

sodium 500 micrograms, water to 10 ml. abdominal discomfort.
Liquid Paraffin and Magnesium Dose: Expressed in terms of an oral
Hydroxide Oral Emulsion BP, Oral solution containing lactulose 3.35 g/5ml
Emulsion, 25% liquid paraffin in acquous Constipation, ADULT initially 15 ml twice
suspension containing 6% hydrated daily, gradually reduced according to
magnesium oxide. Dose:for patient’s needs; CHILD under 1 year 2.5
constipation, 5-20 ml as and when ml, 1-5 years 5 ml, 6-12 years 10 ml
required. twice daily, gradually reduced.
Hepatic encephalopathy, 30-50 ml 3
Proprietary Preparations times daily, subsequently adjusted to
Frelax (Beximco), Oral emulsion,Tk. 95/100ml produce 2-3 soft stools daily.
Magfin(Incepta), Oral emulsion Tk. 95/100ml
Nesifin(Opsonin), Oral emulsion,Tk. Proprietary Preparations
83.57/100ml
Actilac(Healthcare), Oral Solution, 68%, Tk.
230.00/5ml,; 68%, Tk. 125.00/5ml
2.6.4 OSMOTIC LAXATIVES Asilac(Asiatic), Oral Solution, 68%, Tk.
120.00/100ml,; 68%, Tk. 230.00/200ml
Avolac(Aristopharma), Oral Solution, 68%,
Osmotic laxatives are drugs, which act
Tk. 140.00/100ml, Tk. 250.00/200ml
by retaining fluid in the bowel by the Avolose(Team), Oral Solution, 68%, Tk.
mechanism of osmosis. They may also 135.00/100ml,; 68%, Tk. 245.00/200ml
act by changing the pattern of water Conlax(UniMed), Oral Solution, 68%, Tk.
distribution in the faces. 140.00/100ml
Dlac(Drug Intl), Oral Solution, 68%, Tk.
120.40/100ml,; 68%, Tk. 220.70/200ml,;
LACTITOL 68%, Tk. 70.25/50ml
Ezylax(Orion), Oral Solution, 68%, Tk.
Indications : to promote gut motility in 140.00/100ml,; 68%, Tk. 65.00/50ml
chronic constipation Glovolac(Globex), Oral Solu., 3.40 gm/5 ml,
Tk. 120.00/100 ml
Proprietary Preparations Hepalac(Supreme), Oral Solution, 67%, Tk.
120.00/100ml & Tk. 230.00/200ml
Fibolac(Radiant), Powder, 10 gm/Sachet , Tk.
Inolac(Incepta), Oral Solution, 68%, Tk.
40.00/10 gm Sachet
120.00/100ml
Lacticon(ACI), Powder, 10 gm/Sachet, Tk.
Laclose(Opsonin), Oral Solution, 68%, Tk.
25.00/10gm Sachet
120.37/100ml
Laxitol(Eskayef), Liquid, 3.3335 gm /5 ml, Tk.
Lactolax(Pharmasia), Oral Solu.,, 3.40 gm/5
120.00/100ml,; Powder, 10 gm/Sachet, Tk.
ml, Tk. 100.00/100 ml
12.00/10 gm Sachet,; 3.3335 gm /5 ml, Tk.
Lactomose(Monico), Oral Solution, 68%, Tk.
120.00/100ml,; 3.3335 gm /5 ml, Tk.
140.00/100ml
65.00/50ml,; Powder, 10 gm/Sachet, Tk.
Lactu(Biopharma), Oral Solution, 68%, Tk.
12.00/10 gm Sachet
140.00/100ml,; 68%, Tk. 250.00/200ml
Maxilax(Opsonin), Liquid, 3.3335 gm /5 ml,
Lactulose-H(Hudson), Oral Solu, 3.35gm/5ml,
Tk. 120.00/100 ml ,; 3.3335 gm /5 ml, Tk.
Tk.110.00/100 ml
65.00/50 ml,; Powder, 10 gm/Sachet, Tk.
Laxativ(Rangs), Oral Solu, 3.35gm/5ml, Tk.
12.00/10gm Sachet
100/100ml, Tk. 200/200ml
Sinalax(Ibn Sina), Powder, 10 gm/Sachet, Tk.
Laxol(Navana), Oral Solu., 3.40 gm/5 ml, Tk.
13.00/10 gm Sachet
50.19/50 ml; Tk. 120.00/100 ml; Tk.
200.75/200 ml
LACTULOSE[ED] Laxolac(Globe), Oral Solution, 68%, Tk.
140.00/100ml
Indications: Constipation (may take up Leaxe(Alco), Oral Solution, 68%, Tk.
140.42/100ml ,; 68%, Tk. 250.75/200ml
to 48 hours to act), hepatic (portal Livax(Pacific), Oral Solution, 68%, Tk.
systemic) encephalopathy. 140.00/100ml ,; 68%, Tk. 250.00/200ml
Contraindications: Galactosaemia, Livoton(Kemiko), Oral Solution, 68%, Tk.
intestinal obstruction. 120.00/100ml ,; 68%, Tk. 70.21/50ml
Interactions:See Appendix-2 Loctoz(Amico), Oral Solution, 68%, TK.
100.00/100ml
117
Niprolac(Nipro JMI), Oral Solu., 3.40 gm/5 ml, Magmil(Pacific), Suspn. , 400 mg /5 ml, Tk.
Tk. 120.00/100 ml 80.00/100ml ,; 400 mg /5 ml, Tk.
Onlac(One Pharma), Oral Solution, 68%, Tk. 120.00/200ml
140.00/100ml Magnason(Jayson), Susp.,Tk. 50.00/100 ml
Oralax(Somatec), Oral Solution, 68%, Tk.
140.00/100ml
MAGNESIUM SULPHATE[ED]
Osmolax(Square), Oral Solution, 68%, Tk.
250/200ml,; Tk. 140/100ml
Premesis(Globe), Oral Solu., 3.40 gm/5 ml, Indications: Rapid bowel evacuation
Tk. 15.00/100 ml (acts in 24 hours when given by
Regulose(General), Oral Solution, 67%, Tk. mouth);injection preparation is used in
201.35/200ml,; 67%, Tk. 120.36/100ml eclampsia and pre eclampsia.
Relacs(ACI), Oral Solution, 68%, Tk.
(See section16.2.2.3)
65.45/100ml.
Serelose(Beximco), Oral Solution, 70%, Tk. Cautions;Contraindications:See under
130.00/100ml Magnesium Hydroxide; hepatic
Sinalac(Ibn Sina), Oral Solution, 68%, Tk. impairment.
140.00/100ml,; 68%, Tk. 230.00/200ml,; Side-effects: Nausea, bloating,
68%, Tk. 70.00/60ml abdominal cramps (usually transient
Sivolac(Sharif), Oral Solution, 68%, Tk. reduced by taking more slowly); rarely
120.37/100ml
vomiting, anal irritation; urticaria,
Softner(Rephco), Oral Solu., 3.40 gm/5 ml,
Tk. 75.00/100 ml; Tk. 125.00/200 ml rhinorrhoea and dermatitis reported.
Tulac(Eskayef), Oral Solution, 68%, Tk. Dose: For rapid bowel evacuation (in 2-4
140.00/100ml,; Tk. 230.00/200ml,; , Tk. hours), 5-10 g in a glassful of water
65.00/50ml, preferably before breakfast.
Tulac(Eskayef), Oral Solu., 3.40 gm/5 ml, Tk.
65.00/50 ml; Tk. 120/100 ml; Tk. 230/200 ml Proprietary Preparation
Tulos(Acme), Oral Solution, 68%, Tk. Mag Sulph(Gonoshasthaya),
230.69/200ml,; Tk. 120.37/100ml Inj.4%Tk3.00/5ml,
Veelac(Albion), Oral Solu., 3.40 gm/5 ml, Tk. Nlepsin(Beximco), I.V. Infusion, Mag.sulph
100.00/100ml; Tk. 195.00/200ml 4%+Nacl 0.45/%+Dextrose 5%,Tk.70.8/100ml
Xylose(Delta), Oral Solu., 3.40 gm/5 ml, Tk. Magsum (Renata)Inj.2.5g/5ml,Tk.18.06
120.00/100 ml
Zenilac(Zenith), Oral Solution, 68%, Tk.
120.00/100ml POLY ETHYLENE GLYCOL
(Macrogol)
MAGNESIUM HYDROXIDE
Indications:chronic constripation
Indications: Mild constipation (acts in 2- Caution,Contraindications:see under
4 hours) Magnisum hydroxide;breast
Cautions: Use only occasionally; the feeding,pregnancy;cardiovascular
elderly; renal impairment; hepatic impairment
impairment Side-effects: flatulence, cramps, and
Contraindication: Intestinal obstruction abdominal discomfort
Interactions:See Appendix-2 (Antacids Dose:chronic constipation, ADULT and
and absorbents) CHILD over 12years, 25mL 1–3 times
Dose: Aqueous suspension containing daily usually for up to 2
about 8% hydrated magnesium oxide, weeks;maintenance, 25mL 1–2 times
25-50 ml as and when required. daily
Proprietary Preparations Proprietary Preparation

Acme’s Milk of Magnesia(Acme), Suspen., Aqualax(Incepta), Susp., 17g/240ml,
400 mg /5 ml, Tk. 60.18/114ml,; (Orion), Tk.120/240ml
Suspen., 400 mg /5 ml, Tk. 50.15/100ml
Modern Milk of Magnesia(Modern), Suspen.,
400 mg /5 ml, Tk. 60.00/100ml
Mom(Opsonin), Suspen., 400 mg /5 ml, Tk.
60.18/100 ml
118
fissure, and pruritus but good evidence

2.7 PREPARATIONS FOR is lacking. Lignocaine gel and ointment
HAEMORRHOIDS are best applied on a plastic dilator
2.7.1 SOOTHING HAEMORRHOIDAL which ensures contact with the base of
PREPARATIONS the fissure. Alternative local anaesthetics
2.7.2 COMPOUND include amethocaine, cinchocaine, and
HAEMORRHOIDAL pramoxine, but they are more irritant.
PREPARATIONS WITH Local anaesthetics should be used for
CORTICOSTEROIDS short periods only (no longer than 1-2
2.7.3 RECTAL SCLEROSANTS weeks) since they may cause
2.7.4 OTHER PREPARATIONS sensitisation of the anal skin.
ADMINISTRATION. Unless otherwise
indicated a suppository is usually
2.7.5 RECTAL SCLEROSANTS
inserted into the rectum at night and
Anal and perianal pruritus, soreness, morning or after a bowel movement.
and excoriation are best treated by Rectal ointments and creams are applied
application of bland ointments, at night and morning or after a bowel
suppositories or dusting powders. These movement, externally by rectum using a
conditions occur commonly in patients rectal nozzle.
suffering from haemorrhoids, fistulas, Note. Local anaesthetic ointments can
and proctitis. Careful local toilet, as well be absorbed through the rectal mucosa
as, adjustment of the diet to avoid hard therefore excessive application should
stools, taking of bulk forming materials be avoided, particularly in infants and
such as bran (section 2.6.1) and a high children.
residue diet are also helpful. In proctitis
these measures may supplement
2.7.2 COMPOUND PREPARATIONS
treatment with corticosteroids or
WITH CORTICOSTEROIDS
sulphasalazine.
When necessary topical preparations
containing local anaesthetics or Corticosteroids are often combined with
corticosteroids are used provided antiseptics, antibiotics, local anaesth-
perianal thrush has been excluded. etics and soothing agents. They are
Perianal thrush is best treated with suitable for occasional short term use
nystatin by mouth and by local after exclusion of infections, such as
application. herpes simplex; see section 12.3 for
general comments on topical corticos-
teroids.
2.7.1 SOOTHING HAEMORRHOIDAL
Antibiotics may do little more than
PREPARATIONS
encourage the growth of resistant
bacteria and should be avoided.
Bland soothing preparations containing
mild astringents such as bismuth Proprietary Preparations
subgallate zinc oxide and hamamelis Cinchocaine HCl 0.5% + Hydrocortisone 0.5% +
may give symptomatic relief in Neomycin sulphate 1% + Esculin 1%;
haemorrhoids. Many proprietary Anustat(Beximco), RectalOint.,Tk.70.00/15g.
preparations also contain lubricants Anorel(Popular), RectalOint.,Tk.80.30/15g
vasoconstrictors or mild antiseptics Erian (Square),Supp
Tk.8/supp;RectalOintment, Tk. 68.00/15g
Prolonged application of preparations
Methovate(Gaco), Rectal Ointment,
containing resorcinol should be avoided Betametdhasone Valerate0.05 %++Lignocain
because it may interfere with thyroid Hydrochloride 2.5%Tk.30.00/15gm
function. Heparinoids are claimed to
promote the resorption of local oedema
and extravasated blood.
Local anaesthetics are used to relieve
pain associated with haemorrhoids anal
119
2.7.3 RECTAL SCLEROSANTS 2.8 DRUGS AFFECTING

INTESTINAL SECRETIONS
Oily phenol injection is used to inject 2.8.1 DRUGS ACTING ON THE
haemorrhoids particularly when those GALL BLADDER
are unprolapsed. 2.8.2 PANCREATIN
2.8.1 DRUGS ACTING ON THE
PHENOL GALL BLADDER
Indications: injection of hemorrhoids The bile acids chenodeoxycholic acid

Side-effects: irritation, tissue necrosis and ursodeoxycholic acid are used in
Dose: 2-3 ml of oily phenol injection into selected patients to dissolve cholesterol
the submucosal layer at the base of the gallstones as an alternative to surgery.
pile; several injections may be given at
different sites, max. total injected 10 ml URSODEOXYCHOLIC ACID
at any one time
Indication: dissolution ofcholesterol rich
Generic Preparation gallstone, primary biliary cirrhosis.
Oily Phenol Injection BP, contains Cautions: see notes above
phenol 5% in a suitable fixed oil Contra-indications: chronic liver
disease, peptic ulcer disease, non-
2.7.4 OTHER PREPARATIONS functioning gall bladder, inflammatory
bowl disease, pregnancy, radio-opaque
DIOSMIN WITH HESPERIDIN stone and other conditions of the small
intestine, colon and liver which interfere
Indications: treatment of organic and with entro-hepatic circulation of bile salts
idiopathic chronic venous insufficiency of Interactions:see Appendix-2
the lower limbs with the following Side-effects: nausea, vomiting, diarrhea
symptoms: heavy legs; pain; nocturnal and other gastrointestinal disturbance,
cramps. Treatment of hemorrhoids and gallstone calcification; pruritus.
acute hemorrhoidal attacks Dose: dissolution of gallstone,8-12mg/kg
Side effects: some cases of monor daily as a single dose at bedtime or in
gastrointestinal and autonomic disorders two divided doses; for up to 2 years;
have been reported, but these never treatment is continued for 3-4 months
required cessation of treatment after stones dissolve. Primary biliary
Dose: in venous disease: 2 tablets daily. cirrhosis 10-15mg/kg daily in 2-4 divided
In acute hemorrhoidal attacks: the doses.
dosage can be increased up to 6 tablets
daily as prescribing information may vary Proprietary Preparations
Antigall(Incepta), Tab. , 150 mg, Tk.
from country to country.
13.00/Tab., 300 mg, Tk. 22.00/Tab.
Bilicir(ACI), Tab., 150mg , TK. 11.00/Tab.,
Proprietary Preparations 300mg, TK. 20.00/Tab.
Diosmin 450mg with Hesperidin 50mg Liconor(Opsonin), Liquid, 250 mg/5 ml, Tk.
Alvenor(Beacon), Tab. Tk. 10.00/Tab. 180.68/50ml; Tab, 150 mg , Tk. 11.04/Tab.,
Ardium(Drug Intl), Tab.Tk.8.00/Tab. 300 mg, Tk. 21.00/Tab.
Avonoid(UniMed), Tab. Tk. 8.00/Tab. Livacor(Albion), Tab.,150 mg, Tk. 10.00/Tab.;
Daflon(ACI), Tab., Tk. 13.00/Tab. 300 mg, Tk. 20.00/Tab.
Diohes(Opsonin), Tab. Tk. 8.06/Tab. Liveric(Beximco), Tab., 150mg, Tk.
Diorin(Incepta), Tab. Tk. 8.00/Tab. 11.00/Tab., 300mg, Tk. 20.00/Tab.
Hemoral(Aristopharma), Tab. Tk. 8.00/Tab. Oxycol(UniMed), Tab , 300mg, Tk.
Hemorif(Square), Tab. Tk. 8.06/Tab. 36.00/Tab.; 150mg, Tk. 20.00/Tab.
Normanal(Renata), Tab. Tk. 8.03/Tab. Stener(Healthcare), Tab., 150mg , Tk.
Pilestop(Acme), Tab. Tk. 8.07/Tab. 15.00/Tab.; 300mg , Tk. 25.00/Tab.
Sangril(Healthcare), Tab. Tk. 10.00/Tab. Udca(Biopharma), Tab., 300mg , Tk.
Daflon(I)(Servier),Tab.Tk.12/Tab 20.00/Tab.
120
Udihep(Mundipharma), Tab. , 150 mg, Tk. Pancreatin may irritate the skin around
12.67/Tab.; S.R Tab. 300 mg, Tk. 23.50/Tab. mouth and anus, particularly if
Uliv(Acme), Tab. , 150.00 mg , Tk. 12.09/Tab. preparations are retained in the mouth or
; 300 mg, Tk. 20.13/Tab.
Urso(Square), Tab. , 150 mg, Tk. 15.00/Tab.,
dosage is excessive. Hypersensitivity
300 mg, Tk. 25.00/Tab. reactions occur occasionally and may
Ursocol(Sun), Tab., 150 mg, Tk. 11.05/Tab.; affect those handling the powder.
Tab., Tk. 20.10/Tab. Dosage is adjusted according to size,
Ursodil(General), Tab. , 300mg, Tk. needs and number/consistency of stools,
25.00/Tab., 150mg, Tk. 15.00/Tab. so that the patient thrives; extra
Ursolic(Drug Intl), Suspn., 250mg/5 ml, Tk. allowance may be needed if heavy
180.55/50ml; Tab., Tk. 11.05/Tab.; 300mg, Tk.
20.10/Tab.
snacks are taken between meals.
2.8.2 PANCREATIN A-Zyme(Acme), Tab., 325mg, Tk. 3.51/Tab.
Crezyme(Opsonin),Tab., 325mg, Tk.3.50/Tab
Supplements of pancreatin are given by Suzyme(Square),Tab., 325mg, Tk. 3.51/Tab.
mouth to compensate for reduced or Zymet(Beximco), Tab., 325mg, Tk. 3.50/Tab.
absent exocrine secretion in cystic
fibrosis, and following pancreatectomy,
total gastrectomy, or chronic
pancreatitis. They assist the digestion of
starch, fat, and protein.
Pancreatin is inactivated by gastric acid;
therefore pancreatin preparations are
best taken with food (or immediately
before or after food). Gastric acid
secretion may be reduced by giving
cimetidine or ranitidine an hour
beforehand. Con-current use of antacids
also reduces gastric acidity. The newer
enteric coated preparations enclosing
enteric coated granules (or minitablets)
can deliver a higher enzyme
concentration in the duodenum provided
these are swallowed whole without
chewing.
121
3. CARDIOVASCULAR SYSTEM
Chapter-3
CARDIOVASCULAR SYSTEM
3.1 Beta-adrenoceptor blocking drugs p.123
3.2 Drugs affecting renin-angiotensin system and some other
Antihypertensive p.127
3.2.1 Angiotensin converting enzyme inhibitor p.128
3.2.2 Angiotensin II receptor antagonist’s p.132
3.2.3 Renin inhibitors p.136
3.2.4 Alpha adreno-receptor blocking drugs p.136
3.2.5 Angiotensin II receptor blocker Neprilysin Inhibitor (ARNI) p.137
3.2.6 Vasodilator antihypertensive drugs p. 137
3.2.7 Centrally acting Antihypertensive drugs p.138
3.3 Nitrates, calcium-channel blockers, and other antianginal drugs p. 138
3.3.1 Nitrates p.138
3.3.2 Calcium channel blockers p. 139
3.3.3 Other antianginal drugs p. 143
3.3.4 Peripheral and cerebral vasodilators & Neurosensory oxygenator
drugs p.145
3.4 Positive inotropic drugs p. 147
3.5 Diuretics p. 147
3.5.1 Thiazides and related drugs p.147
3.5.2 Loop diuretics p.149
3.5.3 Potassium sparing diuretics p.150
3.5.4 Osmotic diuretics p. 151
3.5.5 Carbonic anhydrase inhibitors p.152
3.6 Antiarrhythmic drugs p. 152
3.7 Sympathomimetic drugs p.155
3.7.1 Inotropic sympathomimetic drugs p.155
3.7.2 Vasoconstrictors p.156
3.7.3 Drugs used in cardiopulmonary resuscitation p.157
3.8 Anticoagulants and protamine sulfate p.158
3.8.1 Parenteral Anticoagulants p.158
3.8.2 Oral Anticoagulants p.161
3.8.3 Protamine sulfate p.161
3.9 Antiplatelet drugs p.162
3.10 Fibrinolytic drugs p.165
3.11 Antifibrinolytic drugs and haemostatics p.167
3.12 Lipid lowering drugs p.168
3.12.1 Anion exchange resins p.168
3.12.2 Fibrates p.169
3.12.3 Statins p.169
3.12.4 Ezetimibe p.173
3.12.5 Omega-3 Fatty Acid Compounds p.173
3.12.6 Nicotinic Acid and Derivatives p.173
3.13 Drugs for the management of pulmonary hypertension p. 174
122
3.1 BETA-ADRENOCEPTOR ARRHYTHMIA. Beta-blockers act as

BLOCKING DRUGS anti-arrhythmic drugs by blocking
sympathetic effects on the heart.
Beta-adrenoceptor blocking drugs (beta- HEART FAILURE. Bisoprolol and
blockers) are effective as antihyperten- carvedilol reduce mortality in any grade
sive, antiarrhythmic and antianginal (with of stable heart failure; nebivolol is
exception of prinzmetal’s angina) agents licensed for stable mild to moderate
by blocking the beta-adrenoreceptors in heart failure in patients over 70 year.
the heart. Beta-blockers decrease THYROTOXICOSIS. Beta-blockers are
mortality in acute phase of myocardial also used before operation for the
infarction and in post infarction period. preparation for thyroidectomy. The
Acebutolol, Pindolol Propranolol, thyroid gland becomes less vascular
Penbutolol and Celiprolol have which makes surgery easier.
intrinsic sympathomimetic activity and OTHER USES. Beta-blockers have been
they tend to cause less bradycardia than used to relieve symptoms of anxiety in
the other beta-blockers and may also patients with palpitations, tremor and
cause less coldness of the extremities tachycardia. Beta-blockers are also used
The water-soluble beta-blockers are in the prophylaxis of migraine.
excreted by the renal route. So these
drugs should be used with caution in ATENOLOL[ED]
renal impairment
Beta-blockers may precipitate or Indications : See under dose
aggravate heart failure. However, Cautions: See under propranolol
Bisoprolol, Carvedilol and Metoprolol hydrochloride; reduce dose in renal
are known to reduce mortality in patients impairment
having stable chronic heart diseases. Contraindications: See under propra-
A cardio selective beta-blocker may be nolol hydrochloride
prescribed with extreme caution under Interactions: See Appendix-2
specialist supervision in patients who Side-effects: See under propranolol
have been suffering from bronchial hydrochloride
ashma or chronic obstructive airways Dose: By mouth, Hypertension, 50-100
disease. Atenolol, Bisoprolol mg daily (higher doses rarely necessary)
Metoprolol and Nebivolol are relatively Angina, 50-100 mg daily in 1 or 2 doses
cardioselective, but they are not
cardiospecific. Ultra short acting, highly Proprietary Preparations
cardioselective beta blockers are Apicard (APC), Tab., 50 mg, Tk.0.75/Tab.
Esomolol and Landiolol. Atebit (Asiatic), Tab., 50 mg, Tk. 0.77/Tab.;
HYPERTENSION. Beta-blockers reduce 100 mg, Tk.1.38/Tab.
cardiac output, change baroceptor’s Ateloc (Popular), Tab., 50 mg, Tk. 0.77/Tab.
reflex sensitivity and block peripheral Atenolol (Albion), Tab., 50 mg, Tk. 0.77/Tab.;
100 mg, Tk.1.38/Tab.;
adrenoceptors. Some beta-blockers Atenolol (Amico), Tab., 100mg, TK. 1.38/Tab.;
decrease plasma renin secretion. Some 50mg, TK. 0.77/Tab.
central effect may also contribute to their Atezen (Zenith), Tab., 100 mg, Tk. 1.37/Tab.;
antihypertensive effect. 50 mg, Tk. 0.77/Tab.
ANGINA. Beta-blockers improve Atin (Jayson), Tab., 50mg, Tk. 0.76/Tab.
exercise tolerance by reducing cardiac B-card(Nipa), Tab., 50 mg, Tk. 0.77/Tab.
work and relieve symptoms in patients Betanol (Sanofi), Tab., 100mg, Tk. 1.37/Tab.;
with angina.. 25mg, Tk. 0.45/Tab.; 50mg, Tk. 0.77/Tab.
Betasec (Opsonin), Tab., 50 mg , Tk.
MYOCARDIAL INFARCTION. Atenolol 0.77/Tab.
and Metoprolol may reduce early Cardilock (Alco), Tab., 50 mg, Tk. 0.77/Tab.
mortality after intravenous and subsequ- Cardipro, (Square), Tab. , 50 mg, Tk.
ent oral administration in the acute 0.77/Tab.
phase..
123
Cardisef (Supreme), Tab. , 50 mg, Tk. Betacor (Popular), Tab. 2.5mg, Tk.6.00/Tab.;
0.77/Tab.; 100 mg, Tk. 1.36/Tab. 5mg, Tk.10.00/Tab.
Carsec (Medimet), Tab., 100mg, Tk. 1.35/Tab.; Betafix, (Healthcare), Tab, 2.5mg, Tk.
50mg, Tk. 0.75/Tab. 180.00/Tab.; 5mg, Tk. 300.00/Tab.
Etnol (Biopharma), Tab., 50 mg, Tk.0.77/Tab.; Betapro (Beximco), Tab., 10mg, Tk.
100 mg, Tk. 1.38/Tab. 16.00/Tab.; 2.5mg, Tk. 6.00/Tab.; 5mg, Tk.
Lonet (Beximco), Tab., 50 mg, Tk. 0.77/Tab. 10.00/Tab.
Lopres, (Orion), Tab. , 50 mg, Tk. 0.71/Tab. Bislol (Opsonin), Tab., 5 mg, Tk. 10.07/Tab.;
Normaten (Navana), Tab., 50 mg, 2.5 mg, Tk. 6.04/Tab.; 10 mg, Tk. 16.11/Tab.
Tk.0.76/Tab. Bisocor (Square), Tab., 2.5 mg, Tk.
Norpress (Kemiko), Tab., 50 mg, Tk.0.75/Tab. 6.04/Tab. 5 mg, Tk. 10.07/Tab.
Tenocard (Aristo), Tab., 50 mg, Tk. 0.75/Tab. Bisoloc (Orion), Tab., 2.5 mg, Tk. 6.02/Tab.; 5
Tenoloc (Acme), Tab., 50 mg, Tk. 0.77/Tab.; mg, Tk. 10.03/Tab.
100 mg, Tk. 1.37/Tab. Bisopress (NIPRO JMI), Tab., 2.5 mg, Tk.
Tenomin (Pacific), Tab. , 50 mg, Tk. 0.77/Tab. 6.02/Tab.; 5 mg, Tk. 10.03/Tab.
Tenoren (ACI), Tab., 25mg, Tk. 0.45/Tab.; Bisopro (Incepta), Tab. 2.5 mg, Tk.6.00/Tab.;
50mg, Tk. 0.77/Tab., Tab., 100mg, Tk. 5 mg, Tk.10.00/Tab.
1.38/Tab. Bisoren (Renata), Tab. 2.5 mg, Tk.6.00/Tab.;
Tenovir (Virgo), Tab., 50 mg, Tk. 75.00/Tab. 5 mg,Tk.10.00/Tab.
B-prolol (Sharif), Tab., 2.5 mg, Tk. 6.01/Tab.,
Atenolol + Chlorthalidone 5 mg, Tk. 10.03/Tab.
Atechlor, (Silva), Tab, 50 mg + 25 mg, Tk. Cardicor (UniMed), Tab. 2.5 mg, Tk.6.00/Tab.;
2.51/Tab.,Tab., 100 mg + 25 mg, Tk. 3.01/Tab. 5 mg, Tk.10.00/Tab.
Tenoren Plus(ACI), Tab., 50 mg+25 mg, Tk. Cardinor (Labaid), Tab. 2.5 mg, Tk.6.00/Tab.;
3.02/Tab. 5 mg, Tk.10.00/Tab.
Cardobis (Eskayef), Tab, 2.5 mg, Tk.
6.00/Tab.; 5 mg, Tk. 10.00/Tab.
BISOPROLOL FUMARATE
Conbis (RAK), Tab. 2.5 mg, Tk.6.00/Tab.;
5mg, Tk.10.00/Tab.
Indications: Hypertension, angina, Myocard (General), Tab., 2.5mg, Tk.
myocardial infarction, arrhythmias, heart 6.02/Tab.; 5mg, Tk. 10.03/Tab.
failure Myocor (Biopharma), Tab.2.5mg, Tk.
Cautions: See under Propranolol 10.00/Tab.; 2.50mg, Tk. 6.00/Tab.
Nubis (Nuvista), Tab. , 2.5 mg, Tk. 6.00/Tab.;
Hydrochloride; dose max. 10 mg daily 5 mg, Tk. 10.00/Tab.
sould be reduced; if GFR less than Orabis (Ibn Sina), Tab. , 2.5mg, Tk.
20 mL/minute/1.73m2 (max. 10 mg 180.00/Tab. ; 5mg, Tk. 300.00/Tab.
daily) Probis, (ACI), Tab., 2.5mg, Tk. 6.02/Tab.;
Contra-indications: See under 5mg, Tk. 10.03/Tab.
Propranolol Hydrochloride; also acute or Tabis (Navana), Tab., 2.5 mg, Tk. 6.02/Tab.; 5
decompensated heart failure; sino-atrial mg, Tk. 10.03/Tab.
Tenobis- (Drug Intl), Tab., 2.5mg, Tk.
block
6.05/Tab.; 5mg, Tk. 10.05/Tab.
Interactions: See Appeddix -2 Tibeta (Doctor TIMS), Tab. 2.5 mg, Tk.6/Tab.
Side-effects: See under Propranolol Bisoprolol Fumarate + Hydrochlorothiazide
Hydrochloride, muscle weakness and
cramp Ancor Plus (Aristo), Tab. 2.5 mg + 6.25 mg,
Dose: Hypertension and angina, usually Tk.6.00/Tab.; 5 mg + 6.25 mg, Tk.10.00/Tab.
5-10 mg once daily max 20 mg daily. Betacor (Popular), Tab., 2.5mg + 6.25mg
Tab., Tk. 6.00/Tab.; 5.00mg + 6.25mg, Tk.
Adjunct in heart failure, initially 1.25 mg
10.00/Tab.
once daily (in the morning) for 1 week Betafix (Healthcare), Tab., 2.5mg + 6.25mg,
then, if well tolerated, increased to 2.5 Tk. 6.00/Tab.; 5mg + 6.25mg, Tk. 10.00/Tab.
mg/ 4 weeks, upto max. 10 mg daily Bislol Plus (Opsonin), Tab., 10 mg + 6.25 mg
, Tk. 16.00/Tab.; 2.5 mg + 6.25 mg, Tk.
Proprietary Preparations 6.02/Tab.
Ancor (Aristo), Tab. 2.5 mg, Tk.6.00/Tab.; Bisocor (Square), Tab. 2.5 mg + 6.25 mg, Tk.
5mg, Tk.10.00/Tab.; 10 mg, Tk.16.00/Tab. 6.04/Tab.; 5 mg + 6.25 mg, Tk. 10.03/Tab.
Betabis (Acme), Tab. 2.5 mg, Tk.6.01/Tab.; Bisopro (Incepta), Tab. 2.5 mg + 6.25 mg,
5mg, Tk.10.003Tab. 10.00/Tab.; 5 mg + 6.25 mg, Tk.6.00/Tab.
124
Probis (ACI), Tab., 2.5mg + 6.25, Tk. Carvista (Incepta), Tab. 6.25mg, Tk.3.00/Tab;
6.02/Tab.; 5mg + 6.25, Tk. 10.03/Tab. 25mg, Tk. 8.00/Tab; 12.5mg,Tk.5.00/Tab.
Tabis Plus (Navana), Tab., 2.5 mg+6.25 mg, Cavelon (Drug Intl), Tab, 12.5mg, Tk.6.05/Tab;
Tk. 6.00/Tab.; 5 mg+6.25 mg, Tk. 10.00/Tab. 6.25mg, Tk.3.05/Tab.
TenobisPlus(DrugIntl),Tab.,10mg+6.25mg, Dilapress (Beximco),Tab, 6.25mg, Tk. 3/Tab.
Tk. 16.05/Tab., 2.5mg+6.25mg, Tk. 6.45/Tab. Dilatrend (Radiant), Tab., 25mg, Tk.
; 5mg+6.25mg, Tk. 10.05/Tab. 22.07/Tab.; 6.25mg, Tk. 11.03/Tab.
Dilgard (General), Tab., 12.5mg, Tk.5.04/Tab.;
Bisoprolol + Amlodipine 25mg, Tk. 8.05/Tab.;6.25mg, Tk. 3.02/Tab.
Bisopro-A 2.5/5(Incepta), Tab. 2.5mg+ 5mg, Dilocard (White Horse), Tab., 6.25 mg,
Tk. 6.00/Tab. Tk.3.00/Tab.; 12.5 mg, Tk. 5.00/Tab.
Diola (Novartis), Tab., 6.25 mg, Tk. 6.25/Tab.;
CARVEDILOL 12.50 mg, Tk. 9.50/Tab.
Durol (Square), Tab. 6.25 mg, Tk.3.01/Tab.
Exepress (Opsonin), Tab., 3.125 mg,
Indications: Hypertension, angina, Tk.1.14/Tab.; 6.25 mg, Tk. 2.26/Tab.; 12.50mg,
adjunct in symptomatic chronic heart Tk. 3.77/Tab.; 25 mg, Tk. 6.04/Tab.
failure Karvedil (ACI), Tab., 12.5mg, Tk.4.03/Tab.;
Cautions: See under propranolol 25mg,Tk. 8.05/Tab.; 6.25mg, Tk. 3.02/Tab.
hydrochloride, acute or decompensated Revodil (Ibn Sina), Tab., 6.25 mg, Tk. 3/Tab.
heart failure requiring intravenous Rovedilol (Healthcare), Tab., 12.5mg, Tk.
7.00/Tab.; 6.5mg, Tk. 4.00/Tab.;
inotropics Ucardol (UniMed), Tab, 12.5mg, Tk.5.00/Tab.;
Contraindication: See under propra- 25mg, Tk.9.00/Tab.;6.25mg, Tk.3.00/Tab.
nolol hydrochloride; hepatic impairment Vedilol (Eskayef), Tab, 12.50mg, Tk.5/Tab.;
Interactions: See Appendix-2 25mg, Tk. 8/Tab. 6.25mg, Tk. 3.00/Tab.
Side-effects: Postural hypotension, Vesodil (Rangs), Tab., 12.5 mg, Tk. 5.00/Tab.;
dizziness, headache, fatigue, gastrointe- 25mg, Tk.8.00/Tab.; 6.25 mg,Tk. 3.00/Tab.
stinal disturbances, bradycardia, painful
extremities,peripheral edema, dry LABETALOL HYDROCHLORIDE
mouth, dry eyes, impotence, (Both alpha and beta adrenergic blocker)
disturbances of micturition, AV block,
exacerbation of intermittent claudication Indications: Hypertension in pregnancy,
,worsening of psoriasis, heart failure, hypertension with angina, and
Dose: Hypertension, initially 6.25 mg hypertension following acute myocardial
twice daily, increase gradually to usual infarction); hypertensive crisis, controlled
dose of 25 mg twice daily; ELDERLY hypotension in anaesthesia
initial dose of 12.5 mg daily may provide Cautions: See under Propranolol
satisfactory control Hydrochloride; renal impairment- dose
reduction may be required; if severe
Proprietary Preparations hepatocellular damage labetalol should
Arilol (Pacific), Tab, 12.5 mg,Tk. 5/Tab; be stopped and not restarted
25mg,Tk.8./Tab;6.25mg, Tk.3/Tab.
Contra-indications: See under
Avidol (Ad-din), Tab., 6.25 mg, Tk. 3.00/Tab.
Cardex (Opsonin), Tab, 12.5mg, Propranolol Hydrochloride
Tk.5.02/Tab;3.125mg,Tk. 1.51/Tab, Interactions: See Appendix-2
6.25mg,Tk.3.01/Tab. Side-effects: Postural hypotension
Cardivas (Sun), Tab., 6.25 mg, Tk. 4.55/Tab.; tiredness, weakness, headache, rashes,
12.50 mg, Tk. 6.55/Tab. scalp tingling, difficulty in micturition,
Carved (Biopharma), Tab, 6.25mg, epigastric pain, nausea, vomiting; liver
Tk.4.50/Tab.
damage
Carvetab (Medimet), Tab., 12.5 mg,
Tk.5.00/Tab.; 6.25 mg, Tk.3.00/Tab. Dose: By mouth, initially 100 mg twice
Carvicard (Novo), Tab, 12.5mg, Tk.5/Tab; daily with food, increased at intervals of
6.2mg, Tk. 3.00/Tab. 14 days to usual dose of 200 mg twice
Carvipress (Acme), Tab; 12.50 mg, daily;
Tk.5.03/Tab;25.mg, Tk. 8.07/Tab;6.25 mg,
Tk.3.01/Tab.
125
By intravenous injection, 50 mg over at Metoprol (Beximco), XR Tab.,50mg,

least 1 minute, repeated after 5 minutes Tk. 3.00/Tab.
if necessary; max. dose 200 mg M-Loc (Sharif), Tab.50 mg,Tk.2/Tab.
Preloc (Opsonin), Tab., 50 mg ,
By intravenous infusion, 2 mg/minute
Tk. 2.00/Tab.
until satisfactory response then Presonil (Incepta),Tab.25 mg,
discontinue; Hypertension in pregnancy, Tk. 1.30/Tab.
20 mg/hour, doubled every 30 minutes; Selomet (UniMed), Tab,50mg,
usual max. 160 mg/hour Tk.4/Tab.;50mg,Tk.2/Tab;25mg,
Hypertension following myocardial Tk.1.50/Tab.
infarction, 15 mg/hour, gradually Topress (Eskayef), Tab., 50mg,
increased to max. 120 mg/hour Tk. 2.00/Tab.
Proprietary Preparations NEBIVOLOL(dilate bold vessels in addition to

Labecard (Popular), Tab., 200 mg, Tk. cardiac effect)
10.04/Tab.;100mg,Tk.6.02/Tab.;Inj,
5 mg/ml, Tk. 100.38/Vial Indications: Essential hypertension;
Labegest (Incepta), Tab., 100mg, Tk. adjunct in stable mild to moderate heart
6.00/Tab.; 200 mg, Tk. 10.00/Tab.;
failure in patients over 70 years
Labeta (Beximco), Tab., 200 mg, Tk. 9.00/Tab.
Cautions: See under Propranolol
Hydrochloride, renal impairment avoid if
METOPROLOL TARTARATE[ED](Selective serum creatinine greater than 250
beta1blocker)
micromol/litre
Contra-indications: See under Propra-
Indications: See under Dose
nolol Hydrochloride; also acute or
Cautions: See under propranolol decompensated heart failure requiring
hydrochloride intravenous inotropes
Interactions: See Appendix-2 Interactions: See Appendix-2
Side-effects: See under propranolol Side-effects: See under Propranolol
hydrochloride Hydrochloride; also oedema and
Dose: By mouth; hypertension, initially depression, fatigue, exercise intolarence
25-100 mg daily, main-tenance 100-200 Dose: Hypertension, 5 mg daily;
mg daily in 2 divided doses; ELDERLY initially 2.5 mg daily,
Angina, 50-100 mg 2-3 times daily; increased if necessary to 5 mg daily
Arrhythmias, usually 50mg 2-3 times Adjunct in heart failure, initially 1.25 mg
daily, up to 300 mg daily in divided once daily, then if tolerated increased at
doses if necessay; intervals of 1–2 weeks to 2.5 mg once
Migraine prophylaxis, 100-200mg daily in daily, then to 5 mg once daily, then to
divided dose; Hyperthyroidism (adjunct), max. 10 mg once daily
50mg 4 times daily. Renal impairment for hypertension,
By intravenous injection, Arrhythmias, initially 2.5 mg once daily, increased to 5
up to 5 mg at rate 1-2 mg/minute, mg once daily if required; for heart
repeated after 5 minutes if necessary, failure
total dose 10-15 mg.
Proprietary Preparations Bipinor (ACI), Tab. 5mg,Tk.8.05/
Angilat (ACI), Inj, 1mg/ml, Tk.120.36/vial; Tab.; 2.5mg, Tk.5.04/Tab.
Tab., 25mg, Tk.1/Tab; 50 mg,TK.1.5/Tab. Cardoneb (Eskayef), Tab.,5 mg,Tk.
Betacard (Aristo), Tab., 50mg, Tk. 2.00/Tab. 10.00/Tab.;2.5mg,Tk.7.00/Tab.
Betaloc (Drug Intl), Tab. 50mg, Tk. Maxineb (Aristo), Tab.,2.5mg,
2.04/Tab.;25mg, Tk.1.55/Tab.; 100mg, Tk.7.00/Tab.; 5mg,Tk.10.00/Tab.
Tk.6.05/Tab.50mg,Tk.4.05/Tab. Nebicard (UniMed), Tab, 5 mg,
Betaone (Acme), Tab. 25 mg, Tk. 1.51/Tab.;50 Tk.12.00/Tab.; 2.5mg,Tk.7.00/Tab.
mg,Tk.2.00/Tab. Nebifast (Drug Intl), Tab. 2.5mg,
Metocard (Popular), Inj.1 mg/ml, Tk.6.00/Tab.; 5mg,Tk.8.00/Tab.
Tk.120.45/vial
126
Nebilol (Opsonin), Tab.5 mg, Tk. 8.03/Tab.; Prophylaxis after myocardial infarction,
2.5 mg,Tk.5.02/Tab. 40 mg 4 times daily for 2-3 days, then 80
Nebita (Square), Tab.5 mg, Tk. 10.03/Tab.; mg twice daily, beginning 5 to 21 days
2.5 mg,Tk.7.02/Tab.
after infarction;
Nebivas (Asiatic), Tab., 2.5mg,
Tk.5.00/Tab.;5mg, Tk.10.00/Tab. Migraine prophylaxis and essential
tremor, initially, 40 mg 2-3 times daily,
maintenance 80-160 mg daily
PROPRANOLOL
HYDROCHLORIDE[ED] Proprietary Preparations
Beta (Sun), TR Cap., 40 mg, Tk.2.50/Cap.
Indications: See under dose G-propranolol (Gonoshasthaya), Tab., 40 mg,
Cautions: Pregnancy and breast- Tk. 0.35 /Tab.
Indever (ACI), SR Cap., 40mg, Tk. 0.92/Cap.,
feeding, avoid abrupt withdrawal in
80mg, Tk.1.55/Cap., Tab., 10mg, Tk.
angina, first-degree AV block, hepatic 0.51/Tab., 40mg,Tk. 3.00/Tab.
impairment, renal impairment, diabetes, Propranol (Opsonin), Tab.10 mg , Tk.
myasthenia gravis 0.51/Tab., 40 mg , Tk. 1.51/Tab.
Contraindications: Asthma or history of Propranolol (Albion), Tab., 10 mg,
obstructive airways disease important: Tk.0.24/Tab.; 40 mg, Tk. 0.34/Tab.
see bronchospasm below; uncontrolled
heart failure, prinzmetal’s angina, SOTALOL HYDROCHLORIDE
marked brady-cardia, hypotension, sick
sinus syndrome, second or third degree Indications: Life threating arrythmias
AV block, cardiogenic shock, metabolic including ventricular tachyarrythmias,
acidosis, severe peripheral arterial paroxysmal, supraventricular tachycardia
disease, phaeochromocytoma after cardiac surgery
Interactions: See Appendix-2 Cautions: See under propranolol
Side-effects: Bradycardia, heart failure, hydrochloride; when stopping sotalol the
hypotension, conduction disorders, bron- dose should be reduced gradually
chospasm, exacerbation of intermittent Contraindications: Congenital or
claudication and Raynaud’s phenome- acquired long QT syndrom, renal failure
non, gastrointestinal disturbances, sleep angina, hypertension, and thyrotoxicosis
disturbances Interactions: See Appendix-2
Dose: By mouth, hypertension, initially Side-effects: See under propranolol
80 mg twice daily, increased at weekly hydrochloride
intervals as required; maintenance 160- Dose: By mouth with ECG monitoring
320 mg daily; and mesaurment of corrected QT
Portal hypertension, initially 40 mg twice interval, arrythmias, initially, 80mg daily
daily, increased to 80 mg twice daily in divided dose; higher doses of 480-
acccording to heart rate; max. 160 mg 640mg daily for life threating ventricular
twice daily; arrhythmias under special supervision
Phaeochromocytoma (only with an
alpha-blocker), 60 mg daily for 3 days Proprietary Preparation
before surgery or 30 mg daily in patients Sotalax (Unimed), Tab. 80 mg, Tk. 10/Tab.
unsuitable for surgery;
Angina, initially 40 mg 2-3 times daily;
3.2 DRUGS AFFECTING THE
maintenance 120-240 mg daily;
RENIN-ANGIOTENSIN SYSTEM
Arrhythmias, hypertrophic obstructive
cardiomyopathy, anxiety tachycardia, AND SOME OTHER
and thyrotoxicosis (adjucnt), 10 mg to 40 ANTIHYPERTENSIVE DRUGS
mg 3-4 times daily; 3.2.1 ANGITOTENSIN CONVERTING
Anxiety with symptoms such as ENZYME INHIBITOR
palpitations, sweating, tremor, 40 mg 3.2.2. ANGITOTENSIN-II RECEPTOR
once daily increased to 40 mg 3 times ANTAGONISTS
daily if necessary; 3.2.3. RENIN INHIBITORS
127
3.2.4 ALPHA-ADRENOCEPTOR functioning kidney ACE inhibitors are

BLOCKING DRUGS likely to cause severe and progressive
3.2.5 ANGIOTENSIN II RECEPTOR renal failure; they are contraindicated in
BLOCKER NEPRILYSIN patients who have critical renovascular
INHIBITOR (ARNI) disease. Glomerular filtration is likely to
3.2.6 VASODILATOR ANTI- be reduced in the affected kidney with
HYPERTENSIVE DRUGS the treatment by ACE inhibitor.
3.2.7 CENTRALLY ACTING Therefore, ACE inhibitors are not to be
ANTI-HYPERTENSIVE DRUGS prescribed in patients with known or
3.2.1 ANGITOTENSIN-CONVERTING suspected renovascular disease, unless
ENZYME INHIBITORS (ACE the blood pressure uncontrollable by
inhibitors) other drugs. If they are used in these
situations renal function tests are to be
ACE inhibitors inhibit the conversion of done regularly.
angiotensin I to angiotension II. They are Renal function and electrolytes should
effective and well tolerated. be measured before initiating ACE
Heart Failure. ACE inhibitors are very inhibitors and monitored during
useful in all grades of heart failure, treatment. Although ACE inhibitors now
combined when appropriate with a have some special role in some forms of
diuretic and digoxin. Postassium supple- renal disease they can occasionally
ments and potassium-sparing diuretics cause renal impairment, which may lead
should be withdrawn before introducing to renal failure. The elderly are at
an ACE inhibitor because of the risk of particular risk. Concomitant treatment
hyperkalaemia. First-dose phenomenon with NSAIDs increases the risk of renal
may occur when ACE inhibitors are damage, and the use of potassium
intro-duced to patients with heart failure sparing diuretics increase the risk of
who are already taking a loop diuretic hyperkalaemia.
(e.g. furosemide 80 mg daily or more). Cautions : May cause sharp fall of
At the start of treatment the ACE blood pressure especially in patients
Inhibitor should therefore be at a very taking diuretics, on a low-sodium diet, on
low dosage (e.g. captopril 6.25mg) with dialysis, dehydrated or with heart failure.
the patient recumbent and under close They should also be given with caution
medical supervision. in peripheral vascular disease or
Hypertension. ACE inhibitors are generalised atherosclerosis owing to risk
recommended for hypertension when of clinically silent renovascular disease.
thiazides and beta-blockers are Renal function tests should be carried
contraindicated, not tolerated, or fail to out before and during treatment and the
control blood pressure. They are dose should be reduced in renal
particularly indicated for hypertension in impairment. The risk of agranulocytosis
insulin-dependent diabetics with nephro- is possibly increased in collagen
pathy. ACE inhibitors may cause very vascular disease. ACE inhibitors should
rapid fall of blood pressure in some be avoided in patients with a history of
patients who are taking diuretic. The first idiopathic or hereditary angiedema. ACE
dose should preferably be at bed time. inhibitors should be prescribed with
caution in breast-feeding. ACE inhibitors
Myocardial Infarction. ACE inhibitors
should also be given with caution in
are indicated for immediate and long-
patients with peripheral vascular disease
term management of patients who have
or those with severe generalised
had myocardial infarction.
atherosclerosis.
Hospital Management. ACE inhibitor
Anaphylactoid Reactions. ACE
therapy for severe heart failure should
inhibitors should be avoided during
be started in hospital.
dailysis with dextran sulphate to prevent
Renal effects. In patients with severe
anaphylactoid reactions. They should
stenosis of the artery supplying a single
also be withheld before deseusitization
128
with bee venom. In the volume depleted Dose: Hypertension, used alone, initially
patients diuretic should be discontiuned 12.5 mg twice daily; if used in addition to
or the dose should be reduced diuretic, or in elderly, initially 6.25 mg
significantly 2-3 days before initiation of two times daily (first dose at bedtime);
an ACE inhibitor. If diuretic therapy usual maintenance dose 25 mg twice
cannot be stopped, clinical supervision daily, max. 50 mg twice daily (rarely 3
is recommended for at least 2 hours times daily in severe hypertension)
after administration of the first dose of Heart failure, initially 6.25-12.5 mg under
the ACE inhibitor or until the blood close medical supervision (see notes
pressure has stabilized. above); usual maintenance dose 25mg
Contra-indications: ACE inhibitors are 2-3 times daily, usual max. 150mg daily
contraindicated in patients with Prophylaxis after infarction in clinically
hypersen-sitivity to ACE inhibitors stable patients with asymptomatic or
(including angioedema) and in known or symptomaitc left ventricular dysfunction,
suspected renovascular disease, aortic initially 6.25mg starting as early as 1 day
stenosis or other outflow tract after infarction, then increased over
obstruction. ACE inhibitors should not be several weeks to maximum tolerated
used in pregnancy level in divided doses
Side-effects: ACE inhibitors can cause Diabetic nephropathy, 50-100mg daily in
profound hypotension and renal divided doses; if further blood press-ure
impairment. They may also cause reduction required, other antihyper-
angioedema, rashes, pruritus, urticaria, tensives may be used in conjunction with
persistent dry cough, pancreatitis and captopril; in severe renal impairment,
upper respiratory tract symptoms such initially 12.5mg twice daily (if concomi-
as sinusitis, rhinitis and sore throat. tant rather than thiazide should be
Gastrointestinal effects reported with chosen)
ACE inhibitors include nausea, vomiting,
dyspepsia, diarrhoea and constipation. Proprietary Preparations
Altered liver function tests, chloestatic Acetor (Drug Int), Tab., 25 mg Tk. 3.05/Tab.
jaundice and hepatitis have been Capotril (Alco)), Tab., 25 mg Tk. 3.00/Tab.
reported. Blood dyscrasias including Captopril (Albion), Tab., 25 mgTk. 3.00/Tab.
thrombocy-topenia, leucopenia, Cardopril (Beximco), Tab. 25 mg, Tk.3.01/Tab.
Catopil (Zenith), Tab., 25 mg, Tk. 3.00/Tab.
neutropenia and haemolytic anemia
have also been reported.
ENALAPRIL MALEATE[ED]
CAPTOPRIL[ED]
Indications: Essential and renovascular
hypertension congestive heart failure,
Indications: Mild to moderate essential
prevention of symptomatic heart failure
hypertension alone or with thiazide
and prevention of coronary ischaemic
therapy and severe hypertension resist-
events in patients with left ventricular
ant to other treatment; congestive
dysfunction
cardiac failure; following myocardial infa-
Cautions: See notes above
rction, diabetic nephropathy (microal-
buminuria greater than 30mg/ day) in Contra-indications : See notes above
insulin-dependent diabetes Interactions: See Appendix-2
Cautions: See notes above Side-effects: See notes above; also
Contra-indications: See notes above palpitation, arrhythmias, angina, chest
Interactions: See Appendix-2 pain, syncope, cerebrovascular accident,
myocardial infarction, anorexia,
Side-effects: See notes above; also
stomatitis, hepatic failure, erythema
tachycardia, serum sickness, weight
multiforme, Stevens-Johnson syndrome,
loss, stomatitis, maculopapular rash,
toxic epider-mal necrolysis, exfoliative
photosensitivity, flushing and acidosis
dermatitis and pemphigus, confusion,
depers-sion, nervousness, asthenia,
129
drowsiness, insomnia, blurred vision, further 24 hours, and continuing with 10

tinnitus, sweating, flushing, impotence, mg once daily for 6 weeks or continued;
alopecia, dyspnoea and muscle cramps systolic blood pressure 100-120 mmHg
Dose: Hypertension, used alone, initially initially 2.5 mg increasing to maintena-
5mg once daily; if used in addition to nce dose of 5mg once daily
diuretic, in ELDERLY patients, or in Diabetic nephropathy, intially 2.5 mg
renal impairment, initially 2.5mg daily; daily adjusted to achieve a sitting
usual maintenance dose 10-20mg once diastolic blood pressure below 75 mmHg
daily; in severe hypertension the dose in normotensive insulin dependent
may be increased to max. 40mg once diabetes and below 90 mmHg in
daily. Heart failure (adjunct), hypertensive non-insulin dependent
asymptomatic left ventricular diabetes; usual dose, 10-20 mg daily
dysfunction, initially 2.5mg daily under
close medical supervision; usual Proprietary Preparations
maintenance dose 20mg daily in 1-2 Acepril (Drug Intl), Tab., 10mg, Tk.7.05/Tab.; 5
divided doses mg, Tk. 4.05/Tab.
Lipril (Acme), Tab., 10 mg, Tk. 5.53/Tab.; 5
mg, Tk. 3.01/Tab.
Lispril (Medimet), Tab., 5 mg, Tk.2.25/Tab.
Anapril (Eskayef), Tab, 5 mg, Tk. 1.51/Tab.;
Nop (Ambee), Tab., 5 mg, Tk.3.55/ Tab
10 mg, Tk. 2.70/Tab.
Stril (ACI), Tab., 5 mg, Tk. 3.02/Tab
Enalapril (Albion), Tab., 5 mg, Tk. 1.52/Tab.;
10 mg, Tk. 2.78/Tab.
Enaril (Beximco), Tab., 5 mg, Tk. 1.00/Tab. PERINDOPRIL
Vasopril (Square), Tab., 5 mg, Tk. 1.25/Tab.;
10 mg, Tk. 2.26/Tab. Indications: Essential and renovascular
hypertension, congestive heart failure
LISINOPRIL Cautions: Inform the physician when
there is swelling of the lips, face, tongue,
Indications: Essential and renovascular and when there is difficulty in breathing
hypertension, congestive heart failure, and swallowing
following myocardial infarction in haemo- Contraindications: See notes above
dynamically stable patients, diabetic Interactions: See Appendix-2
nephropathy in normotensive insulin Side-effects: See notes above;
dependent and hypertensive noninsulin asthenia, flushing mood and sleep
dependent diabetes mellitus disturbances
Cautions: See notes above Dose: Hypertension, initially 2 mg daily
Contraindications: See notes above (before food); usual maintenance
Interactions: See Appendix-2 dosage is 4mg once daily orally in the
Side-effects: See notes above; tachyca- morning, max. 8mg daily, if necessary,
rdia, cerebrovascular accident, myocar- after 1 month of treatment
dial infarction, dry mouth, confusion, Congestive heart failure: treatment
mood change, asthenia, sweating, should be under closed medical
impotence and alopecia supervision, recommended initial dose is
Dose: Hypertension, initially 2.5 mg 2 mg daily orally in the morning which
daily, usual maintenance dose 10-20 mg may be increased to 4 mg daily (once
daily, max. 40 mg daily, if used in blood pressure acceptability has been
addition to diuretic; See notes above demonstrated). In case of renal failure,
Heart failure (adjunct), initially 2.5 mg the dosage of perindopril must be
daily under close medical supervision, adjusted according to the degree of
usual maintenance dose 5-20 mg daily renal failure; periodic determination of
Prophylaxis after myocardial infarction, serum potassium and creatinine levels
systolic blood pressure over 120 mmHg, recommended
5mg within 24 hours followed by further
5mg, 24 hours later, then 10 mg after a
130
Proprietary Preparations intervals of 1-2 weeks; max. 10 mg daily

Pendoril (Renata), Tab., 2 mg, Tk. 9.00/Tab., in single or 2 divided doses.
4 mg, Tk. 14.00/Tab., 8 mg, Tk. 24.09/Tab. Prophylaxis after myocardial infarction
Pericard (Asiatic), Tab., 2mg, Tk. 7.00/Tab., initially 2.5 mg twice daily, increased
4mg , Tk. 12.00/Tab.
after 2 days to 5 mg daily, maintenance
Versil(Acme), Tab., 4 mg., Tk. 12.09/Tab.
Cadnyl (Square), Tab., 4 mg, Tk.12.05/Tab.
2.5-5 mg twice daily.
Coversyl (Servier), Tab., 4mg, 16tk/Tab; 8mg, Note. If initial 2.5 mg dose is not
Tk. 25.00/Tab. tolerated, give 1.25 mg twice daily for 2
days before increasing to 2.5 mg twice
Perindopril Erbumine + Indapamide daily, then 5mg twice daily; withdraw if
Coversyl plus (Servier), Tab., 4mg+1.5mg, Tk. 2.5 mg twice daily not tolerated.
21.00/Tab.
Indapa-plus (Drug Intl), Tab., 625 mcg + 2 mg,
Tk. 6.05/Tab.; 1.25 mg+ 4mg, Tk. 12.05/Tab.
Acecard (Healthcare), Tab, 1.25 mg,
Indapril (Incepta), Tab., 625 mcg + 2 mg, Tk.
Tk.3.00/Tab.; 2.5 mg, Tk. 5.00/Tab.; 5 mg,
12.00/Tab.; 1.25 mg + 4 mg , Tk. 7.00/Tab.
Tk.8.00/Tab.
Midopril (General), Tab., 2 mg + 0.625 mg,
Aceon (Novo Health), Tab., 5 mg, Tk.
Tk. 7.00/Tab.; 4 mg + 1.25 mg, Tk. 12.00/Tab.
8.00/Tab., 2.5 mg, Tk. 5.00/Tab.
Pendoril (Renata), Tab., 625 mcg + 2 mg, Tk.
Aceril (Ibn Sina), Tab.,2.5mg, Tk. 5.00/Tab.,
10.00/Tab.; 1.25 mg + 4 mg , Tk. 15.00/Tab.
5mg, Tk. 240.00/Tab.
Pericard Plus (Asiatic), Tab., 625 mcg + 2 mg
Cartace (Ad-din), Tab., 2.5mg, Tk. 4.60/Tab.
, Tk. 7.00/Tab.; 1.25mg + 4mg , Tk. 12.00/Tab.
Gepril (Globe), Tab., 5 mg, Tk. 8.00/Tab.
Perindal (Opsonin), Tab.,1.25 mg + 4 mg, Tk.
G-Ramipril (Gonoshasthaya), Tab., 2.5 mg,
12.05/Tab.; 625 mcg + 2 mg, Tk. 7.03/Tab.
Tk. 2.50/Tab.; 5 mg, Tk. 4.00/Tab.
Repres Plus (Square), Tab., 4 mg + 1.25 mg,
Mypril (Eskayef), Tab, 2.5 mg, Tk.5.00/Tab.;
Tk. 12.05/Tab.; 2 mg + 0.625 mg, Tk.7.02/Tab.
5mg, Tk. 8.00/Tab.
Nuvace (Orion), Tab., 2.5 mg, Tk. 5.02/Tab., 5
Perindopril erbumine+ Amlodipine
mg, Tk. 8.02/Tab.
Coveram (Servier), Tab. 4mg+5mg, Tk.
Nuvace (Orion), Tab., 2.5 mg, Tk.5.00/Tab.;
21.00/Tab, 4mg+ 10mg, Tk. 21.00/Tab.
5mg, Tk. 8.00/Tab.
Piramil (Novartis), Tab., 2.5 mg, Tk. 7.00/Tab.;
RAMIPRIL 5 mg, Tk. 10.00/Tab.
Pricard (White Horse), Tab., 2.5 mg,
Tk.4.00/Tab.;
Indications: Mild to moderate hyperten-
Primace (Beximco), Tab., 2.5 mg,
sion, congestive heart failure (adjunct); Tk.5.00/Tab.; 5 mg, Tk. 8.00 /Tab.
following myocardial infarction in patie- Protace (UniMed), Tab., 2.5 mg, Tk.5.00/Tab.;
nts with clinical evidence of heart failure; 5 mg, Tk. 8.00/Tab.
prevention of myocardial infarction Racard (Pacific), Tab., 1.25 mg, Tk. 1.88/Tab.;
Cautions: See notes above 2.5 mg, Tk. 3.46/Tab.; 5 mg, Tk. 6.02/Tab.
Contraindications: See notes above Ramace (Opsonin), Tab., 5 mg, Tk. 8.03/Tab.,
1.25 mg, Tk. 2.52/Tab., 2.5 mg, Tk. 5.02/Tab.
Ramicard (Drug Intl), Tab., 1.25mg, Tk.
Side-effects: See notes above; arrhyth- 2.56/Tab., 2.5mg, Tk. 5.05/Tab., 5mg, Tk.
mias, angina, syncope, stomatitis, dry 8.05/Tab.
mouth, erythema multiforme and Ramil(Popular), Tab. , 1.25 mg, Tk. 2.50/Tab.,
pemphigoid exanthema, precipitation or 5.00mg, Tk. 8.03/Tab., 2.5mg, Tk. 5.02/Tab.
exacer-bation or Raynaud’s syndrome, Ramilok (Aristo), Tab., 2.5 mg, Tk.5.00/Tab.;
conjunctivitis, confusion, impotence, 5mg, Tk.8.00/Tab.
Ramilon(Virgo), Tab. , 2.5 mg, Tk. 4.00/Tab., 5
alopecia, bronchitis and muscle crapmps
mg, Tk. 6.00/Tab., 5mg, Tk. 8.05/Tab.
Dose: Hypertension, initially 1.25 mg Ramipro (General), Tab., 2.5mg, Tk. 5.04/Tab.
daily, increased at intervals of 1-2 Ramoril (Incepta), Tab.,1.25 mg, Tk.
weeks; usual 2.5-5 mg once daily; max. 2.50/Tab., 10 mg, Tk. 12.00/Tab., 2.5 mg, Tk.
10 mg daily; for use along with diuretics 5.00/Tab., 5 mg, Tk. 8.00/Tab.
see notes above Rampril (Rangs), Tab., 2.5mg, Tk. 4.00/Tab.;
Heart failure (adjunct), initially 1.25 mg 5 mg, Tk. 6.00/Tab.
once daily under close medical Ripril (Square), Tab., 2.5 mg, Tk. 5.00/Tab., 5
mg, Tk. 8.00/Tab., 1.25 mg, Tk. 2.52/Tab.
supervision, increased if necessary at
131
R-PIL (Biopharma), Tab., 2.5mg , Tk. Proprietary Preparations:

5.02/Tab., 5mg, Tk. 8.03/Tab., 1.25 mg, Tk. Adarbi (NIPRO JMI), Tab., 40 mg, Tk.
3.01/Tab. 12.00/Tab.; 80 mg, Tk. 22.00/Tab.
Tritace (Sanofi), Tab.,2.5mg, Tk. 9.53/Tab., Azisan (Renata), Tab., 40 mg, Tk. 12/Tab.; 80
5mg, Tk. 14.04/Tab. mg, Tk. 22.00/Tab.
Unipril (Acme), Tab.,1.25 mg , Tk. 2.51/Tab.; Tanzil (Drug Intl), Tab., 40 mg, Tk. 12/Tab.
2.5 mg, Tk. 5.03/Tab.; 5 mg, Tk. 8.07/Tab. Zilsart (Acme), Tab., 40 mg, Tk. 12.00/Tab.
Ramipril + Hydrochlorothiazide
CANDESARTAN CILEXETIL
Ramicard Plus (Drug Intl), Tab., 2.5 mg + 12.5
mg, Tk 3.00/Tab.; 5 mg + 25 mg, Tk. 5.00/Tab.
Ramoril Plus (Incepta),Tab.,2.5 mg+12.50mg, Indication: Hypertension
Tk. 5.00/Tab.; 5 mg + 25 mg, Tk. 8.00/Tab. Cautions: See notes above, mild to
Protace H(Unimed), Tab., 2.5 mg + 12.50 mg, moderate hepatic impairment and renal
Tk. 5.00/Tab. impairment
Contraindications: See notes above;
3.2.2 ANGIOTENSIN II RECEPTOR severe hepatic and renal impairment,
ANTAGONISTS (ARB) cholestasis, breast-feeding and
pregnancy
Azilsartan, Losartan, Olmesartan,and Interactions: See Appendix-2
valsartan are specific angiotension-II Side-effects: See notes above;
receptor antagonists; their properties are dizziness, myalgia, headache, nausea,
similar to those of the ACE inhibitors. abdominal pain, back pain, peripheral
Candesartan, Eprosartan, Irbesartan edema, rash and blood disorder
and Telmisartan have been intro-duced Dose: Initial dose is 4mg once daily. A
more recently. However, unlike ACE lower initial dose of 2mg once daily is
inhibitors, they do not cause the suggested for patient with renal
persistent dry cough, which is common impaiment. The dose should be adjusted
with ACE inhibitors. They are useful according to response. The usual
alternatives for patients who have to maintenance dose 4mg once daily with a
discon-tinue an ACE inhibitor beacuse of maximum dose of 16mg once daily
persistent cough.
Cautions: Angiotension-II receptor Proprietary Preparations
antagonists are to be used with caution Giran (Aristo), Tab., 8 mg, Tk. 6.00/Tab.;
16 mg, Tk. 11.00/Tab.
in renal artery stenosis. It is advised that
Candesa (General), Tab., 4 mg, Tk. 3.51/Tab.;
plasma-potassium concentration be 8 mg, Tk. 6.02/Tab.
monitored in the elderly and in patients Vesotan (Rangs), Tab. 16 mg, Tk. 11.00/Tab.;
with renal insufficiency; lower initial 8 mg, Tk. 6.00/Tab.
doses may be suitable in these patients. Candesartan cilexetiL 8 mg +
Anigiotension II receptor antagonists Hydrochlorothiazide 12.50mg ,
should be avoided in pregnancy and Giran (Aristopharma), Tab., Tk. 6.00/Tab.
bilateral renal artery stenosis
Side-effects: Hypotension, hyperkala- IRBESARTAN
emia and angioedema.
Indications: Hypertension, diabetic
AZILSARTAN nephropathy
Cautions: See notes above;
Indication: Hypertnsion alone and in Contraindications: See notes above;
combination with other anti hypertensive breast-feeding and pregnancy
Cautions: See notes above; lactation Interactions: See Appendix-2
Side-effects: See notes above Side-effects: See notes above; diarr-
Dose: 80 mg once daily hoea, dyspepsia, dizziness, myalgia,
asthenia, tinnitus, tachycardia, cough,
rash, urticaria reported
132
Dose: Initially 150mg once daily in LK (Pacific), Tab., 25 mg, Tk. 4.50/Tab. ; 50
hypertension, increased, if necessary, mg, Tk. 8.00/Tab. ; 50 mg, Tk. 8.00/Tab.
300mg once daily Lopo (Biopharma), Tab., 25mg, Tk. 4.50/Tab.;
100mg, Tk. 10.00/Tab.;50mg,Tk. 8.00/Tab.
Lopos (Zenith), Tab., 25 mg, Tk. 3.51/Tab.; 50
Proprietary Preparations mg, Tk. 6.02/Tab.
Arbitan (Opsonin), Tab., 150 mg, Tk. Lopoten (Euro), Tab., 25mg, Tk. 3.5/Tab.;
12.05/Tab.; 75 mg, Tk. 6.02/Tab. 50mg, Tk. 6.00/Tab.
Cavapro (UniMed), Tab., 75 mg, Tk. 6.00/Tab.; Loril (Astra Bio), Tab., 100 mg, Tk. 10.00/Tab.;
150 mg, Tk. 12.00/Tab.; 300 mg, Tk. 25 mg, Tk. 4.50/Tab.; 50 mg, Tk. 6.00/Tab.
24.00/Tab. Losa (Alco), Tab., 25 mg, Tk. 3.51/Tab.; 50
Irbes (Eskayef), Tab., 150 mg, Tk. mg, Tk. 6.02/Tab.
9.00/Tab.;150 mg, Tk. 9.00/Tab.; 75mg, Tk. Losacard (Novo Health), Tab., 50 mg, Tk.
5.00/Tab. 8.00/Tab.; 25 mg, Tk. 4.50/Tab.
Isart (ACI), Tab., 150 mg, Tk. 9.06/Tab. Losacor (Healthcare), Tab., 50mg, Tk.
8.00/Tab.
Irbesartan+ Hydrochlorothiazide Losan (Orion),Tab. 100mg,Tk. 12.04/Tab.;25
Arbitan (Opsonin), Tab., 150 mg+12.5mg , Tk. mg,Tk.4.51/Tab.;50 mg, Tk. 8.02/Tab.
12.05/Tab.; 75 mg+12.50, Tk. 6.03/Tab. Losapot (Somatec), Tab.,50mg,Tk. 8.00/Tab.
Cavazide (UniMed), Tab.,150mg+12.5mg, Tk. Losapress (Benham), Tab., 25 mg, Tk.
12.00/Tab.; 300mg+12.5mg, Tk. 24.00/Tab.; 4.05/Tab.; 50 mg, Tk. 8.00/Tab.
75mg+12.5mg, Tk. 6.00/Tab. Losar (Nipa),Tab.;50 mg,Tk.8.00/Tab.
Losarcar (Medimet), Tab., 50mg, Tk.
LOSARTAN POTASSIUM 6.00/Tab.; 25mg, Tk. 3.50/Tab.
Losardil (Drug Intl), Tab.,25mg,
Losaron (Amico), Tab., 50mg , TK. 5.00/Tab.
Indication: Hypertension Losart (Acme),Tab.; 25 mg.,Tk. 4.51/Tab.;100
Cautions: See notes above; hepatic and mg.,Tk.12.03/Tab.; 50 mg.,Tk.8.03/Tab.
renal impairment Losarva (NIPRO JMI), Tab., 25 mg, Tk.
Contraindications: See notes above; 3.00/Tab.; 50mg, Tk. 4.00/Tab.
pregnancy and breast-feeding Losatan (Popular), Tab. , 50mg, Tk. 8.00/Tab.;
Interactions: See Appendix-2 25mg, Tk. 4.50/Tab.
Losium (Ibn Sina), Tab. , 50mg, Tk. 8.50/Tab.
Side-effects: Diarrhoea, dizziness, taste
Parten (Jayson), Tab., 50mg, Tk. 5.03/Tab.
disturbance, myalgia, migrane, urticaria, Pertilos (Navana), Tab., 50 mg, Tk. 8.03/Tab.
pruritus, rash, altered liver function tests
Dose: Usually 50mg once daily (elderly Losartan Potassium + Hydrochlorothiazide
over 75 years, moderate to severe renal Angilock Plus (Square), Tab., 100 mg + 12.5
impairment, intravascular volume mg, Tk. 12.00/Tab.; 100 mg + 25 mg, Tk.
depletion, initially 25mg once daily); if 12.03/Tab.; 50 mg + 12.5 mg, Tk. 8.03/Tab.
Anreb (General), Tab., 100mg + 12.50mg, Tk.
necessary increase after several weeks
12.04/Tab.; 50mg + 12.50mg, Tk. 8.03/Tab.
to 100mg once daily Araten (UniMed), Tab., 50mg + 12.5mg, Tk.
8.00/Tab.
Proprietary Preparations Arbium (Asiatic), Tab.,100mg + 25mg , Tk.
Angilock (Square), Tab.,50 mg,Tk. 10.00/Tab.; 100mg + 12.50mg , Tk.
8.03/Tab.;100 mg,Tk.12.03/Tab.;25mg, Tk. 10.00/Tab.; 50mg + 12.50mg , Tk. 8.00/Tab.
4.51/Tab. Cardisan (Beacon), Tab., 50mg +12.50mg ,
Anreb (General), Tab.,50mg,Tk. Tk. 8.02/Tab.
8.03/Tab.;25mg,Tk.4.51/Tab. Cardoplus (Eskayef), Tab., 50mg + 12.50 mg,
Araten (UniMed), Tab, 50mg,Tk. 8.00/Tab. Tk. 8.00/Tab.; 50mg+12.50 mg, Tk. 8.00/Tab.;
Arbium (Asiatic),Tab.,100mg ,Tk. 12.00/Tab.; Larb (Opsonin), Tab. ,12.5 mg + 100 mg ,
25mg,Tk.3.50/Tab.;50mg , Tk. 8.00/Tab. Tk. 12.00/Tab. ; 25 mg + 100 mg , Tk.
Cardisan (Beacon),Tab. 50mg ,Tk. 8.02/Tab. 12.00/Tab. ; 12.5 mg + 50 mg , Tk. 8.00/Tab.
Cardon (Eskayef),Tab, 50mg ,Tk. LK (Pacific), Tab., 50 mg+ 12.5 mg, Tk. 8/Tab.
8.00/Tab.;25mg,Tk.4.50/Tab.;50mg,Tk. Lok (Globe),Tab., 50 mg +12.50 mg, Tk.8/Tab.
8.00/Tab.;25mg , Tk. 4.50/Tab. Lopo (Biopharma), Tab., 50mg + 12.500mg,
G-losartan (Gonoshasthaya), Tab., 50 mg, Tk. 8.00/Tab.
Tk.5.00/Tab.; 25 mg, Tk. 3.00 /Tab. Lopos (Zenith), Tab. , 100 mg, +25 mg, Tk.
Larb (Opsonin), Tab.,100 mg , Tk. 12.00/Tab. ; 10.04/Tab.
50 mg , Tk. 8.03/Tab. ; 25 mg , Tk. 4.51/Tab.
133
Losa (Alco), Tab., 50 mg + 12.5 mg, Tk. Dose: Initially 10 mg once daily; if
8.02/Tab. necessary increased to 20 mg once
Losacard (Novo Health), Tab. , 50 mg + 12.5 daily; max. 40 mg daily.
mg, Tk. 8.00/Tab.
Losacor (Healthcare), Tab., 50mg + 12.50 mg,
Reanal impairment-max. 20mg daily if
Tk. 8.00/Tab. eGFR 20-60mL/minutes/1.73m3 ; avoid if
Losan (Orion), Tab.,50mg + 12.50 mg, Tk. eGFR less than 20mL/minutes/1.73m 3
8.02/Tab.
Losapot (Somatec), Tab. , 50 mg +12.50 Proprietary Preparations
mg, Tk. 8.00/Tab.; 100 mg +12.50 mg, Tk. Abetis (ACI), Tab., 10 mg, Tk. 5.04/Tab. ; 20
12.00/Tab. mg, Tk. 8.05/Tab.; 40 mg, TK. 15.11/Tab.
Losardil (Drug Intl), Tab., 25+12.5mg, Tk. Olmecar (Square), Tab. , 20 mg, Tk.
5.05/Tab.; 50 mg+12.5mg, Tk.8.05/Tab.; 8.03/Tab.; 40 mg, Tk. 15.05/Tab.
100+12.50mg, Tk 12.05/Tab.; 100+25mg, Tk. Olmepres (General), Tab. , 20 mg, Tk.
12.05/Tab. 8.00/Tab.; 40 mg, Tk. 15.00/Tab.
Losart (Acme), Tab.,100 mg + 12.50 mg, Tk. Olmesan (Beximco), Tab., 10 mg, Tk.
12.03/Tab.; 100 mg + 25.00 mg, Tk. 5.00/Tab.; 20 mg, Tk. 8.00/Tab.; 40 mg, Tk.
12.03/Tab.; 50 mg + 12.50 mg, Tk. 8.03/Tab. 15.00/Tab.
Losarva (NIPRO JMI), Tab., 50 mg + 12.5 mg, Olmesart (Sharif), Tab. , 40 mg,Tk.
Tk. 6.00/Tab. 15.04/Tab.; 20 mg, Tk. 8.03/Tab.
Losatan (Popular), Tab., 50.00mg + 12.50mg, Olmesta (Eskayef), Tab, 40 mg , Tk.
Tk. 8.00/Tab. 15.00/Tab.; 20 mg, Tk. 8.00/Tab.; 10 mg , Tk.
Losium (Ibn Sina), Tab., 50mg+ 12.5mg, Tk. 5.00/Tab.; 40 mg , Tk. 15.00/Tab.; 20 mg , Tk.
8.50/Tab. 8.00/Tab.; 10 mg , Tk. 5.00/Tab.;
Nusartan (Nuvista), Tab., 50mg + 12.5mg, Tk. Olmetic (Drug Intl), Tab., 20 mg, Tk. 8.05/Tab.
7.50/Tab. Olmevas (Popular), Tab., 10 mg, Tk.
Osartan (Aristo), Tab., 50mg +12.50mg, Tk. 8.03/Tab.; 20 mg, Tk. 8.00/Tab.
8.00/Tab/ Olsart (Opsonin), Tab. , 10 mg, Tk. 5.00/Tab. ;
Osartil (Incepta), Tab., 100 mg + 12.50 mg, 20 mg , Tk. 8.03/Tab. ; 40 mg , Tk. 15.00/Tab.
Tk. 12.00/Tab.; 100 mg + 25 mg, Tk. Orbas (Acme), Tab. , 20 mg. , Tk. 8.03/Tab. ;
12.00/Tab.; 50 mg +12.50 mg, Tk. 8.00/Tab. 40 mg., Tk. 15.04/Tab.
Oscard (Sharif), Tab., 50 mg + 12.5 mg, Tk. Presulock (Aristo), Tab., 20 mg , Tk. 8.00/Tab.
6.01/Tab. Ransys (Healthcare), Tab., 10 mg , Tk.
Parten (Jayson), Tab., 50 mg + 12.5 mg, Tk. 5.00/Tab.; 20 mg , Tk. 8.00/Tab.; 40 mg, Tk.
6.04/Tab. 15.00/Tab.
Pertilos Plus (Navana), Tab., 50 mg + 12.5 Sevitan (Radiant), Tab. , 20 mg , Tk.
mg, Tk. 8.03/Tab. 10.00/Tab.
Precon (Radiant), Tab., 50mg BP + 12.5mg, Tenicar (UniMed), Tab , 40 mg, Tk.
Tk. 10.50/Tab.; 50mg + 12.5mg, Tk. 8.00/Tab. 15.00/Tab.; 20 mg, Tk. 8.00/Tab.
Rosatan (ACI), Tab., 25mg + 12.5mg, Tk. Xyotil (Incepta), Tab., 20 mg, Tk.
4.03/Tab.; 50mg +12.5mg, Tk. 6.04/Tab. 8.00/Tab.; 40 mg, Tk. 15.00/Tab.
OLMESARTAN MEDOXOMIL Olmesartan Medoxomil + Hydrochlorothiazide

Abetis Plus (ACI), Tab., 12.5 mg + 20 mg,
TK. 8.05/Tab.; 12.5 mg + 40 mg, TK.
Indication: Hypertension 15.00/Tab.
Cautions: Hepatic impairment-dose Olmecar (Square), Tab., 12.5 mg + 20 mg,
should not exceed 20mg daily in Tk. 8.03/Tab.; 12.5 mg + 20 mg, Tk.
moderate impairment 8.00/Tab.
Contra-indications: Biliary obstruction, Olmetic -plus (Drug Intl), Tab., 12.5 mg + 20
severe renal impairment mg, Tk. 8.05/Tab.
Olsart (Opsonin), Tab., 12.5 mg + 20 mg, Tk.
Interactions: See Appendix- 2 8.00/Tab.; 12.5 mg + 40 mg, Tk. 15.06/Tab.;
Side-effects: See notes above; also Orbas (Acme), Tab., 12.5 mg + 20 mg, Tk.
gastro-intestinal disturbances, chest 8.03/Tab.
pain, peripheral oedema, hypertrigly- Ransys (Healthcare), Tab., 12.5 mg + 20 mg,
ceridaemia, fatigue, flue like symptoms, Tk. 8.00/Tab.
cough, pharyngitis, urinary tract Sevitan-HTZ (Radiant), Tab., 12.5 mg + 20
infection, haematuria, hyperuricaemia, mg, Tk. 10.50/Tab.
arthritis, myalgia, pruritis, urticaria,
134
Tenizide (UniMed), Tab , 12.5 mg + 20 mg, Proprietary Preparations

Tk. 8.00/Tab. Arovan (Aristo), Cap., 80 mg, Tk. 10.00/Tab.
Xyotil (Incepta), Tab., 12.5 mg + 20 mg, Tk. Cardival (Drug Intl), Tab., 80mg, Tk.
8.00/Tab. 10.05/Tab.
Cardovan (Eskayef), Tab, 160mg. Tk.
TELMISARTAN 16.00/Tab.; 80mg, Tk. 10.00/Tab.;
Diovan (I) (Novartis), Tab., 160 mg, Tk.
74.00/Tab.; 320 mg, Tk. 70.00/Tab.; 40 mg, Tk.
Indication: Hypertension 34.10/Tab.; 80 mg, Tk. 54.00/Tab.
Cautions: See notes above; mild to Disys (Healthcare), Tab., 80 mg,
moderate hepatic impairment and renal Tk.10.00/Tab.; 160 mg, Tk. 18.00/Tab.
impairment Valpress (Silva), Cap., 80mg, Tk. 8.03/Cap.
Valsartil (Incepta), Tab., 160 mg, Tk. 66/Tab.;
40 mg, Tk. 5.00/Tab.; 80 mg, Tk. 9.00/Tab.
biliary obstruction, breast-feeding Valset (Orion), Tab., 80 mg, Tk. 6.04/Tab.
Interactions: See Appendix-2 Valtin (Acme), Tab., 160.00 mg, Tk.
Side-effects: See notes above, 16.04/Tab.; 80.00 mg, Tk. 9.03/Tab.
influenza like symptom, flatulence,
anxiety, vertigo, increased sweating, Valsartan + Hydrochlorothiazide
blood disorder, increase in uric acid Cardival Plus (Drug Intl), Tab., 160 mg +
12.50 mg, Tk. 16.00/Tab.
Dose: Usually 40mg once daily,
Cardovan (Eskayef), Tab, 160 mg + 12.50 mg,
increased if necessary after at least 4 Tk. 16.00/Tab.; 80 mg + 12.50 mg, Tk.
weeks, to max. 80mg once daily 10.00/Tab.;
Co-Diovan (Novartis), Tab. , 80 mg + 12.50
Proprietary Preparations mg, Tk. 48.14/Tab.; 160 mg + 12.50 mg, Tk.
Arbitel (ACI), Tab., 20mg, Tk. 7/Tab.; 40mg, 66.20/Tab.; 160 mg + 25 mg, Tk. 66.20/Tab.
Tk.12.5/Tab.; 80mg, Tk. 20/Tab. Disys (Healthcare), Tab., 80 mg + 12.50 mg,
Telcardis (Unimed), Tab., 40 mg, Tk.10.00/Tab.
Tk.12.50/Tab.; 80 mg, Tk. 20.00/Tab. Valsartil (Incepta), Tab., 160 mg + 12.50 mg,
Mitosan (Novartis), Tab., 40 mg, Tk. 8.00/Tab.; 80 mg +12.50 mg, Tk. 6/Tab.
Tk.13.00/Tab.; 80 mg, Tk. 21.00/Tab. Valzide (Renata), Tab., 160 mg + 25 mg, Tk.
20.00/Tab.; 80 mg + 12.50 mg, Tk. 11/Tab.
Telmisartan + Hydrochlorithiazide
Arbitel (ACI), Tab., 40mg + 12.5mg, Amlodipine + Valsartan
Tk.12.5/Tab.; 80mg +12.5 mg, Tk. 20.00/Tab. Amlosartan (Incepta), Tab., 5 mg +160 mg,
Mitosan Plus (Novartis), Tab., 40 mg + 12.50 Tk. 8.00/Tab.; 5 mg+320 mg, Tk. 9.00/Tab.;
mg, Tk. 13.00/Tab.; 80 mg + 12.50 mg, Tk. 5mg + 80 mg, Tk. 6.00/Tab.
21.00/Tab. Amlovas (Popular), Tab., 5 mg + 80 mg, Tk.
Telcardis Plus (UniMed), Tab., 80 mg + 12.50 9.03/Tab.; 5 mg + 160 mg, Tk. 16.06/Tab.; 5
mg, Tk. 20.00/Tab.;40 mg + 12.50 mg, Tk. mg + 160 mg, Tk. 16.06/Tab.
12.50/Tab. AV (Drug Intl), Tab., 10mg +160mg, Tk.
13.00/Tab.; 5mg +160mg, Tk. 10.00/Tab.; 5 mg
VALSARTAN + 80 mg, Tk. 7.00/Tab.
Avodil VI (Opsonin), Tab., 10 mg + 320 mg,
Tk. 32.00/Tab.
Indications: Hypertension Camoval (Square), Tab., 5 mg + 160 mg, Tk.
Cautions: See notes above; mild to 16.11/Tab.; 5 mg + 80 mg, Tk. 9.06/Tab.
moderate hepatic impairment and renal Co-Disys (Healthcare), Tab., 5 mg + 160 mg,
impairment Tk. 18.00/Tab.; 5 mg + 160 mg, Tk.
18.00/Tab.; 5 mg + 80 mg, Tk. 10.00/Tab.; 5
mg + 80 mg, Tk. 10.00/Tab.
severe hepatic impairment, cirrhosis, Co-Valtin (Acme), Tab.,5 mg + 80 mg, Tk.
biliary obstruction, breast-feeding 9.03/Tab.; 5 mg + 160 mg , Tk. 16.04/Tab.
Interactions: See Appendix-2 Exforge (I)(Novartis), Tab., 10 mg+160 mg, Tk.
Side-effects: See notes above; fatigue, 79.09/Tab.; 5 mg + 80 mg, Tk. 50.50/Tab.; 5
neutropenia reported mg+ 160 mg, Tk. 70.75/Tab.
Dose: usually 80 mg once daily ;(elderly Sacubitril + Valsartan
Arnigen (General), Tab., 97mg + 103mg, Tk.
over 75 years, severe renal impairment,
160.00/Tab.; 49mg + 51mg, Tk. 85.00/Tab.;
initially 40 mg once daily) 24mg + 26mg, Tk. 45.00/Tab.
135
Entresto(I) (Novartis), Tab., 24.3 mg + 25.7 3.2.4 ALPHA ADRENOCEPTOR

mg, Tk. 134.00/Tab.; 48.6 mg + 50.4 mg, Tk.
BLOCKING DRUGS
134.00/Tab.; 97.2 mg + 102.8 mg, Tk.
134.00/Tab.
Sabitar (Incepta), Tab., 24.3 mg + 25.7 mg, Prazosin which has post-synaptic alpha-
Tk. 45.00/Tab. ; 48.6 mg + 50.4 mg, Tk. blocking and vasodilator properties,
80.00/Tab. ; 97.2 mg + 102.8 mg, Tk. causes a rapid reduction in blood
120.00/Tab. pressure after the first dose and should
be prescribed carefully; it rarely causes
3.2.3 RENIN INHIBITORS tachycardia. Doxazosin, indoramin,
and terazosin have properties similar to
Renin inhibitors inhibit renin directly; those of prazosin. Alfuzosin,
renin converts angiotensinogen to Doxazosin, Indoramin, Prazosin,
angiotensin. Tamsulosin and Terazosin are
Aliskiren is the first in the class of renin indicated for benign prostatic
blokers. hyperplasia (see also section 6.4.5).
It may be preferred in renal disease. Phenoxybenzamine a powerful alpha-
Aliskiren also neutralizes any blocker with many side effects can be
compensatory increase in plasma renin used with a beta-blocker for the short-
activity even during combined therapy term management of severe
with a thiazide diuretic, an ACE inhibitor, hypertensive emergencies associated
or ARB with phaeochromocytoma.
Phentolamine is a short-acting alpha-
ALISKIREN blocking drug used on rare occasions for
a suppression test for phaechromo-
Indication: Essential hypertension cytoma.
Cautions: Patients taking concomitant
diuretics, on a low-sodium diet, or who PRAZOSIN
are dehydrated (first doses may cause
hypotension initiate with care); renal Indications: See under dose
artery stenosis, renal impairment; Cautions: First dose may cause
monitor plasma-potassium concentration collapse due to hypotension (therefore
and renal function in diabetes mellitus should be taken on retiring to bed),
and heart failure, pregnancy and breast elderly, renal impairment, hepatic
feeding impairment, pregnancy and breast
Contra-indications: Concomitant use feeding
with ACE inhibitors or ARBs in patients Contraindications: Not recomended for
with diabetes, pregnancy and lactation congestive heart failure due to
Interactions: See Appendix-2 mechanical obstruction (e.g. aoritic
Side-effects: Diarrhea, angioedema stenosis)
acute renal failure (reversible on Interactions: See Appendix-2
discontinuation of treatment), anaemia, Side-effects: Postural hypotension,
and hyperkalaemia also reported drowsiness, weakness, dizziness,
Dose: ADULT over 18 years, 150 mg headache, lack of energy, nausea,
once daily palpitati-ons, leucopenia, hepatitis,
jaundice, urinary incontinence; cases of
Proprietary Preparations priapism and impotence reported
Rasilez(I) (Novartis), Tab. 150 mg, Tk. Dose: Hypertension, 1 mg daily at bed-
62.50/Tab.; Tab., 300 mg, Tk. 78.00/Tab. time ;usual maintenance dose 2-10 mg
daily
Aliskiren + Hydrochlorothiazide
Rasilez HCT(I) (Novartis), Tab., 150 mg + 12.5
mg, Tk. 62.50/Tab. Proprietary Preparations
Alphapress (Renata), Tab, 1 mg, Tk.
4.00/Tab., 2 mg, Tk. 6.00/Tab.
136
G-prazosin (Gonoshasthaya), Tab.,1 mg, Tk. Caution: Concomitant use with ACE
2.00/Tab.; 2 mg, Tk. 3.00/Tab.; 5 mg, Tk. inhibitor, hypotension, dose titration in
7.00/Tab. renal failure patients (eGFR <30
MinipressXL (I) (Pfizer) Tab., 2.5 mg, Tk.
12.71/Tab.; 5 mg, Tk.21.18 Tk. . . .
mL/min/1.73 m2)
Prazolok (Square), Tab., 1 mg, Tk. 4.00/Tab.; Contraindication: Hypersensitivity to
2 mg, Tk. 6.00/Tab. any component, pregnancy,
Prazopress (UniMed), ERTab, 2.5mg, Tk. Concomitant use with ACE inhibitors.
10.00/Tab.; 5mg, Tk.15.00/Tab., 2mg, Tk. History of angioedema related to
6.00/Tab.; 1mg, Tk. 4.00/Tab. previous ACE inhibitor or ARB therapy,
aliskiren in patients with diabetes,
TERAZOSIN severe hepatic impairment
Side Effects: Angioedema,
Indications: Mild to moderate hypotension, impaired renal function,
hypertension; benign prostatic hyperkalemia, Cough
hyperplasia Dose: Starting dose is 49/51 mg
Cautions: First dose may cause (Sacubitril/Valsartan) twice-daily. Double
collapse due to hypotension (within 30- the dose after 2 to 4 weeks to the target
90 minutes, therefore should be taken maintenance dose of 97/103 mg
on retiring to bed) (may also occur with (sacubitril/valsartan) twice-daily, as
rapid dose increase), cataract surgery tolerated by the patient. Reduce the
and breast feeding starting dose to 24/26 mg
Contraindications: History of postural (sacubitril/valsartan) twice-daily for:
hypotension and micturition syncope patients with severe renal impairment
Interactions: See Appendix- 2 (eGFR <30 mL/min/1.73 m2), patients
Side-effects: Drowsiness,postural with moderate hepatic impairment
hypotension, syncope, asthenia,
headache, dry mouth, gastro-intestinal Proprietary Preparations:
Arnigen (General), Tab.; 97mg+103mg,
disturbances, oedema, blurred vision, Tk.160.00/Tab.; 49mg+51mg, Tk. 85.00/Tab.;
intra-operative floppy iris syndrome, 24mg+26mg,Tk.45.00/Tab.
rhinitis, erectile disorders, tachycardia, Entresto (I) (Novartis),Tab.;24.3mg+25.7
and palpitations, rash, pruritus and mg,Tk.134.00/Tab.; 48.6mg+50.4mg,
angioedema; also reported weight gain, Tk.134.00/Tab.;97.2mg+102.8 mg,
dsypnoea, paraesthesia, thrombocy- Tk. 134.00/Tab.
topenia and pain in extremities Sabitar (Incepta), Tab.; 24.3mg+25.7mg,
Tk.45.00/Tab.;48.6 mg + 50.4
Dose: Hypertension, 1 mg at bed time;
mg,Tk.80/Tab.;97.2mg+102.8 mg, Tk.
usual maintenance dose 2–10 mg once 120/Tab.
daily;
Proprietary Preparation 3.2.6 VASODILATOR

Terazon (Incepta), Tab. 2 mg, Tk. 5.00/Tab.; ANTIHYPERTENSIVE
5mg, Tk. 8.00/Tab. DRUGS
Vasodialator, especially when used in
3.2.5 Angiotensin II receptor
combination with beta blocker and a
blocker Neprilysin Inhibitor thiazide may cause rapid fall in blood
(ARNI) pressure precipitating a hypotensive
crisis.
Sacubitril (Neprilysin inhibitor) and Intravenous injection of Diazoxide can
Valsartan be prescribed in hypertensive
Indication: Reduce the risk of emergencies. Hydralazine given by
cardiovascular death and hospitalization mouth is a useful adjunct to other
for heart failure in patients with chronic treatment;
heart failure (NYHA Class II-IV) and Intravenous infusion of Sodium
reduced ejection fraction (LVEF≤35%). nitroprusside is given in hypertensive
137
emergencies on rare occasions when Proprietary Preparation

parenteral treatment is essential. Catapres (Navana), Tab. 0.1mg, Tk.8.03/Tab
Minoxidil should be given when other
antihypertensive drugs have failed to METHYLDOPA [ED]
control severe hypertension; it can
cause tachycardia and fluid retention. Indications: Hypertension, along with
Because of this a beta-blocker and diuretics
frusemide in high dosage must be given Cautions: History of liver impairment;
in combination with this vasodilator. renal impairment; blood counts and liver
Prazosin, Doxazosin and Terasozin (see function tests are advised; history of
section 3.2.3) have alpha-blocking, as depression; positive direct Coombs’ test
well as vasodilator properties. in up to 20% of patients (may affect
blood crossmathcing)
3.2.7 CENTRALLY ACTING ANTI- Note. Drowsiness may affect perform-
HYPERTENSIVE DRUGS ance of skilled tasks (e.g. driving);
Contraindications: Depression, active
Methyldopa which is a centrally acting liver disease, phaeochromocytoma
antihypertensive is safe in pregnancy, in Interactions: See Appendix-2
asthmatics and in heart failure. The daily Side-effects: Dry mouth, stomatitis,
dose is to be kept below 1 g to minimize bradycar-dia, exacerbation of angina,
side-effects. Clonidine has the postural hypotension, sedation, dizzin-
disadvantage that if suddenly withdrawn, ess, myalgia, arthralgia, paraesthesia,
it may cause a hypertensive crisis. nightmares, mild psychosis,
Reserpine is no longer used because of Parkinsonism
adverse side-effects. Moxonidine a Dose: By mouth, Initially 250 mg 2-3
recently introduced centrally acting drug times daily, increased gradually at
may have a role when thiazides, beta- intervals of 2 or more days; max. 2 g
blockers, ACE inhibitors and calcium- daily; ELDERLY initially 125 mg twice
channel blockers are not suitable or daily, increased gradually; max. 2 g daily
have failed to control blood pressure.
Dopamet (Opsonin), Tab., 250 mg, Tk.
CLONIDINE HYDROCHLORIDE
3.08/Tab.
Dopegyt (Ambee), Tab. 250 mg, Tk. 3.09/Tab.
Indications: Hypertension, migraine, Sardopa (Incepta), Tab., 250 mg, Tk.
menopausal flushing 3.080/Tab.; 500 mg, Tk. 5.90/Tab.
Cautions: Must be withdrawn gradually
to avoid severe rebound hypertension; 3.3 NITRATES, CALCUIM-
Raynaud’s syndrome; history of CHANNEL BLOCKERS AND
depression, pregnancy and breast OTHER ANTIANGINAL DRUGS
feeding; Driving-Drowsiness may affect 3.3.1 NITRATES
performance of skilled tasks 3.3.2 CALCIUM-CHANNEL
Contraindications: Hypersensitivity to BLOCKERS
clonidine and avoid intravenous injection 3.3.3 OTHER ANTIANGINAL DRUGS
Interactions: See Appendix- 2 3.3.4 PERIPHERAL AND CEREBRAL
Side-effects: Dry mouth, sedation, VASODILATORS & NEURO-
depression, fluid retention, bradycardia, SENSORY OXYGENATOR
Raynaud’s phenomenon, headache, DRUGS
dizziness, euphoria, nocturnal unrest, 3.3.1 NITRATES
rash, nausea, constipation, impotence
Dose: By mouth, 50–100 micrograms 3
Nitrates as vasodilators play a beneficial
times daily, increased every second or
role in angina. They are potent coronary
third day; usual max. dose 1.2 mg daily
vasodilators, but their main benefit is
138
due to reduction in venous return, which Nitrosol (Beximco), Spray,Tk.225.00/200

reduces left ventricular work. Flushing, Puff,;Tab.,2.6mg, Tk. 5.00/Tab.
headache, and postural hypotension are Nitromint (I) (Egis) Spray, Tk.206.22/Can
Nitrovas (Popular), Oint., 0.4%, Tk.
the main unwanted side-effects of nitrate
130.49/30g,; Tab. , 2.6mg, Tk.4.02/Tab.
preparations. Pactorin (ACI), Spray, 0.40mg/Puff, Tk.
250.00/200 Puff,; Tab., 2.60mg, Tk. 5.00/Tab.
GLYCERYL TRINITRATE [ED] Rectocare (Square), Oint., 0.4%, Tk.
65.45/15gm
Trocer (Incepta), Spray, Tk. 225.00/200 Puff,;
Indications: Prophylaxis and treatment Tab. , 2.6 mg, Tk. 4.00/Tab.
of angina, left ventricular failure Xynocard (White Horse), SR Tab., 2.6 mg, Tk.
Cautions: Severe hepatic or renal 3.00/Tab.
impairment, hypothyroidism, malnutrit-
ion, or hypothermia, recent history of ISOSORBIDE MONONITRATE[ED]
myocardial infarction,
Contraindications: Hypersensitivity to Indications: Prophylaxis of angina,
nitrates, hypotensive conditions and adjunct in congestive heart failure
hypovolaemia, head trauma, cerebral Cautions: See under Glyceryl Trinitrate
haemorrhage, closed angle glaucoma
Contraindications, Side-effect: See
under Glyceryl Trinitrate
Side-effects: Throbbing headache, Interactions: See Appendix-2
flushing, dizziness, postural hypoten-
Side-effects: See under Glyceryl
sion, tachycardia Prolonged
Trinitrate
administration has been associated with
Dose: Initially 20 mg 2-3 times daily or
methaemog-lobinaemia
40 mg twice daily (10 mg twice daily in
Dose: Sublingually, 0.3-1 mg repeated
those who have not previously received
as required
nitrates); up to 120 mg daily in divided
By intravenous infusion, 10-2000
doses if required
micrograms/minut.
Proprietary Preparations A-Card (Acme), Tab., 20 mg, Tk. 1.42/Tab.
Angicard (Drug Intl),Tab.,0.5mg,Tk.3.05/Tab Angifix (Incepta), Tab., 20 mg, Tk. 1.42/Tab
Angist (Acme), Tab.; 2.6mg,Tk.4.03/Tab. Esmo (Square), Tab., 20 mg, Tk. 1.43/Tab.
Anril (Square), Spray, 0.40mg/Puff, Tk. Ism (Aristo), Tab., 20mg, Tk. 1.20/Tab.
216.45/200 Puff,; Tab. , 2.6 mg, Tk. 5.00/Tab.; Moniten (ACI), Tab., 20mg, Tk. 1.42/Tab.
0.5 mg, Tk. 3.01/Tab. ; Inj., 5 mg/ml, Tk. Monocard (Drug Intl), Tab., 20mg, Tk.
75.5/Vial
1.43/Tab.; Cap. , 50mg, Tk. 7.05/Cap.
Glytrin (Novo Health), Cap.; 2.6mg, Tk.
Monotrate (Sun), Tab. 20 mg, Tk. 1.42/Tab.
4.00/Cap.
OD Tab. 50 mg, Tk. 4.13/Tab.
GTN (Eskayef), Tab., 2.6 mg,Tk.5.00/Tab.;
2.6mg,Tk.5.00/Tab.
Nidocard (Drug Intl), Inj. 5mg/ml, Tk. 3.3.2 CALCIUM-CHANNEL
100.30/Amp.; Tab., 2.6mg,Tk.5.00/Tab. ; BLOCKERS
6.4mg,Tk.7.04/Tab.; Tk.250.75/200Puff
Nitrin(Healthcare),Spray,Tk.270.00/200puff,;Ta
These drugs depress the contractility of
b.,2.6mg,Tk. 5.00/Tab.
Nitro (UniMed), Tab., 2.6mg, Tk.4.00/Tab.; myocardium, the formation and
Cap., 2.6 mg,Tk.5.03/Cap. propagation of electrical impulses within
Nitrocard (Aristo), Spray,Tk.250.00/200puff, the heart, and diminish coronary or
Tab., 2.6mg, Tk. 5.00/Tab. systemic vascular tone. Verapamil is a
Nitrocontin (Mundipharma), CR Tab, 2.6 mg, negatively inotropic calcium channel-
Tk. 5.36/Tab.; CR Tab., 6.4 mg, Tk. 8.00/Tab. blocker indicated in angina, hypertension
Nitrodil (Medimet), Cap. 2.6 mg, Tk. 4.65/Cap. and arrhythmias; decreases cardiac
Nitrofix (Opsonin), Tab.;2.6 mg,Tk. 4.00/Tab.
Nitrogina (NIPRO JMI), SR Tab., 50 mg, Tk.
output, slows the heart rate, and impairs
4.00/Tab., atroventricular conduction. It may
precipitate heart failure, and should not
139
be used with beta-blokcers. Constipation Hipre (Pacific),Tab., 5 mg, Tk. 5.00/Tab.;10

is a common side effect. mg, Tk.7.00/Tab.
Locard (Jayson), Tab., 5mg, Tk. 3.05/Tab.
Lodical (Somatec),Tab.,5 mg,Tk. 5.00/Tab.
AMLODIPINE BESYLATE Lodipin (Aristo),Tab.,5 mg , Tk. 5.00/Tab.
Lovapress (NIPRO JMI), Tab., 5mg, Tk.
Indications: Hypertension, prophylaxis 5.00/Tab.
of angina M-Card (Zenith),Tab.,5mg,Tk.4.01/Tab.
Caution: Hepatic impairment Nelod (Kemiko),Tab. 5 mg,Tk.5.02/Tab.
Pristin (Novo Health), Tab.,5 mg, Tk.
Contraindications: Cardiogenic shock, 4.50/Tab.
significant aortic stenosis, pregnancy SB-Amlod (Sunman-Bardem),Tab .5 mg,
and breast-feeding Tk.5.00/Tab.
Interactions: See Appendix-2 Sidopin (Eskayef), Tab., 5 mg,Tk. 5.00/Tab.
Side-effects: Headache, edema, Vasopin (Silva) Tab., 10mg, Tk. 5.01/Tab.;
fatigue, nausea, flushing, dizziness, gum 5mg, Tk. 4.02/Tab.
hyper-plasia, rashes, dry mouth, Virlon (Virgo), Tab.5mg, Tk. 4.00/Tab.
Xelcard (Healthcare), Tab., 10mg,
palpitations, dyspnoea, muscle cramps,
Tk.7.00/Tab.; 5mg, Tk. 5.00/Tab.
myalgia, arthralgia,
Dose: Hypertension or angina, initially Amlodipine + Atenolol
5 mg once daily, max. 10 mg once daily Aloten (Kemiko), Tab., 5mg + 50mg, Tk.
4.51/Tab.
Proprietary Preparations Aloten Forte (Kemiko), 5 mg + 25 mg, Tk.
Amdin (Alco), Tab., 10mg, Tk.6.02/Tab.; 5 mg, 4.24/Tab.
Tk.4.01/Tab. Amdin (Alco), Tab., 5 mg + 50 mg, Tk.
Amdocal (Beximco), Tab., 10mg, Tk. 4.51/Tab.
7.00/Tab.;5mg, Tk.5.00/Tab. Amdocal (Beximco), Tab., 5mg + 25mg, Tk.
Amlocard (Drug Int.),Tab.,10mg,Tk. 7.05/Tab.; 5.25/Tab.; 5mg + 50mg, Tk. 6.00/Tab.
5mg,Tk.4.55/Tab. Amlocard Plus (Drug Intl), Tab., 5mg+25mg,
Amlopin (Acme),Tab.,10mg,Tk. 7.02/Tab.;5.00 Tk. 5.05/Tab.; 5mg+50mg, Tk. 6.05/Tab.
mg.,Tk.5.01/Tab. Amlocom (Beacon), Tab., 50mg +5mg, Tk.
Amlotab (Incepta) Tab., 10 mg, Tk. 7.00/Tab.; 4.52/Tab.
5 mg, Tk. 5.00/Tab. Amloten (Acme), Tab. , 5 mg + 25 mg, Tk.
Amlovas (Popular),Tab.,10mg,Tk. 5.27/Tab.; 5mg + 50 mg., Tk. 6.01/Tab.
6.02/Tab,;5mg,Tk.16.06/Tab. Amlovas (Popular), Tab., 5 mg + 50 mg, Tk.
Amlowide (Beacon),Tab.,5mg,Tk. 3.02/Tab. 6.00/Tab.
Amocal (Opsonin),Tab.5 mg,Tk. 5.00/Tab.;10 Amocal (Opsonin), Tab., 5 mg + 50 mg , Tk.
mg,Tk.6.02/Tab. 6.02/Tab.
Ampress (Benham), Tab., 5 mg, Tk. 5/Tab. Amtenol (Euro), Tab., 5 mg + 50 mg, Tk.
Amtenol (Euro) Tab., 5 mg,Tk. 4.00/Tab. 5.5/Tab.
Cab (ACI),Tab.,5mg,TK.5.02/Tab. Betacal (Orion), Tab., 50 mg + 5 mg, Tk.
Calchek (General),Tab.,5mg,Tk. 5.01/Tab. 6.02/Tab.
Calock (Medimet), Tab., 5mg, Tk. 3.50/Tab.; Calbeta (UniMed), Tab., 5mg+l 50m, Tk.
10mg, Tk. 3.75/Tab. 6.00/Tab.
Calpin (Globe),Tab.,5 mg,Tk.4.50/Tab. Calchek (General), Tab. , 5mg + 50mg, Tk.
Calpress (Asiatic),Tab.,10mg,Tk. 6.02/Tab.
7.00/Tab.;5mg,Tk.5.00/Tab. Calpin (Globe), Tab., 5 mg + 50 mg, Tk.
Calvasc (UniMed), Tab, 10mg, Tk. 8/Tab.; 6.00/Tab.
5mg, Tk.5.00/Tab. Camlodin (Square), Tab., 5 mg + 25 mg, Tk.
Camlodin (Square), Tab.,5 mg,Tk. 5.02/Tab. 5.02/Tab.; 5 mg + 50 mg, Tk. 6.02/Tab.
Cardifort (Nuvista), Tab., 5 mg, Tk. 5.00/Tab. Cardifort (Nuvista), Tab. , 5 mg + 25mg, Tk.
Cardipin (Renata), Tab., 5 mg, Tk. 5.00/Tab. 5.25/Tab.; 5 mg + 50 mg, Tk. 6.00/Tab.
CCB (Orion), Tab, 5 mg, Tk. 3.01/Tab. Cardipin (Renata), Tab., 5mg + 50mg, Tk.
Cvnor (Navana), Tab., 5 mg, Tk. 5.02/Tab. 6.00/Tab.
Dipinol (Supreme),Tab 5mg, Tk. 3.50/Tab. Combicard (Healthcare), Tab., 5 mg + 50 mg,
Diplor (Ibn Sina),Tab.,10 mg,Tk. 7.00/Tab. Tk. 6.00/Tab.
Emlon (Biopharma),Tab., 5mg ,Tk. 5/Tab. Fixocard (Incepta), Tab., 5 mg + 50 mg, Tk.
G-amlo (Gonoshasthaya), Tab., 10 mg, Tk. 6.00/Tab.; 5 mg + 25 mg, Tk. 5.25/Tab.
4.00 /Tab.; 5mg, Tk. 2.50 /Tab.
140
Hipre (Pacific), Tab., 5 mg + 50 mg, Tk. Valdipin (Renata), Tab., 5 mg + 40 mg, Tk.
6.00/Tab. 16.00/Tab.; Tab. , 5 mg + 20 mg, Tk. 9.00/Tab.
Lodical (Somatec), Tab., 50 mg, Tk.6.00/Tab.
Lodicard (Aristo), Tab., 5 mg + 50 mg,, Tk. Amlodipine + Benazepril
6.00/Tab. Amlozep (Beacon), Cap., 5 mg+10mg, Tk.
Pristin-all (Novo Health), Tab., 5 mg + 50 mg, 6.04/Cap.
Tk. 5.00/Tab. Amocal (Opsonin), Cap., 5 mg+10mg, Tk.
Sidoplus (Eskayef), Tab., 5 mg + 50 mg, Tk. 6.02/Cap.
6.00/Tab.;5 mg + 25 mg, Tk. 5.25/Tab. Benadip (Incepta), Cap., 5 mg+10mg, Tk.
Tenocab (ACI), Tab., 5mg +50mg, Tk. 6.00/Cap., 2.5 mg + 10 mg, Tk. 4.00/Tab.; 5
6.02/Tab.; 5mg+25mg, Tk. 5.27/Tab. mg + 20 mg, Tk. 8.00/Tab.
Tenodin (Asiatic), Tab., 5mg + 50mg, Tk. Cacetor (ACI), Cap., 2.5 mg+10mg, Tk.
6.00/Tab.; 5mg + 25mg, Tk. 4.20/Tab. 4.03/Cap.; 5 mg+10 mg, Tk. 6.04/Cap.; 5
Tenopin (Sharif), Tab. , 5 mg + 50 mg, Tk. mg+20 mg, Tk. 8.05/Cap.
4.51/Tab. Camlopril (Square), Cap., 5mg+10 mg, Tk.
Vasopin (Silva), Tab., 5mg + 50mg, Tk. 6.04/Cap.
4.52/Tab. Lodiben (Eskayef), Cap., 5 mg+20mg, Tk.
Cvnor-A (Navana), Tab., 5 mg + 50 mg, Tk. 8.00/Cap.; 2.5 mg + 10mg, Tk. 6.00/Cap.; 5 mg
6.02/Tab. + 10mg, Tk. 4.00/Cap.
Calock Plus (Medimet), Tab. ,5 mg + 50mg,
Tk. 4.50/Tab. CILNIDIPINE
Ampress (Benham), Tab., 5 mg + 50 mg, Tk.
6.00/Tab.
Locard (Jayson), Tab. , 5mg+50mg, Tk. Indications: Hypertension with diabetic
3.02/Tab. nephropathy and hypertriglyceridemia.
Amlodipine + Telmisartan Contraindications and side effects:
Arbitel (ACI), Tab., 5 mg+40 mg, Tk. See notes above
12.50/Tab.; Tab., 5 mg+80 mg, Tk. 18.00/Tab.
Dose: Antihypertensive at doses 10-
Telamlo (UniMed), Tab., 5 mg+40 mg,
Tk.12.50/Tab. 20mg/daily
Amlodipine + Olmesartan Medoxomil Note: Produce less ankle edema
Abecab (ACI), Tab., 5 mg + 20 mg, TK.
10.00/Tab.;5 mg + 40 mg, TK. 15.05/Tab. Proprietary preparations:
Bizoran (Beximco), Tab., 5mg + 40mg, Tk. Cildip (Opsonin), Tab., 10 mg, Tk. 8.00/Tab.; 5
15.00/Tab.; 5mg + 20mg , Tk. 10.00/Tab. mg, Tk. 5.00/Tab.
Calnor (Opsonin), Tab., 5 mg + 20 mg , Tk. Duocard (Acme), Tab., 10 mg, Tk. 9.00/Tab.; 5
8.03/Tab.; 5 mg + 40 mg , Tk. 15.00/Tab. mg, Tk. 7.00/Tab.
Calsart (Globe), Tab. , 5 mg +20 mg, Tk.
8.00/Tab.
DILTIAZEM HYDROCHLORIDE
Camlosart (Square), Tab. , 5 mg + 20 mg, Tk.
10.00/Tab.;5 mg + 40 mg, Tk. 15.05/Tab.
Disartan (Drug Intl), Tab., 5 mg +20 mg, Tk. Indications: Prophylaxis and treatment
5.95/Tab. ; 5 mg + 40 mg, Tk. 12.00/Tab. of angina; hypertension
Duoblock (Aristo), Tab., 5mg + 20 mg, Tk. Cautions: Reduce dose in hepatic and
8.00/Tab. ; 5 mg + 40mg , Tk. 15.00/Tab. renal impairment, heart failure or
Duopres (Incepta), Tab. , 5 mg +20 mg, Tk.
8.00/Tab.; 5 mg + 40 mg, Tk. 14.00/Tab.
singificantly impaired left ventricualr
Duovas (Radiant), Tab. , 5mg + 20mg , Tk. function, bradycardia, first degree AV
10.00/Tab. block or prolonged PR interval
Olmesta (Eskayef), Tab., 5mg + 20 mg, Tk. Contraindications: Severe bradycardia,
8.00/Tab.; left ventricualr failure, second-or third-
Olmevas (Popular), Tab. , 5 mg + 40mg, Tk. degree AV block (unless pacemaker
15.00/Tab.; , 5mg + 20 mg, Tk. 8.00/Tab. fitted) sick sinus syndrome, pergnancy
Olmezest AM (Sun), Tab. 5 mg + 20 mg, Tk.
and breast-feeding
8.50/Tab.
Orbapin (Acme), Tab. , 5 mg + 20.00 mg, Tk. Interactions: See Appendix-2
8.03/Tab.; 5 mg + 40 mg, Tk. 15.00/Tab. Side-effects: Bradycardia, sino-atrial
Ransys (Healthcare), Tab., 5 mg + 20 mg , block, AV block, palpitations,asthenia,
Tk. 8.00/Tab.; 5 mg + 40 mg , Tk. 15.00/Tab. heada-che, hot flushes, gastrointestinal
Tenivasc (UniMed), Tab, 5 mg +20 mg, Tk. disturbances, ankle edema, photosen-
8.00/Tab. sitivity,
141
Dose: Angina, 30 to 60 mg 3 times daily Cautions: Sick sinus syndrom (if

(elderly initially twice daily); increased if pacemaker not fitted) hepatic and renal
necessary max of 360 mg daily impairment, left ventricular dysfunction
Contraindications: Aortic stenosis,
Proprietary Preparations pregnancy and breast-feeding, avoid
Cardil (Ibn Sina), Tab., 30 mg, Tk. 2.25/Tab. within 1 month of myocardial infarction
Cardisef (Supreme), Tab., 30mg, Tkj. unstable angina, uncontrolled heart failur
2.00/Tab.; 60mg, Tk. 3.90/Tab. Interactions: See Appendix-2
Cardizem (Drug Intl), SR Tab., 120mg, Tk.
8.05/Tab. ; 90mg, Tk. 6.05/Tab. ; Tab., 30mg,
Side-effects: Headache, flushing,
Tk. 3.05/Tab.; 60mg, Tk. 5.05/Tab. edema, dizziness, palpitations, rash,
Diltiazem (Albion), Tab., 30 mg, Tk. 2.00/Tab. gum hyperplasia, muscle cramps,
Tab., 60 mg, Tk. 3.80/Tab.; SR Tab., 90 mg, polyuria, chest pain, mood disturbances
Tk. 5.61/Tab. Dose: Initially 10 mg as once daily
Diltizem (Square), SR Tab., 90 mg, Tk. before food, increased if necessary after
5.63/Tab. at least 2 weeks to 20mg daily
LACIDIPINE Proprietary Preparations

Canider (ACI), Tab., 10 mg, Tk. 5.04/Tab.
Indication: Hypertension Larcadip (Incepta), Tab., 10 mg, Tk. 5.00/Tab.
Lotensyl (Sun), Tab., 10 mg, Tk. 5.55/Tab.
Cautions: Cardiac conduction
abnormalities, poor cardiac reserve,
hepatic impairment; withdraw if NIFEDIPINE [ED]
ischaemic pain occurs shortly after
initating treatment or if cardiogenic Indications: Hypertension, prophylaxis
shock develops of angina, Raynaud’s phenomenon
Contraindications: Aortic stenosis, Cautions: Heart failure or singificantly
pregnancy and breast-feeding; avoid impaired left ventricualr function, hepatic
within 1 month of myocardial infarction. impairment, diabetes mellitus;
Interactions: See Appendix-2 pregnancy; breast-feeding
Side-effects: Headache, flushing, Contraindications: Cardiogenic shock,
edema, dizziness, palpitations, gum advanced aortic stenosis; within 1 month
hyperplasia, muscle cramps, polyuria, of myocardial infarction; unstable or
chest pain, mood disturbances acute attacks of angina
Dose: Initially 2 mg as a single daily Interactions: See Appendix-2
dose, preferably in the morning, Side-effects: Headache, flushing,
increased after 3-4 weeks to 4 mg daily, dizziness, tachycardia, palpitation,
then if necessary to 6 mg daily increased frequency of micturition, visual
Proprietary Preparations disturba-nces, gum hyperplasia,
Lacicard (Aristo), Tab., 2 mg, Tk. 4.00/Tab.; 4 paraesthesia, myalgia,
mg, Tk. 6.00/Tab. Dose: Mild to moderate hypertension,
Lacidip (Incepta), Tab., 2 mg, Tk. 4.03/Tab.; 10 to 20 mg twice daily adjusted
4mg, Tk. 6.04/Tab. according to response to 20 mg 3 times
Lacitab (Acme), Tab., 2 mg, Tk. 4.03/Tab.; 4
daily.
mg, Tk. 6.04/Tab.
Laciten (Square), Tab., 4 mg, Tk. 6.04/Tab.;
2mg, Tk. 4.03/Tab. Proprietary Preparations
L-cardin (Drug Int.) Tab., 2 mg, Tk. 4.03/Tab Nidipine SR (Square), SR Tab., 20 mg,
Tk.0.64/Tab.
Nifecap (Drug Intl), Cap., 10 mg, Tk. 2.10/Cap.
LERCANIDIPINE HYDROCHLORIDE Nifedipine (Albion), Tab., 10 mg, Tk.0.34/Tab.
Nifin (Acme), Tab., 10 mg, Tk. 0.34/Tab.
Indications: Mild to moderate essential
hypertension NIMODIPINE
142
Indications: Prevention and treatment Interactions: See Appendix-2

of ischaemic neurological deficits Side-effects: Constipation, less comm-
following aneurysmal subarachnoid only nausea, vomiting, flushing,
haemorrhage headache, dizziness fatigue, ankle
Cautions: Cerebral oedema or severely edema, erythema, pruritus, urticaria,
raised intracranial pressure; angiedema, Stevens-Johnson
hypotension; renal impairment, syndrome, myalgia, arthralgia,
pregnancy and breast feeding. paraesthesia, increased prolactin
Contra-indications: within 1 month of concentration, hypotension, bradycardia,
myocardial infarction; unstable angina; heart block and asystole
acute porphyria Dose: By mouth, supraventricular arrhyt-
Interactions: See Appendix-2 hmias (but see also Contraindications),
Side-effects: Hypotension, variation in 40-120 mg 3 times daily
heart-rate, flushing, headache, nausea, Angina, 80-120 mg times daily
sweating and feeling of warmth, Hypertension, 240-480 mg daily in 2-3
thrombocytopenia divided doses or once daily with
Dose: Prevention, by mouth, 60 mg sustained release preparations
every 4 hours, starting within 4 days of By slow intravenous injection over 2
aneurysmal subarachnoid haemorrhage minutes (3 minutes in elderaly), 5-10 mg
and continued for 21 days. Treatment, (preferrably with ECG monitoring); in
by intravenous infusion via central paroxysmal tachyarrhythmias a further 5
catheter, initially 1 mg/hour (up to 500 mg after 5-10 minutes,every 4-6hr
micrograms/ interval if required
hour if body-weight less than 70 kg or if Note: Verapamil injection has to be
blood pressure unstable), increased given fast, and interval of 30 minutes
after 2 hours to 2 mg/hour if no severe before giving a beta blocker.
fall in blood pressure; continue for at
least 5 days (max. 14 days); if surgical Proprietary Preparations
intervention during treatment, continue Angimil (Medimet), SR Tab., 240mg, Tk.
for at least 5 days after surgery; max. 7.00/Tab.; Tab., 40mg, Tk. 2.25/Tab.; 80mg,
total duration of nimodipine use 21 days Tk. 4.25/Tab.
Veracal (Incepta), Inj., 5 mg/2 ml, Tk.
30.00/Inj.; Tab, 180 mg , Tk. 6.00/Tab., 240
Proprietary Preparations mg, Tk. 7.00/Tab., 80mg, Tk. 3.00/Tab.
Nimocal (Square), Tab.;30 mg,Tk. 5.03/Tab. Veramil (Rangs), SR Tab., 240 mg, Tk.
Nimodi (Eskayef), Tab.,30mg,Tk. 5.00/Tab. 7.00/Tab.; Tab., 80 mg, Tk. 3.00/Tab.
Verapamil (Albion), Tab. 80 mg, Tk. 3.00/Tab
VERAPAMIL HYDROCHLORIDE[ED]
3.3.3 OTHER ANTIANGINAL DRUGS
Indiactions: See under dose and
preparation Nicorandil, a potassium-channel activa-
Cautions: First-degree AV block, acute tor, has both arterial and venous
phase of myocardial infarction (avoid if vasodilating properties and is indicated
bradycardia, hypotension, left ventricular for the prevention and long-term
failure), patients taking beta-blockers, treatment of angina. When added to
hepatic impairment and breast-feeding other antianginal drugs in refractory
Contraindications: Hypotension, brady- unstable angina,
cardia, second and third degree AV Ivabradine selectively inhibits the
block, sick sinus syndrome, cardiogenic pacemaker; reduces cardiac pacemaker
shock, sinoatrial block, history of heart activity, slowing the heart rate and
failure or singificantly impaired left allowing more time for blood to flow to
ventricular function, atrial flutter or the myocardium.
fibrillation compli-cating Wolff-Parkinson- Ranolazine is used as adjunctive
White syndrome, porphyria, patient therapy in patients who are inadequately
recently treated with beta blockers.
143
controlled or intolerant of first line or other arrhythmias (treatment

antianginal drugs. It may be used in ineffective), hypotension, retinitis
combination with amlodipine, beta- pigmentosa; pregnancy and breast-
blockers, or nitrates. feeding
Trimetazidine is a partial inhibitor of Contra-indications: For angina, if heart
fatty acid oxidation without rate below 60 beats per minute; for heart
hemodynamic effects. failure, if heart rate below 70 beats per
minute; unstable or acute heart failure;
NICORANDIL cardiogenic shock; acute myocardial
infarction; unstable angina; immediately
Indications: Prophylaxis and treatment after cerebrovascular accident;sick-sinus
of angina syndrome; sino-atrial block; patients
Cautions: Hypovolaemia, acute pulmo- dependent on pacemaker; second- and
nary edema, acute myocardial infarction third-degree heart block; congenital QT
with acute left ventricular failure, preg- syndrome, hepatic and renal impairment
nancy and breast-feeding Interactions: See Appendix- 2
DRIVING: patients should be warned not Side-effects: Bradycardia, first-degree
to drive or operate machinery until it is heart block, ventricular extrasystoles,
establised that their performance is headache, dizziness, visual
unimpaired disturbances, nausea, palpitations,
Contraindications: Cardiogenic shock, supraventricular extrasystoles,
left ventricular failure with low filling dyspnoea, vertigo, muscle cramps,
pressures, hypotension eosinophilia, hyperuricaemia, and raised
Interactions: See Appendix-2 plasma-creatinine concentration
Side-effects: Headache, flushing, Dose: Initially 5 mg twice daily,
nausea, dizziness, weakness, reduction increased if necessary after 3–4 weeks
in blood pressure and/or increase in to 7.5 mg twice daily (if not tolerated
heart rate; angiedema, hepatic reduce dose to 2.5–5 mg twice daily);
dysfunction also reported ELDERLY initially2.5 mg twice daily
Note. Ventricular rate at rest should not
Dose: Initially 10 mg twice daily (if
be allowed to fall below 50 beats per
susceptible to headache 5 mg twice
minute
daily) usual dose 10-20 mg twice daily,
up to 30 mg twice daily may be used
Corabid (UniMed), Tab , 5mg, Tk. 35/Tab.;
Proprietary Preparations 7.5mg, Tk. 50.00/Tab.
Corangi (UniMed), Tab, 10mg, Tk. 6.00/Tab. Delpino (Healthcare), Tab., 5mg , Tk.
Nicor (Orion), Tab. 10mg, Tk. 6.00/Tab 25.00/Tab.; 7.5mg , Tk. 35.00/Tab.
IVABRADINE Ivanor (Square), Tab. , 7.5 mg, Tk. 35.11/Tab.
; 5 mg, Tk. 25.08/Tab.
Indications: In Chronic stable angina Ivaprex (Incepta), Tab. , 7.5 mg, Tk.
45.00/Tab.; 5 mg, Tk. 30.00/Tab.
pectoris in patients with Ivaten (Drug Intl), Tab., 5mg, Tk. 25.10/Tab. ;
normal sinus rhythm, who have a 7.5mg, Tk. 35.15/Tab.
contraindication to or intolerance to beta
blockers, In chronic heart failure patients
with reduced ejection fraction RANOLAZINE
(LVEF≤35%) with normal sinus rhythm
with resting heart rate ≥ 70 beats/ min Indications: As adjunctive therapy in the
who have a contraindication to or treatment of stable angina in patients
intolerance to beta blockers, inadequately controlled or intolerant of
inappropriate sinus tachycardia first-line antianginal therapies; also in
Cautions: Mild heart failure including atrial fibrillation and SVT
asymptomatic left ventricular Cautions: Moderate to severe
dysfunction; monitor for atrial fibrillation congestive heart failure; QT interval
144
prolongation; elderly; renal impairmen; Cardimet (Eskayef), Tab, 35mg , Tk. 6/Tab.
pregnancy and breast-feeding; renal Feelnor (Incepta),Tab.,35 mg, Tk. 6.00/Tab.
impairment use with caution if eGFR 30– Metacard (Aristo), Tab., 35mg, Tk. 6.00/Tab.
Metavas (NIPRO JMI), MR Tab., 35mg, Tk.
80 mL/minute/ 1.73m 2 ; avoid if eGFR
5.02/Tab.
less than 30 mL /minute/1.73m 2 Metazine (Beximco), Tab., 35mg, Tk. 6/Tab.
Interactions: See Appendix- 2 Trimet (Drug Intl), Tab., 20mg, Tk. 3.05/Tab.,
Side-effects: Flatulence, hot flush, 35mg, Tk. 5.05/Tab.
hypotension, prolonged QT interval, Vastadin (Sharif), Tab., 35 mg, Tk. 5.00/Tab.
peripheral oedema, epistaxis, anxiety, Vestar (Healthcare), Tab., 35mg, Tk. 6/Tab.
anorexia, dysuria, haematuria,
dehydration, pain in extremities, muscle 3.3.4 PERIPHERAL AND CEREBRAL
cramp, joint swelling, visual disturbance, VASODILATORS & NEUROSENSORY
tinnitus, pruritus, sweating, cold OXYGENATOR DRUGS
extremities, disorientation, erectile
dysfunction, parosmia, urticaria, rash Intermittent claudication, a serious
Dose: ADULT over 18 years, initially peripheral vascular complication is due
375 mg twice daily, increased after 2–4 to occlusion of vessels. Cessation of
weeks to 500 mg twice daily and then smoking and exercise are conservative
adjusted according to response to max. measures in the management of
750 mg twice daily (reduce dose to 375– intermittent claudication. Low-dose
500 mg twice daily if not tolerated) aspirin (75-300 mg daily) may be
considered if serum total cholesterol is
Proprietary Preparations elevated. Naftidrofuryl 200 mg 3 times
Ralozine (Incepta), Tab.,500 mg, Tk. daily may improve moderate intermittent
16.00/Tab.
Ranola (General), Tab., 500 mg, Tk.
claudication; but the effect of the drug on
16.05/Tab. the outocme of the disease is uncertain.
Ranolin (Square), Tab., 500 mg, Tk. Patients receiving naftidrofuryl should be
16.05/Tab. assessed for improvement after 3-6
months. Naftidrofuryl may also
TRIMETAZIDINE producesymptomatic improvment
Cilostazole is used in Intermittent
Indication: Angina pectoris claudication to improve walking
Cautions: Pregnancy and breast Nifedipine is useful for reducing the
feeding frequency and severity of vasopastic
Contraindication: Hypersensitivity to attacks.
trimetazidine
Interactions: See Appendix-2 ALMITRINE & RAUBASINE
disturbance, nausea, vertigo Indications: Disorders of memory, lack
Dose: 40 to 60mg given daily by mouth of concentration, hearing loss, dizziness,
in divided doses. 35 mgMR tablet buzzing sounds in the ear
preparations at meal times in the Cautions: Abnormal sensation in the
morning and evening lower limbs, weight loss
Contraindications: Known allergy to
Proprietary Preparations the drug; severe liver disease
Angimet (Orion), Tab., 20 mg, Tk. 3.01/Tab., Side-effects: Nausea, sensations of
35 mg,Tk. 6.00/Tab. heaviness and burning in the stomach,
Anginox (General), Tab., 20mg, Tk. 3.01/Tab., diarrhea, or constipation, agitation,
35mg,Tk. 6.00/Tab.
dizziness; palpitations; sensation of ‘pins
Angirid (Acme), Tab., 35mg, Tk. 5.03/Tab.
Angitrim (Globe), Tab., 35 mg, Tk. 6.00/Tab. and needles’, stinging, weight loss
Angivas (Popular), Tab., 35mg, Tk. 5.00/Tab. Dose: 1 tablet once or twice daily. In
Angivent (Square)Tab., 35mg, Tk. 6.02/Tab. case of missing dose, the next dose at
Antoris (Opsonin), Tab., 35 mg,Tk. 6.02/Tab. the normal time
145

Albasine (Drug Intl), Tab., 30+10mg, Tk. Inosit (ACI),Tab.,500mg,Tk.5.04/Tab. ; 750mg,
12.05/Tab. Tk. 7.55/Tab.
Aruxil (Opsonin), Tab., 30 mg + 10 mg, Tk. Nicosit (Incepta), Tab.,500 mg,
10.00/Tab. Tk. 5.00/Tab.;750 mg,Tk.7.00/Tab.
Duxil (ACI) Tab., 30mg + 10 mg, Tk.
10.05/Tab. OXPENTIFYLLINE / PENTOXIFYLLINE
Truxil (Square) Tab., 30 mg + 10 mg,
Tk.10.03/Tab.
Indication: Peripheral vascular disease
CILOSTAZOL Cautions: Hypotension, coronary artery
disease, renal impairment, severe
hepatic impairment
Indication: Intermittent claudication in
Contraindications: Cerebral haemorr-
patients without rest pain and no
hage, extensive retinal haemorrhage,
peripheral tissue necrosis
acute myocardial infarction, pregnancy
Cautions: Atrial or ventricular ectopy,
and breast-feeding
atrial fibrillation, atrial flutter; diabetes
mellitus (higher risk of intra-ocular
bleeding)
disturbances headache, sleep
disturbances, headache, tachycardia,
Contraindications: Active peptic ulcer,
angina, hypotension, thrombocytopenia,
haemorrhagic stroke in previous 6
intrahepatic cholestasis, hypersen-sitivity
months, surgery in previous 3 months,
reactions.
proliferative diabetic retionpathy, poorly
Dose: 400 mg 2-3 times daily
controlled hypertension
Side-effects: Diarrhoea, headache,
nausea, vomiting, dyspepsia, flatulence, Oxifyl CR (Square), Tab., 400 mg, Tk.
abdominal pain, tachycardia, palpitation, 7.04/Tab.
angina, arrhythmia, dizziness, Trental (Sanofi), Tab., 400 mg, Tk. 15.11/Tab.
ecchymosis, puritus, edema, asthenia
Dose: 100 mg twice daily (30 minutes VINPOCETINE
before or 2 hours after food)
Indications: Acute ischaemic stroke
Proprietary Preparations due to cerebral thrombosis, cerebral
Cilosta (Square),Tab., 100 mg, Tk.12.09/Tab.
Inclaud (ACI), Tab., 100mg, Tk. 10.00/Tab.
embolism; acute circulatory disorder,
Vasocil (Ibn Sina), Tab., 100mg, Tk. hypertensive crisis, the acute cerebro-
12.00/Tab.; 50 mg, Tk.7.00/Tab. vascular disorder, ischemic neurological
deficit, multi infarct dementia, cerebral
INOSITOL NICOTINATE arteriosclerosis, hypertensive
encaphalopathy
Contraindication: Pregnancy
Indications: Peripheral vascular
disease, hyperlipidaemia
Side-effects: Transient hypotension and
Cautions: Cerbrovascular insufficiency
tachycardia
and unstable angina
Dose: 15mg-30mg in divided dose
Contraindications: Recent myocardial
infraction, acute phase of cerbrovascular
accident, pregnancy Avintol (ACI), Tab., 5mg, Tk. 3.00/Tab.
Interactions: See Appendix-2 Camiton (Drug Int), Tab., 5 mg, Tk. 4.05/Tab.
Side-effects: Flushing, dizziness Caviton (Opsonin), Tab., 5 mg , Tk. 3.01/Tab.,
nausea, vomiting Inj., 10mg/2 ml, Tk. 40.12/2ml Vial
Dose: 3g daily in 2-3 divided doses; max Cavinton (I) (Richtor) Tab., 5 mg, Tk.
4g daily 9.78/Tab.,Inj.,10mg/2ml.Tk.53.34/2ml
Cerenin (Ambee), Tab. 5 mg, Tk. 3.55/Tab.
146
Cereton (General), Tab., 5 mg, Tk. intervals of 4-8 hours according to

4.04/Tab.Inj., 10mg/2 ml, Tk. 40.00/2 ml response
Cerevas (Square),Tab., 5 mg, Tk. 4.03/Tab.
Cerivin (Beximco), Tab., 5 mg, Tk. 4.02/Tab.
Cognitol (Sun), Tab., 5 mg, Tk. 4.05/Tab.
Agoxin (Aristo), Tab., 250 mcg, Tk. 1.09/Tab.
Vincet (Eskayef), Tab., 5mg , Tk. 4.00/Tab.,
Centoxin (Opsonin), Tab., 250 mcg, Tk.
Vinsetine (Incepta), Tab., 5 mg, Tk. 4.00/Tab.
1.09/Tab.; Syrup, 250 mcg/5 ml, Tk.
Vinton (Aristo),Tab., 5mg, Tk. 4.00/Tab.
75.28/60ml
Vinpoton (Acme), Tab. , 5mg., Tk. 4.01/Tab.
Digoxen (Drug Int.), Cap. 0.1mg, Tk.0.94/Cap;
0.2mg,Tk.1.34/Cap.
3.4 POSITIVE INOTROPIC DRUGS
3.5 DIURETICS
Cardiac Glycosides, phosphodies-terase
3.5.1 THIAZIDES AND RELATED
inhibitors and sympathomime-tics with
DIURETICS
inotropic activity are positive inotropic
3.5.2 LOOP DIURETICS
drugs.
3.5.3 POTASSIUM-SPARING
DIURETICS
DIGOXIN [ED] 3.5.4 OSMOTIC DIURETICS
3.5.5 CARBONIC ANHYDRASE
Indications: Heart failure, suprarventri- INHIBITORS
cular arrhythmia (particularly in atrial
fibrillation)
3.5.1 THIAZIDES AND RELATED
Cautions: Recent infarction; sick sinus
DIURETICS
syndrome; thyroid disease; elderly,
pregnancy
Contra-indications: Renal impairment, Thiazides and related diuretics are
rapid intravenous administration, heart moderately potent. The onset of action
block, hypokalamia of diuresis of this group starts within 1 to
Side-effects: Usually associated with 2 hours of oral administration and the
excessive dosage; anorexia, nausea, action lasts for 12 to 24 hours. They are
vomiting, headache, fatigue, drowsiness, to be given early in the morning so that
confusion, delirium, hallucination, the diuresis does not interfere with
depression, arrhythmia, heart block, normal sleep pattern.
intestinal ischaemia; gynaecomastia on Bendroflumethiazide (Bendrofluazide),
long-term use; thrombocytopenia a thiazide diuretic is widely used; a low
reported dose of 2.5 mg daily is routinely
Interactions: See Appendix-2 prescribed in the treatment of
Dose: By mouth, rapid digitalization, 1- hypertension. Higher doses of thiazides
1.5 mg in divided doses over 24 hours; cause increased level in plasma uric
less urgent digitalization, 250-500 acid, glucose, and lipids and decreased
micrograms daily (higher dose may be level in plasma potassium. Bendroflu-
divided) methiazide (Bendrofluazide) is randomly
Maintenance, 62.5-500 micrograms daily used for heart failure and for the
(higher dose may be divided) according treatment of mild hypertension or with
to renal function and, in atrial fibrillation, other drugs in severe hypertension.
on heart-rate response; usual range, Chlorthalidone, a thiazide related
125-250 micrograms daily (lower dose compound may be given on alternate
may be appropriate in elderly). day to relieve edema. It is also useful if
Emergency loading dose by intravenous acute retention is liable to be
infusion, total dose of 0.5-1 mg given in precipitated by a more rapid diuresis.
divided doses with about half of the total Other thiazides and related diuretics
dose given over 10-20 minutes, followed (including Benzthiazide, Clopamide,
by further fractions of the total dose Cyclopenthiazide,Hydrochlorothiazide
(also given over 10-20 minutes) at ,Hydroflumethiazide and Polythiazide)
147
are more expensive than the longer

established thiazides, but have no Proprietary Preparations
special advantages. Dihert (Novartis), SR Tab., 1.5 mg,
Metolazone is especially effective when Tk.8.00/Tab.
combined with a loop diuretic; it can be Hypen (Opsonin),Tab.,1.5 mg,Tk. 5.03/Tab.
Idatix (Incepta), SR Tab., 1.5 mg, Tk.5.00/Tab.
given even in renal failure. The patient
Indamid (Sharif), SR Tab., 1.5 mg,
needs to be monitored carefully due to Tk.5.01/Tab.
profound diuresis. Indapa (Drug Intl),SR Tab.,1.5 mg,Tk.
Xipamide and Indapamide are 5.05/Tab.
structurally similar to chlorthalidone. Indelix (Beximco),SR Tab.,1.5 mg,Tk.
Indapamide can cause less metabolic 6.00/Tab.
disturbances, particularly less impair- Indimide (Healthcare), SR Tab., 1.5 mg,
ment of glucose intolerance. Tk.6.50/Tab.
Ipide (Renata), Tab., 1.5 mg, Tk. 5.00/Tab.
Natrilix (ACI),SR Tab.,1.5 mg,Tk. 9.00/Tab.
HYDROCHLOROTHIAZIDE [ED] Repres (Square),SR Tab.,1.5 mg,Tk.
5.03/Tab.
Trilix (Silva),SR Tab.,1.5 mg,Tk. 5.01/Tab.
Indication: Edema, hypertension
Xelix (Aristo),SR Tab.,1.5 mg,Tk. 5.00/Tab.
Cautions: See under benedrofluazide.
Contraindications: See under benedro-
fluazide METOLAZONE
Side-effects: See under benedroflua- Indications: Oedema, hypertension
zide Cautions: Electrolytes should be
Dose: Hypertension, 25 mg daily, monitored, particularly with high doses,
increased to 50 mg daily if necessary long-term use, or in renal impairment;
ELDERLY: in some elderly patients an mayexacerbate diabetes, gout, and
initial dose of 12.5 mg daily may be systemic lupus erythematosus; nephrotic
sufficient syndrome, hyperaldoste-ronism, and
Proprietary Preparations malnourishment; avoid in severe liver
Acuren (Incepta), Tab. 50mg, Tk. 1.00/Tab.; disease, hypokalaemia pregnancy and
25mg, Tk. 0.70/Tab. breast feeding
Hypezide (Pacific), Tab.,50mg, Tk. 1.00/Tab. Contraindications: Refractory
HTZ (UniMed), Tab, 25mg, Tk.0.70/Tab. hypokalaemia, hyponatraemia and
hypercalcaemia, symptomatic
INDAPAMIDE hyperuricaemia and Addison’s disease.
Indication: Essential hypertension Side-effects: Mild gastrointestinal
Cautions: Renal impairment, gout, disturbances, postural hypotension,
hyperparathyroidism (discontinue if altered plasma-lipid concentrations,
hypercalcaema); hyperaldosteronism; metabolic and electrolyte disturbances
pregnancy and breast-feeding including hypokalaemia, hyponatraemia,
Contraindications: Recent cerebrovas- hypomagnesaemia, hypercalcaemia,
cular accident, severe liver disease hyperglycaemia, hypochloraemic
Interactions: See Appendix-2 alkalosis, hyperuricaemia and gout
Side-effects: Hypokalaemia, , dizziness, Dose: Oedema, 5-10 mg daily in the
fatigue, muscular cramps, anorexia, morning, increased if necessary to 20
dyspepsia, rashes, increase in liver mg daily in resistant oedema, max. 80
enzymes, blood disorder, hyponatr- mg daily. Hypertension, initially 5 mg
aemia, metabolic alkalosis, hyperglyce- daily in the morning; maintenance 5 mg
mia, increased plasma urate concentra- on alternate days
tions, paraesthesia, photosensitivity,
impotence, renal impairment Proprietary Preparations
Dose: 2.5 mg daily in the morning
148
Merozolyn (UniMed), Tab., 500 mcg, Contraindications: Precoma state

Tk.5.00/Tab., 5 mg, Tk.25.00/Tab associated with liver cirrhosis and renal
failure with anuria
3.5.2 LOOP DIURETICS Interactions: See Appendix-2
Side-effects: Hyponatraemia,
Loop diuretics are the most efficacious hypokalaemia and hypomagnesa-emia,
oral diuretic agent; useful for the hypoch-loraemic alkalosis, increased
treatment of acute episodes of calcium excretion, hypotension,
pulmonary edema due to left ventricular hyperuricaemia; temporary increase in
failure; plasma cholesterol and triglyceride
concentrations and bone marrow
BUMETANIDE depression, pancreatitis, deafress and
myalgia
Dose : By mouth, edema, initially 40 mg
Indication: Oedema
in the morning; maintenance 20 mg daily
Cautions: Hypovolaemia and
or 40 mg on alternate days, increased in
hypotension should be corrected before
resistant edema to 80 mg daily or 40 mg
initiation of treatment; electrolytes
on alternate days; increased in resistant
should be monitored during treatment;
edema to 80 mg daily or more
can exacerbate diabetes mellitus and
In oliguria, initially 250 mg daily; if
gout and prostate enlargement
necessary larger doses, increasing in
Contra-indications: Severe
steps of 250 mg, may be given every 4-6
hypokalaemia, severe hypona-traemia,
hours to a maximum of a single dose of
anuria, comatose and precomatose
2 g (rarely used)
states associated with liver cirrhosis and
CHILD: 1-3 mg/kg daily, max, 40 mg
in renal failure
daily.
Intercactions: See Appendix-2 By intramuscular injection or slow
Side-effects: See under Furosemide; intravenous injection initially 20-50mg
also gynaecomastia, breast pain, CHILD: 0.5-1.5 mg/kg to a max. daily
musculos-keletal pain dose of 20 mg
Dose: By mouth, 1 mg in the morning, By intravenous infusion (by syringe
repeated after 6–8 hours if necessary; pump if necessary), in oliguria, initially
severe cases, 5 mg daily increased by 5 250 mg over hour (rate not exceeding 4
mg every 12–24 hours according to mg/min). If satisfactory urine output not
response; obtained in the subsequent hour further
By IM injection, 1 mg initially then 500 mg over 2 hours, then if no
adjusted according to response; satisfactory response within subsequent
hour, further 1 g over 4 hours; if no
Proprietary Preparations response obtained dialysis probably
Bumecard (Incepta), Inj., 2 mg/4 ml, Tk.
required; effective dose (up to 1 g) can
30.00/4 ml Vial,; Tab, 1 mg, Tk. 5.00/Tab.; 5
mg, Tk. 8.00/Tab. be repeated every 24 hours
Conart (ACI), Tab., 1 mg, Tk. 5.02/Tab.
Urinide (Navana), Tab., 1 mg, Tk. 10.00/Tab. Proprietary Preparations
Frudema (Pacific), Tab., 40 mg, Tk. 0.53/Tab.
Frunep (UniMed), Tab., 40mg, Tk. 3.20/Tab.
FRUSEMIDE/ FUROSEMIDE[ED] Frusemide (Albion), Tab., 40 mg,
Tk.0.53/Tab.
Indications: Edema, oliguria due to Frusin (Opsonin) Inj. , 20 mg /2 ml, Tk.
renal failure 8.00/2ml amp,; Syrup, 40 mg /5 ml, Tk. 85.32/
Cautions: Pregnancy and breast- 60 ml,; Tab. , 40 mg , Tk. 0.53/Tab.
Fusid (Square), Tab.,40 mg, Tk.
feeding, hypotension, liver failure,
0.64/Tab.;Inj.,20 mg/2 ml, Tk. 8.03/2 ml amp
enlarged prostate; hypovolaemia to be G-Furosemide (Gonoshasthaya), Inj.,
corrected before using in oliguria 20mg/2ml, Tk. 3.00/Amp.; Tab., 40 mg,
Tk.0.50/Tab.
149
Lasix (Sanofi), Tab., 40mg, Tk. 0.64/Tab.; Inj., Cautions: Pregnancy and breast-
20 mg/2 ml, Tk. 8.02/2 ml Amp feeding, monitor in renal impairment
Trofurit (Ambee) , Inj. , 20 mg / 2ml , Tk. 5.53 diabetes mellitus, elderly
/2 ml Amp; Tab., 40 mg , Tk. 0.53/Tab.
Contraindications: Hyperkalaemia,
renal failure
TORASEMIDE Interactions: See Appendix-2
Indications: A loop dueretic edema disturbances, rashes, confusion,
associated with heart failure including postural hypotension, hyperkalaemia,
pulmonary edema with renal and hepatic hyponatraemia
disorder, hypertesion Dose: Used alone, initially 10 mg daily,
Cautions: See under Furosemide, adjusted according to response; max. 20
hepatic impairment, renal inpairment, mg daily
prgnancy, diabetes, gout. With other diuretics, congestive heart
Contra-indications: See under failure and hypertension, initially 5-10
Furosemide mg daily; cirrhosis with ascites, initially 5
Interactions: See Appendix-2 mg daily
Side-effects: See under Furosemide,
also dry mouth, paraesthesia Proprietary Preparation
Dose: edema, uasual dose 5mg once See under hydrochlorothiazaide
daily, increased according to response
to 20mg once daily; usual max.40mg ALDOSTERONE ANTAGONISTS
daily
EPLERENONE (Selective aldosterone
Proprietary Preparations antogonist)
Dilast (Incepta), Tab. 5mg, Tk.8.00/Tab.
Dytor (Unimed), Tab.2.5 mg, Tk. 6.00/Tab.;
Indications: Adjunct in stable patients
5mg, Tk. 11.00/Tab.
Luretic (Drug Int.) Tab. 2.5 mg, Tk. 2.00/Tab.; with left ventricular dysfunction with
5mg, Tk. 3.50/Tab. evidence of heart failure, following
3.5.3 POTASSIUM-SPARING myocardial infarction (start therapy
DIURETICS within 3–14 days of event)
Cautions: Elderly, hepatic impairment-
renal impairment- increased risk of
Triamterene and Amiloride are used in hyperkalaemia—close monitoring
combination with other diuretics for the required; avoid if eGFR less than 50 mL/
treatment of hypertension. They cause minute/ 1.73m2; pregnancy
retention of potassium and are therefore Interactions: See Appendix-2
used as a more convenient alternative to Contra-indications: Hyperkalaemia;
giving potassium supplements along
concomitant use of potassium-sparing
with thiazides or loop diuretics.
diuretics or potassium supplements
Spironolactone is a potassium-sparing
Side-effects: Diarrhea, nausea,
diuretic and a competitive antagonist of
hypotension; dizziness; hyperkalaemia;
aldosterone which is effective in the
rash; flatulence, vomiting, atrial
treatment of the edema due to cirrhosis
fibrillation, postural hypotension, arterial
of liver.
thrombosis, dyslipidaemia, gynaeco-
mastia, pyelonephritis, hyponatraemia,
AMILORIDE HYDROCHLORIDE dehydration, eosinophilia, asthenia, leg
cramps, azotaemia, sweating and
Indications: Edema, potassium pruritus
conservation with thiazide and loop DoseIinitially 25 mg once daily,
diuretics increased within 4 weeks to 50 mg once
daily; CHILD not recommended
150
Proprietary Preparations Fruselac (Aristo), Tab.,20 mg + 50

Aldonist (UniMed), Tab, 50 mg, Tk. mg,Tk.5.00/Tab.
85.00/Tab.; 25 mg, Tk.45.00/Tab. Frusin (Opsonin), Tab., 20 mg + 50 mg, Tk.
Epleron (Incepta), Tab.,25 mg, Tk. 30.00/Tab.; 6.02/Tab.;40 mg + 50 mg, Tk. 8.03/Tab.
50 mg,Tk. 50.00/Tab. Frusiton (Globe), Tab., 20 mg+50 mg, Tk.
6.00/Tab.;40 mg+50 mg, Tk. 8.00/Tab.
Fruspa (Zenith), Tab., 20 mg + 50 mg, Tk.
SPIRONOLACTONE [ED]
6.00/Tab.
Furo (Beacon), Tab., 20mg +50mg, Tk.
Indications: It is used as an adjunct to 6.02/Tab.
other diuretics to reduce the loss of Furotone (Novo Health),Tab.,20
potassium in the management of mg + 50 mg,Tk.6.00/Tab.
refractory edema such as that Fusid (Square),Tab.,20 mg+50 mg,
Tk. 8.03/Tab.; 40 mg + 50 mg, Tk. 10.03/Tab.
associated with ascites in cirrhosis of the
Lacitone (General),Tab.,20 mg+50 mg, Tk.
liver, malignant ascites and nephrotic 6.04/Tab.
syndrome. The drug is also indicated in Lasilactone (Sanofi),Tab.,20 mg+50
congestive heart failure, primary mg, Tk. 6.04/Tab.
hyperaldosteronism Laxur (Healthcare),Tab., 20 mg+50
Cautions: Hepatic and severe renal mg, Tk. 240.00/Tab.
impairment, and electrolytes to be Spirocard (Popular),Tab.,20 mg+50
monitored to prevent hyperkalaemia mg, Tk. 6.02/Tab.
Tonemide (Pacific), Tab.,20 mg+50
Contraindications: Acute renal mg, Tk. 6.00/Tab.
insufficiency, hyperkalaemia, pregnancy Uritone (Renata),Tab. ,20 mg+50 mg, Tk.
and breast-feeding; Addision’s disease; 8.00/Tab.;40 mg + 50 mg , Tk. 10.00/Tab.
the drug should not be given in
combination with another potassium 3.5.4 OSMOTIC DIURETICS
sparing diuretic
Interactions: See Appendix-2 Osmotic diuretics are used to reduce
Side-effects: Diarrhoea, cerebrospinal fluid (CSF) pressure
gynaecomastia, menstrual irregularities, causing cerebral edema; these drugs
hirsutism, lethargy, mental confusion, are filtered at the glomerulous, which do
hyperkal-aemia, hyponatraemia not markedly influence sodium and
Dose: 100-200 mg daily, increased up to chloride excretion. Osmotic diuretics are
400 mg if required. CHILD: initially 3 not used in heart failure as they may
mg/kg daily in divided doses expand the blood volume.
Proprietary Preparations MANNITOL [ED]

Inospiron (Incepta), Tab., 25 mg , Tk.
5.00/Tab.
Spiretic (Drug Intl), Tab., 25 mg, Tk. 5.05/Tab. Indications: Cereberal edema,
Spirocard (Popular), Tab. , 100 mg, Tk. This diuretic is indicated prophylactically
18.07/Tab.; 25 mg, Tk. 5.02/Tab. for acute renal failure in situations
treatment with nephrotoxic injury and
Furosemide + Spironolactone
management of haemolytic transfusion
Dilup (ACI),Tab.,40mg +50mg, Tk.
8.05/Tab.;20mg + 50mg,Tk. 6.04/Tab.
reactions.
Diretic (Drug Intl),Tab.,20 mg+50 mg, Tk. Cautions: Extravasation causes
6.05/Tab.;40 mg + 50 mg, Tk. 8.05/Tab. inflammation and thrombophlehitis
Edeloss (Incepta),Tab. ,20 mg+50 mg, Tk. Contraindications: Congestive cardiac
8.00/Tab.; 40 mg + 50 mg, Tk. 10.00/Tab. failure, pulmonary edema
Edemide (Acme), Tab., 40 mg+50 mg, Tk. Side-effects: Chills, fever, hyperos-
10.03/Tab.;20 mg+50 mg,Tk.8.03/Tab.
molality and hyponatremia may occur
Edenil (Eskayef), Tab, 20 mg + 50 mg, Tk.
8.00/Tab.;40 mg + 50 mg ,Tk. 10.00/Tab. during treatment of renal failure
Frulac (Orion), Tab., 20 mg+50 mg, Tk. Interactions: See Appendix-2
8.03/Tab.; 40 mg + 50 mg, Tk.10.03/Tab. Dose: By intravenous infusion for
diuresis, 50-200 g over 24 hours,
151
preceded by a test dose of 200 mg/kg by accelerated by verapamil with fatal

slow intraven-ous injection; in cerebral consequences.
edema (see notes above) Oral administration of Digoxin is the
Note: 1gm/kg as a20% solution given by treatment of choice in cases of atrial
rapid intravenous infusion fibrillation and atrial flutter. Drugs for
both supraventricular and ventricular
Proprietary Preparations arrhythmias include amio-darone, beta-
Osmosol (Beximco), IV Infusion, 20%, Tk. blockers, disopyramide, flecai-nide,
155.00/500ml procainamide, propafenone and
Acme IV Infusion (Acme), IV Infusion, 20%,
quinidine.
Tk. 155.47/500ml
Manisol (Orion Infusion), I.V. Infusion, 20%, Beta-blockers act as anti-arrhythmic
Tk. 125/500ml drugs principally by attenuating the
Mannisol A(I) (Human Serum Ins), I.V. Infusion effects of the sympathetic system on
10%, Tk.142.64/500ml automatcity and conductivity within the
heart. Intravenous administration of a
3.5.5 CARBONIC ANHYDRASE beta-blocker such as Esmolol or
INHIBITORS Propranolol, can achieve rapid control
of ventricular rate.
Acetazolamide and eye drops of Disopyramide may be given by
Dorzolamide inhibit the formation intravenous injection to control
aqueous humour and are used in arrhythmias after myocardial infarction
glaucoma (see section 10.4.3); also (including those not responding to
used in petit mal epilepsy as an lidocaine but it impairs cardiac
anticonvulsant; in the treatment of contractility. Oral administration of
salicylates or barbiturate poisoning to disopyramide is useful but it has an
alkalinize the urine; side-effects include antimuscarinic effect, which limits its use
drowsiness, paraesthesia, blood in patients with glaucoma or prostatic
dyscrasias and allergic skin rashes. hypertrophy.
Flecanide belongs to the same general
class as lidocaine. It may be of value in
serous symptomatic ventricular arrhyth-
3.6 ANTIARRHYTHMIC DRUGS. mias. It may also be indicated for
junctional re-entry tachycardias and for
paroxysmal atrial fibrillation. As with
Drugs for Supraventricular quinidine it may precipitate serious
arrhythmias include adenosine, cardiac arrhy-thmias in a small minority of
glycosides and verapamil. Adenosine is patients.
usually the treat-ment of choice of Procainamide can be given by
paroxysmal supraven-tricular tachycar- intravenouse injection to control
dia. It has a very short duration of action, ventricular arrhythmias, but prologed
but prolonged in those who are taking oral use can cause a syndrome
dipyridamole. Verapamil is preferred to resembling systemic lupus
adenosine in asthma. Verapamil is very erythematosus.
much effective for supraventricular Propafenone is used for the propylaxis
tachycardia. An initial intravenous dose and treatment of ventricular arrhythmais
may be followed by oral treatment. and also for some supraventricular
Hypotension may occur with larger arrhythmias and It has a complex
doses. It should not be used for mechanism of action, including weak
tachyarrhythmias where the QRS beta-blocking activity (therefore caution
complex is a broad complex. It is also is needed in obstructive airways
contra-indicated in Wolff-Parkinson- diseases; contra-indicated if severe).
White syndrome. It is contraindicated in Quinidine may be effective in supp-
CHILD. Some supra-ventricular ressing supraventricular and ventricular
arrythmias in childhood can be
152
arrhythmais. It may itself precipitate dizziness; dyspnoea; headache; less

rhythm disorders, and is better if used commonly metallic taste; palpitation,
on specialist advice only. It can cause hyperventilation, weakness, blurred
hypersensitivity reactions and gastroin- vision, sweating; very rarely transient
testinal upsets. worsening of intracranial hypertension,
Durgs for ventricular arrhythmias include bronchos-pasm, injection-site reactions;
Bretylium, Lidocaine, Mexiletine and also reported vomiting, syncope,
Phenytoin. Bretylium is only used as an hypotension (discontinue if severe),
antiarrhymic drug in resuscitation; it can cardiac arrest, respiratory failure
cause severe hypotension. Mexiletine (discontinue), and convulsions
may be given as a slow intravenous Dose: By rapid intravenous injection into
injection if lignocaine is ineffective, it has central or large peripheral vein, 6 mg
a similar action. Adverse cardiovascular over 2 seconds with cardiac monitoring;
and central nervous system effects may if necessary followed by 12 mg after 1–2
limit the dose; nausea and vomiting may minutes, and then by 12 mg after a
prevent an effective dose being given by further 1–2 minutes; increments should
mouth. not be given if high level AV block
develops at any particular dose
ADENOSINE Important Patients with a heart
transplant are very sensitive to effects of
adenosine and should receive initial
Indications: Rapid reversion to sinus
dose of 3 mg over 2 seconds, followed if
rhythm of paroxysmal supraventricular
necessary by 6 mg after 1–2 minutes,
tachycardias, including those associated
and then by 12 mg after a further 1–2
with accessory conducting pathways
minutes. Also, if essential to give with
(e.g.Wolff-Parkinson-White syndrome);
dipyridamole reduce adenosine dose to
aid to diagnosis of broad or narrow
a quarter of the usual dose
complex supraventricular tachycardias
Cautions: Monitor ECG and have
resuscitation facilities available; atrial Adecard (Popular) Inj., 6mg/2ml,Tk 150/Amp
fibrillation or flutter with accessory
pathway (conduction down anomalous AMIODARONE
pathway may increase); first-degree AV HYDROCHLORIDE(Broad spectrum action)
block; bundle branch block; left main
coronary artery stenosis; uncorrected Indications: To suppress atrial and
hypovolaemia; stenotic valvular heart ventricular reentrant rhythms and is the
disease; left to right shunt; pericarditis; drug of choice for the treatment of life
pericardial effusion; autonomic threatening ventricular tachycardia
dysfunction; stenotic carotid artery (should be initiated in hospital or under
disease with cerebrovascular specialist supervision)
insufficiency; recent myocardial Cautions: Liver function and thyroid
infarction; heart failure; heart transplant; function tests required before treatment
Contra-indications: Second- or third- and then every 6 month (see notes
degree AV block and sick sinus above for tests of thyroid function); chest
syndrome (unless pacemaker fitted); x-ray required before treatment; heart
long QT syndrome; severe hypotension; failure; renal impairment; elderly; severe
decompensated heart failure; chronic brady-cardia and conduction disturban-
obstructive lung disease (including ces in excessive dosage; intravenous
asthma) and pregnancy use may cause moderate and transient
Interactions: See Appendix-2 fall in blood pressure
Side-effects: Nausea; arrhythmia Contraindications: Sinus bradycardia,
(discontinue if asystole or severe sino-atrial heart block, unless
bradycardia occur), sinus pause, AV pacemaker fitted, avoid in severe
block, flushing, angina (discontinue), conduction disturbances or sinus node
153
disease, history of thyroid dysfunction, glaucoma; hepatic and renal impairment

pregnancy and breast-feeding, avoid (see Appendix-4); pregnancy and breast-
intravenous use in severe respiratory feeding (see Appendix-5 & 6)
failure, circulartory collapse, severe Interactions: See Appendix-2
arterial hypotension Contra-indications: Complete heart
Interactions: See Appendix-2 block or cardiogenic shock and sinus
Side-effects: Accumulation in tissues node dysfuction (unless pacemaker
ceusing extra cardiac adverse effects; fitted)
reversible corneal micro-deposits, Side-effects: Dry mouth, blurred vision,
peripheral neuropathy and myopathy, urinary retaintion; gastrointestinal
phototoxicity, skin disco-loration, irritation other side effects include
hypothyroidism, hyperthyroid-dism, psychosis, cholestatic jaundice,
diffuse pulmonary, alveolitis, hypoglycemia, elevated liver enzyme. It
pneumonitis and fibrosis, janudice, also has cardiac depressant properties
hepatitis and cirrhosis reported, tremor, and may induce cardiac arrhythmias
nightmares, vertigo headache, sleepl- particularly tachycardia and ventricular
esssness, fatigue, alopecia, paraes- fibrillation, heart block, heart failure, and
thesia, benign raised intracranial hypotension (see caution above)
pressure, impotence, epididymoorchitis, Dose: By mouth 300-800mg daily in
ataxia, vasculitis, renal involvement and divided dose.
thrombocytopenia, anaphylaxis on rapid By slow Intravenous injection, 2mg/kg
injection, also bronchospasm or apnoea over at least 5minutes to a max of
Dose: By mouth, 200 mg 3 times daily 150mg,at a rate not exceeding 30 mg
for 1 week reduced to 200 mg twice daily per minute; with ECG monitoring,
for a further week; maintenance, usually followed immediately either by 200mg by
200 mg daily or the minium required to mouth, then 200mg every 8 hours for 24
control the arrhythmia by intravenous hours or 400microgram/kg/hour by
infusion, 5 mg/kg over 20-120 minutes intravenous infusion; max.300mg in first
with EGC monitoring, max.1.2 g in 24 hour and 800mg daily
hours
Doses may need to be reduced to avoid Proprietary Preparation
convulsion, depression of the central Norbit (Incepta), Cap. 100 mg.Tk.8/Cap.
nervous system or depression of the
cardiovascular system LIDOCAINE HYDROCHLORIDE/
LIGNOCAINE HYDROCHLORIDE (ED)
Amidron (ACI), Tab., 100mg , Tk. 5.02/Tab.;
200mg, TK. 10.03/Tab.
Indications: Ventricular arrhythmias,
Cardiron (Drug Int.), Tab., 200mg, Tk. especially after myocardial infarction,
7.05/Tab. complete heart block
Pacet (Beximco), Tab., 100mg, Tk. 5.02/Tab.;
200mg, Tk. 10.04/Tab. Cautions: Congestive cardiac failure, in
hepatic failure and following cardiac
DISOPYRAMIDE [ED] surgery; elderly
Contraindications: Sino-atrial
Indications: Management of disorders, all grades of atrioventricular
supraventricular and ventricular block, severe myocardial depression
arrhythmias. Side-effects: Dizziness, paraesthesia or
Cautions: Discontinue if ventricular drowsiness, confusion, respiratory
tachycardia, ventricular fibrillation, hypo- depression and convulsions;
tension, hypoglycemia develop; atrial hypotension and bradycar-dia (may lead
flutter or tachycardia with partial block, to cardiac arrest)
bundle branch block, heart failure (avoid Dose: By intravenous injection, in
if severe); prostatic enlargment; patients without gross circulatory
154
impairment 100 mg as a bolus over a Dose: Body-weight 70 kg and over,

few minutes (50 mg in lighter patients or initially 150 mg 3 times daily after food
those whose circu-lation is severely under direct hospital supervision with
impaired), followed immediately by ECG monitoring and blood pressure
infusion of 4 mg/minute for 30 minutes; control (if QRS interval prolonged by
2 mg/minute for 2 hours, then 1 more than 20%, reduce dose or
mg/minute; discontinue until ECG returns to normal
If an intravenous infusion is not limits); may be increased at intervals of
immediately available the initial at least 3 days to 300 mg twice daily
intravenous injection of 50-100 mg can and, if necessary, to max. 300 mg 3
be repeated if necessary once or twice times daily; body-weight under 70 kg,
at intervals of not less than 10 minutes reduce dose; ELDERLY may respond to
(see also section 8.2) lower doses

Jasocaine (Jayson), Inj. 4%, Tk. 3.54/2ml Rythmosin (UniMed), Tab. 150mg, Tk.15/Tab.
amp; Inj. 1%,Tk.16.88/50ml; 2%, Tk.
28.65./50ml
3.7 SYMPATHOMIMETICS
3.7.1 INOTROPIC
PROPAFENONE HYDROCHLORIDE
(structully similar to propanol acts like qunidine) SYMPATHOMIMETICS
3.7.2 VASOCONSTRICTOR
SYMPATHOMIMETICS
Indications: Ventricular arrhythmias;
3.7.3 DRUGS USED IN
paroxysmal supraventricular tachy-
CARDIOPULMONARY
arrhythmias which include paroxysmal
RESUSCITATION
atrial flutter or fibrillation and paroxysma
re-entrant tachycardias involving the AV 3.7.1 INOTROPIC
node or accessory pathway, where SYMPATHOMIMETICS
standard therapy ineffective or contra-
indicated
Cautions: Heart failure; elderly; DOBUTAMINE
pacemaker patients; paroxysmal atrial
fibrillation pregnancy, breast-feeding, Indications: Inotropic support in
driving infarction, cardiac surgery, cardiomyopa-
Contra-indications: Congestive heart thies, septic shock and cardiogenic
failure, cardiogenic shock severe shock
bradycardia, electrolyte disturbances, Caution: Severe hypotension compli-
severe obstructive pulmonary disease, cating cardiogenic shock
conduction defects, second degree or Interactions: See Appendix-2
greater AV block, bundle branch block or Side-effects: Tachycardia and marked
distal block increase in systolic blood pressure
Interactions: See Appendix-2 indicate overdosage
Side-effects: QRS prolongation; gastro- Dose: By intravenous infusion, 2.5-10
intestinal disturbances, dry mouth, , micrograms/kg/minute, adjusted accor-
cholestasis, bradycardia, sino-atrial, ding to response
atrioventricular, or intraventricular
blocks, hypotension, syncope, pro- Proprietary Preparations
arhythmic effects; anxiety, restlessness, Dobuject(I) (Bayer) Inj., 250mg/amp,
paraesthesia, fatigue, seizures, Tk.278.49/Vial
extrapyramidal symptoms; impotence, Dobumin (ACI), Inj., 250 mg/20 ml, Tk.
reduced sperm count, blood disorders, 251.69/20ml Vial
lupus syndrome; blurred vision; Dobutin (Incepta), Inj., 250 mg/20 ml, Tk.
hypersensitivity 250.00/20 ml Vial
155
DOPAMINE HYDROCHLORIDE [ED] EPHEDRINE HYDROCHLORIDE[ED]
Indications: Cardiogenic shock in infar- Indications: Reversal of hypotension

ction or cardiac surgery from spinal or epidural anaesthesia
Cautions: Hypovolaemia, low dose in Cautions: Hyperthyroidism, diabetes
shock due to acute myocardial mellitus, ischaemic heart disease,
infarction, see notes above hypertension, angleclosure glaucoma,
Contraindications: Tachyarrhythmia, elderly, pregnancy; may cause acute
pha-eochromocytoma urine retention in prostiatic hypertrophy
Interactions: See Appendix-2 Contraindications: Breast-feeding
Side-effects: Nausea and vomiting, Interactions: See Appendix-2
peripheral vasconstriction, hypoten-sion, Side-effects: Anorexia, tachycardia,
hypertension, tachycardia arrhythmias, anginal pain, vaso-
Dose: By intravenous infusion, 2–5 constriction with hypertension,
micrograms/kg/minute initially, vasodilation with hypotension, dizziness
and flushing, dyspnoea, headache,
Proprietary Preparations anxiety, confusion, psych-oses, tremor,
Cardopa (ACI), Inj., 200mg/5ml,Tk.45.31/5ml urine retention, sweating,
D-Dopamine (Drug Intl), Inj., 200mg/5ml, Tk. hypersalivation;
45.05/5 ml
Dose: Reversal of hypotension from
Dopamin HC(I )(Rotex medica) Inj., ( IV
Infusion), 40 mg/ml,Tk. 63.40/5mlVial spinal or epidural anaesthesia, by slow
Myomine (Incepta), Inj.,(IV Infusion), 40mg/ml, intravenous injection of a solution
Tk. 45.00/5mlVial containing ephedrine hydrochloride 3
mg/ml, 3-6 mg (max. 9 mg) repeated
ISOPRENALINE HYDROCHLORIDE very 3-4 minutes to max. 30 mg. (see
also section 4.7.3)
Indications: Heart block, severe brady-
cardia
Ephedrine hydrochloride 25 mg/5 ml
Cautions: Ischaemic heart disease, Ephidin (Popular), Inj., Tk.12.05/Amp.
diabetes mellitus, hyperthyroidism Epidron (Renata), Inj.,Tk.12.05/Amp.
Interactions: See Appendix-2 Fedrin (Jayson), Inj., Tk.12.06/Amp.
Side-effects: Tachycardia, arrhythmias, G-Ephedrine (Gonoshasthaya), Inj.,
hypotension, sweating, tremor, Tk.12.00/Amp.
headache Nordrine (Incepta), Inj.,Tk.12.00/Amp.
Dose: By intravenous infusion, 0.5-10
NORADRENALINE/NOREPINEPHRINE
micrograms/minute
Indications: See under dose
Generic Preparations Cautions: Coronary, mesenteric, or peripheral
Injection, 0.2%; Tab.30 mg; 20 mg
vascular thrombosis; following myocardial
infarction,
3.7.2 VASOCONSTRICTOR Contra-indications: Hypertension (monitor
SYMPATHOMIMETICS blood pressure and rate of flow frequently)
2Cardiovascularsystem
Pregnancy
Vasoconstrictor sympathomimentics Side-effects: Anorexia, nausea, vomiting,
raise blood pressure transiently by hypoxia, arrhythmias, peripheral ischaemia,
constricting peripheral blood vessels palpitation, hypertension, bradycardia,
acting on alphaadrenergic receptor. tachycardia, dyspnoea, headache, insomnia,
They are sometimes used as an confusion, anxiety, psychosis, weakness,
emergency method of elevating blood tremor, urinary retention, angle-closure
glaucoma
pressure where other measures have
Dose : Acute hypotension, by intravenous
failed. infusion, via central venous catheter, of a
solution containing noradrenaline
156
40micrograms (base)/mL at an initial rate of upper extremity and should be repeated

0.16–0.33mL/minute, adjusted according to every 5 minutes.
response Note 1mg of noradrenaline base is If the peripheral line is used, the drug
equivalent to 2mg of noradrenaline acid
should be used rapidly, then flushed with
tartrate. Dose expressed as the base
20 ml Sodium chloride 0.9% injection
Proprietary Preparations (to expedite entry into the circulation). It
Levofed (Beacon), Inj., 2mg/2ml, Tk. 250.00/2 should not be administered in same IV
ml Amp. line as that use of alkaline solution.
Norline (Radiant), Inj., 2mg/2ml, Tk. 250.00/2 If IV line has not been established, the
ml Amp endotracheal route may be used.
Intracardiac route should be avoided
3.7.3 DRUGS USED IN because it may cause serious
CARDIOPULMONARY complication such as intramyocardial
RESUSCITTATION damage, coronary perforation and
pneumothorax.
Cessation of cardiac function results in Other durgs used in cardiopulmonary
rapid depletion of oxygen in vital organs. resuscitation include Norepinephrine,
After 6 minutes of pulseness, brain Sodium bicarbonate, Atropine and
damage can be expected to occur. For Calcium chloride.
this reason early cardiopulmonary Norepinephrine (see also section 3.7.1)
resucitation (CPR) within 4 minutes and is a potent vesoconstrictor and generally
rapid cardiac life support (ACLS) with produces a rise in blood pressure. Its
attempted defibrillation within 8 minutes disadvantage is renal and mesenteric
are essential for imporving survival and vasoconstriction. It should not be used in
neurological recovery rates. The initial phase of resuscitation
sequence of steps in the performance of Atropine is no longer recommended in
CPR is recommended as the ABC’s: the treatment of asystole or pulse less
Airway, Breathing and Circulation. electrical activity.
The AHA’s (American Heart Association) Calcium chloride (5 to 10 mg/kg)
2000 guideline for CPR and emergency enhances the contractile state of the
cardiac care adopted a new classifi- heart and is indicated in treating severe
cation for therapeutic recommendation. hypotension due to overdose of calcium
Drug Therapy during CPR channel blocker or hyperkalemia. It is
Catecholamines are used in cardiac no longer recommended for use in
arrest to: (1) increase arterial and asystole or electromechanical dissoci-
coronary perfusion during and following ation.
CPR, (2) stimulate contraction during Anti-arrhythmic drugs are used in the
asystole, and (3) act as an ionotropic treatment of various arrhythmias during
agent. cardiac arrest.
Epinephrine increases brain and heart
blood flow by two mechanisms : (1) it ADRENALINE/ EPINEPHRINE [ED]
prevents carotid artery collapse and
raises arterial pressure. During both Indications: See notes above
chest compression and release phase of
Cautions: heart disease, diabetes
chest compression (i.e. systole and
mellitus, hyperthyrodism, hypertension,
diastole). (2) It preferentially reduces
arrhythmias, cerebrovascular disease,
blood flow to the external carotid, renal
angle-closure glaucoma, second stage
and splanchic beds thereby redirecting
of labour
flow toward brain and heart. In cardiac
arrest Adrenaline (epinephrine) 1 in
Side-effects: anxiety, tremor, tachy-
10000 (1 mg per 10 ml) is recommended
cardia, headache, cold extremities; in
in a dose of 10 ml by intravenous
over dosage arrhythmias, cerebral
injection through a central vein or in an
haemorrhage, pulmonary edema;
157
nausea vomiting, sweating, weakness, By subcutaneous or intramuscular

dizziness and hyperglycaemia also injection, 300–600 micrograms 30–60
reported minutes before induction of anaesthesia;
Dose : See notes above Intra-operative bradycardia, by
intravenous injection, 300–600
Proprietary Preparations micrograms (larger doses in
Adrin (Gaco), Inj., 1 mg/ml, Tk. 25/Amp emergencies);
Adrinor (Incepta), Inj.1 mg/ml, Tk. 25.08/Amp. Control of muscarinic side-effects of
neostigmine in reversal of competitive
ATROPINE SULPHATE [ED] neuromuscular block, by intravenous
injection, 0.6–1.2 mg;
Indications:Bradycardia,cardiopulmonar
y resuscitation,premedication, intra- Proprietary Preparations
perative bradycardia; with Atropine (Chemist), Inj., 1mg/ml, Tk. 2.52/1
anticholinesterases for reversal of ml Amp
nondepolarising neuromuscular block; Atropine (Jayson), Inj. 0.6 mg/ml, Tk. 5.60/1
antidote to organophosphorous ml Amp.
G-atropine (Gonoshasthaya), Inj., 0.6 mg/ml,
poisoning; symptomatic relief of gastro- Tk. 5.00 /1 ml Amp
intestinal disorders characterised by
smooth muscle spasm; cycloplegia,
3.8 ANTICOAGULANTS AND
anterior uveitis
Cautions: Should be used with caution in PROTAMINE
children and in the elderly; gastro- 3.8.1 PARENTERAL
oesophageal reflux disease, diarrhoea, ANTICOAGULANTS
ulcerative colitis, autonomic neuropathy, 3.8.2 ORAL ANTICOAGULANTS
acute myocardial infarction, 3.8.3 PROTAMINE SULFATE
hypertension, tachycardia (including
hyperthyroidism, cardiac insufficiency, Anticoagulants are indicated for
cardiac surgery), pyrexia, and in prophylaxis and treatment of deep vein
individuals susceptible to angle-closure thrombosis in the legs; they are also
glaucoma; pregnancy used to prevent thrombi forming on
Contra-indications: Paralytic ileus, prosthetic heart valves. Anticoagulants
pyloric stenosis, toxic megacolon, and prevent the formation of thrombus in the
prostatic enlargement. venous circulation and are not useful for
Interactions: See Appendix-2. preventing thrombus formation in
Side-effects: Constipation, transient arteries.
bradycardia reduced bronchial
secretions, urinary urgency and 3.8.1 PARENTERAL
retention, dilatation of the pupils with ANTICOAGULANTS
loss of accommodation, photophobia,
dry mouth, flushing and dryness of the HEPARIN [ED]
skin. Confusion, giddiness, angle-
closure glaucoma may occur
Dose: Arrhythmias after myocardial Indications: Prophylaxis and treatment
infarction, 500 micrograms of atropine of venous thrombosis and pulmonary
sulfate given intravenously; the dose embolism; treatment of myocardial
may be repeated every 3–5 minutes if infarction and arterial embolism; cerebral
necessary up to a maximum total dose and venous thrombosis; as
of 3 mg. anticoagulant in blood transfusions;
Premedication, by intravenous injection, extracorporeal circulation and dialysis
300–600 micrograms immediately Cautions: Elderly, pregnancy, post
before induction of anaesthesia; surgical patients, advanced hepatic and
renal disease, jaundice, hypersensitivity
158
to heparins; spinal or epidural CHILD: the loading dose to be lower; 15-

anaesthesia 25 units/kg/hour by Intravenous infusion
Interactions: See Appendix-2 NOTE: daily loboratory monitoring of
Contraindications: Haemorrhagic activated partial thorboplasam time
diseases, thrombocytopenia, haemo- (APTT) is essential
philia, subacute bacterial endocarditis,
peptic ulcer, severe hypertension; Proprietary Preparations
patient who has recently undergone G-heparin (Gonoshasthaya), Inj., 5000
surgery at site where hemorrhage is units/ml, Tk. 275.00 /5 ml Vial
Heparin Leo (I) (Leo), Inj., 5000 IU/ml.
special risk
Tk.704.00/5ml Vial
Side-effects: Bleeding, thrombocyto- Heparin(I) (Rotexmedica), Inj., 5000 IU/ml.
penia, hyperkalaemia, transient Tk.325.33/5ml Vial
alopecia, diarrhoea; osteoporosis, Heparon (Beacon), Inj. 5000IU/ml, Tk.
occasionally hypersensitivity reactions 397.72/5 ml Vial
Dose: For the treatment of deepvein Multiparin (I), (CP), Inj. 5000IU/ml, Tk. 300//vial
thrombosis and pulmonary embolism, by
intravenous injection of loading dose of BIVALIRUDIN(direct thrombin inhibitor )
5000 units (10,000 units in severe
pulmonary embolism) followed by Indications: Angina, Unstable angina,
continuous infusion of 1000-2000 undergoing PTCA
units/hour 25 units /kg/hour or by Contraindications: Active bleeding,
subcutaneous injection of15000 units hypersensitivity
every 12 hours (laboratory monitoring Sideeffects: Headache,
essential, preferably on a daily basis, thrombocytopenia, bleeding
and dose adjusted accordingly) Dose: IV bolus of 0.75mg/kg, followed
In unstable angina and in acute by infusion of 1.75mg/kg/hour
peripheral arterial occlusion, intravenous
regimen as for the treatment of deepvein Proprietary Preparation
Biva (Healthcare), Inj., 250mg/vial , Tk.
thrombosis and pulmonary embolism to 10000.00/Vial
be followed.
For acute myocardial infarction or
unstable angina: 5000units intravenous LOW MOLECULAR WEIGHT
bolus, followed by 1000unit/hour in HEPARINS
patients weighing, > 80kg and 800
units/hour in  80kg, maintained for 48 Low molecular weight Heparins are salts
hours or more, with adjustment of fragments of heparin produced by
according to the APTT chemical on enzymatic depolymerisation
Haemodialysis: loading intravenous of the heparin molecule. Common low
dose of 5000 units at the molecular weight heparins are:
commencement of dialysis, followed by Enoxaparin, Dalteparine and
further continuous infusion to be Tinzaparin.
completed 1 hour before completion of Note: Coagulation monitoring is not
dialysis required,
Low dose prophylaxis : In high risk
patients who are undergoing surgery DALTEPARIN SODIUM
intravenous injection or by subcutaneous
injection of 5000 units 8-12 hours before Indication : See under dose
operation, and to be continued post Side effects, Contraindications and
operatively for 7 days until patient is Caution: See under Heparin
mobile to prevent post-operative deep Dose: In unstable angina and Non Q
vein thrombosis or pulmonary embolism; wave myocardial infraction, given
in this regimen laboratory monitoring is subcuta-neously in a dose of 200
not required units/kg 12 hourly for 5-8 days
(max.10,000 units every 12 hours) and
159
low dose aspirin should be given For the treatment of deep vein
concomitantly thrombosis enoxaparin is given
For tratment of deep vein thrombosis subcutaneously in a dose of 1mg (100
and pulmonary embolism, subcutane- units) per kg body weight 12 hourly or
ously, in a dose of 200 units /kg daily for 1.5mg (150 units) per kg once daily for 5
at least 5 days (max 18000 units daily). days or until oral anti-coagUlation is
For prophylaxis of venous thromboem- established.
bolism during surgical procdure, started For the prophylaxis of thrombo-
pre-operatively for patients at moderate embolism in immobilized patients, the
risk, 25,000 units given subcutaneously dose is 40mg (4000 units) once daily for
1 to 2 hours before the procedure, at least 6 days. Treatment should be
followed by 2500units once daily for 5-7 continued (max. 14 days) until patients
days or until the patient is ambulant; for are ambulant.
those at high risk, 2500 units are given 1
to 2 hours before procedure and 8-10 Proprietary Preparations
hours after procedure followed by 5000 Alexa (Healthcare), Inj.,(P.F Syringe), 80
units daily mg/0.80ml , Tk.725.00/Syringe,; 40 mg/0.40ml
For prevention of clotting in the , Tk.425.00/ Syringe,; 60 mg/0.60ml , Tk.
600.00/ Syringe,;
extracorporeal circulation during haemo-
Cardinex (Drug Intl) Inj.,(P.F Syringe),;
dialysis or haemofiltration in adult with 40mg/0.4 ml, Tk. 351.10/ Syringe,;60mg/0.6
chronic renal failuer an intravenous ml, Tk. 526.60/Syringe, 80mg/0.8 ml, Tk.
injection of dalteparin 30 to 40 unit per 577.00/ Syringe
kg followed by an intravenous infusion of Claxo (General), Inj.,(P.F Syringe),,40mg/0.4
10 to 15 unit/kg/hour ml, Tk. 351.06/ Syringe,60mg/0.6 ml, Tk.
Note: long-term use may accumulate in 575.00/Syringe
renel failure,and it has no antidote Claxo (Beximco), Inj., (P.F Syringe),
20mg/0.2ml, Tk. 200.00/ Syringe,40mg/0.4ml,
Tk. 350.00/ Syringe,; 60mg/0.6ml, Tk.
Proprietary Preparations 500.00/Syringe,; 80mg/0.8ml, Tk.
Fragmin(I) (Pfizer), Inj. 5000 IU/0.2 ml, Tk. 550.00/Syringe
337.50/0.2 ml Syringe;7500IU Tk. 631.48/0.3ml Clexane (Sanofi), Inj., (P.F Syringe) 20mg/0.2
Syringe ml, Tk. 270.81/ Syringe,; 40mg/0.4 ml, Tk.
461.38/ Syringe, 60mg/0.6 ml, Tk. 651.95/
ENOXAPARIN SODIUM Syringe, 80mg/0.8 ml, Tk. 802.41/ Syringe,;
Clotinex (Square),Inj.,(P.F Syringe )40
Indications: See under dose
mg/0.4ml, Tk.451.36/ Syringe,60 mg/0.6 ml,
Side-effects; cautions&contra- Tk. 576.73/ Syringe
indications: See under Heparin Enoparin (Popular),Inj., (P.F Syringe),40
Dose: In unstable angina and non Q mg/0.4 ml, Tk. 450.00/ Syringe,;60 mg/0.6 ml,
wave myocardial infarction, given Tk. 500.00/Syringe,; 80 mg/0.8 ml, Tk.
subcutenously in a dose of 1mg (100 550.00/Syringe
units) per kg 12 hourly for 5-8 days; low Eparin (Beacon), Inj., (P.F
Syringe),60mg/0.6ml, Tk. 576.73/ Syringe
dose aspirin should be given Intravas (Aristo), Inj., (P.F Syringe)
concomitantly 80mg/0.8ml, Tk. 550.00/Syringe,; 40mg/0.4ml,
In the prophylaxis of venous thrombosis Tk. 350.00/ Syringe, 60mg/0.6ml, Tk.525.00/
during surgical procedures, given Syringe
subcutaneously; patients with mild to Parinox (Incepta), Inj., (P.F Syringe), 20
moderate risk are given 20mg mg/0.2 ml, Tk. 200/ Syringe,40 mg/0.4 ml, Tk.
(2000units) 2 hours pre-operatively and 450.00/ Syringe,; 60 mg/0.6 ml, Tk. 575.00/
Syringe,; 80 mg/0.8 ml Tk. 650.00/Syringe
then 20mg (2000 units) once daily for 7-
10 days. Patients at high risk are given
40mg (4000 units) 12 hours before
operation and then 40mg (4000 units)
once daily for 7-10 days.
160
3.8.2 ORAL ANTICOAGULANTS Roxarel (Incepta), Tab., 10 mg, Tk. 25/Tab.,

15 mg, Tk. 35.00/Tab., 2.5 mg, Tk. 8.00/Tab.
Varox (Drug Intl), Tab., 2.5mg, Tk. 6.00/Tab.
RIVAROXABAN(Highly selective Xa inhibitor)
DABIGATRAN (directly inhibit thrombin)
Indications: Prophylaxis of
thromboembolism in Nonvalvular Atrial Indications: Atrial fibrillation,
Fibrillation, Prophylaxis of Venous
prophylaxis of deep vein thrombosis, PE
Thromboembolism following Hip/knee
treatment, hip replacement surgery
surgery, Deep vein Thrombosis (DVT),
Cautions, contraindications & side
Reduce risk of recurrent DVT or
effects: See under Rivaroxaban
Pulmonary embolism.
Dose: AF: 20mg, DVT and PE: 15mg,
Cautions: Bleeding disorders;
hip surgery: 10mg daily.
concomitant use of drugs that increase
risk of bleeding;; active or recent gastro-
intestinal ulceration; vascular
Danoxta (UniMed), Cap. 75 mg, Tk.
retinopathy; anaesthesia with 25.00/Cap., 110 mg, Tk. 35.00/Cap.
postoperative indwelling epidural
catheter recent surgery; hepatic WARFARIN[ED]
impairment- ,pregnancy and breast
feeding moderate hepatic and renal
impairment; renal impairment avoid if Indications: Deep vain thrombosis,
eGFR less than 15 mL/minute/1.73m 2; pulmonary embolism, in patient with
pregnancy and breast feeding artial fibrillation, in rheumatic heart
Contra-indications: Active bleeding disease and transisent ischaemic attack.
Interactions: See Appendix-2 Cautions: Hepatic or renal disease,
recent surgery
Side-effects: Nausea; haemorrhage
Contra-indications: Pregnancy, peptic
(see notes above); dyspepsia, dry
mouth, vomiting, hypotension, oedema, ulcer, severe hypertension, bacterial
tachycardia, thrombocythaemia, endocarditis
syncope, dizziness, headache, renal Interactions: See Appendix-2
impairment, pain in extremities, pruritus, Side-effects: Haemorrhage; alopecia,
and rash; jaundice also reported hypersensitivity, hepatic dysfunction,
Dose: DVT prophylaxis: knee rashes
replacement: Adult over 18 years 10mg Dose: ADULT dose is 10 mg daily for 2
PO once daily for 2 weeks starting 6-10 days at the start of treatment. Afterwards
hours after surgery. Hip replacement: the dose is adjusted according to the
adult over 18 years 10mg once daily for prothrombin time; the maintenance dose
5 weeks starting 6-10 hours after is 3 to 9 mg daily
surgery.
DVT or Pulmonary embolism
Farevan (Gaco) Tab., 5 mg, Tk. 3.04/Tab.
treatment: 15 mg PO 12hourly for 21 Warin (Incepta), Tab., 5 mg, Tk. 3.00/Tab.,
days, then 20 mg PO once daily for 6 2mg, Tk. 2.00/Tab.
months.
In Nonvalvular Atrial Fibrillation: 3.8.3 PROTAMINE SULFATE[ED]
20mg PO once daily
Indications: To stop bleeding in case of
Proprietary preparations heparin overdosage
Rivaban (ACI), Tab., 10mg, Tk. 25.00/Tab.,
2.5mg, Tk. 8.00/Tab., 20mg, Tk. 45.00/Tab.
Contraindications: History of allergic
Rivarox (Eskayef), Tab, 10mg, Tk. 25.00/Tab., reactions to protamine insulin; infertility
15mg, Tk. 35.00/Tab., 20mg, Tk. 45.00/Tab., in men; men who have had a vasectomy
2.5mg, Tk. 8.00/Tab. Interactions: See Appendix-2
Rivaxa (Square), Tab., 2.5 mg, Tk. 8.0/Tab.,
10 mg, Tk. 25.00/Tab.
161
Side-effects: Hypersensitivity reactions, with clopidogrel, prasugrel is more

vomiting, dyspnoea, and bradycardia potent, faster in onset, and more
Dose: By intravenous injection for about consistent in inhibiting platelets- but at a
3 minutes, 1 mg neutralizes 80-100 units price of more bleeding.
heparin when given within 15 minutes of Glycoprotein IIb/IIIa inhibitors prevent
heparin; if longer time, less protamine platelet aggregation by blocking the
needed because heparin is rapidly binding of fibrinogen to receptors on
excreted; max. 50 mg platelets. Abciximab is a monoclonal
antibody which binds to glycoprotein
Proprietary Preparations IIb/IIIa receptors and to other related
Prosulf (I) (Wockhardt) Inj., 50mg/Amp, sites; it is licensed as an adjunct to
Tk.140.21/Amp. unfractionated heparin and aspirin for
the prevention of ischaemic
3.9. ANTIPLATELET DRUGS complications in high-risk patients
undergoing percutaneous transluminal
These drugs inhibit thrombus formation coronary intervention. Abciximab should
by decreasing platelet aggregation. be used once only (to avoid additional
Aspirin 75-300 mg daily may be given risk of thrombocytopenia). Eptifibatide
routinely to prevent recurrent attack of andTirofiban also inhibit glycoprotein
thrombotic cerebrovascular or cardiovas- IIb/IIIa receptors; they are licensed for
cular disease. Aspirin 300 mg should be use with unfractionated heparin and
given immediately after the diagnosis of aspirin to prevent early myocardial
ischaemic heart disease. Aspirin infarction in patients with unstable
decreases mortality after myocardial angina or non-ST-segment-elevation
infarction. Low doses of aspirin (75 mg myocardial infarction. Abciximab,
or 100 mg) are to be prescribed Eptifibatide and Tirofiban should be used
following bypass surgery and post by specialists only.
myocardial infarction. Aspirin has also
been used in atrial fibrillation, stable ASPIRIN[ED]
angina and for intermitent claudication.
Ticlopidine inhibits platelet aggregation Indications: Prophylaxis against arterial
and clot retraction; it has currently been thrombotic events including cerebrovas-
used for prevention of thrombosis in cular disease and myocardial infarction
cerebral vascular and coronary heart (see also section 7.5.2.2)
disease. Clopidogrel is an analogue of Cautions: Asthma, uncontrolled hyper-
ticlopidine with similar action and uses. tension, renal and hepatic impairment;
Dipyridamole inhibits embolization from pregnancy
prosthetic heart valves in combination Contraindications: Active peptic ulcer;
with warfarin, and reduces thrombosis in haemophlia, gout, asthma or history of
patients with thrombotic disease. bronchospasm, children below 12 years
Ticlopidine is limited by the need to and in breast-feeding
take the drug twice daily, by poor Interactions: See Appendix-2
tolerability, notably gastrointestinal Side-effects: Bronchospasm, gastro-
distress, but most important by severe intestinal bleeding, Rey’s syndrome
side effects, including bone marrow Dose: See notes above
aplasia. The antiplatelet effects of Proprietary Preparations
clopidogrel have a delayed onset See section 7.5.2.2
(several hours after ingestion), and there
is substantial variability in response CLOPIDOGREL[ED]
among patients. Prasugrel is a novel
Indications: Myocardial infarction,
third- generation thienopyridine that
ischaemic stroke, or established periph-
irreversibly inhibits the P2Y12 receptor at
eral arterial disease
the same site as clopidogrel. Compared
162
Cautions: See under Ticlopidine Clontas (Opsonin), Tab., Tk. 12.00/Tab.

Contraindications: Presence of active Clopicard Plus (Veritas), Tab.,Tk.12.00/Tab.
Clopid-AS (Drug Intl), Tab., Tk. 12.05/Tab.
bleeding and hypersensitivity to the drug
Clopidol Plus (Alco), Tab., Tk. 12.04/Tab.
Interactions: See Appendix-2 Clopigel Plus (Pacific), Tab., Tk. 10.00/Tab.
Side-effects: See under Ticlopidine. Clopilet A (Sun), Tab., Tk.11.00/Tab.
The incidence of blood dyscrasia Clopivas (Novo), Tab., Tk. 11.00/Tab.
(neutropenia) is reported to be lower with Clorel-A (ACI), Tab., Tk. 12.04/Tab.
Clopidogrel. Combiplat (Beacon), Tab., Tk. 11.07/Tab.
Dose: By mouth 75 mg once daily with Dogrel Plus (Astra), Tab., Tk. 11.00/Tab.
or without fail. In acute coronary Dorel Plus (General), Tab., Tk. 12.00/Tab.
Ecosprin Plus (Acme), Tab., Tk. 12.00/Tab.
syndromes, initial dose is 300 mg and
G-Co-aspirin (Gonoshasthaya), Tab., Tk. 5.00
then 75 mg once daily. In coronary /Tab.
stenting, the combination of clopidogrel Lirel (Silva), Tab., Tk. 11.04/Tab.
with aspirin is as effective as ticlopidine Lopirel (Incepta), Tab., Tk. 12.00/Tab.
with aspirin, except that non cardiac Loplate Plus (Kemiko), Tab., Tk.11.00/Tab.
events are better reduced by clopidogrel Navix Plus (Navana), Tab., Tk. 12.08/Tab.
Noclog (Eskayef), Tab., Tk. 12.00/Tab.;
Proprietary Preparations Odrel (Beximco), Tab., Tk. 12.00/Tab.
Anclog (Square), Tab., 75 mg, Tk. 12.03/Tab. Pladex-A (UniMed), Tab., Tk. 12.50/Tab.
Anlet (Globe), Tab., 75 mg, Tk. 11.00/Tab. Plagrin Plus (Renata), Tab., Tk. 12.00/Tab.
AP (Sharif), Tab., 75 mg, Tk. 10.03/Tab. Plavix-Plus (Navana), Tab., Tk.12.05/Tab.
Asclop (Biopharma), Tab., 75 mg, Tk. Preclot AS (Popular), Tab., Tk.12.00/Tab.
12.50/Tab. Replet Plus (Healthcare), Tab., Tk. 11.0/Tab.
Clogfree (Asiatic), Tab., 75 mg, Tk. 12.0/Tab. Zesprin (Zenith), Tab., Tk. 11.00/Tab.
Clognil (Orion), Tab. 75 mg, Tk. 12.00/Tab.
Clont (Opsonin), Tab., 75 mg, Tk. 12.03/Tab. DIPYRIDAMOLE
Clopid (Drug Intl), Tab., 75mg,Tk. 12.05/Tab.
Clopidol (Alco), Tab. , 75 mg, Tk. 10.03/Tab.
Clopigel (Pacific), Tab., 75 mg, Tk. 9.10/Tab. Indications: See notes above
Clopirel (Novo Healthcare), Tab., 75 mg, Tk. Cautions: Recent myocardial infarction,
10.00/Tab. severe angina and heart failure
Cloplet (Nuvista), Tab., 75 mg, Tk. 12.00/Tab. Side-effects: Throbbing headache,
Clorel (ACI), Tab., 75mg, Tk. 12.04/Tab. increasing bleeding during or after
Dclot (Acme), Tab. , 75.00 mg, Tk. 11.00/Tab. surgery, hot flushes, tachycardia and
Dogrel (Astra Bio), Tab., 75 mg, Tk. 10.00 gastro-intestinal effects
/Tab.
Dorel (General), Tab., 75mg, Tk. 10.07/Tab.
Lirel (Silva), Tab., 75mg, Tk. 10.04/Tab. Dose: By mouth 300-600 mg daily in 3-4
Lopirel (Incepta), Tab., 75mg, Tk. 12.00/Tab. divided doses before food
Loplate (Kemiko), Tab., 75 mg, Tk. 10/Tab. By Intravenous injection, for diagnostic
Navix (Navana), Clopidogrel 75 mg, Tab., 75 use only
mg, Tk. 11.00/Tab.
Noclog (Eskayef), Tab., 75mg, Tk. 12.0/Tab. Proprietary Preparation
Odrel (Beximco), Tab., 75mg, Tk. 12.00/Tab. Santinal MR (UniMed), Tab. 200mg,
Pidogrel (Radiant), Tab., 75mg, Tk. 15/Tab. Tk.10.00/Tab.
Pladex (UniMed), Tab, 75mg, Tk. 12.00/Tab.
Plagrin (Renata), Tab., 75mg, Tk. 11.00/Tab.
Preclot (Popular), Tab., 75mg, Tk. 12.0/Tab. EPTIFIBATIDE
Replet (Healthcare), Tab., 75mg,Tk. 12/Tab.
Indications: Coronary angioplasty, non-
Clopidogrel 75mg + Aspirin 75mg
Anclog (Square), Tab., Tk. 12.03/Tab. ST-segment elevation myocardial
Anlet (Globe), Tab., Tk. 12.00/Tab. infarction
Asclop (Biopharma), Tab., Tk.12.50/Tab. Cautions: Measure baseline
Aspin Plus (Aristo), Tab., Tk. 11.00/Tab. prothrombin time, activated partial
Aspirel (Ibn Sina), Tab., Tk. 360.00/Tab. thromboplastin time, platelet count,
Clas (Delta), Tab., Tk. 8.00/Tab. haemoglobin, haematocrit and platelets
Clognil (Orion), Tab., Tk. 12.04/Tab. within 6 hours after start of treatment
163
then at least once daily; discontinue if Side-effects: Haemorrhage (including

thrombolytic therapy, intra-aortic balloon gastro-intestinal and intracranial),
pump , hepatic impairment ,renal haematoma, haematuria, anaemia, rash
impairment; reduce infusion to 1 Dose: Acute coronary syndrome
microgram/kg/minute ;avoid if eGFR less :loading dose 60mg,then 10mg/day if
than 30 mL/minute/1.73m2; pregnancy body weight over 60kg or 5mg /day if
and breast-feeding body weght under 60kg or age over 75
Contra-indications: Abnormal bleeding years.
within 30 days, major surgery or severe
trauma within 6 weeks, stroke within last Proprietary Preparations
30 days or any history of haemorrhagic Apagrel(Healthcare), Tab., 10mg , Tk.
stroke, intracranial disease (aneurysm, 20.00/Tab., 5mg , Tk. 12.00/Tab.
neoplasm or arteriovenous Appras(UniMed), Tab, 10mg, Tk. 25.00/Tab.,
malformation), severe hypertension, 5mg, Tk. 14.00/Tab.
Asurel (Navana), Tab., 5 mg, Tk.20.00/Tab.;
haemorrhagic diathesis, increased Efigrel(Square), Tab. , 10 mg, Tk. 20.06/Tab.
prothrombin time or INR, Efirel (Opsonin), Tab. , 10 mg, Tk. 20.00/Tab.,
thrombocytopenia, significant hepatic 5 mg , Tk. 12.00/Tab.
impairment; if serum creatinine > 4 Hemagrel (ACI), Tab., 10mg, Tk. 20.06/Tab.,
mg/dl. 5mg, Tk. 12.04/Tab.
Interactions: See Appendix-2 .Opagrel(Orion), Tab. , 5 mg, Tk. 8.02/Tab.,
Side-effects: Bleeding manifestations; 10 mg, Tk. 15.04/Tab.
Prapid(Drug Intl), Tab., 10mg, Tk. 20.10/Tab.,
anaphylaxis and rash
5mg, Tk. 12.05/Tab.
Dose: Initially by intravenous injection, Prasugen (Acme), Tab, 10 mg , Tk.
180 micrograms/kg, then by intravenous 20.07/Tab., 5 mg , Tk. 12.03/Tab.
infusion, 2 micrograms/kg/minute for up Prasulet(Beacon), Tab, 10mg , Tk. 20.06/Tab.,
to 72 hours (up to 96 hours) if 5mg , Tk. 12.04/Tab.
percutaneous coronary intervention Prasurel (Incepta), Tab., 10mg, Tk.
during treatment 20.00/Tab., 5 mg, Tk. 12.00/Tab.
Prasuva (Beximco), Tab., 5 mg, Tk.12.0/Tab.
Integril (Incepta), Inj., 2 mg/ml, Tk. TICLOPIDINE HYDROCHLORIDE
3000.00/10ml vial; 75 mg/100 ml, Tk.
9000.00/100 ml Vial Indications: It has currently been used
for preventation of thrombosis in
PRASUGREL cereberal vascular and coronary heart
disease
Indications: Prevention of atherothrom- Cautions: Renal impairment, hepatic
botic events in patients with ACS impairment; there is an increased risk of
undergoing primary or delayed coronary bleeding due to concomitant adminis-
angioplasty tration of other drugs; to be withdrawn
Cautions: Recent trauma, surgery, immediately if there is serious bleeding
gastro-intestinal bleeding, or active Interactions: See Appendix-2
peptic ulcer disease, concomitant use of Side-effects: Bleeding, nausea, diarrh-
drugs that increase risk of bleeding; oea, severe neutropenia
discontinue at least 7 days before Dose: 250mg twice daily
elective surgery if antiplatelet effect not
desirable; Generic Preparation
Contra-indications: Active pathological Tablet, 250mg
bleeding, history of stroke or transient
ischaemic attack, severe hepatic TICAGRELOR (interact with platelet P2Y12 ADP
impairment and hypersensitivity to drug receptor, prevent platelate activation)
Interactions: See Appendix -2 Indications: Acute coronary syndrome
in combination with aspirin
164
Side-effects: Allergic reaction, cough, (Arteriovenous malformation) , known

headache, malignant intracranial malformation,
Cautions, contraindications: See Active bleeding or bleeding
notes above disorder(except menstruation), GI
Dose: As loading dose 180mg, then 90 bleeding within the past month, recent
mg twice daily. major trauma/surgery/ head injury (within
preceding month), aortic dissection,
Proprietary preparations Non-compressible puncture within last
Acora (ACI), Tab., 90mg, TK. 75.00/Tab. 24 hours( liver biopsy, lumber puncture).
Brilinta (Ziska), Tab., 90 mg, Tk. 480.00/Tab. For streptokinase, prior treatment within
Ticacard (Aristo), Tab., 90mg, Tk. 75.00/Tab. the previous 6 months.
Ticalog (Square),Tab., 90 mg, Tk.75.00/Tab. Prolonged persistence of antibodies to
Ticarel (Incepta), Tab., 90mg, Tk. 75.00/Tab. streptokinase and anistreplase (no
Tigarol (Drug Intl),Tab., 90mg, Tk.75.00/Tab.
longer available) can reduce the
effectiveness of subsequent treatment;
3.10 FIBRINOLYTIC DRUGS therefore, streptokinase should not be
used again beyond 4 days of first
Fibrinolytic drugs act as thrombolytics by administration of either streptokinase or
activating plasminogen to form plasmin, anistreplase.
which degrades fibrin and so breaks up previous allergic reactions to either
thrombi.Fibrinolytic agents, sometimes streptokinase or anistreplase (no longer
referred as plasminogen activators, are available).
divided in to 2 categories: Hepatic impairment Thrombolytic drugs
Fibrin-specific agents: Alteplase, should be avoided in severe hepatic
Reteplase, Tenecteplase, Urokinase. impairment as there is an increased risk
Non fibrin specific agents: of bleeding.
Streptokinase, Anistreplase. Pregnancy:Thrombolytic drugs can
Indications: Acute ST elevation possibly lead to premature separation of
Myocardial infarction (STEMI) within 12 the placenta in the first 18 weeks of
hours of symptom onset, Acute Ischemic pregnancy. There is also a risk of
stroke within 4.5 hours, acute massive maternal haemorrhage throughout
pulmonary embolism, Prosthetic valve pregnancy and post-partum, and also a
thrombosis. Deep vein thrombosis, theoretical risk of fetal haemorrhage
acute peripheral arterial occlusion, throughout pregnancy.
occluded intravenous catheters. Side-effects: Nausea and vomiting and
Cautions: Thrombolytic drugs should bleeding. When thrombolytics are used
be used with caution if there is a risk of in myocardial infarction, reperfusion
bleeding including that from arrhythmias and recurrent ischaemia
venepuncture or invasive procedures. and angina may occur. Reperfusion may
They should also be used with caution in also cause cerebral and pulmonary
external chest compression, elderly, oedema. Hypotension can also occur
hypertension, conditions in which and can usually be controlled by
thrombolysis might give rise to embolic elevating the patient’s legs, or by
complications such as enlarged left reducing the rate of infusion or stopping
atrium with atrial fibrillation (risk of it temporarily. Back pain, fever, and
dissolution of clot and subsequent convulsions have been reported.
embolisation), and recent or concurrent Bleeding is usually limited to the site of
use of drugs that increase the risk of injection, but intracerebral haemorrhage
bleeding. or bleeding from other sites can occur.
Contraindications: any prior Serious bleeding calls for discontinuation
Intracranial Hemorrhage, Ischemic of the thrombolytic and may require
stroke within 6 months( except acute administration of coagulation factors and
ischemic stroke within 4.5 hours), known antifibrinolytic drugs (e.g. tranexamic
structural cerebral vascular lesion acid). Rarely further embolism may
165
occur (either due to clots that break intravenous infusion, 1.5 million units
away from the original thrombus or to over 60 minutes. Deep-vein thrombosis,
cholesterol crystal emboli). pulmonary embolism, acute arterial
Thrombolytics can cause allergic thromboembolism, central retinal venous
reactions (including rash, flushing and or arterial thrombosis, by intravenous
uveitis) and anaphylaxis has been infusion, 250 000 units over 30 minutes,
reported. Guillain-Barre´ syndrome has then 100 000 units every hour for up to
been reported rarely afterstreptokinase 12–72 hours according to condition with
treatment. monitoring of clotting parameters
ALTEPLASE Proprietary Preparations

Eptase (Beacon),Inj.,1500000IU, Tk.
4500.00/Vial
Indications: Acute ST elevation STK (Incepta), Inj.,1500000IU, Tk. 4500.00/Vial
Myocardial infarction (STEMI) within 12 Streptase(I) (CSL Behring), Inj. 1.5 MIU, Tk.
hours of symptom onset, acute Ischemic 5250.00/Vial
stroke within 4.5 hours, acute massive TENECTEPLASE
pulmonary embolism.
Indications: Acute ST elevation
Contra-indications: See notes above Myocardial infarction (STEMI) within 12
Interactions: See notes above hours of symptom onset.
Side effects: See notes above Cautions: See notes above
Dose: Acute Myocardial Infarction: Contraindications: See notes above
dose not exceeding 100mg Interactions: See notes above
15-mg IV bolus followed by 0.75 mg/kg Side effects: See notes above
(up to 50 mg) IV over 30 minutes then
Dose: In Acute Myocardial Infarction:
0.5 mg/kg (up to 35 mg) IV over 60
Single I/ V bolus
minutes.
To reconstitute tenecteplase, mix the
Pulmonary embolism: 100 mg I/v
50-mg vial in 10 mL sterile water (5
infused over 2 hour.
mg/mL). Tenecteplase is administered in
Acute Ischemic stroke: 0.9mg/kg I/V;
a 30-50 mg IV over 5-10 seconds. The
not to exceed 90mg total dose.
dosage is calculated on the basis of the
Administer 10% of the total dose as an
patient’s weight, as follows:
initial I/v bolus over 1 minute and the
Below 60 kg - 30 mg (6000 IU)
remainder infused over 60 minutes.
60 to 69 kg - 35 mg (7000 IU)
70 to 79 kg - 40 mg (8000 IU)
Proprietary preparation
Actilyse(i) (Boehringer), Inj. 50 mg/Vial
80 to 89 kg - 45 mg (9000 IU)
Tk46,000/vial At or above 90 kg - 50 mg (10000 IU)
It is recommended to reduce to half of
STREPTOKINASE the usual dose in patient’s ≥75 years of
age.
Indications: Acute myocardial
Proprietory Preparation
infarction; deep-vein thrombosis, Metalyse(i) (Boehringer), Inj. 50 mg/Vial
pulmonary embolism, acute arterial
thromboembolism, and central retinal
venous or arterial thrombosis
Cautions: See notes above; hepatic
impairment, pregnancy UROKINASE
Contra-indications: See notes above
Interactions: See Appendix-2 Indications: Acute myocardial
Side-effects: See notes above infarction; thromboembolic occlusive
Dose: Myocardial infarction (initiated vascular disease including deep-vein
within 12 hours of symptom onset), by
166
thrombosis, pulmonary embolism, and Indications: All haemorrhagic syndro-

occlusive peripheral arterial disease; mes due to enhanced fibrinolysis
occluded arteriovenous haemodialysis Contraindications: Thromboembolic
shunts, and intravenous catheters and disease, arterial and venous thrombosis.
cannulas blocked by fibrin clots Interactions: See Appendix-2
Cautions: See notes above Side-effcets: Fatigue, conjunctival
Contra-indications: See notes above; irritation, pruritus, skin reshes after oral
hepatic impairment- dose reduction may administration, nausea, diarrhoea,
be required; renal impairment-dose dizziness, hypersensitization
reduction may be required; pregnancy; Dose: 8-16 g a day orally and is to be
breast-feeding given as 2-4 grams (diluted in sugared
Side-effects: See notes above water) 6 hourly
Dose: Deep-vein thrombosis, by
intravenous infusion, initially 4400 Proprietary Preparations
units/kg over 10–20 minutes, followed by Caprolex (Techno), Inj, 1gm/5ml, Tk.35/10 ml
100 000 units/hour for 2–3 days. Vial; Tk. 14.50/5 ml Vial
Pulmonary embolism, by intravenous Caprolycin (Pacific),Inj.,2gm/10ml,Tk. 50/10ml
Minocap (ACI),Inj.,2gm/10ml,Tk.50.34/10 ml; 2
infusion, initially 4400 units/kg over 10–
gm/10 ml, Tk. 25.17/5 ml
20 minutes, followed by 4400
units/kg/hour for 12 hours.
Occlusive peripheral arterial disease, TRANEXAMIC ACID (analogue of EACA)
consult product literature
Occluded central venous catheters, by Indications: Hereditary angiedema. In
injection directly into catheter, dissolve prophylaxis and therapy of digestive
in sodium chloride 0.9% to a haemorrhages, haemorrhagic syndro-
concentration of 5000 units/mL; use a mes in leukemia, cirrhosis of liver,
volume sufficient tofill the catheter hemophilia, throm-bocytopenic purpura,
lumen; leave for 20–60 minutes then accidents during thrombolytic therapy
aspirate the lysate; repeat if necessary and transfusion surgical prophylaxis:
Occluded arteriovenous haemodialysis anti-haemorrhagic therapy during
shunts, consult product literature. operations, particularly in pulmonary,
cardiovascular and abdominal surgery
Proprietary Preparation In urology: Prophylaxis and anti
Uronase (Beacon), Inj., 500000 IU, Tk. haemorrhagic therapy of prostatic,
3523.77/Vial vesical, renal surgery and haematurias.
In obstetrics: postpartum and puerperal
3.11 ANTI-FIBRINOLYTIC DRUGS haemorrhages; meno-rrhagias
AND HAEMOSTATICS Cautions: Renal impairment, massive
haematuria, disturbances in colour
Tranexamic acid, a synthetic amino vision, pregnancy
acid, has strong antifibrinolytic activity. Contraindications: Known individual
The anti-haaemorrhagic action of this hypersensitivity to the product,
acid is due to an inhibition of the thromboembolic disease, endocavity
plasminogen activation of both haemorr-hages, serious kidney failure
exogenous activator like streptokinase Interactions: See Appendix-2
and endogenous activators like Side-effects: Sense of fatigue,
urokinase and the plasminogen tissue conjunctival irritation, nasal blockade,
activators. itching, skin reddening, nausea,
diarrhoea
AMINOCAPROIC ACID (EPSILON Dose: Loading dose of 15mg/kg,
AMINOCAPROIC ACID) (inhibit plasminogen followed by 30 mg /kg every 6 hourly
activation) By mouth in menorrhagias, 1-1.5 g 2-4
times daily for 3-4 days
167
By mouth in local fibrinolysis 15-25 LDL receptors using bile acid

mg/kg 2-3 times daily. sequestrant resins like Cholestyramine
By slow intravenous injection in case of (up to 24 g/day) or HMGCoA Reductase
local fibrinolysis 0.5-1 g 3 times daily. inhibitors like Pravastatin or
Simvastatin (10-40 g/day).
Proprietary Preparations In Type 3 hyperlipoproteinaemic patients
Anaxyl (ACI), Cap., 500mg, Tk. 15.11/Cap., accumulate IDL in plasma. This Type
Inj., 500mg/5ml, Tk. 50.34/5 ml Amp; Tab., responds well to diet and drug therapy,
500mg, Tk. 20.06/Tab.
particularly with the new generation of
Bionex (Biopharma), Cap., 500mg, Tk.
16.00/Cap. Clofibrate, Benzafibrate and Gemfi-
Enclot (Opsonin), Cap., 500 mg, Tk. brozil. These agents are very effective
15.06/Cap., Inj., 500mg/5 ml, Tk. 50.19/Amp in reducing the high circulating IDL
Fibrino (Eskayef), Cap, 500mg, Tk. levels.
15.00/Cap., 500mg, Tk. 15.00/Cap., Inj. , Type 4 hyperlipoproteinaemia is asso-
500mg/5ml , Tk. 50.00/Amp ciated with accumulation in the plasma
Fibrostat (Globe), Cap., 500 mg, Tk. of VLDL of normal composition, which
20.00/Cap., Inj, 500 mg/5 ml, Tk. 45.00/ Amp
Frabex (Square), Cap., 500 mg, Tk.
appears to be oversynthesized in some
20.00/Cap., Inj., 500 mg/5 ml, Tk. 50.00/Amp individuals. Dietary modification is the
Hemostat (Aristo), Inj., 250g/5ml, Tk. 25.00/5 first line of treatment of Type 4
ml Amp; Cap., 500mg, Tk.15.00/Cap. hyperlipo-proteinaemic subjects. Carbo-
Hemotrax (UniMed), Tab., Tk. 20.00/Tab hydrate and alcohol restriction achieves
Intrax (Incepta), Cap., 500 mg, Tk. 16.00/Cap., satisfactory control of their plasma TG
Inj., 500mg/5ml, Tk. 50.00/Amp level. Where the response is
Nexyl (Ibn Sina), Cap., 500mg, Tk.15.00/Cap. inadequate, it may be necessary to add
Oranex (Orion), Cap., 500 mg, Tk.15.04/Cap.
nicotinic acid (3-4 g/day).
Taxiclot (One Pharma), Cap., 500 mg, Tk.
15.00/Cap. There is evidence that lowering LDL-
Tracid (Acme), Inj., 500mg/5ml , Tk. 50.35/5 cholesterol by 25-30% is effective in
ml Amp; Tab., 500.00 mg, Tk. 15.10/Tab. both primary and secondary prevention
Tramic (Pacific), Inj., 500mg/5ml, Tk. 80.00/5 of coronary heart disease. Treatment
ml Amp; Cap, 500 mg, Tk. 23.00/Cap. with statins (see Statins below) has
Tranexil (Beximco), Cap., 500mg, Tk. been shown to reduce myocardial
15.00/Cap., Inj., 500mg/5ml, Tk. 50.00/Amp infarction, coronary deaths and overall
Traxyl (Nuvista), Cap.,500mg,Tk. 23.44/Cap.
Trexam (Healthcare), Inj., 250mg/5ml , Tk.
mortality. However, any drug therapy
40.00/5 ml Amp; 500mg/5ml, Tk. 80.00/Amp; must be combined with strict diet control,
Tab., 500mg, Tk. 20.00/Tab. maintenance of ideal body weight and
Xamic (Renata), Cap., 500 mg, Tk. 20/Cap.; cessation of smoking.
Inj., 500mg/5ml, Tk. 50.00/Amp CAUTION: Severe hyperlipidaemia often
requires combination of lipid lowering
3.12 LIPID LOWERING DRUGS drugs such as anion exchange resin with
a fibrate, a statin, or nicotinic acid.
Lipoprotein disorders or dyslipidaemias Combi-nations of a statin with nicotinic
are among the commonest metabolic acid or a fibrate or carry an increased
disorders seen in clinical practice. They risk of side-effects including
may lead to a number of sequelae rhabdomyolysis and should be used with
including coronary heart disease, caution. Concomitant treatment of a
dermatological manifestations like statin with cyclosporin may also increase
xanthelasmata and xanthomata, the risk of muscle toxicity
pancreastitis, and neurolgical and ocular
anomalies. 3.12.1 ANION EXCHANGE RESINS
In Type 2 hyperlipoproteinaemic patients
present with elevated plasma LDL Cholestyramine and Cholestipol are
cholesterol levels. Treatment is aimed at anion exchange resins. These resins
maximizing the efficiency of functional
168
prevent the reabsorption of bile acids by Lipicut (Rangs), Tab., 10mg, Tk. 10.00/Tab.;
binding it. 20mg, Tk. 18.00/Tab.
Cautions: Interfere with the absorption Lipidof (Acme), Cap., 200.00 mg, Tk.
7.04/Cap.
of fat-soluble vitamins Lipired (Square), Cap., 200 mg, Tk.
Interactions: See Appendix-2 7.04/Cap.; Tab., 160 mg, Tk. 5.02/Tab.
Side-effects: Constipation is common Liplo (Globe), Tab., 20 mg, Tk. 15.00/Tab.; 10
but diarrhoea may occur; gastrointestinal mg, Tk. 10.00/Tab.
discomfort and increased bleeding Lofat (Beximco), Cap., 200mg, Tk. 7/Cap.
tendency have been reported Nofiate (Incepta), Cap., 200 mg, Tk. 7/Cap.
Noficon (Eskayef), Cap, 200mg, Tk.
7.00/Cap.; 200mg, Tk. 7.00/Cap
3.12.2 FIBRATES Tigicon (Aristo), Cap., 200mg, Tk. 7.00/Cap.
Tigirate (Opsonin), Cap., 200 mg, Tk.
Clofibrate, Benzafibrate, Cipro-fibrate, 7.06/Cpa.
Fenofibrate, and Gemfibrozil. can Tizabet (ACI), Cap., 200mg, Tk. 7.02Cap.
decrease mainly serum triglycerides; Trigent (UniMed), Tab., 200mg, Tk. 7/Tab.
Vastor (Ad-din), Tab.,10mg, Tk. 10.00/Tab.
they also tend to decrease LDL-chole-
sterol and increase HDL-cholesterol.
GEMFIBROZIL
FENOFIBRATE
Indications: For the prevention of
coronary heart disease in patients with
Indications: For types 2, 3, 4 and 5 hyperlipidaemias of types 2, 3 and 4 who
hyperlipoproteinaemias in patient who do do not respond well to dietary
not respond adequaetly to diet and other restrictions
appropriate measure Contraindications: Biliary obstructions,
Cautions: Renal impairment; liver chronic liver disease, pregnancy and
function test recommended every 3 breast-feeding
months for first year, discontinue Interactions: See Appendix-2
treatment if significantly raised Side-effcets: Nausea, diarrhoea,
Contraindications: sever hepatic and pruritus, rashes, blurred vision,
renal impairment; pregnancy and breast- impotence, cholestatic jaundice,
feeding; existing gall bladder disease myopathy, laryngeal edema
Interactions: See Appendix-2 Dose: 1-2 g daily in 2 divided doses
Side-effcets: nausea, anorexia, gastric
pain; pruritus, urtecaria; impotence; also
headache, dizziness, vertigo, hair-loss; Proprietary Preparations
mytoxicity; photosensivity, raised serum Delipid (Square), Cap., 300mg, Tk. 7.03/Cap.
transaminase; renal impairment Fibril (Beximco), Cap. 300 mg, Tk.7/Cap
Dose: initially 200 mg daily in divided Gelicon (Eskayef), Cap., 300mg, Tk. 7.00/Cap.
dose with food, then adjusted according Gemfil (Aristo), Cap. 300 mg, Tk. 7/Cap
to response to between 200 mg and 400 Lipigem (ACI), Cap., 300mg,Tk. 7.05/Cap.
mg daily (dose form not appropiate for Lipozil (Rephco), Cap. 300 mg, Tk. 6.50/Cap
children or in renal impairment)
3.12.3 STATINS
Atorvast (Medimet), Tab., 10mg, Tk.8/Tab. Statins include Atorvastatin,
Fenatrol (Drug Intl), Tab., 145mg, Tk. Cerivastatin, Fluvastatin, Pravastatin
8.05/Tab.
Fenobate (Renata), Cap., 200 mg, Tk.
Simvastatin, Rosuvastatin, and
7.00/Cap. Pitavastatin. These drugs inhibit
Fenocap (Orion), Cap, 200 mg, Tk. 7.06/Cap. HMGCoA reductase an enzyme involved
Fenolid (General), Cap., 200mg, Tk. 7.05/Cap. in choles-terol synthesis, especially in
Fenorat (Pacific), Cap., 200 mg, Tk. 7.00/Cap. the liver.. These drugs are very effective
Fibre (White Horse), Cap., 200 mg, in lowering LDL-Cholesterol but less
Tk.7.00/Cap. effective than the fibrates in reducing
169
triglycerides and raising HDL- ATORVASTATIN

cholesterol.
Cautions: Statins should be used with Indications: Treatment of
caution in those with a history of liver hypercholesterolaemias and mixed
disease or with a high alcohol intake hyperlipidaemia
(use should be avoided in active liver Side-effects; Cautions; Contra-
disease). Hyperthyroidism should be
indications: As for fluvastatin
managed adequately before staring
treatment. Liver function tests to be
Dose: By mouth as calcium salt; initial
carried out before and within 1-3 months
dose is 10 mg daily which may be
of starting treatment and such tests
adjusted at intervals of 4 weeks up to a
should be repeated at intervals of 6
maximum of 80 mg daily
months for about 1 year. Treatment
should be discontinued if serum Proprietary Preparations
transaminase concentration rises to, and Anzitor (Square), Tab., 10 mg, Tk. 12/Tab. ;
persists at, 3 times the upper limit of the 20 mg, Tk. 20.00/Tab.; 40 mg, Tk. 28.00/Tab.
reference range. Patient should be Aster (Euro), Tab., 20 mg, Tk. 8.00/Tab. ; 10
advised to report unexplained muscle mg, Tk. 15.00/Tab.
pain.Statin should be avoided in Astin (Jayson), Tab., 10mg, Tk. 8.06/Tab.;
Tab., 20mg, Tk.15.10/Tab.
porphyria. Astiva (Supreme), Tab., 10mg, Tk. 10.00/Tab.;
Contra-indications: are contraindi- 20mg, Tk. 18.00/Tab.
cated in active liver diseases (or Atasin (ACI), Tab., 10mg, Tk. 10.07/Tab. ;
persistently abnormal liver function test); 20mg, Tk. 18.12/Tab. ; 40mg, Tk. 24.16/Tab.;
in pregnancy; in breast feeding 80 mg, Tk. 40.12/Tab.
Side effect: The most common side Atonor (Asiatic), Tab., 10mg, Tk.10.00/Tab.;
effect is gastrointestinal disturbance. 20mg, Tk. 18.00/Tab.
Atostin (Somatec),Tab.,10 mg,Tk. 10/Tab.
Other side effects reported include
Atova (Beximco), Tab., 10mg, Tk. 10.00/Tab.;
headache, altered liver function tests 20mg , Tk. 18.00/Tab.; 40mg, Tk. 24.00/Tab.l
and paraesthesia. Reversible myositis is Atovin (Alco), Tab. , 10 mg, Tk. 10.03/Tab. ;
a rare but significant side effect of the 20 mg, Tk. 15.05/Tab.
satins. Rash and hypersensitivity Atrovast (Nuvista), Tab., 10 mg, Tk.
reaction (including angiedema and 12.04/Tab. ; 20 mg, Tk. 18.05/Tab.
anaphylaxis) have been reported rarely. Avas (Opsonin), Tab. , 40 mg , Tk. 24.16/Tab.;
Effects on muscle: Myalgia,myositis and 10 mg , Tk. 10.04/Tab.; 20 mg , Tk. 18.13/Tab.
Avator (NIPRO JMI), Tab., 10mg, Tk.
myopathy have been reported with
10.03/Tab.; Tab., 20mg, Tk. 18.05/Tab.
statin;if myopathy is suspected and Colostat (Ibn Sina), Tab., 10mg, Tk. 10.0/Tab.
certain kinase is markedly elevated Divastin (Drug Intl), Tab., 10mg, Tk. 11/Tab.;
(more than 5 times upper limit of 40mg, Tk. 24.10/Tab.; 20mg, Tk. 18.10/Tab.
normal),treatment should be Frenvas (Radiant), Tab., 10mg, Tk.
discontinued; in patients at high risk of 12.04/Tab.; 20mg, Tk. 20.06/Tab.
muscle effects a stain should not be G-atorvast (Gonoshasthaya), Tab., 10 mg, Tk.
started if creatine kinase is elevated. 7.00 /Tab.; Tab., 20 mg, Tk.12.50 /Tab.
Lipex (Orion), Tab., 20 mg, Tk. 15.10/Tab.;
There is an increased incidence of
10 mg, Tk. 9.06/Tab.
mypathy if the stains are given at high Lipicon (Eskayef), Tab, 10mg, Tk. 10.00/Tab.;
doses or given with a fibrate, with liquid- 20mg, Tk. 18.00/Tab. ; 40mg , Tk. 24.00/Tab.
lowering doses of nicotinic acid, or with Lipigent (Pacific), Tab., 10 mg, Tk. 10/Tab.;
immuno-suppressments such as 20 mg, Tk. 18.00/Tab.
ciclosporin; close monitering of liver Lipitin (General), Tab. , 10mg, Tk. 10.07/Tab.
function and if symptomatic, of creatine ; 20mg, Tk. 18.12/Tab. ; 40mg, Tk.
kinase estimation is required in patients 24.07/Tab.
Liplo (Globe), Tab. , 10 mg, Tk. 10.00/Tab. ;
receiving these drugs. Rhabdomyolysis
20 mg, Tk. 18.00/Tab.
with acute renal impairment secondary Lipobi (Nipa), Tab., 10 mg, Tk. 10.00/Tab.
to myoglobinuria has also been reported.
170
Lipostat (Navana), Tab., 10 mg, Tk. Interactions: See Appendix-2

10.03/Tab. Side-effcets: Altered liver function tests,
Lipovast (Sharif), Tab, 10 mg ,
dyspepsia, nausea, abdominal pain,
Tk.10.03/Tab.;20 mg , Tk. 15.04/Tab.
Liptor (Acme), Tab., 10 mg, Tk. 10.07/Tab.;
rash, urticaria, insomnia and headache
20 mg, Tk. 18.11/Tab.; 40 mg, Tk. 24.16/Tab. Dose: 20-40 mg daily in the evening
Locol (Popular), Tab., 10 mg, Tk.10.04/Tab.;
20 mg, Tk. 18.07/Tab. Proprietary Preparations
Orva (Sanofi), Tab., 10mg, Tk. 12.04/Tab. ; Fluvas (Silva), Cap., 20mg, Tk.12.04/Cap.
20mg, Tk. 20.01/Tab. Lescol (Novartis), Cap., 20 mg, Tk.
Orvatin (Kemiko), Tab., 10mg, Tk. 10.03/Tab. 37.50/Cap.; 40 mg, Tk. 57/Cap.; 80 mg, Tk.
SB-Ator (Sunman-Bardem), Tab., 10 mg, Tk. 58.50/Tab.
12.00/Tab.; 20 mg, Tk. 20.00/Tab. Lesterol (Opsonin), Cap., 20 mg, Tk.
Stacor (UniMed), Tab , 10mg, Tk. 10.00/Tab.; 12.05/Cap.
20mg, Tk. 18.00/Tab. ; 40mg , Tk. 24.0/Tab.
Taven (Renata), Tab., 10mg, Tk. 10.04/Tab.; LOVASTATIN
20mg, Tk. 18.06/Tab. ; 40mg, Tk. 24.00/Tab.
TCL-R (Aristo), Tab., 10mg , Tk. 10.00/Tab. ;
20mg, Tk. 18.00/Tab.; 40mg , Tk. 24.00/Tab. Indications: Hypercholesterolaemia
Tiginor (Incepta), Tab., 40 mg, Tk. 24.0/Tab.; (plasma cholesterol level > 5.5 mmol/l);
20 mg, Tk. 18.00/Tab.; 10 mg, Tk. 10.00/Tab. to halt the progression of coronary heart
Trova (Biopharma), Tab., 40 mg , Tk. disease
18.00/Tab. ; 10 mg, Tk. 10.00Tab.; 20 mg, Tk. Contraindications: Active liver disease,
6.02/Tab.
Xelitor (Novo Health), Tab., 20 mg, Tk.
18.00/Tab. ; 10 mg, Tk. 10.00/Tab. Cautions: Alcoholics, history of liver
Xelpid (Healthcare), Tab., 20mg, Tk. disease
18.00/Tab. ; 40mg , Tk. 24.00/Tab. Interactions: See Appendix-2
Xerova (Beacon), Tab. , 10mg , Tk. 10.06/Tab. Side-effcets: Chest pain, acid reflux,
; 20mg , Tk. 18.11/Tab. alopecia, pruritus and dry mouth
Zuvas (Benham), Tab., 10 mg, Tk. 10.00/Tab.; Dose: Primary hypercholesterol-aemia,
Tab., 20 mg, Tk. 18.00/Tab.
Atorvastatin + Olmesartan
combined hyperlipidaemia, 20 mg daily
Olmepres (General), Tab., 5 mg + 20 mg, Tk. to be taken with the evening meal
8.00/Tab.
Amlodipine 5mg+ Atorvastatin 10 mg Proprietary Preparations
Amovast (Beacon), Tab. Tk. 11.07/Tab. Loplaqor (Novartis), Tab.10mg; 20mg; 40mg
Amdova (Beximco), Tab.,, Tk. 11.00/Tab. Lovatin (Ambee), Tab. 20 mg, 40 mg
Amlip (Eskayef), Tab.,, Tk. 11.00/Tab. Ultracor (Beximco), Tab. 20 mg, 40 mg
Cardual (ACI), Tab., TK. 11.07/Tab.
Lipigent (Pacific), Tab., Tk. 11.00/Tab.
SB-Amloator 5/10 (Sunman-Bardem), Tab.,
Tk. 11.00/Tab. PITAVASTATIN
FLUVASTATIN Indications: It is indicated as an adjunct

to diet in patients with primary
hyperlipidemia or mixed dyslipidemia to
Indications: Type 2 hyperlipidaemia;
reduce elevated total cholesterol, LDL-C,
retardation of coronary atherosclerosis in
apo B, and TG levels and to increase
patients not responding adequately to
HDL-C.
dietary control
Cautions; Contraindications; Side-
Contraindications: Primary biliary
effects: As for fluvastatin
cirrhosis, chronic liver disease; pregn-
ancy and breast-feeding; nephrotic Interactions: See appendix-2
syndrome Dose: Usual starting dose is 2 mg/day
Cautions: Liver function tests to be taken at any time of day and a maximum
carried out before starting treatment and of 4 mg/day. For patients with renal
such tests should be repeated at disease, the recommended starting dose
intervals of 6 months for about 1 year is 1 mg/day up to a maximum of 2
mg/day.
171
Proprietary Preparations Rostatin (Drug Intl), Tab., 20 mg, Tk.

Liploss (Drug Intl), Tab., 2mg, Tk. 10.50/Tab. 10.00/Tab., 10 mg, Tk. 8.00/Tab., 5mg, Tk.
Pavigard (Acme), Tab., 2mg, Tk. 10.03/Tab. 6.00/Tab.
Pitavas (Aristo), Tab., 2mg, Tk. 10.00/Tab. Rosu (Popular), Tab., 10 mg, Tk. 18.00/Tab.,
Pivalo (Square), Tab., 2mg, Tk. 10.03/Tab. 20 mg, Tk.30.00/Tab., 5mg, Tk. 10.00/Tab.
Pivasta (Eskayef), Tab, 2mg, Tk. 10.00/Tab., Rosugen (General), Tab. , 10mg, Tk.
20.06/Tab.; 5mg, Tk. 10.03/Tab.
Rosunor(Asiatic), Tab., 10 mg , Tk.
ROSUVASTATIN CALCIUM
20.00/Tab., 5mg, Tk. 10.00/Tab.
Rosutin (Beximco), Tab., 10 mg, Tk.
Indications: Increase HDL-C in patient 20.00/Tab., 20 mg, Tk. 30.00/Tab., 5 mg, Tk.
with primary hyper cholesterolaemia 10.00/Tab.
(heterozygous familial and non familial) Rosuva (Square), Tab., 10 mg, Tk. 20.13/Tab.,
and mixed dyslipidemia ( Type IIa and 20 mg, Tk. 30.10/Tab., 5 mg, Tk. 10.03/Tab.,
Rosvin (Alco), Tab., 10 mg, Tk. 20.00/Tab.
Iib).or homozygous familial hypercholes-
Rovast (Healthcare), Tab., 10 mg , Tk.
terolaemia in patient who have not 20.00/Tab., 20 mg , Tk. 30.00/Tab., 5 mg, Tk.
responded adequately to diet and other 10.00/Tab.
appropriate measure Rovex (Orion), Tab., 10 mg, Tk. 20.00/Tab., 5
Cautions: See notes above. Patient of mg, Tk. 10.00/Tab.
Asian origin max 20mg dose daily Ruvastin (Aristo), Tab. , 10 mg , Tk.
Contra-indications: See notes above 20.00/Tab., 5mg , Tk. 10.00/Tab.
SB-Rostin (Sunman-Bardem), Tab. , 10 mg,
Tk. 20.00/Tab., 20 mg, Tk. 30.00/Tab.
Dose: By mouth as calcium salt; initial
dose is 10 mg daily which may be
SIMVASTATIN[ED]
adjusted at intervals of 4 weeks up to a
maximum of 20 mg once daily; max
20mg daily Indications : In patients with type 2
Note. 20mg daily with concomitant hyperlipidaemia who does not respond
fibrate to diet control adequately; patients
having coronary heart disease with
Proprietary Preparations plasma cholesterol level 5.5 mmol/l or
Bestcol (Biopharma), Tab., 10 mg, Tk. higher; concomitant therapy with
25.00/Tab. immunosuppressives
Cholcut (Ziska), Tab., 10 mg, Tk. 20/Tab.; 5 Contra-indications: Active liver
mg, Tk. 10.00/Tab. disease; pregnancy and breast-feeding
Corestin(UniMed), Tab , 10 mg, Tk. Cautions: Same as that of fluvastatin
25.00/Tab., 5 mg, Tk. 12.50/Tab., 20 mg, Tk.
50.00/Tab.
Creston (Eskayef), Tab, 5 mg, Tk. 10.00/Tab., Side-effcets: same as that of fluvastatin
10 mg, Tk. 20.00/Tab. Dose: Primary hypercholesterol-aemia,
Creva (Radiant), Tab., 10mg, Tk. 27.00/Tab., combined hyperlipidaemia, 10 mg daily
5mg, Tk. 14.00/Tab. at night, to be adjusted at intervals of 4
Nestor (Navana), Tab., 10 mg, Tk. 20.06/Tab.; weeks; coronary heart disease, 20 mg
5 mg, Tk. 10.03/Tab. once daily at night, to be adjusted at
Restat (Ibn Sina), Tab. , 10 mg, Tk.
intervals of 4 weeks; max. 80 mg once
20.00/Tab., 5mg, Tk. 10.00/Tab.
Rocovas (Incepta), Tab. , 10 mg, Tk. daily
15.00/Tab., 20 mg, Tk. 25.00/Tab., 5 mg, Tk.
8.00/Tab. Proprietary Preparations
Rolip (Renata), Tab., 10 mg, Tk. 20.00/Tab. Novastin (Drug Int.) Tab., 10 mg, Tk.
Ropitor (Opsonin),Tab.,5 mg, Tk. 10.03/Tab., 10.07/Tab.
10 mg, Tk. 20.00/Tab., 20 mg , Tk. 30/Tab. Recol (ACI), Tab., 10 mg, Tk. 10.07/Tab.
Rosetor (ACI), Tab., 5mg, Tk.10.03/Tab., Simacor (Square), Tab., 10 mg, Tk.
10mg, Tk. 18.05/Tab. 10.07/Tab.
Rostab (Acme), Tab., 20 mg , Tk. 25.08/Tab., Simvatin (Acme), Tab., 10 mg, Tk.11.04/Tab.;
10 mg, Tk. 20.07/Tab., 5 mg, Tk. 10.03/Tab. 20 mg, Tk. 18.06/Tab.
Vastocor (Incepta), Tab., 10 mg, Tk. 12/Tab.
172
hyperlipidaemia not adequately

3.12.4 EZETIMIBE controlled with a statin alone. A
Ezetimibe inhibits intestional absorption triglyceride concentration exceeding 10
of cholesterol. mmol/litre is associated with acute
pancreatitis and lowering the
concentration reduces this risk. The fat
EZETIMIBE content of omega-3 fatty acid
Indications: Adjunct to dietary compounds (including excipients in the
measures and statin treatment in preparations) should be taken in to
primary hypercholesterolaemia and consideration when treatinghyper-
homozygous familial hypercholes- triglyceridaemia. There is little clinical
terolaemia (ezetimibe alone in primary trial evidence that the triglyceride
hypercholesterolaemia if statin lowering effect decreases the risk of
inappropriate or not tolerated); adjunct to cardiovascular disease.
dietary measures in homozygous
sitosterolaemia
OMEGA-3-ACID ETHYL ESTERS
Cautions: Hepatic impairment- avoid in
moderate and severe impairment may
accumulate; pregnancy manufacturer Indications: Adjunct to diet and statin in
advises use only if potential benefit type IIb or III hypertriglyceridaemia;
outweighs risk adjunct to diet in type IV
Contraindications: The combination of hypertriglyceridaemia; adjunct in
Ezetimibe with statin is contraindicated secondary prevention in those who have
in patients with active liver disease or had a myocardial infarction in the
unexplained persistent elevations in preceding 3 months
serum transaminases. Cautions: Haemorrhagic disorders,
Interactions: See Appendix-2 anticoagulant treatment (bleeding time
increased); hepatic impairment and
Side-effects:Gastro-intestinal
breast-feeding
disturbances; headache, fatigue;
myalgia; rarely arthralgia, hypersen-
sitivity reactions (including rash, disturbances; less commonly taste
angioedema, and anaphylaxis), disturbances, dizziness, and
hepatitis; very rarely pancreatitis, hypersensitivity reactions; rarely hepatic
cholelithiasis, cholecystitis, thrombo- disorders, headache, hyperglycaemia,
cytopenia, raised creatine kinase, acne, and rash; very rarely hypotension,
myopathy, and rhabdomyolysis nasal dryness, urticaria, and increased
white cell count
Dose ADULT and CHILD over 10 years,
Dose: Hypertriglyceridaemia, initially 2
10 mg once daily
capsules daily with food, increased if
necessary to 4 capsules daily.Secondary
Ezeta (Beximco), Tab. 10 mg, Tk. 10.04/Tab. prevention after myocardial infarction, 1
Ezetrol (Unimed), Tab. 10 mg, Tk. 10.00/Tab. capsule daily with food.
Ezetim (Incepta), Tab. 10 mg, Tk. 10.00/Tab.
Maxomega (UniMed), Cap., 1 gm,Tk.10/Cap.
3.12.5 OMEGA-3 FATTY ACID
Omesoft (Pacific), Cap., 1 gm, Tk. 10/Cap.
COMPOUNDS OMG-3 (Drug Intl), Soft Cap., 1 gm, Tk.
6.05/Cap.
The omega-3 fatty acid compounds
comprise omega-3-acid ethyl esters and 3.12.6 NICOTINIC ACID DERIVATIVES
omega-3-marine triglycerides. Omega-3
fatty acid compounds may be used to Indications: For prevention and
reduce triglycerides, as an alternative to
treatment of pellagra, hypercholes-
a fibrate and in addition to a statin, in
terolaemia, hypertriglyceridaemia
patients with combined (mixed)
173
Contraindications: pregnancy, breast- receptor antagonism. Selective ETA

feeding, active peptic ulcer disease antagonists (Sitaxsentan;
Cautions: diabetes mellitus, gout, peptic Ambrisentan) theoretically preserve the
ulcer and liver disease, acute myocardial vasodilatory action of the ETB receptor.
infarction However, no trial data show whether
Interactions: See Appendix-2 selective ETA antagonism is better than
Side-effcets: flushing, dizziness, combined ETA and ETB antagonism.
palpitation, pruritus, nausea, vomiting. Bosentan is also licensed to reduce the
Dose: 100-200 mg 3 times daily; it is number of new digital ulcers in patients
better to take the drug with meals with systemic sclerosis and ongoing
digital ulcer disease.
Niapid (Drug Int), Tab., 500 mg, Tk.6/Tab. AMBRISENTAN
Niconic (Pacific), Tab., 50 mg, Tk. 2/Tab.
Ridel (Incepta), ER Tab., 500 mg, Tk. 8/Tab.
Indication: Pulmonary arterial
hypertension
INOSITOL NICOTINATE (see section 3.3.4.)
Cautions: Not to be initiated in
3.13 DRUGS FOR THE MANAGEMENT significant anaemia, monitor
OF PULMONARY HYPERTENSION haemoglobin concentration or
haematocrit after 1 month and 3 months
There is no cure for PAH, but treatment of starting treatment, and periodically
options include prostanoids, PDE-5 thereafter , hepatic and renal impairment
inhibitors, and ET-receptor antagonists. ,pregnancy and breast-feeding, renal
Amberisentan, Bosentan, Iloprost, impairment use with caution if eGFR
Sildenafil, Sitaxentan, Tadalafil, and less than 30 mL/minute/ 1.73m 2;
Treprostinil are indicated for the
treatment of pulmonary arterial Side-effects: Abdominal pain,
hypertension and should be used under constipation; palpitation, flushing,
specialist supervision. peripheral oedema, headache; anaemia;
decress haemoglobin
Epoprostenol (prostacyclines) can be
used in patients with primary pulmonary Dose: ADULT over 18 years, 5 mg once
hypertension resistant to other daily, increased if necessary to 10 mg
treatments. Phosphordiesterase- once daily.
5inhibitors (Sildenafil, Tadalafil)
vasodilate by acting on PDE-5 in the Proprietary preparation:
Ambrisan (Square), Tab., 5 mg, Tk.
pulmonary and systemic vasculature.
40.13/Tab.
Furthermore, vascular remodeling can
be promoted by decreased proliferation
and increased apoptosis of pulmonary BOSENTAN
artery smooth muscle cells. RV inotropy Indications: Pulmonary arterial
also increases. There is also a direct hypertension; systemic sclerosis with
action on the lungs, in which expression ongoing digital ulcer disease (to reduce
of PDE-5 is suppressed. Thus sildenafil number of new digital ulcers).
also preferentially improves blood flow to
well-ventilated regions of the lung in Cautions: Not to be initiated if systemic
patients with lung disease such as systolic blood pressure is below 85
idiopathic pulmonary fibrosis mmHg; monitor haemoglobin before and
The first oral therapy approved for during treatment (monthly for first 4
therapy of PAH was Bosentan months, then 3-monthly), avoid abrupt
(endothelin receptor antagonists). withdrawal, monitor liver function before
Bosentan gives combined ETA/ETB treatment, at monthly intervals during
174
treatment, and 2 weeks after dose Side-effects: See notes above &section
increase (reduce dose or suspend 6.4.4
treatment if liver enzymes raised
significantly)-discontinue if symptoms of Dose: By mouth, 40 mg orally once a
liver impairment, hepatic impairment- day. Dividing the 40 mg dose over the
avoid in moderate and severe course of the day is not recommended.
impairment; pregnancy avoid
(teratogenic in animal studies); effective Proprietary Preparations
contraception required during and for at See section 6.4.4
least 3 months after administration
(hormonal contraception not considered
effective),monthly pregnancy tests
advised; breast-feeding.
Contra-indication: acute porphyria
Side-effects: GI disturbances, dry

mouth, rectal haemorrhage, flushing,
hypotension, palpitation, oedema,
dyspnea, dizziness, fatigue, back pain
and pain in extremities, anaemia,
hypersensitivity reactions, elevation of
liver enzyme, decrease hemoglobin
Dose: Pulmonary arterial hypertension,

initially 62.5 mg twice daily increased
after 4 weeks to 125 mg twice daily;
max. 250 mg twice daily. Systemic
sclerosis with ongoing digital ulcer
disease, initially 62.5 mg twice daily
increased after 4 weeks to125 mg twice
daily
Pulmoten(Unimed), Tab.,62.5mg, Tk.150/Tab.
SILDENAFIL
Indications, Cautions
Side-effects: See notes above &section
6.4.4
Dose: By mouth, 20 mg 3 times daily;
CHILD under 18 years not
recommended.
By intravenous injection, when oral route
not appropriate, 10 mg three times daily
See section 6.4.4
TADALAFIL
Indications, Cautions
175
4. RESPIRATORY SYSTEM
Chapter 4
RESPIRATORY SYSTEM
4.1 Bronchodilators p.176
4.1.1 Selective beta2-adrenoceptor stimulants p.176
4.1.2 Antimuscarinic bronchodilators p. 179
4.1.3 Xanthine bronchodilators p. 180
4.2 Corticosteroids p. 181
4.3 Combined Therapy p.182
4.4 Cromoglycates, related therapy and leukotriene receptor antagonists p.183
4.4.1 Cromoglycates p.183
4.4.2 Related therapy p. 184
4.4.3 Leukotriene receptor antagonists p.184
4.4.4 Phosphodiesterase type-4 inhibitors p. 186
4.5 Peak-flow meter, and nebulisers p.186
4.6 Oxygen therapy in asthma and COPD p.186
4.7 Pulmonary surfactants p. 187
4.8 Cough Preparations p.187
4.9 Antihistamines, hyposensitisation and allergic emergencies p.190
4.9.1 Antihistamines p.190
4.9.2 Allergic emergencies p.193
4.1 BRONCHODILATOR REGULAR TREATMENT: Short-acting
4.1.1 SELECTIVE BETA2 beta2-adrenocepteor stimulants (such as
ADRENOCEPTOR salbutamol and terbutaline) should not
STIMULANTS be prescribed on a regular basis in
4.1.2 ANTIMUSCARINIC patients with chronic asthma since
BRONCHODILATORS several studies have shown that regular
4.1.3 XANTHINE treatment with them provides no clinical
BRONCHODILATORS benefit. Longer acting beta2
adrenoceptor stimulants such as
Salmeterol, Formoterol (eformoterol),
4.1.1 SELECTIVE BETA2
Indacaterol when taken regularly have
ADRENOCEPTOR
shown clear benefit compared to
STIMULANTS
placebo or to regular treatment with
short-acting beta2 adrenoceptor
A short-acting selective beta2 stimulants.
adrenoceptor stimulant such as INHALATION. Administration by
Salbutamol or Terbutaline (preferably inhalation delivers the drug directly to the
given by aerosol inhalation) is the safest bronchi and therefore effective in smaller
and a most effective treatment for mild to doses, provides relief more rapidly and
moderate acute symptoms of asthma. If causes fewer side-effects.
beta2 adrenoceptor stimulant ORAL: Oral preparations are available
inhalation is needed more than once for patients who cannot manage the
daily, prophylactic treatment should be inhaled route, particularly children. Oral
considered. However, in more severe preparations have a slower onset but a
exacerbation a short course of an oral slightly more prolonged action than the
corticosteroid may also be necessary to aerosol inhalers. The longer acting pre-
bring the asthma under control. parations may be of value in nocturnal
Treatment of patient with acute severe asthma as an alternative to modified-
asthma or airways obstruction is safer in release theophylline preparation.
hospital where oxygen and resuscitation
facilities are immediately available.
176
PARENTERAL:Intravenous injections of once or twice-daily basis. It is not

Salbutamol and Terbutaline are given indicated for the relief of an acute attack.
for severe bronchospasm. Indications: Reversible airways
CHILD. Selective beta2-adrenoceptor obstructions including nocturnal asthma
stimulants are useful even in children and prevention of exercise-induced
under the age of 18 months. They are bronchospasm in patients requiring long-
most effective by the inhalation route, term regular bronchodilator
but an inhalation device may be needed. Cautions: See under Salbutamol and
They may also be administrated as notes above
tablets or oral liquids although Interactions: See Appendix-2
administration by inhalation is preferred. Side-effects: See under Salbutamol
In severe attacks nebulization using a significant incidence of paradoxical
selective beta2-adrenoceptor stimulant bronchospasm may be clinically
or ipratropium is advisable. important in severe or deteriorating
PREGNANCY AND LACTATION. See asthma
general notes under Asthma. Dose: By inhalation of powder, 6-12
micrograms (1-2 times daily); CHILD
BAMBUTEROL HYDROCHLORIDE under 12 years, not recommended
Indications: See under Salbutamol Proprietary preparations

Efo Cozycap (Square), Inhaler, Cap., 12
Cautions: Renal impairment hepatic
microgram (for use with a inhaler device) Tk.
impairment (avoid if severe), pregnancy 3.33/Cap
Side-effects: See under salbutamol
SALBUTAMOL[ED][OTC]
Dose: 20mg once daily at bedtime if
patient has previously tolerated beta2
agonist, other patient, initially 10mg once Indications: Asthma and other
daily at bedtime, increased if necessary conditions associated with reversible
after 1-2 weeks to 20mg once daily; airways obstruction; premature labour
CHILD not recommended Cautions: Hyperthyroidism, myocardial
insufficiency, and susceptibility to QT-
Proprietary Preparations interval prolongation, hypertension,
Aerodyl (Silva), Tab., 10mg, Tk. 1.51/Tab.; pregnancy and breast-feeding, diabetes
Syrup, 5mg/ml, Tk. 20.0697/60ml -especially intravenous administration to
Bambelor (Incepta), Syrup, 5mg/ml, Tk. diabetics
25.00/60ml,; Tab, 10 mg, Tk. 1.50/Tab.; 20 Interactions: See Appendix-2
mg, Tk. 3.00/Tab. Side-effects: Fine tremor headache,
Buterol (ACI), Syrup, 5 mg/5 ml,Tk. peripheral vasodilatation, tachycardia,
35.24/100 ml; Tab., 10mg, Tk. 1.51/Tab.
Dilator (Eskayef), Syrup, 5 mg/5 ml, Tk.
sleep and behavioral disturbances in
30.00/60 ml ;Tab, 10 mg, Tk. 3.00/Tab.; children; urticaria
20mg, Tk. 4.00/Tab. Dose: By mouth, 4 mg (elderly and
Muterol (Acme), Syrup , 5mg/ml, Tk. sensitive patients initially 2 mg) 3-4 times
20.13/60ml, Tab. , 10.00 mg, Tk. 1.51/Tab. ; daily; max. single dose 8 mg (but
20mg, Tk. 3.01/Tab. unlikely to provide extra benefit or to be
Venterol (Ibn Sina), Tab. ,10 mg, Tk. tolerated); CHILD under 2 years 100
1.50/Tab.;Tab. , 20 mg,Tk.3.01/Tab.,Syrup, 5
mg/5 ml, Tk. 35.14/60 ml
micrograms/kg 4 times daily; 2-6 years
1-2 mg 3-4 times daily, 6-12 years 2 mg
By aerosol inhalation, 100-200 micro-
FORMOTEROL FUMARATE
grams (1-2 puffs), for persistence
(Eformoterol Fumarate) symptoms up to 3-4 times daily; CHILD:
100 micrograms, increased to 200
Formoterol (or eformoterol) is a longer- micrograms if necessary; for persistent
acting beta-2-adrenoceptor stimulant symptoms up to 3-4 times daily; CHILD:
which is administered by inhalation on a 100 micrograms, increased to 200
177
micrograms if necessary. Prophylaxis in H-selax (Hudson), Syrup, 2mg/5 ml, Tk.

exercise-induced bronchospasm, 200 23.00/100ml; Tk. 14.52/60ml; Tab., 4 mg, Tk.
micrograms, CHILD 100 micrograms 0.34/Tab.;
Orsal (Orion), Syrup 2mg/5ml, Tk.
By inhalation of powder, 200-400 22.92/100ml
micrograms; for persistent symptoms up Pulmocare (Healthcare), Inhaler,100
to 3-4 times daily; CHILD: 200 microgram/puff, Tk. 230.00/200puff; Tk.
micrograms. Prophylaxis in exercise 198.00/200 puffs (refill pack),Cap.200
induced bronchospasm 400 micro- microgram /cap.,Tk.3.00/Cap; Cap., 200mcg,
grams; CHILD 200 micrograms Tk. 330.00/Cap., (With device)
By inhalation of a nebulised solution, Pulmolin (Opsonin), Tab., 4 mg, Tk.
0.46/Tab.; Syrup, 2 mg/5 ml , Tk. Tk. 22.93/
chronic bronchospasm unresponsive to 100 ml; Tk. 10.45/60 ml; Resp., Solun., 5
conventional therapy and severe acute mg/ml, Tk.120.37/20mI;
asthma, ADULT and CHILD over 18 Respolin (Jayson), Syrup, 2 mg/5 ml , Tk.
months 2.5 mg, repeated up to 4 times 22.99/100ml; Tab. , 4mg , Tk. 0.45/Tab.
daily; may be increased to 5 mg if Salbu (Biopharma), Tab., 2mg, Tk. 0.26/Tab.,
necessary, but medical assessment 4mg, Tk. 0.34/Tab., Syrup, 2 mg/5 ml,, Tk.
should be considered since alternative 22.93/100ml
Salbut (General), Tab., 4 mg, Tk.0.34/Tab.;
therapy may be indicated; CHILD under Syrup, 2 mg/5 ml,Tk.22.90/100 ml
18 months, clinical efficacy uncertain Salbutal (Sanofi), Syrup, 2mg/5ml, Tk.
consider supplemental oxygen. 22.96/100ml, Tab, 4mg, Tk. 0.46/Tab., 2mg,
Tk. 0.26/Tab.
Proprietary Preparations Salbutamol (Albion), Syrup, 2 mg/5 ml,
Actolin (Globe), Syrup, 2 mg/5 ml , Tk. Tk17.00/100 ml; 2 mg, Tk.0.26/Tab.; 4 mg,
23.00/100ml; Tab, 4 mg, Tk. 0.40/Tab. Tk. 0.34/Tab.
Alvolex (Silva), Syrup, 2 mg/5 ml, Tk. Salbutamol (Amico ), Syrup, 2 mg/5 ml,
16.0664/100ml Tk.21.75/100 ml ;
Asmalin (Aristo), Inhaler, 100 microgram/Puff, Salbutamol (Popular), Tab., 4mg,Tk.
Tk. 195.00/ can; Syrup, 2 mg/5 ml, Tk. 0.40/Tab.
22.92/100 ml Salix (Modern), Syrup, 2 mg/5 ml., Tk.
Asul (Asiatic),Syrup,2 mg/5ml, 14.47/60ml, Tk. 22.90/100ml
Tk.22.92/100ml; Tab. 4 mg, Tk.0.34/Tab. Salmol (Medimet), Syrup, 100ml, Tk.
Azmasol (Beximco), Inhaler, 100 23.00/100ml; Tk. 13.80/60ml; Tab., 4mg, Tk.
microgram/puff, Tk. 230.00/200 doses; Tk. 0.45/Tab.
198.00/200 doses(Refil Pack) , Tk. Salmolin (Acme), Inhaler,100 microgram/puff,
170.00/200 doses; Resp., Solun., 5 mg/ml, Tk. Tk. 195.59/200puffs; Tk.181.23/200puffs,
120.00/20 ml ;Tab. , 2 mg, Tk.0.26/Tab. ; 4 Tk.170.51/200puff, Cap., (for use with a
mg, Tk. 0.40/Tab. ,Cap.,(for use with a inhaler inhaler device) 200 microgram/ Cap., Tk.
device), 200 microgram/cap., Tk.2.50/Cap. 2.50/Cap.
Brodil (ACI), Resp., Solun., 5 mg/ml , Tk. Salomax (Eskayef), Inhaler, 100 mcg/puff, Tk.
120.36/20 ml ;2.5 mg/2.5 mlTk. TK. 160.00/200 Puff; , Tk.170.51/200puff; Tk.
15.05/2.5ml; Syrup, 2 mg/5 ml Tk. 23/100ml, 195.59/200 puff; Tab, 4mg, Tk. 0.46/Tab.
Tk.14.53/60ml.,Tab.,2 mg , Tk.0.26/Tab.; Sultolin (Square), Inhaler,cap, .,( for use with
4mg., Tk.0.46/Tab., SR.Cap., 8mg, a inhaler device) 200 microgram/CAp, Tk.
Tk.2.42/Cap Inhaler, Cap.,( for use with a 2.51/Cap., Resp., Solun., 5 mg/ml, Tk.
inhaler device)200 microgram./cap, 120.82/20ml.; Syrup, 2 mg/5 ml, Tk. 23/100ml;
Tk.2.51/Cap. Inhaler, HFA 100 microgram/puff Tab., 8 mg, Tk. 0.92/Tab. Inhaler 100
, Tk. 230.02/200 puffs(with device); microgram/puff, Tk.195.59/200puffs ,Tk.
Tk.198.00/200 puffs (without device); 170.51/200 puffs(Refill Pack)
Tk.161.08/200puffs Venol (G.A.Co), Syrup, 8 mg/5ml, Tk.
Broncotrol (Pacific), Syrup, 2mg/5 ml, Tk. 10.78/60 ml
22.93/100ml; Tab., 4mg, Tk. 0.45/Tab. Ventil(Drug Intl), Inhaler, 100microgram/puff,
Decabutamol (Decent), Syrup, 2mg/5ml,, Tk. Tk. 190.00/200 puffs
21.83/100ml Ventisal (Ibn Sina), Syrup, 2 mg/5 ml, Tk.
Dilatol (Kemiko), Syrup, 2 mg/5 ml, Tk. 22.92/100 ml; Tab. , 4 mg, Tk.0.34/Tab.
22.84/100 ml Ventol (Central), Syrup, 2 mg/5 ml, Tk.
G-salbutamol (Gonoshasthaya), Syrup, 15.00/100 ml ;Tk. 10.50/60 ml
2mg/5 ml, Tk. 20.00 /100ml; Tab., 4 mg , Tk. Ventolin (GSK), Tab. , 4 mg, Tk. 0.46/Tab.,
0.46 /Tab.; Resp.Solun, 5mg/ml, Tk. 80/20ml Resp. Solun., 5 mg/ml, Tk. 173.42/20ml; 2.5
mg/2.5 ml, Tk. 23.92/ 2.5ml
178
Ventolin Evohaler(GSK), Inhalation, 100 mcg/ years 10 micrograms/kg to a max. of 300

Puff, Tk. 230.69/200 doses micro-grams
Windel (Incepta), Inhaler ,Cap.,( for use with By aerosol inhalation, ADULT and
a inhaler device )200 microgram/Cap.; Tk.
2.50/Cap. Nebuliser Solun, 2.5 mg/2.5 ml, Tk.
CHILD, 250-500 micrograms (1-2 puffs);
14.00/2.5ml; 5 mg/ml, Tk. 120.00/20 ml; Syrup, for persistent symptoms up to 3-4 times
2 mg/5 ml, Tk. 22.90/100 ml; Tab. , 2 mg, daily
Tk.0.26/Tab.; Tab. , 4 mg, Tk. 0.34/Tab
Zentolin (Zenith), Syrup, 2 mg / 5 ml, Tk.
16.00/100ml; Tk. 10.00/60ml Proprietary Preparations
Samisil (Supreme), Syrup, 1.5mg/5ml, Tk.
SALMETEROL 20.00/100ml; Tab. , 2.50 mg, Tk. 0.50/Tab.
Tervent (UniMed), Syrup, 1.5mg/5ml , Tk.
25.00/100ml; Tab , 2.5mg , Tk. 0.50/Tab.
Indications: Reversible airways
obstructions including nocturnal asthma
and prevention of exercise-induced 4.1.2 ANTIMUSCARINIC
bronchospasm in patients requiring long- BRONCHODILATORS
regular bronchodilator See notes above
Cautions: See under Salbutamol and IPRATROPIUM BROMIDE
above note
Interactions: See Appendix-2 Indications: Relative airways
Side-effects: See under Salbutamol; obstruction, particularly in chronic cases.
significant incidence of paradoxical Cautions: Glaucoma, prostatic
bronchospasm may be clinically hypertrophy, pregnancy
important in severe or deteriorating Side-effects: Dry mouth, urine retention,
asthma constipation
Dose: ADULT & CHILD over 4 years, Dose: By aerosol inhaler, 20-40
by inhalation, 50 micrograms (2 puffs) micrograms in early treatment up to 80
twice daily; CHILD under 4 years not micrograms at a time, 3-4 times daily.
recommended By inhalation of nebulized solution, 100-
Note: Salmeterol is not for immediate 500 micrograms up to 4 times daily.
relief of acute attacks and existing
corticosteroid therapy should not be Proprietary Preparations
reduced or withdrawn G-Ipra (Gonoshasthaya), Resp, Solu., 250
microgram/ml, Tk. 60.00/20 ml
Proprietary Preparations Ipramid (Beximco), Resp.Solun,
Axinat (Acme), Inhaler, 25 mcg/puf, Tk. 250microgram/ml,, Tk.130.00/20 ml
191.29/200 Puff Ipratop (Incepta), Nebuliser Solun 250
Seravent (Drug Intl), Inhaler, 25mcg/puff, Tk. microgram/ml,, Tk. 130.00/20ml
200.00/200 Puff Iprex (Square), Aerosol Inhaler 20 mcg/puff,
Tk. 250.75/200puff,; Resp. Solun., 250
microgram/ml,, Tk. 130.88/20ml
TERBUTALINE SULPHATE Rinase (ACI), Resp.Solun, 250 microgram/ml,,
Tk. 130.39/20ml ,Tk. 14.04/2ml,;
Indications: See under Salbutamol Ipratropium Bromide + Salbutamol
Cautions: See under Salbutamol Combair (ACI), Inhaler, 20 microgram +
100microgram/puff, TK. 230.69/200puff (refill
Interactions: See Appendix-2 pack), TK. 250.75/200puff ,; Resp. Solun,
Side-effects: See under Salbutamol 0.5mg +2.5mg/ml, TK. 226.38/20ml , 0.02gm
Dose: By mouth, initially 2.5 mg 3 times +0.10gm/100ml, TK. 15.05/20 ml
daily for 1-2 weeks, then up to 5 mg 3 Combiver (Healthcare), Inhaler 20 microgram
times daily; CHILD 75 micrograms/kg 3 + 100microgram/Puff Tk. 270.00/200puff
times daily; 7-15 years 2.5 mg 2-3 times Ipralin (Aristo), Inhaler, 20 microgram +
daily 100microgram /puff, Tk. 250.00/200 Puff
Iprasol (Beximco), Inhaler,20 microgram +
By subcutaneous, intramuscular or 100microgram, Tk. 250.00/200 Puff, Tk.
intravenous injection, 250–500 microgr- 230.00/200 Puff (Refil Pack); Resp. Solutn,
ams up to 4 times daily. CHILD 2–15 0.5mg +2.5mg/ml, Tk. 225.00/20ml
179
Salpium (Acme), Resp.,Solutn, 0.5 mg + 2.5 Cautions: Hypertension, hyperthyroi-

mg/2.5 ml, Tk. 15.00/2.5ml, Inhaler , ,20 dism, peptic ulcer, hepatic impairment,
microgram + 100microgram, /puff, Tk. epilepsy, pregnancy and breast-feeding,
250.76/200puff, Tk. 231.55/puff Tk.
230.69/200 puff,
elderly, fever,
Ventil (Drug Intl), Inhaler, 20 microgram + Interactions: See Appendix-2
100microgram /puff, Tk. 250.00/200 Puff Side-effects: Tachycardia, palpitation,
nausea, headache, insomnia,
4.1.3 XANTHINE arrhythmia, hypokalaemia and
BRONCHODILATOR convulsions especially if given by
intravenous injection
Dose: 125 mg 3-4 times daily after food,
AMINOPHYLLINE[ED] increased up to 250 mg if required;
CHILD, 7-12 years 62.5 mg 3–4 times
Indications: Treatment of severe acute daily
attacks of bronchial asthma that do not
respond to a nebulized beta2 Proprietary Preparations
adrenoceptor stimulant Arofil (Incepta), SR Tab., 400 mg, Tk.
Cautions: See under Theophylline 2.98/Tab., 200 mg, Tk. 1.60/Tab., 400mg, Tk.
Side-effects: See under Theophylline Asmacon (Pacific), SRTab., 400 mg, Tk.
2.67/Tab.
Dose: By mouth, initially 100-300 mg
Asmaloc (Sharif), Syrup, 120mg /5ml, Tk.
twice daily for one week, then 200-600 30.00/100ml; SRTab, 400 mg, Tk. 2.98/Tab.,
mg twice daily; CHILD over 3 years, SR,Tab.,300 mg, Tk. 2.35/Tab.
initially 6 mg/kg twice daily, may be Breathlin (Beximco), Tab., 200mg, Tk.
increased after a week to 12 mg/kg 1.60/Tab.
By slow intravenous injection over at Contifil(Square), SR Tab. , 400 mg, Tk.
least 20 minutes, 250-500 mg usually 2.99/Tab.
given in 5% dextrose in aqua or normal Contine (Aristo), CR Tab. , 200mg , Tk.
1.60/Tab., CR.,300mg, Tk. 2.35/Tab.,; CR.,
saline 400mg, Tk. 2.98/3gm Syrup, 120mg/5ml, Tk.
30.95/50ml
Proprietary Preparations G-theophylline (Gonoshasthaya), Syrup, 120
Aminophylline (Ambee) , Tab., 100 mg, Tk. mg/5 ml, Tk. 15.00 /50ml; Tab., 300 mg, Tk.
4.75/Tab; Inj., 125mg/ 5ml, Tk. 5.46/5 ml 1.20 /Tab.
Filin (Opsonin), Tab., 100 mg, Tk. 0.39/Tab.; Jasophylin (Jayson), Syrup, 120mg/5ml, Tk.
Inj., 125 mg /5 ml, Tk. 5.45/5ml 25.17/100ml
Minomal (Pacific), Tab., 175 mg, Tk. Neulyn (Orion), SR Tab., 400mg, Tk.
1.23/Tab.; 350 mg, Tk. 2.20/Tab.; 600 mg, Tk. 2.52/Tab.
3.59/Tab. OD Phylline (Sun), SR Tab., 400 mg, Tk.
2.67/Tab.
THEOPHYLLINE Teolex(ACI), CR.Cap., 300mg, Tk.
3.52/Cap., Cap., 400mg , Tk. 4.25/Cap.,
Tab.,SR 200mg, Tk. 1.50/Tab., SR 300mg,
Theophylline modified-release Tk. 2.01/Tab., SR 400mg, Tk. 2.68/Tab.,
preparations are usually able to produce Syrup, 120 mg/5ml, Tk. 31.04/100ml
adequate plasma concentrations for up Thenglate (Acme), SR Tab., 250 mg, Tk.
to 12 hours. When given as a single 1.76/Tab.;SR Tab., 400 mg, Tk. 2.68/Tab.;
dose at night they have a useful role in Syrup, 120mg/5ml, Tk. 30.95/100 ml
Theofast (Globe), Syrup, 120mg/5 ml, Tk.
controlling nocturnal asthma and early 30.95/100 ml
morning wheezing. Theovent (Drug Intl), SR Tab., 400mg, Tk.
Indications: Theophylline is a 2.70/Tab., SR 200mg, Tk. 1.60/Tab., SR
bronchodilator used for reversible 300mg, Tk. 2.05/Tab.
airways obstruction. It may have an Unikon(Ibn Sina),SR Tab., 400mg, Tk.
additive effect when used in conjunction 2.98/Tab.
with small doses of beta 2 adrenoceptor Unilin (Opsonin),CR Tab., 200 mg , Tk.
1.60/Tab., CR 300 mg , Tk. 2.35/Tab., CR 400
stimulants , severe asthma mg, Tk. 2.99/Tab., Syrup, 120 mg/5 ml, Tk.
15.30/ 50 ml ; Tk. 30.95/ 100 ml
180
4.2 CORTICOSTEROIDS Dose: By aerosol inhalation, standard

dose inhalers, 200 micrograms twice
Corticosteroids are very effective in daily or 100 micrograms 3-4 times daily;
asthma. They reduce airways CHILD 50-100 micrograms 2–4 times
inflammation (and thus reduce oedema daily
and secretion of mucus into the airway). By aerosol inhalation, high dose inhalers
INHALATION. Inhaled corticosteroids 500 micrograms twice daily or 250
are recommended for prophylactic micrograms 4 times daily; if necessary
treatment of asthma when patients are may be increased 500 micrograms 4
using a beta 2-adrenoceptor more than times daily
once daily. Corticosteroid inhalation
must be used regularly to obtain Proprietary Preparations
Ascon(Acme), Inhaler, 100microgram/puff, Tk.
maximum benefit; alleviation of
270.81/200puff,; 250microgram/puff , Tk.
symptoms usually occurs 3 to 7 days 320.96/200puff
after initiation. Beclomethasone Azbec (Eskayef) Inhaler ,100 microgram/puff,
Dipropionate, Budesonide and Tk. 270.00/200puff.; 250microgram/puff, Tk.
Fluticasone propionate appear to be 320.00/200puff
equally effective. Beclocort (Aristo),Inhale,r100 microgram/Puff
AEROSOL INHALATION. Corticost- Tk. 270.00/200puff
Beclomin (Square), Inhaler,, 100
eroids are preferably inhaled from
microgram/puff, Tk. 270.82/200 Puffs ; 250
aerosol inhalers using large-volume microgram/puff, Tk. 320.96/200 Puffs
spacer devices, particularly if high doses Becovent (Drug Intl), Inhaler,
are required. Budesonide is also 100microgram/puff, Tk. 250.00/200dose
available as a suspension for Decomit (Beximco), Inhaler, 100
nebulization. Corticosteroids May also microgram/puff, Tk. 270.00/200 puffs ;50
be taken orally or parenterally. Inhaled microgram/puff, Tk. 220.00/200 puffs
Steradin (ACI), Inhaler, 100microgram/puff ,
corticosteroids have considerably fewer
Tk. 271.84/200 Puffs ; 250microgram/puff Tk.
systemic side-effects than oral 352.38/200 Puffs
corticosteroids.
ORAL. Acute attacks of asthma should
BUDESONIDE
be treated with short course of oral
corticosteroids starting with high dose,
e.g. prednisolone 30–60 mg daily for a Indications: Chronic asthma not
few days, gradually reducing once the controlled by short acting beta2-
attack has been controlled. stimulants
PARENTERAL.Hydrocortisone injection Cautions: Active or quiescent
is used in the emergency treatment of tuberculosis, systemic thrapy may be
acute severe asthma (see Table 4B). required during periods of distress or
when airways obstruction or mucus
prevent drug access to smaller airways
BECLOMETHASONE DIPROPIONATE
Side-effects: Hoarseness and
(Beclometasone Dipropionate) candidiasis of mouth or throat
Dose: By aerosol inhalation, standard
Indications: Treatment of airway dose inhalers, 200-400 micrograms
inflammation in chronic asthma twice daily, in severe asthma dose may
Cautions: Active or quiescent be increased to 800 micrograms twice
tuberculosis, systemic therapy may be daily; CHILD, 50-200 micrograms twice
required during periods of stress or when daily, in severe cases may be increased
airways are obstructed or mucus prevent to 400 micrograms twice daily
drug access to smaller airways By inhalation of powder, 200-800
Side-effects: Hoarseness and micrograms daily, in severe asthma may
candidiasis of mouth or throat; rarely be up to 1600 micrograms daily in
hypersensitivity reactions including rash divided doses; CHILD, 200-800
and angioedema
181
micrograms daily in divided doses in Cautions: See Beclomethasone

severe asthma Side-effects: See Beclomethasone
Dose: By inhalation, ADULT & CHILD
Proprietary Preparations over 16 years, 100 to 250 micrograms
Aeronid (Beximco), Inhaler, 200 twice daily, increased according to
microgram/Puff, Tk. 410.00/120 MD severity of asthma to up to 1 mg twice
Budicort (Incepta), Nebuliser Susp., daily. CHILD 4-16 years, 50-100
0.5mg/2ml Amp, Tk. 40.00/2ml Amp
micrograms twice daily adjusted as
Formoterol fumarate + Budesonide necessary
Budemet (Incepta), Inhaler, Cap., 6
microgram+100 microgram , Tk. 7.00/Cap.; 6 Proprietary Preparation
microgram+200 microgram , Tk. 9.00/Cap.; 12 Flomyst (Beximco), Resp. Suspn., 2mg/2ml,
microgram+400 microgram Tk. 14.00/Cap. Tk. 70.00/2 ml,; 0.5mg/2ml, Tk. 40.00/2 ml
Budison (Aristo), Inhaler, 4.5 microgram + 80 Fluticon (Acme), Inhaler. Cap. , 0.25 mg., Tk.
microgram, Tk. 400.00/60puff.;4.5 microgram 8.07/Cap. ; 0.50 mg., Tk. 13.09/Cap.
+ 160 microgram, Tk. 500.00/60puff. Lutisone (Incepta), Nebuliser,Solun 2mg/2ml,
Bufocort (Square), Inhaler,Cap12 microgram Tk. 100.00/2 ml; 0.5mg/2ml, Tk. 45.00/2 ml
+ 400 microgram , Tk. 14.05/Cap.; 6
microgram + 200 microgram , Tk. 9.03/Cap
4.3 COMBINED THERAPY
Symbion (Beximco), Inhaler, Cap. , 6
microgram + 0.1 mg, Tk. 9.00/Cap, Cap. , 6
microgram + 0.2 mg, Tk. 12.00/Cap. SALMETEROL plus FLUTICASONE
Oxycort (ACI), Inhaler, 4.5 microgram +
80microgram/ puff , Tk. 601.80/ 120puff,
4.5microgram+ 160microgram/puff , Tk. Indication: Chronic asthma not
802.41/120puff ; controlled by long acting beta2-agonist
(Inhaler,Cap are use with a device) or corticosteroid individually
Cautions: See Fluticasone & Salmeterol
CICLESONIDE Side-effects: See Fluticasone and
Salmeterol
Indications: Asthma and allergic rhinitis Dose: Poduct is available in different
Side effects: Headache, burning or fixed combinations of salmeterol and
irritation in the nose, painful white fluticasone propionate to meet individual
patches in nose or throat,flu-like requirements as CFC Free aerosol
symptoms, rash, itching, hoarseness inhaler (Evohaler) and Dry Powder for
Contraindications: Allergy to inhalation (Accuhaler)
ciclesonide aerosol; recent open sore in ADULT & CHILD over 12 years, 1
nose, nasal surgery, or a nasal injury aerosol inhalation (Accuhaler) or 2 dry
and it has not healed yet. powder inhalations (Evohaler) twice daily
Dose: By aerosol inhalation, 160 as per severity of asthma
micrograms daily as a single dose
reduced to 80 micrograms daily if control Proprietary Preparations
Aroflo(Aristo), Inhaler ,
maintained; dose may be increased to 25 microgram + 250microgram/Puff, Tk.
max. 320 micrograms twice daily. 795.00/120puff ,Tk. 430.00/200puff .,25
microgram +125microgram/Puff, Tk.
Proprietary Preparations 595.00/Can
Cesonide (Beximco), Inhaler, 160 mcg/puff, Arotide (Eskayef), Inhaler , 25 microgram +
Tk. 375.00/120 dose 250 microgram/puff, Tk. 795.00/ 120dose;25
Ezonide (Square), Inhaler, 80 mcg/puff, Tk. microgram + 125 microgram/puff, Tk.
275.00/120 Puffs ;160 mcg/puff, Tk. 595.00/120dose
375.00/120 Puffs Bexitrol (Beximco), Inhaler, 25 microgram +
125 microgram/puff, Tk. 595.00/120 doses ;
25 microgram + 250 microgram/puff, Tk.
FLUTICASONE PROPIONATE 750.00/120doses;
Indication: Chronic asthma not Tk. 430.00/60doses, 25 microgram + 50
controlled by short-acting beta2- microgram/puff, Tk. . 520.00/120doses
stimulants Inhaler, Cap.,50mirogram +100microgram
182
Tk. 6.50/Cap. 50 microgram.,+ 250 microgram Cap.,(for use with a device), 50 microgram +
Tk. 12.00/Cap + 50 microgram + 500 microgram, Tk. 15.05/Cap., 50 microgram
500microgram,Tk.17.00/Cap.; + 250microgram , Tk. Tk. 9.23/Cap.; 50
Flumetol(Healthcare), Inhaler,Cap., 50 microgram + 100microgram , Tk. 4.86/Cap.
microgram +100 microgram , Tk. 6.00/Cap.;
Tk.420.00/Cap.(Cap+device)
50microgram+250microgram, Cap Tk.
10.67/Cap .,Tk.560.00/Cap. (Cap+device); 4.4 CROMOGLYCATES ,
Inhaler, 25 microgram +125 microgram RELATED THERAPY AND
Tk.640.00/120Puffs,; 25 microgram +250 mg, LEUKOTRIENE RECEPTOR
Tk. 850.00/Puffs ANTAGOSISTS
Flutisal (Incepta),Inhaler, Cap., (for use with a 4.4.1 CROMOGLYCATES
inhaler device) 50 microgram + 100
4.4.2 RELATED THERAPY
microgramTk. 5.00/Cap. ; 50 microgram + 250
microgram, Tk. 12.00/Cap. ; 50 microgram + 4.4.3 LEUKOTRIEN RECEPTOR
500 microgram, Tk.15.00/Cap. ANTAGONISTS
Salflu (Acme), Inhaler ,Cap., (for use with a 4.4.4 Phosphodiesterase type-4
inhaler device), 50 microgram + 250 inhibitors
microgram, Tk. 10.50/Cap.; 50 microgram +
100 microgram, Tk. Tk. 6.50/Cap.; .; 50 4.4.1 CROMOGLYCATES
microgram + 500 microgram, Tk. 16.00/Cap.;
Inhaler, SODIUM CROMOGLYCATE
25microgram + 125 microgram/puff, Tk.
596.79/can; 25 microgram + 250
microgram/puff, Tk. 797.39/120dose Indications:Prophylaxis of asthma; food
25 microgram + 50 microgram/puff, Tk. allergy; allergic conjunctivitis; allergic
521.57/can rhinitis
Seretide Accuhaler(I)(GSK), Inhaler, disk 50 Side-effects: Coughing, transient
microgram +100 microgram, Tk. 1086.51/60 bronchospasm, and throat irritation due
doses,; 50 microgram +250 microgram, Tk.
1136.00/60 doses 50 microgram + 500
to inhalation of powder
microgram, Tk. 1,240.50/60 doses Dose: By aerosol inhalatiion, ADULT
Seretide Evohaler (I)(GSK), Inhaler, 25 and CHILD, 10 mg (2 puffs) 4 times
microgram + 125 microgram, 1357.00/120 daily, increased in severe cases or
doses; during periods of risk to 6–8 times daily;
Ticamet (Square), Inhaler 25 microgram + additional dose may also be taken
250 microgram/ puff, Tk.; before exercise; maintenance 5 mg (1
797.39/120puff 25 microgram + 125
microgrampuff, Tk. 596.79/120puff; Cap.,(for
puff) 4 times daily
use with a inhaler device) 50 microgram + 100 By inhalation of nebulised solution,
microgram, Tk. 6.52/Cap.; 50microgram + 250 ADULT & CHILD 20 mg 4 times daily,
microgram, Tk. 12.03/Cap. increased in severe cases up to 6 times
Protide(UniMed), Inhaler,Cap., 50microgram+ daily
100 microgram, Tk. 6.50/Cap,50 Note:Sodium cromoglycate is of value in
microgram+250 microgram, Tk. 12.00/Cap; the prevention of exercise-induced
50microgram+500microgram, Tk. 17.00/Cap.;
Inhaler,25 microgram, +125 microgram, Tk.
asthma, a single dose being inhaled half-
595.00/120puffs. an-hour before. It is not effective in acute
25 microgram+ 250 microgram, Tk. asthma
795.00/120puffs
Seraflo(Drug Intl), Inhaler, 25microgram+ 125 Proprietary Preparations
microgram Tk. 575.00/120 Puff,; 25 (For ENT preparationSee section 11.2)
microgram + 250 microgram, Tk.
780.00/120puff
NEDOCROMIL SODIUM
Seroxyn (ACI), Inhaler, 25microgram + 250
microgram/Puff , Tk. Tk.755.09/120puffs
Tk.700.00/120puffs (Refill Pack); 25 Indication: Prophylaxis of asthma
microgram + 125 microgram/Puff, Tk. Side-effects: See under sodium
596.79/120 puffs , Tk. 578.91/120puffs, cromoglycate; also nausea, vomiting,
Tk.500/10puff (Refill Pack); 25 microgram + 50 dyspepsia, headache, abdominal pain,
microgram/Puff , Tk. 528.56/120puffs
bitter taste
Tk.520.00/120Puffs (Refil Pack);Inhaler ,
183
Dose: By aerosol inhaler, ADULT and Ketocure (Benham), Syrup, 1 mg/5 ml, Tk.
CHILD over 6 years, 4 mg (2 puffs) 4 50.00/100ml; Tab., 1 mg, Tk. 2.00/Tab.
times daily; when control achieved, may Ketof (Ibn Sina), Syrup, 1 mg/5 ml, Tk.
55.00/100ml,; Tab., 1 mg, Tk. 250.00/Tab.
reduce to twice daily Ketomar (Incepta), Syrup, 1 mg/5 ml, Tk.
50.00/100ml,; Tab., 1 mg, Tk. 2.00/Tab.
Generic Preparation Ketopac (Pacific), Syrup, 1 mg/5 ml, Tk.
Aerosol inhalation, 2mg/metered dose 40.00/100ml.; Tab., 1 mg, Tk. 2.00/Tab.
Ketorif (Biopharma), Syrup, 1 mg/5 ml, Tk.
4.4.2 RELATED THERAPY 52.00/100ml,; Tab., 1 mg, Tk. 2.25/Tab.
Kofen (Opsonin), Tab. , 1 mg, Tk. 2.00/Tab. ;
Syrup, 1 mg/5 ml, Tk. 45.13/ 100 ml
Antihistamines are of no value in the Ktin(Kemiko), Syrup, 1 mg/5 ml, Tk.
tretment of bronchial asthma. Ketotifen 50.14/100ml ,; Tab., 1 mg, Tk. 2.00/Tab.
is an antihistamine with an action said to Minia (Novo Health), Syrup, 1 mg/5 ml, Tk.
resemble that of Sodium cromoglycate, 45.00/100ml
but it has not proved encouraging. Orotifen (General), Syrup, 1 mg/5 ml, Tk.
40.12/100ml,; Tab., 1 mg, Tk. 1.51/Tab.
Prosma (ACI), Syrup, 1 mg/5 ml,
KETOTIFEN 55.00/100ml ,;Tab., 1 mg, Tk. 2.50/Tab.
S-Kit (Sharif), Syrup, 1 mg/5 ml, Tk.
Indications: See notes above 45.13/100ml ,; Tab., 1 mg, Tk. 2.00/Tab.
Cautions: Previous anti-asthmatic Stafen (Aristo), Syrup, 1 mg/5 ml, Tk.
55.00/50ml,100ml,200ml,; Tab., 1 mg, Tk.
treatment should be continued for a 2.50/Tab.
minimum of 2 weeks after initiation of Tifen (Somatec), Tab., 1 mg, Tk. 2.00/Tab.;
ketotifen treatment; pregnancy and Syrup, 1 mg/5 ml, Tk. 45.00/100ml
lactation Tofen (Beximco), Syrup, 1 mg/5 ml, Tk.
Side-effects: Drowsiness, dry mouth, 55.00/100ml,; Tab., 1 mg, Tk. 2.50/Tab.
slight dizziness; CNS stimulation Toma (Navana), Syrup, 1 mg/ 5 ml, Tk.
30.00/50ml; Tk. 50.00/100ml; Tab.,1 mg, Tk.
2.00/Tab.
Dose: ADULT: 1 mg twice daily with Toti (Eskayef), Syrup, 1 mg/5 ml, Tk.
food increased if necessary to 2 mg 55.00/100ml,; Tab, 1 mg, Tk. 2.50/Tab.
twice daily; initial treatment in readily Totifen (Renata), Syrup, 1 mg/5 ml, Tk.
sedated patients 0.5-1 mg at night; 45.00/100ml,; Tab. , 1 mg, Tk. 2.00/Tab.
CHILD over 2 years 1 mg twice daily Zadifen (UniMed), Tab , 1 mg, Tk. 1.50/Tab.;
Syrup , 1 mg/5 ml, Tk. 35.00/100ml
Zadit (Popular), Tab. , 1 mg, Tk. 1.51/Tab.;
Syrup, 1 mg/5 ml, Tk. 40.15/100ml
Aerofen (Silva), Syrup, 1 mg/5 ml, Tk.
45.00/100ml , Tab. , 1 mg, Tk. 1.51/Tab.
Airnaaf (Naafco), Syrup, 1 mg/5 ml, Tk. 4.4.3 LEUKOTRIENE RECEPTOR
50.00/100ml ANTAGONISTS
Alafen (Supreme), Syrup, 1 mg/5 ml, Tk.
40.00/100ml,; Tab., 1 mg, Tk. 1.50/Tab.
Alarid (Square), Syrup, 1 mg/5 ml, Tk. MONTELUKAST
55/100ml,; Tab. , 1 mg, Tk. 2.50/Tab.
Allerkit (Monico), Syrup, 1 mg/5 ml, Tk. Indication: Prevention of asthma or anti
40.00/100ml inflammatory
Asfen (Virgo), Syrup, 1 mg/5 ml, Tk.
Cautions: Pregnancy and lactation
45.00/100ml
Asmafen (Globe), Syrup, 1 mg/5 ml, Tk. Side-effects: Gastrointestinal disturba-
50.00/100ml,; Tab. , 1 mg, Tk. 2.00/Tab. nces, dry mouth, dizziness, irritability,
Broket (Orion), Syrup, 1 mg/5 ml, Tk. restlessness,
45.00/100ml,; Tab. , 1 mg, Tk. 1.52/Tab. Dose: ADULT 10 mg daily at bedtime.
Fenat (Drug Intl), Tab., 1 mg, Tk. 2.05/Tab. ; CHILD 2-5 years 4 mg daily at bedtime,
Syrup, 1 mg/5 ml, Tk. 45.00/100ml, Tk. 6-14 years 5 mg daily at bedtime
75.00/200ml,;
Kefton (Zenith), Syrup, 1 mg/5 ml, Tk.
40.00/100ml,; Tab., 1 mg, Tk. 1.15/Tab. Proprietary Preparations
Ketifen (Acme), Syrup, 1 mg/5 ml, Tk. Aeron (Healthcare), Tab., 5mg, Tk. 8.00/Tab.;
50.00/100ml,; Tab., 1 mg, Tk. 2.00/Tab. 4mg , Tk. 6.00/Tab.; 10mg , Tk. 15.00/Tab.
184
Aeron FT (Healthcare), Tab., 4 mg,Tk. 6/Tab.; Monovas (White Horse),Tab.,10 mg, Tk.
5 mg, Tk. 8/Tab.; 10 mg, Tk. 15/Tab. 12/Tab.
Airway (One Pharma), Tab., 10 mg , Tk. Monprox (Rangs), Tab., 10 mg, Tk. 15/Tab.; 5
15.00/Tab.; 5 mg , Tk. 7.95/Tab. mg, Tk. 7.50/Tab.;
Amekast (Beacon), Tab. , 10mg , Tk. Montair (Incepta), Tab., 10 mg, Tk. 15/Tab.;
15.05/Tab.; 4mg , Tk. 6.02/Tab.; 5mg , Tk. 4mg, Tk.6/Tab. ; 5 mg, Tk. 8/Tab.
8.02/Tab. Montek (Sun), Tab.,10 mg, Tk. 15/Tab.; 4 mg,
Amikast (Amico), Tab., 10mg , TK. Tk. 6/Tab.
15.00/Tab.; 5mg, TK. 8.00/Tab. Montekast (Pacific), Tab.,10 mg, Tk.
Arokast (Navana), Chewable Tab., 4 mg, Tk. 15.00/Tab.,5 mg, Tk. 7.00/Tab.
7.00/Tab.; Tab. , 10 mg, Tk. 15.00/Tab.; 4 mg, Montela (Delta), Tab. , 10 mg, Tk. 10.00/Tab.;
Tk. 6.00/Tab.; 5 mg , Tk. 8.00/Tab. Tab. , 5 mg, Tk.6.00/Tab.
Arovent (Orion), Tab. , 10 mg, Tk. Montelon (Apex), Tab. , 10 mg, Tk.
15.04/Tab.; 5 mg, Tk. 8.02/Tab. 15.00/Tab.
Asmatab (Veritas), Tab., Tk. 10/Tab. Monteluk (Astra Bio), Tab. , 10 mg, Tk.
Asmont (Somatec), Tab., 4 mg, Tk. 6.00/Tab.; 15.00/Tab. ; 5 mg, Tk. 8.00 /Tab.
5 mg, Tk. 7.00/Tab.; 10 mg, Tk. 12.00/Tab. Montemax(Doctor TIMS), Tab. , 10 mg,
Brocast (Concord), Tab.,10 mg, Tk.15/Tab. Tk.16.00/Tab.; 5 mg, Tk. 8.00/Tab.
Croma (Sharif), Tab., 4 mg, Tk. 6.01/Tab. ; 5 Montenaaf (Naafco), Tab. , 10 mg, Tk.
mg, Tk. 8.03/Tab. ; 10 mg, Tk. 12.03/Tab. 14.00/Tab.
Ezair (Novo), Tab.,10 mg, Tk. 15.00/Tab. Montene (Square), Chewable Tab. , 4 mg,
Ezevent (SMC Enterprise), Tab., 10 mg, Tk. Tk. 6.02/Tab. ; 10 mg, Tk. 15.05/Tab. ; 5 mg,
10.00/Tab. Tk. 8.03/Tab.
Flomont (Nipa), Tab., 10 mg, Tk. 12.00/Tab. Montex(Ibn Sina), Tab. , 10mg, Tk.
Freegest (Biopharma), Tab., 10mg , Tk. 16.00/Tab.; 5mg, Tk. 8.00/Tab.;
15.00/Tab.; 4mg , Tk. 6.00/Tab.; 5mg , Tk. Montica (Euro), Tab., 4 mg, Tk. 6.00/Tab. ;
8.00/Tab. 10 mg, Tk. 14.00/Tab. ; 4 mg, Tk. 8.00/Tab.
Liam (Asiatic), Tab., 5mg , Tk. 8.00/Tab.; Monti Fast (Globe), Tab. , 10 mg, Tk.
10mg , Tk. 12.50/Tab. 15.00/Tab.; 4 mg, Tk. 7.00/Tab.; 5 mg, Tk.
Lumenta (Novartis), Tab, 10 mg, Tk. 16/Tab.; 7.50/Tab.
Tab., 5 mg, Tk. 9/Tab. Montilab(Labaid), Tab.,10 mg, Tk. 15/Tab.
Lumona (Eskayef), Powder, 4mg, Tk. Montilet (Amulet), Tab., 10 mg, Tk. 15/Tab.
8.00/Sachet,;2mg, Tk. 6.00/Sachet.;Tab, Montiluk(Rephco), Tab., 10 mg, Tk. 15/Tab.;
10mg, Tk. 12.00/Tab.; Tab, 4 mg, Tk. 4 mg, Tk. 6/Tab.
5.99/Tab.; 5mg, Tk. 7.00/Tab.; 10mg , Tk. Montiva (NIPRO JMI), Tab., 10 mg, Tk.
10.00/Tab. 15.00/Tab.; 4 mg, Tk. 6.00/Tab.; 5 mg, Tk.
Maxair (Julphar), Tab., 10 mg, Tk. 15/Tab.; 8.00/Tab.
Tab., 5 mg, Tk. 8/Tab. Montril (Aristo), Tab., 10mg , Tk. 15.00/Tab. ;
Medikast (Leon), Tab.,10 mg, Tk. 15/Tab. 5mg , Tk. 8.00/Tab.; 4mg , Tk. 7.00/Tab.
Metok (MST), Tab., 10 mg, TK. 13.00/Tab. Nozma (Organic), Tab. , 10 mg, Tk.
M-Kast (Drug Intl), Tab., 10mg, Tk. 13/Tab., 10.00/Tab.
4mg, Tk. 5.05/Tab., 5mg, Tk. 7.05/Tab. Odmon (Renata), Tab., 10 mg, Tk. 15/Tab. ;
M-Lucas (Popular), Tab. , 5 mg, Tk. Tab., 10 mg, Tk. 15/Tab.; 5 mg, Tk. 8/Tab.
8.00/Tab.; 4 mg, Tk. 6.00/Tab.; 10mg, Tk. Provair (UniMed), Powder, 4mg, Tk.
15.00/Tab. 8.00/Sachet,; Tab , 5mg, Tk. 8.00/Tab.; 10mg
Mokast(Alco), Tab. , 10 mg, Tk. 10.03/Tab.; , Tk. 15.00/Tab.; 4mg, Tk. 6.00/Tab.
4 mg, Tk. 6.02/Tab. Pulmont (Nuvista), Tab., 5 mg, Tk. 8.00/Tab.;
Molukat (Kemiko), Tab., 10 mg, Tk. 10 mg, Tk. 15.05/Tab.
12.04/Tab. ; 5 mg, Tk. 8.00/Tab. ; 4 mg, Tk. Recast (Monico), Tab., 10mg, Tk. 15.00/Tab.;
6.02/Tab. 4mg, Tk. 6.00/Tab.; 5mg, Tk. 8.00/Tab.
Mon (Benham), Tab., 10 mg, Tk. 15.00/Tab.; 5 Reversair (ACI), Tab., 10 mg , Tk. 15.06/Tab;
mg, Tk. 8.00/Tab. 4 mg , Tk. 7.03/Tab.; 5 mg , Tk. 8.03/Tab.
Monalast (Ziska), Tab. , 10 mg, Tk. SB-Monec (Sunman-Bardem), Tab.10 mg, Tk.
15.00/Tab.; 5 mg, Tk. 8.00/Tab. 15.00/Tab.
Monas (Acme), Tab. , 4 mg, Tk. 6.04/Tab. ; Tab., 5 mg, Tk. 7.50/Tab.
10 mg, Tk. 15.05/Tab. . 5 mg , Tk. 8.07/Tab. Tekast (Team), Tab., 5 mg, Tk. 7.00/Tab.; 10
Monkast (Pharmasia), Tab. , 10 mg, Tk. mg, Tk. 14.00/Tab.
14.50/Tab.; 5 mg, Tk. 7.50/Tab. Telukast (General), Tab., 4mg, Tk.
Monkon (Albion), Tab. , 4 mg, Tk. 7.00/Tab. 5.52/Tab.; 10mg, Tk. 5.00/Tab.; 5mg, Tk.
Monocast (Beximco), Powder, 4mg, Tk. 7.56/Tab.
8.00/Sachet,; Tab., 10mg, Tk. 15.00/Tab.;
4mg, Tk. 6.00/Tab.; 5mg, Tk. 8.00/Tab.
185
Trilock (Opsonin), Powder, 4 mg , Tk. It is particularly helpful to measure the

8.06/Sachet,; 10 mg, Tk. 15.10/Tab. ; 4 mg , peak flow for patients who are ‘poor
Tk. 6.04/Tab. , Tab., 5 mg, Tk. 8.03/Tab. perceivers’ and hence slow to detect
Xyflo (Radiant), Tab., 5mg, Tk. 10.00/Tab.;
10mg, Tk. 16.00/Tab
deterioration in their asthma, and for
those with moderate or severe asthma.
Patients must be given clear guidelines
4.4.4 Phosphodiesterase type-4 as to the action they should take if their
inhibitors peak flow falls below a certain level.
ROFLUMILAST NEBULISERS
Indication: As an adjunct to A nebuliser is a converter of a solution of

bronchodilators for the maintenance a drug into an aerosol for inhalation to
treatment of patients with severe chronic deliver higher doses of drugs to the
obstructive pulmonary disease airways than is usual with standard
associated with chronic bronchitis and a inhalers.The main purpose for use of
history of frequent exacerbations. nabuliser are:
Cautions: Should not be used for the  To deliver beta-adrenoreceptor
treatment of a sudden attack of stimulant or Ipratropium to a patient
breathlessness ;weight should be with an acute exacerbation of asthma.
monitored regularly ;should be given with  To deliver the drugs on regular basis
caution in patients with severe to a patient with severe asthma.
immunological diseases severe acute The proportion of a nebuliser solution
infectious diseases cancer, severe that reaches the lungs depends on the
impairment of the heart function; hepatic type of nebuliser. It can be as higher as
impairment ;Pregnancy and Breast- 30%, it is more frequently close to 10%
feeding and sometimes below 10%.
Side-effects: Weight decrease, JET NEBULISERS. Most jet nebulisers
decreased appetite, sleeplessness, require an optimum gas flow 6-8
headache, diarrhoea, nausea, stomach litre/minute and in hospital can be driven
ache by piped air or oxygen.
Dose: ADULT over 18 years, NEBULISER DILUENT. Nebulisation
500micrograms once daily may be carried out using an undiluted
nebuliser solution or it may require
Proprietary Preparations dilution beforehand. The usual diluent is
Adair(ACI), Tab., 500microgram, Tk. 15/Tab. sterile sodium chloride 0.9%.
Dilarof (UniMed), Tab , microgram Tk.
20.00/Tab.
Lumast (Square), Tab. , 500 microgram, Tk. 4.6 OXYGEN THERAPY IN
15.05/Tab. ASTHMA AND COPD
Milast(Acme), Tab. , 500 microgram, Tk.
15.04/Tab.
Oxygen should be regarded as a drug. It
Roflast (Beacon), Tab. , 500 microgram, Tk.
15.05/Tab. is prescribed for hypoxaemic patients to
Roflu (Eskayef), Tab, 500 microgram, Tk. increase alveolar oxygen tension and
15.00/Tab. decrease the work of breathing
Rofumil (Drug Intl), Tab., 500 microgram, Tk. necessary to maintain a given arterial
10.05/Tab. oxygen tension.
Roxair (Incepta), Tab. , 500 microgram, Tk. HIGH CONCENTRATION OXYGEN
15.00/Tab.
THERAPY. In acute severe asthma, the
arterial carbon dioxide (pCO2) is usually
4.5 PEAK FLOW METERS, sub normal, but as asthma deteriorates it
AND NEBULISER may rise steeply, particularly in children.
These patients require high
PEAK FLOW METERS concentration of oxygen, and 35% to
186
50% oxygen delivered through a 700g; prophylaxis of respiratory distress

conventional mask is recommended. If syndrome in preterm neonates less than
arterial carbon dioxide (pCO2) remains 32 weeks post-menstrual age
high despite other treatment, intermittant Cautions: Consult product literature
positive pressure ventillation may be Side-effects: Pulmonary surfactants
needed urgently. Acute asthma with long have been associated with intracranial
history of chronic bronchitis and haemorrhage. Bradycardia, pulmonary
probable respiratory failure may require haemorrhage, hyperoxia and obstruction
a lower concentration (24% to 28%) of the endotracheal tube by mucous
oxygen to limit oxygen induced reduction secretions have also been reported.
of respiratory drive. Dose:Consult Physician and product
LOW CONCENTRATION OXYGEN literature
THERAPY. Controlled low concentration
oxygen therapy is reserved for patients Proprietary Preparations
with ventilatory failure due to chronic Survanta (I) (AbbVie) A Suspension, beractant
obstructive plumonary diseases (COPD) providing phospholipid 25mg/ml, with lipids
or other causes. In such cases, the and proteins, Tk.33000/8ml vial; 27500/4ml
vial
oxygen concentration should not exceed
28% and in some patients a concen-
tration above 24% may be exessive. The 4.8 COUGH PREPARATIONS
aim is to provide the patient with just
enough oxygen to improve hypoxaemia The use of cough suppressants
without worsening pre-existing carbon containing codeine or similar opioid
dioxide retention and respiratory cough suppressants is not generally
acidosis. Treatment should be initial in recommended in children and should be
hospital as repeated. avoided altogether in those under 1 year
INTERMITTENT OXYGEN THERAPY. of age.
Oxygen is occasionally prescribed for
episodes of hypoxaemia of short AMBROXOL HYDROCHLORIDE
duration, for example in asthma and in
chronic COPD to ease discomfort of Indications : Acute & chronic diseases
breathing. It is important, however, that of respiratory tracts associated with
the patient does not rely on oxygen viscid mucus including acute and chronic
instead of obtaining medical help or bronchitis; Asthmatic bronchitis;
taking more specific treatment. Oxygen Bronchiectasis,
is supplied through refillable cylinders. Cautions: It should be given cautiously
Oxygen flow can be controlled with to patients with gastric or duodenal
attached oxygen flow meter (2-4 l/min). ulceration, hepatic and renal impairment
PORTABLE OXYGEN CYLINDERS. Contraindications: Contraindicated in
Bangladesh Oxygen Company (BOC) known hypersensitivity to ambroxol or
supplies portable oxygen cylinders which bromhexine
have bull-nose fittings as nomal Interactions: See Appendix -2
domiciliary headsets. The cylinder holds Side-effects: Epigastria pain, gastric
about 300 litres of oxegen which last fullness may occur occasionally
approximately 2 hours at a standard flow Dose: 10 years & ADULT 10ml (2
rate of two litres/minute. teaspoonful) 3 times a day; 5-10 yrs.
CHILD 5ml (1 teaspoonful) 2-3 times a
4.7 PULMONARY SURFACTANTS day
BERACTANT Proprietary Preparations

Acorex (Apex),Syrup,15mg/5ml,Tk.40/100 ml
Acticol (GSK), Syrup 15 mg/5 ml, Tk.
Indications: (specialist use only); 35.19/100 ml
Treatment of respiratory distress Adebrox (Supreme), Syrup, 15 mg / 5 ml., Tk.
syndrome in preterm neonates over 40.00/100ml
187
Ambix (Modern), Syrup, 15 mg / 5 ml., Tk. Femex (Globe), Syrup, 15 mg /5 ml, Tk.
40.00/100ml 40.00/100 ml
Ambolin (Virgo), Paed. drops, 6mg/ml Tk. Hybrox(Kemiko), syrup, 15 mg / 5 ml, Tk.
40.00/15ml,; Syrup, 15 mg / 5 ml.,Tk. 40.12/100ml,; Paed. drops, 6 mg / ml, Tk.
40.00/100ml 30.09/15ml
Ambolyt (Incepta), Paed. drops, 6mg/ml, Tk. Leucofil (Leon), Syrup, 15mg/5ml, Tk.
30.00/15ml,; Syrup, 15mg/5ml, Tk. 40.00/100 ml
40.00/100ml, Tk. 75.00/200ml Lytex (Ibn Sina), Syrup, 15mg/5ml, Tk.
Ambosil (Silva), Syrup, 15mg/5ml, Tk. 50.00/100ml,; SR Cap., 75mg, Tk.
40.00/100ml 165.00/Cap.; Pead.drop, 6 mg/ml, Tk.
Amboten (Eskayef), Syrup, 15mg/5ml, Tk. 35.00/15ml
45.00/100ml; Paed. drops, 6mg/ml, Tk. M Boss (Central), Syrup, 15mg/5ml,
35.00/15ml Tk.40.00/100 ml
Ambozin (Rephco), Syrup, 15mg/5ml, Tk. Maxof (MST),Syrup,15mg/5ml, Tk. 40/100 ml
40/100 ml; SRCap. 75 mg, Tk. 5/Cap. Mbroxol (Benham), Syrup, 15 mg/5 ml, Tk.
Ambronaaf (Naafco), Syrup, 15mg/5ml ml, Tk. 40.00/100ml
40.00/100ml Mucobrox (Somatec), Syrup, 15mg/5ml,
Ambronil (Orion), Syrup, 15 mg/ 5 ml Tk. Tk.40.00/100 ml; Paed. drops, 6 mg/ ml, Tk.
40.12/100ml,; Paed. drops, 6 mg / ml, Tk. 30.00/15ml
25.05/15ml Mucosol (Beximco), Syrup, 15mg/5ml,
Ambrosol (Popular), Syrup, 15 mg/ 5 ml, Tk. Tk.40.00/100 ml; Paed. drops, 6 mg/ ml, Tk.
40.00/100ml 30.00/15ml
Ambrotil(Amico), Syrup, 15mg/5ml, TK. Mucovan (Ad-din), Syrup, 15mg/5ml, Tk.
40.00/100ml 30.00/100 ml
Ambroton (Organic), Syrup, 15 mg/5ml, Tk. Mukofix (Asiatic), Syrup, 15mg/5ml, Tk.
40.13/100ml 30.00/100ml
Ambrox(Square), Syrup, 15 mg/5 ml, Tk. Mutex, (Astra Biopharma), Syrup, 15 mg/5 ml,
45/100ml,; Paed. drops, 6 mg/ml,Tk. 35/15ml,; Tk. 40.00/100ml
SR Cap., 75 mg, Tk. 5.50/Cap. Myrox (ACI), Syrup, 15mg/5ml, Tk. 40.12/100
Ambroxol (Albion), Paed. drops, 6mg/ml, ml; Paed. drops, 6 mg/ ml, Tk. 30.09/15ml; SR
20.07/15ml;Syrup, 15mg/5ml,Tk. 30.00/100ml Cap., 75mg, Tk. 5.04/Cap.
Ambroxol (Biopharma), Syrup, 15mg/5ml,, Tk. Nexol (Aristo), Syrup, 15mg/5ml, Tk.40.00/100
40/100 ml; SR Cap. 75 mg, Tk. 5.00/Cap. ml; Paed. drops, 6 mg/ ml, Tk. 30.00/15ml
Ambryl (Julphar), Syrup, 15mg/5ml, Tk. Onecof (One Pharma), Syrup, 15 mg/5 ml ,
40/100 ml; Paed. drops, 6 mg/ ml, 30.00/15ml Tk. 40.00/100ml
Amsiv (Delta), Syrup, 15mg/5ml, Tk. Recof (Renata), Syrup, 15mg/5ml,
40.00/100 ml Tk.40.00/100 ml; Paed. drops, 6 mg/ ml, Tk.
Aroxol (Healthcare), Paed. drops, 6 mg/ ml,, 30.00/15ml
Tk. 35.00/15 ml; Syrup15mg/5ml, Tk. Remap(Monico), Syrup, 15mg/5ml, Tk.
45.00/100 ml 40.00/100ml
Axsol (Nipa), Syrup15mg/5ml, Tk. Resol (Sharif), Syrup, 15 mg / 5 ml, Tk.
40.00/100ml 40.12/100ml
Boxol (Opsonin), Syrup, 15mg/5ml, , Tk. Safoxol (Beacon), Syrup, 15mg/5ml, Tk.
40.13/100 ml,; Paed. drops, 6mg/ml,, Tk. 45.14/100ml,; SRCap., 75mg , Tk. 5.02/Cap.
30.10/ 15 ml,; SR.Cap., 75 mg, Tk. 5.01/Cap. Winkof (Chemist), Syrup 15mg/5ml, Tk.
Broculyt (NIPRO JMI), Syrup, 15mg/5ml, Tk. 40.00/100 ml
40.12/15mg X-Cold (Acme), Syrup, 15mg/5ml,
Brox (Navana) , Paed Drops, 6 mg/ ml, Tk. Tk.40.12/100 ml; Paed. drops, 6 mg/ ml, Tk.
30.10/15ml, Syrup, 15 mg/ 5 ml, Tk. 30.10/15ml
40.13/100ml Xerokof (Pharmasia), Syrup, 15mg/5ml, Tk.
Broxidil (Ziska), Syrup, 15 mg/5 ml, Tk. 40.00/100 ml
40.00/100ml
Broxolin (Jayson), Syrup, 15 mg/5 ml, 1 Tk.
BROMHEXINE HYDROCHLORIDE
40.12/100ml
Broxolit (Pacific), Syrup, 15mg/5ml, Tk.
40.00/100ml,; Paed. drops, 6mg/ml, Tk. Indications: Respiratory disorder
19.00/15ml associated with productive cough and
Dilyt (Novo Health), Syrup, 15mg/5ml , Tk. dry eye syndromes (For local use).
40.00/100ml Side-effects: Headache, dizziness, skin
Emulyt (Alco), Syrup, 15mg/5ml Tk.
rash, gastro-intestinal discomfort
45.14/100ml
188
Dose: ADULT 8-16 mg tds, CHILD Cautions: Elderly, ulcer in stomach or

more than 3 years 8mg three times gut, pregnancy and breast-feeding, Skin
daily,1-3 years 4mg three times daily rashes not recommended for children
Proprietary Preparations Side-effects: Anaphylactic reactions
A-Cold(Acme), Syrup, 4 mg/5 ml, Tk. and fixed drug eruption gastrointestinal
40.12/100ml bleeding, skin rashes and allergic skin
Brolyt (Alco), Syrup, 4 mg/5 ml, Tk. eruptions. and erythema multiforme have
40.12/100ml; Tab. , 4 mg, Tk. 0.70/Tab.; 8
mg, Tk. 1.00/Tab.
also been reported.
Bromotex (Ibn Sina), Syrup, 4 mg/5 ml, Tk. Dose: Adult: Initially, 2.25 g daily in
40.00/100ml divided doses, then 1.5 g daily in divided
Bromoxol (Healthcare), Syrup, 4 mg/5 ml, Tk. doses as condition improves.
45.00/100 ml,8 mg/5 ml , Tk. 65.00/100 ml Child: 2-5 year: 62.5-125 mg 4 times
Bronchodex (Organic), Syrup, 4 mg/5 ml, Tk. daily; 6-12 year 250 mg tid.
40.13/100ml
Brostin (Rephco), Syrup, 4 mg/5 ml, Tk.
40.00/100ml; Tab. , 8 mg, Tk. 2.00/Tab.
Carbolin (Eskayef), Syrup, 125 mg/5 ml, Tk.
Broxine(General), Syrup, 4 mg/5 ml, Tk.
30.00/100ml,; 250 mg/ 5 ml, Tk. 40.00/100ml,;
30.20/100ml
Tab., 375 mg , Tk. 2.50/Tab.
Clod-B (Medimet), Tab., 4 mg, Tk.0.70/Tab.
Coflyt (Asiatic), Syrup, 4 mg/5 ml, Tk. Carboten DS(Amico), Syrup, 250 mg/5 ml,
TK. 40.00/100ml
30.00/100 ml
Carin (Supreme), Syrup, 125 mg/5 ml, Tk.
Expecto (Aristo), Syrup, 4 mg/5 ml, Tk.
30.00/100ml,; Cap., 375mg, Tk. 2.50/Cap.
20.00/50ml,
Castin (ACI), Cap., 375mg , TK. 2.52/Cap.;
Mucodil (NIPRO JMI), Syrup, 4mg/5ml, Tk.
40.12/100 ml Syrup, 125mg/5ml, TK. 30.20/100ml ,;
Mucola (Amico), Syrup, 4 mg/5 ml, Tk. 250mg/5ml, TK. 40.27/100ml
25.00/100 ml Flegnil (Orion), Syrup, 125 mg/5 mll, Tk.
Mucolyt (Incepta), Syrup, 4 mg/5 ml, Tk. 30.20/100ml,; 250 mg/5 ml, Tk. 40.27/100ml
Tulsi (Euro), Syrup, 125 mg/5 ml, Tk.
40.00/100ml,; 8 mg/5 ml, Tk. 75.00/200ml,;
40.00/100ml
Tab., 8 mg, Tk. 2.00/Tab.
Muconil (Ziska), Syrup, 4 mg/5 ml, Tk.
30.00/100ml DEXTROMETHORPHAN [CD]
Mucospel (Square), Tab. , 8 mg, Tk.
2.01/Tab.; Syrup, 4 mg/5 ml,Tk. 40.13/100ml Indication: Unproductive cough
Mucoten (Eskayef), Syrup, 4 mg/5 ml, Tk.
Cautions: Asthma, hepatic and renal
40.00/100ml
Mucut (Biopharma), Syrup, 4 mg/5 ml Tk. impairments; history of drug abuse
40.00/100ml Interactions: See Appendix-2
Mulyt (G.A.Co), Syrup, 4 mg/5 ml, Tk. Side-effects: Nausea, dizziness,
40.12/100 ml respiratory depression in sensitive
Munil (Opsonin), Syrup, 4 mg/5 ml, , Tk. patients or if given large doses
40.00/100 ml Dose: ADULTS 10-15 ml (dextromethor-
Mute(Astra Bio), Syrup, 4 mg/5 ml, Tk.
phen as hydrobromide) 3 times daily
40.00/5ml
Mytil (Albion), Syrup, 4 mg/5 ml, Tk.
30.00/100ml Proprietary Preparations
Spulyt (Beximco), Syrup, 4 mg/5 ml, Tk. Brofex (Square), Syrup, 10mg/5ml, Tk.
40.00/100ml 40.13/100ml
Sputen (Silva), Syrup, 4 mg/5 ml, Tk. Coldflu (Amico), Syrup,, 10 mg/5 ml, Tk.
30.1112/100ml 23.00/100 ml
Topsil (Zenith), Tab., 4 mg, Tk. 0.70/Tab.; D-Cough (Opsonin), Syrup, 10mg/5ml, Tk.
Syrup,, 4 mg/5 ml, Tk. 30.00/100ml 35.11/ 100 ml
X-pectoran (Rangs), Syrup, 4 mg/5 ml, Tk. Delkof (Popular), Syrup, 10mg/5ml, Tk.
40.00/100 ml; Tab., 8 mg, Tk. 2.00/Tab. 70.00/100ml
Dexpofen (Eskayef), Syrup, 10mg/5ml, Tk.
40.00/100ml
CARBOCISTEINE Dexsol (G.A.Co), Syrup, 10mg/5ml, Tk.
Indication: For respiratory tract 35.11/100 ml
disorders when too much mucus is made Dextromethorphan (Albion), Syrup,, 10 mg/5
or the mucus is too sticky. ml, Tk. 18.75/100 ml
189
Dextromethorphan (Beximco), Syrup, 10

mg/5 ml, Tk. 35.00/100 ml
DESLORATADINE
Dixar (ACI), Syrup, 10mg/5ml, Tk.
40.00/100ml
Tomephen (Incepta), Syrup, 10mg/5ml, Tk. Indications: Symptomatic relief of
40.00/100ml allergic rhinitis (seasonal and perineal),
chronic idiopathic urticaria
4.9 ANTIHISTAMINES Cautions: Pregnancy, lactation, elderly,
AND ALLERGIC EMERGENCIES renal or hepatic impairment
4.9.1 Antihistamines Contraindications: Hypersensitivity to
4.9.2 Allergic emergencies loratadine, pregnancy, breast-feeding,
4.9.1 ANTIHISTAMINES elderly
Side-effects: Fatigue, dry mouth,
(See also section12.5 and 11.2.1)
headache;
The older antihistamines such as
Diphenhydramine,Pheniramine and Proprietary Preparation
promethazine are short-acting and have See section 12.5
unwanted sedative action.
Newer antihistamines such as FEXOFENADINE HYDROCHLORIDE
Acrivastine, Cetirizine, Levocetirizine
(an iso-mer of cetrizine), Loratadine and
Indications: Relief of symptoms
Desloratadine are longer acting (once-
associated with seasonal allergic rhinitis,
daily dose); they cause less sedation
uncomplicated skin manifestations of
and psychomotor impairement .
chronic idiopathic urticaria in ADULT and
Fexofenadine has been introduced
CHILD above 12 years
recently.
Cautions: Elderly, liver disease, renal
impaired patients, pregnancy and
NON-SEDATIVE ANTIHISTAMINES lactation.
ACRIVASTINE Side-effects: Dyspepsia, drowsiness,
Indications: Symptomatic relief of dizziness, nausea, chest tightness and
allergy such as hay fever, urticaria
Side-effects: Incidence of sedation and Proprietary Preparations
See section 12.5
antimuscurinic effects low
Interactions: See Appendix-2.
Dose: 8 mg three times daily LEVOCETIRIZINE
DIHYDROCHLORIDE
Semprex (I) (GSK), Cap. 8 mg, Indications: Symptomatic relief of
Tk.7.65/Cap allergy such as hay fever, urticaria
Cautions; Interaction & Side-effects:
CETIRIZINE HYDROCHLORIDE See under Cetrizine Hydrochloride
Dose: ADULT and CHILD over 6 years,
Indications: Symptomatic relief of 5 mg daily
allergy such as hay fever, urticaria Proprietary Preparations
Cautions: Renal impairment See section 12.5
Side-effects: Incidence of sedation and LORATADINE
antimuscurinic effects low
Dose : ADULT and CHILD over 6 years,
Indications: Symtomatic relief of allergy
10 mg daily or 5 mg twice daily. CHILD
like hay fever and urticaria
2-6 years 5 mg daily or 2.5 mg twice
daily
Side-effects: Sedation and antimuscu-
See section 12.5 rinic effects low
190
Dose: ADULT and CHILD over 12 years, SEDATIVE ANTIHISTAMINES

10 mg daily; CHILD 2-12 years 5mg
daily
CHLORPHENAMINE MALEATE
See also section12.5 Indications: Symptomatic relief of
allergy such as hay fever, urticaria;
MIZOLASTINE emergency treatment of anaphylactic
reactions
Indications: symptomatic relief of Cautions: Injection may be irritant;
allergy such as hay fever, urticaria drowsiness may affect skilled tasks such
Cautions & Contra-indications: as driving
Hepatic impairment Pregnancy and Interactions: See Appendix-2
Breast-feeding Side-effects: Exfoliative dermatitis,
Side-effects: weight gain; anxiety, tinnitus reported and injection may cause
asthenia; less commonly arthralgia and transient hypotension or CNS stimu-
myalgia lation
Dose: ADULT and CHILD over 12 years, Dose: By mouth, 4 mg every 4-6 hours,
10mg once daily max. 24mg daily. CHILD 1-2 years, 1 mg
twice daily; 2-5 years 1 mg every 4-6
Proprietary Preparations hourly, max. 6 mg daily; 6-12 years 2 mg
Mastel (ACI), Tab., 10mg, Tk. 6.52/Tab. every 4-6 hours, max. 12 mg daily
Rhinor (Opsonin), Tab., 10 mg, Tk. 5.02/Tab. By intramuscular injection, 10-20 mg,
repeated if necessary up to 40 mg daily.
MEBHYDROLIN NAPADYSYLATE By intravenous injection, 10-20 mg over
1 minute.
Indications: Allergic disease or
symptoms, such as urticaria pruritus of Acira(ACI), Syrup, 2 mg/ 5 ml, TK.
different origins, eczema, drug rash, 14.09/100ml , TK. 14.94/60ml ,;Tab., 4mg,TK.
allergic conjunctivitis, dermatitis of nutri- 0.30/Tab.
tional origin, hay fever, vasomotor Alerjess (Ad-din), Tab., 4mg, Tk. 0.20/Tab.;
rhinitis, allergic asthma Syrup, 2mg/5ml, Tk. 20.00/100ml
Cautions: driving or operating Allermine (Renata), Syrup, 2 mg/ 5 ml, Tk.
14.14/100ml
machinery
Antista (Square), Syrup, 2 mg/ 5 ml, Tk.
Contra-indications: Patient to whom 21.85/100ml
Mebhydrolin has previously been proved Biocin(Biopharma), Syrup,
to cause agranulocytosis and 2 mg/ 5 ml, Tk. 21.78/100ml,; Tab., 4mg, Tk.
neutropenia; 1st trimester of pregnancy 0.20/Tab.
Side-effects: sleepiness, drowsiness, Centagan(Central), Syrup, 2 mg/5 ml, Tk.
mild gastro-intestinal disturbances 9.50/60 ml ;Tk. 12.00/100 ml
Chlorpheniramine (Popular ), Tab., 4 mg, Tk.
Dose: ADULT and CHILD above 12
0.20/Tab.
years 50-100 mg 2-3 times daily; CHILD Clomin(Alco ), Syrup, 2 mg/5 ml, Tk.
below 12 years 50-100 mg daily in 13.00/100 ml
divided doses Cloramin(Orion), Syrup, 2 mg/ 5 ml, Tk.
21.85/100ml
Proprietary Preparations Cytacin (Albion), Tab. , 4 mg, Tk. 0.20/Tab.
Aexidal (Albion), Tab., 50 mg, Tk. 1.50/Tab. Expilin (G.A.Co), Tab., 4 mg, Tk. 0.20/Tab.;
Bexidal (Beximco), Tab., 50mg, Tk. 3.00/Tab. Syrup, 2 mg/5ml, Tk. 21.50/100 ml,Tk. 13.5/60
Dayhista (Medimet),Tab.,50mg, Tk. 2.00/Tab. ml
Mebastin (Incepta), Tab., 50 mg, Tk.2/Tab. G-antihistamine (Gonoshasthaya), Syrup , 2
Mebidal (Eskayef), Tab, 50 mg, Tk. 3/Tab. mg/5 ml, Tk.12.00 /60ml; Tab., 4 mg, Tk. 0.25
Mebolin (Acme), Tab., 50 mg, Tk. 2.01/Tab. /Tab.
Medrolin (Opsonin), Tab.,50mg,Tk. 1.51/Tab. Hisnul (Somatec), Syrup, 2 mg/ 5 ml, Tk.
21.85/100ml
191
Histacin (Jayson), Syrup, 2mg/5ml, Tk. HYDROXYZINE HYDROCHLORIDE

14.94/60ml; Tk. 21.85/100ml; Inj., 10mg/1ml,
Tk. 33.50/Amp.; Tab., 4mg , Tk. 0.29/Tab.
Histaco (Supreme), Syrup, 2 mg/ 5 ml, Tk. Indications: Pruritus and other allergic
11.70/60ml; Tab., 4 mg, Tk. 0.20/Tab. conditions (chronic urticaria), atopic and
Histal (Opsonin), Syrup, 2 mg /5 ml, Tk. contact dermatitis, anxiety (short-term)
14.94/60 ml Cautions: Pregnancy, lactation,
Histalex (Acme), Syrup, 2 mg/5 ml, Tk. glaucoma, difficulty in urination; caution
21.78/100 ml;Tab., 4 mg, Tk. 0.3/Tab.
required while driving or operating
Histam (Maks ), Syrup, 2 mg/5 ml, Tk.
11.70/60 ml ;Tk. 21.75/100 ml machinery
Histanol (Chemist), Syrup , 2 mg/5 ml l, Tk. Interactions : See Appendix-2
13.30/100 ml; Tab., 4 mg, Tk. 0.21/Tab. Side-effects: Constipation, dry mouth
Histason (Hudson), Syrup, 2mg/5ml, drowsiness, visual disturbances, mental
Tk.18.00/100 ml; Tab., 4mg, Tk.0.22/Tab. confusion in elderly patients
Histatab (Bristol), Tab. , 4mg , Tk.
100.00/Tab.
Hitagen (General), Syrup, 2 mg/ 5 ml, Tk.
21.50/100ml Tk. 14.95/60ml,; Tab. , 4mg, Tk. See section 12.5
0.30/Tab.
Penamin (APC ), Tab., 4 mg, Tk. 0.20/Tab. ; PHENIRAMINE HYDROGEN MALEATE
Syrup, 2 mg/5 ml, Tk. 11.70/60 ml [ED][OTC]
Pheramin (Amico), Syrup, 2 mg/ 5 ml, TK.
14.90/60ml,; Tab., 4mg , TK. 0.10/Tab.
Piriton (GSK), Syrup, 2 mg/ 5 ml, Tk. Indications: Hay fever, sneezing attack,
21.81/100ml,; Tab. , 4 mg, Tk. 0.27/Tab itching, running nose, conjunctivitis
Safamin (Benham), Syrup, 2mg/5mL, Tk. urticaria with pruritus, reddening and
21.50/100ml swelling of skin, eczema
Sedilux (Modern), Syrup, 2 mg/ 5 ml, Tk. Cautions: Pregnancy and lactation;
11.70/60ml,;Tk. 21.70/100ml,; Tab. , 4 mg, Tk.
drowsiness may affect skilled tasks such
0.20/Tab.
Sinamin (Ibn Sina), Syrup, 2 mg/5 ml, Tk. as driving; sedating effects enhenced by
21.78/100 ml; Tab., 4 mg, Tk. 0.20/Tab. alcohol
Tymin (Astra Bio), Syrup, 2 mg/ 5 ml, Tk. Interactions : See Appendix-2
11.00/60ml,; Tab. , 4 mg, Tk. 0.20/Tab. Side-effects: Occasionally drowsiness,
Winkol (Globe), Syrup, 2 mg /5 ml , Tk. Gastro-intestinal complaints, dry mouth,
8.00/60 ml; Tk. 21.78/100 ml palpitations urinary retention, restless-
Zistacin (Zenith), Syrup, 2 mg/ 5 ml, Tk.
ness, confusion in high dose, agitation in
14.00/100ml, Tk. 9.00/60ml,; Tab., 4 mg, Tk.
0.28/Tab. small children, rise in intra-occular
pressure.
DIPHENHYDRAMINE
HYDROCHLORIDE
Aerovil (Beximco), Syrup, 15 mg/5 ml, Tk.
20.07/100 ml
Indications: See under Chlorphenamine Alervil (Incepta), Syrup, 15 mg/5 ml , Tk.
maleate; also to aid relief of temporary 25.00/75ml
sleep disturbance in adults Amarin (Opsonin), Syrup, 15 mg/5 ml, Tk.
Cautions & Side-effects: See under 20.00/100 ml ; Tab. , 22.7 mg , Tk. 0.47/Tab.,
Inj., 45.5mg/2ml, Tk. 7.48/2ml Amp
Chlorphenamine maleate Avil (Sanofi), Tab., 22.7 mg, Tk. 1.51/Tab;
Dose: ADULT 25 mg 3 times daily, 50 Tab., 22.7 mg, Tk. 1.51/Tab.; Syrup, 15
mg at bedtime for temporary relief of mg/5ml, Tk. 20.08/100 ml ; Tk. 25.00/75 ml;
sleep disturbance; CHILD 6-12 years, Inj., 45.5 mg/2 ml, Tk. 7.53/amp.;SR Tab., 75
10-20 mg 2-3 times daily mg, Tk. 2.01/Tab.
Fenimex (Asiatic), Inj., 45.50mg /2ml, Tk.
Proprietary Preparations 7.50/2 ml Amp
Pevil (ACI), Tab., 22.7mg, Tk. 0.46/Tab.
See section 12.5
192
PROMETHAZINE HCL[ED] repeated every 10 minutes until blood

pressure and pulse have stabilized.
Indications:, Urticaria; emergency An antihistamine such as
treatment of anaphylactic reactions Chlorphenira-mine is a useful
Cautions: Intramuscular injection may adjunctive treatment given after
be painful; drowsiness may affect skilled adrenaline injection and continued for
tasks such as driving; sedating effects 24-48 hrs to reduce the severity and
enhenced by alcohol duration of symptoms and to prevent
Dose: By mouth, 25 mg at night relapse. Intravenous corticosteroid such
increased to 25 mg twice daily if as Dexamethasone should be given to
necessary or 10-20 mg 2-3 times daily. help to prevent later deterioration in
CHILD, 2-5 years 5-15 mg daily in severely affected patients.
divided doses, 5-10 years 10-25 mg Administration of Oxygen is of primary
daily in 2 divided doses importance.
By deep intramuscular injection, 25-50 Further treatment of anaphylaxis may
mg, max. 100 mg; CHILD 5-10 years include intravenous fluids, intravenous
6.25–12.5 mg. vasopressor such as Dopamine,
By slow intravenous injection, 25-50 mg intravenous Aminophylline or a
as a solution containing 2.5mg/ml in nebulized bronchodilator such as
water for injection; max. 100 mg. Salbutamol. If there is reversible
airways obstruction, it may be necessary
Proprietary Preparations to give Ephedrine.
See section 12.5 Adrenaline 1 in 1000 solution (1mg/ml)
may be given by intramuscular or
subcutaneous injection. The dose for an
4.9.2 ALLERGIC EMERGENCIES
adult is 500 micrograms to 1 mg (0.5-
1 ml); for children 6-12 years 500
Anaphylactic shock and conditions such micrograms (0.5ml); children 5 years 400
as angioedema are medical micrograms (0.4ml); infant 2 years 200
emergencies that can result in micrograms (0.2ml); 1 year 100
cardiovascular collapse, and even death. micrograms (0.1ml); and those under 1
Such conditions need immediate year 50 micrograms (0.05ml). The above
treatment of laryngeal oedema, doses may be repeated several times if
bronchospasm and hypotension. Atopic necessary at 10 minutes intervals,
individuals are susceptible. Insect bites according to blood pressure, pulse, and
and certain foods such as eggs, fish and respiratory function until improvement
some vegetables are also a risk for occurs (may be repeated several times).
sensitized persons. Some therapeutic Chlorpheniramine maleate given by
substances may cause anaphylaxis such slow intravenous injection (over 1
as blood products, vaccines, minute) in a dose of 10-20 mg is a useful
hyposensitizing preparations like adjunctive treatment after the adrenaline.
allergen, some antibiotic especially It may be continued for 24 to 48 hours to
penicillins, iron injections, heparin, and prevent relapse (max. 40mg in 24
neuromuscular blocking drugs. hours). It may also be given by slow
Anaphylaxis is more likely to occur after subcutaneous or intramuscular injection
parenteral administration. Resuscitation over 1 minute
facilities should always be available Dexamethasone Phosphate (sodium
when injecting a drug associated with salt) 4 mg/ml may be given by slow
the risk of anaphylactic reactions. intravenous injection or by infusion; the
First line treatment includes Adrenaline dose for ADULT is 0.5-20mg; CHILD
injection for keeping airway open and 200-500 micrograms/kg. Alternately,
restoring blood pressure. Adrenaline hydro-cortisone (as sodium succinate)
should immediately be given by may be given by slow intravenous
intramuscular injection and should be injection.
193
Dose: Acute anaphylaxis, by

ADRENALINE [ED] intramscular or subcuteneos injection of
1 in 1000 solution; See notes above and
Indications: Emergency treatment or also section 3.7.3
acute anaphylaxis, angeoedema,
cardiopulmonary resuscitation Proprietory Preparations
Cautions: Hyperthyroidism, diabetes See section 3.7.3
mellitus, ischaemic heart disease,
hypertension, elderly patients
194
5. ENDROCRINE SYSTEM
Chapter 5
ENDOCRINE SYSTEM
5.1 Thyroid hormones and antithyroid drugs p.195
5.1.1 Thyroid hormones p.195
5.1.2 Antithyroid drugs p.196
5.2 Drugs used in diabetes p.198
5.2.1 Insulin p.201
5.2.1.1 Short-acting insulin p.202
5.2.1.2 Intermediate and long acting insulin p.203
5.2.2 Oral anti-diabetic drugs p.204
5.2.2.1 Sulphonylureas p.205
5.2.2.2 Biguanides p. 207
5.2.2.3 Meglitinide p. 209
5.2.2.4 Thiazolidinediones p. 210
5.2.2.5 Dipeptidyl peptidase-4 (DPP-4) inhibitors p. 210
5.2.2.6 Gliflozin p. 212
5.2.2.7 Alpha glucosidase inhibitor p. 213
5.2.3 Other anti-diabetic agent’s p. 214
5.2.4 Diabetic emergency p.214
5.2.4.1. Diabetic ketoacidosis p.214
5.2.4.2 Hypoglycaemia p.215
5.2.5 Drugs used in diabetic neuropathy p.215
5.3 Adrenocortical steroids p.216
5.3.1 Replacement therapy p.216
5.3.2 Glucocorticoids Therapy p.217
5.4 Sex-hormones p.221
5.4.1 Female sex-hormones and antagonists p.221
5.4.1.1 Estrogen and HRT p.221
5.4.1.2 Progestogens p.223
5.4.2 Anti-oestrogens p. 226
5.4.3 Male sex-hormones and antagonists p.226
5.4.4 Anabolic steroids p. 228
5.5 Hypothalamic and pituitary hormones p.228
5.5.1 Hypothalamic hormones p. 228
5.5.2 Anterior-pituitary hormones p. 229
5.5.2.1 Growth hormones p. 229
5.5.2.2 Gonadotropins p. 229
5.5.2.3 Corticotropins p. 230
5.5.3 Posterior-pituitary hormones p.231
5.6 Drugs affecting bone metabolism p. 231
5.6.1 Bisphosphonates p. 232
5.6.2 Calcitonin p. 234
5.1 THYROID HORMONES AND Thyroid hormones are secreted from

ANTITHYROID DRUGS Thyroid Glands. They are thyroxine (T4)
and tri-iodothyronine (T3). They are also
5.1.1 Thyroid hormones produced synthetically. These include
5.1.2 Antithyroid drugs Levothyronine and Liothyronine. The
principal effect of thyroid hormones is to
increase the cellular metabolic rate in
5.1.1 THYROID HORMONES
general and thus to increase the basal
195
metabolic rate (BMR). They also exert a diarrhoea, vomiting, tremors, restless-
cardio-stimulatory effect which may be ness, insomnia, headache, flushing,
the result of direct action on the heart. sweating and rapid weight loss
Deficiency of thyroid hormones leads to Dose: ADULTS, initially with a low dose
a generalized slowing down of metabolic of 25- 50 micrograms once daily orally in
processes. Infantile/congenital and empty stomach and regular increment to
childhood hypothyroidism affects growth a dose that keeps FT4 at or near to the
and development, producing serious middle of the normal range and which
permanent consequences including also will keep TSH within normal range.
mental retardation. Severe cases are Monitoring is done clinically as well as
short with very low IQ called cretinism. biochemically
Myxedema in adults slows down CHILD, in congenital hypothyroidism,
metabolism leading to deposits of start with 6-8/µgm/kg/day and increase
glycosaminoglycans in intercellular by 25 micrograms every 2–4 weeks until
spaces particularly in skin and muscle; euthyroid or hypothyroidism symptoms
severe cases called myxedema . appear, then reduce the dose slightly so
Thyroid hormones are used mostly for that serum FT4 is near upper limit of
replacement therapy in hypothyroidism; normal; in children above 1 year of age,
and thyroid nodule and thyroid start with 2.5 – 5 micro-grams/kg daily
carcinoma. and then increase the dose stepwise to
attain serum FT4 at near upper limit of
THYROXINE SODIUM [ED] the normal
(Other names: Levothyroxine sodium; L-
Thyroxine sodium) Proprietary Preparations
Eltroxin (I)(GSK), Tab., 50 microgram, Tk.
2.56/Tab.
Indication: Hypothyroidism Euthycin (Incepta), Tab., 50 microgram, Tk.
Cautions: Panhypopituitarism or 1.20/Tab.
predisposition to adrenal insufficiency Leroxin (Popular), Tab., 50 microgram, Tk.
from any cause (initiate corticosteroid 1.20/Tab.
therapy before starting thyroxine); Thynor (Eskayef), Tab., 50 microgram,
elderly, cardiac ischemia, ECG evidence Tk.1.50/Tab.
Thyrin (Square), Tab., 25 microgram,
of myocardial infarction, diabetes
Tk.1.10/Tab.; 50 microgram, Tk.1.60/Tab.
insipidus. Start lower and go more Thyrolar (Acme), Tab., 25 microgram, Tk.
slowly. Diabetes mellitus (increase dose 0.70/Tab.; 50 microgram, Tk. 1.20/Tab.
may be needed for antidiabetic drugs Thyrotab (Ibn Sina), Tab., 50 microgram, Tk.
including insulin) 2.00/Tab.
Interactions: See Appendix-2 Thyrox (Renata), Tab., 50 microgram, Tk.
Initial dosage: A pre-therapy ECG is 2.00/Tab.
Tyroid (ACI), Tab., 50 microgram, Tk.
valuable as changes induced by
1.35/Tab.
hypothyroidism may be confused with
evidence of ischaemia. Too rapid
5.1.2 ANTITHYROID DRUGS
increase in dosage may increase
metabolism that can cause vomiting,
diarrhoea, nervousness, rapid pulse, Anti-thyroid drugs are used in the
insomnia, tremors and sometimes treatment for hyperthyroidism with high
anginal pain; if such symptoms appear, uptake of iodine by the thyroid such as
reduce dose for 1-2 days before starting Graves’ disease, multinodular toxic
again at a lower dosage goiter and toxic thyroid nodule.
Contraindication: Thyrotoxicosis Hyperthyroidism is defined as a clinical
Side-effects: Usually at excess dosage syndrome consisting of symptoms and
(see Initial dosage), there may be signs reflecting peripheral response to
anginal pain, cardiac arrhythmias, excessive amount of thyroid hormone.
hyperactivity, mood swings, palpitations, Clinical manifestations of
skeletal muscle cramps, tachycardia, hyperthyroidism (thyrotoxicosis) include
196
restlessness, tachycardia, weight loss, Radioablation of the thyroid gland is

tremulousness etc. In hyperthyroidism, used in thyrotoxicosis when antithyroid
biochemically, there is TSH suppression drugs fail to produce desired results.
along with rise of free T3 and free T4 Radioablation may cure hyperthyroidism
levels. There are three modalities for the due to a single hyperfunctiong nodule or
treatment of hyperthyroidism: Antithyroid control hyperthyroidism with multiple
drugs, radioablation and surgery. nodules. Radioactive sodium iodide
Carbimazole is the most commonly solution is used for the treatment of
used antithyroid drug. It is given in a thyrotoxicosis at all ages, particularly
daily dose of 15–45 mg and maintained when medical therapy or compliance is a
at this dose until the patient become problem, in patient with cardiac disease,
euthyroid, usually after 4-8 weeks; the and in cases of relapse after
dose is than gradually reduced to thyroidectomy.
maintenance of between 5–15 mg daily; Propranolol (a beta-blocker) is useful
therapy is usually given for 18 months for rapid relief of thyrotoxic symptoms
but may need longs. CHILD may be and may be used as short term adjunct
given an initial dose of 15 mg daily, and to antithyroid drugs or radioactive iodine
then adjusted according to response. to control severe sympathetic over-
Puritius and rashes are common and activity, such as in thyroid storm (see
can be treated with antihistamines below). Beta-blockers are also useful in
without discontinuing therapy. Patients neonatal thyrotoxicosis and in
should be advised to report any sore supraventicular arrhythmias due to
throat immediately because of the rare hyperthyroidism. Propranolol may be
but possible complication of used in conjunction with iodine to
agranulocytosis; for the same reason, prepare mild thyrotoxic patients for
routine blood counts during the course of surgery. Laboratory thyroid function tests
therapy is also recommended. If side are not altered by beta-blockers. Use of
effects of Carbimazole are severe, beta blockers in mild to moderate
propylthiouracil may be substituted.with hyperthyroidism is unnecessary.
caution. Propylthiouracil is given in a Most cases of thyrotoxicosis do not
daily dose of 100 to 300 mg and require surgery. However, hyper
maintained on this dose until the patient functioning multinodular goiter requires
become euthyroid; the dose may then be debulking surgery if antithyroid drugs or
progressively reduced to a maintenance radioablation fails to control. Patients
level between 50–150 mg daily must be informed that after surgery,
Saturation solution of potassium iodide follow up is needed for life long.
(SSKI) Iodinated contrast and Lithium Thyrotoxic crisis (‘thyroid storm’) is a
can be given. medical emergency arising out of an
Iodine may be given in the form of extreme accentuation of thyrotoxicosis.
Aqueous Iodine Oral Solution (Lugol’s It is usually associated with toxic
Iodine) for 10-14 days in addition to multinodular goitre or subtotal
Carbamizole or Propylthiouracil prior thyroidectomy, surgical cases
to partial thyroidectomy to assist control inadequately prepared before the
and reduce vascularity of the thyroid. operation. Other precipitating factors are
Iodine should not be used for long-term radiation thyroiditis, diabetic
treatment since its antithyroid action ketoacidosis, toxemia of pregnancy and
tends to diminish with time. Although parturition. Management of the crisis
antithyroid drugs have a short half-life requires emergency treatment with
they should only be given once daily intravenous fluids, propranolol (5mg) and
because of their prolonged effect on the hydrocortisone (100 mg every 6 hours,
thyroid. Over treatment may lead to a as sodium succinate), as well as oral
rapid onset of hypothyroidism, and this iodine solution and carbimazole or
should be avoided particularly during propylthiouracil, which may need to be
pregnancy since it can cause fetal goitre.
197
administrated by nasogastric tube for Indications: Thyrotoxicosis

which ICU support may be needed. (preoperative)
Pregnancy and breast-feeding: Cautions: Pregnancy, children (not for
Radioactive iodine therapy is contra- long-term treatment)
indicated during pregnancy. Propyl- Contraindications: Breast-feeding
thiouracil or carbimazole can be given, Side-effects: Hypersensitivity reactions
but the blocking-replacement regimen including headache, laryngitis, lachry-
(see notes above) is not suitable. Both mation, conjuctivities, coryzalike
propylthiouracil and carbimazole cross symptoms, pain in the salivary glands,
the placenta and in high dose can cause rashes; on prolong treatment
foetal goitre and hypothyroidism; the depression, insomnia, impotence may
lowest dose that control the hyperthyroid occur; goiter in infants of mothers taking
state should be used (requirements of iodides
antithyroid drugs tend to fall during COUNSELING: warn patient to report
pregnancy). Rarely carbimazole has immediately if sore throat, mouth ulcers,
been associated with ‘aplasia cutis’ of rashes, fever, malaise, or non-specific
neonate. Carbimazole and propylthio- illness develops
uracil appear in the breast milk but this Generic Preparation: Aqueous Iodine
does not preclude breast-feeding as long Oral solution (Lugol’s Solution), iodine
as neonatal development is closely 5%, potassium iodide 10% in purified
monitored and the lowest effective dose water, freshly boiled and cooled; total
is used. iodine 130 mg/ml
Dose: 0.1–0.3 ml, 3 times daily well
CARBIMAZOLE diluted with milk or water
Indications: Hyperthyroidism 5.2 DRUGS USED IN DIABETES

Cautions: Large goiter, liver disorders, 5.2.1 INSULINS
pregnancy, breast-feeding (see also 5.2.1.1 SHORT ACTING INSULIN.
Appendix-6) 5.2.1.2 INTERMEDIATE AND LONG
Side-effects: Nausea, rashes, ACTING INSULIN
headache, pruritus, mild gastrointestinal
disturbances, arthralgia; agranulocytosis; 5.2 DRUGS USED IN DIABETES
rarely alopecia, jaundice ,etc
WARNING. A white blood cell count DIABETES MELLITUS (DM)
should be performed if there is any Diabetes mellitus is defined as
clinical evidence of infection, especially chronic/persistent hyperglycemia, due to
sore throat. Carbimazole should be deficiency of insulin secretion, or of
stopped promptly if there is clinical or insulin action, or both. At present time
laboratory evidence of neutropenia. several other pathological processes are
Dose: See notes above recognized in causing diabetes,
COUNSELING: Warn patient to report especially type-2. Diabetes mellitus is
immediately if sore throat, mouth ulcers, classified on the basis of etiology into
fever, malaise, or non-specific illness four types.
develops. Recommend routine blood 1. Type-1 diabetes mellitus (T1DM)
counts from time to time during therapy 2. Type-2 diabetes mellitus (T2DM)
3. Other specific types.
Proprietary Preparations 4. Gestational diabetes mellitus(GDM)
Carbimazole (Popular), Tab. 5 mg, Tk.
3.00/Tab.
Carbizol (Square), Tab. , 5 mg , Tk. 3.01/Tab. Type-1 Diabetes mellitus (T1DM)
Mercazole (Renata), Tab. , 5 mg, Tk. Type-1 diabetes (also previously called
3.00/Tab. “insulin dependent diabetes/juvenile
IODINE AND IODIDE PREPRATION onset diabetes”) occurs due to
destruction of the insulin producing beta
198
cells of the islets of Langerhans of vascular and macrovascular changes. A

pancreas by auto –immune mechanism. diabetic is at risk of development of
At the time of onset of diabetes, there is coronary artery disease, stroke,
little or on insulin in the body. Some blindness, renal failure, lower limb
environmental factors trigger the amputation etc. many times more than a
autoimmune reaction in genetically non diabetes person. Children with
susceptible individuals. This type of uncontrolled diabetes may have problem
diabetes can affect people of any age, in growth. Pregnancy in women with
but usually occurs in children or young diabetes threatens both expectant
adults. The onset is often sudden and mother and foetus. Acute metabolic
symptoms are florid. derangement may lead to life threatening
diabetic comas, such as diabetic
Type-2 diabetes mellitus (T2DM) ketoacidosis (DKA), hyperosmolar non-
Type-2 diabetes constitutes major ketotic coma (HONK) etc.
portion of diabetic population. This type
of diabetes occurs due to insulin Treatment of diabetes:
resistance and relative insulin deficiency, Goals of diabetes treatment is not only
usually develops with increasing age the control of high blood glucose but also
(previously called noninsulin dependent disease conditions (hypertension,
diabetes/maturity onset diabetes). dyslipidemia) and modification of risk
Environmental factors like obesity and factors (obesity, physical inactivity), and
physical inactivity are known strong screening for early detection of chronic
determinants in genetically susceptible complications. Treating to target
individuals. This type of diabetes usually provides effective prevention of diabetic
passes through pre-diabetic stage complications. Two basic components of
(Impaired Fasting Glucose-IFG and treatment are lifestyle modification
impaired Glucose Tolerance-1GT). At (dietary measures and exercise) and
diagnosis a large number of cases of medications. Modalities of drug
T2DM remain asymptomatic and often treatment are expanding with time.
present with diabetic specific Compliance to treatment regimen and
complications. better outcome is brightened by ensuring
patient’s participation in management,
Other specific Types of diabetes: and can be achieved satisfactorily by
Some specific diseases, drugs or genetic providing diabetes education to the
conditions/syndromes are associated patients and their families.
with development of chronic
hyperglycemia. These forms of diabetes ORAL GLUCOSE TOLERANCE TEST
are classified as specific types of (OGTT): The test should be done in the
diabetes mellitus. morning after 10-16 hours overnight
fasting. The person should take at least
Gestational diabetes mellitus (GDM) previous 3 days unrestricted diet
GDM is glucose intolerance of any containing more than 150gram
degree which starts or is recognized carbohydrates daily. A fasting blood
during pregnancy. Maintaining blood sample is collected. Then an oral
glucose very tightly reduces the risk to glucose load (for adult 75 g, for child
the mother and the baby. 1.75 g/kg body weight up to maximum
75 g) is given in 250-300 ml of water
Diabetic complications: over the course of 5 minutes. A blood
Uncontrolled diabetes mellitus sets in a sample is collected 2 hours after the test
abnormal state in metabolism in the load. If glucose is not estimated
body. Therefore all tissues/organs of the immediately, the blood sample may be
body are in threat of developing preserved with sodium fluoride (6 mg/ml
complications of diabetes. Long term whole blood) centrifuged and plasma
complications are mediated by micro frozen until estimation. Smoking, tea or
199
physical stress is not allowed during the diabetes

test. Values for diagnosis of diabetes 8.0 – 9.5 High diabetes
mellitus and other categories of > 9.5 Very high diabetes
hyperglycaemia are tabled as follows:
NB: Adult, uncomplicated should be
Table 5.2 A. Diagnostic values for the <7.0%
oral glucose tolerance test OGTT
(Glucose concentration mmol/L): DIABETES AND PREGNANCY
Adverse pregnancy outcomes like
Venous abortions and congenital malformations
Plasma are more common in diabetics; improved
DM Fasting =/> 7.0 management of diabetes particularly
2-hrs after =/> 11.1 early in pregnancy lessens the incidence
glucose load of such events.
IGT Fasting <6.1 and
Insulin is the preferred treatment in
2-hrs after =/> 7.8 to pregnancy even in Type-2 diabetes;
glucose load <11.1 patients on OHA should be switched to
insulin. Insulin requirement may
IFG Fasting 6.1 to 6.9
2-hrs after and decrease in first trimester but then
glucose load < 7.8 increases during later two, reaching
about thrice pre-pregnancy requirement
Normal Fasting <6.1 and
2-hrs after =/> 7.8 at term, then they decline once labour
glucose load has begun and fall again after delivery.
Pregnant diabetics are at risk of
nocturnal hypoglycaemia due to
MONITORING OF THERAPY continued foetal glucose consumption.
Monitoring of therapy is an integral part They are prone to develop ketoacidosis,
of management. Monitoring of blood which need to be treated with urgency.
glucose has generally superseded Diabetes which develops during
detection of urinary glucose. For pregnancy (gestational diabetes) may
adequate diabetic control the aim is to simply be IGT and can be managed by
reduce fasting plasma glucose to below diet alone or if necessary also with
5.6mmol/L and post prandial insulin.
concentration below 10 mmol/L. DIABETES AND SURGERY
Measurement of total glycated or If blood glucose is not properly
glycolsylated haemoglobin (HbA1c) controlled, the outcome of surgery can
provides a good indication for long term be poor; there is chance of wound
control of blood sugar. The ideal HbA1c infection and delayed healing. Insulin is
level is around 7%, which is often difficult suitable for the treatment of diabetic
to achieve without risk of hypoglycemia patients during the perioperative period.
(Table 5.2B). There is debate, however, about the
The value of self-monitoring of blood optimum route of insulin administration
glucose in Type-2 diabetes is debatable during surgeries. Although some
and may be necessary for intensified clinicians advocate subcutaneous insulin
insulin regimens, when tight control is administration; most of them now
required. recommend intravenous insulin infusion.
Most physicians give patients half of
Table 5.2 B: Diagnostic values of HbA1c their normal dose of insulin as
for diabetes intermediate acting insulin
subcutaneously on the morning before
HbA1c Normal/Abnormal
an operation, and then administer
(%)
4- 6.5 Normal for those without
soluble insulin 16 units/litre added to the
diabetes intravenous infusion of 5% dextrose
6.5 – 7.5 Target ranges for those with containing potassium chloride 10
200
mmol/litre (provided the patient is not nephropathy and retinopathy also need
hyperkalaemic), and the infusion is run insulin. It is also indispensable in acute
to adjust the insulin dose. Blood-glucose metabolic decompensated states in
concentration should be measured Type-2 DM (like diabetic ketoacidosis,
preoperatively and then every 2 hours. hyperosmolar nonketotic coma, lactic
acidosis, etc.). Insulin in Type-2 DM is
5.2.1 INSULIN [ED] also used as a combination therapy with
OHA. The subcutaneous route is ideal in
Insulin is needed by all patients of Type- most cases. The dose of insulin is
1 DM regardless of age, those with adjusted on an individual basis, by
ketoacidosis, and most of those with gradually increasing the dose but
rapid onset of symptoms or weight loss. carefully avoiding hypoglycemic
Almost all children with diabetes require reactions. Based on the onset and
it. Type-2 DM cases where other duration of action, insulin preparations
methods fail or with frequent acute are of various types. Short-acting
infection, tuberculosis, hepatitis, during insulins (e.g. soluble insulin; insulin
surgery and with other complications like lispro)
Table 5.2 C Classification of injectable anti-diabetic agents
Class Name Onset of peak duration Time with meals

action action
A. Insulin
1. Conventional
Short Regular 30-60 min 2-3 hr 6-8 hr 30.-60 min ac
acting (higher the GB,
more the
interval)
Intermediat NPH,Lente 2-4 hr 6-8 hr 12-18 hr 30.-60 min ac;or
e acting bed time
Interdediat NPH, Lente 2-4hr 6-8hr 12-18hr. 30-60min ac; or
e acting bed time.
2. Analogues
Aspart, 5-15min 1-1.5hr 3-4hr With meals
Lispro,Glulis (within 15 min
ine ac/pc)
Glargine, 2-4hr No peak 24hr No specific time
Detemir
degludec 0.5-1.5hr No peak 40 hrs (half No specific time
life 24 hrs)
3. Premixed (biphasic)
Conventional premixed Short acting & intermediate acting in proportions of
30/70%, 50/50%, 25/75%
Premixed analogues co Rapid acting analogue & intermediate acting (protaminated
formulation (Deglude 70% + rapid acting) analogue in proportions of 30/70%, 50/50%,
Aspart 30%) 25/75%
B. Other agents
GLP-1 agonists Exenatide Type 2 DM; weight-friendly; 10mirogram (in
2doses) ac within 1hr of meal; increase
dose after 4 weeks (max.20microgram/day)
Liraglutide Type 2 DM; weight-friendly; 0.6mg daily,

increase to 1.2mg after 1 week; max. dose
1.8mg.
201
Amylin analogues Pramlintide Weight-friendly; use with insulin; immediate

ac.
Type 1 DM: 15microgram x 3; increase
dose after 7 days (max .60 x 3)
Type 2 DM: 60microgramg x 3; increase
dose after 7 days (max .120 x 3)
EXAMPLES OF INSULIN REGIMENS 5.2.1.1 SHORT ACTING INSULIN

An appropriate regimen of insulin
therapy must be individualized. Usual
SOLUBLE INSULIN[ED]
regimens are one injection a day, two
injections a day, and multiple (3to7) (Other names: Insulin Injection; Neutral
injections a day and insulin pump. Insulin)
One injection a day: One injection of Indications: Diabetes mellitus, diabetic
intermediate or long acting insulin is ketoacidosis
given either in morning or evening pre-
meal time. It serves, as Cautions: Reduce dose in renal
supplement/basal secretion. It may be impairment
effective in Type-2 DM as monotherapy Interactions: See Appendix-2
or in combination with other oral Side effects: Local reactions and fat
hypoglycemic agents (OHA). hypertrophy at injection site; over dose
Two injections a day: This is the most causes hypoglycemia
commonly used regimen. It can be used Dose: By subcutaneous, intramuscular
in type-1 DM and type-2 DM. A short or intravenous injection or intravenous
acting and an intermediate acting-insulin infusion, according to patient’s
are mixed in proportion that is adjusted requirement and response
by trail and injected before breakfast and
dinner. Alternatively, each injection can Actrapid (Novo Nordisk), Inj., 40 IU/ml ;
be either intermediate-acting insulin or Tk.198.36/10mlvial
biphasic insulin. Actrapid (Novo Nordisk), Inj., 100 IU/ml
Multiple injections: As many as 3 to 7 Tk.422.15/10 ml vial vial; Cartridge;
injections per day may be needed where Tk.1855/box.
there is difficulty in achieving optimal Ansulin R (Square), Inj., 100 IU/ml Tk.
control with other regimes. A dose of 422.15/10ml vial;40IU/ml Tk. 198.36/10 ml vial
;Cartidge Tk. 223.79/3 ml cartidge
short-acting insulin is given before each Diasulin R (ACI), Inj.,100 IU/ml vial
meal, an intermediate-acting/ long acting Tk.422.15/10ml;Inj.,40IU/ml Tk. 198.36/10 ml
insulin is given before bedtime and vial
sometimes before breakfast as basal Humulin-R (I) (Eli Lilly), Inj. 100 IU/ml. Tk.
dose. This is very flexible and suitable 680.00/10 ml vial; Tk.265.00/4ml vial;
for those who are very active and cannot Cartidge, Tk.,336.00/3ml
comply with a rigid meal plan. Insul R (Popular), Inj.40IU/ml, Tk. 195.00/10
ml vial;Inj.,100IU/ml Tk. 415.00/10 ml vial; Inj.,
Insulin pump: Insulin pumps are Tk. 220.00/3 ml cartidge
available in two forms open or closed Insulet R (Aristo), Inj.,vial100IU/ml Tk.
loop (Artificial Pancreas). The open loop 169.70/4 mlvial ;Tk. 422.00/10
system is composed of two parts a ml;40IU/ml,TK.195.00/10ml
battery-operated pump and a computer Insuman Rapid (I) (Aventis), Inj.vial 100 IU/ml.
programmed system for insulin delivery. Tk. 281.7/5ml
The closed loop consists of three parts-a Maxsulin R(Incepta) Inj. 100 IU/mlTk
415.00/10ml vial; 40IU/mlTK.195.00/10mlvial
battery-operated pump, a computer
controlled insulin delivery system and a
glucose sensor giving feedback to the INSULIN ASPART, INSULIN
computer. These are portable and GLULISINE, INSULIN LISPRO
designed to deliver basal amount of (Other name: Recombinant human
regular insulin throughout the day as well insulin analogues)
as meal related boluses. Indication: Diabetes mellitus
202
Cautions: See under Soluble Insulin; Insulin Mixtard 30 (Novo Nordisk), Inj. 100
use in children if benefit as good as with IU/ml, Tk.422.15/10ml vial; 40IU/ml.
Soluble Insulin Tk.198.36/10ml vial
Insulin Mixtard 30(I) (Novo Nordisk), Inj.
Side effects: See under Soluble Insulin (penfill)100 IU/ml.Tk.374.58/3ml cartidge;
Interactions: See Appendix-2 Insulin Mixtard 50(I) (Novo Nordisk), Inj.,
Dose: By subcutaneous injection (penfill)100 IU/ml.Tk.374.58/3ml cartidge
according to the patient’s requirement Ansulin 30/70 (Square), Inj., Cartridge 100
and response IU/ml Tk. 225.83/3ml cartridge; vial Tk.
422.15/10ml ;40IU/ml,Tk.198.36/10ml
Proprietary Preparations Ansulin 50/50 (Square), Inj., Cartridge 100
INSULIN ASPART IU/ml Tk. 225.83/3ml cartridge; vial
Acilog (ACI), Inj., 30% + 70%, TK. 100IU/ml,Tk. 422.15/10 ml ;40IU/ml ,Tk.
450.00/3ml ,; 100IU/ml, TK. 450.00/ 3ml 198.36/10 ml
Insulet (Aristo), Inj., 100IU/ml, Tk. Diasulin 30/70 (ACI), Inj.,vial 100 IU/ml Tk.
450.00/3ml,; 100IU/ml, Tk. 422.15/10 ml ;Inj., 40 IU Tk. 198.36/10 ml
450.00/3ml,4ml,5ml,10ml Diasulin 50/50 (ACI), Inj., 100 IU/ml Tk.
Novo Rapid Penfill(I (Novo Nordisk), 100 422.15/10 ml ; Inj.,40 IU /ml,Tk. 198.36/10 ml
IU/ml, Inj. (Cartridge); TK.3875/pkt. Insulet 30/70 (Aristo), Inj.,vial 100 IU/ml.Tk.
Novo Rapid FlexPen (I) (Novo Nordisk), 100 169.70/4 ml ; TK.415.00/10 ml
IU/ml, inj., pre-filled pen; TK.865/pen. Insulet 50/50 (Aristo), Inj.,vial 100 IU/ml.Tk.
INSULIN GLULISINE 169.70/4 ml ;Tk. 415.00/10 ml
Apidra SoloStar (I) (Sanofi), Inj., Tk. Insul 30/70 (Popular), Inj.,vial100IU/ml Tk.
4,673.60/3 ml 5Pens ; Inj., Tk. 1,990.28/10 ml 415.00/10 ml; Tk. 210.00/5 ml;40IU Tk.
vial 195.00/10 ml; 112.27/5 ml
INSULIN LISPRO Insul 50/50 (Popular), Inj., 100IU/ml Tk.
Humalog(I) (Eli Lilly),Inj100IU/ml(P.F Pen) 415.00/10 ml ;Inj., 40IU/mlTk. 195/10 ml
Tk.4,397/3ml pen Maxsulin 30/70 (Incepta) Inj.,100IU/ml Tk.
Humalog mix 50/50(I)(Eli Lilly),Inj100IU/ml(P.F 357.73/10 ml; pen Tk222.00/pen ;
Pen) Tk.4,397/3ml pen vial40IU/mlTk. 168.09/10ml
Insul Lispro (Popular), Inj., cartidge100IU /ml Maxsulin 50/50(Incepta) Inj.,vial100IU/ml Tk.
Tk. 500.00/3 ml Cartridge 415.00/10ml; pen,Tk.222.00/pen
Insuman-Comb (Sanofi), Inj., Tk. 281.70/5 ml;
Tk. 287.00/3 ml Cartridge
5.2.1.2 INTERMEDIATE AND LONG-
ACTING INSULIN ISOPHANE INSULIN[ED]
(Isophane Insulin-NPH):Neutral protamin
BIPHASIC INSULINS[ED] Hagedorn
(Other name: Biphasic Isophane Insulin) A sterile suspension of bovine or porcine
insulin or of human insulin in the form of
A sterile buffered suspension of porcine a complex obtained by the addition of
insulin complexed with protamine protamine sulphate.
sulphate in a solution of porcine insulin Indications: Diabetes mellitus (for
or a sterile buffered suspension of intermediate action)
human insulin complexed with protamine Cautions; Side effects: See under
sulphate in a solution of human insulin. soluble insulin; protamine may cause
Indications: diabetes mellitus allergic reactions
Cautions; Side effects: See under Interactions: See Appendix-2
soluble insulin; protamine may cause Dose: By subcutaneous injection,
allergic reactions. Should be dispensed according to the patient’s response
under prescription only
Dose: by subcutaneous injection, Proprietary Preparations
according to the patient’s response Humulin N (I) (Eli Lilly), Inj.,100IU, Tk.680/10ml
vial;Tk.310.00/4ml vial;Tk. TK.336.00/3 ml
Proprietary Preparations cartridge
Humulin 70/30(I) (Eli Lilly), Inj. 100 IU/ml. Tk. Insulin Insularated (NovoNordisk), Inj.
310.00/10ml vial; Tk.336.00/3ml cartidge 40IU/ml, Tk. 198.36/10ml vial; 100 IU/ml, Tk.
422.15/10ml vial
203
Insuman basal (I) (Aventis), Inj. 100 IU/ml, Tk. Insul Glargine (Popular), Inj.,Cartidge,100IU
259.69/10 ml Tk. 600/3 ml
Insulatard Penfill(I) (NovoNordisk ) Inj. Insulet GN (Aristo), Inj.100IU,Tk.600/3 ml vial
374.58/3ml cartridge Insulet (Aristo), , 100IU/ml, Tk. 600.00/Inj.
Insul N(Popular), Inj.,vial 100IU Tk. 415.00/10 Lantus Cartridge(I) (Sanofi), Inj.,
ml ;40 IUTk. 195.00/5 ml ; Cartridge 100IU/ml Cartidge,100IU Tk. 711.20/3 ml
Tk. 222.00/3 ml Lantus Optiset(I) (Sanofi), Inj.,100IU Tk.
Ansulin N (Square), Inj., Cartridge 100 IU/ml 5395.75
Tk. 223.79/3 ml Cartridge; vial,100 IU/ml Tk. Lantus SoloStar (I)( (Sanofi), Inj.,100IU Tk.
422.15/10 ml;40IU Tk. 198.36/10 ml 1117.54/3 ml
Diasulin N (ACI), Inj.,vial 100IU Tk. 422.15/10 Lantus(I)(Aventis),inj.100IU/ml,
ml ;40IUTk. 198.36/10 ml Tk.1,025.74/3ml cartridge
Insulet N (Aristo), Inj., vial, 40IU, Levemir FlexPen(I)((Novo Nordisk),Inj.,,
Tk.172.00/4ml; Tk.195/10ml (P.F.Pen) 100U/ml Tk.1305/pen
100IUTk. 422.00/10 ml; .Tk. 172.00/4 ml Vibrenta Penset (Incepta), Inj., 100IU
Maxsulin (Incepta) Inj.,vial 100IU Tk. Tk.600/Penset
415.00/10 ml ;40IUTk. 195.00/10 ml Vibrenta (Incepta), Inj., 100 IU/ml , Tk.
600.00/3ml
INSULIN ZINC SUSPENSION
(Other names: Insulin Zinc suspension INSULIN DEGLUDEC
[Mixed]; I.Z.S.)
Indications: Diabetes mellitus
A sterile neutral suspension of bovine Cautions; Side effects: See under
and/or porcine insulin or of human soluble insulin
insulin in the form of a complex obtained Dose: By subcutaneous injection,
by the addition of a zinc salt; may be ADULT and CHILD over 6years,
amorphous or microcrystalline consisting according to requirements
of rhombohedral crystals. Note. Sustained 40 hour duration of
Indications: diabetes mellitus (long- action allows dosing independently of
acting) meals
Cautions; Side effects: See under
soluble insulin Proprietary Preparation
Interactions: See Appendix-2 Tresiba flex touch (I) (Novo-nordisk), Inj.
100IU/ml, Tk.2490.00/3ml pen
Dose: By subcutaneous injection,
according to the patient’s response
5.2.2 ORAL ANTIDIABETIC AGENTS
Generic Preparation 5.2.2.1 SULPHONYLUREAS
Injection,100IU 5.2.2.2 BIGUANIDES
5.2.2.3 MEGLITINIDE
INSULIN GLARGINE, DETEMIR 5.2.2.4 THIAZOLIDINEDIONES
5.2.2.5 DIPEPTIDYL PEPTIDASE-4
Indications: Diabetes mellitus (DPP-4) INHIBITORS
Cautions; Side effects: See under 5.2.2.6 GLIFLOZIN
soluble insulin 5.2.2.7 ALPHA GLUCOSIDASE
Dose: By subcutaneous injection, INHIBITOR
ADULT and CHILD over 6 years,
according to requirements A number of oral hypoglycaemic agents
Note. Sustained 24 hour duration of are used in the treatment of type 2 DM.
action allows dosing independently of These should be used to augment the
meals effect of diet modification. They should
not be prescribed until within three
Proprietary Preparations months it is seen that the patient does
Glarine (ACI), Inj., 10000IU/100ml, Tk. not respond adequately to diet control.
600.00/ Inj. Sulfonylureas and biguanides are the
Glarine (ACI), Inj., 100IU Tk. 610.34/3 ml vial common oral antidiabetic drugs, though
there are also other agents. They should
204
be avoided in patients with renal Insulin therapy is also substituted during

impairment and also in condition likely to pregnancy. Sulphonylurea therapy is
predispose lactic acidosis, severe contraindicated in presence of
dehydration, infection, hepatic ketoacidosis.
impairment, pregnancy and breast- Side effects: These are generally mild
feeding. and infrequent and include gastroin-
testinal disturbances and headache.
5.2.2.1 SULFONYLUREAS Chlorpropamide may cause facial
flashing after drinking alcohol. It may
The sulfonylureas act mainly by also enhance sensitivity of antidiuretic
augmenting insulin secretion. They are hormone and rarely cause
effective only when some residual beta hyponatraemia. Sensitivity reactions
cell activity is present. During long-term (usually in first 6-8 weeks of therapy)
administration they also have some include transient rashes which rarely
extra-pancreatic effect. All may cause progress to erythema multiforme and
hypoglycemia though uncommon except exfoliative dematitis, fever, and jaundice;
with high dose; hypoglycemia may photosensitivity has also been reported
persist for several hours. There are with chlorpropamide. Blood disorders are
several sulphonylureas, all being similar rare but include thrombocytopenia,
in effectiveness. Chlorpropamide has a agranulocytosis, and aplastic anemia.
very long duration of action but has more
side effects including unpleasant flashes GLIBENCLAMIDE[ED]
after alcohol consumption. Selection of
an individual sulphonylurea depends on Indications: Diabetes mellitus (Type 2
the age of the patient, renal function, or DM)
more generally on personal experience. Cautions; Contraindications; Side-
Elderly patients are prone to develop effects: See notes above
severe hypoglycemia when taking long- Interactions: See Appendix-2
acting drugs such as Chlorpropamide Dose: Initially 5 mg daily (for elderly
and Glibenclamide. They should be patients 2.5 mg, see note above), adjust
replaced by short acting oral according to response; maximum 15 mg
hypoglycemic agents such as Gliclazide daily; taken with breakfast
or Tolbutamide.
Cautions& Contra-indications: These Proprietary Preparations
drugs tend to encourage weight gain and Dibenol (Square), Tab., 5mg, Tk. 0.35/Tab.
should be prescribed after trial with Gliden (Amico), Tab., 5mg, Tk. 0.28/Tab.
Glucon (Opsonin), Tab., 5mg,Tk. 0.34/Tab.
appropriate diet control and exercise. Dicon (Jayson), Tab., 5mg, Tk. 0.28/Tab.
They should not be used during breast- Glibeno (Albion), Tab., 5mg,Tk. 0.30/Tab.
feeding. Caution is needed in elderly and Gluconil (Acme), Tab., 5mg,Tk. 0.28/Tab.
those with hepatic and renal impairment
because of hazards of hypoglycemia. GLICLAZIDE[ED]
The short-acting tolbutamide may be
used in renal impairment, as may be
Indications: Diabetes mellitus (Type 2
gliclazide and gliquidone, which are
DM)
metabolised and inactivated in the liver.
Sulphonylureas should be avoided in
effects: See notes above
porphyria. Insulin therapy should be
introduced temporarily during inter-
Dose: initially 40-80 mg daily, adjust
current illness (such as myocardial
according to response; up to 160 mg as
infarction, coma, infection, and trauma)
a single dose, taken before breakfast;
and during surgery since control of
higher dose to be divided; maximum 320
diabetes with sulphonylureas is often
mg daily
inadequate in such circumstances.
205
Proprietary Preparations Norglic (Monico), Tab.,80mg, Tk. 6.00/Tab.

Admira (UniMed), MR Tab, 30mg, Tk. Oclazid (Orion), MR Tab., 30mg, Tk.
6.00/Tab. ; 80mg, Tk. 6.00/Tab. 6.04/Tab.; 80 mg, Tk. 7.02/Tab.
Claz (Astra Biopharma), Tab. , 80 mg, Tk. Onzid (Leon), Tab., 30 mg, Tk. 6.00/Tab. ;
6.00/Tab. Tab. , 80 mg, Tk. 8.00/Tab.
Comprid (Square), XRTab. , 30 mg, Tk. Orazid (Somatec), Tab, 80 mg, Tk. 7.00/Tab.
6.04/Tab. ; 60 mg, Tk. 11.03/Tab.; 80 mg, Proglid (Supreme), Tab., 80mg, Tk. 8.00/Tab.
Tk. 7.02/Tab. SB-Glic (Sunman-Bardem), Tab. , 80 mg, Tk.
Consucon (Incepta), MR Tab. , 30 mg, Tk. 7.00/Tab. ; 30 mg, Tk. 6.00/Tab. ; 60 mg, Tk.
6.00/Tab.; 60 mg, Tk. 7.00/Tab.; 80 mg, Tk. 11.00/Tab.
11.00/Tab. Sinazid (Ibn Sina), Tab., 80 mg, Tk. 6.50/Tab.
Diab (Rephco), Tab., 80 mg, Tk. 6.00/Tab. Sucleer (Julphar), Tab., 80 mg, Tk.
Diamicron (ACI), MR Tab., 30mg, Tk. 8.0/Tab.;MR Tab., 30 mg, Tk. 8.00/Tab.
12.00/Tab.; 60mg, Tk. 18.50/Tab. Sucotab (Globe), Tab. , 80 mg, Tk. 7.00/Tab.
Diaprid (Alco), Tab. , 80 mg, Tk. 6.02/Tab. .Sugred (Ad-din), Tab., 80 mg, Tk. 6.00/Tab.
Diapro (Beximco), MR Tab., 30mg, Tk. Xido (Delta), Tab., 80 mg, Tk. 7.00/Tab.
7.00/Tab. ; 80mg, Tk. 7.00/Tab.; 60mg, Tk. Zenzide (Zenith), Tab., 80mg, Tk. 6/Tab
12.00/Tab.
Diatrol (Pacific), MR Tab. , 30 mg, Tk.
GLIMEPIRIDE
8.00/Tab.; 60 mg, Tk. 15.00/Tab.; 80 mg,
Tk. 8.00/Tab. ; 80 mg, Tk. 8.00/Tab.
Diazid (Nipro JMI),Tab., 80 mg, Tk. 6.00/Tab. Indication: Type 2 DM
Dimerol (Drug Intl), MR Tab., 30mg, Tk. Cautions: See notes above
6.05/Tab.; 60mg, Tk. 10.00/Tab.; 80mg, Tk. Contra-indications: See notes above
7.05/Tab. Interactions: See Appendix-2
Eucron (Euro), Tab., 80mg, Tk. 6.00/Tab.
G-gliclazide (Gonoshasthaya), Tab. 80 mg,
Tk. 4.00/Tab. Dose: Initially 1 mg daily; adjusted
Gl (Central), Tab., 80 mg, Tk. 7.00/Tab. according to response in 1mg steps at
Glad (Novartis), Tab., 80 mg, Tk. 7.00/Tab. 1-2 week intervals; usual max 4mg daily
Gle (Asiatic), Tab., 80 mg, Tk. 11.00/Tab. (exceptionally up to 6mg daily may be
Gliclid (Acme), Tab., 80mg, Tk. 7.02/Tab.; MR used);taken shortly before or with first
Tab. 30 mg , Tk. 6.01/Tab. meal
Glicron (Renata), CR Cap., 80 mg, Tk.
7.00/Cap.; 60 mg, Tk. 7.00/Tab.
Glikazid (Eskayef), Tab, 30mg, Tk. 5.00/Tab.;
Adglim (uniMed), Tab, 1mg, Tk. 3.00/Tab.;
80mg , Tk. 5.00/Tab.; 80mg, Tk. 5.00/Tab.;
2mg, Tk. 5.00/Tab.
60mg , Tk. 10.00/Tab.
Amaryl(Sanofi), Tab. , 1mg, Tk. 6.92/Tab.;
Glimicron (White Horse), Tab. 80 mg, Tk.
2mg, Tk. 12.94/Tab.; 3mg, Tk. 16.55/Tab.;
7.00/Tab.;MR Tab., 30 mg, Tk. 6.00/Tab.
4mg, Tk. 21.06/Tab.
Glirol (Albion), Tab., 80 mg, Tk. 6.00/Tab.
Condia (Julphar), Tab., 1 mg, Tk.4.50/Tab.;
Glitab (Hudson), Tab., 80 mg, Tk.4.50/Tab.
Tab., 2 mg, Tk. 8/Tab.; 3mg, Tk. 10/Tab.
Glitz (Sharif), Tab., 80 mg, Tk. 7.02/Tab.
Dactus (Acme), Tab. , 2 mg., Tk. 6.50/Tab.;
Glivir (Virgo), Tab. , 80 mg, Tk. 5.00/Tab.
3 mg., Tk. 8.50/Tab.; 1 mg., Tk. 4.00/Tab.
Glix (Navana), Tab., 80 mg, Tk. 8.00/Tab.
Dialon (Eskayef), Tab, 3mg, Tk. 12.00/Tab.;
Glizid (Opsonin), Tab., 60 mg , Tk.
3mg, Tk. 10.00/Tab.; 2mg, Tk. 8.00/Tab.;
11.00/Tab.; 80 mg , Tk. 7.02/Tab.; 30 mg ,
1mg, Tk. 4.50/Tab.; 2 mg, Tk. 12.00/Tab.
Tk. 6.02/Tab.
Diaryl (Beximco), Tab., 3mg, Tk. 12.00/Tab.;
Glucoact (Veritas), Tab., 80 mg, Tk. 6.00/Tab.
1mg, Tk. 6.00/Tab.; 2mg, Tk. 9.00/Tab.
Glucocare (Doctor TIMS), Tab., 80 mg, Tk.
Diavir (Virgo), Tab. , 1 mg, Tk. 150.00/Tab.;
7.00/Tab.
2 mg, Tk. 5.00/Tab.
Glucostat (Biopharma), Tab., 80mg, Tk.
Dieta (Pacific), Tab. , 1 mg, Tk. 6.00/Tab.; 2
7.00/Tab.
mg, Tk. 9.00/Tab.; 3 mg, Tk. 12.00/Tab.; 4
Glucozid (Aristo), Tab., 80mg , Tk. 7.00/Tab.
mg, Tk. 15.00/Tab.
Gluzit (Popular), Tab., 80.00mg, Tk.
Gifon (Monico), Tab., 2mg , Tk. 5.00/Tab.;
7.00/Tab.
1mg , Tk. 3.00/Tab.
Gored (General), Tab. ,80mg, Tk. 7.03/Tab.;
Gipid (Alco), Tab. , 1 mg, Tk. 5.02/Tab.;
30mg, Tk. 8.86/Tab.
1mg, Tk. 3.01/Tab.
Kezid (Kemiko), Tab., 80 mg, Tk. 8.02/Tab. ;
Glemep (Healthcare), Tab., 1mg , Tk.
MR Tab. 30 mg, Tk. 8.00/Tab.
3.00/Tab.; 2mg, Tk. 5.00/Tab.
Likazid (Amico), Tab., 80 mg, Tk. 4.90/Tab.
Lozide (ACI), Tab., 80mg, Tk. 7.02/Tab.
206
Glimepiride (Albion), Tab., 1 mg, Tk. Proprietary Preparations

3.00/Tab.; 2 mg, Tk. 5.01/Tab. Diaplus (Pacific), Tab. , 5 mg, Tk. 2.80/Tab.
Glimirid (ACI), Tab., 2mg, Tk. 9.00/Tab.; ; 5 mg, Tk. 2.00/Tab.
1mg, Tk. 6.00/Tab.; 3mg, Tk. 12.00/Tab.; Diactin (Beximco), Tab., 5mg, Tk. 1.50/Tab.
4mg, Tk. 15.00/Tab. Diazipi (Medimet), Tab. 2.5 mg, Tk. 1.00/Tab.;
Glims (Opsonin), Tab. , 2 mg , Tk. 8.03/Tab.; 5 mg, Tk. 2.00/Tab.
1 mg , Tk. 4.50/Tab. Gipix (Doctor TIMS),Tab., 5 mg, Tk. 2.00/Tab.
Glirid (General), Tab. , 1mg, Tk. 6.00/Tab.; Glimerol (Drug Intl), Tab., 5 mg, Tk. 1.50/Tab.
2mg, Tk. 9.00/Tab. Glipizied (Albion), Tab., 5 mg, Tk. 2.00/Tab.
Gluconor (Aristo), Tab., 2mg , Tk. 8.00/Tab. Glipizide + Metformin Hydrochloride
Glucorid (Biopharma), Tab., 2mg, Tk. Mefoglip, (Incepta), Tab., 2.5 mg + 250 mg,
5.00/Tab.; 1mg, Tk. 3.00/Tab. Tk. 2.8.00/Tab.; 5 mg + 500 mg, Tk,.
Limaryl (Popular), Tab. , 1mg, Tk. 4.50/Tab.; 3.7.00/Tab.; 2.5 mg + 500 mg, Tk.
2mg, Tk. 8.00/Tab.; 3mg, Tk. 10.00/Tab.; 4 1.9.00/Tab.
mg, Tk. 12.00/Tab Metglip, (Pacific), Tab., 500 mg + 2.5 mg, Tk.
Limerid (Supreme), Tab. ,1mg, Tk. 3.00/Tab.; 4.00/Tab. ; 500 mg + 5 mg, Tk. 5.00/Tab.;
2mg, Tk. 5.00/Tab. 250 mg + 2.5 mg, Tk. 2.50/Tab.
Limpet (Drug Intl), Tab. , 1mg, Tk. 3.05/Tab.;
2mg, Tk. 5.05/Tab.; 3mg, Tk. 7.05/Tab.; 4mg,
5.2.2.2 BIGUANIDES
Tk. 9.05/Tab.
Losucon (Incepta), Tab. , 2mg, Tk.
9.00/Tab.; 3mg, Tk. 12.00/Tab.; 1mg, Tk . Metformin is the only available
6.00/Tab.; 4mg, Tk. 15.00/Tab. biguanide for the treatment of diabetes
Pride (White Horse), Tab.,1 mg, Tk.3.30/Tab.; mellitus. It acts by reducing the basal
2 mg, Tk.5.00/Tab. hepatic glucose output mainly by
SB-Glim 1 (Sunman-Bardem), Tab. , 1 mg,
suppression gluconeogenesis. It also
Tk. 6.00/Tab.,; 2 mg, Tk. 9.00/Tab.; 3 mg, Tk.
12.00/Tab.; 4 mg, Tk. 15.00/Tab. reduces gastro-intestinal absorption of
Secrin (Square), Tab. , 1 mg, Tk. 6.00/Tab.; 2 glucose and increases glucose utilization
mg, Tk. 9.00/Tab.; 3 mg , Tk. 12.00/Tab.; 4 in the cells by potentiating insulin action.
mg, Tk. 15.00/Tab. Metformin is the drug of choice in obese
Stimulin (Orion), Tab. , 1 mg Tk. 3.01/Tab.; 2 patients, inadequately controlled with
mg , 5.03/Tab diet and/or sulphonylurea. The
Sucorid (Globe), Tab. , 2 mg, Tk. 5.00/Tab. 4
advantages include absence of
mg, Tk. 8.00/Tab.
Glimepiride + Metformin HCl hypoglycaemia and decrease in weight
Amaryl(Sanofi), Tab. , 1mg+ 500mg, gain. Metformin may provoke lactic
Tk. 12.00/Tab.; 2mg+ 500mg, acidosis, which is most likely to occur in
Tk.18.00/Tab. patients with kidney diseases, but the
Losucon (Incepta), Tab. , 2mg+ condition is very rare. If it occurs, 50
500mg, Tk. 9.00/Tab. percent of the cases become fatal.
Dieta (Pacific), Tab. , 1mg + 500mg, Hypoglycaemia is not a problem with
Tk. 12.00/Tab. Metformin; it is therefore called an oral
anti-hyperglycaemic agent rather than an
oral hypoglycaemic agent. The
GLIPIZIDE advantages include lower incidence of
hypoglycemia and weight gain.
Indications: Type 2 DM Gastrointestinal side effects are usually
Cautions; Contraindications; Side- common and may persist in some
effects : See notes above patients. Metformin may provoke lactic
Interactions: See Appendix-2 acidosis, which is most likely to occur in
Dose: Initially 2.5-5.0 mg daily, adjust patients with kidney diseases.
according to response; up to 15 mg as a Extended release formulation of
single dose, taken before breakfast; metformin has now been developed to
higher dose to be divided; maximum 40 provide better glycaemic control over 24
mg daily hours. It is well-tolerated and
gastrointestinal side-effects like nausea
and diarrhoea are less marked than
conventional metformin.
207
METFORMIN HYDROCHLORIDE [ED] Glymin (Healthcare), Tab.,XR 500mg , Tk.

5.00/Tab.; 850mg , Tk. 4.00/Tab.; 500mg , Tk.
3.00/Tab.
Indications: Diabetes mellitus, G-Metformin (Gonoshasthaya), Tab., 500 mg,
especially in obese patients with TYPE 2 Tk. 2.50/Tab.; 850 mg, Tk. 4.25/Tab.
DM. It may be used alone or in Guamin (Ad-din), Tab., 850 mg, Tk. 3.00/Tab.
combination with sulphonylurea or with Hi-Met (Hudson), Tab., 850 mg, Tk.3.00/Tab.
insulin where resistance is dominant (as Informat (Beximco), Tab.,XR 500mg, Tk.
5.00/Tab.; 500mg, Tk. 3.00/Tab.; 850mg, Tk.
in acromegaly or Cushing's syndrome)
4.50/Tab.; XR750mg, Tk. 7.00/Tab.
Cautions: is not recommended during Insimet (Ibn Sina), Tab. , 500mg, Tk.
pregnancy and should be used only if 5.00/Tab.; 850mg, Tk. 4.00/Tab.; 500mg, Tk.
clearly needed while breast-feeding; it 4.00/Tab.
should not be used in patients with pre- Kemin (Kemiko), Tab., 500 mg , Tk.
existing liver disease, kidney disease or 5.00/Tab. ; 500 mg, Tk. 2.50/Tab. ; 850 mg,
any allergies Tk. 4.01/Tab.
Meforex (Jayson), Tab., 500 mg, Tk.
Contraindications: See notes above
2.00/Tab.; 850 mg, Tk. 3.00/Tab.
Interactions: See Appendix-2 Meforin (Julpher), Tab., 500 mg, Tk.
Side-effects: Gastrointestinal upset like 4.00/Tab.; 850 mg, Tk. 6.00/Tab.; XRTab.,
loss of appetite, nausea, abdominal 500 mg, Tk. 7.00/Tab.
discomfort and diarrhoea, lactic acidosis, Meformin (Organic), Tab. , 500 mg, Tk.
metallic taste, vitamin B12 and Folic acid 2.00/Tab. ; 850 mg, Tk. 3.01/Tab.
deficiency with prolonged use Meglu (UniMed), Tab , XR 500mg, Tk.
5.00/Tab.; XR 750mg, Tk. 7.00/Tab.; XR1gm,
Dose: 500 or 850 mg daily 8 hourly;
Tk. 8.00/Tab.; 850mg, Tk. 4.00/Tab.; 500mg,
taken during meals; maximum 3 g daily Tk. 3.00/Tab.
Met (Opsonin), Tab. ,XR 1 gm , Tk. 9.00/Tab. ;
Proprietary Preparations XR500 mg , Tk. 6.00/Tab. ;XR 750 mg , Tk.
Bigmet (Renata),Tab., 500 mg, Tk. 8.00/Tab. ; 850 mg , Tk. 6.00/Tab. ; 500 mg ,
5.00/Tab.; 850 mg, Tk. 6.00/Tab. Tk. 4.00/Tab.
Comet (Square), Tab., 1 gm, Tk.7.02/Tab.;XR Metarin (Popular), Tab. , 500mg, Tk.
1 gm, Tk. 9.03/Tab.; 500 mg, Tk. 4.02/Tab.; 3.00/Tab.; 850.00mg, Tk. 4.50/Tab.
XR500 mg, Tk. 6.02/Tab.; 850 mg, Tk. Metarin (Popular), Tab., 500 mg, Tk.
6.02/Tab. 2.51/Tab.; 850 mg, Tk. 4.02/Tab.
Daomin (Acme), Tab. , 500 mg., Tk. Metfar (White Horse), Tab., 500mg, Tk.
4.00/Tab. ; 1gm Tk. 8.00/Tab. ; XR500 mg, 4.00/Tab.; 850 mg, Tk. 5.00/Tab.;
Tk. 6.00/Tab. ; 850.00 mg., Tk. 6.00/Tab. ; Metfo (Pacific), Tab. , 500 mg, Tk. 4.00/Tab.
Deformin (Zenith), Tab. , 850 mg, Tk. ; XR500mg, Tk. 7.00/Tab. ; 850 mg, Tk.
4.00/Tab.; 500 mg, Tk. 3.00/Tab. 6.00/Tab. ;XR 1gm, Tk. 10.00/Tab. ; 500 mg,
D-Fo (Decent), Tab., 850mg, Tk. 4.00/Tab. Tk. 4.00/Tab. ; XR750mg, Tk. 9.00/Tab.
Dia-M (Medimet), Tab., 850mg, Tk.2.50/Tab.; Metfomin (Astra Bio), Tab. , 500 mg, Tk. 3.00
500 mg, Tk.1.10/Tab. /Tab. ; 850 mg, Tk. 4.00/Tab.
Diamin (Virgo), Tab. , 500 mg, Tk. 2.50/Tab.; Metform (ACI), ER Tab., 500mg, Tk.
850mg, Tk. 3.00/Tab. 6.00/Tab. ; 500mg, Tk. 4.00/Tab. ; XR1gm,
Diout (Asiatic), Tab., 850mg , Tk. 2.25/Tab. Tk. 9.00/Tab. ; 850mg, Tk. 6.00/Tab.
Etform (Novartis), Tab., 500 mg, Tk. Metin (Supreme), Tab. , 500 mg, Tk.
3.20/Tab.; 850 mg, Tk.5.50/Tab. 3.00/Tab.; 850 mg, Tk. 4.96/Tab.
Formet (Biopharma), Tab.,XR 500mg , Tk. Metlife (Silva), Tab. , 850mg, Tk. 4.02/Tab. ;
6.00/Tab.; 500mg , Tk. 4.00/Tab.; 850mg, Tk. 500mg, Tk. 3.01/Tab.
6.00/Tab. Metmin (Alco), Tab. , 500 mg, Tk. 3.01/Tab.
Glucomet (Aristo), Tab., 500mg Tk. ; 850 mg, Tk. 4.01/Tab.
4.00/Tab.; XR500mg, Tk. 6.00/Tab. ; Metnor (Monico), Tab., 500mg, Tk. 3.00/Tab.
XR750mg , Tk. 9.00/Tab. ; 850mg , Tk. Metomin (Somatec), Tab., 850 mg, Tk.
6.00/Tab. 5.00/Tab.; 500 mg, Tk. 3.00/Tab.
Glucomin (Nipro JMI), Tab., 500 mg, Tk. Metsa (Sanofi), Tab., 500mg, Tk. 3.01/Tab.;
3.00/Tab.; 850 mg, Tk. 5.00/Tab. XR500mg, Tk. 6.02/Tab.; XR1gm Tk.
Glunor (Eskayef), Tab., 500 mg, , Tk. 9.00/Tab.; 850mg, Tk. 5.02/Tab.
4.00/Tab.; 850mg , Tk. 6.00/Tab.;XR 500 mg, M-Form (Central), Tab., 850 mg, Tk. 5.50/Tab.
Tk. 6.00/Tab. M-Fort (Albion), Tab., 500 mg, Tk. 3.00/Tab.;
850 mg, Tk. 4.00/Tab.; XR Tab., 500 mg, Tk.
5.00/Tab.
208
M-Min (Sharif), Tab. , 500 mg, Tk.3.01/Tab.; Ca2+ channels. The rise in intracellular
850 mg, Tk. 4.51/Tab. calcium leads to increased fusion of
Nobesit (Incepta), Tab.,XR 1gm, Tk. 9.00/Tab. insulin granulae in the cell membrane,
; 500 mg, Tk. 4.00/Tab. ; 850 mg, Tk.
6.00/Tab.
and therefore increased secretion of
Nvmet (Navana), Tab., 500 mg, Tk. 3.00/Tab.; (pro) insulin.
850 mg, Tk. 5.00/Tab.; SR Tab., 500 mg, Tk.
5.00/Tab.
Obemet (Euro), Tab., 500mg, Tk. 2.00/Tab. ;
Side effects: include weight gain and
850mg, Tk. 4.00/Tab. hypoglycemia. While the potential for
Obid (Delta), Tab., 500 mg, Tk. 3.00/Tab.; hypoglycemia is less than for those on
850 mg, Tk. 5.00/Tab. sulfonylureas, it is still a serious potential
Onmet (Leon), Tab., 500 mg, Tk. 3.00/Tab.; side effect that can be life-threatening.
850 mg, Tk. 5.00/Tab. Patients on this medication should know
Oramet (Drug Intl), Tab. ,XR 1gm, Tk.
the signs and symptoms of
7.05/Tab.; 500mg, Tk. 4.00/Tab.; XR500mg,
Tk. 5.05/Tab.; 850mg, Tk. 5.00/Tab.
hypoglycemia and appropriate
Ormin (Orion), Tab. , 500 mg, Tk. 3.01/Tab.; management.
850 mg, Tk. 5.01/Tab.
Radimet (Radiant), Tab. , 500mg, Tk.
4.00/Tab.; 850mg, Tk. 6.00/Tab.; 1gm, Tk. NATEGLINIDE
9.00/Tab.; XR500mg, Tk. 7.00/Tab.
Ruzmet (Amico), Tab., 500 mg, Tk. 3.00/Tab. Indications: Lowering blood sugar
SB-Met (Sunman-Bardem), Tab. ,500 mg, Tk. levels in patients with type 2 diabetes. It
4.00/Tab. ; 850 mg, Tk. 6.00/Tab.; XR1gm, Tk.
8.00/Tab. ; XR500 mg, Tk. 6.00/Tab.
used along with diet and exercise
Sucomet (Globe), Tab. , 500 mg, Tk. Cautions: Type 1 diabetes, diabetic
3.00/Tab.; 850 mg, Tk. 4.50/Tab.;XR 850mg., ketoacidosis, pregnancy & breast
Tk. 5.50/Tab.; XR500mg., Tk. 3.50/Tab. feeding; elderly
Sugamet (General), Tab., 500 mg, Tk. Side Effects: Dizziness; flu-like
3.00/Tab.; 850 mg, 4.50/Tab. symptoms (fever, chills, sore throat);
Verimet (Veritas), Tab., 500 mg, Tk. joint pain; upper respiratory tract
3.00/Tab.; 850 mg, Tk. 4.00/Tab.
infection. : changes in vision; headache;
Metformin Hydrochloride + Glipizide increased hunger; loss of
Mefoglip (Incepta), Tab250 mg+., 2.5 mg +, consciousness; nervousness; seizures;
Tk. 2.8.00/Tab.; 500 mg+5mg, Tk,. shakiness; sweating; tiredness.
3.7.00/Tab.; 500 mg+2.5mg, Tk. 1.9.00/Tab. Dose:120 mg orally three times daily
Metglip (Pacific), Tab.,500 mg+2.5 mg, Tk. before meals
4.00/Tab.; 500 mg + 5 mg, Tk. 5.00/Tab.; 250
mg +2.5 mg,Tk. 2.50/Tab Proprietary Preparations
Metazid (Popular), Tab., 500 mg + 2.5 mg, Tk. Starlex(I) (Novertis), Tab., 120mg,
2.51/Tab. Tk.28.68/Tab.
5.2.2.3 MEGLITINIDE REPAGLINIDE
Meglitinides (glinides) make up a class Indications: Diabetes mellitus as

of drugs used to treat diabetes type monotherapy or in combination with
2.They bind to an ATP-dependent K+ metformin
(KATP) channel on the cell membrane of Cautions: Monitor liver function; not
pancreatic beta cells in a similar manner recommended for children/adolescent
to sulfonylureas but have a weaker under 18 years and elderly over 70 years
binding affinity and faster dissociation Contra-indications and Side-effects:
from the SUR1 binding site. This Diabetic ketoacidosis; renal or hepatic
increases the concentration of impairment; pregnancy and breast-
intracellular potassium, which causes the feeding
electric potential over the membrane to Interactions: See Appendix-2
become more positive. This Side effects: Same as that of
depolarization opens voltage-gated pioglitazone
209
Dose: Initially 500 micrograms within 30 dizziness, arthralgia, haematuria,

minutes before main meals, adjusted impotence,risk of bladder cancer, less
according to response at intervals of 1-2 commonly hypoglycaemia, fatigue,
weeks; maximum up to 15 mg daily sweating, altered blood lipids, proteinuria
Interactions: See Appendix 2
Proprietary Preparations Dose: 15-30 mg once daily
Glimet (Drug Int), Tab., 1 mg, Tk. 3/Tab.
Gluretor (Pacific), Tab., 1mg,Tk. 4/Tab., 2 mg, Proprietary Preparations
Tk. 6/Tab., 0.5 mg, Tk. 2.80/Tab. Actose (UniMed), Tab, 15 mg, Tk. 8.00/Tab.
Nomopil (Incepta), Tab., 0.5 mg, Tk. Adpas (General), Tab., 15 mg, Tk. 8.03/Tab.
2.00/Tab.; 1 mg, Tk. 3.00/Tab., 2 mg, Tk. Diaglit (Beximco), Tab., 15 mg, Tk. 8.00/Tab.
5.00/Tab. Diapiotab (Medimet), Tab., 15mg,
Prandil (UniMed), Tab.,1 mg,Tk. 3.00/Tab. Tk.8.00/Tab.
Premil (Beximco), Tab., 0.5 mg, Tk.2.00/Tab.; Diatag (ACI),Tab., 15 mg, Tk. 8.05/Tab.
1 mg, Tk. 3.00/Tab.; 2 mg, Tk. 5.00/Tab. Glitazon(Ibn Sina), Tab.,15 mg, Tk.8/Tab.
Prifid (White Horse), Tab., 1mg, Tk.3.00/Tab. Glucozon (Aristo), Tab., 15 mg, Tk. 8.00/Tab.
Repaglid (Alco), Tab., 2 mg, Tk. 5.02/Tab. Lit (White Horse), Tab., 15 mg, Tk. 8.00/Tab.
Repanid (Opsonin), Tab, 1 mg, Tk. 3.01/Tab., Pidus (Acme), Tab.,15 mg, Tk. 8.07/Tab.
2 mg, Tk. 5.02/Tab. Piglit (Pacific), Tab.,15 mg, Tk. 8/Tab.
Pigzon (Sharif),Tab.,15 mg,Tk.8.03/Tab.
5.2.2.4 THIAZOLIDINEDIONES Piodar (Incepta), Tab. ,15mg,Tk. 8/Tab.
Piol (Opsonin), Tab., 15 mg, Tk. 6.04/Tab.
Piolit (Alco), Tab. ,15 mg, Tk. 8.02/Tab.
Thiazolidinediones abbreviated as TZDs Saglit (Sanofi), Tab., 15 mg, Tk. 8.03/Tab.
also known as Glitazones—work on Tos (Square), Tab., 15 mg, Tk. 8.04/Tab.
lowering your insulin resistance, which is
the underlying problem for many people ROSIGLITAZONE
with type 2 diabetes.TZDs make your
body produce new fat cells, and those
cells are actually more sensitive to
Cautions: Congestive heart failure,
insulin—that is, they allow insulin to do
heart attack, chest pain, discomfort;
its job. If you’re insulin resistant, your
hepatic impairment, pregnancy and
cells don’t allow insulin to do its job
breast feeding.
(which is to get glucose into the
Side effects: Same as that of
cells). The new fat cells, then, can
pioglitazone
eventually lower your blood glucose level
by making your body use insulin and Proprietary Preparations
glucose better. The first-generation Rosiglitazone1 mg + Metformin HCl 500 mg,
thiazolidinediones actually caused Sensimet (Square), Tab., Tk. 4.01/Tab.;
serious liver damage in a few people. Metarin Plus (Popular), Tab.Tk. 4.02/Tab.
The second-generation TZDs shouldn’t
do that, but it’s still something to keep in 5.2.2.5 DIPEPTIDYL PEPTIDASE-4
mind, especially if you already have liver (DPP-4) INHIBITORS
problems. Examples of TZDs:
Pioglitazone, Rosiglitazone DPP-4 inhibitors work by blocking the
action of DPP-4, an enzyme which
PIOGLITAZONE destroys the hormone incretin. Incretins
help the body produce more insulin only
when it is needed and reduce the
amount of glucose being produced by
Cautions: Liver function tests to be
the liver when it is not needed. These
carried out. There is risk of heart failure;
hormones are released throughout the
so the drug should be used with caution
day and levels are increased at meal
in cardio-vascular disease
Side effects: Gastro-intestinal times.
disturbances, weight gain, edema,
anemia, headache, visual disturbance,
210
LINAGLIPTINE 50mg/day for CCR <50 ml/min),

Saxagliptin (2.5 mg/day once or twice ;
Indications: Type 2 diabetes in 2.5mg/day for CCR <50 ml/min).
patients who cannot control blood sugar
Proprietary Preparations:
levels by diet and exercise alone. It is
Saxagliptin
used along with diet and exercise. It may Glyza (Ibn Sina), Tab. , 2.5 mg, Tk.
be used alone or with other antidiabetic 20.00/Tab., 5 mg, Tk. 35.00/Tab.
medicines. Sixtin (Drug Intl), Tab. , 2.5 mg, Tk.
Cautions:Type1 diabetes & 16.00/Tab., 5 mg, Tk. 30.00/Tab.
ketoacidosis; pregnancy & breast
feeding Sitagliptin
Glipita (Beximco), Tab., 100mg, Tk.
Side effects: Headache, joint pain,
25.00/Tab., 50mg, Tk. 13.00/Tab.
runny or stuffy nose, sore throat; severe Incrit(Sanofi), Tab. , 100mg, Tk. 30.09 /Tab.,
stomach or back pain. 50 mg, Tk. 18.05/Tab.
Dose: 5 mg orally once a day Janvia (Acme), Tab. , 100 mg , Tk.
28.08/Tab., 50 mg , Tk. 15.04/Tab.
Proprietary Preparations Rediglip (Radiant), Tab. , 50 mg, Tk.
Adlina (UniMed), Tab., 5 mg, Tk. 20.00/Tab. 16.00/Tab.
Dialina (Biopharma), Tab., 5mg, Tk. 15/Tab. SB-Sita (Sunman-Bardem), Tab. , 50 mg, Tk.
Glitin (ACI), Tab., 5mg, Tk. 15.00/Tab. 15.00/Tab., 100 mg, Tk. 28.00/Tab.
Ligazid (Eskayef), Tab, 5mg, Tk. 15.00/Tab.; Sgn (Pacific), Tab. , 100 mg, Tk. 28.00/Tab.,
5mg, Tk. 15.00/Tab.; 5mg , Tk. 15.00/Tab.; 25 mg, Tk. 8.00/Tab., 50 mg, Tk. 15.00/Tab.
5mg, Tk. 15.00/Tab. Siglita (Square), Tab. , 100 mg, Tk.
Lijenta (Nipro JMI), Tab., 5 mg, Tk. 30.00/Tab. 25.00/Tab., 50 mg, Tk. 13.00/Tab.
Linadi (Pacific), Tab., 5 mg, Tk. 15.00/Tab. Silinor (Healthcare), Tab., 100mg , Tk.
Linadus (Opsonin), Tab, 5 mg, Tk. 30.00/Tab., 50mg, Tk. 54.00/Tab., 25mg , Tk.
15.00/Tab. 10.00/Tab.
Linaglip (Aristo), Tab., 5mg , Tk. 20.00/Tab. Sitagil , (Incepta), Tab. , 50 mg, Tk.
Linajen (Popular), Tab., 5mg, Tk. 15.00/Tab. 15.00/Tab., 100 mg, Tk. 28.00/Tab., 25 mg,
Linaptin (General), Tab., 5mg, Tk. 18.00/Tab. Tk. 8.00/Tab.
Linarol (Drug Intl), Tab., 5mg, Tk. 15.05/Tab. Sitap (ACI), Tab., 50 mg, Tk. 15.05/Tab., 100
Linatab (Incepta), Tab., Tk. 15.00/Tab. mg , Tk. 28.08/Tab.
Linax (Ibn Sina), Tab., 5mg, Tk. 210.00/Tab.; Sitavia (Sharif), Tab. , , Tk. 15.00/Tab.
5mg, Tk. 7.00/Tab. Sitazid (Eskayef), Tab, 100mg , Tk.
Linita (Square), Tab., 5 mg, Tk. 15.00/Tab. 25.00/Tab., 50mg, Tk. 13.00/Tab.,
Lino (Acme), Tab. , 5 mg, Tk. 15.00/Tab. Sliptin (Drug Intl), Tab. , 100mg, Tk.
Lintin (Kemiko), Tab., 5 mg, Tk. 20.00/Tab. 28.10/Tab., 25mg, Tk. 8.05/Tab., 50mg, Tk.
SB-Lina (Sunman-Bardem), Tab., 5 mg, Tk. 15.05/Tab.
15.00/Tab. Sucosit (Globe), Tab. , 100 mg, Tk.
Traneta (Beximco), Tab., 5mg, Tk. 18/Tab. 28.00/Tab., 50 mg, Tk. 16.00/Tab.
OTHER INCRETIN MIMETICS Vidagliptin

Aptin (ACI), Tab., 50 mg, TK. 20.00/Tab.
Dialiptin (Drug Intl), Tab. , 50 mg, Tk.
Indications: Diabetes mellitus 15.05/Tab.
inadequately controlled by diet with or Galvus (I) (Novartis), Tab. , 50 mg, Tk.
without other antidiabetic agent 31.50/Tab.
Cautions: Drug allergy Gluvan (Aristo), Tab., 50 mg, Tk. 20.00/Tab.
Gluvil (Alco), Tab. , 50 mg, Tk. 20.00/Tab.
Contraindications and Side-effects:
Redia (Healthcare), Tab., 50 mg, Tk.
Impaired renal function (except 20.00/Tab.
linagliptin): GI upset, upper Respiratory SB-Vilda (Sunman-Bardem), Tab. , 50 mg,
Tract Infection and pancreatitis Tk. 15.00/Tab.
Interactions: See Appendix-2 Sucovil (Globe), Tab. , 50 mg, Tk. 20.00/TAb.
Dose: Sitagliptins (100 mg/day once; Vida (Pacific), Tab. , 50 mg, Tk. 20.00/Tab.
50mg/day for CCR <50 ml/min, & 25 Vigatin (Eskayef), Tab, 50 mg, Tk. 20.00/Tab.,
Viglita (Square), Tab. , 50 mg, Tk. 16.00/Tab.,
mg/day for CCR <30 ml/min),
Vildagil (Sharif), Tab. , 50 mg, Tk.
vildagliptin, ( 50 mg once or twice/; 18.04/Tab.
211
Vildapin (Acme), Tab. , 50 mg, Tk. 15.04/Tab. Sitavia (Sharif), Tab. , 50+ 100 mg, Tk.
Vildus (Opsonin), Tab. , 50 mg, Tk. 18.00/Tab. ; 50+ 500 mg, Tk. 16.00/Tab.
20.00/Tab. Sitomet (ACI), Tab., 50 mg + 1 gm, Tk.
Viptin (General), Tab. , 50 mg, Tk. 20.06/Tab. 18.05/Tab. ; 50 mg + 500mg, Tk. 16.05/Tab.
Sliptin(Drug Intl), Tab. , 500mg, Tk.
Vildagliptin + Metformin HCl 16.05/Tab.; 500mg, Tk. 16.05/Tab.;
Aptin (ACI), Tab., 50mg + 850mg, TK. 50mg+1gm,Tk.18.10/Tab.;50mg+500mg, Tk.
23/Tab. ; 50mg +500mg, TK. 22/Tab. 16.05/Tab.;
Dialiptin M (Drug Intl), Tab. , 50mg+500mg,
Tk. 16.05/Tab.; 50mg+850mg, Tk. 17.05/Tab.
5.2.2.6 GLIFLOZIN
Galvus Met(I) (Novartis), Tab. , 50 mg+ 500
mg, Tk. 31.50/Tab.; 50 mg+ 850 mg, Tk.
31.50/Tab. Gliflozin drugs are a class of medications
Gluvan (Aristo), Tab., 50 mg + 500mg , Tk. that inhibit reabsorption of glucose in the
21.00/Tab.; 50 mg + 850mg , Tk. 22.00/Tab. kidney and therefore lower blood sugar.
Redia (Healthcare), Tab., 50 mg + 500mg, They act by inhibiting sodium-glucose
Tk. 22.00/Tab.; 50mg + 850mg , Tk.
transport protein 2 (SGLT2), and are
24.00/Tab.
SB-MetVilda, (Sunman-Bardem), Tab. , 50 mg therefore also called SGLT2 inhibitors.
+ 500 mg , Tk. 17.00/Tab. ; 50 mg 850 mg, Tk. Gliflozins are used in the treatment of
17.00/Tab. type II diabetes mellitus (T2DM). Apart
Sucovil (Globe), Tab. , 50 mg + 500 mg, Tk. from glycemic control, gliflozins have
15.75/Tab.; 50 mg + 850 mg, Tk. 23.00/Tab. been shown to provide significant
Vidaplus (Pacific), Tab. , 50 mg+l 850 mg , cardiovascular benefit in T2DM patients.
Tk. 24.00/Tab. ; 50 mg+ 500, Tk. 22.00/Tab.
The gliflozins are used to treat type 2
Vigamet (Eskayef), Tab, 50mg + 500mg, Tk.
20.00/Tab.; 50mg + 850mg, Tk. 22.00/Tab.; diabetes mellitus but are most often
Vildagil M (Sharif), Tab. , 50+500mg, Tk. used as second- or third-line agents
20.07/Tab. ; 50+ 850mg , Tk. 22.07/Tab. instead of first-line because there are
Vildamet (Opsonin), Tab. , 50 mg + 500 mg, other drugs on the market that have
Tk. 22.06/Tab. ; 50 mg+ 850 mg , Tk. much longer safety record and are less
23.00/Tab. expensive than gliflozins. Gliflozins may
Vildapin plus (Acme), Tab. , 50mg + 850 mg,
be a good option for patients who are
Tk. 20.00/Tab. ; 50mg + 500 mg , Tk.
16.00/Tab. failing with metformin monotherapy,
Viglimet (Square), Tab., 50 mg + 850 mg, Tk. especially if weight is part of the
23.00/Tab.; 50 mg + 500 mg, Tk. 22/Tab. underlying treatment. They are often
Viptin Plus (General), Tab. , 50mg + used in combination therapy, for
850mg, Tk. 22.07/Tab.; 50mg + 500mg, Tk. example the dual therapy metformin plus
21.07/Tab. gliflozin and the triple therapy metformin,
Sitagliptin + Metformin
sulphonylurea and gliflozin.
Glipita M (Beximco), Tab., 50mg + 1gm, Tk.
16.00/Tab.; 50mg +500mg, Tk. 14.00/Tab.
Incrit (Sanofi), Tab. , 50mg +500mg, Tk. DAPAGLIFLOZIN
20.06/Tab.; 50mg+1gm, Tk. 22.07/Tab.
Janmet (Acme), Tab. , 50 mg + 500 mg, Tk.
Indications: Type 2 diabetes as
16.04/Tab. ; 50 mg + 1gm, Tk. 18.04/Tab.
Rediglip M (Radiant), Tab. , 50mg + 500mg, monotherapy (if metformin not
Tk. 20.00/Tab. tolerated), or in combination with insulin
SB-Metsita (Sunman-Bardem), Tab. , 50 mg + or other antidiabetic drugs (if existing
1 gm, Tk. 22.00/Tab. ; 50 mg + 500mg, Tk. treatment fails to achieve adequate
20.00/Tab. glycaemic control);
SGN (Pacific), Tab. , 50 mg+ 500 , Tk. Cautions: Kidney disease/failure
16.00/Tab.
(dialysis), bladder cancer, dehydration,
Siglimet (Square), XRTab. , 50 mg + 1gm ,
Tk. 16.00/Tab. ;ER 50 mg + 1gm , Tk.
low blood pressure, heart failure, yeast
18.00/Tab. ; 50 mg + 500 mg , Tk. 14.00/Tab. infections in the vagina or penis
; XR100 mg + 1gm , Tk. 30.00/Tab. electrolyte disturbances; cardiovascular
Sitagil (Incepta), Tab. , 50 mg + 1gm, Tk. disease or elderly (risk of hypotension);
35.00/Tab. ; 50 mg + 500 gm, Tk. 18.00/Tab. Contraindications: ketoacidosis,
Sitamet (Renata), Tab. , 50mg+50mg, Tk.
20.00/Tab.
212
hepatic impairment ,renal impairment, Proprietary Preparations:

pregnancy Empa (NIPRO JMI)Tab. 10 mg; Tk.
Side-effects: Hypoglycaemia (in 25.00/Tab.; 25mg, Tk.40.00/Tab.
Empazin (Delta), Tab. 10mg, Tk.15/Tab.; 25
combination with insulin or mg,
sulphonylurea), constipation, Jardian (Beximco), Tab. 10 mg Tk. 25/Tab.;
dyslipidaemia, back pain, genital 25mg, Tk. 40/Tab.
infection, urinary-tract infection, dysuria, Jardiance(I) (Boehringer) Tab. 10 mg Tk.
polyuria, thirst, sweating; 25/Tab.; 25mg, Tk. 40/Tab.
Dose:ADULT over 18 years, 10mg once
daily; ELDERLY over75 years, initiation 5.2.2.7 ALPHA GLUCOSIDASE
not recommended INHIBITOR
Proprietary Preparations Alpha-glucosidase inhibitors are oral

Dapaglip (Incepta), Tab. , 5 mg, Tk.
anti-diabetic drugs used for diabetes
16.00/Tab.
Glycema (ACI), Tab., 5 mg, Tk. 16.00/Tab.; mellitus type 2 that work by preventing
10 mg, Tk. 30.00/Tab. the digestion of carbohydrates (such as
Note: Dose of concomitant insulin or drugs starch and table sugar). Carbohydrates
that stimulate insulin secretion may need to be are normally converted into simple
reduced sugars (monosaccharides) by alpha-
glucosidase enzymes present on cells
EMPAGLIFLOZIN lining the intestine, enabling
monosaccharides to be absorbed
Indications : Type 2 diabetes through the intestine. Hence, alpha-
mellitusas an adjunct to diet and glucosidase inhibitors reduce the impact
and exercise of dietary carbohydrates on blood sugar.
Cautions: Assessment of renal function Dose: Since alpha-glucosidase inhibitors
is recommended prior to initiation of are competitive inhibitors of digestive
Empagliflozin and periodically thereafter. enzymes, they must be taken at the start
Empagliflozin should not initiated in of main meals to have maximal effect.
patients with an eGFR less than 45 Their effects on blood sugar levels
mL/min/1.73m2. No dose adjustment is following meals will depend on the
needed in patients with an eGFR greater amount of complex carbohydrates in the
than or equal to 45 mL/min/1.73m2 meal.
Contra-indications: Empagliflozin is Side effects and precautions: Since
contraindicated in patients with history of alpha-glucosidase inhibitors prevent the
serious hypersensitivity reaction to degradation of complex carbohydrates
Empagliflozin or any of its ingredients, into glucose, the carbohydrates will
severe renal impairment, renal disease, remain in the intestine. In the colon,
dialysis, breast feeding, pregnancy bacteria will digest the complex
Interactions: Diuretics; Insulin or Insulin carbohydrates, thereby causing
Secretagogues: Co-administration of gastrointestinal side effects such as
Empagliflozin with insulin or insulin flatulence and diarrhea. Since these
secretagogues increases the risk for effects are dose-related, it is generally
hypoglycemia advised to start with a low dose and
Side effects Urinary tract infections and gradually increase the dose to the
female genital mycotic infections. Others desired amount.
common side effects includes
dehydration, hypotension, weakness, ACARBOSE
dizziness and increased thirstiness
Dose:The recommended dose of Indications: Diabetes mellitus
Empagliflozin10 is 10 mg once daily, inadequately controlled by diet with or
taken in the morning, with or without without other antidiabetic agent
food.
213
Cautions: Monitor liver function Hypoglycaemia, Anorexia, Appetite

Contraindications and Side-effects: decreased, Headache Dizziness,
Pregnancy and breast-feeding, Vomiting, Dyspepsia, Abdominal pain
inflammatory bowel disease (ulcerative upper, Constipation, Gastritis,
colitis, Crohn’s disease), hepatic Flatulence, Abdominal distension,
impairment, severe renal impairment Gastro esophageal reflux disease,
Interactions: See Appendix-2 Abdominal discomfort, Toothache
Dose: Initially 50 mg daily, increased up Cautions: Liraglutide should not be
to 100 mg three times daily slowly; single used in patients with type 1 diabetes
dose taken with breakfast, higher doses mellitus or for the treatment of diabetic
divided; maximum 600 mg daily. CHILD ketoacidosis. Liraglutide is not a
under 12 years not recommended substitute for insulin
Proprietary Preparations Dose: To improve gastro-intestinal
Carbos (Ibn Sina), Tab. 50mg.Tk 8/Tab tolerability, the starting dose is 0.6 mg
Gluco (Acme), Tab. 100 mg, Tk. 20.07/Tab.; liraglutide daily. After at least one week,
50 mg, Tk. 11.04/Tab.
Sugatrol (Pacific), Tab. 100 mg, Tk.
the dose should be increased to 1.2 mg.
25.00/Tab.; 50 mg, Tk. 15.00/Tab. Some patients are expected to benefit
from an increase in dose from 1.2 mg to
MIGLITOL 1.8 mg and based on clinical response,
after at least one week, the dose can be
increased to 1.8 mg to further improve
Indications: Type 2 diabetes alone or glycaemic control. Daily doses higher
in combination with a sulfonylurea such than 1.8 mg are not recommended
as glyburide
Side Effects: Diarrhoea, bloating, soft Proprietary Preparations
stools, stomach pain Victoza (Novo Nordisk), Inj., 6 mg/ml, Tk.
Cautions: Pregnancy breast-feeding, if 6500.00/Pen.
the patient has stomach or bowel
problems, liver disease, or kidney
disease 5.2.4 DIABETIC EMERGENCY
Interactions: See Appendix -2 5.2.4.1 DIABETIC KETOACIDOSIS
Dose: 25 mg three times daily and then (DKA)
increase after four to eight weeks to 50- 5.2.4.2 HYPOGLYCAEMIA
100mg three times daily
5.2.4.1 DIABETIC KETOACIDOSIS
Proprietary Preparations (DKA)
Diaset (ACI),Tab 25mg, Tk. 10.07/Tab; 50 mg,
15.11/Tab. Diabetic Ketoacidosis (DKA) is a medical
emergency in diabetics often found in
5.2.2.3 OTHER ANTIDIABETIC Typ1 DM and also in stressful situation
AGENTS in other types of diabetes. It results from
lack of insulin leading to hyperglycaemia
LIRAGLUTIDE and ketoacidosis. Its causes are:
omission or reduction of insulin dose;
undiagnosed diabetes; and intercurrent
Indications: Indicated for the treatment
illness, especially acute infection.
of adults with insufficiently controlled
Soluble insulin given intravenously, is
type 2 diabetes mellitus as an adjunct to
used in the management of DKA. If
diet and exercise as monotherapy, in
infusion pump is available, infuse at a
addition to other medicinal products for
rate of 3-6 units per hour. Alternately,
the treatment of diabetes.
give intramuscularly 10-20 units,
followed by hourly 5-10 units. Hourly fall
Side-effects: Nausea Diarrhoea,
of blood sugar should be in the range of
Nasopharyngitis, Bronchitis,
3-6 mmol/L. Usual subcutaneous regime
214
of insulin may be started when blood patient himself/herself or by a family

glucose falls below 15 mmol/L. member with sugar or a glass of soft
Intravenous replacement of fluid and drinks or fruit juice or biscuit, chocolate
electrolytes is an essential part of the or honey. If the symptoms reappear
management of ketoacidosis. Normal within half an hour, repeat the treatment
Saline is infused initially at 1 litre per or let the patient take the next meal. In
hour, and then the rate is calculated severe hypoglycaemia with
against clinical status. If blood level of K+ unconsciousness (stupor, coma or
is < 3 mmol/L, infuse at a rate of 39 seizures), intravenous dextrose (25%)
mmol/hr; if blood level is 3-4 m mol/L, should be given by infusion through a
infuse at a rate of 26 mmol/hr; if blood large-gauge needle. If recovery does not
level is 5-6 mmol/L, infuse at a rate of 13 occur, search for additional causes.
mmol/hr; and if blood level is more than Frequent blood glucose monitoring will
6 mmol/L, stop infusion. Sodium help to prevent severe hypoglycaemia.
bicarbonate infusion is only used in Glucagon may be given (1 mg
cases of extreme acidosis and shock. In intramuscularly or intravenously) as an
patients with severe acidosis alternative to parenteral glucose. It
(bicarbonate less than 15 mmol/L), increases plasma glucose concentration
infuse 500 ml of 1.4% Sodium by mobilizing glycogen stored in the
bicarbonate and consider extra liver. If there is no response within 10
potassium supplement. Glucose solution minutes, intravenous glucose must be
(5%) is infused if the blood glucose level given. In nocturnal hypoglycaemia,
falls below 10 mmol/L but insulin infusion reduce the dose of insulin or change the
must continue. timing of evening insulin dose with
dinner time. These adjustments are
5.2.4.2 HYPOGLYCAEMIA made in conjunction with blood glucose
monitoring.
The most frequent complication of insulin
therapy and of high doses of GLUCAGON
sulphonylureas is hypoglycemia and it
occurs when blood sugar becomes very Indications: Hypoglycemia
low (less than 50 mg/litre). Patients need Cautions: Insulinoma, starvation and
to be educated about its warning adrenal insufficiency; ineffective in
symptoms and treatment. Warning signs chronic hypoglycemia
include hunger pain, sweating, tremor, Contra-indications:
light headedness and dizziness. Later on Phaeochromocytoma
patients develop behavioral and Side-effects: Nausea, vomiting,
sensorial changes with subsequent diarrhoea; rarely hypersensitivity
coma and even convulsions if Dose: By intramuscularly, intravenously
uncorrected. Unfortunately some or subcutaneously, for adult and child
patients especially those with over 25 kg, 1 mg (1 unit); child under 25
neuropathy or on beta blocker therapy kg, 0.5 unit.
do not experience the early warning
signs. Common causes of hypogly- Generic Preparation
caemia in a diabetic are: unusual Injection: powder for reconstitution, glucagon
excessive exercise; delay or omission of as hydrochloride with lactose, 1 mg (=1 unit)/
vial; 1mg/ml/vial.
a snack or meal; administration of too
much of insulin (especially in
intramuscularly); excess intake of 5.2.5 DRUGS USED IN DIABETIC
sulphonylurea; over indulgence in NEUROPATHY
alcohol; and severe impairment of renal
function. Mild and to moderate In case of painful diabetic neuropathy,
hypoglycaemia may be treated by the optimal control is essential. Patients
should be treated with insulin and relief
215
can be probably accelerated by Duloxen (Incepta), Tab., 20 mg, Tk.

continuous insulin infusion. Aspirin and 7.00/Tab.; 30 mg, Tk.10.00/Tab.
paracetamol (non-opioids analgesics) Duzela (Sun), Cap., 20 mg, Tk. 7.05/Cap.
Loxetine (ACI), Tab., 20mg, Tk. 7.00/Tab.;
are indicated for pain. (Tricyclic 30mg, Tk. 10.00/Tab.
antidepressants like Amitriptyline, Stresin (Unimed), Cap., 20 mg, Tk. 8.00/Cap.
Imipramine, Nortriptyline) are also Xinolax (Opsonin), Cap., 60 mg, Tk.
recommended for the relief of pain. 16.05/Cap.; 30 mg, Tk. 10.00/Cap.
Duloxetine is effective for the treatment
of 5.3 ADRENOCORTCALSTEROIDS
painful diabetic neuropathy. If treatment 5.3.1 Replacement therapy
with amitriptyline or duloxetine is 5.3.2 Glucocorticoid therapy
inadequate, treatment with Pregabalin 5.3.1 REPLACEMENT THERAPY
should be tried. Gabapentin and
Carbamazepine are sometimes used for The adrenal cortex secretes
the treatment of neuropathic pain (see
hydrocortisone (cortisol) which is
section 7.6) predominantly a glucocorticoid with weak
In autonomic neuropathy diabetic, mineralocorticoid activity. It also secretes
diarrhoea can be controlled by 2 or 3
aldosterone, a potent mineralocorticoid
doses of Tetracycline 250 mg. hormone. Physiological replacement in
Antiemetics may control vomiting in deficiency state is best achieved by a
gastroparesis. In neuropathic postural
combination of Hydrocortisone and the
hypotension an increased salt intake and mineralocorticoid Fludrocortisone;
the use of the mineralocorticoid hydrocortisone alone usually does not
Fludrocortisone 100 to 400 microgram
provide sufficient mineralocorticoid
daily help by increasing plasma volume activity for complete replacement. In
but edema is a common side-effect. Addison’s disease or following bilateral
Gustatory sweating can be managed by
adrenalectomy, hydrocortisone 20–30
antimuscarinics e.g. Propantheline mg daily by mouth is usually required.
bromide (see section 2.3.2). This is given in 2 divided doses, 2/3rd in
the morning and rest in the evening;
DULOXETINE mimicking the normal diurnal rhythm of
cortisol secretion. The optimal daily dose
Indications: Major depressive disorder, is determined on the basis of clinical
generalized anxiety disorder, response. Glucocorticoid therapy is sup-
osteoarthiritis, painful peripheral plemented by fludrocortisone 50–300
neuropathy, particularly diabetic micrograms daily. In acute
neuropathy, to control the symptoms of adrenocortical insufficiency, hydrocor-
fibromyalgia. tisone is given intravenously, (preferably
Cautions: Increase the risk of suicide in as sodium succinate) in doses of 100 mg
persons younger than 25. every 6-8 hourly in sodium chloride
Contraindications: children and (0.9%) intravenous infusion. Glucocor-
adolescents and in the 18–24 age group. ticoids should be given in hypopituitarism
Side-effects: nausea, somnolence, as in adrenocortical insufficiency, but
insomnia, dizziness since the production of aldosterone is
Dose: diabetic neuropathy, ADULT over also regulated by the renin-angiotensin
18 years, 60mg once daily; max. 120mg system, a mineralocorticoid is not usually
daily in divided doses required. Additional replacement therapy
with thyroxine and sex hormones should
Proprietary Preparations be given as indicated by the hormone
Deloxi (Eskayef), Cap., 20 mg, Tk. deficiency.
7.00/Cap.; 30 mg, Tk. 18.00/Cap.
Diliner (Square), DR Cap., 60 mg, Tk.
Corticosteroid cover for adrenalectomy,
16.11/Cap. for hypophysectomy or for operations on
Dulox (Acme), Tab., 30 mg, Tk. 10.07/Tab.; patients on long term treatment with
20mg, Tk. 7.04/Tab. steroids is determined from the
216
knowledge that normally a person in glucocorticoid activity; it is derived from

major stress will not secrete more than prednisolone.
300 mg of cortisol in 24 hours; once the Side-effects: include diabetes mellitus,
stress is over, return to maintenance osteoporosis, muscle wasting, peptic
dose (approximately 20 mg per 24 ulcer, mental disturbances like euphoria,
hours) gradually. For example: an paranoid state or depression. In children,
operation under steroid coverage can be there may be growth suppression.
done by one injection of 100 mg During pregnancy high dose can affect
hydrocortisone given intramuscularly or foetal adrenal development. High doses
intravenously as a premedication, and may cause exogenous Cushing’s
then repeated 8 hourly. In absence of syndrome and suppression of pituitary-
complications, the dose can be halved adrenal axis leading to secondary
every 24 hours until a maintenance dose adrenal insufficiency and atrophy. This
of 20–30 mg per day is reached on the atrophy may persist for years, requiring
5th day after the operation. steroid coverage during any illness or
surgical emergency.
5.3.2 GLUCOCORTICOID THERAPY Indications: In acute hypersensitive
(See also section 4.2) reactions like angiedema of upper
Used on a short-term basis, respiratory tract or anaphylactic shock,
hydrocortisone is given by intravenous corticosteroids are indicated as adjunct
route during emergency management of to emergency treatment with adrenaline.
some conditions. The relatively In such case hydrocortisone by
moderate anti-inflammatory potency of intravenous injection in a dose of 100 to
hydrocortisone also makes it a first 300 mg may be required. Corticosteroids
choice topical corticosteroid for the are used by inhalation in the
management of inflammatory skin management of asthma but systemic
conditions; cortisone is not active therapy in association with
topically. Prednisolone has predomin- bronchodilators are required for the
antly glucocorticoid activity and is most management of severe acute asthma.
commonly used by mouth for long-term Corticosteroids are also useful in
disease suppression. Prednisone has conditions such as rheumatic fever,
similar level of glucocorticoid activity but chronic active hepatitis and sarcoidosis;
is only active after conversion in the liver they may also lead to remissions of
to prednisolone; it is not recommended. acquired haemolytic anemia, and some
Betamethasone and Dexamethasone cases of nephrotic syndrome and
have very high glucocorticoid activity in thrombocytopenic purpura. Corticoste-
conjunction with insignificant mineraloco- roids can improve the prognosis of
rticoid activity. This makes them serious conditions such as systemic
particularly suitable for high dose lupus erythematosus (SLE),
therapy such as in cerebral edema. They The suppressive action of corticosteroid
have long duration of action; so they are on cortisol secretion is least when it is
suitable for conditions which require given in the morning; therefore whenever
suppression of ACTH secretion (e.g. possible single morning dose of steroid
congenital adrenal hyperplasia). Some is preferred. For special safety
esters of betamethasone and of precautions during pregnancy and
Beclomethasone have a marked topical breast-feeding,see Appendix-5 & 6.
effect (e.g. on the skin or the lungs) than
when given orally. Such topical effect BECLOMETHASONE DIPROPIONATE
without much systemic activity is useful
for skin applications and asthma Indications: Chronic bronchial asthma
inhalations. Deflazacort is a newly not controlled by short-acting beta2
introduced corticosteroid with high agonists (See also section 4.2)
Cautions: See section 4.2
217
Side effects: See also section 4.2. It Proprietary Preparations

can cause candidiasis which can be Cortiflo (Beximco), Tab.,6mg,Tk.10/Tab.
prevented by using spacer. It also Cortimax (Acme), Tab., 24 mg, Tk.
30.00/Tab.; 6.00 mg, Tk. 8.00/Tab.
responds to antifungal lozenges after Deflacort (Square), Suspn. , 6 mg/5 ml, Tk.
inhalation of a dose. There may not be 200.00/60ml,Tab., 24 mg, Tk. 30.00/Tab.; 6
any need to discontinue the therapy mg, Tk. 8.03/Tab
Dose & Preparations: See section 4.2 Deflazit (Incepta), Tab., 24 mg, Tk.
30.00/Tab.; 6 mg, Tk. 8.00/Tab.
Defzort (ACI), Tab., 24mg, Tk. 30.00/Tab.;
BETAMETHASONE [ED]
6mg, Tk. 8.00/Tab.
Flacort (Aristo), Tab., 6mg, Tk. 8.00/Tab.
Indications: Suppression of Nuvicort (Nuvista), Tab., 6 mg, Tk. 8.00/Tab.
inflammatory and allergic disorders, Xalcort (Beacon), Tab. , 24mg , Tk.
congenital adrenal hyperplasia, cerebral 30.00/Tab.; 6mg , Tk. 8.02/Tab.; Suspn.,
edema; see notes above and ENT 6mg/5mg , Tk. 200.00/60 ml
(sec.11.), eye (sec 10), and skin (sec.
12) DEXAMETHASONE [ED]
effects: See notes above Indications: Suppression of
Interactions: See Appendix-2 inflammatory and allergic disorders;
Dose: By mouth, usual range 0.5-5 shock; diagnosis of Cushing’s syndrome;
mg/day.;by intramuscular injection or congenital adrenal hyperplasia; cerebral
slow intravenous injection or infusion, 4– edema; rheumatic disorders
8 mg, repeat up to 4 times in 24 hours; Cautions; Contraindications; Side-
for CHILD: by slow intravenous effects: See notes above and under
injection, up to 1 year 1 mg, 1–5 years 2 prednisolone;
mg, 6–12 years 4 mg Interactions: see Appendix-2
Dose: By mouth, usual range 0.5-10
Proprietary Preparations mg/day; by intramuscular injection or
Bet-A (Acme), Tab., 0.50 mg, Tk. 0.72/Tab slow intravenous injection or infusion (as
Betnelan (GSK), Tab., 0.5 mg, Tk. 0.63/Tab. with dexamethasone phosphate), initially
0.5–20 mg; for CHILD: 200–500
DEFLAZACORT micrograms/kg daily. For cerebral edema
(as dexamethasone phosp-hate),by
Indications: Suppression of intravenous injection, 10 mg initially,
inflammatory and allergic disorders then 4 mg intramuscularly once every 6
Cautions: History of adrenal hours as required for 2–10 days
suppression, infections (ex-chickenpox,
shingles, measles) children, elderly, Proprietary Preparations
tuberculosis, recent heart attack, Amason (Ambee), Tab., 0.5mg, Tk 1/Tab.
Contra-indications: Renal impairment, D-Cort (Globe), Tab., 0.50 mg, Tk. 0.75/Tab.;
Inj., 5 mg /ml, Tk. 15.00/Amp.
pregnancy and breast feeding, active
Decafos (Techno), Tab., 0.5 mg, Tk.
thyroid, osteoporosis, diabetes mellitus 0.38/Tab.; Inj, 5 mg/ml , Tk. 17.00/Amp.
Side-effects: Impaired glucose Decason (Opsonin), Inj., 5 mg/ ml, Tk.
tolerance, weight gain, abdominal 16.66/Amp.;Tab., 0.5 mg, Tk. 0.75/Tab.
bloating, nausea, muscle weakness, Dexa (Renata), Tab. , 0.5 mg, Tk. 0.75/Tab.;
change in pigmentation, increased hair Inj, 5 mg/ml , Tk. 25.00/Amp.
growth, mood changes Dexagen (General), Inj, 5 mg/ ml, Tk.
22.00/Amp.;Tab. , 0.5 mg, Tk. 1.00/Tab.
Dose: ADULT: Initially up to 120
Dexam (Medimet), Inj., 0.05mg/Amp.,
mg/day maintenance: 3-18 mg/day. Tk.15.00/Amp.; Tab., 0.05mg, Tk.1.00/Tab.
CHILD: oral: 0.25-1.5 mg/kg/day given Dexamet (Rephco), Inj, 5 mg/ ml , Tk.
on alternate days. Suspension: 5 ml- 16.00/Amp.;Tab. , 0.5 mg, Tk. 0.70/Tab.
60ml per day. Dexamethasone (Albion), Tab. , 0.5 mg, Tk.
1.00/Tab.
218
Dexamethasone(APC), Tab., 0.5 mg, Tk. edema; rheumatic disorders (see sec.
0.42/Tab. 9.1.2.1), skin diseases (see section 12)
Dexamin (Jayson), Inj, 5 mg/ ml, Tk. Cautions; Contraindications & Side-
18.00/Amp. Tab. , 0.5 mg, Tk. 0.55/Tab.
Dexan (Chemist), Tab., 0.5 mg, Tk. 0.42/Tab.;;
effects: See notes above and; rapid
Inj., 5 mg, Tk. 15.00/ ml Amp. intravenous adminis-tration of large dose
Dexon (Ibn Sina), Inj, 5 mg/ ml, Tk. 16/Amp. has been associated with cardiovascular
Dexonex (Square), Inj, 5 mg / 5 ml, Tk. collapse
20.00/Amp. ;Tab. , 0.5 mg, Tk. 0.89/Tab. Interactions: See Appendix-2
Dextason (Ziska), Inj., 5mg/1ml, Tk. Dose: By mouth, usual range 2-40
12.00/1mlAmp.; Tab., 0.5mg, Tk. 0.60/Tab. mg/day, for chemotherapy emesis. By
Dextor (Eskayef), Tab, 0.5 mg, Tk. 1.00/Tab.
G-Dexamethasone (Gonoshasthaya), Inj,
intramuscular injection or slow
4mg/ ml, Tk. 10.00/Amp intravenous injection or infusion (as
Gludex (Kemiko), Inj, 5 mg/ml , Tk. dexamethasone phosphate), initially 10-
22.00/Amp. ;Tab. , 0.5 mg, Tk. 1.00/Tab. 100 mg; graft rejection up to 1 g/day by
Odeson (Beximco), Inj, 4 mg/ ml, Tk. 15/Amp. infusion for up to 3 days
Sonexa (Aristo), Inj, 5 mg/ ml, Tk. 15/Amp.
Stedex (Navana), Inj, 5 mg/ ml, Tk. 22/Amp Proprietary Preparations
Steron (Acme), Inj, 5 mg/ ml , Tk. 22.00/Amp. Depodrol (Opsonin), Tab.,16 mg , Tk.
;Tab. 0.5mg, Tk. 0.9/Tab. 20.00/Tab.; 2 mg , Tk. 3.00/Tab.; 4 mg , Tk.
5.00/Tab.; 8 mg , Tk. 10.00/Tab.
HYDROCORTISONE [ED] Depomed (Drug Intl), Tab., 4mg, Tk. 6.00/Tab.
;
Medrol (I) (Pfizer), Tab.,4mg, Tk. 7.52/Tab.;
Indications: Adrenocortical insufficie- 16mg, Tk. 23.45/Tab
ncy; shock; hypersensitivity reactions Mepcort (Globe), Tab., 8mg, Tk. 10.03/Tab.;
(such as anaphylactic shock, angioe- 16mg, Tk. 20.06/Tab.; 4mg, Tk. 5.01/Tab.;
dema), inflammatory bowel disease, 2mg, Tk. 3.01/Tab.
rheumatic disease, eye disease, skin Methipred (General), Tab. , 8mg, Tk.
disease (see sections 10 & 11 ) 10.03/Tab.; 16mg, Tk. 20.06/Tab.; 4mg, Tk.
5.01/Tab.; 2mg, Tk. 3.01/Tab.
Cautions; Contraindications & Side-
Methsolon (Incepta), Tab. , 4 mg, Tk.
effects: See notes above and under 5.00/Tab. ; 16 mg, Tk. 20.00/Tab.
Prednisolone Predixa (UniMed), Tab , 16mg, Tk.
Interactions: See Appendix-2 24.00/Tab.; 4mg, Tk. 6.00/Tab.; 8mg, Tk.
Dose: By mouth, replacement therapy, 12.00/Tab.
20-30 mg/day in divided doses. For Solupred (Ziska), Tab., 4 mg, Tk. 5.00/Tab.;
CHILD: 10-30 mg/day. By Intramuscular 8 mg, Tk. 3.00/Tab.; 16 mg, Tk. 15.00/Tab.; 2
mg, Tk. 3.00/Tab.
injection or slow intravenous injection or
infusion, 100–500 mg, 3–4 times in 24
Methylprednisolone Acetate
hours or as required; in CHILD: by slow Depo Medrol (I) (Pfizer) Inj., 40mg/ml, Tk.
intravenous injection up to 1 year 25 mg, 111.36/Vial,; 80mg/2ml, Tk. 143.00/Vial.
1-5 years 50 mg, 6–12 years 100 mg Depodrol (Opsonin), Inj., 40 mg/vial, Tk.
48.87/Vial
Proprietary Preparations Depomed (Drug Int), Inj., 40mg/ml, Tk.
Anacort (Techno ), Inj.,100 mg/vial,Tk. 60/Vial 75.25/Vial,; 80mg/2ml, Tk. 100.30/Vial.
Cortef (Aristo), Inj., 100 mg/vial, Tk. 50/Vial Depo-pred (Ziska), Inj., 40mg/ml, Tk.
Cortinex (Ziska), inj., 100 mg/Vial, Tk. 50/Vial 75.00/ml Vial
Cotson (Opsonin),Inj.,100 mg/vial, Tk. Medrol (Techno), Inj., 40 mg/vial, Tk.
37.74/Vial 65.00/Vial ; 80 mg/vial, Tk. 90.00/Vial
Glucort (Globe), Inj., 100 mg/Vial, Tk. 50/Vial Mepcort (Globe), Inj., 1 gm, Tk. 1000.00/Vial;
Hison (ACI), Inj., 100 mg/vial, Tk. 50.19/Vial 500 mg, Tk. 600.00/Vial
Hycort (Chemist), Inj., 100 mg/Vial, Tk. 50/Vial Uni-medrol (Chemist), Inj., 40mg/1ml, Tk.
Intasone (Incepta),Inj.,100 mg/vial, Tk. 50/Vial 65.00/1 ml Vial; 80mg/2ml, Tk. 90.00/2 ml Vial
METHYLPREDNISOLONE Methylprednisolone (as Sodium Succinate )

Depomed (Drug Intl), Inj. 500mg/Vial, Tk.
Indications: Suppression of inflamma- 600.00/Vial
tory and allergic disorders; cerebral
219
Mepcort (Globe), Inj. , 500 mg/Vial, Tk. on precautions to be taken to minimize

600.00/Vial risk and provide details of drug, dose
Methsolon, (Incepta), Inj. , 1gm/Vial, Tk. and duration of treatment. Anaesthetists
1000.00/Vial ,; 500 mg/Vial, Tk. 600.00/Vial
Methyl Prednisolon sodium succinate(I)
must know whether a patient is taking or
(Rotex),Inj.,500mg/15ml vial Tk.679.65/vial has been taking corticosteroids to avoid
Pro-Medrol (Techno), Inj., 1 gm/Vial, Tk. precipitious fall of blood pressure during
1,200.00/Vial; 500 mg/Vial, Tk. 800.00/Vial anaesthesia or in the immediate post-
Solu Medrol (I) (Pfizer) Inj., 1 gm/Vial, Tk. operative period
1,975.65/Vial; 500mg/Vial, Tk. 1,580,.24/Vial Infections: Susceptibility and severity of
Solupred (Ziska), Inj., 125 mg/Vial, Tk. infections may be increased and clinical
200.00/Vial; 1g/Vial, Tk. 1000.00/Vial;
500mg/Vial, Tk. 600.00/Vial
presentation may be atypical. Serious
infections e.g. septicaemia and
tuberculosis may reach an advanced
PREDNISOLONE [ED]
stage before being recognized.
Symptoms of amoebiasis, strongyloi-
Indications: Suppression of diasis, measles and chickenpox may
inflammatory and allergic disorders, exacerbate if corticosteroids are being
inflammatory bowel disease, asthma, taken by the patients simultaneously
immunosuppression, rheumatic disease Contra-indications: Systemic infection
(sec 9.1.2.1); see notes above and also (until specific treatment is given); avoid
sub-sections on ear (sec.11.1), eye (sec live virus vaccines in those receiving
10), nose (sec11.2) and skin (sec 11.2) immunosuppressive doses
Cautions: Adrenal suppression, Side-effects: Use of lowest effective
infection, children and adolescents dose can minimize side-effects.
(growth retardation); elderly frequent Gastrointestinal effects include
monitoring required in those with history dyspepsia, peptic ulceration (with
of tuberculosis, hypertension, recent perforation), abdominal distension, acute
myocardial infarction, congestive heart pancreatitis, oesophagial ulceration and
failure, liver failure, renal impairment, candidiasis. Musculoskeletal effects
diabetes mellitus, osteoporosis, include proximal myopathy,
glaucoma, severe affective disorders, osteoporosis, vertebral and long bone
epilepsy, peptic ulceration, fractures, avascular osteonecrosis,
hypopituitarism, history of steroid tendon rupture. Endocrine effects
myopathy; pregnancy and breastfeeding. include adrenal suppression, menstrual
Adrenal suppression: Prolonged irregularities and amenorrhoea.
therapy with prednisolone may cause Cushing’s syndrome (with high dose),
adrenal atrophy which may persist for hirsutism, weight gain, negative nitrogen
years after withdrawal of the drug. Too and calcium balance, increased appetite.
rapid reduction of dose after prolonged Neuropsychiatric effects include
course (more than 7 days) can lead to euphoria, dependence, depression,
adrenal crisis (shock). So withdrawal insomnia, increased intracranial
should be gradual-over weeks or even pressure with papilledema in children,
months, depending on dose and duration psychosis and aggravation of
of therapy. Withdrawal may also be schizophrenia, suicidal tendencies,
associated with fever, myalgia, arthalgia, aggravation of epilepsy. Ophthalmic
rhinitis, conjunctivitis, painful itchy skin effects include glaucoma, papilledema,
nodules and loss of weight. Any posterior sub-capsular cataract, corneal
significant intercurrent illness, traumas, or scleral thinning and exacerbation of
or surgical procedures requires a viral or fungal eye disease. Other side-
temporary increase in dosage, or if effects include impaired healing, skin
already stopped, a temporary re- atrophy, bruise, striae, telengiectasia,
introduction of corticosteroids. Patients acne, myocardial rupture following
on steroid therapy should carry a recent myocardial infarction, fluid and
treatment card giving clear instructions electrolyte imbalance, leukocytosis,
220
hypersensitivity reactions (including TRIAMCINOLONE

anaphylaxis), thromboembolism,
nausea, hiccup and malaise Indications: Suppression of inflamma-
Interactions: See Appendix-2 tory and allergic disorders; rheumatic
(corticosteroids) disorders (section 9.1.2.1), mouth and
Dose: By mouth, up to 10-20 mg/day skin diseases (sections 11.2.1 & 12.3)
(severe disease, up to 60 mg/day), Cautions; Contraindications & Side-
preferably taken in the morning after effects: See notes above and under
breakfast; can often be reduced within Prednisolone; triamcinolone in high
few days but may need to be continued dosage has a greater tendency to cause
for several weeks or months. For proximal myopathy and should be
maintenance, usual range 2.5–15 avoided in chronic therapy
mg/day, but higher dose may be needed; Interactions: See Appendix-2.
Cushingoid side-effects are likely with Dose: By mouth, usual range 2-24
dose above 7.5 mg/day mg/day; by deep intramuscular injection,
by intramuscular injection, prednisolone 40 mg of acetonide for depot effect,
acetate, 25–100 mg once or twice repeated at intervals according to
weekly patient’s response; maximum single
dose 100 mg
Adam (Nuvista), Tab. , 20 mg, Tk. 6.28/Tab.,
5 mg, Tk. 1.73/Tab.
Alfacort (Ziska), Inj., 40 mg/ml, Tk.60/Vial
Altason (Albion), Tab., 10 mg, Tk. 2.07/Tab.;
Cenolon (Incepta), Inj., 40 mg/vial, Tk. 75/Vial
Tab., 20 mg, Tk. 3.73/Tab.; Tab., 5 mg, Tk.
Cynocort (Techno), Inj., 40 mg/vial,Tk. 60/Vial
1.14/Tab.
Trecilon (Rephco), Inj., 40 mg/vial, Tk. 65/Vial
Bexipred (Beximco), Tab., 10mg, Tk.
Triacin (Kemiko), Inj., 40 mg/vial, Tk. 60/Vial
3.23/Tab., 20mg , Tk. 6.28/Tab., 5mg, Tk.
Trialon (Drug Int.), Inj., 40 mg/vial, Tk. 75/Vial;
3.23/Tab.
Triamon (Globe), Inj.,40 mg/ml, Tk.70/1ml
Cortan (Incepta),; Tab. , 2.5 mg, Tk.
amp
0.80/Tab., 20 mg, Tk. 6.27/Tab., 5 mg, Tk.
Trimcort (Chemist), Inj., 40 mg/ml Tk. 60/1 ml
1.72/Tab., 10 mg, Tk. 3.23/Tab.
Vial;
Cortisol (Aristo), Tab. , 5 mg, Tk. 1.70/Tab. ;
20 mg, Tk. 6.25/Tab. ; 10 mg, Tk. 3.20/Tab. ;
Syrup 5 mg/5 ml, 5 mg/5 ml, Tk. 65.00/50 ml 5.4 SEX HORMONES
Deltapred (Ziska), Tab., 10mg, Tk. 2/Tab.; 5.4.1 FEMALE SEX HORMONES
20mg, Tk. 3.70/Tab.; 5mg, Tk. 1.10/Tab. AND ANTAGONISTS
Deltasone (Renata), Tab. , 2.5 mg, Tk.
0.33/Tab., 20 mg, Tk. 6.26/Tab., 5 mg, 5.4.1.1 OESTROGENS AND HRT
Tk.1.72/Tab., 10 mg, Tk. 3.23/Tab 5.4.1.2 PROGESTERONE
G-Prednisolone (Gonoshasthaya), Tab. , 5 5.4.2 ANTI-OESTROGENS
mg, Tk.1.14/Tab. 5.4.3 MALE SEX HORMONES
Inflagic (Square), Tab., 5 mg, Tk. 1.15/Tab.; AND ANTAGONIST
Tab. , 20 mg, Tk. 6.27/Cap. 5.5.4 ANABOLIC STEROIDS
P-cort (Globe), Tab. , 5 mg, Tk. 1.70/Tab.,
Syrup, 5 mg/5 ml, Tk. 60.00/50 ml 5.4.1 FEMALE SEX HORMONES
Pedipred (Ziska), Syrup, 5mg/5ml, Tk. AND ANTAGONISTS
95/100ml; Tk. 60/50ml 5.4.1.1 OESTROGENS AND
Precodil (Opsonin), Tab., 10 mg, Tk. HORMONE REPLACEMENT
2.43/Tab20 mg, Tk. 4.71/Tab.; 5 mg, Tk. THERAPY (HRT)
0.86/Tab.
Pred (Eskayef), Tab, 5 mg, Tk. 1.14/Tab.;20
mg, Tk. 3.70/Tab.;10 mg, Tk. 2.00/Tab. Oestrogens are necessary for puberty
Prednelan(GSK), Tab. , 20 mg, Tk. development in female; they also
281.97/Tab. ;Tab. , 5 mg, Tk. 1.50/Tab. stimulate myometrial hypertrophy with
Prednisolone (Ambee), Tab., 5 mg, Tk. endometrial hyperplasia. Natural
1.2/Tab.Syrup 5 mg/5 ml, Tk. 60.00/50 ml; oestrogens (oestradiol, oestrone and
Tk.95.00/100ml
oestriol) have more appropriate profile in
terms of oestrogenic activity than
221
synthetic oestrogens (ethinyloestradiol, studies indicate an increased risk of

mestranol, stilboesterol) for hormone deep vein thrombosis and of pulmonary
replacement therapy (HRT). The activity embolism in women taking HRT. Being
of Conjugated oestrogens resemble beneficial for most menopausal women,
that of natural oestrogens. HRT may be prescribed if not specifically
Oestrogen therapy is given cyclically or contraindicated. HRT should be
continuously for a number of undertaken only under specialist
gynaecological conditions. During long supervision.
term treatment a progestogen should be Side-effects of HRT include nausea,
added to prevent cystic hyperplasia of vomiting, breast enlargement and
endometrium and possible transform- tenderness, premenustrual-like
ation to cancer. Oestrogens are no syndrome, fluid retention, change in liver
longer used to suppress lactation function, cholestetic jaundice, rashes
because of their association with and chloasma, depression, migraine or
thromboembolism. migraine like headache. Transdermal
Hormone Replacement Therapy (HRT) delivery system may cause contact
Hormone replacement therapy is sensation (possible severe
indicated for menopausal women to hypersensitivity reaction on continued
relieve the inconveniences due to exposure).
vaginal atrophy or vasomotor instability. Contraindication of HRT: Oestrogen
Oestrgens relieve vasomotor symptoms, dependent neoplasm (oestrogen recep-
prevent bone loss, promote new bone tor positive); active thromboembolism;
formation, restore normal urogenital and liver diseases, Dubin-Janson and Rotor
skin epithelium, reduce incidence of syndrome; undiagnosed abnormal
stroke and myocardial infarction. Only genital bleeding.
small dose oestrogens are used for Choice of Preparation: Many
HRT, either alone or in combination with proprietary single or combination
progestogens. A woman with uterus preparations for HRT are available in the
requires oestrogen with cyclical international market but only a few of
progestogen for the last 10-14 days of them are available in Bangladesh now.
the cycle or administration of a Some of the preparations available in
preparation which combines both Bangladesh are listed below. For doses
oestrogenic and progestogenic activity. and instructions “see manufacturers’
Oestrogen therapy alone is suitable for literature and inserts.
long-term continuous therapy in a
woman without a uterus. Cyclical HRT Proprietary Preparations
(where a progestogen is taken for 10-14 Preampak-C(I) (Ayrest),Tab.conjugated
days of each cycle) usually results in a oestrogen 625 microgram and norgestrel 150
microgram.Tk.12.33/Tab
regular withdrawal bleeding towards the Pausogest(I) (Richter),Tab.estradio2mg and
end of the progestogen. The aim of Norethisteron 1mg Tk.25.22/Tab.
continuous combined HRT (where a Estrimox(I) (Richter), Tab. estradiol 2mg
combination of oestrogen and Tk.417.23/28’s Tab
progestogen is taken continuously) is to
avoid withdrawal bleeding but irregular Conjugated oestragens only
bleeding may occur during early Estracon (Renata),Tab., 0.625mg, Tk. 20/Tab.
Premicon (Techno),Tab., 0.625mg, Tk.15/Tab
treatment stages; if it continues, Premarin (I)(Ayrest), Tab. 0.625mg,
endometrial abnormality needs to be Tk.29.85/Tab
excluded and cyclical HRT considered.
With HRT, there is an increased risk of ETHINYLOESTRADIOL
endometrial cancer, which can be
reduced by combining progestogens (Other name: Ethinylestradiol)
along with oestrogens. After prolonged
use for some years, there may be an Indications: Used as hormone
increased risk of breast cancer. Recent replacement in menopause in a dose of
222
10-20 micrograms daily. This has now releasing hormone analogues),

been largely replaced by more suitable osteoporosis pro-phylaxis and HRT.
forms of oestrogen. It is also used in Tibolone is now popular for HRT
breast cancer because no withdrawal bleeding occurs
Cautions; Contra-indications; Side- if it is started after one year of
effects: Cardiovascular disease and spontaneous menopause
hepatic impairment Cautions: Renal insufficiency, epilepsy,
Interactions: see appendix-2 migraine, diabetes,
Dose: see indications above hypercholesterolemia, abnormal liver
function tests, thrombophlebitis,
Generic Preparation thromboembolism, pregnancy, breast-
Tablets, 10 micrograms; 50 micrograms feeding, uninvesti-gated vaginal bleeding
Contraindications: Hormone depen-
OESTRIOL dent neoplasm; active thromboembo-
lism; liver diseases, undiagnosed
Oestriol is a naturally occurring abnormal genital bleeding
oestrogen with actions similar to other Interactions: See Appendix-2
oestrogenic hormones. Side-effects: Weight change, ankle
Indications: Treatment of and edema, seborrhoeic dermatitis, vaginal
prophylaxis of menopausal disorders. It bleeding, gastrointestinal disturbance,
has also been given in combination with headache, increased facial hairs,
other natural oestrogens in HRT (see migraine, visual disturbance, liver
notes above) function test abnormality; rash and
Cautions, Contraindications: pregna- pruritus has also been reported
ncy, thrombosis, oestrogen dependent Dose : 2.5 mg daily continuous
tumours, undiagnosed vaginal bleeding
Interactions:see Appendix-2 Proprietary Preparations
Side-effects: pain in breast, spotting or Menorest (Renata), Tab., 2.5 mg, Tk.
20.07/Tab.
excessive cervical exudation (reduce
Renorma (Square), Tab., 2.5 mg, Tk.
dose), nausea 20.07/Tab.
Doses: for short-term treatment orally Tibo(Popular), Tab., 2.5 mg, Tk. 20.08/Tab.
500 micrograms to 3 mg daily as single Tibon (Techno), Tab., 2.5 mg, Tk. 15.00/Tab.
dose for one month and then reduced to Tibonor (Eskayef), Tab., 2.5 mg, Tk.
500 micrograms to 1 mg daily; usual 20.00/Tab.
doses range from 250 micrograms to 2 Tivion (ACI), Tab., 2.5 mg, Tk. 20.00/Tab.
Ubilon (Incepta), Tab., 2.5 mg, Tk. 20.00/Tab.
mg daily
Liviol(I)(Organon) Tab., 2.5 mg, Tk.
2,200.00/Tab.
Defogen (Incepta), Tab., 1 mg, Tk. 8.00/Tab.
Femastin (Square), Tab., 1 mg, Tk. 8.00/Tab. 5.4.1.2 PROGESTOGENS
Ovestin (Nuvista), Tab. 1mg Tk. 9.90/Tab.;
Ovestin(I)(Organon) Cream 1 mg/g; Tk. There are two main groups of
240.05/15g progestogen-progesterone and its
analogues (dydrogestenone, hydroxy-
TIBOLONE progesterone, medroxyprogesterone);
and testosterone analogues
Tibolone (a synthetic steroid structurally (norethisterone and norgestrel). The
related to norethinodrel) combines newer progest-ogens (desogestrel,
oestrogenic and progestogenic activity norgestimate, and gestodene) are
with weak androgenic activity. derivative of norgestrel; levonorgestrel is
Indications: Treatment of vasomotor the active isomer of norgestrel and has
symptoms in oestrogen deficiency twice its potency. Progesterone and its
menopausal women (including women analogues are less androgenic than the
being treated with gonadotrophin testosterone derivatives; neither
223
progesterone nor dydrogesterone oestrogen) from 11th to 25th day of cycle

causes virilisation. Other synthetic to prevent bleeding; dysmenorrhoea
derivatives are variably metabolised into (see notes above), 10 mg twice daily
testosterone and oestrogen; thus side- from 5th to 25th day of cycle;
effects vary with preparations and the amenorrhoea, 10 mg twice daily from
dose. Some progestogens such as 12th to 25th day of cycle with oestrogen
norethisterone are used in therapy from 1st to 25th day of cycle;
endometriosis. premenstrual syndrome (see notes
Oral progestogens are used widely for above), 10 mg twice daily from 12th to
menorrhagia but they are relatively 26th day of cycle increased if necessary;
ineffective compared to other agents. hormone replacement therapy, with
Oral progestogens are also used for continuous oetrogen therapy (see
severe dysmenorrhea, but in young section 7.5.1.1), 10 mg daily on days 15-
women where contraceptive is also 28 of each 28-day oestrogen HRT cycle,
necessary, best choice is combined oral increased to 10 mg twice daily if
contraceptives. Progestogens are used withdrawal bleeding is early or
for alleviation of premenstrual endometrial biopsy shows inadequate
symptoms, but no convincing progestational response; habitual
physiological basis for treatment has abortion (see notes above), 10mg twice
been shown. Progestogens have been daily from 16th to 25th day of cycle until
used in habitual abortion but there is no conception, then continuously until 20th
evidence of benefit; if they are used for weeks of gestation and gradually
this purpose they should be of true reduced
progesterone derivatives (e.g. hydroxyp-
rogesterone hexanoate) to avoid Proprietary Preparation
possible musculinisation of female fetus. Duphaston(I) (Abbott), Tab. 10 mg.
In post-menopausal women receiving Tk.29.81/Tab
long-term oestrogen therapy for
hormone replacement, a progestogen HYDROXYPROGESTERONE
needs to be added to prevent cystic HEXANOATE
hyperplasia of the endometrium and
possible transformation to cancer. Indications: Habitual abortion & see
Desogestrel, Ethynodiol, Gestodene, note above.
Levonorgestrel, Norethisterone and Cautions: Pregnancy, diabetes.
Norgestimate are used in combined oral Contraindications & Side-effects: See
contraceptives and in progestogen only under Medroxyprogesterone and notes
contracep-tives (see section 6.3.2.1). above.
Progestogens have no role in neoplastic Dose: By slow intramuscular injection,
disease. 250–500 mg weekly during first half of
pregnancy.
DYDROGESTERONE
HPC (Popular), Inj., 250 mg/vial, Tk. 350/Vial
Indications: See under dose and notes
above
Cautions; Contra-indications & Side- LYNOESTRENOL
effects: See under Medroxypro- (Lynestrenol)
gesterone Acetate and notes above;
break-through bleeding may occur Indications: Uses similar to those
Dose: Endometriosis, 10 mg 2-3 times described for other progestogens. It has
daily from 5th to 25th day of cycle or been used as an adjunct to oestrogen
continuously; dysfunctional uterine therapy in menopausal disorders. It is
bleeding, 10 mg twice daily (together also used as the progestogenic
with an oestrogen) for 5–7 days to arrest component of some combined oral
bleeding, and 10 mg (together with an
224
contraceptives or as a progestogen only Dose: Endometriosis, 10 mg daily for

contraceptive. 4-6 months or longer, starting on day 5
Cautions; Contraindications & of cycle (increase the dose to 20–25 mg
Side-effects: As with other daily if spotting occurs, reduce once
progestogens. bleeding stops); menorrhagia, 5 mg 3
times daily for 10 days to arrest
Proprietary Preparation bleeding, and to prevent bleeding 5 mg
Lynotril (ACI), Tab., 5mg, Tk. 12.00/Tab. twice daily from 19th to 26th day of
Orgatril (Nuvista), Tab. 5mg, Tk. 11.55/Tab. cycle; dysmenorrhoea, 5 mg 3 times
daily from day 5 to 24 for 3-4 cycles;
MEDROXYPROGESTERONE premenstrual syndrome, 5 mg 2 to 3
ACETATE times daily from day 19 to 26 for several
cycles; postponement of menstruation, 5
Indications: See under dose, mg 3 times daily starting 3 days before
contraception (see section 6.3.2.1), anticipated onset (menstruation occurs
malignant disease (see section 14.3.2). 2-3 days after stopping); progestonic
Cautions: Diabetes, hypertension, supplement to oestrogen in HRT (see
cardiac or renal disease section 5.4.1.1)
Interactions: See Appendix -2.
Contraindications: Pregnancy, undiag- Proprietary Preparations
Ethinor(Eskayef), Tab, 5 mg , Tk. 5.00/Tab.
nosed vaginal bleeding, active liver
Menogia (ACI), Tab., 5 mg , Tk. 5.00/Tab.
disease, breast or genital tract Menoral (Square), Tab. , 5 mg , Tk.
carcinoma 5.50/Tab.
Side-effects: Gastrointestinal upset, Norestin (Beximco), Tab., 5 mg , Tk.
change in libido, breast discomfort, 6.84/Tab.
premenstrual symptoms, irregular Normens (Renata), Tab. , 5 mg , Tk.
menstrual cycles, depression, insomnia, 5.50/Tab.
Noteron(Incepta), Tab. , 5 mg , Tk. 5.50/Tab.
alopecia, hirsutism, anaphylectoid-like
Remens(Popular), Tab. , 5 mg , Tk. 5.01/Tab.
reactions, rarely jaundice
Dose: By mouth, 2.5–10 mg daily for 5- PROGESTERONE
10 days beginning on 16th to 21st day of
cycles, repeated for 2 cycles in Indications: See under dose and notes
dysfunctional uterine bleeding and 3 above
cycles in secondary amenorrhoea; mild Contraindications: See notes above;
to moderate endometriosis, 10 mg 3 missed or incomplete abortion
times daily for 90 consecutive days Side-effects: See notes above; injection
beginning on 1st day of cycle. By deep site reaction; pain; diarrhoea and
intramuscular injection (see section flatulence can occur with rectal
6.3.2.2) administration
Dose: Menopausal symptoms, insert 1
Proprietary Preparations applicator of 4% gel on alternate days for
See section 6.3.2.1 the last 12 days of oestrogen therapy in
each cycle
NORETHISTERONE Infertility due to inadequate luteal phase,
insert 1 applicator of 8% gel daily
starting either after documented
Indications: See under dose, HRT ovulation or on day 18-21 of cycle In
(section 5.4.1.1); contraception (section vitro fertilization, daily application of 8%
6.3.2.1) gel, continued for 30 days after
Cautions; & Side-effects: see under laboratory evidence of pregnancy.
medroxyprogesterone acetate,
Contraindications: pregnancy, Proprietary Preparations
epilepsy and migraine Crinone(I)(Merck), Gel, 8%,Tk.339.00/1.45 gm
225
Microgest (Renata), Cap.,100 mg,Tk.15/Cap. Proprietary Preparations

200 mg, Tk. 30/Cap. Clomifen (Novo Health), Tab. , 50 mg, Tk.
10.00/Tab.
Comipen (Pacific), Tab., 50 mg, Tk. 3.76/Tab.
5.4.2. ANTI-OESTROGENS
Fermid(G.A.co), Tab., 50 mg, Tk. 10/Tab
Fertil (Beximco), Tab., 50 mg, Tk. 10/Tab.
The anti-oestrogens Clomiphene and Ovuclon (Incepta), Tab., 100 mg, Tk.
Tamoxifen are used in treatment of 18.00/Tab.;Tab., 50 mg, Tk. 10/Tab.
infertility due to ovulatory dysfunctions Ovulet (Renata), Tab., 100 mg, Tk.
(as in polycystic ovarian syndrome). 18.06/Tab.; Tab., 50 mg, Tk. 10.04/Tab.
Reomen (Eskayef), Tab., 50mg, Tk. 10/Tab.
They induce gonadotropin release by
occupying oestrogen receptors in the
hypothalamus, thereby interfering with 5.4.3 MALE SEX HORMONES AND
feedback mechanism; chorionic ANTAGONISTS
gonadotropin is sometimes used as
adjunct. Patient should be warned that Masculinisation is caused by androgens;
there is risk of multiple pregnancy. they may be used as replacement
therapy in adult with androgen deficiency
CLOMIPHENE CITRATE due to pituitary or testicular disease or
(Clomifene Citrate) for castration. In normal males they
inhibit gonadotropin secretion and
Indications: An ovulatory infertility, see thereby suppress spermatogenesis.
notes above; Men: when a low sperm Androgens also have anabolic action
count is caused by low testosterone which led to the development of anabolic
levels steroids (see section 5.4.4).
Cautions: Polycystic ovary, ovarian Treatment of impotence and impaired
hyper stimulation syndrome, uterine spermatogeneis by androgens is useless
fibroids, ectopic pregnancy, multiple if there is associated hypogonadism.
pregnancy, visual impairment. Androgen treatment in hypopituitarism
Contraindications: Hepatic disease, can lead to normal sexual development
ovarian cysts, hormone dependent and potency but not to fertility. When
tumours, undiagnosed abnormal uterine fertility is desired, gonadotropins or
bleeding, pregnancy. pulsatile gonadotropin releasing
Interactions: See Appendix-2. hormones therapy will stimulate
Side-effects: Visual disturbance, hot spermatogenesis as well as androgen
flushes, ovarian hyperstimulation, production. Induction of puberty in boys
abdominal discomfort, nausea, vomiting, with delayed puberty by use of
depression, insomnia, breast androgens or Chorionic gonadotropin
tenderness, headache, intermenstrual should be used with caution, and only
spotting, menorrhagia, endometriosis, under expert supervision.
convulsi-ons, weight gain, rashes, Intramuscular depot preparations of
dizziness, hair loss Testosterone esters are preferred for
Dose: An ovulatory infertility; 50 mg replacement therapy. Testosterone
daily for 5 days, starting within about 5 enanthate or propionate or a mixture of
days of menstruation (preferably on 2nd them has long duration of action.
day) or at any time (normally preceded Menopausal women are also sometimes
by a progestogen-induced withdrawal given implant of testosterone (in a dose
bleeding) if no menses; second course 50-100 mg every 4–8 months) as an
of 100 mg daily for 5 days may be given adjunct to hormone replacement
if there is no ovulation; 3 courses should therapy.
constitute adequate trial; long term TESTOSTERONE AND ESTERS
cyclical therapy not recommended
Indications: Testosterone replacement
therapy in male hypogonadal disorders;
osteoporosis due to androgen deficiency
226
Cautions: Cardiac, renal or hepatic sperm forms are produced. Fully

impairment; elderly, ischaemic heart informed consent and an initial sperm
disease, hypertension, epilepsy, count and morphology are
migraine, skeletal metastasis (risk of recommended before anti-androgen
hypercalcaemia), pre-pubertal boys (see therapy. Hepatic tumors have been
notes above) reported in animals. Therefore, careful
Contraindications: Breast cancer in consideration should be given to the
men, prostate cancer, hypercalcaemia, risk/benefit ratio before treatment.
pregnancy, breast-feeding; nephrosis Cyproterone acetate is also used as an
Interactions: See Appendix-2 adjunct in prostatic cancer and in the
Side-effects: Prostate abnormalities, treatment of acne and hirsutism in
prostate cancer, headache, depression, women.
gastro-intestinal bleeding, nausea, Finasteride is a specific inhibitor of the
cholestatic jaundice, change in libido, enzyme 5-alpha-reductase which
anxiety, generalized paraesthesia, metabolises testesterone into the more
electrolyte imbalance including sodium potent androgen, dihydrotestesterone.
retention with edema and This inhibition of testesterone metabo-
hypercalcemia; increase bone growth, lism reduces the prostate size with the
androgenic effects such as hirsutism, improvement of the urinary flow rate and
male pattern baldness, seborrhoea, relieves obstructive symptoms. It is
acne, excessive frequency and duration alternative to alpha-blockers particularly
of penile erections, precocious sexual in men with a significantly enlarged
development and premature closure of prostate. A low strength of finasteride is
epiphysis in prepubertal males, virilism in used for treating male pattern baldness
women, and suppression of spermatoge- in men.
nesis in men
Dose : See under preparations CYPROTERONE ACETATE
Proprietary Preparations Indications: For the treatment of severe
Andriol (I) (Organon), Cap. Testosterone
hypersexuality or sexual deviation in
undeconate 40 mg,Tk.22.44/Tab
Androcap (Renata), Cap. Testosterone male; also used as an adjunct in prostate
undeconate 40 mg, Tk. 20.00/Cap cancer and hirsutism in women (along
Dose: initially 120-160 mg daily for 2-3 weeks, with oestrogen)
maintenance 40-120 mg daily. Cautions: Blood counts initially and
throughout treatment; monitor hepatic
Testosterone Propionate 30mg, Testosterone function regularly. A semen analysis
phenylpropionate 60mg, Testosterone
and fully informed consent from the
isocaproate 60mg, Testosterone decanoate
100 mg/ml patient is recommended
Contraindications:Prostate
Testanon (Nuvista), Inj. Tk.161.70/1ml amp cancer,hepatic disease, diabetes with
Sustogen (Techno), Inj., Tk. 129.00/ml Amp. vasculopathy; sickle cell anemia,
Testoren (ACI), Inj., Tk. 174.00/Amp malignant or wasting disease, severe
Dose: For androgen deficiency, deep depression, history of thromboembolic
intramuscular injection 1 ml usually every 3
disorders; before 18 years of age (may
weeks .
arrest bone maturation and testicular
development).
ANTI-ANDROGENS Interactions: See Appendix-2
Side-effects: Fatigue, lassitude,
Cyproterone acetate is an antiandrogen breathlessness, weight changes, reduce
used in the treatment of severe sebum production, change in hair
hypersexuality and sexual deviation in pattern, gynaecomastia (rarely
the male. It inhibits spermatogenesis and galactorrhoea), osteoporosis, inhibition
produces reversible infertility but it is not
used as male contraceptive; abnormal
227
of spermatogenesis; hepatotoxicity (in Cautions: Cardiac and renal

high dose) impairment, hepatic impairment,
Dose: Male hypersexuality, 50 mg twice hypertension, diabetes, epilepsy,
daily after food migraine, monitor skeletal maturation in
young patients, skeletal metastasis (risk
Proprietary Preparations of hypercalcemia)
Giane (Renata),Tab Cyproterone acetate2mg Side-effects: Acne, sodium retention
+ethinylestradiol35microgram,Tk.9.50 with edema, virilisation, amenorrhoea,
inhibition of spermetogenesis, premature
FINASTERIDE epiphysial closure, abnormal liver
function tests
Indications: Benign prostatic Dose: For osteoporosis, 50 mg deep
hyperplasia, male pattern baldness in intramus-cular every 3 weeks; for
men palliative treatment in selected case of
Cautions: Obstructive uropathy, mammary carcinoma in women, 50mg
prostate cancer (may decrease markers by deep intramascular injection weekly
such as prostate specific antigen); use of
condoms recommended if sexual partner Proprietary Preparation
is pregnant or is likely to become Decabolon (Techno), Inj., 50mg/ml, Tk.
pregnant since finasteride is excreted in 112/Amp.; 25 mg/ml, Tk. 40/Amp.
Deca-Durabolin (Nuvista) Inj., 50mg/ml, Tk.
semen. It is not recommended in women
217.80/Amp
of child bearing age Durabolin (Nuvista), Inj. 25 mg/ml Tk.
Side-effects: Impotence, decreased 86.90/Amp
libido, ejaculation disorders, testicular Hybolin (Chemist), Inj., Inj. 25 mg/ml Tk.
pain, breast tenderness and 42.00/1 ml Amp.
enlargement, hypersensitivity reactions Hydeca (Chemist), Inj., 50 mg/ml, Tk.
such as pruritus, rashes, lip and face 125.00/Amp.
Nandron (Renata), Inj., 50mg/ml, Tk.
swelling
195.00/Amp,; 25mg/ml, Tk. 75.00/Amp
Dose: 5mg daily, treatment to be
reviewed after 6 months; sometimes it
may require several months to get 5.5 HYPOTHALAMIC AND
benefit PITUITARY HORMONES
5.5.1 HYPOTHALAMIC HORMONES
Proprietary Preparations 5.5.2 ANTERIOR PITUITARY
Pronor (Square), Tab., 5mg, Tk. 10.07/Tab. HORMONES
Prosfin (Beximco), Tab., 5mg, Tk.10.04/Tab. 5.5.3 POSTERIOR PITUITARY
Recur (Beximco), Tab., 1mg, Tk. 4.02/Tab. HORMONES
5.5.1 HYPOTHALAMIC HORMONES
5.4.4 ANABOLIC STEROIDS
Gonadorelin if injected intravenously in
Anabolic steroids have some androgenic normal subjects leads to a rapid rise in
activity but they cause less virilisation both Follicular Stimulating Hormone
than androgens in women. They have (FSH) and Leutinizing Hormone (LH). It
protein-building property. Their use as can distinguish between hypothalamic
body builders or tonics is unjustified; and pituitary lesions. Gonadorelin is also
they are some times abused by some used in treatment of infertility.
athletes. Anabolic steroids are used in Gonadorelin analogues are used in
the treatment of some aplastic anemia, treatment of endometriosis and infertility
and to reduce itching of chronic biliary and in breast and prostrate cancer.
obstruction. Protirelin if injected intravenously in
normal subjects leads to a rapid rise in
NANDROLONE TSH; it fails to show such a response
Indications: Osteoporosis in post even in subclinical hyperthyroidism. So it
menopausal women, aplastic anemia is used in confirming difficult cases of
228
hyperthyroidism. Sermorelin, an
analogue of growth hormone releasing Indications: See under dose
hormone is used in a diagnostic test for Cautions: Diabetes mellitus, papill
growth hormone secretion. edema, relative deficiency of other
Somatostatin is a polypeptide obtained pituitary hormones, history of malignant
from the hypothalamus or by synthesis. disease, slipped epiphysis of the hip,
Somatostatin is usually given as the history of intracranial hypertension; avoid
acetate in the treatment of gastrointes- in pregnancy
tinal haemorrhage. Contra-indications: Evidence of
tumour activity (start after completion of
SOMATOSTATIN tumour treatment); renal transplantation;
for growth promotion in children with
Indications: Upper gastrointestinal closed epiphysis
haemorrahage including variceal Side-effects: Headache, visual
haemorrhage, insulin resistance, and the disturbance (due to benign intracranial
management of hormone-secreting pressure fundoscopy); arthalgia,
tumours myalgia, peripheral edema due to fluid
Cautions: Concomitant parenteral retention; antibody formation, transient
nutrition has been suggested because of reaction at injection site; leukaemia in
the inhibitory effects of somatostatin on children with growth hormone deficiency
intestinal absorption; blood sugar should has also been reported
be monitored since somatostain may Dose: By subcutaneous injection,
interfere with carbohydrate metabolism weekly dosage tailored for individual and
Side-effects: Abdominal discomfort, given in 3, 6 or 7 divided doses (rotate
flushing, nausea, and bradycardia have injection sites); alternatively by
been associated with too rapid intramuscular injection, weekly dosage
administration given in 3 divided dose; in gonadal
Dose: Somatostatin is usually given as dysgenesis (Turner syndrome), 0.6–1.0
the acetate. 3.5 microgram/kg body- unit/kg weekly in divided doses
weight per hour has been given by subcutaneously; in children with growth
intravenous infusion hormone deficiency, 14–20 units/square
meter body surface weekly in divided
Proprietary Preparations doses given subcutaneously or
Stilamin(I) (Serono) Inj., 3 mg, Tk. 5085/Vial intramuscularly; in chronic renal failure in
children, 30 units/square meter body
5.5.2 ANTERIOR PITUITARY surface weekly in divided doses given
HORMONES subcutaneously or intramuscularly; in
5.5.2.1 GROWTH HORMONES adult with growth hormone deficiency,
5.5.2.2 GONADOTROPINS 0.125 to 0.25 units/kg weekly divided in
5.5.2.3 CORTICOTROPINS daily doses subcutaneously or
intramuscularly
5.5.2.1 GROWTH HORMONES Proprietary Preparation
Norditropin Simplex(I) (Novo Nordisk), Inj.
Growth hormone is required in the (Pre filled pen) 5mg/1.5ml.Tk.10901.22/pen.
treatment of growth hormone deficiency. Omnitrope(I) (Sandoz), Inj.,3.3 mg/ml, Tk.
Only the growth hormone of human type 9,000.00/1 ml Cartridge
is effective. Human growth hormone
(HGH) has been replaced by human 5.5.2.2 GONADOTROPINS
sequence type somatropin, produced
by using recombinant DNA technology. FSH and LH together (as in human
menopausal gonadotropin) or FSH
SOMATROPIN alone (as in urofollitropin or
(Synthetic Human Growth Hormone) follitropin), are used in the treatment of
229
infertility due to nonovulation or Indications:See notes above

superovulation in assisted reproductive Cautions; Side-effects: See under
techniques (such as in vitro fertilization). human menopausal gonadotropins
Gonadtrophins are also used in Dose: By subcutaneous injection
treatment of oligospermia associated according to patient’s response
with hypopituitarism. Chorionic
gonadotropin is also used in delayed Proprietary Preparations
puberty in male to stimulate endogenous Gonal F (I) (Serono), Inj. (P.Fsyringe). 75IU.,
testosterone production but has little Tk.1889.13/syringe
Puregon (I) (Organon), Inj. 50 IU,
advantage over testosterone. Tk.2,600.00/amp 100 IU; Tk. 5,100.00/amp.
HUMAN MENOPAUSAL Follitropin alfa150IU+ Lutropin75IU

GONADOTROPINS Pergoveris (I) (Serono), Inj. Tk.4783.57/vial
Purified extract of human postmen- CHORIONIC GONADOTROPHIN

opausal urine containing FSH and LH; (Human Chorionic Gonadotropin; HCG)
the relative in vivo activity is designated
as a ratio; 1:1 ratio is known as A preparation of a glycoprotein fraction
menotropin. secreted by the placenta and obtained
Indications: See notes above from the urine of pregnant women,
Cautions: Ovarian cysts, adrenal or having the action of pituitary luteinising
thyroid disorders, hyperprolactinmi or hormone
pituitary tumour Indications: see notes above
Side-effects: Ovarian hyperstimulation, Cautions: see notes above; cardiac and
multiple pregnancy; local reactions renal impairment, asthma, epilepsy,
Dose: By deep intramuscular injection migraine
according to patient’s response Side-effects: edema, headache,
tiredness, mood changes, gynaeco-
Proprietary Preparations mastia, local reactions; sexual precocity
Menogon(I) (Ferring) Inj. 75 IU; Tk. with high doses; ovarian hyper
4967.90/amp; stimulation syndrome has been reported
Pergonal (I) (Serono) Inj. 75 IU; Tk.
721.65/amp; 150IU Tk.1298.51/amp
Dose: by subcutaneous or
intramuscularly injection according to
UROFOLLITROPHIN patient’s response
(Other name: Urofollitropin) Proprietary Preparations
Choragon(I) (Ferring) Inj. 5000IU,
Extract of the urine of post menopausal Tk.1382.54/Vial
women containing follicle-stimulating HCG (Popular), Inj., 5000IU, Tk.1300/Vial
hormone Ovidril(I) (Serono), Inj, 250 mcg, Tk. 2383/Vial
Indications: See notes above Pregnyl(I)(Organon),Inj.5000IU.Tk.2350/Vial
Cautions & Side-effects: See under
human menopausal gonadotropins 5.5.2.3 CORTICOTROPINS
Dose: By subcutaneous or intramuscular
injection according to patient’s response Tetracosactrin an analogue of
corticotropins (ACTH) is used to test
Proprietary Preparation adrenocortical function. Failure of the
FSH50 (Popular), Inj., 50IU/vial, plasma cortisol to rise after
Tk.1375.00/vial intramuscular administration indicates
adrenal insufficiency. Corticotrophins
FOLLITROPIN ALFA and BETA were formerly used as alternatives to
(Recombinant human follicular corticosteroids in conditions such as
stimulating hormone) Crohn’s disease or rheumatoid arthritis.
230
5.5.3 POSTERIOR PITUITARY variceal bleeding in portal hypertension.

HORMONES AND Terlipressin has effects milder than
ANTAGONISTS vasopressin and is used to control
bleeding from oesophageal varices.
Vasopressin (Antidiuretic hormones, Oxytocin, another posterior pituitary
ADH) is used in treatment of cranial hormone is used in obstetrics (see
diabetes insipidus, as is its analogue section 6.1.1).
desmopressin. The synthetic form of
vasopressin is known as Argipressin. DESMOPRESSIN
Dosage is tailored according to
response; slight diuresis is maintained to Indication: See notes above
avoid water intoxication. Diabetes Side effects, caution & contra-
insipidus after trauma or pituitary surgery indication: consult product literature
may be transient; so a short period of Dose: See notes above and consult
treatment may be enough. physician
Desmopressin has a longer duration of
action than vesopressin; unlike Proprietary Preparations
vesopressin it has no vasoconstricting Minirin Melt(I) (Ferring), Sublingual tab. 120
effect. It is given by mouth or intranasally microgram, Tk. 85.15/Tab., 60microgram, Tk.
for maintenance therapy, and by 50.67/Tab.
injection in the postoperative period or in
uncon-scious patients. Desmopressin is ANTIDIURETIC HORMONE
also used in differential diagnosis of ANTAGONISTS
diabetes insipidus. Following a dose of 2
micrograms intramuscularly or 20 Demeclocycline may be used in the
micrograms intranasally, restoration of treatment of hyponatraemia resulting
urine concentration capacity after a from inappropriate secretion of
water deprivation confirms a diagnosis of antidiuretic hormones. It is thought to act
cranial diabetes insipidus; a failure to by directly blocking the renal tubular
produce such a response indicates effect of anti-diuretic hormones. Initial
nephrogenic diabetes insipidus. In dose: 0.9-1.2 g daily in divided dose;
nephrogenic and partial cranial (pituitary) maintenance with 600-900 mg daily.
diabetes insipidus, benefit may be
gained from the paradoxical antidiuretic 5.6 DRUGS AFFECTING BONE
effect of thiazide (e.g. chlorthalidone METABOLISM
100 mg twice daily, reduced to 50 mg 5.6.1 BISPHOSPHONATES
daily for maintenance). Chlorpropamide 5.6.2 CALCITONIN
is also used in partial cranial diabetes
insipidus; it acts by increasing renal Osteoporosis is a quantitative reduction
tubular sensitivity to vasopressin (e.g.
of bone with increased fragility. This is
chlorpropamide 250 mg once daily for
common sequelae of aging process and
adult; 125–200 mg once daily in is more marked in postmenopausal
children); care must be taken so that
woman. Risk factors for osteoporosis
hypoglycemia does not occur.
include corticosteroid therapy, lack of
Carbamazepine is also used with limited physical activity, low body weight,
success (dose: 200 mg daily); its mode
smoking, alcoholism, and calcium and
of action is similar to that of
vitamin D deficiency. Other causes
chlorpropamide. include hyperthyroidism,
Desmopressin is also used to boost
hyperparathyroidism, hypogonadism and
factor VIII concentration in mild to
Cushing’s disease.
moderate haemophilia and for the Early treatment of osteoporosis is useful
control of nocturnal enuresis.
to prevent its complications. For any
Vasopressin infusion is used to control
established complication (e.g.
231
development of a low trauma fracture), complex is phagocytosed by an

therapy is strongly indicated. The osteoclast that cell is inhibited and can
therapeutic options for treatment and not reabsorb more bone.
prophylaxis are the same: Bisphosphonates are used in the
treatment of Paget’s disease,
Post-menopausal osteoporosis. osteoporosis in postmenopausal women
Bisphosphonates (alendronic acid and and hypercalcaemia due to cancer. They
risedronate, section 5.6.1) are effective may be given orally or intravenously.
for preventing postmenopausal Bioavailability of oral bisphosphonates is
Osteoporosis, if phosphonates are very poor and constitutes only 10
unsuitable Calcitriol (section16.2.3.4) or percent and the rest is eliminated
strontium ranelate may be considered. unchanged by the kidney. Fall in serum
Hormone replacement therapy (HRT calcium begins in 1-2 days, reaches a
section 5.4.1.1) is an option where other nadir in 5-6 days and lasts for 20-30
therapies are contraindicated, cannot be days.
tolerated, or if there is a lack of
response. Calcitonin is no longer ALENDRONIC ACID
recommended for the treatment of
postmenopausal osteoporosis as the Indications: Treatment of osteoporosis
benefits are outweighed by the risk of in postmenopausal women
malignancy associated with long-term Side-effects: Pyrexia, diarrhoea,
use. Parathyroid hormone, and oesophageal reactions, abdominal pain
teriparatide have been introduced for the and distension, headache, nausea,
treatment of postmenopausal vomiting, increase of bone pain. Long
osteoporosis. term use of high dose may cause
Corticosteroid induced osteoporosis. fracture of bone and esophageal
The dose of corticosteroid should be as irritation
low as possible and the course as short Cautions: Gastritis, dysphagia, vitamin
as possible to reduce the chance of D deficiency, renal impairment
osteoporosis. With a dose of Contraindications: Strictures of
prednisolone 7.5mg/day or more for 3 oesophagus, achalasia, hypocalcaemia
months or longer, the patient should be and breast-feeding
assessed for osteoporosis. During Interactions: See Appendix-2
corticosteroid therapy, age of 65 years Dose: Treatment of post-menopausal
and above constitute a high-risk group. osteoporosis 10 mg daily or 70mg once
During prolonged therapy the maximum weekly at least 30 minutes before
bone loss occurs during the first 6-12 breakfast
months. COUNSELLING: Swallow the tablet
whole with a full glass of water on an
Note:Those who are at risk of osteoporosis
empty stomach at least 30 minutes
should maintain an adequate intake of calcium
and vitamin D and any deficiency should be
before breakfast; stand or sit upright for
corrected by increasing dietary intake or at least 30 minutes and do not lie down
taking supplements. until after eating breakfast. Do not take
the tablets at bedtime or before rising
5.6.1 BISPHOSPHONATES
Ostel (Square), Tab., 70 mg,Tk. 25.10/Tab.;10
The bisphosphonates (Alendronic acid, mg, Tk. 5.01/Tab.
Disodium etidronate, Disodium Alendon (Beximco) Tab., 70 mg,Tk.
pamidronate, Ibandronic acid, Sodium 25.10/Tab.;10 mg, Tk. 5.01/Tab
clodronate) become absorbed on to Ostomax(Easkayef) Tab., 70 mg,Tk.
25.10/Tab.;10 mg, Tk. 5.01/Tab
bone crystals (hydroxyapetite) conferring
resistance to hydrolysis and prolonging Alendronic acid + Colecalciferol
of half-life in the skeleton. Also when the
232
Bonemass D (Incepta), Tab.,70 mg + 2800 IU Osnil (Acme), Tab. , 150 mg, Tk.
Tk.30.00/Tab 500.00/.Tab.
Ostel-D 70/2800 (Square),Tab. ,70 mg + 2800
IU, Tk. 30.11/Tab. ;Tab. , 10 mg + 400 IU, Tk. Calcium Orotate 400 mg and Ibandronic Acid
6.02/Tab 150 mg (KIT)
Alen-D (ACI), Tab., 70mg+2800IU, Tk. Calorate (Beximco), Kit Tab., Tk. 990/Kit
25.17Tab. Maxbon (Square), Kit.,Tab.,Tk. 990/Kit
O-Cal Kit (Acme), Kit, Tab., Tk. 990/Kit
IBANDRONIC ACID Orocal (Ziska), Kit, Tab., Tk. 400/Kit
Indications: Hypercalcaemia induced by RISEDRONATE SODIUM

metastatic bone diseases
Cautions: Hepatic impairment; monitor Indications: See under dose
renal function and serum calcium, Cautions: Oesophageal abnormalities
phosphate and magnesium; cardiac and other factors which delay transit or
disease (avoid volume over load); not emptying (e.g. stricture or achalasia-see
recommended for use in children under side-effects); renal impairment
Contraindications: Moderate to severe (manufacturer advises avoid if creatinine
renal impairment, pregnancy, breast- clearance is less than 30mL/minute);
feeding correct hypocalcaemia before starting,
Side-effects: Hypocalcaemia, correct other disturbances of bone and
hypophos-phatemia, flu-like symptoms mineral metabolism (e.g. vitamin-D
including fever, chills, muscle and bone deficiency) at onset of treatment
pain reported; rarely hypersensitivity Interactions:See Appendix- 2
reactions; bronchospasm and angioe- Contraindications: hypocalcaemia (see
dema reported Cautions above), pregnancy and breast-
Dose: by mouth, 150mg once a month in feeding
empty stomach at least 30 minutes Side-effects: Gastro-intestinal effects
before breakfast (Counselling as for (including dyspepsia, nausea, diarrhoea,
Alandronic Acid) constipation, oesophageal stricture, and
By intravenous infusion, according to duodenitis); dizziness, headache;
serum calcium concentration, 2-4 mg in influenza-like symptoms, musculos-
single infusion; CHILD not keletal pain, rarely glossitis, edema,
recommended weight loss, apnoea, bronchitis, sinusitis,
rash, nocturia, ambylopia, corneal lesion,
Proprietary Preparations dry eye, tinnitus, iritis
Boncare (Orion), Tab., 150 mg, Tk. Dose: Paget’s disease of bone, 30mg
1203.61/Tab. daily for 2 months; may be repeated if
Bondrova (Healthcare), Inj., 3mg/3ml, Tk. necessary after at least 2 months
4500.00/Inj. ,Tab.,150mg, Tk. 1960.00/Tab.
Bondronat (I) (Roche), Inj., 6 mg/6 ml, Tk.
treatment of postmenopausal
22211.00/6 ml Vial osteoporosis to reduce risk of vertabral
Bone (Incepta), Tab., 150mg , Tk. 510.00/Tab. or hip fractures, 5 mg daily or 35 mg
Bonfix (Opsonin), Tab.,150 mg , Tk. once weekly
500.00/Tab. prevention of osteoporosis (including
Bonmax (Globe), Tab, 150 mg, Tk. corticosteroid induced osteoporosis) in
510.00/Tab. postmenopausal women, 5mg daily
Bonova (Radiant), Tab., 150 mg,
Tk.2,500.00/Tab.
COUNSELLING. swallow tablets whole
Ibandron (Aristo), Tab., 150mg, Tk. with full glass of water; on rising, in
1,200.00/Tab. empty stomach at least 30 minutes
Idrofos (Sun Pharma), Tab., 150 mg, Tk. before first food or drink of the day or, if
1500.00/Tab. taking at any other time of the day, avoid
Ivana (Renata), Tab. , 150mg , Tk. food and drink for at least 2 hours before
995.00/Tab. or after risedronate (particularly avoid
Maxbon (Square), Tab. , 150 mg, Tk.
510.00/Tab.
calcium-containing products e.g. milk,
also avoid iron and mineral supplements
233
and antacids); stand or sit upright for at dose over at least 15 minutes, once a
least 30 minutes; do not take tablets at year
bedtime or before rising reduction of bone damage in advanced
malignancies involving bone (with
Proprietary Preparations calcium and vitamin D supplement), by
Risedon (Square), Tab. , 35 mg + 500 mg, Tk. intravenous infusion, 4 mg every 3-4
7.88/Tab. weeks
Risedon (Square), Tab., 150 mg, Tk.
120.37/Tab.
Hypercalcaemia of malignancy, by
Risedronate Sodium + Calcium intravenous infusion 4mg as a single
Risonet (Opsonin), Tab., 150 mg , Tk. dose.
120.00/Tab., 35 mg , Tk. 50.00/Tab.
Salost (UniMed), Tab., 150mg, Tk. Proprietary Preparation
200.00/Tab., 5mg, Tk. 8.00/Tab., 35mg, Tk. Aclasta(I) (Novartis), Inj.,( IV Infusion), 0.05%,
50.00/Tab. Tk. 32500.00/Vial
Sedron (General), Tab., 5mg, Tk. 8.05/Tab., Bonizol (Square), Inj.,( IV Infusion), 0.05%,
35mg, Tk. 35.25/Tab. Tk. 6000/Vial
Drometa (Incepta), 4mg/5ml, Tk. 5000.00/Vial
Xoleron (Beacon), Inj., 4 mg/5 ml, Tk.
ZOLEDRONIC ACID
5,000.00/Vial
Zoclast (Healthcare), Inj 4mg/5ml, Tk.
Indications: See under dose 6499.99/Vial
Cautions: Monitor serum electrolytes, Zoledron (Opsonin), Inj.,( IV Infusion),
calcium, phosphate and magnesium, 0.05%,, Tk. 5950.00/100 ml
assess renal function before each dose, Zolenic (Incepta), Inj.,( IV Infusion), 0.05%,
Tk. 5947.00/Vial
renal impairment severe hepatic
Zoltero (Beximco), Inj.,( IV Infusion), 0.05%,
impairment; cardiac disease (avoid fluid Tk. 7000.00/100ml
overload) Zometa (Novartis), Infusion 4 mg/5ml,
Interactions: See Appendix-2 30000.00/Vial
Contra-indications: Pregnancy, breast-
feeding 5.6.2 CALCITONIN
Side-effects: Hypophosphataemia,
anemia, influenza like symptoms Calcitonin is a peptide hormone
including bone pain, fever and rigors produced by the C-cell of thyroid. It acts
gastro-intestinal effects including on bone to inhibit osteoclasts to reduce
nausea, vomiting, and anorexia, the rate of bone turnover, and on kidney
headache, conjunctivitis renal impair- to reduce the reabsorption of calcium
ment (rarely acute renal failure); rarely and phosphate. It is used to lower the
diarrhoea, constipation, taste disturba- plasma calcium concentration in some
nce, dry mouth, stomatitis, chest pain, patients with hypercalcaemia, especially
dyspnoea, cough, dizziness, paraesth- associated with malignant disease.
esia, tremor, anxiety, sleep disturbance, Effect on serum calcium is observed
blurred vision, weight gain, pruritus, within 4-6 hours and last for 6-10 hours
rash, sweating, haematuria, proteinuria, only. Prolonged used of porcine
hypersensitivity reactions (including calcitonin can lead to production of
angiedema) peripheral edema, neutralizing antibodies. Salcatonin, the
thrombocytopenia, leucopenia, partially synthesized calcitonin derived
hypomagnesaemia, also injection site from salmon is less immunogenic and is
reactions; very rarely bradycardia, more suitable for long-term therapy.
confusion, hyperkal-aemia, Indications: Paget’s disease; hypercalc-
hypokaleamia, hypernatraemia, aemia; see notes above and also under
pancytopenia dose.
Dose: For post-menopausal
osteoporosis and osteoporosis in men by
intravenous infusion, 5mg as a single
234
Cautions: history of allergy, heart

failure, breast feeding, pregnancy
Side-effects: Inflammatory reactions at
injection site, gastrointestinal upset,
allergic reactions, flushing, tingling
sensation in hands
Dose: in Paget’s disease of bone, by
subcutaneous or intramuscular injection,
dose range 50 units 3 times weekly to
100 units daily, in single or divided doses
In hypercalcaemia, by subcutaneous or
intramuscular injection, initially 4 units/
kg daily adjusted according to clinical
and biochemical response
Miacalcic(I) (Novartis), Injection, 100 IU/ml, Tk.
591.00/Vial
Miacalcic(I) (Delpharm), Nasal Spray, 200
IU/ml, Tk. 2958.00/ml
235
6. OBSTETRICS, GYNAECOLOGY AND URINARY-TRACT DISORDERS
Chapter 6
OBSTETRICS, GYNAECOLOGY AND GENITO-
URINARY TRACT DISORDERS
6.1 Drugs used in obstetrics p.236
6.1.1 Oxytocic’s and prostaglandins p.236
6.1.2 Ductusarteriosusp.239
6.1.3 Misoprostalp. 239
6.1.4 Mifepristone p.239
6.1.5 Myometrial relaxants p.240
6.2 Treatment of vaginal and vulval conditions p.241
6.2.1 Preparation for vaginal atrophy p.241
6.2.2 Anti-infective drugs for common vaginal conditions p.242
6.3 Contraceptives p.244
6.3.1 Combined oral contraceptives p.244
6.3.2 Progesterone only contraceptivesp.248
6.3.2.1 Oral progesterone only contraceptives p.248
6.3.2.2 Parenteral progesterone only contraceptives p.249
6.3.2.3 Intrauterine progesterone only contraceptives p.250
6.3.3 Spermicidal contraceptives p.251
6.3.4 Contraceptive devices p.251
6.3.5 Emergency contraceptives p.253
6.4 Drugs for genito-urinary disorders p.253
6.4.1 Drugs for urinary retention p.254
6.4.2 Drugs for urinary incontinence and nocturnal enuresis p.256
6.4.3 Drugs used in urological pain p.258
6.4.4 Drugs for erectile dysfunctionp.258
6.4.5 Alkalinisation and acidification of urine p.260
6.5 Hormone therapy of gynecological disorders p.261
6.5.1 Bromocriptinep.261
6.5.2 Danazolp.262
6.5.3 Cetrorelixp.263
6.5.4 TRIPTORELINp. 263
6.5.5 CABERGOLINEp. 263
For hormone therapy of gynaecological disorders see section 5.4.1 (female sex
hormones), section 5.5.1 & 5.4.2.3 (hypothalamic, anterior pituitary hormones and
antioestrogens) and section 14.3.4.2 (gonadorelin analogues).
6.1 DRUGS USED IN OBSTETRICS 6.1.1 OXYTOCICS

ANDPROSTAGLANDINS
6.1.1 OXYTOCICS AND
PROSTAGLANDINS Oxytocics and prostaglandins are known
6.1.2 DUCTUS ARTERIOSUS to increase myometrial activity and can
6.1.3 MISOPROSTAL be used to stimulate (induce or augment)
6.1.4 MIFEPRISTONE labour, to minimize blood loss from
6.1.5 MYOMETRIAL RELAXANT placental site and to induce abortion.
They include oxytocin, ergometrine and
the prostaglandins. All induce uterine
contraction with varying degrees of pain
236
according to the strength of contractions impairment; multiple pregnancy (it can

induced. be given after the delivery of last baby)
INDUCTION OR AUGMENTION OF Contraindications: Induction of labour,
LABOUR: Oxytocin is administered by first and second stages of labour,
slow intravenous infusion preferably vascular disease, severe cardiac
using infusion pump to induce or disease, impaired pulmonary function,
augment labour, usually in conjunction severe hepatic and renal impairment,
with amoniotomy. Uterine activity must sepsis, severe hypertension, eclampsia.
be monitored carefully and hyperstimu- Interactions: See Appendix-2
lation avoided. Large doses of oxytocin Side effects: Nausea, vomiting, head-
may result in excessive fluid retention ache, dizziness, tinnitus, abdominal pain,
due to its vasopressin like action, though palpitation, dyspepsia, bradycardia,
it may not occur with presently available transient hypertension, vasoconstriction,
synthetic products (e.g. Syntocinon). stroke, myocardial infarction and
Prevention and Treatment of PPH pulmonary edema also reported.
(Postpartum Hemorrhage): Bleeding Dose:0.25- 0.50 mg I/M or I/V initial
due to incomplete abortion can be dose and continuing according to clinical
controlled with Ergometrine and need. 1 unit = 2 microgram.
Oxytocin. Usually given intramuscularly
(or intravenously), the dose is adjusted Proprietary Preparations
according to the patient's condition and G-Ergometrine(Gonoshasthaya),Inj.
blood loss. This is used prior to surgical 0.2mg/ml, Tk. 3.90/Amp.; Tab. 125 microgram,
Tk. 0.55/Tab.
evacuation of uterus, particularly when Urgotin(Chemist), Inj. 0.2mg/ml,, Tk. 30.00/
surgery is delayed or after evacuation. Amp.
Ergometrine acts better in first trimester, Metherspan(Opsonin), Tab. , 125 mcg , Tk.
but later oxytocin and ergometrine 0.55/Tab. ;Inj.,200 mcg/Amp, Tk. 3.01/Amp
combined are more effective than either
drug alone. CARBETOCIN
For active management of third stage of
labour inj. oxytocin 10 units is given by Indications:Prevention of uterine atony
intramuscular injection immediately after after caesarean section
delivery of baby. & after excluding the Cautions:Hyponatraemia;
presence of additional babies. In case of cardiovascular disease (avoid if severe);
home delivery where oxytocin is not migraine; asthma
available tab. Misoprostol 3 tab 600 Contraindications: Pre-eclampsia and
microgram taken orally can be a good eclampsia; epilepsy, hepatic and renal
alternative. impairment
In high risk cases where there is Side-effects: nausea, vomiting,
increase risk of PPH, abdominal pain, metallic taste; flushing,
intravenousinfusion of oxytocin 10-20 hypotension, chest pain; dyspnoea;
unit in 500 ml of normal saline can be headache, tremor, dizziness; anaemia;
given after delivery as a measure of back pain; pruritus.
prevention and/or treatment of Dose: By slow intravenous injection over
postpartum hemorrhage, particularly 1 minute, a single dose of
when the uterus is atonic. Excessive 100micrograms, as soon as possible
bleeding also has to be controlled with after delivery, preferably before removal
inj. Ergometrine and tab.prostaglandin. of placenta
ERGOMETRINE MALEATE[ED] Proprietary Preparations

Arbecin(Renata), Inj., 100microgram/ml, Tk.
Indications:PPH, heavy bleeding in 150.00/vial
Carbate(Incepta), Inj., 100microgram/ml,, Tk.
incomplete abortion. 150.00/vial
Cautions: Cardiac disease; Duratocin(Beacon), Inj., 100microgram/ml,,
hypertension; hepatic and renal Tk. 150.45/vial
237
OXYTOCIN[ED] (see also under Dose below); also

nausea, vomiting, arrhythmias, rashes
Indications:Induction of labor for and anaphylactic reactions (with
medical reasons or stimulation of labor in dyspnoea, hypertension or shock)
hypotonic uterine inertia by intravenous reported; placental abruption and
infusion until labor pattern established amniotic fluid embolism also reported on
similar to normal.(see under dose and overdose
notes above) Dose : Induction of labour for medical
Cautions: Particular caution needed reasons or stimulation of labor in
when given for induction or enhance- hypotonic uterine inertia by intravenous
ment of labour in presence of borderline infusion 0.001-0.004 units/minute until
cephalopelvic disproportion; mild to labour pattern established similar to
moderate pregnancy induced hyperten- normal (usually less than 0.01 units/
sion or cardiac disease; history of lower minute for pregnancy at term); maximum
uterine segment Caesarean section (see recommended rate 0.02 unit/minute (use
also under Contraindications); if foetal solution containing 10 units/500 ml if
death in utero or meconium stained higher rate required); (may be repeated
amniotic fluid, avoid tumultuous labour the following day starting again at 0.001-
(may cause amniotic fluid embolism); 0.004 units/minute)
avoid large infusion volumes and restrict IMPORTANT: Careful monitoring of fetal
fluid intake by mouth (to prevent water heart rate and uterine contraction by
intoxication and hyponatremia); caudal trained personnel essential to allow dose
block anaesthesia (may enhance hyper- titration according to response (never
tensive effects of sympathomimetic give direct intravenous injection);
vasopressors); discontinue immediately in uterine
Contraindications : Hypertonic uterine hyperactivity or fetal distress. In
contraction, mechanical obstruction to Caesarean section: by slow intravenous
delivery, fetal distress; any condition injection immediately after delivery, 5-10
where spontaneous labour or vaginal units. Prevention of postpartum
delivery is inadvisable (e.g. significant haemorrhage after delivery of placenta:
cephalopelvic disproportion, by slow intravenous injection 5-10 units
malpresentation, placenta Previa, vasa (if infusion used for induction or
Previa, placental abruption, cord enhancement of labour, increase rate
presentation or prolapse, predisposition during third stage and for next few
to uterine rupture as in multiple hours). May be given in a dose of 5-10
pregnancy, polyhydramnios, grand units by intramuscular injection instead
multiparty and presence of uterine scar of oxytocin with ergometrine (see notes
from major surgery including Caesarean above). Treatment of postpartum
section); avoid prolonged administration hemorrhage: by slow intravenous
in oxytocin-resistant uterine inertia, injection 5-10 units followed in severe
severe pre-eclampsia or severe cases by intravenous infusion of 5-20
cardiovascular disease. units in 500 ml of non hydrating diluent
Interactions :See Appendix-2 (e.g. glucose 5% solution) at a rate
Side-effects: Uterine spasm (may occur sufficient to control uterine atony. Avoid
even at low doses), uterine rapid intravenous injection (may cause
hyperstimulation (usually with excessive short-lasting drop in blood pressure);
doses may causes fetal distress, prolonged administration, see warning
asphyxia and death, or may lead to below. Incomplete, inevitable or missed
hypertonicity, tetanic contractions, soft abortion: by slow intravenous injection 5
tissue damage or uterine rupture); water units, followed if necessary by
intoxication and hyponatremia intravenous infusion of 0.02-0.04 units/
associated with high doses with large minute or faster
infusion volumes of electrolyte-free fluid WARNING. Prolonged intravenous
administration at high dose with large
238
volume of fluid (as possible in inevitable initially by vagina, or by buccal

or missed abortion or postpartum administration or by sublingual
haemorrhage) may cause water administration.
intoxication with hyponatraemia. To Adult: 800 micrograms for 1 dose, dose
avoid: use electrolyte containing diluent to be given 24-48 hours after
(i.e not glucose), increase oxytocin mifepristone, if abortion has not occurred
concentration to reduce fluid, restrict 4 hours after first misoprostol dose a
fluid intake by mouth; monitor fluid and further dose may be given,(by mouth or
electrolytes. dy vagina) 400 micrograms for 1dose.
Termination of pregnancy following
Proprietary Preparations mifepristone (gestation of 9 to 13 weeks)
Inducin(Incepta),Inj.,5 IU/ml, Tk. 25.00/ Amp initially by vagina
Linda-SDS(Nuvista),Inj.,10 IU/ml, Tk. Adult: 800 micrograms for 1 dose, dose
25.29/Amp
Ocin(Opsonin), Inj., 5 IU/ml, Tk. 15/Amp
to be given 36-48 hours after
Oxyton(Renata),Inj.,5 IU/ml, Tk. 10.00/ Amp mifepristone, following by (by vagina or
Pitocin(Chemist), Inj.,10 IU/ml, Tk. 15/Amp.; 5 by mouth) 400 micrograms every 3
IU, Tk. 8.35/Amp. hours if required for a maximum of 4
Syntocin(Techno),Inj., 5IU/ml,Tk. 7.50/ Amp doses, if abortion has not occurred 3
hours after the last dose of misoprostol,
6.1.2 DUCTUS ARTERIOSUS a further dose of mifepristone may be
given, and misoprostol may be
Alprostadil (Prostaglandin E1) is used to
recommended 12 hours later.
maintain patency of the ductusarteriosus
in neonates with congenital heart
defects, prior to corrective surgery in
centres where intensive care is Cytomis(Incepta), Tab., 200 mcg, Tk.
immediately available. Prostaglandin E1 15.00/Tab.
maintains the patency of the G-Misoprostol (Gono), Tab. 200mcg Tk
ductusarteriosus; Indomethacin is 30.00/Tab
believed to close it by inhibiting Indula(Renata), Tab. , 200 mcg, Tk.
prostaglandin synthesis. 15.00/Tab.
Isovent(Square), Tab., 200 mcg, Tk.
6.1.3 MISOPROSTOL 15.10/Tab., 600 mcg, Tk.40.13/Tab.
Misoclear(Acme), Tab., 200 mcg , Tk.
Indications: Termination of pregnancy 15.04/Tab.
Misopa(Beximco), Tab., 200mcg, Tk.
following mifepristone.
15.00/Tab.
Cautions: Cerebrovascular disease, Misopil(General), Tab. , 200mcg, Tk.
cardiovascular disease, Inflammatory 15.00/Tab.
bowel disease. Misoprostol(Amico), Tab., 200mcg, Tk.
Contraindications:Pregnant women 15.00/Tab.
,history of allergy to prostaglandins. Misotab(Euro), Tab., 200mcg, Tk. 15/Tab.
Side effects: Diarrhea, abdominal pain, Misotec(Sharif), Tab.,200 mcg, Tk.
15.04/Tab.
abnormal vaginal bleeding, dizziness,
Misotol(Ziska), Tab., 200 mcg, Tk. 15.00/Tab.
dyspepsia, flatulence, Intermenstrual
bleeding, menorrhagia, nausea, 6.1.4 MIFEPRISTONE
postmenopausal bleeding rashes,
vomiting.
Indications: Medical termination of
Dose: It is given by mouth for the
intrauterine pregnancies of up to 49 days
termination of pregnancy up to 49days.
gestation .It is used in combination
In adult 400 micrograms for 1 dose, dose
withGemeprostfor termination of
to be given 24-48 hours after
pregnancies between 13 and 24 weeks
mifepristone.
gestation;can also be used in smaller
Termination of pregnancy following
doses as an emergency
mifepristone (gestation 50 to 13 days)
contraceptive;used in combination with
misoprostol for the termination of
239
intrauterine pregnancy through day 49 of NIFIDIPINE[ED]

the pregnancy
Contraindications: Presence of an Indication: Premature labour.
intrauterine device, ectopic pregnancy, Caution: Should not be given combined
adrenal failure, hemorrhagic disorders with magnesium sulphate or beta 2
and anticoagulant or long-term agonists.
corticosteroid therapy Dose: It is given in the dose of 20mg
Side effects:Vaginal bleeding, stat followed by 10 -20 mg after 30 min &
cramping, nausea, vomiting, diarrhea, then 10-20 mg every 6-8 hourly for 48
dizziness, back pain, and tiredness. hours until the dose of inj.
Dose:It is given by mouth for the Dexamethasone for lung maturity has
termination of pregnancy up to 63 days been completed.
duration. Single dose of 600 mg of Note:Pretreatment with fluids before
mifepristone followed by gemeprost 1 infusion reduce hypotension and
mg vaginallyor misoprostol400 uteroplacental perfusion.
micrograms by mouth 36-48 hours later
if the abortion has not been completed. Proprietary Preparations
Lower doses of mifepristone and other (See section 3.3.2)
prostaglandins have also been used for
medical termination of pregnancy. RITODRINE HYDROCHLORIDE
Note. Treatment with mifepristone and
misoprostol requires three separate
Indication :Uncomplicated premature
office visits.
labour(See notes above)
Day 1: Three 200 mg tablets (600 mg) of
Cautions: Cardiac disease
mifepristone are taken as a single dose.
hypertension, hyperthyroidism, special
Day 3: 400 microgram of misoprostol is
risk with potassium depleting diuretics,
given orally unless abortion has been
diabetes mellitus (closely monitor blood
confirmed.
glucose during intravenous treatment);
Day 14: No medication administered.
mild to moderate preeclampsia monitor
Patient returns for a post-treatment
blood pressure and pulse rate (see
examination to confirm that a complete
section-16).over hydration.
termination of pregnancy has occurred.
Closely monitor state of hydration
Proprietary Preparations (discontinue immediately and institute
Mifetab(Euro), Tab., 200 mg, Tk. diuretic therapy if pulmonary oedema
240.00/Tab. occurs);
Mifeston(Incepta), Tab. , 200 mg, Tk. Contraindications: Cardiac disease,
175.00/Tab.
MIF(Renata), Tab., 200 mg, Tk. 175.00/Tab.
eclampsia, severe preeclampsia,
Mprix(Sharif), Tab.,200 mg , Tk. 240.72/Tab. intrauterine infection, intra uterine fetal
death, antipartumhemorrhage (requires
Misoprostol 0.20mg1Tab and Mifepristone immediate delivery) placenta praevia
200mg 4Tablet
Abkit(Renata), Tab.,Tk.300.00/Kit
(requires immediate delivery), cord
Abo kit(Globe), Tab., Tk.280.00/Kit compression; first or second trimesters.
Cytomis(Incepta), Tab.,Tk.300.00/Kit Interactions:SeeAppendix-2
Kit-63(General), Tab., Tk.300.00/Kit Side-effects: Nausea, vomiting, flush-
Mariprist(Acme), Tab., Tk. 300.00/Kit ing, sweating, tremor, hypokalaemia,
MM Kit(Ziska), Tk. 280.00/Kit tachycardia, palpitations and hyperte-
MTP Kit(Sharif),Tk 300.00/Kit nsion (left lateral position throughout
Terminex(Square), Tab., Tk. 300.00/Kit
infusion to minimize risk); increased
6.1.5MYOMETRIAL RELAXANTS tendency to uterine bleeding (see
cautions), pulmonary oedema(see below
and under cautions); chest pain or
tightness (with or without ECG changes)
and arrhythmias; salivary gland
240
enlargement; on prolonged reactions. They are indicated only in

administration (several weeks) cases of pruritus where specific local
leucopenia and agranulocytosis causes have been excluded. Systemic
reported; liver function abnormalities drugs are required in the treatment of
(including increased transaminase level infections such as gonorrhea and
and hepatitis) reported. syphilis
Dose: Used (by mouth or by injection) as
a myometrial relaxant. Usual dose 10 mg 6.2.1 PREPARATION FOR
three times daily. VAGINAL ATROPHY
Application of an oestrogen containing
Ritopar(ACI), Tab. 10 mg, Tk. 8.00/Tab.; Inj.
50 mg/5 ml, Tk. 70.00/Vial cream may be used on a short-term
basis to improve the quality of the
vaginal epithelium in menopausal
SALBUTAMOL[ED]
atrophic vaginitis. It is important to bear
in mind that topical oestrogen should be
Indications: Uncomplicated premature used in the minimum effective amount to
labour(see notes above); asthma (see minimize absorption of the oestrogen; if
section 4.1.1) they are used on a long-term basis,
Cautions; Contraindications; Side- some require oral progestogen for 10-14
effects:See under Ritodrine days of each month to combat
Hydrochloride endometrial hyperplasia (for details see
Dose:By intravenous infusion, 10 under preparations below). Topical
micrograms/minute gradually increased oestrogen are also used prior to vaginal
to max. of 45 micrograms/minute until surgery in postmenopausal women, e.g.
con-traction have ceased, then gradually in prolapse when there is epithelial
reduced; or by intravenous or intramu- atrophy.
scular injection, 100-250 micrograms
repeated according to response; then by
TOPICAL OESTROGENS
mouth (but see notes above), 4 mg
every 6-8 hours.
Indications: Menopausal atrophic
Proprietary Preparation vaginitis; Topical oestrogen are also
See section 4.1.1 used prior to vaginal surgery, in
prolapse when there is epithelial atrophy.
6.2 TREATMENT OF VAGINAL AND
effects: See Oestrogen for HRT (section
VULVAL CONDITIONS
5.4.1.1); contraindicated in pregnancy
and lactation. Examine patients
6.2.1 PREPARATION FOR VAGINAL periodically to assess the need for
ATROPHY. further treatment.
6.2.2 ANTI-INFECTIVE DRUGS FOR
COMMON VAGINAL Proprietary Preparations
CONDITIONS Ovestin(I)(Organon),Intravaginal cream,
oestriol 0.1%; 1 applicator-dose to be inserted
Symptoms are preliminarily referred to daily for 2-3 weeks, before retiring at night,
then reduce to twice a week dose (discontinue
the vulva, but infections almost invariably
every 2-3 months for 2 weeks to assess the
involve the vagina which should also be need of further treatment; vaginal surgery, 1
treated. Applications to the vulva alone applicator dose daily for 2 weeks before
are likely to give only symptomatic relief surgery resuming 2 weeks after surgery; 1
without cure. Aqueous medicated application (with calibrated applicator filled up
douches may disturb normal vaginal to ring mark) contains 0.5 mg ovestin cream
acidity and bacterial flora. Topical which corresponds to 0.5 mg oestriol. Tk.
1114.00/15g tube
anaesthetic agents give only sympto-
matic relief and may cause sensitivity
241
Premarin(I)(Pfizer),Vaginal cream, conjugated digits, nail beds and umbilicus as well as

oestrogens (equine) 0.625 mg in 1 g non- the gastrointestinal tract and the bladder.
liquidifying cream; insert 1-2 daily, starting on The partner may also be the source of
day 5 of cycle for 3 weeks followed by one
weak interval; if therapy is long term in women
reinfection and should be treated with
with intact uterus, oral progesterone needs to cream at the same time.
be given for 10-14 days at end of each cycle.
Tk. 801.03/14 gmTube CLOTRIMAZOLE
6.2.2 ANTI-INFECTIVE DRUGS FOR Indications:See notes above

COMMON VAGINAL Dose:See notes above.
CONDITIONS Pessary (with applicator), Clotrimazole
Effective specific treatments are 500 mg; 1tablet is to be inserted at night
available for common vaginal infections. as a single dose.
FUNGAL INFECTIONS Note: Treatment should be timed to avoid
menstrual period. Effect on latex condoms and
(See section1.2&12.2) diaphragms is not yet known
Candidalvulvitis can be treated locally Proprietary Preparations

with cream but is almost invariably Afun VT (Square), .Vaginal Tab.,200 mg, Tk.
associated with vaginal infection which 20.6/Tab.;500 mg, Tk. 60.18/Tab.
should also be treated. Vaginal candiasis Clotrim(Acme), Vaginal Tab. , 200.00 mg, Tk.
is treated primarily with antifungal 20.13/Tab.; Vaginal Supp , 200 mg, Tk.
20.13/supp.;
pessaries or cream inserted high into the
ClozolVT(Chemist), Vaginal Tab.,200 mg, Tk.
vagina (including during menstrual). 60/Tab.
Imidazole drugs (Clotrimazole, DermasimVT(ACI), Vaginal Tab., 500 mg , Tk.
EconazoleFenticonazol, Isoconazole 60.41/Tab, 200mg, Tk. 20.14/Tab.
and Miconazole, Ticonazole) are Neosten(Beximco), Vaginal Tab., 200mg, Tk.
effective in short course of 3 to 14 days 20.00/Tab.
according to the preparation used; single
dose preparations offer an advantage ECONAZOLE
when compliance is a problem. Vaginal
applications may be supplemented with Indications: Same as that
antifungal cream for vulvitis and to treat ofclotrimazole.
other superficial sites of infection. Dose: Insert one tablet high in vagina for
Nystatin is a well established treatment 3 consecutive nights regardless of any
(but stains clothings yellow). One or two intervening menses.
pessaries are inserted for 14 to 28 Note:Econazole vaginal preparations
nights; they may be supplemented with are known to damage latex condoms
cream for vulvitis and to treat other and diaphragms.
superficial sites to infection. Oral
treatment with Fluconazole or Proprietary Preparations
Itraconazole(see section 12.2.2) is also EconateVT(Incepta), Vaginal Tab.,150 mg,
effective; oral Ketoconazole (see Tk. 23.33/Tab.
section 12.2.2) has been associated with EcorenVT(ACI), Vaginal Tab., 150 mg, Tk.
24.16/Tab.
fatal hepatotoxicity. Ecozol-VT(Opsonin), Vaginal Tab. 150mg Tk.
Recurrence is common if the full course 23.49/Tab.
of treatment is not completed and
particularly if there are predisposing NYSTATIN[ED]
factors such as antibiotic therapy, oral
contraceptive use, pregnancy or
diabetes mellitus. Possible reservoirs of Indications:Vulvitis, perineal pruritus,
infection may also lead to dyspareumia and dysuria due to fungal
recontamination and should be treated. infection.
These include other skin sites such as Side-effects: Local irritation and burning
sensation; stains clothing yellow.
242
case of trichomonal infection, the male

Proprietary Preparation partner should be treated concurrently
Nystat VT(Acme), Vaginal tablet 5 Lac IU,, with metronidazole 200 mg orally twice
insert 1-2 tablets daily and continue for 2 daily for 10 days.
weeks; may be continued during
menstruation.Tk. 1.95/Tab.
Topical vaginal products containing
Povidone iodine may be used to treat
vaginitis due to candidal, trichomonal,
FENTICONAZOLE
non-specific or mixed infections; they are
also used for the pre-operative
Indications: Vulvovaginal candidiasis. preparation of the vagina. Clindamycin
Cautions: Pregnancy, lactation cream and Metronidazole gel are also
Contraindications: known indicated for bacterial vaginosis. Anti-
hypersensitivity to imidazole derivatives bacterial and antifungal combination
Side-effects:Transient burning, products are also available for mixed
sensitization infections.
Dose:One applicator full (about 5 g) is The antiviral drugs Aciclovir, Famci-
administered into the vagina by a re- clovir and Valaciclovir may be used in
usable applicator (morning and evening the treatment of genital infection due to
for three days). herpes simplex virus, the HSV type 2
being a major cause of genital
ulceration. They have a beneficial effect
Fentizol(Square), Vaginal Tab., 600 mg, Tk.
120.00/Tab. on virus shedding and healing generally
FentigalVT(Sharif), Vaginal Tab, 600 mg, Tk. giving relief from pain and other
120.00/Tab symptoms. For antiviral drugs, see
section 1.4 for systemic preparations
TIOCONAZOLE and section 12.2.3 for topical
preparations.
Note:Avoid in impaired renal function.
Indications:Vaginal yeast infections;
reduces vaginal burning, itching.
Side-effects:Same as that of Nystatin. PREPARATIONS FOR OTHER
VAGINAL INFECTIONS
Tycon(Acme), Vaginal Supp., 300 mg Tk. Proprietary Preparations
60.40/Supp Clindax(Opsonin),Vaginal
cream,Clindamycin 2%, Tk. 70.26/20 gm
OTHER INFECTIONS Flamyd(Incepta), Vaginal Gel, 750mg/100gm,
Tk. 50.00/30gm
Povisep(Jayson), Gel, Povidone iodine 10%,
Vaginal preparations intended to restore Tk.80/30 gm
normal acidity may prevent recurrence of
vaginal infections and permit the re- Neomycin sulphate 35,000 IU polymyxin B
establishment of the normal vaginal sulphate 35,000 IU, nystatin 1,00,000 IU and
metronidazole 200 mg
flora. Trichomonal infections commonly
Gynastin(Acme), Vaginal Supp., Tk.
involve the lower urinary tract as well as 24.08/Supp
the genital system and need systemic Gyned(Pacific), Vaginal Supp., Tk.
treatment with Metroindazole or 35.00/Supp
Tinidazole Bacterial infections are Gynepro(Square), Vaginal Supp., Tk.
particularly common in association with 24.08/Supp
gynaecological operations and trauma. Gynoheal (Globe)Vaginal Supp., Tk.
25.10/Supp
Metronidazole is effective against
Gynomix(Drug Intl), Vaginal Supp., Tk.
certain Gram-negative organisms, 25.10/Supp
especially Bacteroides may be used Gynoril(Opsonin), Vaginal Supp., Tk.
prophylactically in gynaecological 24.16/Supp
surgery (for systemic preparations of Gynoxin(Aristo), Vaginal Supp.,
Metronidazole, (see section 1.1.9). In Tk.24.00/Supp
243
Vcap(Renata), Vaginal Supp., Tk. 25.00/Supp the case of those also containing
desogestrel or gestodene, see advice
below).
6.3 CONTRACEPTIVES High dose preparations (containing
6.3.1 COMBINED ORAL either ethinyloestradiol 50 micrograms or
CONTRACEPTIVES mestranol 50 micrograms) provide
6.3.2 PROGESTERONE ONLY greater contraceptive security but with
CONTRACEPTIVES an increase in the possibility of side-
6.3.2.1 ORAL PROGESTERONE effects. These are used mainly in
ONLY CONTRACEPTIVES circumstances of reduced bioavailability
6.3 .2.2 PARENTERAL (e.g. during long term use of enzyme
PROGESTERONE ONLY inducing antiepileptics, see under
CONTRACEPTIVES Interactions below).
6.3.2.3 INTRAUTERINE The progestogensdesogestrel, gesto-
PROGESTERONE ONLY dene and norgestimate in combination
CONTRACEPTIVES with ethinyloestradiol have been
6.3.3 SPERMICIDAL reported to have less adverse effects on
CONTRACEPTIVES lipids than ethynodiol, levonorgestrel and
6.3.4 CONTRACEPTIVE DEVICES norethisterone in combination with
6.3.5 EMERGENCY ethinyloestradiol. Desogestrel and
CONTRACEPTIVES gestodene may be given to women who
experience side-effects (such as acne,
6.3.1 COMBINED ORAL headache, depression, weight gain,
CONTRACEPTIVES breast symptoms and breakthrough
bleeding) with other progestogens.
However, women should be advised that
Their advantages include: Reliability; desogestrel and gestodene have also
reduction of dysmenorrhoea; less pre- been associated with an increased risk
menstrual tension; significant protection
of venous thromboembolism (see
against endometrial and ovarian cancer; below).
and protection against pelvic It is, therefore, advised that combined
inflammatory disease.
oral contraceptives containing gestodene
Low dose preparations (containing or desogestrel should not be used by
ethinyloestradiol 20 micrograms) are women with risk factors for venous
particularly appropriate for obese or
thromboembolism including obesity
older women provided a combined oral (body mass index greater than 30 kg/
contraceptive is otherwise suitable. It is m2), varicose veins or a previous history
recommended that the combined oral
of thrombosis from any cause.
contraceptive is not continued beyond 50 Combined oral contraceptives containing
years of age since there are more desogestrel or gestodene should only be
suitable alternatives. Switching from low
used by women who are intolerant of
dose to high dose pill or from high dose other combined oral contraceptives and
to low dose pill does not cause any are prepared to accept an increased risk
major problem.They are particularly
of thromboembolism. Any personal
appropriate for obese or older history of venous or arterial thrombosis
women.The latest 4th generation OCP is a contraindication to any combined
contains ethinyloestradiol 0.030 mg. and
oral contraceptive.
4th generation progesterone MISSED PILL: The following advice is
Drospirenone 3 mg. now recommended by family planning
Standard dose preparations (contain-
directorate: 'If you forget one pill, take it
ingethinyloestradiol 30 or 35 microgr- as soon as you remember and the next
ams) are appropriate for standard use in one at normal time, so that 2 pills are to
the case of those also containing
be taken on that particular day. If you
levonorgestrel or norethisterone (but in forget two pills, take 2 pills as soon as
244
you remember, take another 2 pills on oversight), and a patient admitted for an
the next day. Take one pill daily and use elective procedure is still on an
condom, till you finish rest of the pills. oestrogen containing oral contraceptive,
When the pills are finished and some consideration should be given to
menstruation starts, start a new packet. subcutaneous heparin prophylaxis
If you forget three pills, pills will no more against thromboembolism. These
work; stop pills and use condom. recommendation do not apply to minor
Probably menstruation will start; start the surgery with short duration of
next packet at the first day of menses. anaesthesia, e.g. laparoscopic
DIARRHOEA AND VOMITING: Vomiting sterilization or tooth extraction or to
and severe diarrhoea can interfere with women taking oestrogen free hormonal
absorption and limit the effectiveness. contraceptives (whether by mouth or by
Additional precautions (use condom) injection).
should therefore be used during and for Combined oral contraceptives should be
7 days after recovery. If vomiting and stoppedif any of the following occur:
diarrhoea occurs during the last 7
tablets, the next pill-free interval should • Sudden severe chest pain (whether
be omitted; in the case of Every Day or not radiating to the left arm);
(ED) pills, the inactive ones should be • Sudden breathlessness (or cough
omitted. with blood stained sputum);
Some broad-spectrum antibiotics (e.g. • Severe stomach pain;
ampicillin) may reduce the efficacy of • Hepatitis, jaundice, generalized
combined oral contraceptives by itching, liver enlargement;
impairing the bacterial flora responsible • Severe depression;
for recycling of ethinyloestradiol form the • Blood pressure above systolic 160
large bowel. Additional contraceptive mmHg and diastolic 95 mm Hg;
precautions should be taken whilst • Detection of a risk factor-see
taking a short course of a broad- Cautions and Contraindications
spectrum antibiotic and for 7 days after under Combined Oral
stopping. If these 7 days run beyond the Contraceptives.
end of a packet the next packet should
be started immediately without a break
(in the case of ED pills, the inactive ones COMBINED ORAL
should be omitted). If the course CONTRACEPTIVES(COC) [ED]
exceeds 2 weeks, the bacterial flora (See section 5.4.2.2, Progesterone)
develops antibiotic resistance and addi-
tional precautions become unnecessary. Indications: Contraception; menstrual
Interactions: See also Appendix-2 symptoms.
SURGERY: Oestrogen containing oral Contraindications : Pregnancy; severe
contraceptives should be discontinued or multiple risk factors for arterial
(and adequate alternative contraceptive disease (see above); risk factors for
arrangements made) 4 weeks before venous thromboembolism (see above);
major elective surgery (requiring at least valvular heart disease associated with
one week of bed rest) and all surgery to pulmonary hypertension or risk of mural
the legs. They should normally be thrombi, ischaemic heart disease;
recommended at the first menses transient cerebral ischaemic attacks
occurring at least 2 weeks after full without headaches; migraine; liver
mobilization. A depot injection of a diseases including disorders of hepatic
progestogen only contraceptive may be excretion (e.g. Dubin-Johnson or Rotor
given, if required, until the oestrogen syndromes), infective hepatitis (until liver
containing contraceptive can be function returns to normal); systemic
reinstated. When discontinuation of an lupus erythematosus; porphyria (section
oestrogen containing contraceptive is not 9.8.2); liver adenoma, gallstones; after
possible (e.g. after trauma or if by evacuation of hydatidiform mole (until
return to normal of urine and plasma
245
gonadotrophin concentration); history of aura persist for more than 1 hour, see
haemolyticuraemic syndrome or history also notes above)
of pruritus or cholestatic jaundice during Side effects: Nausea, vomiting,
pregnancy, pemphigoidgestationis, headache, breast tenderness, changes
chorea or deterioration of otosclerosis, in body weight, fluid retention,
breast or gastrointestinal tract thrombosis (more common when factor
carcinoma; undiagnosed vaginal V present or in blood groups A, B and
bleeding; breast feeding (until weaning AB) (see notes above); changes in
or for 6 months after birth) libido, depression, chorea, skin
Interactions:See above and also reactions, chloasma, hypertension,
Appendix-2 (contraceptives, oral) contact lenses may irritate impairment of
Cautions: Risk factors for venous liver function, hepatic tumours, reduced
thromboembolism, arterial disease and menstrual loss, spotting in early cycles
migraine, see below and also notes absence of withdrawal bleeding rarely
above; hyperprolactinaemia (seek speci- photosensitivity.
alist advice); severe depression, BREAST CANCER: There is a small
sicklecell disease, inflammatory bowel increase in the risk of having breast
disease including Crohn's disease. cancer diagnosed in women taking the
RISK FACTORS FOR VENOUS combined oral contraceptive pills; this
THROMBOEMBOLISM: Use with relative risk may wholly or partly be due
caution if any of following factors to earlier diagnosis. In users of
present: Family history of venous combined oral contraceptive pills, the
thromboembolism in first degree relative cancers are more likely to be localized to
aged under 45 years (avoid if the breast. The most important risk
prothrombotic coagulation abnormality factors appears to be the age at which
e.g. factor V Leiden or antiphospholipid the contraceptive is stopped rather than
antibodies (including lupus the duration of use; the risk disappears
anticoagulant); obesity (avoid if body gradually during the 10 years after
mass index exceeds 39 kg/m 2; Long- stopping and there is no excess risk by
term immobilization e.g. in a wheelchair 10 years. A small increase in the risk of
(avoid if confined to bed or leg in plaster breast cancer should be weighed against
cast); varicose veins, avoid during the benefits and evidence of the
sclerosing treatment or where definite protective effect against cancers of the
history of thrombosis exists. ovary and endometrium.
RISK FACTORS FOR ARTERIAL Dose:By mouth every day combined
DISEASE: Use with caution if any one of (mono-phasic) preparations (28-tablets
following factors present but avoid if two packet; each tablet should be taken at
or more factors present; family history of approximately same time each day; if
arterial disease in first degree relative delayed by longer than 12 hours
aged under 45 years (avoid if contraceptive protection may be lost.
atherogenic lipid profile); diabetes Always start with the first tablet, follow
mellitus (avoid if diabetes complication the arrow/finger and swallow from the
present); hypertension (avoid if blood first tablet 21 tablets in 21 days. After
pressure is above systolic 160 mmHg finishing the white tablets similarly take
and diastolic 95 mm/Hg); smoking (avoid one brown tablet a day for the next 7
if smoking 40 or more cigarettes daily); days. Irrespective of starting of
age over 35 years (avoid if over 50 menstrual bleeding, after finishing the 7
years); obesity (avoid if body mass index brown tablets, start taking the first white
exceeds 39 kg/m2 ); migraine, subject tablet from a new packet
should report any increase in headache Pills showed should be swallowed with
frequency or onset of focal symptoms water, take tablet same time each day.
(discontinue immediately and refer Best time is after meal at night or at bed
urgently to neurology expert if focal time. If for any reason husband is out of
neurological symptoms not typical of home for few days pills have to be
246
continued. After starting taking pills clients decides on using oral

some clients may experience minor side contraceptive pills, give proper
effects (e.g. nausea, spotting) but information on how OCP acts;
nothing to be worried. It corrects itself advantage and disadvantage; probable
after 3-4 months of continuing taking side effects (nausea vomiting; headache;
pills. If these are matter of inter-menstrual bleeding). If a woman is
concern/anxiety client should contact nervous she may stop taking pills
family planning clinics. Pills should be management. Inform on common side
kept in dry place and out reach of the effects, how to take pills and what to do
children. During each follow up visit for missing pill; danger signs and for
clients should bring the rest of the pills. follow up visits. Resupply should be
During taking any other health related ensured before the pervious supply is
services a client should always mention finished. In follow-up visits clients should
that she is taking oral contraceptive pills. be asked about proper use of OCP,
21-day combined (monophasic) prepar- problems encountered in taking the pills,
ations (21 tablets packet); 1 tablet daily detection of side effects, and treatment.
for 21 days; subsequent course repeated Encourage using of condom in case of
after a 7-day interval (during which missing pill and stoppage of use of OCP
withdrawal bleeding occurs). First course due to side effect.
usually started on 1st day of cycle; if Note:Under the national family planning
starting on 4th day of cycle or later, program, the Govt. is supplying in the
additional precautions (barrier methods) brand name of Shukhithe standard
necessary during first 7 days. preparation of oral contraceptive.
Biphasic and triphasic preparations: Shukhi White tablets levonorgestrel 150
As instructed under individual micrograms, ethinyloestradiol 30
preparations. microgram; brown tablets, ferrous
CHANGING FROM PROGESTOGEN- fumerate 75 mg; Govt. supply. Dose: 1
ONLY TABLET: Start on first day of white tablet (active) daily from 1st day of
menstruation, or any day if amenorrhoea menstruation for 21 days followed by 7
is present and pregnancy has been brown (inactive) tablets; withdrawal
excluded. bleeding usually occurs during taking of
SECONDARY AMENORRHOEA the brown tablets; brown tablets to be
(exclude pregnancy): Start any day, continued during bleeding; the 1st white
additional precautions (barrier methods) tablet from the next packet should be
necessary during first 7 days. started from the next day after finishing
AFTER CHILDBIRTH (not breast- the brown tablets irrespective of
feeding): Start 3 weeks of postpartum occurrence of withdrawal bleeding.
(increased risk of thrombosis if started
earlier): later than 3 weeks of postpartum Proprietary Preparations
additional precautions (barrier methods) Levonorgestrel 0.15mg + Ethinyl
are necessary for first 7 days. Not estradiol0.03mg
Levopil(Popular), Tab.Tk. 1.36/Tab.
recommended if woman is breast- Lyta 28 Pill(Incepta), Tab.Tk. 0.84/Tab.
feeding (oral progestogen only Mini 28(ACI), Tab. Tk. 1.00/Tab.
contraceptive is to be given). Nordette(I)(Pfizer) Tab. Tk.
AFTER ABORTION OR MISCARRIAGE Ovorest(Renata) Tab. Tk. 1.00/Tab.
OR MENSTRUAL REGULATION (MR):
Start on the same day. Dose: as Shukhi above
COUNSELING: Clients must be
Ethinylestradiol0.03mg + Norgestrel0.30mg
counseled before giving oral Conrena-R(Renata) Tk. 1.20/Tab
contraceptive pills (OCP). The subject of Norpil(Popular), Tab. Tk. 1.368/Tab.
discussion should include all other
available methods of contraception, Desogestrel 0.15mg + Ethinylestradiol 0.03mg
previous experience, superstitions and Ceptiva(ACI), Tab., TK. 5.00/Tab.
actual information's on OCP. If the Desolon(Renata), Tab. ,Tk. 5.00/Tab.
Marvelon(Nuvista), Tab.Tk. 5.00/Tab
247
Noret(Popular), Tab. Tk. 1.36/Tab but is reduced by enzyme inducing drugs

(see Appendix-2). All progestogen only
Dose: 1 tab daily from 1st day of menstruation contraceptives (including those given by
for 21 days followed by 7 days tab-free interval
(during which withdrawal bleeding occurs).
injection) are suitable for use as an
alternative to combined oral
Desogestrel 0.15mg + Ethinylestradiol 0.02mg contraceptives before major elective
Microlon(Nuvista)Tab.Tk.4.30 surgery.
Gestodene 0.30mg & Ethinylestradiol0.075mg STARTING ROUTINE: 1 tablet daily on
Gestop(Incepta),Tab.,Tk.3.56/Tab a continuous basis, starting on 1st day of
cycle and taken at the same time each
Other Proprietary Preparations
High Dose Pills
day (if delayed by longer than 3 hours
Lynestrenol 2.5 mg with Ethinyloestradiol 50 contraceptives protection may be lost).
micrograms Additional contraceptive precautions are
Lynes(Nuvista), Tab; Tk. 5.91/Tab. not necessary when initiating treatment.
Regumen(Reneta) Tab; Tk. 4.77/Tab. Changing from a combined oral
contraceptive: start on the day following
Dose: 1 tab daily from 1st day of menstruation completion of the combined oral
for 22 days followed by 6 tab-free days (during
which withdrawal bleeding occurs).
contraceptive course without a break (or
in the case of ED tablets omitting the
OvostatGold(Nuvista), Tab.Ethinyloestradiol inactive ones). After childbirth: start any
0.0375mg +Lynestrenol 0.75mg.Tk. 3.19/Tab time after 3 weeks postpartum
(increased risk of breakthrough bleeding
Drospirenone 3mg + Ethinylestradiol 0.03mg if started earlier); lactation is not
Novelon(Renata), Tab. Tk. 19.00/Tab. affected.
Rosen(Incepta), Tab., Tk. 14.25/Tab.
ADVICE ON MISSED PILL: If a pill is
forgotten, take it as soon you remember
6.3.2 PROGESTOGEN-ONLY and carry on with the next pill at the right
CONTRACEPTIVES time. If the pill was more than three
6.3.2.1 ORAL PROGESTOGEN- hours overdue you are not protected.
ONLY CONTRACEPTIVES Continue normal pill taking but you must
6.3.2.2 PARENTERAL also use another method, such as the
PROGESTOGEN-ONLY condom, for the next 7 days.
CONTRACEPTIVES
6.3.2.1 ORAL PROGESTOGEN ORAL PROGESTOGEN-ONLY
ONLY CONTRACEPTIVES CONTRTACEPTIVES
(Progestogen-only pill, 'POP')
Oral progestogen,are the only
preparations offer a suitable alternative Indications:Contraception; for use in
when oestrogens are contraindicated Emergency Contraception, see section
(including patients with venous 6.3.5
thrombosis or a past history or Cautions: Heart disease, sex-steroid
predisposition to venous thrombosis), dependent cancer, past ectopic
but have a higher failure rate than pregnancy, malabsorption syndromes,
combined preparations. These are functional ovarian cysts, active liver
suitable for older women, for heavy disease, recurrent cholestatic jaundice,
smokers and for those with history of jaundice in pregnancy,
hypertension, valvular heart disease, uncontrolled diabetes mellitus. Advised
diabetes mellitus and migraine. caution in patients with history of
Menstrual irregularities (oligomeno- thromboembolism, hypertension,
rrhoea, menorrhagia) are more common diabetes and migraine
but tend to resolve on long-term Contraindications: Pregnancy, undiag-
treatment. Effectiveness of oral nosed vaginal bleeding; severe arterial
progestogen-only preparations is not disease; live adenoma, porphyria; after
affected by broad spectrum antibiotics
248
evacuation of hydatid form mole (until Medroxy-progesterone acetate in the

return to normal urine and plasma immediate puerperium (the first dose is
gonadotrophin values), lump in breast or best delay-ed until 5 to 6 weeks
breast cancer. postpartum). If the woman is breast-
Interactions: See Appendix-2 feeding, the first injection may be given
Side-effects: Menstrual irregularities; within 5 days postpartum (she should be
nausea, vomiting, headache, dizziness, warned that the risk of heavy or
breast discomfort, depression, skin diso- prolonged bleeding may be increased).
rders, disturbance of appetite, weight Reduction in bone mineral density has
changes, changes in libido. Vomiting and also been reported.
severe diarrhoea can interfere with Norethisteroneenanthateis a long-
absorption and limit effectiveness; acting progestogen given as an oily
additional precautions should be used injection, which provides contraception
during and for 7 days after recovery. for 8 weeks to provide short-term interim
contraception e.g. before vasectomy
Proprietary Preparations becomes effective.
Desogestrel The cautions and contra-indications of
Bredicon(Renata), Tab. , 75 microgram, Tk. the oral progestogen only contraceptives
2.15/Tab
Pop-D(Incepta), Tab. , 75 microgram, Tk.
apply except that since the injection also
2.15/Tab. inhibits ovulation, it protects against
ectopic pregnancy and functional ovarian
Levonoregestrel cysts. Clients who have PID or are high
Emcon 1(Renata), Tab. ,1.5mg, Tk. 70/Tab. risk for PID and cannot take IUD are
Emcon(Renata), Tab., 75 mcg, Tk. 65/Tab. suitable candidates for receiving
E-plan(ACI), Tab., 75mcg,, Tk. 22.50/Tab. ; parenteral progestogen only contracep-
E-PlanMax(ACI),.1.5mg, Tk. 70/Tab.
I-PilMax(Popular), Tab., 1.50mg , Tk. 70/Tab.
tives; these can also be used for
I-Pil(Popular),Tab., 75mcg, Tk. 22.50/Tab. endometriosis (monthly injections).
Norpill(Square), Tab.,75 mcg, Tk. 22.57/Tab. Levonorgestrel-releasing implant
Norpill1(Square), Tab. , 1.5 mg, Tk. 70/Tab. system is also available. Its efficacy is
Setfree(Nuvista), Tab. ,1.5 mg, Tk. 65/Tab comparable to that of injected
Medroxyprogesterone acetate but
Medroxyprogesterone lasts for 5 years. The cautions and
Medogen(Incepta), Tab. , 10 mg , Tk.
10.00/Tab. ; 5 mg , Tk. 5.38/Tab.
contraindica-tions are again as for oral
Medora(Nuvista), Tab., 5 mg, Tk. 4.78/Tab.; preparations, but irregular and prolonged
10 mg, Tk. 8.89/Tab. bleeding and amenorrhoea are common;
Medrina(Beacon), Tab., 5mg , Tk. 4.70/Tab. unlike the injectable preparations the
Medrogest(Renata), Tab., 5 mg, Tk. method is almost immediately reversible
5.38/Tab. ; 10 mg , Tk. 10.00/Tab. on removal of the implants. The risk of
Medroxy(Popular), Tab. , 10mg , Tk. ectopic pregnancy is believed to be
10.07/Tab. ;
Movera(ACI), Tab., 10mg, Tk. 0.03/Tab. ;
reduced overall but the proportion of
5mg, Tk. 5.40/Tab. ectopic to intrauterine pregnancies is
Perlutex(I)(Leo)Tab 5 mg. Tk. 8.53/Tab increased among the very few
Provenor(Eskayef), Tab., 10mg , Tk. pregnancies that do occur; since
10.00/Tab.; 5 mg, Tk. 5.00/Tab.; functional ovarian cysts may also be
more common they need to be
6.3.2.2 PARENTERAL distinguished from ectopic pregnancy.
PROGESTOGEN-ONLY Health personnel administering (or
CONTRACEPTIVES removing) the system should be fully
trained in the technique and should
Delayed return of fertility and irregular provide full counseling backed by the
cycles may occur after discontinuation of manufacturer's approved leaflet.
treatment but there is no evidence of
permanent infertility. Heavy bleeding has
been reported in patients given
249
PARENTERAL PROGESTOGEN-ONLY 6.3.2.3 INTRAUTERINE

CONTRACEPTIVES PROGESTOGEN-ONLY
CONTRACEPTIVE
MEDROXYPROGESTERONE
ACETATE Levonorgestrel is released directly in
to the uterine cavity from an
Indications: Contraception for women intrauterine system. Effects are
who have at least one living child; therefore mainly local and hormonal
endometriosis; see also notes above and including prevention of proliferation of
under preparations. the endometrium, thickening of
Cautions; Contraindications; Side- cervical mucus, and suppression of
effects: See notes above and under ovulation in some women (in some
preparations. cycles): the physical presence of the
Interactions: Effectiveness is not system in the uterus may also make a
affected by broad-spectrum antibiotics minor contribution to the overall
but may be reduced by enzyme including contraceptive effect. Return of fertility
drugs; the interval between injections of after removal is rapid and appears to
medroxyprogesterone acetate should be be complete. Advantages over copper
reduced from 12 weeks to 10 weeks; see intra-uterine devices are that there
Appendix-2 (progestogens) may be an improvement in any
Dose: By deep intramuscular injection, dysmenorrhoea and a reduction in
150 mg within first 5 days of cycle or blood loss; there is also evidence that
within first 5 days after parturition (delay the frequency of pelvic inflammatory
until 6 weeks after parturition if breast- disease may be reduced (particularly
feeding); for long-term contraception, in the youngest age groups who are
repeated every 12 weeks (if interval most at risk).
greater than 12 weeks and 5 days, Cautions and contraindications are
exclude pregnancy before next injection as for standard intra-uterine devices
and advise patient to use additional (section 6.3.4) but the risk of ectopic
contraceptive measures (e.g. barrier) for pregnancy is considerably reduced
14 days after the injection). It should be and pre-existing heavy menses and
started immediately after abortion or MR. anaemia may be alleviated. Moreover,
To be started immediately after stopping since the progestogen is released
other contraceptive methods. During close to the site of the main
Ramadan, Muslim ladies will not take contraceptive action (on cervical
injection during daytime, so the injection mucus and endometrium) progesto-
can be given 14 days earlier/later or at genic side-effects and interactions are
night. During rainy season or flood doses less likely to be a problem in particular,
of injections can be given 14 days enzyme inducing drugs are unlikely to
earlier/later. have much influence on the
Note: Injection (aqueous suspension), contraceptive effect. Initially changes
medroxyprogesterone acetate 150mg/ml in the pattern and duration of
available free ofchange under the menstrual bleeding (spotting or
national family planning program. prolonged bleeding) are common and
full counseling should be undertaken
Proprietary Preparations before insertion. Improvement usually
Depoprovera(I)(Pharmasia)Inj., 150 mg/ml, Tk. occurs a few months after insertion
279.05/vial. and bleeding may often become
Medogen(Incepta), Inj., 150 mg/ml, Tk. scanty or absent; this may therefore be
38.00/vial. a method of choice for women who
Medroxy(Popular), Inj., 150 mg/ml, Tk.
have excessively heavy menses.
38.00/Vial
Provera(Techno), Inj., 150 mg/ml, Tk. Functional ovarian cysts (usually
43.40/Vial asymptomatic) may occur and usually
250
resolve spontaneously (ultrasound and the woman wishes to continue to

monitoring recommended). full-term, the device should be removed
Indication: Contraception in the first trimester if possible.
Cautions; Contra-indications; Side-
effects: See notes above; avoid in INTRA-UTERINE CONTRACEPTIVE
severe liver impairment. Insert into DEVICES (IUDs)
uterine cavity within 7 days of onset of
menstruation (any time if replacement) Indications: Contraception; secondary
or immediately after first-trimester amenorrhoea due to Asherman's
termination by curettage; post-partum syndrome; see notes above
insertions should be delayed until 6 Cautions:Anaemia, heavy menses,
weeks after delivery; effective for 5 years endometriosis, severe primary
Interactions: See notes above and dysmenorrhea, history of pelvic
Appendix-2 inflammatory disease, history of ectopic
pregnancy or tubal surgery, diabetes,
6.3.3 SPERMICIDAL fertility problems, nullparity and young
CONTRACEPTIVES age, severely scarred uterus (including
after endometrial resection) or severe
Spermicidal contraceptives based on cervical stenosis, valvular heart disease
nonoxinol (Delfen, double Check, (antibiotic cover needed), avoid if
Duragel, etc.) are useful additional prosthetic valve or past attack of
safeguards but do not give adequate infective endocarditis; HIV infection or
protection if used alone; they are immunosuppressive therapy (avoid if
suitable for use with barrier methods. immunosuppression); joint and other
However, no such drug preparation is prostheses; epilepsy; increased risk of
registered in Bangladesh. expulsion if inserted before uterine
involution ; anti coagulant therapy (avoid
6.3.4 CONTRACEPTIVE DEVICES if possible); remove if pregnancy occurs
(if pregnancy occurs, increased
INTRA-UTERINE DEVICES likelihood that it may be ectopic).
The intra-uterine device (IUD) is suitable Gynecology examination advised before
for older parous women but should be a insertion, 6 weeks after (or sooner if
last-resort contraceptive for young there is a problem), then after 6 months
nulliparous women because of the and then yearly.
increased risk of pelvic inflammatory Contraindications : Pregnancy, severe
disease and infertility. In recent times, anemia, recent sexually transmitted
smaller devices have been introduced to infection (if not fully investigated and
minimise side-effects; these consist of a treated), unexplained uterine/vaginal
plastic carrier wound with copper wire or bleeding, distorted or small uterine
fitted with copper bands; some also have cavity, genital malignancy, trophoblastic
a central core of silver to prevent disease, pelvic inflammatory disease,
fragmentation of the copper. Family chronic cervicitis, erosion, polyp; history
planning services now recommend that of vaginal discharge and ectopic
the replacement time for these devices pregnancy; established or marked
should be 5 years. IUDs are also useful immunosuppression; copper devices:
for emergency contraception (see copper allergy, Wilson's disease,
section 6.3.5). medical diathermy
An intra-uterine device should not be Side effects: Uterine or cervical
removed in midcycle unless an perforation, displacement, pelvic
additional contraceptive was used for the infection may be exacerbated, heavy
previous 7 days. If removal is essential menses, dysmenorrhea, allergy on
(e.g. to treat severe pelvic infection), insertion: some pain (helped by giving
post-coital contraception should be Buprofen 30 minutes before insertion);
considered. If an intrauterine device fails
251
and bleeding; occasionally epileptic transmitted diseases (STDs), ensures

seizure, vasovagal attack. male participation in contraception, are
COUNSELING: Inform the patient about safe, easily available and inexpensive
all available contraceptive methods in a and almost devoid of any side-effect.
friendly environment. IUD is a suitable Additional advantages include
method of contraceptive for couple with prevention of premature ejaculation and
one or more children and who want over-coming of dryness during
contraceptive measures for longer time. intercourse; prevention of STDs and
If a client chooses IUD as her Reproductive Tract Infections (RTIs). It
contraceptive method she should be also prevents anti sperm antibody
informed on what can happen during and formation.
after its insertion; she should be also Contraindication: Practically nil; only
informed about the side-effects, and that medical contraindication is allergy to
though there are some side-effects, the latex which is very rare (recommend
method suits most women who fulfill non-latex condom in that case)
selection criteria. Use a checklist during INSTRUCTIONS FOR USE: Put the
counseling and take feedback. Provide a condom on the erect penis before penis
card to the client with her name, date of touches the vagina. Hold the pack at its
insertion, date of removal and date of edge and open by tearing from a ribbed
follow up. Clients should be shown how edge. Hold the condom so that the rolled
to feel the thread and asked to feel it. rim is facing up, away from the penis.
She should also be informed about Pull the foreskin back if the penis is
danger signs and return of fertility after uncircumcised. Place the condom on the
removal of IUD tip of the penis and unroll it all the way to
CuT 380. Intrauterine device, copper the base of the penis. The condom
wire surface area 320 mm 2 wound on should unroll easily; if it does not, it is
vertical stem of T-shaped plastic carrier probably placed backwards; turn it over
(impregnated with radio opaque and try again. If using the condom to
substance), plastic thread attached to avoid passing an STD, throw away the
base of vertical stem and copper collar condom that was on backwards and start
surface 30 mm 2 on distal portions of over with a new one.
each arm; replacement time 5 years. It is Any lubricant used should be water
available free of charge in family based. Water can also be used. Good
planning clinics (Green Umbrella) under lubricants include spermicides, glycerine
the national family planning program. and other specially made products. They
CuT 200B, Intrauterine device, copper help keep condoms from tearing during
wire surface area 200 mm 2 wound on intercourse. Natural vaginal secretions
vertical stem of T-shaped plastic carrier also act as a lubricant. Do not use
(impregnated with radio opaque lubricants made with oil because most
substance), plastic thread attached to oils damage condoms. Never use
base of vertical stem; replacement time cooking oil, baby oil, coconut oil, hair oil,
3 years. Available free of charge in mineral oil, petroleum jelly, vaseline, skin
family planning clinics (Green Umbrella) lotions, suntan lotions, cold cream,
under the national family planning butter, cocoa butter or margarine.
program. After ejaculation, hold the rim of the
condom to the base of the penis so that
BARRIER METHODS it does not slip off. It is advisable that the
penis be withdrawn out of the vagina
before completely losing its erection.
CONDOMS[ED]
Take off the condom without spilling
A condom is a sheath or covering made semen on the vaginal opening. Throw
to fit over a man's erect penis usually the condom into a pit latrine, bury it, burn
made of thin latex rubber. Condoms help it or dispose of it in some other way; do
prevent both pregnancy and sexually not leave it where children can find it and
252
play with it. Do not use a condom more effective if taken within 120 hours (5
than once. If a condom breaks while it is days) of unprotected intercourse.
being used: immediately insert a Levonorgestrel is less effective than
spermicide into the vagina, if a insertion of an intra-uterine device (see
spermicide is available. Washing both below). Ulipristal is as effective as
penis and vagina with soap and water levonorgestrel, but its efficacy compared
may reduce the risk of STDs and to an intrauterine device is not yet
pregnancy to some extent. Some client known.
may want to use emergency oral If vomiting occurs within 2 hours of
contraception to prevent pregnancy (see taking levonorgestrel or within 3 hours of
below). taking ulipristal, a replacement dose
Various brands of condoms are available should be given.
in the market. Raja, Panther and Side-effects of hormonal methods
Sensation are some of the popular include nausea, vomiting, headache,
brands which are available both in family dizziness, breast discomfort and
planning clinics and also in most menstrual irregularities.
pharmacies. IUD METHOD. Insertion of an IUD is
Proprietary Preparation more effective emergency contraceptive
Pengun(I)(Unidus),Tk.3.03 method than the hormonal method.
Copper based IUDs may be appropriate
6.3.5 EMERGENCY for some women who meet the strict
CONTRACEPTIVES screening requirements for IUD use and
who wish to retain the IUD for long-term
Emergency contraception refers to contraception. Inserted within five days
contraceptive methods that can be used (120 hours) of unprotected intercourse,
by women in the first few days following IUDs provide a highly effective method
unprotected intercourse to prevent an of emergency contraception.
unwanted pregnancy. The hormonal
(Yuzpe) method is suitable for ULIPRISTAL ACETATE
emergency use (2% failure) but it is less (See section 6.3.5)
effective than insertion of an intra-uterine Indications: Emergency contraception;
device (1% failure). Emergency uterine fibroids
contraception is indicated to prevent
pregnancy within 3 days (72 hours) of Proprietary Preparations
unprotected sexual intercourse or a Ulipristal Acetate
contraceptive accident or misuse (e.g. 5x(Renata), Tab., 30mg, Tk. 200/Tab.
condom rupture, slippage, or misuse; Fibropress(Beximco), Tab., 5mg, Tk. 55/Tab.
Peuli(Ziska), Tab., 30 mg, Tk.195/Tab.
failed coitus interruptus; IUD expulsion; Preroid(Renata), Tab., 5mg, Tk. 40/Tab.
in cases of sexual assault, etc.). Tulip(Square), Tab., 30 mg, Tk. 280/Tab.
Emergency contraception is not suitable Ulicon(Eskayef), Tab., 30mg, Tk. 195/Tab.
as a regular method of contraception. Uliroid(Ziska), Tab., 5 mg, Tk. 40/Tab.
HORMONAL METHOD. Utal(Square), Tab., 5 mg, Tk. 54.50/Tab.
Hormonal emergency contraceptives
include Levonorgestrel and Ulipristal; 6.4 DRUGS FOR GENITO-
either drug should be taken as soon as URINARY DISORDERS
possible after unprotected intercourse to 6.4.1 DRUGS FOR URINARY
increase efficacy. RETENTION
Levonorgestrel is effective if taken within 6.4.2 DRUGS FOR URINARY
72 hours (3 days) of unprotected INCONTINENCE AND
intercourse and may also be used NOCTURNAL ENURESIS
between 72 and 96 hours after 6.4.3 DRUGS USED IN UROLOGICAL
unprotected intercourse , but efficacy PAIN
decreases with time. Ulipristal, a 6.4.4 DRUG FOR ERECTILE
progesterone receptor modulator, is DYSFUNCTION
253
6.4.5 ALKALINISATION AND specialist supervision (as do those with

ACIDIFICATION OF URINE cardiac disorders). Selective alpha-
blockers may cause drowsiness and so
For individual drugs used in the affect ability to drive or operate
treatment of urinary tract infection, see machinery. For interactions, see
section 1.1 Appendix-2 (alpha-blockers).
Note:FIRST DOSE EFFECT: First dose
6.4.1 DRUGS FOR URINARY may cause collapse due to hypotensive
RETENTION effect (therefore should be taken on
retiring to bed). Patient should be
warned to lie down if symptoms such as
Acute retention is painful and is treated
dizziness, fatigue or sweating develop
by catheterisation. Chronic retention is
and to remain lying down until they pass
painless and often long standing;
off completely
catheterisation is not needed unless
there is deterioration of renal function.
After the cause has initially been ALFUZOSIN
established and treated, drugs may be
required to increase detrusor muscle Indications, Cautions, Contra-
tone. Benign prostatic hyperplasia is indications &Side-effects: See notes
treated either surgically or medically with above;
alpha-blockers (see below) or with the Dose:Benign prostatic hyperplasia 10
anti-androgenFinasteride(section mg once daily.Acute urinary retention
12.8.2). associated with benign prostatic
hyperplasia in men over 65 years, 10 mg
ALPHA-BLOCKERS once daily for 2–3 days during
catheterisation and for one day after
(See also section 3.2.3)
removal; max. 4 days
The selective alpha-blockers Alfuzosin, Proprietary Preparations
Doxazosin, Indoramin, Prazosin, Alfasin(Incepta)Tab, 10 mg, Tk. 10/Tab.
Tamsulosin and Terazosin relax Alfumax(UniMed), Tab, 10 mg, Tk. 10/Tab.
smooth muscle in benign prostatic Uriten(Square), Tab., 10 mg, Tk. 10.07/Tab.
hyperplasia producing an increase in Zatral(Eskayef), Tab., 10 mg, Tk.10.00/Tab.
urinary flow rate and an improvement in
obstructive symptoms. Side-effects of PRAZOSIN HYDROCHLORIDE
selective alpha blockers include
sedation, dizziness and hypotension Indications:Benign prostatic
(notably postural hypotension particularly hyperplasia; see notes above;
after the first dose); other side-effects hypertension; also see section 3.2.3
associated with this group of drugs Cautions, Contraindications & Side-
include drowsiness, weakness and lack effects:See notes above and also
of energy, depression, headache, dry section 3.2.3
mouth, nausea, urinary frequency and Dose : Initially 500 micrograms twice
incontinence, tachycardia and daily for 3-7 days, subsequently adjusted
palpitations. They should be avoided in according to response; usual
patients with a history of orthostatic maintenance (and maximum) 2 mg twice
hypotension and micturition syncope; daily. ELDERLY: initiate with lowest
special care (and reduced dosage) is possible dose.
needed when initiating them in the
elderly and in renal and possibly hepatic Proprietary Preparations
impairment. Since selective alpha- Alphapress(Renata), Tab, 1mg, Tk.
blockers are also anti-hypertensive, 4.00/Tab., 2mg, Tk. 6.00/Tab.
patients receiving antihypotensive Prazolok(Square), Tab. , 1mg , Tk. 4.00/Tab.;
2 mg, Tk.6.00/Tab.
treatment require reduced dosage and
254
Prazopress(UniMed), 2mg, Tk. 6.00/Tab.; Eziflo(Biopharma), Cap.,Tk. 20.00/Cap.

1mg, Tk. 4.00/Tab. XRTab , 2.5mg, Tk. Maxrin(Square), Cap.,Tk. 20.00/Cap.
10.00/Tab.; 5mg, Tk. 15.00/Tab., Prostacin-D(Incepta), Cap. , Tk. 20.00/Cap.
TamsinD(Delta), Cap., Tk. 20.00/Cap.
Urocap-D(IbnSina), Cap. Tk. 600.00/Cap.
TAMSULOSIN HYDROCHLORIDE
UrolosinD(General), Cap. ,Tk. 20.00/Cap.
Indications:See notes above Uromax-D(UniMed), Tab ,Tk. 20.00/Tab.
Cautions, Contraindications & Side- Uropass(Acme), Cap.,Tk. 20.00/Cap.
effects:See notes above; avoid in TERAZOSIN
severe liver impairment
Dose: 400 micrograms daily after break- Indications; Cautions, Contr-
fast aindications& Side-effects: :See notes
above and also section 3.2.3
Eziflo(Biopharma), Cap., 400 microgram Tk.
Dose: Initially 1 mg at bedtime; dose
10.00/Cap. may be doubled at weekly intervals
Flonor(Novo), Cap., 400 microgram , Tk. according to response to maximum 10
10.00/Cap. mg once daily; usual maintenance 5-10
Maxrin(Square), Cap., 400 microgram, Tk. mg daily
10.07/Cap. FIRST DOSE EFFECT: First dose may
Prostam(Drug Intl), Cap., 400 microgram , Tk. cause collapse due to hypotensive effect
10.05/Cap.
Prostanil(Aristo), MR.Cap., 400 microgram,
(therefore should be taken on retiring to
Tk. 10.00/Cap. bed). Patient should be warned to lie
Protinavit(Incepta), Cap., 400 microgram Tk. down if symptoms such as dizziness,
9.00/Cap fatigue or sweating develop and to
Sasolin(ACI), Cap., 400 microgram , Tk. remain lying down until they pass off
10.07/Cap. completely
Tamfast(Radiant), Cap., 400 microgram, Tk.
10.03/Cap.
Tamisol(Healthcare), MR.Cap., 400 Terazon(Incepta), Tab. 2 mg, Tk. 5.00/Tab.;
microgram, Tk. 10.00/Cap. 5mg, Tk. 8.00/Tab.
Tamlosin(Orion), Tab., 400 microgram, Tk.
10.07/Tab.
Tamosin(Supreme), Cap, 400 microgram, Tk. PARASYMPATHOMIMETICS
10.00/Cap.
Tamsule(Sharif),XR Cap., 400 mcg, Tk. Parasympthomimetics produce the effect
10.03/Cap.
of parasympathetic nerve stimula-tion:
Tamurin(Globe), Cap., 400 microgram, Tk.
10.00/Tab. they possess the muscarinic rather than
Urinom(Opsonin),MR.Cap., 400 microgram, the nicotinic effect of acetylcholine and
Tk. 10.00/Cap., Tab., Tk. 10.04/Tab. improve voiding efficiency by increasing
Urocap(IbnSina), Cap., 400 microgram, Tk. detrusor muscle contraction. In the
10.00/Cap. absence of obstruction to bladder outlet
Uroflo(Beximco), Cap., 400 microgram, Tk. they have a limited role in relieving
10.00/Cap.
urinary retention. Generalisedparasym-
Urolosin(General), Tab., 400 microgram , Tk.
10.07/Tab. pathomimetic side effects such as
Uromax(UniMed), Cap, 400 microgram, Tk. sweating, bradycardia and intestinal colic
10.00/Cap. may occur, particularly in the elderly.
Uropass(Acme), Cap., 400 microgram, Tk. Use of parasympathomimetics is now
10.07/Cap. limited because they do not give clinical
Urosin(Eskayef), Cap, 400 microgram, Tk. benefit to patients as might be expected.
10.00/Cap.,
Their use has largely been replaced by
Urotam(Navana), Cap.400 microgram, Tk.
10.00/Cap. intermittent catheterisation, especially in
cases of areflexia. Carbachol and
TamsulosinHCl400 microgram + Bethanechol are choline esters that
Dutasteride500 microgram, have been used in postoperative urinary
retention. Bethanechol has a more
Combomax(Drug Intl),Cap., Tk. 15.05/Cap. selective action on the bladder than
255
carbachol but the use of both has now enuresis; particular care is needed to
been superseded by catherterisation. avoid fluid overload and treatment
Distigmine inhibits the breakdown of should not be continued for longer than 3
acetylcholine. It may help patients with months without stopping for a week for
an upper motor neuron neurogenic full reassessment. Tricyclic antidepre-
bladder. No drug preparation containing ssants(see section 7.3) such as
carbachol, bethanechol or distigmine is amitriptyline, imipramine, and less often
presently registered in Bangladesh. nortriptyline, are also used but behavior
disturbances may occur and relapse is
6.4.2 DRUGS FOR URINARY common after withdrawal. Treatment
INCONTINENCE AND should not normally exceed 3 months
NOCTURNAL ENURESIS unless a full physical examination
(including ECG) is given and the child is
URINARY INCONTINENCE: fully reassessed; toxicity following over
Antimuscarinic drugs such as dosage with tricyclics is of particular
Oxybutynin and Flavoxate are used to concern.
treat urinary frequency; they increase Darifenacin, Fesoterodine, Propive-
bladder capacity by diminishing unstable rine,Solifenacin, and Trospium are
detrusor contractions. The dosage needs newer anti-muscarinicdrugsindicatedfor
to be carefully assessed, particularly in urinary frequency, urgency,
the elderly. Flavoxate has less marked andincontinence.
side effects but is also less effective. Mirabegron, a selective beta3 agonist,
Tolterodine and Propiverine are also is used for the treatment of urinary
antimuscarinic drugs used for urinary frequency, urgency, and urge
frequency, urgency and incontinence. incontinence associated with overactive
Propantheline was formerly widely used bladder
in urinary incontinence but had a low
response rate with a high incidence of DARIFENACIN
side-effects; it is now primarily indicated
in adult enuresis. The Tricyclic Indications, Cautions, Contra-
antidepressants(see section 7.3) such indications&Side-effect:See notes
as Imipramin, Amitriptyline, and above
Nortriptyline(see section 7.3) are
sometimes effective in the management Proprietary Preparations
of unstable bladder because of their Darilax(Incepta), ER Tab.,15 mg, Tk.
antimuscarinic properties. 40/Tab.;ERTab., 7.5 mg, Tk. 22/Tab.
Darifen(Acme), Tab. , 7.50 mg, Tk. 22.07/Tab.
NOCTURNAL ENURESIS: Nocturnal
enuresis is a normal occurrence in
young children but persists in about 5% FLAVOXATE HYDROCHLORIDE
by 10 years of age. In the absence of
urinary-tract infection simple measures Indications: Urinary frequency and
such as bladder training or the use of an incontinence, dysuria, urgency, bladder
alarm system may be successful. Drug spasm due to catheterization.
therapy not usually appropriate for Cautions, Contraindications: See
children under 7 years of age and should under oxybutynin hydrochloride (antimu-
be reserved for cases when alternative scarinic effect considerably less marked)
measures have failed, and preferably on Side-effects: antimuscarinic side-
a short term basis to cover period away effects; see also notes above.
from home. The possible side effects of Dose: 200 mg 3 times daily; for CHILD
the drugs should be borne in mind when under 12 years, not recommended.
they are prescribed. Desmopressin(see
section 5.3.3), an analogue of Proprietary Preparations
Avox(Opsonin) Tab, 100 mg, Tk. 10.07/Tab.;
vasopressin, is used or nocturnal
200 mg, Tk. 18.13/Tab.
256
Flavox(Somatec), Tab, 100 mg, Tk. Dose: 5 mg 2-3 times daily increased if
10.00/Tab.; 200 mg, Tk. 18.00/Tab. necessary to max. 500 mg 4 times daily.
Urilax(Incepta), Tab. , 100 mg, Tk. 10.00/Tab. ELDERLY, 2.5-3 mg twice daily initially,
increased to 5 mg twice daily according
MIRABEGRON to response and tolerance. CHILD, over
5 years, neurogenic bladder instability,
Indications:See notes above 2.5-3 mg twice daily increased to 5 mg 3
Cautions:History of QT-interval times daily, max. 5 mg 3 times daily;
prolongation; concomitant use with drugs nocturnal enuresis (preferably over 7
that prolong the QT interval years), 2.5-3 mg twice daily increased to
Contraindications: severe hyper- 5 mg 2-3 times daily (last dose before
tension, Hepatic impairment Breast- bedtime)
feeding
Side-effects: Tachycardia, urinary-tract Proprietary Preparation
infection; less commonly dyspepsia, Uricon(Beximco), Tab. 5mg, Tk.6/Tab.
gastritis, palpitation, atrial fibrillation,
hypertension, vulvovaginal infection and PROPANTHELINE BROMIDE
pruritus, joint swelling, rash, pruritus
Dose: ADULT over 18 years, 50mg Indications: Adult enuresis, see notes
once daily above; see also section 2.2.
Cautions; Contraindications:See
Proprietary Preparations under oxybutynin hydrochloride.
Iragon(Drug Intl), Tab., 25mg, Tk. 30.00/Tab.
Mirabeg(General), Tab., 25mg, Tk. 30/Tab.;
Side-effects: Antimuscarinic side-
50mg, Tk,. 55.00/Tab. effects; see also notes above
Miragon(ACI), Tab., 25mg, Tk. 30.00/Tab. Dose: 15-30 mg 2-3 times daily one
Utromeg(UniMed), Tab., 50mg, Tk. 55/Tab.; hour before meals
25mg, Tk. 30.00/Tab.
OXYBUTYNIN HYDROCHLORIDE Proprietary Preparation
See section 2.2
Indications: Urinary frequency, urgency
and incontinence; neurogenic bladder SOLIFENACIN SUCCINATE
instability and nocturnal enuresis
Cautions: Frail elderly; hepatic and Indications: Urinary frequency, urgency
renal impairment; hyperthyroidism; and urgeincontinence
cardiac disease where increase in heart Cautions: See notes above; neurogenic
rate undesirable; prostatic hypertrophy; bladder disorder
hiatus hernia with reflex oesophagitis; Contraindications:See notes
pregnancy, breast feeding; porphyria above;hepaticimpairment;renalimpairme
Contraindications: Intestinal nt;pregnancy:
obstruction or atony; severe ulcerative Side-effects:See notes above; also
colitis or toxic megacolon; significant chest pain, peripheral oedema; sinusitis,
bladder outflow obstruction; glaucoma; bronchitis; paraesthesia
myasthenia gravis
Side-effects: Dry mouth, constipation, Proprietary Preparations
blurred vision, nausea, abdominal Solicare(Acme), Tab., 10 mg, Tk. 30.00/Tab.;
discomfort, facial flushing (more marked 5 mg, Tk. 15.00/Tab.
Solider(Square), Tab., 10 mg, Tk. 30/Tab.; 5
in children), difficulty in micturition (less mg, Tk. 15.00/Tab.
commonly urinary retention), also head- Solifen(Aristo), Tab., 5 mg, Tk. 20.00/Tab.
ache, dizziness, drowsiness, dry skin, Utrobin(UniMed), Tab, 10 mg , Tk. 30/Tab.; 5
rashes, angioedema, photosensitivity, mg, Tk. 15.00/Tab.
diarrhoea, arrhythmia, restlessness,
disorientation, hallucination (children TOLTERODINE TARTRATE
higher risk of excitatory effects); Indications: Urinary frequency, urgency
convulsions and incontinence.
257
Cautions: Significant bladder outflow DAPOXETINE

obstruction; gastro-intestinal obstruction;
hiatus hernia; neuropathy; liver Indications: Premature ejaculation
impairment; renal impairment. Cautions: Bleeding disorders;
Contraindications: Urinary retention, concomitant use of drugs that increase
uncontrolled angle-closure glaucoma; risk of bleeding; epilepsy (avoid if
myasthenia gravis; severe ulcerative uncontrolled, discontinue if convulsions
colitis or toxic megacolon, develop); susceptibility to angle-closure
Side-effects: Dry mouth, dyspepsia, glaucoma;
constipation, abdominal pain, flatulence, Contraindications: Significant cardiac
vomiting, headache; paraesthesia; less disease; history of syncope; history of
commonly blurred vision, chest pain; mania, bipolar disorder, or severe
rarely urinary retention, confusion. depression; discontinue if psychiatric
Dose: 2 mg twice daily; reduce to 1 mg disorder develops,hepatic and severe
twice daily if necessary to minimise side- renal impairment
effects; review after 6 months Side-effects: Nausea, vomiting,
Not recommended forCHILDREN diarrhoea, constipation, abdominal pain,
abdominal distension, dyspepsia, dry
mouth, flushing, sweating, hypertension,
DetrusinLA(UniMed), Tab., 2 mg, Tk.
3.50/Tab., 1 mg, Tk. 2.66/Tab; ERCap., 4 mg, malaise, irritability, dizziness, headache,
Tk. 15.00/Cap., ER2 mg, Tk. 8.00/Cap. ,. anxiety, agitation, abnormal dreams,
Tolorin(General), Tab., 2 mg, Tk. 3.02/Tab. sleep disturbances, drowsiness, tremor,
Tolter(Renata), Tab., 2 mg, Tk. 3.00/Tab., paraesthesia, impaired attention,
1mg, Tk. 2.00/Tab. Dose: ADULT 18–64 years, initially
Toltrex(Incepta), Tab., 2 mg, Tk. 3.00/Tab. 30mg approx. 1–3 hours before sexual
Ucol(Square), Tab., 2 mg, Tk. 3.01/Tab.
activity, subsequent doses adjusted
Uritol(Eskayef), Tab., 1 mg, Tk. 2.00/Tab.,
2mg, Tk. 3.00/Tab. according to response to max. 60mg as
a single dose; max. 1 dose in 24 hours;
6.4.3 DRUGS USED IN review treatment after 4 weeks (or 6
UROLOGICAL PAIN doses) and at least every 6 months
The acute pain of ureteric colic may be Daporex(Euro), Tab., 30mg, Tk. 30.00/Tab.;
relieved with Pethidine(see section 60mg, Tk. 50.00/Tab.
7.5.1). Diclofenac by injection or as Dapotin(Beacon), Tab., 30mg, Tk. 30.09/Tab.
suppositories (see section 9.1.1) is also Dapoxen(Opsonin), Tab., 30 mg, Tk.
effective and compares favorably with 30.00/Tab.; 60 mg, Tk. 50.00/Tab.
pethidine; other non-steroidal antiinflam- Daxetin(ACI), Tab., 30mg, Tk. 30.00/Tab.,
60mg, Tk. 50.00/Tab.
matory drugs are occasionally given by Dejac(Globe), Tab., 30 mg, Tk. 30.00/Tab.
injection. Lignocaine gel is a useful Dulong(Radiant), Tab., 30mg, Tk. 30.00/Tab.
topical application in urethral pain or to Dumax(Eskayef), Tab., 30mg, Tk.30/Tab.;
relieve the discomfort of catheterization 60mg, Tk. 50.00/Tab.
(see section 8.2). Impreja(UniMed), Tab., 30mg, Tk. 30.00/Tab.
Maturex(Incepta), Tab., 60mg, Tk. 50.00/Tab.;
30 mg, Tk. 30.00/Tab.
6.4.4 DRUG FOR ERECTILE Prolong(Ziska), Tab, 30 mg, Tk. 30.00/Tab.;
DYSFUNCTION 60 mg, Tk. 50.00/Tab.
Susten(Square), Tab., 30 mg, Tk.30.00/Tab.;
Erectile disorders are treated with drugs 60 mg, Tk. 50.00/Tab.
givenby mouth which increase the blood X ride(Somatec), Tab., 30mg, Tk.30.00/Tab.;
60mg, Tk. 50.00/Tab.
flow to the penis.Drugs should be used
with caution if the penis isdeformed.
258
SILDENAFIL Immense(Biopharma), Tab., 50mg , Tk.

25.00/Tab.
KX(Kemiko), Tab., 100 mg, Tk. 50.14/Tab., 50
Indications: Erectile dysfunction, mg, Tk. 30.09/Tab.
pulmonary arterial hypertension and for Peak(General), Tab., 100mg, Tk. 50.15/Tab.,
the prevention and treatment of high- 50mg, Tk. 20.00/Tab.
altitude pulmonary edema. Silagra(Incepta), Tab. , 100 mg, Tk.
Cautions: Angina, heart failure, 50.000/Tab., 50 mg, Tk. 30.00/Tab.
Silfil(Organic), Tab. , 50 mg, Tk. 250.75/Tab.,
hypotension, dehydration,priapism.It is
100 mg, Tk.50.50/Tab.
taken not more than once per day Sohagra(Popular), Tab., 25 mg, Tk.
between 30 minutes and 4 hours prior to 20.06/Tab., 50 mg , Tk. 30.00/Tab.
sexual intercourse. Trigger(Globe), Tab. , 50 mg, Tk. 30.00/Tab.
Contraindications: Takingorganic Veagra(Astra Bio), Tab. , 100 mg, Tk.
nitrites and nitrates, men having 50.00/Tab., 25 mg, Tk. 20.00/Tab., 50 mg, Tk.
cardiovascular risk factors, hepatic 30.00/Tab. ,
Viamax(UniMed), Tab , 50mg, Tk.
impairment ,impairment in renal
30.00/Tab., 100mg, Tk. 50.00/Tab., 25mg, Tk.
function,recent stroke or heart attack. 20.00/Tab.
Side-effects: Headache, flushing, Viax(Opsonin), Tab. , 50 mg , Tk. 30.00/Tab.,
dyspepsia, nasal congestion and 100 mg , Tk. 50.00/Tab.
impaired vision. Vigorex(Square), Tab. , 100 mg, Tk.
Note: Rare but serious adverse effects 50.15/Tab., 25 mg, Tk.20.06/Tab., 50 mg,
found through postmarketing Tk.30.10/Tab.
Visagra(Sharif), Tab. 50 mg, Tk. 30.10/Tab.
surveillance include priapism, severe
X-cite(Alco), Tab. , 50 mg, Tk. 30.09/Tab.,
hypotension, myocardial infarction (heart 100 mg, Tk. 50.15/Tab.
attack), ventricular arrhythmias, stroke,
increased intraocular pressure, and
TADALAFIL
sudden hearing loss.
Dose:ADULT over 18 years initially
50mg approx. 1 hourbefore sexual Indications:Erectile
activity, subsequent doses dysfunction,pulmonary
adjustedaccording to response to 25– hypertension,benign prostatic
100mg as a single doseas needed; max. hyperplasia with erectile dysfunction.
1 dose in 24 hours (max. single dose100 Caution and Contraindications: Same
mg) as that of sildenafil
Side-effects: Headache, stomach
Proprietary Preparations discomfort or pain, indigestion, burping,
Acmegra(Acme), Tab. , 25 mg, Tk. acid reflux, back pain, muscle aches,
20.07/Tab., 50 mg, Tk. 30.10/Tab., 100 mg, flushing, and stuffy or runny nose.
Tk. 50.14/Tab. Dose: For BPH, or BPH and erectile
Activa(Pacific), Tab. , 50 mg, Tk. 25.00/Tab., dysfunction is 5 mg daily taken about the
100 mg, Tk. 40.00/Tab. same time each day. Tadalafil may be
Adegra(ACI), Tab., 25mg, Tk. 20.06/Tab.,
100mg , Tk. 50.15/Tab., 50mg, Tk.
taken with or without food since food
30.09/Tab. does not affect its absorption from the
Aggra(Eskayef), Tab, 100 mg, Tk. 50.00/Tab., intestine.
50 mg, Tk. 30.00/Tab.
Edegra(Sun), Tab. 100 mg, Tk. 50.00/Tab.; 50 Proprietary Preparations
mg, Tk. 30.00/Tab. Adafil(Beximco), Tab., 10mg, Tk. 35.00/Tab.;
Enegra(Beximco), Tab., 100mg, Tk. 20mg, Tk. 60.00/Tab.
50.00/Tab., 50mg, Tk. 30.00/Tab., Ciaton(ACI), Tab., 10mg, Tk. 35.11/Tab.;
Enigma(Healthcare), Tab., 50mg , Tk. 20mg, Tk. 60.18/Tab.; 5mg, Tk. 18.05/Tab.
33.00/Tab. Edysta(UniMed), Tab , 2.5mg, Tk.
Enjofil(Navana), Tab., 100 mg, Tk. 10.00/Tab.; 20mg, Tk. 60.00/Tab.; 5mg, Tk.
50.00/Tab.; 25 mg, Tk. 15.00/Tab. 18.00/Tab.; 10mg, Tk. 35.00/Tab.
Erecta(Renata), Tab. , 25 mg, Tk. Intimate(Square), Tab. , 10 mg, Tk.
30.00/Tab., 50 mg, Tk. 50.00/Tab. 35.11/Tab.; 20 mg, Tk. 60.18/Tab. ; 5 mg, Tk.
Fulfeel(Orion), Tab. , 50 mg, Tk. 30.09/Tab. 18.05/Tab.
259
KTX (Kemiko), Tab., 10 mg, Tk. 35.11/Tab.; Valenty(Eskayef), Tab., 10mg , Tk.
20 mg, Tk. 60.00/Tab. 35.00/Tab.; 20mg , Tk. 60.00/Tab.
Megafil(Acme), Tab., 10 mg, Tk. 35.11/Tab., Vardena(Globe), Tab. , 10 mg, Tk. 32.00/Tab.;
20 mg, Tk. 60.18/Tab. 20 mg, Tk. 58.00/Tab.
Nirvana(Healthcare), Tab., 10mg , Tk.
38.00/Tab., 20mg , Tk. 60.00/Tab., 5mg , Tk.
6.4.5 ALKALINISATION AND
24.00/Tab.
Penfil(Biopharma), Tab., 10mg , Tk. ACIDIFICATION OF URINE
30.00/Tab.; 20mg , Tk. 55.00/Tab.
Prolonga(Pacific), Tab. , 10 mg, Tk. Alkalinisation of urine may be
25.00/Tab., 20 mg, Tk. 40.00/Tab. undertaken with Potassium citrate.
Refeel(Orion), Tab. , 10 mg, Tk. 30.09/Tab., The alkalinising action may relieve the
20 mg, Tk. 50.15/Tab.
discomfort of cystitis caused by lower
Tada(Eskayef), Tab, 10mg, Tk. 35.00/Tab.,
20mg , Tk. 60.00/Tab., 5mg, Tk. 18.00/Tab., urinary tract infections. Sodium
Tadafil(Astra Bio), Tab. , 10 mg, Tk. bicarbonate and sodium citrate are also
35.00/Tab., 5 mg, Tk. 18.00/Tab., 20 mg, Tk. used as urinary alkalinising agents for
60.00/Tab. relief of discomfort in mild urinary tract
Tadalis(Incepta), Tab. , 10 mg, Tk. 35.00/Tab. infections.
Tafil(Sharif), Tab. , 10 mg, Tk. 35.11/Tab. Acidification of urine has been
Tealis(Opsonin), Tab. , 10 mg , Tk.
undertaken with Ascorbic acid but it is
35.00/Tab., 5 mg , Tk. 18.00/Tab.
Tiagra(Ziska), Tab. , 5 mg, Tk. 18.00/Tab., 10 not always reliable. Large doses may
mg, Tk. 30.00/Tab. cause gastrointestinal disturbances
TopUp(Euro), Tab., 10 mg, Tk. 35.00/Tab., including diarrhoea. Special pH-
20 mg , Tk. 50.00/Tab. modifying solutions are necessary for the
Viev(Alco), Tab. , 10 mg, Tk. 35.11/Tab., 20 maintenance of indwelling urinary
mg, Tk. 60.18/Tab. catheters.
Urological surgery
VARDENAFIL Endoscopic surgery within the urinary
tract requires an isotonic irrigant since
Indications: Erectile dysfunction there is a high risk of fluid absorption; if
Cautions: Elderly; bleeding disorders or this occurs in excess, hypervolaemia,
active peptic ulceration; susceptibility to haemolysis, and renal failure may result.
prolongation of QT interval (including Glycine Irrigation Solution (1.5%) is
concomitant use of drugs which prolong the irrigant of choice for transurethral
QT interval) resection of the prostrate gland and
Interactions:SeeAppendix 2 bladder tumours. Sterile sodium
Contraindications: Hereditary chloride solution 0.9% (physiological
degenerative retinal disorders Hepatic saline) is used for percutaneous renal
impairment surgery.
Side-effects: Same as that of sildenafil
also less commonly drowsiness, ASCORBIC ACID[ED]
dyspnoea, increased lacrimation,
photosensitivity; rarely anxiety, transient Indications: Acidification of urine but
amnesia, hypertonia, and raised intra- see notes above; prevention and
ocular pressure treatment of scurvy (see section
Dose: ADULT over 18 years, initially 16.2.4.3)
10mg (patients on alpha-blocker therapy Dose: By mouth 4 g daily in divided
5mg) approx. 25–60 minutes before doses.
sexual activity, subsequent doses
adjusted according to response up to Proprietary Preparation
max. 20mg as a single dose; max. 1 See section 16.2.3.3
dose in 24 hours
GLYCINE
260
Indications: Bladder irrigation during Indications: Relief of discomfort in mild

urological surgery; see notes above urinary tract infections; alkalinisation of
Cautions; Side-effects: See notes urine.
above Cautions; Side effects: Caution in
elderly; see also section 1.1.2
Generic Preparations Dose: 3 gm in water every 2 hours until
Irrigation Solution1.5% urinary pH exceeds 7; for maintenance
Glycine(Opso Saline), Tk. 60.15/1000 ml of alkaline urine 5-10 gm daily.
Irigate(Acme)TK. 80.24
Irigon(Beximco), Tk. 70.80/1000 ml
Sterisol(Popular), Tk.165.00/2000 ml
Sodium Bi Carbonate(Opso
Saline),Inj.,(IVInfusion) 7.5%, 75mg/ml, Tk.
5.29/25 ml
POTASSIUM CITRATE Sodinate(Opsonin), Tab. , 600 mg, Tk.
6.02/Tab.
Indications: Relief of discomfort in mild Sodicarb(Popular), Tab. , 600mg, Tk.
urinary tract infections; alkalinisation of 6.02/Tab.
urine; stone prophylaxis.
Cautions: Renal impairment, cardiac 6.5 HORMONE THERAPY OF
disease; elderly; GYNAECOLOGICAL
Interactions:see Appendix-2 (Potassium DISORDERS
salts)
Side-effects:Hyperkalaemia on prolon- 6.5.1 BROMOCRIPTINE
ged high dosage, mild diuresis. 6.5.2 DANAZOL
Potassium Citrate MixtureBP: Oral 6.5.3 CETRORELIX
solution, potassium citrate 30%, citric 6.5.4 TRIPTORELIN
acid monohydrate 5% in a suitable 6.5.5 CABERGOLINE
vehicle with a lemon flavour.
Preparations should be freshly prepared; 6.5.1 BROMOCRIPTINE
contains about 28 mmol k+/10 ml
Dose: 10 ml (well diluted with water) 3 Bromocriptine is a stimulant of
times daily dopamine receptors in the brain. It also
inhibits release of prolactin by the
pituitary. It is used in the treatment of
Urokit(Easkayef),Tab.,1080mg,Tk.10/Tab.
Urilit(Opsonin), Tab.1080mg, Tk. 10.03/Tab. galactorrhoea and cyclic benign breast
Urokit(Eskayef), Tab, 1080mgTk. 10/Tab., disease, and for treatment of
prolactinomas (when it reduces both
Potassium Citrate30gm + Citric serum prolactin and tumour size).
Acid5gm/100ml Bromocriptine also inhibits the release of
Alkamax(Drug Intl), Oral Solutn, , Tk. growth hormone and is sometimes used
200.00/200ml
in treatment of acromegaly. Other
Citra-K(UniMed), Oral Solution, Tk.
200.00/200ml dopamine-receptor stimulants are
Potacit(Healthcare), Oral Solutn,Tk. Cabergoline and Quinagolide.
200.00/200ml Bromocriptine and other
Urikal(Incepta), Oral Solutn, Tk. dopaminereceptorstimu-lants are not
120.00/100ml; Tk. 200.00/200ml recommended for routine suppression of
Uriset(Square), Oral Solutn, Tk. lactation or for the relief of postpartum
200.00/200ml
pain and engorgement of the breasts,
Urokit(Eskayef), Oral Solutn, , Tk.
200.00/200ml which can be adequately treated with
simple analgesics and breast support.
SODIUM BICARBONATE
BROMOCRIPTINE MESYLATE
261
Indication: Prevention and suppression gradually; usual dose 7.5 mg daily in

of lactation (see notes above), divided doses; increased if necessary to
hypogonadism, galactorrhoea, infertility, a maximum of 30 mg daily; usual dose in
cyclical benign breast disease, infertility without hyperprolactinemia, 2.5
acromegaly, prolactinoma; see also mg twice daily. Cyclical benign breast
under Dose. Use in children under 15, disease and cyclical menstrual disorders
not recommended with pain, 1.25 mg at bed time,
Cautions: Pituitary enlargement, increased gradually; usual dose 2.5 mg
particularly during pregnancy; peptic twice daily. Acromegaly, initially 1.25 mg
ulcer in acromegalic patients; oral at bedtime, increased gradually to 5 mg
contraceptives may increase prolactin every 6 hours. Prolactinoma, initially
concentrations; caution in patients with 1.25 mg at bedtime, increased gradually
serious mental or psychotic disorders or to 5 mg every 6 hours
with cardio-vascular disease or
Raynaud’s syndrome (monitor for Proprietary Preparations
retroperitoneal fibrosis); hepatic and Bromodel(Opsonin), Tab., 2.5mg, Tk.12/Tab.
renal impairment; porphyria; hypotensive Bromolac(Square), Tab., 2.5mg, Tk.
12.03/Tab.
reactions (may be disturbing in some Bromotine(Nuvista), Tab., 2.5mg, Tk.
patients during the first few days of 11.03/Tab.
treatment); caution with antihypertensive Criptine(Renata), Tab. , 2.5mg, Tk.12/Tab.
therapy and avoid other ergot alkaloids.
Should be dispensed under prescription 6.5.2 DANAZOL
only
Contraindications: Hypersensitivity to Danazolis a 19 Nortestosterone
bromocriptine or other ergot alkaloids; derivative.Itinhibits pituitary
toxaemia of pregnancy and hypertension gonadotropins; it has androgenic,
in post-partum women or in puerperium; antioestrogenic and antiprogestogenic
advise women not to breast-feed if properties. It is used in the treatment of
lactation prevention fails. Should not be endometriosis and also in mammary
used in postpartum or in puerperium in dysplasia and gynaecomastia where
women with high blood pressure, other measures have proved
coronary artery disease or with unsatisfactory; it has been used in
symptoms (or history) of serious mental menorrhagia and other menstrual
disorder. Discontinue immediately if disorders but in view of its side-effects,
hypertension, unremitting headache or treatment with other drugs may be
signs of CNS toxicity develop preferable. It may be effective in the
Interactions: See Appendix-2 long-term in management of hereditary
Side-effects: Nausea, vomiting, indi- angioedema. Another less common drug
gestion, constipation, headache, fatigue, Gestrinone, has general action similar to
dizziness, insomnia, nasal congestion, those of danazol and has also been
postural hypotension, vasospasm of used in the treatment of endometriosis.
fingers and toes particularly in patients Indications:See notes above and under
with Raynaud’s syndrome. With high dose
doses, confusions, psychomotor Cautions: Cardiac, renal and hepatic
excitation, hallucination, dyskinesia, dry impairment (avoid if severe); elderly
mouth, leg cramps, pleural effusions, :polycythaemia, epilepsy, diabetes mel-
retroperitoneal fibrosis (needs litus, hypertension, migraine, lipoprotein
monitoring) disorders, history of thrombosis; withd-
Dose: Prevention/suppression of lacta- raw if signs virilisation appear; nonhor-
tion 2.5 mg on first day (prevention) or monal contraception should be used.
daily for 2–3 days (suppression); then Contraindications: Pregnancy (ensure
2.5 mg twice daily for 14 days. Hypo- that patient with amenorrhoea are not
gonadism/galactorrhoea, infertility, initi- pregnant); breast-feeding; severe renal,
ally 1.25 mg at bed time increased
262
cardiac and hepatic impairment; Side effects: nausea, hedache, injection

thromboembolic disease; undiagnosed site reaction, rarely hypersensitivity
vaginal bleeding; androgen dependent reactions
tumours; porphyria. Dose: 0.25 mg/ml (250 microgram) by
Interactions: See Appendix-2 subcutaneous injection into the lower
Side-effects: Nausea, headache, abdominal wall to be administered daily
dizziness, rashes, backache, in the morning on day 5 or 6of ovarian
nervousness, weight gain; menstrual stimulation with gonadotropins continue
disturbances, flashing, reduction in throughout the administration of
breast size; skeletal muscle spasm, hair gonadotropins
loss; androgenic effects like- acne, oily
skin, oedema, hirsutism, voice changes Proprietary Preparation
and clitoral hypertrophy; insulin Cetrotide(I) (Serono), Inj. 0.25mg,
resistance; leucopenia, Tk.3,592.90/Vial
thrombocytopenia; benign intracranial
hypertension and visual disturbance
reported 6.5.4 TRIPTORELIN
Dose: Usual range 200-800 mg daily in
up to 4 divided dose; all dose should Indications: Endometriosis; precocious
start during menstruation, preferably on puberty; reduction in size of uterine
first day of cycle. Endometriosis: initially fibroids; male hypersexuality with severe
400 mg daily up to 4 divided doses, sexual deviation; advanced prostate
adjust according to response, usually for cancer
6 months. Menorrhagia: 200 mg daily, Cautions: Non-hormonal, barrier
usually for 3 months. Severe cyclical methods of contraception should be
mastalgia: 200-300 mg daily, usually for used during entire treatment period,;
3–6 months. Benign breast cysts: 300 also use with caution in patients with
mg daily, usually for 3-6 months. metabolic bone disease
Gynaecomastia: 400 mg daily in divided Contraindications:Gonadorelin
doses for 6 months (adolescents 200 mg analogues are contra-indicated for use
daily, increased to 400 mg daily if longer than 6 months in the treatment of
response after 2 months). Pre-operative endometriosis (do not repeat) and when
thinning of endometrium: 400–800 mg there is unexplained vaginal
daily for 3–6 weeks. bleeding;pregnancy,breast feeding
Side-effects: gastro-intestinal
Proprietary Preparations disturbances; in precocious puberty,
Danzol(Renata), Cap., 100 mg, Tk. 20/Cap.; withdrawal bleeding in females may
200 mg, Tk. 38.00/Cap. occur in the first month of treatment and
Danamet(Eskayef), Cap, 100mg , Tk.
also see consult product literature.
20.00/Cap.; 200mg, Tk. 38.00/Cap.
Danazol(IbnSina), Cap. , 100mg, Tk. Dose: Consult physician and consult
20.00/Cap.; 200mg, Tk. 38.00/Cap.; product literature
Lozana(Incepta), Cap, 200 mg, Tk.
38.00/Cap.; 100 mg, Tk. 20.00/Cap. Proprietary Preparation
Decapepty(I)(Ferring),Inj.,95.6
mcg/ml,Tk.683/amp.; 3.75mg/ml,Tk.7,968.31
6.5.3 CETRORELIX
6.5.5 CABERGOLINE
Indications:Combination with
gonadotropins used in the treatment of
female infertility (under fertility specialist Indications: Treat hyperprolactinemia
supervision) (high levels of prolactin, a natural
Contraindications: Pregnancy, breast- substance that helps breast-feeding
feeding, moderate renal impairment, women produce milk but can cause
moderate hepatic impairment. symptoms such as infertility, sexual
problems, and bone loss in women who
263
are not breast-feeding or men). Side-effects:Cardiac valvulopathy,

Cabergoline is in a class of medications dyspepsia, gastritis, epigastric and
called dopamine receptor agonists. It abdominal pain, angina, syncope,
works by decreasing the amount of depression, confusion, hallucinations,
prolactin in the body. breast pain; rarely vomiting, palpitation,
Cautions: Should be used with caution epistaxis, digital vasospasm, hot flushes,
in patients with a history of peptic ulcer, transient hemianopia, muscle weakness;
particularly in acromegalic patients. also reported erythromelalgia
Treatment should be withdrawn if gastro- Dose: ConsultPhysician or product
intestinal bleeding occurs. In literature
hyperprolactinaemic patients,monthly
pregnancy tests during the amenorrhoeic Proprietary Preparation
period; advise nonhormonal Argolin(Opsonin), Tab., 500mcg, Tk.80/Tab.
contraception if pregnancy not desired . Cabergol(Popular) Tab., 500mcg, Tk.80/Tab.
Cabolac(Incepta), Tab., 500mcg, Tk.80/Tab.
Contra-indications:History of puerperal Cabolin(Renata), Tab., 500mcg, Tk.80/Tab.
psychosis; history of pulmonary,
pericardial, or retroperitoneal fibrotic
disorders (see Fibrotic Reactions in
notes above); cardiac valvulopathy
Hepatic impairment reduce dose in
severe hepatic impairment Pregnancy
exclude pregnancy before starting and
discontinue 1 month before intended
conception (ovulatory cycles persist for 6
months)—discontinue if pregnancy
occurs during treatment (specialist
advice needed) Breast-feeding
suppresses lactation; avoid
breastfeeding if lactation prevention fails
264
7. CENTRAL NERVOUS SYSTEM
Chapter 7 
CENTRAL NERVOUS SYSTEM

7.1 Hypnotics and Anxiolytics p.265
7.2 Drugs used in Psychosis and Related Disorderp. 271
7.3 Antidepressant Drugp. 278
7.4 Drugs used in Substance Dependence p.285
7.5 Analgesics p. 286
7.5.1 Opioids p. 286
7.5.2 Non-Opioids p.289
7.5.2.1 Paracetamol p. 289
7.5.2.2 Aspirin (Acetylsalicylic acid) p.291
7.5.2.3 Other Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) p.291
7.5.3 Drugs used in Neuralgic/ Neuropathogenic pain p. 291
7.5.4 Drugs used in Migraine p. 292
7.5.4.1 Acute Migraine attack p.292
7.5.4.2 Prophylaxis of Migraine p.294
7.6 Antiepileptic Drugs p. 295
7.6.1 Control of Epilepsy p. 295
7.6.2 Status Epilepticus p. 301
7.7 Drugs used in Parkinsonism p.302
7.7.1 Dopaminergic drugs p. 302
7.7.2 Antimuscarinic drugs p. 304
7.7.3 Drugs used in Essential tremor, Chorea, Tics and related disorders p.305
7.8 Drugs used in Nausea, Vomiting and Vertigo p. 305
7.9 Drugs used in the treatment of Obesity p. 311
7.10 Drugs used for Dementia p. 312
Benzodiazepines are indicated in the
7.1 HYPNOTICS & ANXIOLYTICS management of anxiety disorders or for
the short time relief of the symptoms of
anxiety and the short-term relief of some
Hypnotics are used to treat insomnia and sleep disorders. They are also used to
as anxiolytics are used to treat treat acute symptom of alcohol
anxiety.Drugs that relieve anxiety withdrawal.
generally cause a degree of sedation Lorazepam,Temazepam and
and drowsiness. Hypnotics and Oxazepam are preferred in patients with
anxiolytics should be reserved for short- hepatic impairment but they carry a
time use because these drugs can cause greater risk of withdrawal symptoms.
dependence and tolerance. Sleep disturbance is very common in
CHILD: The prescribing of hypnotics to depressive illness. In such cases an
children are not rational except for night antidepressant such as Amitriptyline
terror and sleep-walking. (See section 7.3) is the drug of choice
ELDERLY: It is adviseable to avoid instead of benzodiazepines.
hypnotics for the elderly who are prone Anxiolytic treatment with benzodiaze-
to develop confusion and at risk of pines should be with the minimum
becoming ataxic. possible dose and for the shortest
possible time. Diazepam, Alprazolam,
BENZODIAZEPINES Bromazepam, Chlordiazepoxide,
Chlorazepate, Clobazam, Oxazepam,
Benzodiazepines have anxiolytic, LorazepamTemazepam are indicated
sedative, hypnotic,anticonvulsant for the short-term relief of anxiety. In
skeletel musclerelaxant action. children, anxiolytic treatment should be
265
used only to relieve acute anxiety

caused by fear. Proprietary Preparations
Contraindications: known hypersen- Actrim(Globe), Tab. 500 microgram, Tk.
sitivity to benzodiazepines and acute 1.75/Tab.
Alpam(Asiatic), Tab. 250 microgram, Tk.1.00;
narrow angle Glaucoma are usually 500 microgram, Tk. 2.00/Tab.
considered as absolute Contra- Alprax(Opsonin), Tab., 250 microgram , Tk.
indications. Persons predisposed to 1.00/Tab.; 500 microgram, Tk. 2.01/Tab.; 1
substance abuse or alcoholism should mg, Tk. 4.02/Tab.;2 mg , Tk. 8.03/Tab.
be given benzodiazepines with Cautions Alprazol(Albion), Tab. 250 microgram,
because these may cause physical and Tk.1.00/Tab.; 500 microgram, Tk.2.00/Tab.
psychological dependence and also Alzolam(Sun), Tab. 250 microgram,
Tk.1.12/Tab.; 500 microgram, Tk.2.03/Tab.;
interact additively with other sedative or SR Tab. 1 mg, Tk.4.00/Tab.
hypnotic drugs. Pregnant women should Nixalo(Square), Tab. 500 microgram,
be prescribed benzodiazepines with Tk.2.00/Tab.
Cautions as there are increasing Serelam(General), Tab. 250 microgram,
numbers of reports of congenital Tk.1.00/Tab.; 500 microgram Tk. 2.01/Tab.
malformations. Xanax(Navana), Tab., 250 microgram, Tk.
Interactions :Clinically the most 1.00/Tab.; 500 microgram, Tk. 2.51/Tab.
Xiotic(Globe), Tab., 500 microgram, Tk.
important Interactions of 2.00/Tab.
benzodiazepines are their additive Xolam(Aristo), Tab., 500 microgram, Tk.
effects when combined with other 2.00/Tab.; 1 mg, Tk. 4.00/Tab.
sedative or hypnotic drugs including Zolax(Beximco), Tab., 250 microgram, Tk.
alcohol (Ethanol), Phenothiazines, 1.00/Tab.; 500 microgram, Tk. 2.00/Tab.
narcotics, barbiturates, MAOIS, tricyclic Zolium(Incepta), Tab., 250 microgram Tk.
anti-depressants (See also Appendix-2). 1.50/Tab.; 500 microgram, Tk. 3.00/Tab.
Benzodiazepines being central nervous
system depressants have the common BROMAZEPAM[CD]
effects of sedation, fatigue, drowsiness,
ataxia and confusion, progressing to Indications: Anxiety, agitation,
coma which may occur at high doses. insomnia, muscle spasmand alcohol
withdrawal syndrome
ALPRAZOLAM[CD] Interactions: See Appendix-2
Side-effects: dependence, sedation,
Indications: Short term use in anxiety, mental confusion
agoraphobia with frequent panic attack, Dose: ADULT: 3-18 mg daily in divided
panic disorder, depressive syndrome doses
where anxieties are the predominant CHILD: Not recommended
cause, generalized anxiety disorder,
situational anxiety Ancotil(Rangs), Tab., 3 mg, Tk. 4.00/Tab.
Cautions: Driving and operating Anxio(UniMed), Tab. 3 mg, Tk. 4.50/Tab.
machinery. Children: Dependence; 10 Anxionil(NIPRO JMI), Tab., 3mg, Tk.
times more potent than diazepam 5.02/Tab.
Contraindications: Pregnancy and Anxirel(Novo), Tab., 3 mg, Tk. 4.00/Tab.
lactation Anxopam(Popular), Tab. 3 mg, Tk. 4.00/Tab.
Interactions: See Appendix-2 Benzopam(Benham), Tab., 3 mg, Tk. 5/Tab.
Bomaz(Sharif), Tab., 3 mg, Tk. 4.01/Tab.
Side-effects: Drowsiness, light Bopam(Opsonin), Tab., 3 mg, Tk. 4.54/Tab.
headedness, dry mouth, nausea, Brolon(Albion), Tab. 3 mg, Tk. 3.00/Tab.
vomiting, allergy, rebound anxiety Bromazep(Orion), Tab, 3 mg, Tk. 4.01/Tab.
Dose: 2 to 6mg daily. For anxiety, 0.25- Broze(Biopharma), Tab., 3 mg, Tk. 5.00/Tab.
0.5 mg three times daily Brozep(Alco), Tab., 3 mg, Tk. 5.00/Tab.
Panic disorder with agoraphobia needs Carbocal-D(Globe), Tab. 3 mg, Tk. 4.50/Tab.
higher doses such as 0.5 mg 3 times Kpam(Kemiko), Tab., 3 mg, Tk. 4.01/Tab.
Laxonil(Rephco), Tab. 3 mg, Tk. 3.00/Tab.
daily. Dose depend upon the individual Laxyl(Square), Tab., 3 mg, Tk. 5.02/Tab.
and severity of condition
266
Lexnil(Asiatic), Tab., 3 mg, Tk. 4.00/Tab. Frisium(Sanofi), Tab., 10mg, Tk. 5.02/Tab.
Lexopil(Healthcare), Tab. 3 mg, Tk. 6.00/Tab. Keolax(Beximco), Tab.,10 mg, Tk. 2.77/Tab.
Lexotanil(Radiant), Tab, 3 mg, Tk. 8.00/ Tab. Nebium(Globe), Tab., 10 mg, Tk. 2.55/Tab.
Nightus(Beximco), Tab., 3 mg, Tk. 3.00/Tab. Prozium(Astra), Tab., 10 mg, Tk. 2.55/Tab.
Norry (Renata), Tab., 3 mg, Tk. 5.00/Tab. Sedazam(ACI), Tab., 10mg , Tk. 2.82/Tab.
Notens(Aristo), Tab. 3 mg, Tk. 5.00/Tab. Suzium(Supreme), Tab., 10mg, Tk.2.55/Tab.
Relaxium(Amico), Tab. 3 mg, Tk. 4.00/Tab. Tensnil(Alco), Tab., 10 mg, Tk. 4.01/Tab.
Restol(Eskayef), Tab, 3 mg, Tk. 5.00/Tab. Tranquil(Ibn Sina), Tab.,10 mg,Tk. 4.00/Tab.
Siesta(Incepta), Tab. 3 mg, Tk. 4.00/Tab. Venium(Hudson), Tab., 10mg, Tk.2.70/Tab.
Tenapam(General), Tab.,3 mg, Tk. 5.01/Tab.
Tenil(Acme), Tab. , 3 mg, Tk. 5.01/Tab.
CHLORDIAZEPOXIDE
Tensfree(Globe), Tab., 3 mg, Tk. 4.50/Tab.
Tynaxie(Navana), Tab., 3 mg, Tk. 5.02/Tab. Indications: Short term anxiety,as an
Xionil(Novartis), Tab. 3 mg, Tk. 5.00/Tab. adjunct in alcohol withdrawal.
Xiopam(Euro), Tab., 3 mg, Tk. 5.00/Tab.
Cautions,Contraindications&Side-
Zepam(ACI), Tab., 3 mg, Tk. 5.02/Tab.
Zerotens(Popular), Tab., 3 mg, Tk. 4.00/Tab. effects:See under diazepam
Dose: 10 mg three times to 60-100 mg
in divided doses.
CLOBAZAM Proprietary Preparations
Amitriptyline 12.5mg + Chlordiazepoxide5mg
Indications: Generalized anxiety Limbix(Acme), Tab., 7.00/Tab.
disorder, stress, agitation, aggression, Reelife(Eskayef), Tab., Tk. 7.00/Tab.
psych-osomatic disorders, sleeps
disturbances associated with anxieties, DIAZEPAM[ED] [CD]
an adjunctive therapy in epilepsy

Cautions&Contraindications: See
Indications: Insomnia,generalized
under diazepam
anxiety disorder, phobic disorder, panic
Interactions: See also Appendix-2
disorder, status epilepticus, catatonia,
It potentiates the effects of alcohol and
muscle spasm, alcohol withdrawal
of drugs that depress the Central
syndrome
Nervous System such as analgesics,
Cautions: Pregnancy, lactating mother,
hypnotics, neuroleptics. Respiratory
respiratory diseases, muscle weakness
depression occur if used in combination
(special care in myasthenia gravis),
treatment with Clozapine.
history of alcohol or drug abuse and
Side-effects: Ataxia, drowsiness (espe-
elderly
cially in the elderly), disorientation,
Contraindications: Hypersensitivity,
dizziness and occasionally confusion. It
drug dependence
can develop dependence on higher
dosesused for long duration. Muscle
Side-effects:Dependence,sedation,
weakness, and sedation may also occur.
confusion, headache, decrease of libido
Dose: Anxiety: 20-30mg daily in divided
Dose: 15 - 60 mg/dayReduce dose in
dose or as a single dose at bed
the elderly.
time,increased in severe anxiety (indoor
hospital patient) to a maximum of 60mg Proprietary Preparations
daily in divided dose; ELDERLY andor Azepam(Acme), Tab., 5 mg, Tk. 0.69/Tab.
Debilitated: 10-20 mg daily. Eplilepsy, Diazem(Albion), Tab., 5 mg, Tk. 0.69/Tab.
20-30mg daily; maximum 60mg daily; Diazemet(Medimet), Tab., 5 mg, Tk. 0.69/Tab
CHILD: over 3 years, not more than half Diazepam(Popular),Tab.,5 mg,Tk.0.68/Tab.
the adult dose D-Pam(General), Tab., 5 mg, Tk. 0.68/Tab.
Easium(Opsonin), Suppository, 10 mg , Tk.
3.01/Supp.; Inj., 10 mg/2 ml, Tk. 3.71/Amp,;
Tab., 5 mg , Tk. 0.69/Tab.
Alsium(Albion),Tab., 10 mg, Tk. 1.00/Tab.
Evalin(Aristo), Tab., 5mg, Tk. 0.68/Tab
Calm(Biopharma), Tab.,10 mg, Tk. 2.76/Tab.
G-diazepam(Gonoshasthaya), Inj. 10 mg/2 ml,
Clob(Opsonin), Tab., 10 mg, Tk. 3.51/Tab.
Tk. 3.70 /Inj.; Tab., 5 mg, Tk. 0.50 /Tab.
Clobam(Square), Tab., 10 mg, Tk. 4.02/Tab.
Relaxen(Sonear), Tab., 5 mg, Tk. 0.68/Tab.
Clobid(Medimet), Tab., 10mg, Tk.3.00/Tab.
Seda(Supreme), Tab., 5 mg, Tk. 0.68/Tab.
Cosium(Acme), Tab., 10mg., Tk. 3.52/Tab.
267
Sedapan(Amico), Tab., 5mg , Tk. 0.69/Tab.

Sedil(Square), Inj., 10 mg/2 ml, Tk. FLURAZEPAM[CD]
3.05/Amp.; Tab., 5 mg, Tk. 0.69/Tab.
Seduxen(Ambee), Inj., 10 mg/2ml,Tk.3.6/2ml
Amp; Tab., 5 mg,Tk. 0.23/Tab Indications: Mainly used as hypnotic in
Insomnia and generalized anxiety
MIDAZOLAM disorders
Cautions: Pregnancy and Lactating
Indications: Status epilepticus; febrile mother; see under Diazepam
convulsions Contraindications: Respiratory
Contraindications: See section 8.1.2 depression, drug dependence
use with caution in Renal and hepatic Interactions: See Appendix-2
impairment impairment, Pregnancy Side-effects: Dependence, sedation,
Side-effects: See section 8.1.2 also confusion, headache
depression of consciousness Dose: 15–30 mg/day:ELDERLY 15 mg/
Dose : By buccal administration, ADULT day
over 18 years, 10mg repeated once after
10 minutes if necessary; CHILD up to 3 Aluctin(Ambee),Cap., 30 mg, Tk. 6.00/Cap.
months , 300micrograms/kg (max. Flurazepam(Albion), Cap.,15 mg,Tk.
2.5mg), 3 months–1 year 2.5mg, 1–5 3.51/Cap.; 30 mg, Tk. 6.00/Cap.
years 5mg, 5–10 years 7.5mg, 10–18 Slipam(General), Cap.,15 mg,Tk.
years 10mg; these doses may be 4.51/Cap.;30 mg, Tk. 8.03/Cap.
repeated once after 10 minutes if
necessary HYDROXYZINE (H1 antigonist)
Proprietary Preparations Indications: Genaralized anxiety

Anquil (General), Tab., 7.5 mg, Tk. 8.05/Tab.;
disorder, urticaria, atopic dermatities
15 mg, Tk. 15.11/Tab.; Inj,15mg/3 ml , Tk.
75.22/3 ml amp Cautions, Side-effects:
Benquil, (Biopharma), Tab., 15mg , Tk. Seesection:4.8.1
8.00/Tab. Dose: 10-25mg at bed time
Dormax (Aristo), Inj, 15mg/3 ml , Tk. 75.00/3
ml amp.; Tab., 7.5mg , Tk. 8.00/Tab. Proprietary Preparations
Dormicum (Radiant), Tab. , 7.5mg, Tk. See section:4.8.1
19.56/Tab.
Dormilat (ACI), Tab., 15mg, Tk. 15.05/Tab. ; LORAZEPAM[CD]
7.5mg, Tk. 8.02/Tab. ; Inj, 1mg/ ml , Tk.
55.17/3 ml amp.; 15mg/3 ml , Tk. 75.23/3ml
Dormitol(Square), Inj, 15mg/3 ml , Tk. Indications: Anxiety(Short term),
120.37/3ml amp.; Tab. , 7.5 mg, Tk. insomnia,as an anticonvulsant in the
10.03/Tab. management of Status Epilepticus. It is
Hypnocum (Healthcare), Tab., 7.5mg, Tk. also used for its sedative and amnestic
10.00/Tab.
properties in premedication; also in
Hypnofast (Incepta), Inj, 1mg/ ml , Tk.
50.00/3 ml amp.; 15mg/3 ml , Tk. 90.00/3 ml antiemetic regimens for the control of
amp,; Tab.,7.5 mg, Tk. 8.00/Tab.; nausea and vomiting associated with
Midaben (Amico), Tab., 7.5mg , TK. 8.00/Tab. cancer chemotherapy.
Midolam (Opsonin), Inj, 1mg/ ml , Tk. Cautions, Contraindications&Side-
50.19/5mg amp,; 15mg/3 ml , Tk. 75.28/3ml effects: See underDiazepam
amp, Tab. , 15 mg , Tk. 15.06/Tab. ; 7.5 mg , Interactions: See Appendix-2
Tk. 8.03/Tab. ;
Dose: Anxiety disorders: By mouth, 1-4
Midzo (Renata), Inj, 15mg/3 ml , Tk. 75.00/3
ml amp,; Tab., 7.5 mg, Tk. 8.00/Tab. mg divided dose; in insomnia associated
Milam (Eskayef), Inj, 15mg/3 ml , Tk. with anxiety, a single dose of 1-2 mg at
120.00/3 ml amp, Tab, 7.5mg, Tk. 10.00/Tab.; bedtime. In the management of Status
15mg , Tk. 20.00/Tab.; 7.5 mg, Tk. 10.00/Tab. Epilepticus, 4 mg may be given as a
Mizolam (Acme), Tab. , 7.50 mg, Tk. single intravascular injection
8.07/Tab. CHILD: Not recommended
Sedoz (Asiatic), Tab., 7.50mg , Tk. 9.50/Tab.
268
Dose: 10 mg, no more than once per

Proprietary Preparations night taken before 30 minutes of going to
Lorapam(Popular),Inj.,4 mg/ml,Tk.75.28/Amp bed
Lorazem(Albion),Tab.,1 mg Tk. 2/Tab.
Lozicum(Incepta), Tab., 1 mg, Tk. 2/Tab. Proprietary Preparations
Trapex(Sun), Tab.,1 mg, Tk. 2/Tab. Somarant(Incepta), Tab., 10 mg, Tk.
35.00/Tab.
MELATONIN(Hormone produces by pineal Suvotol(Square), Tab. , 10 mg, Tk.
gland) 35.00/Tab.
Indications: Insomnia (shot term use), TEMAZEPAM[CD]

Jetleg, Attention deficite disorder in
children Indications: Short term insomnia for
Cautions: Depression, dibetes, peri-operative use; see also section 7.1
hypertension, pregnancy Cautions: See under Nitrazepam&notes
Dose: Tab.3mg, use one before bed above
time Contra-indications: See under
Nitrazepam &notes above
Proprietary Preparation Interactions: See Appendix-2
Filfresh(Square), Tab. , 3 mg, Tk. 3.01/Tab. Side-effects: See under Nitrazepam.
Dose: ADULT 10–20 mg at bedtime,
NITRAZEPAM[CD] exceptional circumstances 30–40 mg;
ELDERLY and or Debilitated: 10mg
Indications: Insomnia, myoclonic atbedtime, exceptional circumstances 20
seizure mg; CHILD: Not recommended
Cautions: Respiratory diseases, muscle
weakness. pregnancy and lactating Proprietary Preparations
Temazin(Globe),Tab., 10 mg
mother (see also Diazepam above) Temazepam(Renata), Tab., 10 mg
Contraindications: Respiratory
depression, drug dependance,
sleepapnoea. OXAZEPAM
Side-effects: Dependence, sedation, Indications: For short term anxiety,
confusion, headache, light headedness insomnia associated with anxiety,
Dose: 5–10 mg/dayat bed time irritation in elderly.
Side-effects: Drowsiness, withdrawal
Proprietary Preparations effect
Epam(Opsonin), Tab., 5 mg, Tk. 0.75/Tab. Dose: 10-15mg 3 time a day
Nectum(Albion), Tab., 5 mg, Tk. 0.69/Tab.
Noctin(Ambee), Tab. 5 mg, Tk. 0.69/Tab Proprietary Preparation
Anoxa(Square), Tab., 10 mg, Tk. 3.52/Tab.
SUVOREXANT
OTHER HYPNOTICS/ANXIOLYTICS
insomnia, characterized by difficulties Zopiclone, Zolpidem and Zaleplon are
with sleep onset and/or sleep non benzodiazepine hypnotics; “Z-
maintenance. drugs”but they act at the benzodiazepine
Cautions: Daytime somnolence: Risk of receptors and rapidly initiates sleep,
impaired alertness and motor without reduction of total REM sleep.
coordination, including impaired driving; Zopiclone and Zolpidem have short
risk increases with dose; elimination half-life, with no significant
Side-effects: Sleepiness during the day, accumulation of drug substance on
not thinking clearly, act strangely, repeated doses.Course of treatment with
confused, or upset sleep-walking these drugs should be not be
269
recommended for more than 4 weeks of Side-effects: Nausea, dizziness, heada-

duration. che, nervousness, rarely tachycardia,
Beta-blockers (beta-adrenoceptor bloc- palpitation and chest pain
king agents) such as Propranolol and Dose:By mouth, initially 5 mg 2-3 times
Oxprenolol (See section 3.1) do not daily, increased as necessary every 2-3
affect psychological symptoms (such as days; usual range 15-30 mg in divided
anxiety, tension, fear, etc.), but they doses; maximum upto 45mg daily.
reduce autonomic symptoms such as CHILD: Not recommended
palpitation and tremor. Beta-blockers are
used mainly to reduce psycho-somatic Proprietary Preparation
symptoms (e.g. tremor, palpita-tions, Busper(Kumudine),Tab.,5mg,Tk 4.00/Tab,
sweating etc.) which in turn may prevent Tab.10mg,Tk. 7.00/Tab
the onset of worries, anxieties and fear.
Antihistamines with sedative action, ESZOPICLONE
such as Diphenhydramine and Prome-
thazine hydrochloride (for details see Indications, Cautions, Contra-
section 4.7.1) are sometimes used for indications&Side-effects: See under
inducing sleep, particularly for wakeful Zopiclone
children but the random use of these Dose:Initial dose: 1 mg
drugs in children is not clinically justified. orallyimmediately before bedtime
In recent times, Buspirone which acts
specifically on the 5HT (5-Hydroxytrypt- Proprietary Preparations
Sleepon(Silva), Tab., 1mg, Tk. 2.01/Tab.;
amine) receptors has been used as an
2mg, Tk. 3.01/Tab.
anxiolytic; it does not have any Sleepwell(Popular), Tab.,1 mg, Tk.2.01/Tab.;
appreciable sedative action. 2 mg, Tk. 3.01/Tab.
Barbiturates are now practically Sono(Acme), Tab., 2 mg, Tk. 3.01/Tab.; 1 mg,
obsolete as sedative and anxiolytic Tk. 2.01/Tab.
agents, though some intermediate-acting Zopilone(Incepta), Tab., 2mg, Tk. 3.00/Tab.
barbiturates (e.g. amobarbitone, butob-
arbitone, secobarbital, etc.) are still PROPRANOLOL[ED]
occasionally prescribed in the treatment
of severe intractable insomnia. Barbitur- Indications: Treatment of somatic
ates should be avoided in the elderly. manifestations of generalized anxiety
Chloralhydrate and Paraldehyde are disorder, anticipatory and situational
no longer recommended as sedatives. anxiety, and treatment of drug induced
Meprobamate is less effective than tremor, anaesthesia, migraine, alcohol
benzodiazepines, more hazardous in withdrawal syndrome
over-dosage, and more likely to induce Side-effects&Contra-indications:See
dependence; it is not recommended for section 3.1
use. Interactions : See Appendix-2
Dose : 20–240 mg/day
BUSPIRONE HYDROCHLORIDE
(Acts on 5HT14) Proprietary Preparation
See section 3.1
Indications:In short term anxiety low
dependence & abuse potential ZALEPLON
Cautions: History of hepatic or renal
impairment; does not alleviate benzodi- Indications: Short term treatment of
azepine withdrawal insomnia
Contraindications: Epilepsy;severe Contra-indications: Sleep apnoea
hepatic or renal impairment; children, syndrome; myasthenia gravis; not to be
pregnancy and lactating women used individually to treat psychosis and
Interactions: See Appendix-2 in lactating mothers
270
Cautions: Respiratory insufficieny,

hepatic impairment (Appendix-3), history ZOPICLONE
of drug or alchohal abuse, avoid
prolonged use and abrupt withdrawl Indications: Short-term treatment of
thereafter, pregnancy (Appendix-5), insomnia, including difficulties in falling
Interactions: See Appendix-2 asleep, and early awakening, transient
Sideeffects: Headache, asthenia, insomnia, insomnia secondary to
drowsiness, dependence, dizziness, psychiatric illness and insomnia due to
amnesia, paradoxical effects severe distress
Dose: 10mg at bedtime or after going to Cautions: Dose should be half in liver
bed if difficulty in falling asleep; CHILD: diseases
Under 18 years not recommended. Contraindications: Children, pregnancy
and lactating mother
Eplon(Beximco),Cap.10mg Tk. 10/Cap;
Somna(Square), Cap. 10mg, Tk. 7/Cap.; Side-effects: Bitter taste following
ingestion, behavioral disturbances
including confusion, depressed mood,
ZOLPIDEM TARTRATE
irritability and amnesia have been
reported. With accidental overdoses,
Indications: Insomnia (short-term use— drowsiness, lethargy and ataxia have
up to 4 weaks) been reported without any other serious
Cautions: Respiratory depression, effects
muscle weakness and myasthenia Dose:By mouth, 7.5 mg Zopiclone just
gravis, history of drug or alcohol abuse; before going to sleep up to four weeks.
elderly; avoid prolonged use (and abrupt In severe or persistent insomnia up to 15
withdrawal thereafter);Driving mg may be needed. In elderly, start with
Drowsiness may persist the next day a lower dose of 3.75 mg; subsequently
and affect performance of skilled tasks; the dose may be increased if the
effects of alcohol enhanced condition improves clinically
ContraIndications: Obstructive sleep
apnoea, acute or severe respiratory Proprietary Preparation
depression, marked neuromuscular Imovane(Sanofi), Tab., 7.5mg, Tk. 10.03/Tab.
respiratory weakness including unstable Hypnoclone(ACI) Tab., 7.5mg, Tk. 4.03/Tab
myasthenia gravis, psychotic Zopi(Astra), 7.5 mg, Tk. 4.03/Tab.
illness,hepatic impairment;renal
impairment,pregnancy andbreast- 7.2 DRUGS USED IN PSYCHOSIS
feeding AND RELATED DISORDERS
(anxiolytics and hypnotics) Behavioral and cognitive effects of
Side-effects:Diarrhoea, nausea, vomi- psychotropic drugs have contributed
ting, dizziness, headache, drowsiness, much to a better understanding of the
hallucination, agitation, asthenia, amne- relationship between brain functions,
sia; dependence, memory disturbances, psychiatric illnesses and their therapy.
nightmares, depression, confusion, These drugs are useful for psychotic
perceptual disturbances or diplopia, symptoms such as paranoia, delusion,
tremor, ataxia, falls, skin reactions, hallucination, disordered thinking, and
changes in libido; paradoxical effects, also in Shizophrenia. They are known as
muscular weakness, and sleep-walking psychotropic or anti-psychotic drugs, and
also reported also called as ‘Neuroleptics’. Modern
Dose:ADULT:Over 18 years: 10mg at psychotropic drugs have profoundly
bedtime; ELDERLYor Debilitated: 5mg changed the treatment of psychiatric
disorders.
Proprietory Preparations Regardless of which antipsychotic drug
Nitrest(Sun), Tab., 10 mg, Tk. 3.16/Tab. is chosen for the treatment of a
Zolexin(Opsonin), Tab., 10 mg, Tk. 3.71/Tab.
271
psychotic patient, it is important to be receptors including mainly the

fully familiar with the pharmacology of dopaminergic D2-receptors. Newer com-
the drug including its therapeutic and pounds like Sulpiride and Remazopride
Side-effects profile. Proper dosage of block D4-receptors in addition to blocking
any of the therapeutic agents is a critical the D2-receptors.
issue for its safe and effective Other atypical antipsychotics include
application. Aripiprazole,Olanzapine and
Antipsychotic drugs are thought to act by Risperidone.Risperidone which is
interfering with dopaminergic transmi- indicated for psychosis in which both
ssion or by blocking dopamine receptors positive and negative symptoms are
in the brain. They may also affect present, andOlanzapinewhich is effective
cholinergic, alpha-adrenergic, histamin- in maintaining clinical improvement in
nergic and serotonergic receptors in the patients who have responded to initial
brain.Differential effect of the various treatment.
antipsychotic drugs on the storage, Lithium salts are a class by itself, and
release, destruction and uptake or are used in the prophylaxis and
reuptake of either serotonin or norepine- treatment of mania, in the prophylaxis of
phrine may account for their differential manicdepressive disorder and in the
efficacy in various psychotic or behavior prophylaxis of recurrent unipolar depres-
disordered patients. sion. The decision to use lithium salts
Many of the antipsychotic drugs are needs careful and special considerations
PHENOTHIAZINE derivatives which may of specialists. Lithium is unsuitable for
be classified into three groups: children.
Group 1: Chlorpromazine belongs to WITHDRAWAL:Withdrawal of antipsyc-
this group which is characterized by hotic drugs after long-term therapy
strong sedative effects and moderate should always be gradual and closely
antimuscarinic and extrapyramidal Side- monitored to avoid the risk of acute
effects. withdrawal syndromes or rapid relapse.
Group 2: Thioridazine belongs to this
group whichis generally characterized by ARIPIPRAZOLE
moderate sedative effects, marked Indications: Schizophrenia, bipolar
antimuscarinic effects but fewer extrapy- mania and mixed manic/depressive
ramidal Side-effects than groups 1 and episodes and as adjunctive therapy for
3. major depressive disorder
Group 3: Fluphenazine, Prochlorper- Cautions: History of
azine, and Trifluoperazine belong to seizures,neuroleptic malignant
this group which is generally syndrome,dementia,history of diabetes
characterized by fewer sedative effects, mellitus&hypertension
fewer antimuscarinic effects, but more Interactions:See Appendix-2
pronounced extrapyramidal Side-effects Side effects: Constipation, dizziness,
than groups 1 and 2. drowsiness, headache, nausea, pain,
Psychotropic drugs of other chemical restlessness, stomach upset
types tend to resemble the phenothi- Dose:Schizophrenia, by mouth, ADULT
azines of Group 3. They include: over 18 years: 10 - 15mg once daily,
BUTYROPHENONES (e.g. Haloperidol, usual maintenance 15mg oncedaily;
Droperidol); maximum 30mg once daily
THIOXANTHINES (e.g. Flupenthixol,
Zuclopenthixol); Proprietary Preparations
SUBSTITUTED BENZAMIDES (e.g. Aripen(Opsonin), Tab., 15 mg, Tk. 7.03/Tab.;
Sulpiride; Remazopride); 10 mg, Tk. 5.02/Tab.
DIBENZODIAZEPINES(e.g.Clozapine). Aripra(Incepta), Tab., 10 mg, Tk. 5.00/Tab. 15
Phenothiazines and related thioxanthi- mg, Tk. 7.00/Tab.
Ariprazole(General), Tab., 10mg, Tk.
nes and also butyrophenones block
5.04/Tab.; 5 mg, Tk. 3.52/Tab.
many types of neurotransmitter
272
Ariprex(Square), Solutn.,, 5 mg/5 ml, Tk. 25 mg up to 300 mg daily in divided

75.00/50ml; Tab., 10 mg, Tk. 5.00/Tab.; 15 doses.
mg, Tk. 7.00/Tab.; 2 mg, Tk. 2.00/Tab.
Sizopra(Acme), Tab., 10.00 mg, Tk. Proprietary Preparations
5.03/Tab.; 15.00 mg, Tk. 7.04/Tab.
Clozapin(Albion), Tab. , 100 mg, Tk.
9.00/Tab.; 25 mg, Tk. 2.55/Tab.
CHLORPROMAZINE HCl [ED] Sensipin(Beximco), Tab. , 25 mg, Tk.
(See also Section 7.8) 3.84/Tab.
Sizopin(Sun), Tab.,100mg, Tk. 9.55/Tab.;
25mg, Tk. 2.55/Tab.
Indications: Schizophrenia, delusional Zapenia(Incepta), Tab., 100 mg, Tk.
disorder, mania, and aggressive 9.00/Tab.; 25 mg, Tk. 2.50/Tab.
behavior; other psychosis; emesis
Cautions: Pregnancy, lactation, cardiov- FLUPENTHIXOL
ascular and cerebrovascular disease,
(Flupentixol)
respiratory disease, seizure
Contra-indications:Coma due to CNS
Indications: Schizophrenia, other psyc-
depression, Parkinsonism, glaucoma,
hoses, particularly with apathy and
hepatic disease, jaundice, bone marrow
withdrawal but not in mania or hypera-
depression, blood dyscrasias
ctivity; Depression (see section 7.3)
Contra-indications: Parkinsonism, liver
Side-effects:Anorexia nervosa, sedat-
disease, blood dyscrasia, neuroleptic
ion, postural hypotension, extrapyrami-
malignant syndrome, Tardive dyskinesia
dal symptoms (EPS), dry mouth, tachyc-
ardia, galactorrhoea, impaired ejacula-
Side-effects:Asthenia,sedation,
tion, amenorrhoea, constipation, weight
hypotension, extrapyramidal symptoms
gain, jaundice, agranulocytosis
(EPS), amenorrhoea, galactorrhoea, loss
Dose: 300–1500 mg per day.
of libido, weight gain
Dose: Orally for psychosis, initially 0.5-3
See section 7.8 mg twice daily adjusted according to
response
CLOZAPINE ELDERLY (or debilitated), quarter to half
of the adult dose
CHILD:Not recommended. Intramus-
Indications: Only for the treatment of cularly,see next entry for the depot
Schizophrenia in patients unresponsive injection of flupenthixol decanoate
to, or intolerant of, conventional antipsy-
chotic drugs Proprietary Preparations
Cautions: Should not drive or operate Funam(Amico), Tab., 0.5 mg, Tk. 3.00/Tab.
any machinery Sentix(Eskayef), Tab, 1 mg, Tk. 5.00/Tab.; 0.5
Contra-indications: Bone marrow depr- mg, Tk. 3.50/Tab.
ession, drug induced agranulocytosis; Fluxanol(I)(Lundbeck),Tab, 1mg,Tk.
patients receiving carbamazepine, CNS 16.79/Tab.
Flupenthixol 500 microgram+ Melitracen 10
depressants; renal or hepatic impair-
mg
ment; epilepsy; pregnancy and breast- Adelax(ACI), Tab., Tk. 5.02/Tab.
feeding Amilax(Amico), Tab., Tk. 2.00 / Tab.
Interactions: See Appendix-2 Anfree(Aristo), Tab., Tk. 5.00/Tab.
Side-effects: Sedation, drowsiness, Angentz(Healthcare), Tab., Tk. 5.00/Tab.
hypersalivation, postural hypotension, Antison(Asiatic), Tab., Tk. 4.50/Tab.
hyperthermia, constipation, weight gain, Anzet(Popular), Tab., Tk. 4.00/Tab.
Banxyt(Bristol), Tab., Tk. 3.50/Tab.
agranulocytosis, seizures with high
Benzit(Biopharma), Tab., Tk. 5.00/Tab.
doses Danxit(Astra Bio), Tab., Tk. 5.00/Tab.
Dose: Initially, 12.5 mg once on the first Deleta(General), Tab., Tk. 5.01/Tab.
day followed by 25 mg on the second Dexit(UniMed), Tab., Tk. 5.00/Tab.
day, subsequently daily dose may be Diconten(Drug Intl), Tab., Tk. 4.05/Tab.
increased gradually, if well tolerated, by Dormir(Somatec), Tab., Tk. 4.00/Tab.
273
Femanol(kemiko), Tab., Tk. 4.01/Tab. Side-effects, Contraindicationsand

Femixit(Monico), Tab., Tk. 3.50/Tab. Interactions: See Appendix-2
Flumetra(Virgo), Tab., Tk. 4.00/Tab. Dose: By deep intramuscular injection
Fluxit(Opsonin), Tab., Tk. 5.02/Tab.
Folison(Jayson), Tab. Tk. 0.34/Tab.
into the gluteal muscle, test dose of 2.5
Frenxit(Beximco), Tab., Tk. 5.00/Tab. mg (6.25 mg in the elderly), then after 5-
Henxit(Hudson), Tab., Tk. 4.00/Tab. 7 days 12.5–100 mg repeated at inter-
Leanxit(Acme), Tab., Tk. 5.01/Tab. vals of 2-5 weeks, adjusted according to
Melanxit(Organic), Tab., Tk. 4.02/Tab. response. CHILD:Not recommended
Melipen(Supreme), Tab., Tk. 3.50/Tab.
Melixol(Square), Tab., Tk. 5.02/Tab. Proprietary Preparations
Meltix(Navana), Tab., Tk. 5.00/Tab. Fenazine(Incepta), Inj., 25 mg/ml, Tk.
Melxit(Ziska), Tab., Tk. 3.50/Tab. 75.00/Amp.
Neoxit(Novo), Tab., Tk. 4.00/Tab. Fluphenazine(I)(Rotex),Inj., 25mg/ml, Tk.
Penticin(Euro), Tab., Tk. 5.00/Tab. 90.35/Amp.
Radex(Globe), Tab., Tk. 5.00/Tab.
Remood(Ibn Sina), Tab., Tk. 5.00/Tab.
Renxit(Renata), Tab., Tk. 5.00/Tab. HALOPERIDOL[ED]
Sensit(Eskayef), Tab., Tk. 5.00/Tab.
Tenaxit(Incepta), Tab., Tk. 5.00/Tab. Indications: Schizophrenia, Mania,
Thenxet(Pacific), Tab., Tk. 5.00/Tab. other psychosis, Tourette’s syndrome,
Thixtra(NIPRO JMI), Tab., Tk. 5.02/Tab. autism, Huntington’s Chorea, Syden-
Tixocin(Sharif), Tab., Tk. 5.00/Tab.
ham’s Chorea, Delirium
Tixol(Alco), Tab., Tk. 4.01/Tab.
U4(Orion), Tab., Tk. 5.01/Tab. Cautions: Pregnancy, lactation,
Xolitra(Beacon), Tab., Tk. 5.02/Tab. coadministration with lithium may cause
Zenxit(Zenith), Tab., Tk. 3.25/Tab. neurotoxicity
Contra-indications: Parkinsonism, liver
FLUPENTHIXOL DECANOATE disease, depressive illness
Indications: Schizophrenia and other Side-effects: Sedation, hypotension,
psychoses with depressive symptoms EPS, amenorrhoea, loss of libido,
but not mania or any psychomotor constipation, retention of urine
hyperactivity Dose:Orally 5–100 mg/day, adjusted
Cautions, Contraindications, Side- according to response; ELDERLY:
effects, and Interactions: See under initially half of adult dose. CHILD: initially
Flupenthixol 25-50 micrograms/kg daily; adolescents
Interactions: See Appendex-2 up to 30 mg daily
Dose: By deep intra-muscular injection By intramuscular injection 2–10 mg,
into the gluteal muscle, initial test dose subsequent dose given every 6–8 hours
20 mg, then after at least 7 days, 20-40 according to response, to a maximum of
mg repeated at intervals of 2 to 4 weeks, 60mg daily; CHILD:Not recommended
adjusted according to response, max. Depot Injection (as Haloperidol
400 mg weekly; usual maintenance dose Decanoate) by deep intramuscular
50-100 mg every 4 weeks injection into the gluteal muscle initially
ELDERLY: Initially quarter to half the 50 mg every 4 weeks, if necessary
adult dose; increasing gradually up to 200 mg every
CHILD: Not recommended 4 weeks
Proprietary Preparation Proprietary Preparations

G-haloperidol(Gonoshasthaya), Tab., 5mg,
Fluanxol(I)(Lundback), Inj. 20 mg/ml,
Tk349.15./amp, 40 mg/2 ml; Tk.511.08/amp; Tk.0.49/Tab.
Halop(Opsonin), Tab., 5 mg, Tk. 1.00/Tab.
Haloperidol(Albion), Tab., 5 mg, Tk.1.00/Tab.
FLUPHENAZINE DECANOATE[ED] Halopid(Incepta), Inj., 5mg/ml, Tk. 10.80/1 ml
Amp; Tab., 5 mg, Tk.1.00/Tab.
Indications: Maintenance therapy of Peridol(Square), Tab.,5 mg, Tk. 1.01/Tab.
Perigen(General), Inj., 5mg/ml, Tk. 12.03/1ml
schizophrenia and other psychoses
Amp; Tab., 5mg, Tk. 1.00/Tab.
274
Perol(Ambee), Tab., 5 mg, Tk. 0.51/ Tab.; Inj., lty, exacerbation of Parkinson’s disease,
5 mg/5 ml, Tk. 10.04/1 ml Amp akathisia, asthenia, increased appetite,
raised triglyceride concentration, oede-
LITHIUM CARBONATE[ED] ma, hyperprolactinaemia (but clinical
manifestations are rare), occasionally
Indications: Treatment and prophylaxis blood dyscrasias, rarely bradycardia,
of mania, bipolar mood disorder and rash, photosensitivity, diabetes mellitus,
recurrent depression; impulsive aggre- priapism, hepatitis, pancreatitis
ssive or self-mutilating behavior; see Dose: Schizophrenia, combination
also notes above therapy for mania, ADULT: Over 18
Cautions: Fever, sweating, driving, years, 10 mg daily adjusted to usual
alcohol. To be used only under the range of 5-20 mg daily; doses greater
supervision of a specialist than 10 mg daily only after
Contra-indications: Cardiac, renal, reassessment
thyroid or neurological dysfunction, blood Monotherapy for mania, ADULT over 18
dyscrasia, pregnancy and lactation years, 15 mg daily adjusted to usual
Interactions: See Appendix-2 range of 5-20 daily; doses greater than
Side- 15 mg only after reassessment
effects:Hypersalivation,anxiety,drowsine Note. When one or more factors (e.g.
ss, malaise, polyuria, polydipsia, female gender, elderly, non-smoker) are
delirium, hypothyridism, nausea, present that might result in slower
vomiting, diarrhoea, and renal failure metabolism consider initial lower dose
Dose: 800–2000 mg/day.ELDERLY:400 then increase it gradually
mg to 1000 mg. CHILD: Not
recommended. Proprietary Preparations
Deprex(Square), Tab., 10 mg, Tk. 4.51/Tab.;
Proprietary Preparations 5 mg, Tk. 2.50/Tab.
Litiam(ACI), ER Tab., 400 mg, Tk. 5.02/Tab. Lopez(General), Tab., 10 mg, Tk. 4.53/Tab.; 5
Lithin(Incepta), SR Tab., 400 mg,Tk. 5/Tab. mg, Tk. 2.52/Tab.
Lithosun(Sun), SR Tab., 400 mg, Tk. Lopez(General), Tab., 10 mg, Tk. 4.52/Tab.; 5
5.05/Tab. mg, Tk. 2.51/Tab.
Lithium(Albion), SR Tab., 400 mg, Tk. Olanap(Incepta), Tab., 10 mg, Tk. 4.5.00/Tab.;
5.05/Tab. 5 mg, Tk. 2.50/Tab.
Olanor(Beacon), Tab.,5 mg, Tk. 2.50/Tab.; 10
mg , Tk. 4.50/Tab.
OLANZAPINE(Atypical antipsychotic drug. Olanza(Albion), Tab., 10 mg, Tk. 4.52/Tab.
Effective against both positive and negative
Oleanz(Sun), Tab., 10 mg, Tk. 4.55/Tab.; 5
symptoms)
mg, Tk. 2.55/Tab.
Pericam(Beximco), Tab., 10 mg , Tk.
Indications: Schizophrenia, treatment of 2.51/Tab. ; 5 mg , Tk. 1.50/Tab.
moderate to severe episodes of mania, Xytrex(ACI), Tab., 10 mg, Tk. 4.53/Tab.; 5 mg,
drug induced psychosis in Parkinsons Tk. 2.52/Tab.
Disease.
Cautions: Pregnancy, prostatic hypert- PROCHLORPERAZINE
rophy, paralytic ileus, hepatic or renal (See section 7.5)
impairment, diabetis mellitus (risk of
exacerbation or ketoacidosis), low leuc- Indications: Schizophrenia, emesis (see
ocyte or neutrophil count, bone marrow also section 7.5.4.1)
depression, hypereosinophilic disorders, Contra-indications: Parkinsonism, liver
myeloproliferative disease, Parkinson's disease
disease Interactions: See Appendix-2
Contra-indications: Angle closure Side-effects: Sedation, EPS
glaucoma and breast-feeding Dose: Orally, short-term management of
Interactions: See Appendix-2 psychomotor agitation, 100–200 mg 4
Side-effects:Mild, transient antimuscar- times daily; CHILD:Not recommended.
inic effects; drowsiness, speech difficu- As antiemetic: 5-15 mg daily
275
By intramuscular injection, for short-term QUETIAPINE (Atypical antipsychotic drug)

adjunctive management of psychomotor
agitation, 50 mg (25 mg in elderly), Indications: Acute manic depression
repeated if necessary. CHILD: Not inBipolar disorderas monotherapy or
recommended adjunct to Lithium & Valproic acid,
Schizophrenia,Major depressive
Proprietary Preparations disorder,Alzheimer's disease,psychosis
Almetil(Albion), Tab. , 5 mg, Tk. 0.30/Tab. Cautions :Behavioral disorders in
Ametil(Aristo), Tab., 5mg , Tk. 0.30/Tab.
Avotil(Rephco), Tab. , 5 mg, Tk. 0.30/Tab.
elderly patients with dementia, less than
Emitab(Sonear), Tab., 5 mg, Tk. 0.46/Tab. 18 years old.
Promtil(Square), Tab. , 5 mg, Tk. 0.45/Tab. Contra-indications: Hypersensitivity to
Stemetil(Sanofi), Tab., 5mg, Tk. 0.46/Tab. quetiapine
Vergon(Opsonin), Inj., 12.5 mg/ml, Tk. 5.01/ Interactions:See Appendix-2
Amp; Tab, 5 mg, Tk. 0.46/Tab. Sideeffects:Drymouth,dizziness,headac
he,somnolence,constipation,asthenia,tre
PALIPERIDONE(Atypical antipsychotic drug) mor, peripheral oedema,Stevens-
Johonson syndrome
Indications: Used to treat schizophrenia Dose: ADULT:50 mg daily for bipolar
andschizoaffective disorder. disorder;25 mg orally once a day
Cautions:Patients with diabetes mellitus forSchizophrenia
should be monitored regularly for
worsening of glucose control. Should not Proprietary Preparations
be used Patients in severely psychotic Qmax(ACI), Tab., 25mg, Tk. 3.01/Tab.,
100mg, Tk. 10.03/Tab.
state,knowncardiovascular disease Qpine(Sanofi), Tab., 100mg, Tk. 10.07/Tab.,
hypotension,seizures , renal impairment 200mg, Tk. 18.05/Tab., 25mg, Tk. 3.02/Tab.
Contra-indications: Known Qpine(Sanofi), Tab., 100 mg, Tk. 10.04/Tab.;
hypersensitivity to paliperidone, 200 mg, Tk. 18.00/Tab.;25 mg, Tk. 3.01/Tab.
risperidone. Quetinil(Albion), Tab.,100 mg, Tk.10.50/Tab.
Side-effects: Allergic reaction; Adults Quiet(Incepta), Tab., 100 mg, Tk. 10/Tab.,
with schizophrenia: extrapyramidal 25mg, Tk. 3.00/Tab., 200 mg, Tk. 8.00/Tab.
Qutap(Healthcare), Tab., 100mg, Tk. 10/Tab.,
symptoms, tachycardia, and akathisia. ;
25mg, Tk. 3.00/Tab.
Adolescents with schizophrenia: Qutipin(Sun), Tab., 100mg, Tk.10.05/Tab.;
somnolence, akathisia, tremor, dystonia, 25mg, Tk. 3.00/Tab.
cogwheel rigidity, anxiety, weight Seropin(Eskayef), Tab., 25mg, Tk. 3/Tab.,
increased, and tachycardia. 100mg, Tk. 10.00/Tab., .
Dosage: 150 mg on treatment day 1 and Seroquet(UniMed), Tab., 100mg,Tk. 10/Tab.,
100 mg one week later (day 8),both 25mg, Tk. 3.00/Tab.
Tiapine(General), Tab., 50mg, Tk. 7.00/Tab.,
administered in the deltoid muscle in 200mg, Tk. 20.00/Tab., 25mg, Tk. 3.01/Tab.,
order to attain therapeuticconcentrations 100mg, Tk. 10.07/Tab.
rapidly.Consult product literature
Note: used for the short-term treatment
RISPERIDONE
of schizoaffective disorder in adults and
for the treatment of schizophrenia in
adults and in adolescents (12-17 years Indications: Acute and chronic
of age). psychoses, especially for psychoses in
which both positive and negative
Proprietary Preparations symptoms are present
Invega(I)(Janssen) Inj.75m,Tk.9093.18 / P.F Cautions: Parkinson’s disease; pregna-
Syringe;100mg Tk.9093.18 / P.F ncy; hepatic or renal impairment
Syringe;150mg Tk.9093.18/P.F Syringe; Contra-indications: Breast-feeding
Palimax(ACI) Tab., 1.5mg, Tk. 4.00/Tab.; Interactions: See Appendix-2
3mg, Tk. 7.00/Tab.; 6mg, Tk. 10.00/Tab. Side-effects:Insomnia, agitation,
anxiety, headache, drowsiness, impaired
concentration, fatigue, blurred vision,
276
constipation, nausea and vomiting, Cautions: Pregnancy and lactation

dyspepsia, abdominal pain, hyperprola- Contra-indications: Parkinsonism,
ctinaemia (with galactorrhoea, menstrual depression, blood dyscrasia, liver
disturbances, amenorrhoea, gynaecom- disease, tardive dyskinesia, neuroleptic
astia), sexual dysfunction, priapism, malignant syndrome,
urinary incontinence, tachycardia, hyper- pheochromocytoma
tension, rash, rhinitis, cerebrovascular Interactions: See Appendix-2
accidents, neutronpenia and thrombo- Side-effects: Sedation, hypotension,
cytopenia EPS, galactorrhoea, amenorrhoea
Dose: 2 mg in 1-2 divided doses on first Dose: 200 - 400 mg twice daily
day, then 4 mg in 1-2 divided doses on ELDERLY: Low initial dose to be
second day (slower titration appropriate increased gradually according to
in some patients); usual dose range 4-6 response. CHILD: Under 14 years not
mg daily; doses above 10 mg daily only recommended
if benefit considered to outweigh risk
(max. 16 mg daily). ELDERLY (or in Generic Preparation
hepatic or renal impairment), initially 500 Tablet, 200mg
micro-grams twice daily to 1-2 mg twice
daily. CHILD:Under 15 years not TRIFLUPERAZINE
recommended
Indications: Schizophrenia and other
Proprietary Preparations psychoses; short-term management of
Frenia(Incepta), Tab. , 1 mg, severe anxiety
Tk.2.00/Tab.;2mg, Tk. 3.00/Tab. ; 4 mg,
Contra-indications: Parkinsonism,
Tk.5.50/Tab.
Resco(Drug Intl), Tab., 1mg, Tk. 1.55/Tab., blood dyscrasia, liver disease
2mg, Tk. 2.05/Tab. Interactions:See Appendix-2
Residon(Healthcare), Tab., 1mg , Tk. Side-effects: Sedation, hypotension,
3.00/Tab., 2mg, Tk.5.00/Tab., 4mg , Tk. extrapyramidal symptoms, dry mouth,
9.00/Tab. constipation, tachycardia, galactorr-
Riscord(General), Tab. , 1mg, Tk. 2.50/Tab., hoea, amenorrhoea, impaired ejacu-
2mg, Tk. 5.00/Tab., 4mg, Tk. 8.00/Tab.
lation, cardiac arrhythmia
Risdon(UniMed), Tab , 1mg, Tk. 3.00/Tab.,
2mg, Tk. 5.00/Tab., 4mg, Tk. 9.00/Tab. Dose:Schizophrenia and Psychoses:
Rislock(Albion), Tab. , 1 mg, Tk.1.50/Tab.; initially 5 mg twice daily (half in the
2 mg , Tk.3.00/Tab.; 4 mg , Tk.9.00/Tab. elderly), increased by 5 mg after one
Risomax(ACI), Tab., 1mg, Tk. 3.00/Tab., 2mg, week, then at intervals of 3 days,
Tk. 5.00/Tab., 4mg, Tk. 9.00/Tab. according to response, maximum 60mg
Rispa(Orion), Tab., 1 mg, Tk. 3.01/Tab., 2 mg, daily.
Tk. 5.01/Tab.
Short-term adjunctive for management of
Risperdalconsta(I)(Cilag),Inj.,25mg/vial,Tk.
9413.42/vial; 37.50mg /vial,Tk. 12521.23/vial; severe anxiety, 2–4 mg daily in divided
50mg /vial,Tk18826.82/vial doses
Risperdex(Opsonin), Tab., 1 mg , Tk.
1.51/Tab., 2 mg , Tk. 2.01/Tab. Proprietary Preparations
Risperdex(Opsonin),Tab., 1 mg , Flurazine(Incepta), Tab., 1 mg, Tk. 1.50/Tab.;
Tk.1.14/Tab.; 2 mg, Tk.1.51/Tab. 5 mg, Tk. 2.50/Tab.
Rispolux(Novartis), Tab. , 1 mg, Tk.3.20/Tab.; Sizonil(Healthcare), Tab., 1mg, Tk. 2.00/Tab.;
2 mg, Tk.6/Tab. ; 4 mg, Tk. 9.20/Tab. 5mg, Tk. 3.5.00/Tab.
Sizodon(Sun), Tab. , 1 mg, Tk.3.00/Tab.; 2 Stela(Delta), Tab., 1 mg, Tk.1.50/Tab.; 5 mg,
mg, Tk.6.00/Tab.; 4 mg, Tk.9.00/Tab. Tk. 2.50/Tab.
Sperdal(Sanofi), Tab., 2mg, Tk. 5.02/Tab., Telazine(Eskayef), Tab., 5mg, Tk. 3.00/Tab.;
1mg, Tk. 3.01/Tab., 4mg, Tk. 8.02/Tab., 1mg, Tk. 2.00/Tab.
Syrup, 1mg/ml, Tk. 15.00/Bottle;
Trifluoperazine HCl+ Isopropamide iodide
SULPIRIDE Telabid(Eskayef), Tab., 1 mg+5 mg, Tk.
2.00/Tab.; 2 mg + 5 mg, Tk. 3.00/Tab.
Indications: Schizophrenia
277
ZUCLOPENTHIXOL DECANOATE B. Serotonin Noradrenaline re-uptake

inhibitors (SNRIs,)
Indications: Psychoses, especially schi- -SNRIs : Duloxetine, Venlafexine,
zophrenia with agitation and aggression -Tricyclic Antidepressants: Amitriptyline,
Contraindications, Side-effects & Nortriptyline, Imipramine,
Cautions: As for chlorpromazine HCl Clomipramine
Interactions: See Appendix-2 C.Serotonin receptor modulator:
Dose: By deep intramuscular injection Trazudone, Nefuzudone
into the upper outerbuttock or lateral D.Monoamine-oxidase inhibitors or
thigh, test dose 100 mg, followed after at MAOIs (e.g. Phenelzine, and Selegiline
least 7 days by 200–500mg or more, E. Others: Bupropion, Mitrazapine,
repeated intervals of 1–4 weeks, Amoxapine, Meprotyline
adjusted according toresponse; max.
600 mg weekly; ELDERLY quarter to Cautions: Hyponatraemia has been
half of usual starting dose; associated with all types of antidepre-
Note: CHILD: Not recommended. ssants (especially in the elderly and
possibly due to inappropriate secretion
Proprietary Preparations of antidiuretic hormone), and should be
Clopixol Depot (I) (Lundback), Inj. 200mg/1ml. considered in all patients who develop
Tk.511.08/vial drowsiness, confusion or convulsions
Clopixol Acuphase (I)(Lundback), Inj. while taking an antidepressant drug.
50mg/2ml. Tk.736.82/vial;50mg/ml;
Tk.552.61/vial
SELECTIVE SEROTONIN (5-HT)
REUPTAKE INHIBITORS
ZUCLOPENTHIXOL
HYHDROCHLORIDE
Selective serotonin (5-HT) re-uptake
inhibitors (SSRIs) such as Citalopram,
Indications, Side-effects& Contra- Fluoxetine(see sec 7.9)Paroxetine and
Indications:As under Chlorpromazine Sertraline are effective as
hydrochloride. antidepressants. SSRIs are less
Interactions: See Appendix-2. sedative and have fewer antimuscarinic
Dose: Orally,initially 20-30 mg daily in and cardiotoxic side effects than tricyclic
divided doses, increasing to a max. of antidepressants.
150 mg daily if necessary; usual Cautions: Should be avoided in patients
maintenance dose 20-50 mg daily. with epilepsy (prolonged seizures
ELDERLY or Debilitated: initially quarter reported with Fluoxetine). SSRIs should
to half of the adult dose. not be used if the patient enters a manic
CHILD: Not recommended. phase. These drugs may also interfere
with performance of skilled tasks (e.g.
Copixol(I)(Lundback), Tab. 10mg., Tk.8.05/Tab driving).
(Depot Injection:see under Zuclopenthixol Interactions: Citalopram, Fluoxetine,
Decanoate below). Sertaline should not be started until 2
weeks after stopping an MAOI.
7.3 ANTIDEPRESSANT DRUGS Conversely, an MAOI should not be
started until at least a week after these
The major drugs that are used to treat drugs have been stopped.
Depressive illness, Neuropathic pain,
Migraine Prophylaxis.Depending on CITALOPRAM
moleculer target, antidepressants are
sub-grouped as follows: Indications: Depressive illness, panic
A.Selective serotonin (5-HT) re-uptake disorder
inhibitors or (SSRI,): Citalopram, Cautions: Epilepsy (bleeding disorders
Fluoxetine, Sertraline (especially gastro-intestinal bleeding),
278
hepatic and renal impairment, pregnancy daily increase to 10mg daily after 7 days,
and breast-feeding;see also notes above maximum 20mg daily
Contra-indications: Should not be used
if the patient enters a manic phase Proprietary Preparations
Interactions:See notes above;see also Acipam(Ibn Sina), Tab., 10mg, Tk.
appendix-2 10.00/Tab.; 5mg, Tk. 5.00/Tab.
Andepram(Radiant), Tab., 10mg , Tk.
Side-effects: Palpitations, tachycardia, 12.00/Tab.; 5mg , Tk. 7.00/Tab.
postural hypotension, coughing, yawn- Citalam(ACI), Tab., 10mg, Tk. 12.00/Tab.;
ing, confusion, impaired concentration, 5mg, Tk. 7.00/Tab.
amnesia, migraine, paraesthesia, taste Citalex(Opsonin), Tab. , 10 mg , Tk.
disturbance, increased salivation, 8.03/Tab.; 5 mg, Tk. 5.50/Tab.
rhinitis, tinnitus, and micturation Citalon(Popular), Tab., 10mg, Tk. 10.00/Tab.;
disorders have been reported 5mg , Tk. 6.00/Tab.
Elodep(Acme), Tab. , 10 mg , Tk. 10.03/Tab.;
Dose:Depressive illness, 20 mg daily as 5 mg, Tk. 5.52/Tab.
a single dose in the morning or evening, Epram(Albion), Tab., 10 mg, Tk. 10.00/Tab.; 5
increased if necessary up to 60 mg daily; mg, Tk. 5.52/Tab.
ELDERLY, maximum 40 mg daily; Esipram(Incepta), Tab. , 10 mg, Tk.
CHILD, Not recommended 10.00/Tab.; 5 mg, Tk. 5.50/Tab.
Panic disorder, initially 10 mg daily Esita(Healthcare), Tab., 5 mg, Tk. 7.00/Tab.;
increased to 20 mg after a week, usual 10 mg, Tk. 12.00/Tab.
Expres(Sanofi), Tab., 10mg, Tk. 12.00/Tab.;
dose 20-30 mg daily; CHILD, not 5mg, Tk. 7.00/Tab.
recommended Losita(Eskayef), Tab, 10mg, Tk. 10.00/Tab.;
5 mg, Tk. 6.00/Tab.
Proprietary Preparations Meliva(Jayson), Tab., 10mg, Tk. 8.06/Tab.
Arpolax(Incepta), Tab. 20 mg, Tk. 8.00/Tab. Nexcital(UniMed), Tab, 10mg , Tk.
Citapram(General), Tab. 10 mg,Tk. 10.00/Tab.; 5mg , Tk. 5.50/Tab.
5.04/Tab.;Tab. 20 mg,Tk. 8.05/Tab. Nexito(Sun), Tab., 10 mg, Tk.10/Tab.; 5mg,
Tk. 5.50/Tab.
ESCITALOPRAM Oxapro(Square), Tab., 10 mg, Tk.
10.03/Tab.; 5 mg, Tk. 5.54/Tab.
S-citapram(General), Tab, 10mg, Tk.
Indications: Depressive illness, panic 10.07/Tab.; 5mg, Tk. 7.03/Tab.
disorder, social anxiety disorder Seropam(Beximco), Tab., 10 mg, Tk. 8/Tab.;
Cautions: Epilepsy, history of mania, 5 mg, Tk. 5.50/Tab.
cardiac disease, diabetes mellitus, angle Talopram(Navana), Tab., 10 mg, Tk.
closure glaucoma, hepatic impairment, 9.00/Tab.; 5 mg, Tk. 5.30/Tab.
renal impairment, breast feeding, abrupt
withdrawal should be avoided FLUOXETINE
Contraindications: Should not be used
if the patient enters a manic phase. Indications: See under dose
Adolescent & Child under 18 yrs not Cautions:Epilepsy (avoid if poorly
recommended controlled, discontinue if convulsions
Interactions :See Appendix-2 develop), concurrent electroconvulsive
Side-effects: Nausea, vomiting, therapy, history of mania, cardiac
dyspnoea, abdominal pain, diarrhoea, disease, diabetes mellitus, angle-closure
constipation, anorexia with weight loss glaucoma, concomitant use of drugs that
and hypersensitivity reactions possibly increase risk of bleeding, history of
associated with vasculitis,risk of Suicidal bleeding disorders (especially gastro-
thinking and behavior intestinal bleeding), hepatic and renal
Dose :Depressive illness, 10mg once impairment, pregnancy and breast-
daily, increased if necessary to max feeding
20mg daily; elderly initially half the adult Contra-indications: Should not be used
dose, lower maintenance dose may be if the patient enters a manic phase.
sufficient; panic disorder, initially 5mg Interactions: See notes above
279
Side-effects:Possible changes in blood Side-effects: nausea, diarrhea, gas,

sugar, fever, neuroleptic malignant loss of appetite; increased sweating,
syndrome-like event; also reported (no palpitation, tachycardia, malasi
causal relationship established), abnor- Dose: 50mg increase to 300mg in steps.
mal bleeding, aplastic anaemia, haem-
olytic anaemia, cerebrovascular Proprietary Preparation
aceident, ecchymoses, eosinophilic Relafin(General), Tab., 50mg, Tk. 15.11/Tab.
pneumonia, gastrointestinal
haemorrhage, pancre-atitis, MILNACIPRAN
pancytopenia, thrombocytopenia,
thrombocytopenic purpura, vaginal blee- Indications: Depression, fibromyalgia
ding on withdrawal, risk of Suicidal Cautions: Delirium, psychosis
thinking and behavior, Contra-indications: Known hypersen-
hair loss have been also reported. sitivity, patients under 15 years of age,
Hypersensitivity including angioedema advanced renal disease,BPH,
and other allergic reactions have also hypertension and heart disease,open
been reported angle glaucoma,pregnancy
Dose:Depressive illness, 20 mg daily, Interactions: See Appendix-2
CHILD:Not recommended. Bulimia Side-effects: Nausea, headache,
nervosa, 60 mg daily; CHILD not constipation, dizziness, insomnia, hot
recommended flush, hyperhidrosis, palpitations, dry
Obsessive-compulsive disorder, initially mouth and hypertension
20 mg daily; may be increased if no Dose: ADULT: Initial dose on day 1:
response after several weeks; maximum 12.5 mg once daily
60 mg daily; CHILD not recommended. Days 2 and 3: 12.5 mg twice daily
Premenstrual dysphoric disorder, 20 mg Days 4 through 7: 25 mg twice daily
daily for 6 months, then reassess for After day 7: 50 mg twice daily
benefit before continuing.
LONG DURATION OF ACTION. Long Proprietary Preparations
half-life of Fluoxetine should be Milran(Beacon), Tab., 12.50 mg, Tk.
considered when adjusting dosage (or in 6.02/Tab.; 50 mg, Tk. 15.05/Tab.
Neocipran(Ibn Sina), Tab., 50 mg, Tk.
overdosage)
15.50/Tab.
Fluoxetine(Albion), Cap., 20 mg, Tk. PAROXETINE
2.58/Cap.
Modipran(Beximco), Cap., 20 mg, Tk. Indications: Depression, obsessive-
2.89/Cap. compulsive disorder, post-traumatic
Nodep(General), Cap., 20 mg, Tk. 2.81/Cap.
Nodepress(Kemiko), Cap., 20 mg, Tk.
stress disorder and premenstrual
2.60/Cap. dysphoric disorder
Oxetin (Decent), Cap., 20mg, Tk. 2.88/Cap. Contra-indications: Pregnancy and
Prodep(Sun), Cap., 20 mg, Tk. 3.01/Cap. patients under 18 years of age.
Prolert(Square), Cap., 20 mg, Tk. Side-effects:Belching,decreased
3.01/Cap.;Syrup, 20 mg/5 ml, Tk. 60/50ml appetite,decreased sexual ability,
heartburn, tenderness around the eyes
FLUVOXAMINE and cheekbones,unusual
drowsiness,risk of Suicidal thinking and
behavior
Indications: Depressive illness,
Dose: Initial dose: 20 mg orally once a
Compulsive disorder, tension headache.
day with or without food, usually in the
Cautions: History of mania, seizure,
morning. Maintenance dose: 20 to 50 mg
diabetes, glaucoma, breast feeding,
orally once a day with or without food,
pregnancy, hepatic impairment, skilled
usually in the morning.
perfomance (driving)
Contra-indications: See notes above
280
Proprietary Preparations Andep(Healthcare), Tab., 100 mg , Tk.
Oxat(Square), Tab., 20 mg, Tk. 12.03/Tab. 10.00/Tab., 25 mg , Tk. 5.00/Tab., 50mg Tab.,
Panirid(Incepta), Tab.,10 mg, Tk. 9.50/Tab. Tk. 5.50/Tab.
Parotin(ACI), Tab, 10 mg, Tk. 6.04/Tab., Atralin(Beximco), Tab. 50 mg, Tk. 5.00/Tab.
20mg, Tk. 10.07/Tab. Chear(ACI), Tab., 100 mg, Tk. 10.07/Tab., 25
Paroxet(Jayson), Tab., 20mg, Tk.9.06/Tab. mg, Tk. 3.02/Tab., 50 mg, Tk. 6.04/Tab.
Mudiral(Opsonin), Tab., 50 mg , Tk.
6.02/Tab., 25 mg , Tk. 3.01/Tab.
SERTRALINE Repose(Incepta), Tab., 100 mg, Tk.
9.50/Tab., 50 mg, Tk. 6.00/Tab., 25 mg, Tk.
Indications: Depressive illnesses; see 3.00/Tab.
also under dose Sartra(Pacific), Tab., 50 mg, Tk. 4.51/Tab.
Cautions:Epilepsy concurrent Selotin(White Horse),Tab., 50 mg, Tk.
5.00/Tab.
electroconvulsive therapy, history of
Serlin(Ibn Sina), Tab., 25 mg, Tk. 3.00/Tab.;
mania, cardiac disease, diabetes Tab., 50 mg, Tk. 6.00/Tab.
mellitus, angle-closure glaucoma, Serolux(Novartis), Tab., 100 mg, Tk.
concomitant use of drugs that increase 11.10/Tab.; 25 mg, Tk. 4.00/Tab. ;Tab., 50
risk of bleeding, history of gastro mg, Tk. 7.00/Tab.
intestinal bleeding; heaptic and renal Sertal(Drug Intl),Tab., 100 mg, Tk. 8.05/Tab.,
impairment, pregnancy and breast- 25 mg, Tk. 3.05/Tab., 50mg, Tk.6.04/Tab.
Sertalin(Popular), Tab., 50 mg, Tk. 6.02/Tab.
feeding; may impair performance of
Sertlin(Albion), Tab.50 mg, Tk. 6.00/Tab.
skilled tasks (e.g. driving),risk of Suicidal Setra(General), Tab., 100 mg, Tk. 10.07/Tab.
thinking and behavior Zosert(Sun), Tab., 100 mg, Tk.10/Tab.;25mg,
Interactions: See notes above Tk. 3.00/Tab.;50 mg, Tk. 6.00/Tab.
Side-effects: Tachycardia, confusion,
amnesia, aggressive behaviour, psycho- TRIMIPRAMINE
sis, pancreatitis, hepatitis, jaundice, liver
failure, menstrual irregularities, Indications: Depressive illness with
paraesthesia; thrombocytopenia sedative effect
Contra-indications: Should not be used Dose: Initially 50-75mg at bed time to
if patient enters a manic phase 150-300mg.Elderly: 10-25mg three time
Dose:Depressive illness, initially 50 mg daily
daily, increased if necessary by
increments of 50 mg over several weeks Proprietary Preparation
to maximum 200 mg daily; usual Surmontil (Sanofi), Tab. 25 mg
maintenance dose 50 mg daily;
CHILD:Not recommended TRAZODONE
Obsessive-Compulsive Disorder: for
ADULT and ADOLESCENT over 13
Indications: Depression when sedation
years, initially 50 mg daily, increased if
is required
necessary in steps of 50 mg over several
Cautions:Epilepsy history of psycosis,
weeks; usual dose range 50-200 mg
cardiac disease,history of bipolar
daily; CHILD 6-12 years initially 25 mg
disesse,cardiovascular disease, angle-
daily, increased to 50 mg daily after 1
closure glaucoma,urinary retantion
week, further increased if necessary in
heaptic and renal impairment, pregnancy
steps of 50 mg at intervals of at least 1
and breast-feeding
week (max. 200 mg daily); CHILD under
Contra-indications:Age less then
6 years not recommended
18year,may provoke suicide thinking,
Post-traumatic stress disorder, initially
Serotonin syndrome
25 mg daily, increased after 1 week to
Side-
50 mg daily; if response is partial and if
effects:Nausea,somnolence,constipatio
drug is tolerated, dose is increased in
n,myalgia
steps of 50 mg over several weeks to
max. 200 mg daily
281
Dose: Age over 18year 50mg daily CLOMIPRAMINE

increase at 3-40 interval to maximum
400mg daily Indications: Depressive illness,
obsessional state, catalepsy
Generic Preparation Cautions:Purpura, thrombocytopenia),, a
Tablet,50mg sthma, chronic bronchitis angle-closure
glaucomatype),arrhythmias, coronary
SEROTONIN NORADRENALINE RE- artery disease, recent heart attack,
UPTAKE INHIBITORS (SNRIS,) Interactions: MAO inhibitors
anticholinergics drug "blood thinners"
AMITRIPTYLINE HCl[ED] such as warfarin/heparin, anti-
platelet drug
Indications: Depressive illness, mixed includingaspirin or NSAIDs such
anxiety with depression, nocturnal as ibuprofen
enuresis in children Side-effects: Abdominal pain,
Cautions: Cardiac disease, pregnancy, hypotension, muscle weakness
history of mania Dose: Age over18 over-10mg, increase
Contra-indications: Recent myocardial to 30-150mg in divided doses
infraction, arrhythmia, liver disease,
manic phases, renal failure, enlarged
Anafranil (Novartis)Tab., 25 mg, Tk. 5.01/Tab
prostate, co-administration with MAO Tk. 9.25/Tab
inhibitors Timex(Orion), Tab., 25 mg, Tk. 5.01/Tab.
Side-effects:Dry mouth, sedation,
DOXEPIN
blurred vision, increased intraocular
pressure, constipation, nausea, difficulty (See alsosection12.5)
in micturition, cardiovascular side
effects, ECG changes, arrhythmia, Indications:Depressive illness, when
postural hypotension, tachycardia, sedation is required, Pruritus
syncope particularly with high dose, Side-effects: Abdominal pain,
hypersensitivity reactions, hypomania or stomatitis, flushing, edema
mania, confusion (particularly in elderly), Dose:Age over 12year : 75mg daily in
disturbances in sexual function divided dose, or at single dose at bed
Dose: By mouth initially 75 mg daily in time.
divided dose or as a single dose at bed
time (in ELDERLY 30-50 mg daily). Somopin(Incepta), Tab., 3 mg, Tk.
Increased gradually as necessary to 6.00/Tab.; 6 mg, Tk. 10.00/Tab.
maximum 150mg Slipaid(Beacon), Tab., 3 mg, Tk. 6.00/Tab.;
CHILD:Nocturnal enuresis 7–10 years: 6mg, Tk. 10.00/Tab.
10-20 mg at night; 11–16 years: 25-
50mg at night. DULOXETINE
Proprietary Preparations Indications: Depressive illness

Amilin (Opsonin), Tab., 10 mg , Tk. 0.85/Tab.; Cautions,Side-effects,contra-
25 mg, Tk. 1.75/Tab. indicaton:See section 5.2.4
Amit (General), Tab., 10mg, Tk. 0.85/Tab.;
25mg, Tk. 1.76/Tab.
Dose: ADULTt >18year 30-60mg as a
Reptylin(Albion), Tab., 10 mg, Tk. 0.55/Tab.; single dose.
25 mg, Tk. 1.00/Tab.
Tryptin (Square), Tab., 10 mg, Tk. Proprietary Preparations
0.85/Tab.;25 mg, Tk. 1.76/Tab. Deloxi(Eskayef), Cap., 20 mg, Tk. 7/Cap.;
30mg, Tk. 18.00/Cap.
Diliner(Square),DR Cap., 60mg,
Tk.16.11/Cap.
282
Dulox(Acme), Tab., 30 mg, Tk. 10.07/Tab.; prostate hypertrophy, pregnancy,

20mg, Tk. 7.04/Tab. lactation, liver disease
Duloxen(Incepta), Tab., 20 mg, Tk. 7/Tab.; 30 Interactions: MAOIs, anti-
mg, Tk. 10.00/Tab.
Loxetine(ACI), Tab., 20mg, Tk. 7.00/Tab.;
hypertensives, sympathyomimetics,
30mg, Tk. 10.00/Tab. anticholinergic agents, anticonvulsants,
Stresin(UniMed), Cap., 20mg, Tk. 8.00/Cap.; alcohol, antico-agulants, antidiabetics,
30mg, Tk. 12.00/Cap. epilepsy; also see Appendix-2
Xinolax(Opsonin), Cap., 60 mg, Tk. Side-effects:Sedation, postural hypote-
16.05/Cap.; 30 mg , Tk. 10.00/Cap. nsion, inhibition of ejaculation, reflex
tachycardia, nasal congestion, weight
IMIPRAMINE HYDROCHLORIDE gain, drowsiness, constipation, dry
mouth, fine tremor, akathisia, headache,
Indications:Depressive disorder, panic lowering of seizure threshold, less
disorder, phobic disorder, enuresis, anticholinergic effects, disturbances of
attention deficit disorder, narcolepsy, cardiac conduction occasionally
chronic pain Dose: Initially 25 mg once daily, then
Cautions: Pregnancy, administration increasing gradually according to
along with MAO inhibitors therapeutic response up to 75-150 mg
Contra-indications:Myocardial daily. In elderly reduce to 75 mg daily
infarction, glaucoma, enlarged prostate, depending on the patient’s response.
liver disease More than 200 mg has been associated
Side-effects: Sedation, dry mouth, with a higher incidence of seizures than
tachycardia, constipation, decreased with the usual dosage of tricyclic
libido treatment
Interactions:See Appendix-2 Overdosage:Severe anticholinergicand
Dose: 75-300mg/day cardiotoxic effects such as
CHILD:Not recommended for use for ataxia,restlessness, drowsiness,
depression; for nocturnal enuresis, 7-11 convulsions, arrhythmia, convulsions,
years 25-50 mg, over 11 years 50-75mg hypotension, respiratory depression,
muscle twitching, stupor, coma. There is
Proprietary Preparations no specific antidote. Recommended
Depram(Square), Tab., 25 mg, Tk. 4.02/Tab. totransfer patient to the hospital for
Pinor(Aristo), Tab., 25 mg, Tk. 4.00/Tab. intensive care
Pramin(Incepta), Tab., 25 mg,Tk. 2.00/Tab.
Tofranil(Novartis), Tab., 25 mg, Tk. 5.50/Tab.
Ludiomil(Novartis), Tab. 25mg, Tk.6.50/Tab
MAPROTILINE HYDROCHLORIDE
NORTRIPTYLINE
It is a selective noradrenergic (NA)
uptake inhibitor, also having moderate Indications:Depressive disorders;
antihistaminic properties but has less nocturnal enuresis in
anticholinergic effects than imipramine. children,neuropathic pain
Indications: Depressive disorders Cautions: History of convulsion
where sedation is required, depression Contra-indications:Myocardial infarc-
of late onset, neurotic or reactive tion, enlarged prostate, pregnancy, liver
depression; depressive mood disorders disease, glaucoma, simultaneous admin-
characterized by anxiety, dysphoria, istration with MAO inhibitor
irritability, apathetic condition, bipolar Interactions:See Appendix-2
depressive disorder Side-effects: Sedation, dry mouth,
Contra-indications:Hypersensitivity to tachycardia, constipation, tremor,
the drug itself, epilepsy or lowered confusion
convulsive threshold; recent myocardial Dose: Depression, initial low dose
infarction, cardiac conduction defects increased as necessary to 75-100 mg
e.g., bundle branch block, glaucoma, daily in divided doses or as a single
283
dose; ELDERLY, 30-50 mg daily in Proprietary Preparations

divided doses Agotin(Beacon), Tab. , 25mg , Tk. 50.15/Tab.
Compound Preparation: Fluphenazine
HCl 0.5 mg + Nortriptyline 10 mg (per MIRTAZAPINE(Increase central
tablet) 2-3 time daily for 3 months. serotonergic, noradrenergic transmission)
For nocturnal enuresis, CHILD 7 years,
10 mg, 8-11 years 10-20 mg, over 11 Indications: Depressive illness (produce
years 25-35 mg at night; maximum sedation)
period of treatment 3 months; CHILD: Cautions: Epilepsy, hepatic and renal
Not recommended for depression in impairment, hypotension, history of
children. urinary retention and bipolar depre-
ssion, avoid abrupt withdrawal;
Proprietary Preparations pregnancy and breast-feeding
Nortin(Navana), Cap., 10 mg, Tk. 1.00/Cap.; Interactions: See Appendix-2
25 mg, Tk. 1.50/Cap.
Side-effects: Increased appetite and
Compound preparations (Fluphenazine weight gain, sedation; abnormal dreams,
hydrochloride 0.5 mg with nortriptyline tremor, myoclonus, paraesthesia,
hydrochloride 10 mg): arthralgia, myalgia, reversible
Amival-F(Amico), Tab., Tk. 2.01/Tab. agranulocytosis
Anflu(Alco), Tab. Tk. 0.75/Tab. Dose: Initially 15 mg daily at bed time
Apresin(Beximco), Tab., Tk. 1.05/Tab. increased according to response up to
Ateval(Ziska), Tab., Tk. 1.00/Tab.
45 mg daily as a single dose at bedtime
Euphor(Biopharma), Tab., Tk. 0.80/Tab.
Flutrip(General), Tab., Tk. 0.71/Tab. or in 2 divided doses; CHILD:Not
Fresh(Nipa), Tab., Tk. 0.80/Tab. recommended
Moodon(Ibn Sina), Tab., Tk. 1.00/Tab.
Norflu(Acme), Tab. Tk. 1.06/Tab. Proprietary Preparations
Norzin(Aristo), Tab., Tk. 1.05/Tab. Mirapin(Beacon), Tab., 15mg, Tk. 9.03/Tab.
Permival(Opsonin), Tab., Tk. 0.75/Tab. Mirez(Healthcare), Tab., 7.5mg, Tk. 6.50/Tab.;
Sanit(Square), Tab. Tk. 0.80/Tab. 15mg, Tk. 8.00/Tab.; 30mg , Tk. 15.00/Tab.
Mirtaz(Sun), Tab., 15 mg, Tk. 8.05/Tab.; 30
mg, Tk. 15.00/Tab.
OTHER ANTIDEPRESSANT DRUGS Mirzalux(Novartis), Tab., 15 mg, Tk.
10.00/Tab.; 30 mg , Tk. 18.00/Tab.
AGLOMELATINE(melatonin receptor agonist) Mitaprex(Incepta), Tab., 30 mg,
Tk.15.00/Tab.; 15 mg, Tk. 8.00/Tab.; 7.5 mg,
Tk. 6.00/Tab.
Indications: Major depression Mitrazin(General), Tab.,15mg, Tk. 8.05/Tab.;
Cautions: Bipolar disorder, mania or 30mg., Tk. 15.04/Tab.; 7.5mg, Tk. 6.50/Tab.
hypomania; concomitant use of drugs Rapine(ACI), Tab., 15mg, Tk. 8.00/Tab. ;
associated with hepatic injury; excessive 30mg, Tk. 15.00/Tab.; 7.5mg, Tk. 6.00/Tab.
alcohol consumption; obesity; diabetes; Resant(Drug Intl), Tab., 15mg, Tk. 6.00/Tab.
Contra-indications: dementia; Hepatic Trazapin(Albion), Tab., 15 mg, Tk. 8.00/Tab.
and Renal impairment,pregnancy ,
breast-feeding VENLAFAXINE
Side-effects:Nausea, vomiting,
diarrhoea, constipation, abdominal pain, Indications: Depressive illness, genera-
increased serum transaminases lised anxiety disorder
headache, dizziness, drowsiness, Cautions:History of myocardial
agitation, sleep disturbances, fatigue, infarction or unstable heart disease,
anxiety; back pain; sweating; less epilepsy, mania, hepatic or renal
commonly paraesthesia, blurred vision, impairment; glaucoma; avoid abrupt
and eczema withdrawal ;driving; diabetes; epilepsy;
Dose: ADULT over 18 years, 25mg at glaucoma; bleeding disorder
bedtime, increased if necessary after 2 Skin ReactionAdvise patients to contact
weeks to 50mg at bedtime doctor if rash, urticaria or related allergic
reaction develops.
284
Contra-indications: Severe hepatic or given.Disulfiram can be given as an

renal impairment; pregnancy and breast- adjunct to other treatments. High-dose of
feeding vitamin B1 (Thiamine) should be given
Interactions: See Appendix-2 during withdrawal syndrome.Multivitamins
Side-effects:nausea, constipation, dry may be given intravenously 8 hourly for 2
mouth, headache, insomnia, drowsiness, days followed by intramuscular injection
dizziness asthenia, nervousness, for the following 7 days.
sweating, sexual dysfunction; Opioid dependence: Methadone, an
hypertension, palpitations, dyspnoea, opioid agonist can prevent the onset of
chills, tinnitus, tremor, hypertonia, withdrawal syndrome due to opioids. It
psychiatric disturbances, increased should only be prescribed for those who
urinary frequency, arthralgia, myalgia, are physically dependenton opioids;
visual disturbances, ecchymoses, Buprenorphine can also be given.
photosensitivity, hyponatraemia; Before starting buprenorphine, the action
neuroleptic malignant syndrome, of opioids is to be blocked; it may be
Stevens-Johnson syndrome. given to former addicts to prevent
Dose: Depression, initially 75 mg daily in relapse of withdrawal syndrome.
2 divided doses, increased if necessary Nicotine replacement therapy and
after several weeks to 150 mg daily in 2 Bupropion are effective aids
divided doses
Severely depressed or hospitalized Cigarette smoking cessation:Nicotine
patients, initially 150 mg daily in 2 replacement therapy and Bupropion are
divided doses, increased if necessary in effective aiding to smoking cessation for
steps of up to 75 mg every 2-3 days to those smoking more than 10 cigarettes a
max. 375 mg daily, then gradually day. Bupropion has been used as an
reduced; ADOLESCENT and CHILD antidepressant but its mode of action in
under 18 years not recommended smoking cessation is not clear and may
involve an effect onnoradrenaline and
Proprietary Preparations dopamine neuotransmission. Nicotine
Veniz XR(Sun), XR Cap.,75 mg, Tk.10/Cap. replacement therapy is regarded as the
Venlax(General),Tab., 37.5mg,Tk.5.54/Tab;75 pharmacological treatment of choice in
mg, Tk.10.07/Tab. the management of smoking cessation.
DES-VENLAFOXINE BUPRENORPHINE
(Active metabolite of venlofexine)

Indications: Major depressive illness. Cautions, Contra-indications& Side-
Cautions,Side-effects: See under effects: See notes above and also
Venlafaxin under Bupropion
Dose: Tab 25,50,100mg Dosage: Oral ADULT Sublingual
Moderate to severe pain: 200-400 mcg
Proprietary Preparations 6-8 hourly.
Hapytab(Eskayef), ER Tab, 50 mg, Tk.
10.00/Tab. Proprietary Preparation
Nevola(Ziska), ER Tab. , 100 mg, Tk. Acron (ACI), Tab., 200mcg, TK. 10.07/Tab.
15.00/100mg,; 50 mg, Tk. 9.00/50mg Note: Consult product literature and
physician
7.4 DRUGS USED IN SUBSTANCE
DEPENDENCE(See Appendix-1e) BUPROPION(Block reuptake of dopamine
noradrenaline serotonin; Also block nicotine
receptor)
Alcohol dependence:Benzodiazepines
are drugs of choice for alcohol withdrawal
symptoms; diazepam 20mg 6 hourly over
a period of 5-7 days may be
285
Indications: Adjunct to smoking frequently used narcotic analgesic. It

cessation in combination with produces prompt but short-lasting
motivational support analgesia; it is less constipating, less
Cautions:Elderly, hepatic impairment, nauseating and causes less respiratory
measure blood pressure before and depression than morphine, but even in
during treatment high doses is a less potent analgesic. It
Contraindications:History of seizures, is mostly used during labour and in
of eating disorders and of bipolar postoperative painful conditions.
disorder; pregnancy and breast feeding Codeine is effective for the relief of mild
Interactions:See Appendix-2 to moderate pain but is used mainly for
Side-effects:Insomnia, tremor, dizzin- its cough suppressant property (see
ess, depression, hallucinations, memory section 4.6.1).
impairment, paraesthesia, in coordi- Tramadol is a relatively newer opioid
nation, Stevens JohnsonSyndrome derivative, which has fewer of the typical
Dose:Initially 1-2 weeks before target Side-effects than other opioids (notable,
stop date, initially 150 mg daily for 6days less respiratory depression, constipation
then 150 mg twice daily(maximum single and addiction).
dose 150 mg, maximum daily dose
300mg; minimum 8hours between MORPHINE SULPHATE[ED] [CD]
doses).
Indications:Postoperative painful
condition; pain in labour, myocardial
Depnox SR(Jayson), SR Tab. 150 mg,
Tk.10.06/Tab. infarction, acute pulmonary oedema, and
Zybex (Beximco) SR Tab. 150 mg, other acute pain of visceral origin
Tk.10.00/Tab. resistant to non-narcotic analgesics;
chronic pain in terminal illness
7.5 ANALGESICS Cautions: Hypotension, hypothyroidism,
asthma and decreased respiratory
7.5.1 OPIOIDS reserve, prostatic hypertrophy, pregna-
7.5.2 NON-OPIOIDS ncy and breast-feeding; hepatic and
7.5.2.1 PARACETAMOL renal impairment; elderly, epilepsy
7.5.2.2 ASPIRIN (ACETYLSALI-CYLIC Contra-indications: Acute respiratory
ACID) depression, acute abdomen, raised
7.5.2.3 OTHER NON-STEROIDAL intracranial pressure or head injury,
ANTI-INFLAMMATORY phaeochromocytoma
DRUGS (NSAIDS) Interactions: See Appendix-2
7.5.3 DRUGS USED IN NEURA- Side-effects:Nausea and vomiting,
LGIC/NEUROPATHIC PAIN constipation, drowsiness, respiratory
7.5.4 DRUGS USED IN MIGRAINE depression, hypotension, dry mouth,
7.5.4.1 ACUTE MIGRAINE ATTACK sweating, headache, facial flushing,
7.5.4.2 PROPHYLAXIS OF MIGRAINE vertigo, bradycardia, tachycardia, palpit-
ation, postural hypotension, hypother-
mia, hallucination, dysphoria, mood
7.5.1 OPIOIDS
changes, miosis, ureteric or biliary
(See also section 8.1.4.1)
spasm; severe dependence and
tolerance
Morphine is the most valuable narcotic Dose: Acute pain, by subcutaneous or
analgesic for severe pain, although it intravenous injection, 10 mg every 2-4
frequently causes nausea and vomiting. hours according to the need. Myocardial
It is the standard against which other infarction and pulmonary oedema, by
opioid analgesics are compared, and is slow intravenous injection (2 mg/minute)
mostly used in the treatment of severe 10 mg followed by a further 5-10 mg if
pain in the terminal conditions. necessary
Pethidine is probably the most
286
Proprietary Preparations require daily, around-the-clock, long-

G-morphine(Gonoshasthaya), Tab., 15 mg, term opioid treatment and for which
Tk. 14.00 /Tab.; Inj.,15 mg/ml, Tk. 40.00/1ml alternative treatment options are
Amp.
Morphine(Renata), Inj., 15 mg/ml, Tk.
inadequate.
22.31/Amp Opioid-naïve patients (extended-
Morphinex(Popular), Inj., 15 mg/ml, Tk. release); 5mg PO q12hr initially, then
20.31/amp titrated in increments of 5-10mg q12hr
MSL Oral(UniMed), Oral Solution, 5mg/5ml, every 3-7 days to level that provides
Tk. 80.00/100ml; Tab., 15 mg, Tk. 14.00/Tab.; adequate analgesia and minimizes side
effects.
OXYMORPHONE Conversion from IV oxymorphone to
extended-release PO: The absolute oral
Indications: For the relief of moderate to bioavailability of Opana ER is ~100%,
severe pain and also as a preoperative therefore convertion from 1mg IV q 6hr
medication to alleviate apprehension, (4mg/day) is equipotent to 20mg PO
maintain anaesthesia and as an obstetric q12hr (40mg/daly)
analgesic. It can be used for the
alleviation of pain in patients with Proprietary Preparation
dyspnoea associated with acute left O-morphon(Ziska), Inj., 1mg/ml, Tk.
50.00/1ml Amp.; Tab., 10mg, Tk. 20.00/Tab.
ventricular failure and pulmonary
oedema
Cautions: Reduce the dose gradually; PETHIDINE HYDROCHLORIDE [ED][CD]
sudden withdrawal may cause
withdrawal reactions Indications: Moderate to severe pain,
Contra-indications: Similar to other labour pain, peri-operative pain
opioids Cautions,Contraindications&Side-
Side effects: Similar to other opioids effects: See under Morphine; avoid in
with constipation, nausea, vomiting, severe renal impairment; convulsions
dizziness, dry mouth and drowsiness. may occur with over dosage
Over dosage is characterized by Interactions: See Appendix-2
respiratory depression, extreme Dose: 50-150 mg every 4 hours
somnolence progressing to stupor or according to requirement
coma, skeletal muscle flaccidity, cold
and clammy skin Proprietary Preparations
Dose: G-Pethidine(Gonoshasthaya), Inj.,
100mg/2ml,Tk. 34.50/Amp.
Acute Pain Pehin(Popular), Inj., 100 mg/2 ml, Tk.
→ Immediate-release tablets indicated 19.95/Amps
for acute moderate-to-severe pain Pethidine(Renata), Inj., 100 mg/2 mL, Tk.
where opioid use is appropriate. 19.88/2 ml Amp; 50 mg/ml, Tk. 6.79/Amp.
→ Opioid-naïve patients (immediate-
release): 10-20mg PO q4-hr PRN TAPENTADOL
initially, then titrated as warranted
(may start with 5-mg increments) Indications: Pain due to injury or
→ Conversion from IV oxymorphone following surgery,peripheral neuropathy
to PO: The absolute bioavailability in diabetic patients
of PO is ~100% therefore Cautions: Operating heavy machinery
conversion from 1mg IV q4-6hr in and any vehicle
equipotent to 10mg PO q4-hr. Contraindications: Severe bronchial
→ Elderly patients or those with renal asthma, hypercapnia, and patients who
or hepatic impairment : 5 mg PO have or are suspected to have
q4-6hr initially. paralytic ileus
Chronic Severe Pain: Side-effects: Dizziness, constipation,
Extended-release is indicated for the sedation ,dependence
management of pain severe enough to Dose: Acute Moderate-to-Severe Pain.
287
Immediate-release tablet or oral solution; By intramuscularor intravenous injection,

50-100mg PO q4-6hr PRN; not to 50-100 mg every 4-6 hours. CHILD not
exceed 700mg on day 1 and 600mg/day recommended
thereafter Postoperative pain 100 mg initially then
Chronic (extended-release tablet) 50 mg every 15-20 minutes, maximum
→ 50-250mg PO q1 12hr PRN; not to 250 mg in the first hour including initial
exceed 500mg/day dose; then 50-100 mg every 4-6 hours to
→ Opioid-naïve patients; 50mg PO q1 a max. 600 mg daily. CHILD: Not
2hr; titrated to optimal dosage as recommended
needed; not to exceed 500mg/day
Chronic Severe Pain Proprietary Preparations
Indicated for the management of pain Anadol(Square), Inj., 100 mg/2 ml, Tk.
severe enough to require daily, around- 20.14/2 ml Amp; Suppo.100 mg, Tk.
15.10/Supp; Cap., 50 mg, Tk. 8.07/Cap., 100
the-clock, long-term opioid treatment and mg, Tk.12.09/Cap.
for which alternative treatment options Dolonil(Acme), Inj., 100mg/2ml, Tk.
are inadequate 50-250mg PO q1 2hr 20.13/2ml Amp; Cap. 50 mg, Tk. 7.55/Cap.,
PRN; not exceed 500mg/day Tab., 100.00 mg, Tk. 25.08/Tab.
Opioid-naïve patients; 50mg PO q1 2hr; Dolorex(Biopharma), ER Cap., 100mg, Tk.
titrated to optimal dosage as needed; not 20.08/Cap.
to exceed 500mg/day Kadol(Kemiko), Cap., 50 mg, Tk. 8.00/Cap.
Kingdol(Drug Intl), Cap. , 50mg, Tk. 7.00/Cap.
Lucidol(Beximco), Supp., 100mg, Tk.
15.00/Supp; Cap., 50mg, Tk. 7.50/Cap., Inj.,
Centradol(Incepta), Tab, 50 mg, Tk.
50mg/ml, Tk. 20.00/2 ml Amp
12.00/Tab., 75 mg, Tk. 17.00/Tab. Murtrum (Monico), Inj., 50 mg/ml, Tk. 20.00/2
Cynta(Healthcare), Tab., 100mg, Tk. ml Amp
25.00/Tab., 50mg, Tk. 14.00/Tab., 75mg , Tk. Opalgic(Euro), Cap., 50mg, Tk. 8.00/Cap.
20.00/Tab. Pendol(Alco), Cap., 50 mg, Tk. 6.02/cap.
Lopenta(ACI), Tab., 75mg, Tk. 20.00/Tab.,
Reladol(Globe), Inj., 100 mg/2 ml, Tk. 20.00/2
50mg, Tk.14.00/Tab.
ml Amp
Pentadol(Square), Tab., 100 mg, Tk.
Syndol(Healthcare), Inj., 100mg/2ml , Tk.
25.08/Tab., 75 mg, Tk. 20.06/Tab., 50 mg, Tk. 25.00/2 ml Amp; Cap., 50mg, Tk. 8.50/Cap.
14.05/Tab. Tendia(ACI), Cap., 50mg, Tk. 7.55/Cap.,
Tapendol(Opsonin), Tab., 50 mg, Tk. 100mg, Tk. 14.09/Cap., Inj., 100mg/2ml, Tk.
12.00/Tab., 75 mg, Tk. 17.00/Tab., 50mg,
20.13/2 ml Amp
Tk.12.00/Tab.
Trado(Pacific), Cap., 50 mg, Tk. 8.00/Cap.,
Tapenta(Eskayef), Tab., 100mg , Tk.
Inj., 100 mg/2 ml, Tk. 25.00/2 ml Amp
20.00/Tab., 50mg, Tk.12.00/Tab.,, 75mg, Tramadol(Amico), Cap., 50mg, Tk. 6.00/Cap
Tk.17.00/Tab. Tramanil(Ziska), Inj., 100 mg/2 ml, Tk. 20.00/2
Tapexia(Globe), Tab., 50 mg, Tk. 12.00/Tab., ml Amp
75 mg, Tk. 17.00/Tab. Tramapan(Popular), Inj., 100 mg/2 ml, Tk.
20.08/2 ml Amp
TRAMADOL HYDROCHLORIDE Tramavir(Virgo), Tab.,100 mg, Tk. 13.00/Tab.,
Cap, 50 mg, Tk. 8.50/Cap.
Tranal(Opsonin), Cap., 50 mg , Tk. 7.53/Cap.,
Indications: Moderate to severe pain
Inj., 100 mg/2ml, Tk. 20.08/2 ml Amp., Supp.,
Cautions: See under morphine; Tk. 15.06/Supp.
Contra-indications: History of epilepsy; Trumen(General), Cap., 50mg, Tk. 6.00/Cap.,
pregnancy and lactation Inj., 100mg, Tk. 22.07/2ml Amp
Interactions: See Appendix-2 Utramal(UniMed), Tab., 100mg, Tk.
Side effects:Paraesthesia,hypotension, 20.00/Tab., 50mg, Tk. 10.00/Tab., Cap ,
anaphylaxis, hallucinations and 50mg, Tk. 8.50/Cap., Supp. , 100mg, Tk.
25.00/Supp; Inj., 100mg, Tk. 25.00/2 ml Amp
confusion
Winpain(Incepta), Cap., 50 mg, Tk. 8.50/Cap.
Dose: By mouth, 50-100 mg every 4 Xtrapel(Beacon), Cap., 100mg , Tk.
hours; total of more than 400 mg daily by 12.08/Cap., 50mg , Tk. 8.05/Cap., Inj.,
mouth is not usually required. CHILD: 100mg/2ml, Tk. 20.13/2 ml Amp
Not recommended
288
Zydol(Novo Health), Cap. , 100 mg, Tk. Acep(Zenith), Paed. drop, 80 mg/ ml, Tk.
12.00/Cap., 50 mg, Tk. 7.50/Cap., Inj. 100 10.91/15 ml, , Suspn., 120 mg/ 5 ml, Tk.
mg/2 ml, Tk. 18.00/2 ml amp 16.11/60ml, Tab., 500 mg, Tk. 0.80/Tab.
Aceta(Biopharma), Suspn., 120 mg/5 ml, Tk.
20.63/60ml, Tab., 500.00mg , Tk. 0.80/Tab.,
7.5.2 NON-OPIOID ANALGESICS
TabXR., 665.00mg, Tk. 1.50/Tab., Paed.
drops, 80 mg/ml, Tk. 12.30/15ml
Paracetamoland Aspirin and other non- Actol(Somatec), Suspn., 120 mg/5 ml, Tk.
steroidal anti-inflammatory drugs or 20.69/60ml
NSAIDs (see sec. 9.1.1) are useful for Asmol(Sharif), Suspn., 120 mg/5 ml, Tk.
relief of pain of musculo-skeletal origin. 20.64/60ml , Tab, 500 mg, Tk. 0.800/Tab.
Atopen(Kemiko), Tab., 500 mg, Tk. 0.80/Tab.
Narcotic analgesics are particularly
ATP(General), Syrup, 120mg/5ml, Tk.
required for moderate to severe pain of 20.63/60ml, Tab, 500mg, Tk. 0.80/Tab.,
visceral origin especially where non- Suspn.,120 mg/5 ml, Tk. 20.63/60ml
narcotic analgesics fail to provide Benalgin(Benham), Suspn., 120 mg/5 ml, Tk.
adequate relief. 21.69/60ml; Tab., 665 mg, Tk. 1.50/Tab.
Cetal(Supreme), Tab., 500 mg, Tk. 0.80/Tab.,
Suspn.,120 mg/5 ml, Tk. 20.63/60ml
7.5.2.1 PARACETAMOL[ED] Cetam(Pacific), Tab., 500 mg, Tk. 0.60/Tab.,
500 mg, Tk. 0.60/Tab., 500 mg, Tk.
Indications: Mild to moderate pain e.g. 0.60/Tab., Suspn.,120 mg/5 ml, Tk.
muscle pain, tension headache, 20.00/60ml
neckache, lumbago; pyrexia D-Cetamol(Decent), Suspn., 120 mg/5 ml, Tk.
16.00/60ml, Tab., 500mg, Tk. 0.80/Tab.
Cautions&Contra-indications: Hepatic
Fap(Beacon), Tab., 500mg , Tk. 0.80/Tab.
and renal impairment Fast(Acme), Supp., 125.00 mg., Tk.
Interactions: See Appendix-2 4.03/Supp, 250.00 mg., Tk. 5.03/Supp, 500.00
Side-effects: Blood disorders, mild mg, Tk. 8.07/Supp.
gastrointestinal upset; liver damage Fea(Navana), Suspn., 120 mg/5 ml,Tk.
following overdose and misuse; less 20.06/60ml; Tab., 500 mg, Tk. 0.80/Tab.
frequently renal damage may also occur. Fea-XR(Navana), Tab., 665 mg, Tk. 1.51/Tab.
OVERDOSAGE with paracetamol is Fevac(Orion), Suspn.,120 mg/5 ml, Tk.
20.06/60ml
particularly dangerous as it may cause G-paracetamol(Gonoshasthaya), Suspn., 120
hepatic damage (see Appendix-7 for mg/5 ml Tk. 16.00 /60ml; Syrup, 120mg/5 ml,
treatment of overdose and poisoning) Tk. 15.00/50ml; Tab., 500 mg, Tk. 0.60/Tab.
Dose: By mouth, 0.5-1 g every 6 hours Hepa(Hudson), Suspn., 120 mg/5 ml, Tk.
to a max. dose of 4 g daily; CHILD under 20.00/60ml; Tab., 500 mg, Tk. 0.80/Tab.
3 months 10 mg/kg (5mg/kg if Longpara(Ibn Sina), XR Tab., 665 mg, Tk.
1.51/Tab.
jaundiced); 3 months to 1 year 60-120
M-Pol(Modern), Suspn., 120 mg / 5 ml., Tk.
mg,1 to 5 years 120-250 mg, 6 to 12 20.00/60ml, Tab. , 500 mg , Tk. 0.80/Tab.
years 250-500 mg, Dose may be Nap(Beximco), Supp, 125mg, Tk. 4.00/Supp
repeated 4 to 6 hourly Napa(Beximco), Suspn., 120mg5/ml, Tk.
By rectum as suppositories, ADULT and 20.69/60ml, Syrup, 120mg5/ml, Tk.
CHILD over 12 years 0.5 to 1 g up to 4 20.70/60ml, XR Tab., 665mg, Tk. 1.51/Tab.,
times daily; CHILD 1 to 5 years 125 to 500mg, Tk. 0.80/Tab., Infusion, 1 gm/100 ml,
Tk. 150/100 ml, Paed. drops, 80mg/ml, Tk.
250 mg, 6 years to 12 years 250-500 mg
14.82/15ml, Supp, 250mg, Tk. 5.00/Supp,
up to 4 times daily. 500mg, Tk. 8.00/Supp, 60mg, Tk. 3.50/Supp,
Pamix(Ziska), Suspn., 120mg/5ml, Tk.
Proprietary Preparations 20.70/5ml, Tab, 500 mg, Tk. 0.80/Tab.
Ace(Square), Paed. drops, 80 mg/ml, Tk. Panol(Virgo), Suspn., 120 mg/5 ml, Tk.
20.7/30ml, Supp, 500 mg, Tk. 8.06/Supp, 250 20.00/60ml, 120 mg/5 ml, Tk. 30.00/100ml,
mg, Tk. 5.03/Supp, Syrup, 120 mg/5 ml, Tk. Tab, 500 mg, Tk. 0.65/Tab.
20.7/60ml, , Tk. 31.88/100ml, Suspn.,120 Para(Amico), Paed. drops, 80 mg/ml, TK.
mg/5 ml, Tk. 20.7/60ml,Tab. , 500 mg, Tk. 12.00/15ml, Suspn., 120mg/5ml, TK.
0.80/Tab., 125 mg, Tk.4.03/Supp., Tab., 665 20.00/60ml, Tab., 500mg , TK. 0.80/Tab.
mg, Tk.1.51/Tab. Paracetamol(Ziska), Tab. , 500 mg, Tk.
0.57/Tab.
289
Paraciv (Beacon), IV Infusion, 1 gm/100ml, Tk. 14.80/15ml; Supp. , 250mg , Tk.

Tk. 120.36/100 ml 6.00/Supp; 125mg , Tk. 5.00/Supp; 500mg ,
Paradil(Biogen), Syrup, 120mg/5ml, Tk. Tk. 9.00/Supp; Suspn.,120 mg/5 ml, Tk.
20.00/60 ml 20.60/60ml; , Tk. 30.00/100ml;
Parafen(Ziska), Suspn., 120 mg/5 ml, Tk. Zerin(Jayson), Ped. drops, 80mg/ml, Tk.
16.28/60ml 12.34/15ml; Suspn., 120 mg/5 ml, Tk.
Paragesic(SMC Enterprise), Tab., 500 mg , 20.06/60ml; Tab. , 500mg , Tk. 0.80/Tab.
Tk. 0.80/Tab.
Parapyrol(GSK), Tab. , 500 mg, Tk. 0.72/Tab ParacetamoI 500 mg + Caffeine 65 mg
Pol(Globe), Suspn., 120 mg/5 ml, Tk. Ace(Square), Tab., Tk. 2.51/Tab.,
20.56/Vial, Tab, 500 mg, Tk. 0.80/Tab. Acep(Zenith), Tab., Tk. 1.51/Tab.
Pyrac(Medimet), Suspn., 120 mg/5 ml, Tk. Aceta(Biopharma), Tab. Tk. 2.50/Tab.
20.00/60ml; Syrup, 120 mg/5 ml, Tk. Asmol(Sharif), Tab., Tk. 1.51/Tab.
18.25/50ml; Tab. , 500 mg, Tk. 0.80/Tab. Atopen(Kemiko), Tab., Tk. 2.51/Tab.
Pyralgin(Renata), Suspn., 120 mg/5 ml, Tk. Benalgin(Benham), Tab., Tk. 2.50/Tab.
20.64/60ml, Tab, 500mg, Tk. 0.80/Tab. Cafedon(Healthcare), Tab., Tk. 2.50/Tab.
Reliv(Astra Bio), Suspn.,120 mg/5 ml, Tk. Cafenol(General), Tab., Tk. 1.92/Tab.
20.63/5ml, Tab., 500 mg, Tk. 0.80/Tab. Cafeta(Nipa), Tab., Tk. 2.50/Tab.
Renova(Opsonin), Inj.,(IV Infusion), 1 gm/100 Caffo(Somatec), Tab., Tk. 1.90/Tab.
ml, Tk. 120.00/100 ml, Supp, 250 mg, Tk. Caf-N(Globex), Tab., Tk. 1.00/Tab.
5.02/Supp,500 mg , Tk. 8.03/Supp; 125 mg , Caftyl(One Pharma), Tab., Tk. 1.91/Tab.
Tk. 4.02/ Supp, 60 mg, Tk. 3.51/Supp, Capdol(Novo Health), Tab., Tk. 1.90/Tab.
Suspn.,120mg/5 ml, Tk. 20.70/60 ml, Tk. Cetal(Supreme), Tab., Tk. 1.90/Tab.
24.53/100 ml, 120mg/5 ml, Tk. 31.60/100 ml, Cetam(Pacific), Tab., Tk. 2.50/Tab.
Paed. drops, 100 mg /1.25 ml, Tk. DC-Plus(Decent), Tab., Tk. 2.00/Tab.
12.35/1.25ml; 120mg/5 ml, Tk. 20.64/ 60 ml; Duet(Silva), Tab., Tk. 2.25/Tab.
Tab., 500 mg, Tk. 0.80/Tab., 665 mg , Tk. Enyl(Euro), Tab., Tk. 2.00/Tab.
1.50/Tab. Fap(Beacon), Tab., Tk. 1.92/Tab.
Reset(Incepta), Inj.,(IV Infusion),, 0.5 gm/50 Fast(Acme), Tab., Tk. 1.91/Tab.
ml, Tk. 120.00/50 ml ; Paed. drops, 80 mg/ml , Fea Plus(Navana), Tab., Tk. 2.51/Tab.
Tk. 12.30/15 ml; Suspn., 120 mg/5 ml, Tk. Gesic(Popular), Tab., Tk. 1.51/Tab.
20.64/60ml; Tab. , 500 mg, Tk. 0.80/Tab., 665 Hedex(Orion), Tab., Tk. 2.50/Tab.
mg, Tk. 1.50/Tab. Hepa(Hudson), Tab., Tk. 2.00/Tab.
Sinapol(Ibn Sina), Suspn., 120 mg/5 ml, Tk. K-Pol(Modern), Tab., Tk. 1.90/Tab.
20.00/60ml; Tab., 500 mg, Tk. 0.80/Tab. Napa(Beximco), Tab., Tk. 2.50/Tab.
Tamen(Eskayef), Suspn, 120 mg/5 ml, Tk. Neopara(Bristol), Tab., Tk. 1.50/Tab.
20.68/60ml; 120 mg/5 ml, Tk. 20.68/60ml; P+C(Alco), Tab.,Tk. 1.91/Tab.
Syrup, 120 mg/5 ml, Tk. 24.53/100ml; Tab, Pac(Ibn Sina), Tab., Tk. 2.50/Tab.
665mg , Tk. 1.50/Tab., 500mg , Tk. 0.80/Tab., Pamix(Ziska), Tab., Tk. 2.50/Tab.
500mg, Tk. 0.80/Tab.,Inj.,(IV Infusion),1 Panadol(GSK), Tab., Tk. 2.50/Tab
gm/100 ml, Tk. 120.00/100 ml; Paed.Drops, 80 Panol(Virgo), Tab., Tk. 1.90/Tab.
mg/ml, Tk. 14.77/15ml; Para-C(Amico), Tab., Tk. 1.90/Tab.
Tamino(NIPRO JMI), Suspn., 120 mg/5 ml, Paragesic(SMC), Tab., Tk. 2.50/Tab.
Tk. 20.69/60ml; Tab., 500 mg, Tk. 0.80/Tab.; Pol(Globe), Tab. , Tk. 2.00/Tab.
Tab., 665 mg , Tk. 1.50/Tab. Pyra(Renata), Tab, Tk. 2.00/Tab.
Temol(Team), Suspn., 120mg/5ml, Tk. Reliv(Astra Bio), Tab., Tk. 1.90/Tab.
20.70/60ml; Tab., 500mg, Tk. 0.80/Tab. Renova(Opsonin), Tab., Tk. 2.51/Tab.
Tempil(Alco), Tab., 500 mg, Tk. 0.80/Tab., Reset(Incepta), Tab., Tk. 2.50/Tab.
500 mg, Tk.0.80/Tab. Tamen(Eskayef), Tab., Tk. 1.90/Tab.,
Tempol(Asiatic), Paed. Drops, 80 mg/ml, Tk. Tamino(NIPRO JMI), Tab., Tk. 1.51/Tab.
12.31/15ml;80 mg/ml, Tk. 15.73/30ml; Suspn., Temfin(Organic), Tab. Tk. 1.80/Tab.
120 mg/5 ml, Tk. 16.34/60ml; Temol(Team), Tab., Tk. 2.40/Tab.
Timidal(G.A.Co), Suspn, 120 mg/5ml, Tk. Tempol(Asiatic), Tab.,Tk. 1.90/Tab.
20.06/60 ml; Tab., 500 mg, Tk. 0.80/Tab. Temrif(Monico), Tab., Tk. 1.50/Tab.
Xcel(ACI), Tab., 665mg, Tk. 1.28/Tab., Paed. Timidal(G.A.Co), Tab., Tk. 2.01/Tab.
drops, 80mg/ml, Tk. 20.70/30ml; Supp. Xcel(ACI), Tab., Tk.2.35/Tab.
125mg, Tk. 4.00/Suspp; 250mg, Tk. Xpa-C(Aristo), Tab., Tk. 2.5.00/Tab.
5.00/Suspp; 500mg, Tk. 8.00/ Supp; Suspn., Zerin-XP(Jayson), Tab., Tk. 1.9/Tab.
120mg /5ml, Tk. 20.70/60ml; Syrup,
120mg/5ml, Tk. 30.00/60ml ; Paracetamol 325 mg + Tramadol 37.50 mg,
Xpa(Aristo), XR Tab., 665mg, Tk. 1.50/Tab., Aceta(Biopharma), Tab., Tk. 8.00/Tab.
500mg , Tk. 0.80/Tab, Paed.drops, 80mg/ml , Acetram(Square), Tab., Tk. 8.03/Tab.
290
Atopen(Kemiko), Tab., Tk. 8.02/Tab. Asorin(Kemiko), Tab. 75 mg, Tk.0.50/Tab.

Fapdol(Beacon), Tab., Tk. 8.00/Tab. Aspirin(Albion), Tab. 300 mg,
Fastdol(Acme), Tab., Tk. 8.03/Tab. Tk.1.07/Tab.; 75 mg, Tk.0.50/Tab.
Fevedol(Drug Intl), Tab., Tk. 5.00/Tab. Caid(Jayson), Tab. 75 mg, Tk.0.50/Tab.
Napadol(Beximco), Tab., Tk. 8.00/Tab., Carva(Square), Tab. 75 mg, Tk.0.57/Tab.
Paratadol(Euro), Tab., Tk. 8.00/Tab. Disprin(Reckitt), Tab., 100 mg, Tk. 0.80/Tab.;
P-Dol(Popular), Tab., Tk. 5.00/Tab. 300 mg, Tk. 1.60/Tab.
Resadol(Incepta), Tab., Tk. 8.03/Tab. Ecosprin (Acme), Tab. 150 mg, Tk.0.8/Tab.;
Syndol(Healthcare), Tab., Tk. 8.00/Tab. 300 mg, Tk. 1.72/Tab.; 75 mg, Tk.0.58/Tab.
Tamenol(Eskayef), Tab, Tk. 8.00/Tab. Encoprin(Medimet), Tab., 75mg, Tk.0.50/Tab
Tempol-D(Asiatic), Tab., Tk. 8.00/Tab. Erasprin(UniMed), Tab. 75 mg, Tk.0.57/Tab.
Tramatol(Somatec), Tab. Tk. 8.00/Tab. G-aspirin(Gonoshasthaya), Tab., 100 mg, Tk.
Tramp(General), Tab., Tk. 6.02/Tab. 0.60 /Tab.; 300 mg, Tk. 0.30/Tab.
Utracet(UniMed), Tab, Tk. 8.00/Tab. Mysprin(Pacific), Tab., 75 mg, Tk. 0.58/Tab.
Xcel (ACI), Tab., Tk. 8.02/Tab. Solrin(Opsonin), Tab., 75 mg, Tk. 0.63/Tab.
7.5.2.2 ASPIRIN 7.5.2.3 OTHER NON-STEROIDAL

(ACETYLSALICYLIC ACID)[ED] ANTI-INFLAMMATORY DRUGS
(NSAIDS)
Because of its potent anti-inflammatory (See also section 9.1.1)
effect, it may also be used in many
inflammatory diseases e.g. rheumatic 7.5.3 DRUGS USED IN NEURALGIC/
fever, Aspirin causes significant gastric NEUROPATHIC PAIN
irritation. Its use (in low dose) is now
more and more restricted to its Neuralgic pain responds poorly to
antiplatelet action (see section 3.9). conventional non-opioid or opioid
Dispersible aspirin tablets are adequate analgesics. They can sometimes be
for most purposes as they act rapidly distressing and difficult to control with
and are less irritant for the stomach. drugs and may require special measures
Indications: Mild to moderate pain, like transcutaneous electrical nerve
pyrexia, inflammatory condition; used as stimulation (TENS), nerve blocks or
an antiplatelet drug surgery. The neuralgic/neuropathic pain
Cautions: Asthma, peptic ulcer, gastric includes trigeminal neuralgia, brachial
hyperacidity, renal and hepatic impairm- neuralgia (and other radicular pain),
ent, allergic conditions and pregnancy post-herpetic neuralgia, diabetic amyot-
Contra-indications: Children under 12 rophy, atypical facial pain, pains from
years and breast-feeding mothers are entrapment neuropathies, thalamic pain
not to be given aspirin because it may and phantom limb syndrome.
cause Reye’s syndrome; active peptic Carbamazepine is a frequently used
ulcer, haemophilia, known hypersensi- drug for neurogenic pain. It is particularly
tivity to NSAIDs effective in the treatment of trigeminal
Interactions: See Appendix-2 neuralgia, thalamic pain and sometimes
Side-effects: Gastric irritation, nausea, in radicular pains. It is always started
vomiting, heartburn, epigastric burning, with a low dose and gradually increased
gastro-intestinal bleeding, bronchosp- to the required dose to prevent initial
asm and precipitation of bronchial gastrointestinal and CNS Side-effects.
asthma, hypersensitivity Patients should be counselled about the
Dose: As ananalgesic antipyretic anti- possible hypersensitivity reaction that
inflammatory300-900 mg every 4-6 may occur usually within 7 days and may
hours when necessary; maximum 4 g be fatal (causing Stevens Johnson
daily; CHILD:Not recommended syndrome) if not stopped immediately.
For antiplatelet activity, 75-300mgdaily. Amitriptyline is also a frequently used
Also see section. 3.9 drug in this category. It has less short
and long term Side-effects than
Proprietary Preparations carbamazepine but sometimes requires
Aciprin CV(ACI), Tab. 75mg, Tk.0.39/Tab. very high dose to be effective. It can
291
sometimes be distressingly sedating and used anti-emetic is Prochlorperazine

is particularly effective in post-herpetic though Metoclorpramide is equally
neuralgia and often prescribed in other effective and has the added advantage
neurogenic pains along with of promoting gastric emptying and
carbamazepine. normal peristalsis which may be
Phenytoin, gabapentin and sodium impaired in this condition.These may be
valproate may also be used either alone used either by mouth or by intramuscular
or in combination with amitriptylin or injection. Domperidone is a suitable
carbamazepine. alternative.
AMITRIPTYLINE[ED] DOMPERIDONE
(See section 7.3 on Anti-depressant See also section 2.2
drug)
METOCLOPRAMIDE HCl[ED]
Dose: By mouth, initially 10-25 mg daily See section 2.2
as a single dose in the evening;
increased gradually as necessary to
PROCHLORPERAZINE
maximum 100mg/day in divided doses
(See also section 7.2)
See section 7.3 Indications:Severe nausea, vomiting,
vertigo irrespective of the aetiology;
CARBAMAZEPINE[ED] acute migraine attack
(See section 7.6.1 on anti-epileptic Cautions and Contra-indications:See
drugs). under Chlorpromazine Hydrochloride in
section 7.2
Proprietary Preparation Interactions:See Appendix-2
See section 7.6.1 Side-effects:See under Chlorpro-
mazine Hydrochloride (see section 7.2);
7.5.4 DRUGS USED IN MIGRAINE extrapyramidal symptoms may occur,
particularly in children, elderly and
7.5.4.1 ACUTE MIGRAINE ATTACK debilitated
7.5.4.2 PROPHYLAXIS OF MIGRAINE Dose:By mouth, 5-10 mg 1-3 times/day
according to the requirement and
response. CHILD: Not recommended. By
7.5.4.1 ACUTE MIGRAINE ATTACK
deep intramuscular injection, 12.5 mg
followed if necessary after 6 hours by
Treatment of acute attack of Migraine is oral dose, as above. CHILD: Not
symptomatic mostly with analgesics and recommended
antiemetics, and should be initiated as
soon as the headache phase starts. Proprietary Preparations
Patients should also be instructed to rest See Section 7.2.
in a dark and quiet room during this
phase. Rarely in refractory cases,
specific treatment such as the use of TOLFENAMIC ACID
Ergotamine may be required.
Most Migraine headaches respond to Indications :Acute attack of migraine
simple analgesics such as paracetamol Cautions:History of asthma, bleeding
or aspirin (see section 7.5.2.1) but disorders, peptic ulcer, hypertension
occasionally more potent NSAIDs e.g. Contra-indications: Hepatic or renal
Naproxen (see section 9.1.1) and impairment, elderly, pregnancy and
Tolfenamic acid may be needed. breastfeeding
At the beginning of the headache phase Side-effects: Dysuria in males,diarrhea,
of a migraine attack, the most frequently nausea, redness of the skin, headache,
tremor, fatigue.
292
Dose: 200 mg when 1st symptoms Side-effects: Most common side effects
appear, may be repeated once after 1-2 are dizziness, flushing, weakness,
hour drowsiness, fatigue. Nausea and
vomiting may occur. Pain and tingling
Proprietary Preparations sensation, heat, heaviness of any part of
Anilic(Drug Intl), Tab., 200 mg, Tk.8.00/Tab. the body are also reported.
Arain(Opsonin), Tab., 200 mg,Tk.10.00/Tab.
Lograin(IbnSina),Tab., 200mg,Tk.10.00/Tab.
Migratol(Beacon),Tab., 200 mg, Tk.8.05/Tab. ALMOTRRIPTAN
Migrex(Incepta), Tab., 200mg,Tk.10.00/Tab.
Namitol(ACI), Tab., 200 mg, Tk.10.00/Tab. Indications:Acute Migraine
Tolfi(Benham), Tab., 200 mg, Tk. 9.50/Tab. Contraindications:History of
Tolmic(Beximco),Tab., 200 mg, Tk.8.03/Tab.
cardiovascular accident, TIA, Peripheral
Tufnil(Eskayef), Tab, 200 mg, Tk. 10.00/Tab.
vascular disease,hepatic and renal
insufficiency
5HT1AGONIST
Dose: At onset 12.5mg, 2hour after
another 12.5mg. Maximum 25mg in 24
A 5HT1 agonist may be usedand is of hours.
value in the treatment of acute migraine
attack and is preferred if the treatment is Proprietary Preparation
not responding to simple analgesic or Almitan(Opsonin), Tab., 6.25 mg , Tk.
NSAIDs .The 5HT1 agonist (triptans) act 25.08/Tab.
on the 5HT1 (serotonin) IB/ID receptors Altrip(Nipro JMI) Tab.,6.25 mg , Tk.
and they are therefore sometimes 25.08/Tab.
referred to as 5HT1 receptor agonist.
The 5HT agonist available for treating RIZATRIPTAN
migraine are Almotriptan,Frovatriptan,
Naratriptan, Rizatriptan, Sumatriptan, Indications:Treatment of the headache
andZolmitriptan phase of acute migraine attacks
Cautions: 5HT1 agonist should be used Cautions: See notes above and under
with Cautions in conditions which sumpatriptan
predispose to coronary artery disease; Contraindications: See notes
hepatic impairment; pregnancy; and aboveand under Sumpatriptan
breast feeding. 5HT1 agonist are Interactions: See Appendix-2
recommended as monotherapy and Side effects: See notes above and
should not be taken concurrently with under sumpatriptan
other therapies for acute migraine. If Dose: By mouth Initially 10mg dose
intense chest and throat pain and may be repeated after not less than 2
tightness occur, treatment should be hours if migraine recurs; (patient not
discontinued as it may be due to responding should not take second dose
coronary vasoconstriction. for same attack) max. 20mg in 24 hours
Contraindications: 5HT1 agonistshould
not be used prophylactically and should Proprietary Preparations
not be administered to patients with Rizamig(Healthcare),Tab., 5 mg, Tk.
basilar or hemiplegic migraine. They are 35.50/Tab.
Rizat(Acme), Tab., 5 mg, Tk. 30.20/Tab.
contraindicated in uncontrolled or severe
hypertension, ischemic heart disease, a
history of myocardial infraction,coronary SUMATRIPTAN
vasospasm (Prinzmetal angina),
peripheral vascular disease. Indications: Treatment of acute
Drowsiness may occur following migraine attacks, cluster headache
treatment with 5HT1 agonist so it may Cautions: See notes above; renal
affect performance of skilled tasks e.g impairment and hepatic impairement,
driving, operating machine etc. history of epilepsy
293
Contra-indications: See notes above; Miotrol(Drug Int),Tab.,2.5 mg, Tk. 15.05/Tab.

ischaemic heart attack, moderate and Nomi(Square), Tab., 2.5 mg, Tk. 25.17/Tab.
sever hypertension Zomitan(Incepta), Tab.,2.5 mg, Tk. 25/Tab.
Side-effects: See notes 7.5.4.2 PROPHYLAXIS OF MIGRAINE
above.drowsiness, transient increase in
blood pressure, hypotension, Preventive treatment is not necessary for
bradycardia or tachycardia, visual many migraine patients. Those who
disturbance, ischaemic colitis, require it should be carefully chosen. An
Raynaud’s syndrome altered liver elaborate searchto find out relevant
function; seizuresare reported; erythema common migraine precipitants e.g.
at injecton site excess physical or mental stress, sleep
Dose: Initially 50mg (some patient may or food deprivation, certain food or drink
require 100mg)as soon as possible at that precipitate an attack etc. and the
onset (patient not responding should not patient is asked to avoid these as far as
take second dose for same attack);dose possible. If the attacks are still too
may be repeated after not less than 2 frequent or severe or prolonged enough
hours if migraine recurs; maximum to impair ones lifestyle, it is generally
300mg in 24 hours CHILD and advisable to start a prophylactic drug.
ADOLESCENT under 18 years:Not The commonly used drugs are Sodium
recommended. Valproate,PropranololandAmitriptyline
Other possible useful drugs are
Proprietor Preparation Pizotifen, some beta-blockers e.g.
Nomigran (Ambee), Tab., 100 mg , (Metoprolol, Nadolol, Timolol),
Tk.90.35/Tab; 50 mg , Tk. 45.17/Tab Tricyclic antidepressants
(Nortriptyline, Imipramine) and calcium
ZOLMITRIPTAN channel blockers (e.g. Verapamil).
Sodium valproate(see section 7.6.1)
Indications: Treatment of acute may be effective in a dose of 300-600
migraine attacks mg/day in 2 divided doses. It can be a
Cautions: See notes above and under very effective migraine prophylactic drug
sumatriptan; should not be taken within but has been associated with severe
12 hours of any other 5HT1 agonist hepatic and pancreatic toxicity, although
Contraindications: See notes such effects are rare. It should not be
aboveand under Sumpatriptan; Wolf- prescribed in young females of
Parkinson-White syndrome or childbearing age (many migraine
arrhythmias associated with accessory patients are) because of its potential
cardiac conduction pathways; previous teratotoxicity. However, it is still possibly
cereb-rovascular accident or transient the best prophylactic drug for migraine in
ischaemic attack adult males.
Interactions: See Appendix-2 Propranolol is the most commonly used
Side-effects: See notes above and beta-blocker for migraine and can be
under Sumpatriptan; quite effective when given in a dose of
Dose: By mouthInitially 2.5 mg .as soon 80-160 mg/day in 2-3 divided doses. The
as possible after onset; dose may be value of beta-blockers is limited by their
repeated after not less than 2 hours if Contraindications (see section 3.1).
migraine persists or recurs; (incrase to Amitriptyline (see section 7.3) may be
5mg for subsequent attacks in patients useful even when there is no evidence of
not achieving satisfactory relief with depression. It is started with dose of 10
2.5mg dose); maximum 10mg in 24 mg at night, increasing to a maintenance
hours dose of 50-75 mg at night.
CHILD: Not recommended Pizotifen is an antihistamine and
serotonin antagonist. It is indicated in
Proprietary Preparations prophylactic treatment of migraine
294
probably after sodium valproate, propra- Once the diagnosis of epilepsy is made,
nolol and amitriptyline have failed though it is crucial to decide the correct choice
it is said to be very much effective in of anticonvulsant.
children. Occasionally its use is limited IDIOPATHIC GENERALISED EPI-
by its Side-effects of excess drowsiness LEPSY: The drugs of choice for all types
and weight gain. of IGEs are Sodium Valproate,
Phenobarbitone, Phenytoin and
PIZOTIFEN Lamotrigine.
ABSENCE EPILEPSY (Petit Mal):
Indications: Prevention of vascular Ethosuximide and Sodium Valproate
headache including migraine with or are the drugs of choice, and both are
without aura and cluster headache about equally effective.
Cautions: Urinary retention; closed MYOCLONIC EPILEPSY: Clonazepam
angle glaucoma, renal impairment; is considered second best choice after
pregnancy and breast-feeding sodium valproate.
Interactions: See Appendix-2 LOCALISATION RELATED EPILEPSY:
Side-effects: Drowsiness, increased Carbamazepine, Sodium Valproate,
appetite and weight gain; nausea, Phenobarbitone, Phenytoin and
dizziness; hyperactivity in children Lamotrigine are the drugs of choice for
Dose: 1.5 mg at night or 0.5 mg 3 times secondary (partial) epilepsy. Second line
daily, adjusted according to response drugs include Clonazepam and
within the usual range 0.5-3 mg daily; Clobazam. Gabapentine, Vigabatrin
maximum single dose 3 mg, and Topiramate are used as adjunct
maximumdaily dose 4.5 mg; CHILD up therapy where control is difficult to
to 1.5 mg daily in divided doses; obtain.
maximum single dose at night 1 mg Levetiracetam is also used in partial
seizures, or as an adjunctive
Proprietary Preparations therapy for partial, myoclonic and tonic
Antigrain(Ibn Sina), Tab., 0.5mg, Tk. clonic seizures.
3.25/Tab. Fosphenytoinis a pro drug.It can
D-Fen(Drug Intl), Tab., 0.5mg, Tk. 3.05/Tab., beadministred through IM/IV
1.5mg, Tk. 5.05/Tab.
Migranil(Square), Tab., 0.5 mg, Tk.
3.01/Tab., 1.5 mg, Tk. 7.04/Tab. CARBAMAZEPINE[ED]
Pifen(Opsonin), Tab., 0.5 mg , Tk. 3.01/Tab.,
1.5 mg , Tk. 7.03/Tab. Indications:Partial and secondary
Pigrain(Supreme), Tab., 1.5mg, Tk. 7.00/Tab., generalized seizure, alcohol withdrawal
0.5mg, Tk. 3.00/Tab.
Pizo-A(Acme), Tab., 0.5mg, Tk. 3.01/Tab., 1.5
seizure, prophylaxis of manic depressive
mg , Tk. 7.04/Tab. illness, trigeminal neuralgia, other forms
Pizofen(Navana), Tab., 0.5 mg, Tk. 3.01/Tab. of neuralgic pains
Pizofen TS(Navana), Tab., 1.5 mg, Tk. Cautions:Pregnancy; hepatic or renal
7.02/Tab. impairment; cardiac disease; skin reac-
Pizotin(Nipa), Tab., 1.5 mg, Tk. 7.00/Tab., 0.5 tions to other drugs; breast-feeding;
mg, Tk. 3.00/Tab. avoid sudden withdrawal
Zeromig(Eskayef),Tab, 0.5mg, Tk. 3.00/Tab.,
1.5mg, Tk. 7.00/Tab.
Contra-indications: Hypersensitivity,
Zofen(Aristo), Tab.,1.5mg, Tk. 7.20/Tab., history of bone marrow depression, AV
0.5mg, Tk. 3.00/Tab. conduction abnormalities
7.6 ANTI-EPILEPTIC DRUGS Side-effects: Nausea, vomiting, heada-
che, drowsiness, diplopia, ataxia, dizzin-
7.6.1 CONTROL OF EPILEPSY
ess, blurred vision, dry mouth, Stevens-
7.6.2 STATUS EPILEPTICUS
Johnson-Syndrome, leucopenia and
7.6.1 CONTROL OF EPILEPSY other blood disorders.
295
Other Side-effects include cholestatic Side-effects: Drowsiness, ataxia is dose

jaundice, hepatitis and acute renal related which usually subsides within 3
failure. to 4 days; paradoxical behavioural
Dose: Epilepsy in ELDERLY, initially changes like hyperactivity, irritability and
100-200 mg 2 times daily, increased aggressiveness
slowly to usual dose of 0.8-1.2 g daily in Dose: Initially1 mg (half in elderly) at
divided doses, in some cases, 1.6-2 g night for 4 nights, increased over 2-4
daily may be needed. CHILD up to 1 weeks to a maintenance dose of 4-8 mg
year of age 100-200 mg daily in divided daily in divided doses; doses must be
doses; 1-5 years, 200-400 mg; 5-10 individually adjusted according to clinical
years, 400-600 mg; 10-15 years, 0.6-1 g response. CHILD, up to I year 250
Prophylaxis of Manic Depressive Illness micrograms increased as above to 0.5-1
(bipolar disorder) unresponsive to lithium mg, 1-5 years 250 micrograms increased
therapy, initially 400 mg daily in divided up to 1-3 mg, 5-12 years 500
doses increased until symptoms control- micrograms increased up to 3-6 mg
led; usual range 400-600 mg daily OVERDOSE:Specific benzodiazepine
maximum 1.6 g daily antagonist Flumazenil may be used in
severe cases. Supervision of other vital
Proprietary Preparations function with supportive measure is
Anleptic(Square), Tab., 200 mg ,Tk. 6.02/ necessary
Tab.; Suspn., 100 mg/5 ml, Tk. 300.9/100ml
Carbazine(Eskayef), Tab, 200 mg, Tk. Proprietary Preparations
4.00/Tab.; CR Tab, 200 mg, Tk. 4.50/Tab. Arotril(Aristo), Tab., 1 mg, Tk. 8.00/Tab.;
Carmapine(Incepta), Suspn., 100mg/5 ml, Tk. 0.5mg, Tk. 6.00/Tab.; 2mg, Tk. 10.00/Tab.
250.00/100ml,; Tab., 200 mg, Tk. 4.00/Tab.;
Cloma(Biopharma), Tab., 0.500mg, Tk.
CR Tab., 200 mg, Tk.5.00/Tab.
4.00/Tab.; 2.00mg, Tk. 6.00/Tab.
Cazep(Opsonin), Tab., 200 mg, Tk. 4.02/Tab.
Clon(Globe), Tab., 0.5 mg, Tk. 4.50/Tab.; 2
Cepilep(ACI), Tab., 200mg, TK. 4.03/Tab. mg, Tk. 7.00/Tab.
Epilep(Beximco), CRTab., 200mg, Tk. Clonaben(Benham), Tab., 0.5 mg, Tk.
4.52/Tab.; Tab. 200mg, Tk. 3.51/Tab.
5.00/Tab.; 2 mg, Tk. 7.00/Tab.
Tegretol(Novartis), Syrup, 100 mg/5 ml, Tk.
Clonapin(Popular), Tab. , 0.500mg, Tk.
379.00/100ml.,Tab., 200 mg, Tk. 9.03/Tab.;
3.00/Tab.; 1.00mg, Tk. 8.00/Tab.
CR Tab. 200 mg, Tk. 9.53/Tab.
Clonatril(Healthcare), Tab., 0.5mg , Tk.
6.00/Tab.; 1mg , Tk. 8.00/Tab.; 2mg, Tk.
CLONAZEPAM 10.00/Tab.
Clonazepam(Amico), Tab., 0.5mg, Tk.
3.00/Tab .; 2mg, Tk. 5.00/Tab.
Indications: Most clinical forms of
Clonium(ACI), Tab., 0.5mg, Tk. 6.00/Tab. ;
epilepsy in infants and children, specially 1mg, Tk. 8.00/Tab.; 2mg, Tk. 10.00/Tab.;
partial seizures and absence seizures as Paed. drops, 2.5mg/ml, TK. 130.88/10ml
an adjunctive therapy; panic and phobic Clopam(Sharif), Tab., 0.5 mg, Tk. 3.01/Tab.;
disorders; anticipatory anxiety associa- 2 mg, Tk. 5.01/Tab.
ted with alprazolam treatment; Cloron(Eskayef), Paed. drops, 2.5 mg/ml, Tk.
myoclonus; status epilepticus (see 80.00/10ml,; Tab, 0.5mg , Tk. 6.00/Tab.; 1mg
, Tk. 8.00/Tab.; 2mg , Tk. 10.00/Tab.
section7.6.2)
Conpan(Navana), Tab., 0.5 mg, Tk. 5.80/Tab.;
Contraindications: Respiratory 2mg, Tk. 9.00/Tab.
depression; acute pulmonary Denixil(Renata), Tab. , 0.5mg, Tk. 6.00/Tab.
insufficiency; alcohol intoxication Disopan(Incepta), Tab., 0.5 mg, Tk.
Cautions: Respiratory, renal and 6.00/Tab.; 1 mg, Tk. 8.00/Tab.; 2 mg, Tk.
hepatic diseases; those receiving 10.00/Tab. Inj.,1mg/ml,Tk.150/Amp
barbiturates; elderly, pregnancy and Epiclon(General), Tab., 0.5mg, Tk. 6.00/Tab.;
1mg, Tk. 8.00/Tab.; 2mg, Tk. 10.00/Tab.
breast-feeding (mothers undergoing
Epitra(Square), Tab., 0.5 mg, Tk. 6.00/Tab.; 1
treatment should not breast feed); has mg, Tk. 8.00/Tab.; 2 mg, Tk. 10.00/Tab.
been associated with the emergence of Epizam(Alco), Tab., Tk. 4.00/Tab.; Tk.
depression; avoid sudden withdrawal 6.00/Tab.
Interactions: See Appendix-2 Esypan(Silva), Tab., 0.5 mg, Tk. 2.01/Tab.; 2
mg, Tk. 4.02/Tab.
296
Leptic(Acme), Tab, 0.50 mg., Tk. 5.50/Tab.; Cautions: Avoid sudden withdrawal
1.00 mg., Tk. 8.00/Tab.; 2.00 mg., Tk. (taper off over at least 1 week); history of
8.50/Tab. psychotic illness, elderly (may need to
Myotril(Ibn Sina), Tab., 0.5mg, Tk. 5.00/Tab.
Pandura(NIPRO JMI), Tab., 2mg, Tk.
reduce dose), renal impairment, diabetes
10.00/Tab.; 0.50mg, Tk. 6.00/Tab.; 1mg, Tk. mellitus, false positive readings with
8.00/Tab. some urinary protein tests, pregnancy
Pase(Opsonin), Tab., 1 mg , Tk. 6.00/Tab.; 2 Interactions: See Appendix-2
mg , Tk. 7.00/Tab.; 500 mcg , Tk. 5.00/Tab.; Side-effects: Drowsiness, dizziness,
Paed. drops, 2.5mg/ml, Tk. 80.30/10 ml,; ataxia, fatigue, tremor, diplopia,
Rivo(Orion), Tab. , 0.5 mg, Tk. 4.00/Tab.; 2 amnesia, asthenia, paraesthesia,
mg, Tk. 6.00/Tab.
Rivotril(Radiant), Tab., 0.5mg, Tk. 8.00/Tab.;
arthralgia, purpura, leucopenia rhinitis,
2mg , Tk. 13.00/Tab. urinary incontinence,
Sypam(Asiatic), Tab., 0.5mg , Tk. 6.00/Tab.; Dose: Epilepsy, 300mg on day 1, then
2.00mg , Tk. 10.00/Tab. 300mg twice daily on day 2, then 300mg
Xetril(Beximco), Tab., 0.5mg, Tk. 6.00/Tab.; 3 times daily (approx. every 8 hours) on
2mg, Tk. 8.00/Tab. day 3, then increased according to
Xioclon(Somatec), Tab., 0.5 mg, Tk. response in steps of 300mg daily (in 3
5.00/Tab.; 1 mg, Tk. 6.00/Tab.; 2 mg, Tk.
7.00/Tab.
divided doses) to maximum 2.4g daily,
ususal range 0.9-1.2 g daily; CHILD: 6-
ESLICARBAZEPINE(Cerbamazepine 12 years (under specialist guidance)
related drug) 10mg/kg on day 1, then 20mg/kg on day
2, then 25-35mg/kg daily (in divided
doses approx. every 8 hours)
Indications: Used as add-on therapy in
maintenance 900 mg daily (body-weight
partial or generalized seizure
26-36Kg) or 1.2g daily (body-Wight 37-
Dose: ADULT;400 mg once daily which
50 kg)
should be increased to 800 mg once
For neuropathic pain, 300 mg on day 1,
daily after one or two weeks. Based on
300mg twice daily on day 2, 300mg 3
individual response the dose may be
times daily on day 3, then increased
increased to 1200 mg once daily
according to response in steps of 300mg
Eslicar(Square), Tab. , 400 mg, Tk.
daily (in 3 divided doses) to maximum
35.11/Tab. 1.8g daily.
ETHOSUXIMIDE Gaba(Renata), Tab., 300 mg, Tk. 16.07/Tab.;
300 mg, Tk. 30.11/Tab.
Indications: Drugs of choice in absence Gabamax(Beacon), Tab., 300 mg, Tk.
seizure 16.11/Tab.
Cautions: Hepatic & renal impairment Gabapen(Incepta), Tab., 300 mg, Tk.
16.00/Tab.; 300 mg, Tk. 6.00/Tab.
Side-effects: GI disturbances,
Gabastar(Square), Tab., 300 mg, Tk.
dizziness, hypersensitivity 6.04/Tab.; 300 mg, Tk. 16.11/Tab.
Dose: 3-6 years : 250mg>6yr : 500mg Gabatin(UniMed), Tab, 300 mg, Tk.
15.00/Tab.
Proprietary Preparations Gabon(Acme),Tab., 300 mg, Tk. 16.04/Tab.
Serontin(ACI), Syrup, 5mg/100ml, Gpentin(Opsonin), Tab., 300 mg, Tk.
Tk.130.39/70ml 16.06/Tab.
Nepsy(Eskayef), Tab, 300 mg, Tk. 16.00/Tab.
GABAPENTIN Neuropen(Drug Intl), Tab., 300 mg, Tk.
16.05/Tab.
Indications: Adjunctive treatment of

LAMOTRIGINE
partial seizures with or without
secondary generalization not satisfac-
torily controlled with other antiepileptics, Indications: Monotherapy and adjunct-
neuropathic pain ive treatment of partial seizures and
primary and secondary generalized
297
tonic-clonic seizures; Lennox-Gestaut

Syndrome associated seizures
Cautions: Closely monitor hepatic, renal Proprietary Preparations
and clotting parameters and consider Lamicet(Square),Tab., 50 mg, Tk. 20.00/Tab.
Lamitrin(ACI), Tab., 25mg, Tk. 10.07/Tab. ;
withdrawal if rash, fever, influenza-like 50mg, Tk. 18.05/Tab.
symptoms, drowsiness, or worsening of Lamogin(Incepta), Tab., 25 mg, Tk.
seizure control develops; avoid abrupt 10.00/Tab.; 50 mg, Tk. 18.00/Tab.
withdrawal; elderly, pregnancy and Lameptil(Novertis)Tab., 25mg, Tk. 12.00,
breast-feeding Tab. , 50 mg, Tk. 20.00/Tab.
Contraindications: Hepatic impairment
Interactions: See Appendix-2 LEVETIRACETAM
Side-effects: Skin rashes, influenzalike (Piracetam analog)
symptoms, drowsiness lymphadenopa-
thy,leucopenia and thrombocytopenia, Indications: Partial seizures, or as
angioedema, photosensitivity,blurred anadjunctivetherapyforpartial,myoclonica
vision, ataxia, aggression, tremor, ndtonic clonicseizures.
confusion; Cautions: Should not be discontinued
Dose: Monotherapy, initially 25 mg daily suddenly because of the risk of
for 14 days, increased to 50 mg daily for increased seizure activity,patients who
further 14 days, then increased by are started on therapy should be closely
maximum of 50-100 mg every 7-14 days; observed for clinical worsening, suicidal
usual maintenance with 100-200 mg thoughts, or unusual changes
daily in 2-3 divided doses (up to Interactions: See Appendix-2
maximum 500 mg daily) Side-effects: Headache, sleepiness,
Adjunctive therapy with Valproate: dizziness, and difficultywalking or
Initially 25 mg every other day for 14 moving, ataxia.
days then 25 mg daily for further 14 Dose: Monotherapy of focal seizures, by
days, thereafter increased by maximum mouth or by intravenousinfusion, ADULT
of 25-50 mg every 7-14 days; usual and CHILD over 16 years: initially 250
maintenance with 100-200 mg daily in 1- mg once daily
2 divided doses Adjunctive therapy of focal seizures, by
Adjunctive therapy withoutValproate: mouth, ADULTand CHILD over 12 years,
Initially 50 mg daily for 14 days then 50 body-weight over 50 kg,initially 250 mg
mg twice daily for further 14 days, twice daily, increase to maximum1000
thereafter increased by maximum of 100 mg daily.
mg every 7-14 days; usual maintenance CHILD over 6 months, body-weight
with 200-400 mg daily in 2 divided doses under 50 kg, initially10 mg/kg once daily,
(up to 700 mg daily may be required) increased by max. 10 mg/kg twice daily
CHILD under 12 years:Monotherapy not every 2 weeks
recommended; adjunct therapy with
Valproate: initially 150 micrograms/kg Proprietary Preparations
daily for 14 days then 300 microgram/kg Citazar(ACI), Tab., 250mg, Tk. 15.11/Tab. ;
daily for further 14 days, thereafter 500mg, Tk. 25.17/Tab.
increased by 300 microgram/kg every 7- Eletam(UniMed), Tab., 250mg, Tk.
16.00/Tab.; 500mg, Tk. 30.00/Tab.; Suspn,
14 days; usual maintenance with 1-5
100mg/5ml, Tk. 400.00/100ml
mg/kg daily in 1-2 divided doses. CHILD Erata(Novartis), Tab., 250 mg , Tk.
under 12 years, adjunct therapy without 16.25/Tab.; Tab., 500 mg , Tk. 30.50/Tab.
Valproate, initially 600 microgram/kg Iracet(Square), Suspn, 100mg/ml, Tk.
daily in 2 divided doses for 14 days then 200.61/50ml,; Tab. , 250 mg, Tk. 16.00/Tab. ;
1.2 mg/kg daily in 2 divided doses for 500 mg, Tk. 30.00/Tab.; Inj., 500 mg/5 ml, Tk.
further 14 days, thereafter increased by 40.13/5mlAmp
Leveron(Sanofi), Tab., 250mg, Tk.
maximum of 1.2 mg/kg every 7-14 days;
16.05/Tab.; 500mg, Tk. 30.09/Tab.; Suspn,
usual maintenance with 5-15 mg/kg daily 100mg/ml, Tk. 400.00/100ml.
in 2 divided doses
298
Neurocet(Incepta), Tab., 250 mg, Tk. FOSPHENYTOIN

15.00/Tab.; 500 mg, Tk. 25.00/Tab.
When only parenteral administration is

OXCARBAMAZEPINE
possible, fosphenytoin (section 4.8.2), a
pro-drug of phenytoin, may be
Indications: In partial generalized convenient to give. Unlike phenytoin
epilepsy (which should only be given
Contra-indications: Hypersensitivity intravenously), fosphenytoin may also be
reaction given by intramuscular injection.
Side-effects: Dizziness, somnolence
Dose: 600-2400mg/ day in two divided Proprietary Preparations
doses Fosfen(Popular), Inj., 150mg/2ml, Tk.
Preparations: Oxetol (Sun), tab 70.26/Amp
150/300mg
PREGABALIN
Leptal(Healthcare), Tab., 300 mg , Tk.
18.00/Tab., 600 mg , Tk. 30.00/Tab. Indications: As an adjunct treatment in
Trileptal(Novartis), Tab. , 300 mg, Tk. partial & generalized tonic clonic
20.06/Tab., Suspn., 60 mg/ml, Tk. seizures, neuropathic pain associated
1072.00/100 ml., Tab. , 600 mg, Tk. with diabetic peripheral neuropathy and
35.11/Tab. in combination with other drugs to treat
partial onset seizures in adults.
PHENYTOIN[ED] Cautions: Neuropathic painrenal
impairment, pregnancy, breast-feeding;
Indications: All forms of epilepsy except avoid sudden withdrawal
absence seizures; trigeminal neuralgia Side-effects: Somnolence, ataxia,dry
as an alternative to carbamazepine mouth, constipation, vomiting,flatulence,
Cautions: Hepatic impairment, oedema, dizziness, drowsiness,
pregnancy, breast-feeding; avoid sudden confusion, malaise, appetitechanges,
withdrawal insomnia, sexual dysfunction, blurred
Interations: See Appendix-2 vision,
Side-effects:Nausea, vomiting, mental Dose: Neuropathic pain, ADULT over 18
confusion,tremor, insomnia, peripheral years, initially150 mg daily in 2–3 divided
neuropathy, ataxia, slurred speech, doses, ADULT over 18 years,
nystagmus, gingival hypertrophy, coarse initially25mg twicedaily;consult product
facies, acne and hirsutism, lupus literature
erythematosus, hypocalcaemia,
Stevens-Johnson syndrome; Proprietary Preparations
haematological effects including
Asibalin(Asiatic), Cap., 50mg , Tk.
megaloblastic anaemia, leucopenia,
12.00/Cap., 75mg , Tk. 16.00/cap.
thrombocytopenia, agranulocytosis, and Gaba(Renata), Cap., 25 mg, Tk.
aplastic anaemia; 8.00/Cap., 50 mg, Tk. 12.00/Cap.; 75 mg, Tk.
Dose: By mouth, initially 100 mg/day, 16.07/Cap.
increased gradually as necessary; usual Gabamet(Somatec), Cap., 75 mg, Tk.
dose 200-500 mg daily. CHILD initially 5 16.00/Cap., 50 mg, Tk. 12.00/Cap., 25 mg,
mg/kg daily in 2 divided doses, usual Tk. 8.00/Cap.
Gabarol(ACI), Cap., 150mg, Tk. 34.00/ Cap.,
dose range 4-8 mg/kg daily (max. 300
25mg, Tk. 8.02/Cap., 75mg, Tk. 16.11/ Cap.,
mg). by intravenous injection-see section 100mg, Tk. 22.15/ Cap., 50mg, Tk.
7.6.2 on status epilepticus. 12.04/Cap.
Lirica(Biopharma), Cap., 25mg, Tk. 7.00/Cap.,
Proprietary Preparations 50mg, Tk. 13.00/Cap., 75mg, Tk. 16.00/Cap.
D-Toin(Drug Intl), Tab., 100mg, Tk. 3.00/Tab. Lyric(Healthcare), Cap. , 150mg ,Tk.
Sizatoin(Incepta), Tab., 100mg, Tk. 4.00/Tab. 30.00/Cap., 25mg, Tk. 160.00/Cap., 75mg ,
Xentoin(Beacon), Tab., 100mg, Tk. 4.01/Tab. Tk. 540.00/Cap., 50mg , Tk. 420.00/Ca.
299
Lyrinex(NIPRO JMI), Cap., 50 mg, Tk. Xil(Orion), Cap., 75 mg, Tk. 16.05/Cap., 50
12.00/Cap.; 75 mg, Tk. 16.00/Cap. mg, Tk. 12.04/Cap.
Myrica(UniMed), Cap., 50mg, Tk.
28.00/Cap., 100mg, Tk. 20.00/Cap., 75mg, Tk. SODIUM VALPORATE[ED]/ VALPROIC
16.00/Cap.
ACID
Nepco(Pacific), Cap. , 150 mg, Tk.
35.00/Cap. , 100 mg, Tk. 22.00/cap. , 25 mg,
Tk. 10.00/Cap., 50 mg, Tk. 14.00/Cap., 75 Indications: All forms of epilepsy, also
mg, Tk. 19.00/Cap. bipolar disorder and migraine
Nervalin(Beximco), Cap., 25mg, Tk. prophylaxis
8.00/cap., 50mg, Tk. 11.00/Cap., 75mg, Tk. Cautions: Monitor liver functions before
16.00/Cap., 150.00 mg, Tk. 30.10/Cap.
and 6 months after initiation of therapy
Neugalin(Acme), Cap. , 25.00 mg, Tk.
8.00/Cap., 50 mg, Tk. 11.03/Cap., 75 mg, Tk. (especially in children under 3 years of
16.04/Cap. age where there has been reports of
Neurega(Ibn Sina), Cap. , 25mg, Tk. fatal hepatic failure); undue potential for
8.00/Cap., 50mg, Tk. 13.00/Cap., 75mg, Tk. bleeding; renal impairment; breast
340.00/Cap., 100mg, Tk. 2.64/Cap. feeding; SLE; avoid sudden withdrawal
Neurica(Globe), Cap., 75 mg, Tk. 16.00/Cap., Contraindications: Active liver disease,
50 mg, Tk. 12.00/Cap
family history of severe hepatic
Neurolin(Square), Cap. , 25 mg,
Tk.8.03/Cap., 50 mg, Tk.12.03/Cap., 75 mg, dysfunction,pregnancy nd child bering
Tk.16.05/Cap. women
Neurovan(Aristo), Cap. , 50mg , Tk. Interactions: Inhibit metabolism of other
12.00/Cap., 75mg , Tk. 16.00/Cap., 25mg , Tk. antiepileptic drugs, See Appendix-2
8.00/Cap. Side-effects: Gastric irritation, ataxia
Pegalin(Popular), Cap. , 100mg, Tk. and tremor, weight gain; transient hair
22.08/Cap., 25mg, Tk. 8.00/Cap., 75 mg, Tk.
loss, oedema, leucopenia, pancytopenia,
16.06/Cap., 50mg , Tk. 12.00/Cap., 150mg,
Tk. 30.11/Cap. amenorrhoea, gynaecomastia, toxic
Pegamax(Astra Bio), Cap. , 50 mg, Tk. epidermal necrolysis, hearing loss,
11.00/Cap., 75 mg, Tk. 16.00/Cap. vasculitis Stevens-Johnson
PG(Eskayef), Cap. , 150mg , Tk. 30.00/Cap., syndrome.Idiosyncraticthrombocytopenia
25mg , Tk. 8.00/Cap., 75mg, Tk. 16.00/Cap., , hepatotoxicity
25mg , Tk. 8.00/Cap., 50 mg, Tk. 11.00/Cap., Dose: Initially 400 mg daily in 2 divided
Prebalin(General), Cap. , 25mg, Tk.
doses, preferably after food, increased
8.00/Cap., 50mg, Tk. 12.04/Cap., 150mg, Tk.
30.20/Cap., 75mg, Tk. 16.11/Cap. by 200 mg at 3 day intervals to a max. of
Pregaba(Opsonin), Cap. , 150 mg , Tk. 2g daily in divided doses; usual
30.20/Cap., 25 mg , Tk. 8.03/Cap., 50 mg , Tk. maintenance dose 800-1600 mg daily.
12.09/Cap., 75 mg , Tk. 16.06/Cap. CHILD up to 20 kg, initially 10 mg/kg
Pregaben(Incepta), Cap. , 150 mg, Tk. daily in divided doses, may be increase
30.00/Cap., 75 mg, Tk. 16.00/Cap., 25 mg, Tk. to 20 mg/kg (further increase requires
8.00/Cap., 50 mg, Tk. 12.00/Cap.
regular plasma concentration monitor-
Pregalex(Sharif), Cap. , 50 mg, Tk.
11.03/Cap., 75 mg, Tk. 16.04/Cap., 150 mg, ing); over 20 kg, initially 400 mg daily in
Tk. 30.10/Cap. 2 divided doses, increase until control
Pregan(Navana), Cap., 50 mg, Tk. (usually in range of 20-30 mg/kg/day);
11.03/Cap.; 75 mg, Tk. 16.05/Cap. max. 35 mg/kg/day
Prelica(Radiant), Cap. , 50mg , Tk.
14.54/Cap., 75mg , Tk. 19.06/Cap., 150mg , Proprietary Preparations
Tk. 35.11/Cap., 25mg , Tk. 10.03/Cap. Encorate(Sun), ECTab. ,200mgTk. 3.00/Tab.
Prelin(Drug Intl), Cap., 25mg, Tk. 8.05/Cap., Epilim(Sanofi), Syrup, 40mg/ml, Tk.
50mg, Tk. 11.05/Cap., 150mg, Tk. 30.10/Cap., 80.54/100ml., Tab., 200 mg, Tk. 5.02/Tab.,
75mg, Tk. 16.05/Cap. 300 mg, Tk. 8.02/Tab.
Pretor(Sanofi), Cap. , 50mg, Tk. Epival(Albion), Tab. , 200 mg, Tk. 3.00/Tab.
12.04/Cap., 75mg, Tk. 16.05/Cap. Nalipsy(Drug Intl), Tab., 200mg, Tk. 3.00/Tab.
Priga(Monico), Cap., 75mg, Tk. 16.00/Cap. Proval(General), Tab. , 200mg, Tk.
Regab(Beacon), Cap., 25mg , Tk. 8.02/Cap., 2.52/Tab.,Syrup, 200 mg/5 ml, Tk.
50mg , Tk. 12.04/Cap., 75mg , Tk. 16.05/Cap. 75.51/100ml;
Vaxar(Nuvista), Cap., 50 mg, Tk. 12.00/Cap.,
25 mg, Tk. 8.00/Cap., 75 mg, Tk. 16.00/Cap,.
300
Sodival(ACI), Tab., 200mg , Tk. 2.52/Tab., intervals of 1-2 weeks and taken in 2
300 mg, Tk. 6.02/Tab Syrup, 200 mg/5 ml, divided doses; recommended dose
Tk. 80.24/100ml; range 5-9 mg/kg daily in 2 divided doses
Valex(Incepta), Tab. 200 mg , Tk. 3.00/Tab.,
Syrup, 200 mg/5 ml, Tk. 80.00/100ml;
Valoate(Square), CR Tab. , 500 mg, Tk. Proprietary Preparations
12.03/Tab., 200 mg, Tk. 5.02/Tab., , CR.300 Etopira(UniMed), Tab., 25 mg,Tk. 5.00/Tab.;
mg, Tk. 8.03/Tab. Syrup, 200 mg/5 ml, Tk. 50 mg, Tk.10.00/Tab.
Piramed(Square), Tab., 200 mg,Tk.
100.3/100ml
15.05/Tab.; 25 mg, Tk. 3.01/Tab.
Topirva(Incepta),Tab., 25 mg, Tk.
Sodium Valporate and valporic acid
3.00/Tab.; 50 mg, Tk. 5.00/Tab.
ConvulesCR(Opsonin), Tab. , 200 mg, Tk.
4.02/Tab., CR Tab., 300 mg, Tk. 10.07/Tab., Topmate(Renata), Tab., 25 mg, Tk.
4.00/Tab.; 50 mg, Tk. 6.00/Tab.
300 mg, Tk. 6.04/Tab., Syrup 200 mg/5 ml, Tk.
75.28/ 100 ml
Encorate chrono(Sun), Tab. , 200 mg, Tk. 7.6.2 STATUS EPILEPTICUS
4.50/Tab.; 300 mg, Tk. 7.00/Tab.; 500 mg, Tk.
11.00/Tab.
Epilim(Sanofi), Tab., 200 mg, Tk. 5.02/Tab., DIAZEPAM[ED] [CD]
300 mg, Tk. 8.02/Tab. , 500 mg, Tk. (See also section 7.1 )
12.04/Tab.
Epival Chrono(Albion), CR Tab. , 200 mg, Indications: Status epilepticus; convuls-
Tk. 4.50/Tab. ; Tab. , 300 mg, Tk. 7.00/Tab. ions due to poisoning; for other
;Tab. , 500 mg, Tk. 11.00/Tab.
ProvalCR(General), CRTab. 300 mg, Tk. Indicationsee section 7.1
8.00/Tab.,500 mg, Tk. 12.00/Tab., 200 mg, Cautions: Intravenous diazepam is
Tk. 5.00/Tab., potentially hazardous, calling for close
SodivalCR(ACI), CR Tab., 200 mg, Tk. and constant observation and best
4.01/Tab., 300 mg, TK. 10.03/Tab., carried out with ICU facilities in a
ValexCR(Incepta), CR Tab. , 500 mg, Tk. hospitalsee section 7.2
11.00/Tab., CR 300 mg, Tk. 7.00/Tab., 200
Contraindications: See section 7.1 on
mg , Tk. 4.50/Tab., Syrup, 200 mg/5 ml, Tk.
80.00/100ml; psychiatric drugs.
Side-effects: Hypotension and
apnoea;See also section 7.2
TOPIRAMATE
Interactions : See Appendix-2
Dose: By intravenous injection, 10-20
Indications: Adjunctive therapy for mg at a rate of 0.5 ml (2.5 mg) per 30
partial seizures (LRE); seizures associ- seconds, repeated if necessary after 30-
ated with Lennox-Gastaut syndrome; 60 minutes; may be followed by
idiopathic GTCS; absence seizure, intravenous infusion to max. 3 mg/kg
migraine headache, infantile spasm over 24 hours; CHILD 200-300
Cautions: Avoid abrupt withdrawal; micrograms/kg or 1 mg per year of age
ensure adequate hydration; pregnancy;
hepatic or renal impairment Proprietary Preparations
Contraindications: Breast-feeding See section 7.1
Side-effects: Myopia glaucoma,nausea,
PHENOBARBITONE/
anorexia, abdominal pain, weight loss;
PHENOBARBITONE SODIUM[ED][CD]
confusion, impaired speech, depression,
ataxia, paraesthesia, fatigue, asthenia,
visual disturbances leucopenia Indications: All forms of epilepsy except
Dose: Initially 25 mg daily for 1 week absence seizures; status epilepticus;
then increased in steps of 25-50 mg febrile convulsion
daily at intervals of 1-2 weeks in 2 Cautions: Pregnancy and lactation
divided doses; max. 800mg daily. CHILD Contra-indications: Drug dependence,
2-16 years, initially 25 mg at night for liver disease, renal disease
one week then increased in steps of 1-3 Interactions: See Appendix-2
mg/kg daily according to response at
301
Side-effects: Nausea, vomiting, hypera- symptoms. It is effective and well

ctivity, cognition impairments, folate defi- tolerate in the majority of patients.
ciency, decreased libido, dependence Its use is often limited by its Side-effects;
Dose:By mouth, 30-180 mg at night. when used with levodopa, abnormal
CHILD, 5-8 mg/kg daily involuntary movements and confusional
By intramuscular injection, 200 mg, states are common.
repeated after 6 hours if necessary. Amantadine has modest antiparkinson-
CHILD 15/kg as a single dose ian effects. It improves mild brady-kinetic
By intravenous injection in status disabilities as well as tremor and rigidity.
epilepticus, (dilute injection 1 in 10 with Unfortunately only a small proportion of
water for injection), 10 mg/kg at a rate of patients derive much benefit from this
not more than 100 mg/minute; max. 1 drug and tolerance to it occurs. However
gram it has the advantage of being relatively
free from untoward Side-effects.
Proprietary Preparations Pramipexoleis adopamine agonist of the
Barbipan(Albion), Elixir, 20mg/5ml Tk. non-ergolineclass indicated for
56.00/100 ml;Tab. , 15 mg, Tk. 0.57/Tab.; 30 treatingParkinson's diseaseandrestless
mg, Tk. 0.78/Tab. ; 60 mg, Tk. 1.14/Tab.
Barbit(Incepta), Elixir, 20 mg/5 ml , Tk.
legs syndrome
29.06/50ml; Tk. 57.00/100ml; Tab, 60mg, Tk.
1.14/Tab., Tab, 30 mg, Tk. 0.78/Tab., Inj., 200 AMANTADINE HYDROCHLORIDE
mg/ml, Tk. 16.00/Amp (Releases dopamine, weak anti parkinsonismagent,
Berdinal(G.A.Co), Tab., 30 mg, Tk. 0.78/Tab. shortacting)
Emer(Opsonin), Elixir, 20 mg/5 ml , Tk. 57.32/ (See also section 1.3.3)
100 ml ; Tab, 30 mg , Tk. 0.78/Tab., 60 mg , Indications: Parkinson’s disease
Tk. 1.14/Tab., Inj., 200 mg/ml, Tk. 16.05/Amp Antiviral.For other indications, see also
Epinal(Square), Elixir, 20 mg/5 ml, Tk. section 1.3.3
56.37/100ml; Tab, 30 mg, Tk. 0.78/Tab.
G-phenobarbitone(Gonoshasthaya), Inj., 200
Cautions:Seizure, heart failure,hepatic
mg/ml, Tk. 15.00 /Amp.; Tab., 30 mg , Tk. or renal impairment, congestive heart
0.75/Tab. disease, confusions or hallucinatory
Pheno(Delta), Tab. , 30 mg, Tk. states, elderly; avoid abrupt withdrawal
0.78/Tab.;Tab. , 60 mg, Tk. 1.14/Tab. Contra-indications:Epilepsy, history of
Phenoba(Biopharma), Tab., 30mg, Tk. gastric ulceration, severe renal
0.78/Tab., Tab., 60mg, Tk. 1.14/Tab. impairment; pregnancy, breast-feeding
Phenoson(Jayson), Tab., 30 mg, Tk.
0.78/Tab.
Side-effects:Excitement, hallucination,
dermatological reaction. Anorexia,
7.7 DRUGS USED IN
nausea, nervousness, inability
PARKINSONISM
toconcentrate, insomnia, dizziness,
7.7.1 DOPAMINERGIC DRUGS convulsions, blurred vision,
7.7.2 ANTIMUSCARINIC DRUGS gastrointestinal disturbances, peripheral
7.7.3 DRUGS USED IN ESSENTIAL oedema.
TREMOR, CHOREA, TICS AND Dose: 100 mg daily increased after one
RELATED DISORDERS week to 100 mg twice daily, usually in
conjunction with other treatment; some
7.7.1 DOPAMINERGIC DRUGS patients may require higher doses, max.
400 mg daily
Levodopa used along with a dopa-
decarboxylase inhibitor is the treatment Proprietary Preparation
of choice for patients disabled by Amantril(ACI), Cap., 100mg, Tk.10.00/Cap.
Altrip(NIPRO JMI), Tab., 6.25 mg, Tk.
idiopathic Parkinson’s disease. It is in
35.08/Tab.
combination with dopa-decarboxylase
inhibitoruseful in the elderly or frail
patients with other significant disease
and in those with more severe
302
BROMOCRIPTINE(Dopamine Receptor Note: Carbidopa 70-100 mg daily is

Agonist) necessary to achieve full inhibition of
dopa-decarboxylase
Indications: Parkinsonism, endocrine
disorders (see section 6.5.1) Proprietary Preparations
Cautions: Contra-indications&Side- Aldopa (Albion), Tab. ,25 mg + 250 mg, Tk.
6.00/Tab.
effects: See section 6.5.1
Cinemat(ACI),Tab., 50 mg + 200mg, Tk.
Interactions: See Appendix-2 12.50/Tab.; 25mg + 100 mg, TK. 10.00/Tab.
Dose: First week 1-1.25 mg at night, Co-dopa(UniMed), Tab, 10mg + 100mg, Tk.
second week 2-2.5 mg at night, third 7.00/Tab.; 25mg+ 250mg, Tk. 10.00/Tab.;
week 2.5 mg 3 times daily then 50mg+200mg, Tk. 20.00/Tab.
increasing by 2.5 mg every 3-14 days D-dopa(Drug Intl), Tab., 10 mg + 100 mg, Tk.
according to response to a usual range 5.05/Tab.; 25 mg + 250 mg, Tk. 6.05/Tab.
Levopa(Acme), Tab. , 10 mg + 100 mg , Tk.
of 10-40 mg daily; taken with food
4.01/Tab. ; 25 mg + 250 mg, Tk. 7.52/Tab.
Perkidopa(Square), Tab., 10 mg + 100 mg,
Proprietary Preparations Tk. 7.00/Tab.; 25 mg + 250 mg , Tk.
Bromodel(Opsonin), Tab., 2.5 mg, Tk.12/Tab. 10.00/Tab.
Bromolac(Square),Tab.,2.5 mg,Tk.12.03/Tab. Syndopa (Sun), CR Tab. , 25 mg + 100 mg,
Bromotine(Nuvista),Tab., 2.5 mg, Tk. Tk. 10.00/Tab.;Tab. , 10 mg + 100 mg, Tk.
11.03/Tab. 7.00/Tab.CR Tab., 50 mg + 200 mg, Tk.
Criptine(Renata), Tab., 2.5 mg, Tk. 12/Tab. 12.50/Tab.
CO-CARELDOPA Levodopa+Carbidopa+Entacapone
CARBIDOPA-LEVODOPA Stalevo(I)(Novartis), Tab., 75 mg + 18.75 mg
+ 200 mg, Tk.85.00/Tab
125 mg + 31.25 mg + 200 mg Tk.85.00/Tab
This is a combination of levodopa and 200 mg+ 50 mg + 200 mg Tk.,85.00/Tab
carbidopa at a proportion of 10:1. Tridopa(ACI), Tab. , 50mg+12.5mg+200mg
Indications:Parkinson’s disease Tk. 15.00/Tab.; 200mg+50mg+200mg, Tk.
Cautions:Pulmonary disease, peptic 40.00/Tab.; 150mg+37.5mg+200mg, Tk.
ulcer, cardiovascular disease, osteomal- 30.00/Tab.;100mg+25mg+200mg, Tk.
25.00/Tab.
acia, diabetes mellitus, openangle
glaucoma, skin melanoma, psychiatric
illness; avoid abrupt withdrawal; ENTACAPONE
Contra-indications: Closed-angle Indications: Adjunct to levodopa in
glaucoma Parkinson’s disease patients who have
Interactions:See Appendix-2 ‘end-of-dose’ motor fluctuations
Side-effects:GI-effect: nausea, Cautions: Concurrent levodopa dose
vomitingCVS effect: postural may need to be reduced by about 10-
hypotension arrhythmia, CNS effect: 30%
Anxiety,delusion Contra-Indications:Pregnancy and
MotorFunction: dyskinesias, breast-feeding; hepatic impairment; pha-
choreoatelosis anorexia insomnia, eochromocytoma; concomitant use of
agitation; abnormal involuntary non-selective MAO-A or MAO-B
movements and psychiatric symptoms, inhibitors; history of neuroleptic
drowsiness, peripheral neuropathy, taste malignant syndrome or non-traumatic
disturbance, pruritus, rhabdomyolysis
Dose: Expressed as levodopa, initially Interactions:See Appendix-2
100mg (with carbidopa 25 mg) 3 times Side-effects: Nausea, vomiting, abdomi-
daily, increased by 50–100mg(with nal pain, constipation, diarrhea, urine
carbidopa 12.5 or 25 mg) daily or on may be coloured reddish-brown, dry
alternatedays according to response, up mouth, dyskinesias; dizziness; rarely
to 800 mg (withcarbidopa 200 mg) daily elevated liver enzymes; anaemia
in divided doses reported
303
Dose: 200 mg with each dose of SELEGILINE

levodopa with dopa-decarboxylase HYDROCHLORIDE(Selective irreversible
inhibitor; max. 2 g daily inhibitor of MAO-B,enhance& prolong action of
levodopa,slow disease progression)
Comtan(I)(Orion),Tab. 200 mg, Tk. 92.00/Tab Indications: Parkinson’s disease
Comtan(I)(Novartis), Tab. , 200 mg, Tk. Cautions: Gastric and duodenal ulcer,
92.00/Tab. uncontrolled hypertension, arrythmias,
angina, psychosis, pregnancy and
PRAMIPEXOLE(Dopamine receptor agonist breast-feeding
as a monotherapy or with Levodopa) Interactions: See Appendix-2
Side-effects: Constipation, diarrhoea,
Indications:Parkinson’s diseaseand nausea and vomiting, dry mouth, sore
restless legs syndrome throat, confusion, psychosis, vertigo,
Contra-indications: Renal insomnia, back pain, difficulty in
impairment,hypotension micturition
Interactions: See Appendix-2 Dose: 10 mg in the morning or 5 mg at
Sideeffects:Nausea,vomiting,sedation,s breakfast and midday
omnolence,weight loss,
insomnia,hallucinations,unusual Proprietary Preparations
tiredness Jumex(I)(Chinoin),Tab 5mg,Tk14.5/Tab.
Dose: Initial dose: 0.125 mg orally three
times a day with or without food.at 7.7.2 ANTIMUSCARINIC DRUGS
weekly interval increased to 0.5 to 1.5 (See also section 8.1.3 & 2.2)
mg three times daily
Note: used as monotherapy or with PROCYCLIDINE HYDROCHLORIDE
levodopa.
Indications: Parkinsonism, drug-
Parixol(ACI),Tab.88microgram, Tk. 2.01/Tab, induced extrapyramidal symptoms (EPS)
180 microgram, Tk.6.02/Tab Cautions: cardiovascular diseases,
hepatic or renal impairment, elderly;
ROPINIROLE (Dopamine receptor agonist) avoid sudden withdrawal; liable to abuse
Contraindications: Narrow angle
glaucoma, enlarged prostate, and
Indications:Parkinson's disease,
myasthenia gravis
extrapyramidal symptoms.
Contraindications: known Interactions: See Appendix-2
Side-effects: Dry mouth, constipation,
hypersensitivity to ropinirole
blurring of vision, urinary, retention,
postural hypotension, tachycardia
Side effects: Nausea, dizziness,
Dose: By mouth, 2.5 mg 3 times daily,
hallucinations, orthostatic hypotension,
gradually increase if necessary; usual
and sudden sleep attacks during the
max. 30 mg daily. ELDERLY, preferably
daytime.
reduced doses
Dose:ADULT: 0.25 mg orally three times
By intramuscular injection in acute
daily for Parkinson's Diseasesmay be
dystonia, 5-10 mg repeated if necessary
increased by 0.75 mg at weekly interval
after 20-30 minutes; max. 20 mg daily.
Proprietary Preparations. ELDERLY, reduce dose
Perkirol(Square), Tab., 2 mg, Tk. 6.04/Tab. ,
0.25 mg, Tk. 2.01/Tab. Proprietary Preparations
Repitol(Beximco), Tab. , 0.25 mg , Tk. Kemadrin(GSK), Tab., 5 mg, Tk. 1.87Tab
2.00/Tab.; 2 mg, Tk. 10.00/Tab. Cyclid(Incepta), Inj., 10 mg/ 2 ml, Tk. 30.00/ 2
Ropinol(Incepta), Tab., 0.25 mg, Tk. ml Amp; Tab., 5 mg, Tk. 1.00/Tab.
2.00/Tab., 1 mg, Tk. 4.00/Tab., 2 Perkinil(Square), Inj., 10 mg/2 ml, Tk.35.00/2
mgTk.6.00/Tab ml Amp., Tab, 5mg, Tk. 1.00/Tab.
304
Extranil(General), Inj., 10mg/2ml, Tk. Piracetam is used as an adjunctive

30.10/2ml Amp; Tab., 5mg, Tk. 0.76/Tab. treatment for myoclonus of cortical
Procilin(Supreme), Tab., 5mg, Tk. 0.50/Tab. origin.
Kdrin(Opsonin), Inj., 10 mg/2 ml, Tk.
30.11/2ml Amp; Tab, 5 mg , Tk. 1.00/Tab.
PIRACETAM
TRIHEXYPHENIDYL
Indications: Adjunctive treatment of
Indications:Parkinson disease and cortical myoclonus
other Parkinson-like disorders when Cautions: Avoid abrupt withdrawal;
used in combination with other drugs; elderly; renal impairment (avoid if
Parkinson-like side effects of certain severe)
drugs Contraindications: Hepatic and renal
Cautions: May be abused due to a short impairment; pregnancy and breast-
acting mood-elevating and euphoriant feeding
effect; obstructive diseases of the Interactions: See Appendix-2
urogenital tract, known history of Side-effects: Diarrhoea, weight gain;
seizures somnolence, insomnia, nervousness,
Contraindications:Hypersensitivity,narr depression; hyperkinesia; rash
owangle glaucoma,Ileus, under 18years Dose: Initially 7.2 g daily in 2-3 divided
of age doses, increased according to response
Interactions: See Appendix-2 by 4.8 g daily every 3-4 days to max.
20g daily. CHILD under 16 years not
Sideeffects: Drowsiness, vertigo, recommended
headache, and dizziness are frequent,
delirium and confusion. Proprietary Preparations
D-Pira(Drug Intl), Tab., 800mg, Tk. 6.00/Tab.
Dose:ADULT:4 to 10 mg orally daily Juvain(Opsonin), Syrup, 500 mg /5 ml, Tk.
150.57/100 ml; Tab, 800 mg , Tk. 6.02/Tab.
Proprietary Preparations Memopil(ACI), Syrup, 500mg/5ml, Tk.
Delpark(Healthcare), Tab., 5mg, 151.02/100ml; Tab., 800mg, Tk. 6.04/Tab.,
Tk.12.00/Tab., 2mg, Tk. 5.50/Tab. 1200mg, Tk. 9.06/Tab., Inj., 200 mg/ml, Tk.
Hexinor(Beacon), Syrup, 2mg/5ml, Tk. 75.51/15ml vial;
100.00/Bottle; Tab., 2mg, Tk. 5.02/Tab., 5mg, Neuratam(Ibn Sina), Syrup, 500mg/5ml, Tk.
Tk. 10.03/Tab. 150.00/100ml; Tab., 800mg, Tk. 300.00/Tab.
Parkifen(UniMed), Tab., 2mg, Tk. 5.00/Tab., Neurolep(Square), Tab. , 800 mg, Tk.
5mg, Tk. 12.00/Tab. 6.04/Tab., syrup, 500 mg/5 ml, Tk.
Tricalm(ACI), Tab., 2mg, Tk. 5.00/Tab., 5mg, 151.02/100ml
Tk. 10.00/Tab. Piramax(Aristo), Tab. , 800mg , Tk. 6.00/Tab.
Trihexy(Incepta), Tab., 2mg, Tk.5/Tab., 5 mg, Piratam(General), Syrup, 10gm/100ml, Tk.
Tk. 10.00/Tab 100.00/100ml; Tab., 800mg, Tk. 4.00/Tab.
7.7.3 DRUGS USED IN ESSENTIAL 7.8 DRUGS USED IN NAUSEA,

TREMOR CHOREA, TICS AND VOMITING AND VERTIGO
RELATED DISORDERS
BETAHISTINE
Haloperidol, Clonidine, Sulpiride,
Chlorpromazine, Propranolol and
Piracetam are used in this type of Indications: For treatment of Ménière's
disorders. Haloperidol (see section 7.2) syndrome, symptoms of which may
may relieve motor tics and some include vertigo, tinnitus, hearing loss and
choreas Propranolol or some other beta- nausea.
adrenoceptor blocking agent (see Cautions: History of peptic ulcer,
section 3.1) is indicated for treating bronchial asthma
essential tremors associated with anxiety Contraindications:Pheochromocytoma
or thyrotoxicosis in a doses of 40mg 2-3 Side-effects: GI disturbances, rash,
times daily pruritis
305
Dose: 8-16mg three times daily. Side-effects: Drowsiness, dry mouth,

Preparations: Tab. 8,16mg blurred vision, allergic skin reactions,
fatigue; rarely extrapyramidal symptoms
Proprietary Preparations in elderly on prolonged therapy
Menaril(Incepta), Tab., 8 mg, Tk. 2.00/Tab.; Dose: 15-30 mg 3 times daily. CHILD 5-
16 mg, Tk. 4.00/Tab. 12 years, half adult dose
Merison(Square), Tab., 6 mg, Tk. 2.01/Tab.
Tiniril(Opsonin), Tab., 16 mg , Tk. 5.00/Tab. ;
8 mg , Tk. 2.01/Tab.
Vectra(Healthcare), Tab., 16 mg , Tk. Cinaron(Square), 15 mg, Tk. 1.00/Tab.
Cinaryl(Opsonin), Tab., 15 mg, Tk. 0.75/Tab.
250.00/Tab.; 8 mg , Tk. 150.00/Tab.
Cinarzin(Ibn Sina), Tab. , 15 mg, Tk. 1/Tab.
Veserc(UniMed), Tab , 16 mg, Tk. 5.00/Tab.;
Cinazin(Acme), Tab.,15 mg, Tk. 0.70/Tab.
8 mg, Tk. 3.00/Tab.
Cinnarizine(Albion),Tab.,15 mg, Tk. 1/Tab.
Cinrim(Supreme), Tab., 15 mg,Tk. 1/Tab.
CHLORPROMAZINE[ED] Inarzin(Beximco), Tab.,15 mg,Tk. 0.90/Tab.
(See also section 7.2) Suzaron(Rephco), Tab.,15 mg,Tk. 1/Tab.
Zincin(Aristo), Tab.,15 mg, Tk. 1.00/Tab.
Indications: Nausea and vomiting of
Cinnarizine 20mg+Dimenhydrinate40mg
terminal illness where other drugs have is used in the treatment of vertigo.
failed or are not available; other
Indications, see section 7.2 Proprietary Preparations
Cautions; Contraindications; Side- Artigo(ACI), Tab., Tk. 2.01/Tab.
effects: See section 7.2 Cinaron(Square), Tab., Tk.2.00/Tab.
Interactions: See Appendix-2 Cinaryl(Opsonin), Tab., Tk. 2.00/Tab.
Cinarzin Plus(Ibn Sina), Tab., Tk.2.00/Tab.
Dose:By mouth, 10-25 mg every 4-6
Cinazin(Acme), Tab., Tk. 1.51/Tab.
hours. CHILD 500 g/kg every 4-6 hours Revert(Incepta), Tab, Tk. 2.00/Tab.
(1-5 years max. 40 mg daily, 6-12 years
max. 75 mg daily) DOMPERIDONE
By deep intramuscular injection initially
25 mg then 25-50 mg every 3-4 hours (See notes above and also section 2.2)
until vomiting stops. CHILD 500
Indications: See section 2.2
microgram/kg every 6-8 hours (1-5 years
maximum 40 mg daily, 6-12 years Cautions: age over 60 years – risk of
ventricular arrhythmiaalso see section:
maximum 75 mg daily)
2.2
Proprietary Preparations Contra-indications: Cardiac conduction
Gevril(Albion), Syrup, 0.5 gm/100 ml, Tk. defect (prolong QT)
15.00/100 ml Side-effects: See section 2.2
Largactil(Sanofi), Inj., 25 mg/ ml , Tk. Interactions: See Appendix-2
4.12/Amp.; Tab., 50 mg, Tk. 0.60/Tab. ;25 mg, Dose: By mouth, acute nausea and
Tk. 0.41/Tab.; Tab., 100 mg, Tk. 1.01/Tab. vomiting, 10-20 mg every 4-8 hours,
Opsonil(Opsonin), Tab., 100 mg, max. period of treatment 12 weeks
Tk.1.01/Tab.; 50 mg, Tk. 0.60/Tab.; Inj., 50
CHILD: Nausea and vomiting following
mg/2 ml, Tk. 4.02/2ml amp.
cytotoxic therapy or radiotherapy only,
200-400 micrograms/kg every 4-8 hours.
CINNARIZINE By rectum as suppositories, nausea and
vomiting, 30-60 mg every 4-8 hours.
Indications:Vestibular disorders, such CHILD following cytotoxic therapy or
as Meinner’s disease, vestibular neuro- radiotherapy, over 2 years bodyweight
nitis, paroxysmal positional vertigo, 10-15 kg max. 15 mg twice daily, body
motion sickness; vascular disease weight 15-25 kg max. 30 mg twice daily,
Cautions and Contraindications: body weight 25-45 kg max 30 mg 3-4
Prostatic hypertrophy, urinary retention, times daily; suppositories may be cut up
glaucoma, hepatic disease, epilepsy; for children.
porphyria, severe heart failure
306
Note:Does not cause CNS effect, e.g. Cautions: Pregnancy and breast-
sedation, dystonia can be used with anti feeding
parkinson drug. Interactions: See Appendix-2
Side-effects: Constipations, headache,
Proprietary Preparations rash; transient increases in liver
See section 2.2 enzymes; hypersensitivity reactions
reported.
APREPITANT (Neurokinin 1-receptor Dose:Nausea and vomiting induced by
antagonist) cytotoxic chemotherapy or radiotherapy,
(See section 2.1.2) by mouth 1-2 mg within 1 hour before
Indications: as adjunct to setrons/ start of treatment, then 2 mg daily in 1-2
dexamethasone in chemotherapy divided doses during treatment; when
Side-effects: Hiccough, dyspepsia,GI intravenous infusion also used, max.
disturbance, dizziness, confusion combined total 9 mg in 24 hours; CHILD
Dose:ADULT:125mg before 20micrograms/kg (maximum 1 mg)
chemotherapy. Fos aprepitant: IV within 1 hour before start of treatment,
infusion 150mg 30 minutes before then 20 micrograms/kg (max. 1 mg)
chemo theraphy twice daily for up to 5 days during
treatment
Proprietary Preparations By intravenous injection (diluted in 15 ml
Emestop(Incepta), Cap., 40 mg, Tk. sodium chloride 0.9% and given over not
50.00/Cap. ; 125 mg, Tk. 150.00/Cap. less than 30 seconds) or by intravenous
Emend(Opsonin), Cap., 40 mg , Tk.
infusion (over 5 minutes),prevention, 3
45.13/Cap.
mg before start of cytotoxic therapy (up
to 2 additional 3 mg doses may be given
CYCLIZINE within 24 hours); treatment, as for
prevention (the two additional doses
Indications:Nausea,vomiting,motion must not be given less than 10 minutes
disturbance, sickness apart); max. 9 mg in 24 hours; CHILD,
Side-effects:Hypertension, paresthesia by intravenous infusion, (over 5
Dose: 50mg three times daily minutes), prevention, 40 micrograms/kg
(max. 3 mg) before start of cytotoxic
Generic Preparations therapy; treatment as for prevention-one
Tab.,50mg
additional dose of 40 micrograms/kg
(max. 3mg) may be given within 24
DROPERIDOL hours (not less than 10 minutes after
initial dose)
Indications: Post-operative nausea, Postoperative nausea and vomiting, by
vomiting intravenous infection (diluted to 5ml and
Cautions: Coronary artery disease, given over 30 seconds), prevention, 1
asthma, bronchitis mg before induction of anaesthesia;
Contra-indications: QT prolongation, treatment, 1 mg, given as for prevention;
hepatic-renal impairment max. 2 mg in one day; CHILD not
Dose: IV. infusion at 0.625-1.25mg recommended.
30minbefore surgery
Generic Preparations Naurif (Square), Inj., 1 mg/ml, Tk. 48.19/1 ml
Inj., IV infusion Inj. Tab., 1 mg, Tk. 28.10/Tab.
GRANISETRON MECLIZINE HYDROCHLORIDE
Indications: In managment of nausea, Indications:Nausea, vomiting, motion

vomiting in patient requiring cytotoxic sickness, vertigo
drug & operation; also see under: dose
307
Cautions: Patients with asthma, bronc- Dose:Motion sickness: Over age of10yr,
hitis, emphysema, enlarged prostate, 150-300mg 30minute before;
glaucoma or urinary tract blockage hypersection: 300mg upto three times
should take Meclizine (like other daily; adhesive patch 1mg/72 hours.
antiemetics) with Cautions;driving and Preparations: 300mg upto three times
effects of alcohol enhanced. daily .adhesive patch 1mg/72hr
Contraindications: Hypersensitive to
Meclizine Proprietary Preparations
Interactions: See Appendix-2 Asipan(Asiatic), Tab., 20mg, Tk. 3.00/Tab.
Side-effects: Drowsiness, dry mouth, Buscon(Ibn Sina), Tab., 10 mg, Tk.
689.00/Tab.; Inj., 20mg/ml, Tk. 29.50/1 ml
and blurred vision Amp
Dose: Nausea and vomiting: 25-100 mg Butapan(Sanofi), Tab., 10mg, Tk. 6.90/Tab.;
daily (single dose) or directed by 20mg, Tk. 13.64/Tab.
physician; Motion sickness: 25-50 mg 1 Colik(ACI), Tab., 10mg, TK.6.90/Tab.; 20mg,
hour before travel. The dose may be TK. 6.72/Tab., Inj., 20 mg/ml, TK. 29.90/ml
repeated every 24 hours as needed, Amp,
Vertigo: 25-100 mg daily, in divided Eziride(Opsonin), chewableTab., 150
microgram, Tk. 5.00/Tab.
doses Hybucin(Supreme), Tab., 10 mg, Tk.
3.40/Tab.
Proprietary Preparations Hybut(Amico), Tab., 10mg, TK. 3.43/Tab.
Acliz(Aristo), Tab., 50 mg, Tk. 2.50/Tab. Hysomide(Opsonin), Inj., 20 mg/ml, Tk.
Anosea(Ibn Sina), Tab., 50 mg, Tk. 2.60/Tab. 29.90/ ml Amp; Tab., 10 mg, Tk. 6.90/Tab.;
Avert(Biopharma), Tab., 50 mg, Tk. 2.51/Tab. 20 mg , Tk. 13.64/Tab.
Emenil(Incepta), Tab., 50 mg, Tk. 2.50/Tab. Spanil(Beximco), Tab., 10mg, Tk. 6.90/Tab.
Emezin(Eskayef), Tab., 50 mg, Tk. 2.50/Tab. Spasmozen(Zenith), Tab., 10 mg , Tk.
Melizin(Pacific), Tab., 50 mg, Tk. 1.88/Tab. 3.44/Tab.
Nomosic(Drug Int), Tab., 50 mg, Tk.2.50/Tab. Typan(Astra Bio), Tab., 10 mg, Tk. 3.43/Tab.
Vomec(Beximco),Tab., 50 mg, Tk. 2.50/Tab.
Meclizine HCl25mg + Pyridoxine HCl50mg NABILONE(A synthetic Cannabinoid).

Acliz Plus(Aristo), Tk. 3.00/Tab.
Ancliz(Monico), Tab.,Tk. 3.00/Tab. Indications:Use in unresponsive to
Anoseaplus(Ibn Sina), Tab., Tk. 150.00/Tab. conventional antiemefics associated with
Anvert(Orion), Tab. , Tk. 3.01/Tab. cytotoxicchemotherapeutics.
Asivert(Asiatic), Tab., Tk. 3.00/Tab.
Cautions:Hypertension, psychiatric
Avert plus(Biopharma), Tab, Tk. 3.00/Tab.
Avonex(Novo Health),Tk. 2.5./Tab. disorder
Devomit(Silva), Tab.,Tk. 3.25/Tab. Side-effects: Drowsiness, vertigo,
Emego plus(Opsonin), Tab. ,Tk. 3.00/Tab. euphoria, ataxia.
Emenil plus(Incepta), Tab.,Tk. 3.00/Tab. Dose: 1 mg or 2 mg twice a day. The
Emezinplus(Eskayef), Tab, Tk. 3.00/Tab. lower starting dose may be used and
Meclixin(General), Tab. Tk. 2.00/Tab. increased later if necessary.It should be
Melizin plus(Pacific), Tab., 50 mg, Tk.
given 1 to 3 hours before chemotherapy,
3.00/Tab.
Nomesis(Healthcare), Tab.Tk. 3.50/Tab. and a dose given the night before may
NVP(Acme), Tab. Tk. 3.01/Tab. be useful.
Pyrimac(ACI), Tab., Tk. 2.50/Tab.
S-Vom(Sharif), Tab. Tk. 3.01/Tab. Generic Preparation
Vertina plus(Square), Tab. Tk. 3.01/Tab. Capsule,1mg,2mg
V-Nil(Alco), Tab. Tk. 3.01/Tab.
Xmec(Beacon), Tab.,Tk. 3.02/Tab. METOCLOPRAMIDE HCl[ED]
(See also section 2.2)
HYOSCINE HYDROMIDE
(SCOPLOMINE HYDROBROMIDE) Indications:Post operative nausea
vomiting, chemotherapy induced nausea
Indications: Motion sickness, and vomiting; acute migraine attack
hypersecretion state,premedication to
control salivary,respiratory secretion.
308
Cautions:Hepatic and renal impairment; Severely emetogenic chemotherapy, by

elderly, young adults, and children; may intramuscular injection orslow intraven-
mask underlying disorders such as ous injection, 8mg immediately before
cerebral irritation; avoid for 3-4 days treatment, where necessary followed by
following gastro-intestinal surgery, may 8 mg at intervals of 2-4 hours for 2
cause acute hypertensive response in further doses (or followed by 1 mg/hour
phaeochromocytoma; pregnancy, by continuous intravenous infusion for up
breast-feeding and Parkinsonism to 24 hours) then by mouth, 8 mg every
Interactions:See Appendix-2 12 hours for up to 5 days or by rectum,
Side-effects:Acute dystonic reaction, 16mg daily for up to 5 days alternativel,
oculogyric crisis,conduction by intravenous infusion over at least 15
defect,extrapyramidal effects, minutes, 32 mg immediately before
hyperprolactinaemia, occasionally tardi- treatment or by rectum, 16 mg 1-2 hours
ve dyskinesia on prolonged administra- before treatment then by mouth, 8 mg
tion; drowsiness, restlessness, diarrho- every 12 hours for up to 5 days or by
ea, depression, neuroleptic malignant rectum, 16mg daily for up to 5 days
syndrome, cardiac conduction Note. Efficacy may be enhanced by
abnormalities reported following addition of a single dose of dexameth-
intravenous administration asone sodium phosphate 20mg by
Dose:By mouth 10 mg 3 times daily. intravenous injection.
CHILD up to 1 year, 1 mg twice daily; 1- CHILD:By slow intravenous injection or
3 years 2 mg 2-3 times daily, 5-9 years by intravenous infusion over 15 minutes,
2.5 mg 3 times daily, 9-14 years 5 mg 3 5mg/ml immediately before chemothe-
times daily rapy then, 4mg by mouth every 12 hours
for up to 5 days
Proprietary Preparations Prevention of postoperative nausea and
See also section 2.2 vomiting, by mouth, 16mg 1 hours before
anaesthesia or 8 mg at intervals of 8
ONDANSETRON hours for 2 further doses.
Alternatively, by intramuscular or slow
Indications:See under dose intravenous injection, 4 mg at induction
Cautions:ubacuteintestinal obstruction, of anaesthesia;
QT prolongation,pregnancy and breast- CHILD over 2 years, by slow intravenous
feeding; moderate or severe hepatic injection, 100 microgram/kg (max. 4 mg)
impairment before, during, or after induction of
Interactions:See Appendix-2 anaesthesia.
Side-effects:Constipation, headache, Treatment of postoperative nausea and
sensation of warmth or flushing, hiccups; vomiting, by intramuscular or slow intrav-
occasional alterations in liver enzymes; enous injection, 4 mg; CHILD over 2
occa-sional transient visual disturbances years, by slow intravenous injection, 100
and dizziness following intravenous micrograms/kg (max. 4 mg)
adminis-tration; involuntary movements,
chest pain, arrhythmias, hypotension
Anset(Opsonin), Supp, 16 mg, Tk.
and bradycardia 11.28/Supp.;Tab., 4 mg, Tk. 3.40/Tab.; Tab.,
Dose: Moderately emetogenic chemo- 8 mg, Tk. 7.55/Tab.Inj., 2 mg/ ml, Tk.
therapy or radiotherapy, by mouth, 8 mg 22.56/Amp.
1-2 hours before treatment or by rectum, Avona(Popular), Syrup, 4 mg/5 ml, Tk.
16 mg 1-2 hours before treatment or by 35.00/50 ml .;Cap. , 8 mg, Tk. 10.00/Cap., 4
intramuscular injection or slow intrave- mg, Tk. 4.00/Cap. ;Inj. , 8 mg/4 ml, Tk.
30.00/Amp ;
nous injection, 8mg immediately before
Emeren(Renata), Tab. , 4 mg, Tk. 6.00/Tab.
treatment then by mouth, 8mg every 12 ; 8 mg, Tk. 10.00/Tab. ;Inj., 8 mg/4 ml, Tk.
hours for up to 5 days or by rectum, 16 30.00/Amp.
mg daily for up to 5 days Emistat(Healthcare), Inj., 8 mg /4 ml, Tk.
30.00/Amp. ; Tab., 4 mg, Tk. 6.00/Tab.;4 mg/5
309
ml, Tk. 45.00/50 ml ; Tab., 8 mg, Tk. Cautions:Pregnancy,breast

10.00/Tab. feeding,driving, QT prologation
Emiston(Ibn Sina), Inj., 8 mg/4 ml, Tk. Side-effects:Constipation,
25.00/Amp.; Syrup, 4 mg/5 ml,
Leofran(Leon), Inj, 4 mg/2 ml, Tk. 25.00/Amp.
headache,,swelling,
;Tab. , 8 mg, Tk. 10.00/Tab. ; oral Solution, 4 tiredness,severeallergic
mg/5 ml, Tk. 45.00/50 ml reactions,unusual muscle movement
Nauset(Navana), Inj. 8 mg/4 ml, Tk. 30.10/Inj.; Dose:oral: 0.5 mg orally administered
Syrup, 4 mg/ 5 ml, Tk. 45.13/50ml; Tab., 8 mg, approximately1hour
Tk. 10.03/Tab. Parenteral: 0.25 mg IV as a single dose
Ofran(Square), Inj., 8 mg/4 ml, Tk. 30.00/Amp. 30 minutes before the start of
;Syrup, 4 mg/5 ml, Tk. 40.00/50 ml ;Supp, 16
mg, Tk. 20.00/Supp.; Tab. , 8 mg, Tk.
chemotherapy.
10.04/Tab.
Onaseron(Incepta), Inj., , Tk. 25.00/Amp;ODT Proprietary Preparations
, 4 mg, Tk. 5.00/Tab. ;8 mg, Tk. 10.00/Tab. ; Palnox(Drug Intl), Inj., 250 mcg/5 ml, Tk.
Syrup,, 4 mg/5 ml, Tk. 40.00/50 ml 100.30/5 ml Amp, Tab., 0.5mg, Tk. 10.00/Tab.
Onasia(Orion), Inj, 2 mg/ ml, Tk. 25.00/Amp.; Paloron(Ziska), Inj. , 75 mcg/1.5 ml, Tk.
Syrup,, 4 mg/5 ml, Tk. 45.00/50 ml ;Tab. , 8 75.00/1.5 ml amp, 250 mcg/5 ml, Tk. 100.00/5
mg, Tk. 5.00/Tab. ml Amp, Tab, 0.50 mg, Tk. 20.00/Tab.
Oncodex (Jayson), Inj. 8mg/4mL, Tk. Paloset(Square),Inj., 75 mcg/1.5 ml, Tk.
25.17/Inj.; Tab., 4mg, Tk. 4.54/Tab.; 8mg, Tk. 75.22/1.5 ml Amp, 250 mcg/5 ml, Tk. 100.30/5
8.06/Tab. . ml Amp, Tab, 0.5 mg, Tk. 20.00/Tab.
Oncodex(Jayson), Tab. , 4 mg, Tk. 4.52/Tab.; Palosis(Eskayef), Cap, 0.5mg , Tk.
Tab. , 8 mg, Tk. 8.03/Tab.; Inj., 8 mg/4 ml, 20.00/Cap., 0.5mg , Tk. 20.00/Cap., Tab,
Tk. 25.10/Amp. 0.5mg, Tk. 20.00/Tab., 0.5mg , Tk. 20.00/Tab.
Ondamax(Somatec), Tab. , 4 mg, Tk. Palostar(Orion), Inj, 75 mcg/1.5 ml, Tk.
5.00/Tab.; Tab. , 8 mg, Tk. 10.00//Tab.; 75.00/1.5 ml Amp, 75 mcg/1.5 ml, Tk.
Syrup,, 4 mg/5 ml, Tk. 40.00/50 ml 75.00/1.5 ml Amp, 250 mcg/5 ml, Tk. 100.00/5
Ondantor(Novartis), Tab. , 8 mg, Tk. ml Amp, Tab, 0.5 mg, Tk. 20.00/Tab., 0.5mg,
12.00/Tab. Tk. 200.00/Tab.
Ondaron(General), Inj., 8 mg/4 ml, Tk. Paloxi(Beacon), Cap., 0.5mg , Tk. 22.00/Cap.,
30.00/Amp. Inj., 75 mcg/1.5 ml, Tk. 75.23/1.5 ml Amp, 250
Ondason(Drug Int.), Syrup, 4 mg/ 5 ml, Tk. mcg/5 ml, Tk. 100.30/5 ml Amp, Tab, 0.50mg,
40.00/50 ml; Inj., 2 mg/ml, Tk. 30.00/Amp. Tk. 20.06/Tab.
;Tab. , 8 mg, Tk. 10.00/Tab. Paloxiron(Incepta), Inj., 250 mcg/5 ml, Tk.
Onsat(Beximco), Inj., 8 mg/4 ml, Tk. 100.00/5 ml Amp, 75 mcg/1.5 ml ,Tk. 75.00/1.5
25.00/Amp.; oral Soluble Film, 4 mg , Tk. ml Amp, Tab, 0.5 mg, Tk. 20.00/Tab.
12.00/Pcs.;oral Soluble Film, 8 mg, Tk. Palzen(Healthcare), Inj, 75 mcg/1.5 ml, Tk.
18.00/Pcs ;Tab. , 8 mg, Tk. 10.00/Tab. 90.00/1.5 ml Amp, 250 mcg/5 ml, Tk. 125.00/5
Osetron(ACI), Inj., 2 mg/ ml , Tk. 25.09/Amp.; ml Amp., Tab., 0.5mg , Tk. 25.00/Tab.
Syrup,4 mg/5 ml, Tk. 30.11/50 ml .;Tab. , 8 mg Panoset(Opsonin), Inj., 250 mcg/5 ml, Tk.
, Tk. 10.04/Tab. 100.00/5ml Amp, 75 mcg/1.5 ml, Tk.
Periset(Acme), Inj., 8 mg/4 ml, Tk. 75.00/1.5ml Amp, Tab, 500 mcg , Tk.
30.00/Amp.Syrup, 4 mg/5 ml, Tk. 40.00/50 20.00/Tab.
ml.;Tab., 8 mg , Tk. 10.00/Tab. Patron(Acme),Inj., 75 mcg/1.5 ml, Tk.
Seton(Delta), Tab. , 8 mg, Tk. 8.00/Tab. 75.00/1.5 ml Amp, 250 mcg/5 ml, Tk. 100.00/5
Syrup, 4 mg/5 ml, Tk. 33.83/50 ml ml Amp, Tab., 0.5 mg, Tk. 20.00/Tab.
Tk.35.00/50 ml ;Tab. , 8 mg, Tk. 10.00/Tab.
Vomiset(RAK), Tab., 8 mg, Tk. PROCHLORPERAZINE
10.0/Tab.;Syrup,4 mg/5 ml, Tk. 30.0/50 ml (See also section 7.2)
Zofer MD(Sun), Tab. ,4 mg, Tk. 5.50/Tab.
Zofra(Eskayef), Syrup, 4 mg/5 ml, Tk.
40.00/50 ml ;Inj.,Tk. 30.00/Amp. ODT, 4 mg, Indications:Severe nausea and
Tk. 5.00/Tab.; ODT , 8 mg, Tk. 10.00/Tab. vomiting; for other Indications, see
section 7.2
PALONOSETRON Cautions, Contra-indications & Side-
effects:See section 7.2 on psychiatric
drugs
Indications:In prevention of nausea and
vomiting caused by cancer
chemotherapy.
310
Dose: 2-4 mg daily in divided doses; symptoms (EPS) may occur particularly
max. 6 mg daily. CHILD 3-5 years up to in children and elderly
1 mg daily, 6-12 years up to 4 mg daily Interactions: See Appendix-2
Dose: 2-4 mg daily in divided doses or
Proprietary Preparations as a single dose. CHILD, 3-5 years up to
See section 7.2 1 mg daily; 6-12 years, up to 4 mg daily
PROMETHAZINE HCl[ED] Proprietary Preparations

Sizonil(Healthcare), Tab., 1mg, Tk. 2/Tab.;
5mg, Tk. 3.5.00/Tab.
Indications: Nausea, vomiting, vertigo,
Telazine(Eskayef), Tab., 5mg, Tk. 3/Tab.; 1
labyrinthine disorders, motion sickness; mg, Tk. 2.00/Tab.
For other Indications: see section. 4.9.1
Cautions, Contra-indications & Side-
7.9 DRUGS USED IN THE
effects:See section 4.9.1
TREATMENT OF OBESITY
Dose : 20-25 mg twice daily; CHILD
under 2 years not recommended, 2-5 Obesity is a most common nutritional
years 5 mg twice daily, 5-10 years 10 mg disorder in affluent societies. Obesity
twice daily may be defined as a condition in which
there is excessive amount of body fat.
Proprietary Preparations This condition is most prevalent in
See section 12.5 middle age, but can occur at any earlier
stage of life. The use of Steroids, Oral
PROMETHAZINE THEOCLATE Contraceptives, Phenolthiazines and
Insulin is commonly followed by weight
gain due to stimulation of appetite.
Indications: Nausea, vomiting vertigo,
Whatever the ultimate cause of obesity,
labyrinthine disorders, motion sickness
weight reduction can be achieved only
(action longer than of promathazine
by restricting diets and increasing
hydrochloride)
physical activities. Although there is no
Cautions; Contra-indications&Side-
substitute for dietary regimen, a limited
effects: See section 4.9.1 under
use as an adjunct in carefully selected
promethazine hydrochloride.
patients may be useful in refractory
obesity.
Dose: 25-75 mg, max. 100 mg daily;
The most useful group of drugs at
CHILD 5-10 years, half adult dose.
present to support a weight reducing
Prevention of Motion Sicknes: 25 mg at
regime acting as appetite suppressants
bedtime on night before traveling. CHILD
are Phentarsine and centrally acting
5-10 years, half adult dose
Fluoxetine. Anti-obesity drugs acting on
For vomiting in pregnancy, 25 mg
the gastro-intestinal tract are Methylce-
increased if necessary to a max. of 100
llulose and Orlistat (a pancreatic lipase
mg daily
inhibitor which reduces the absorption of
Proprietary Preparations fat).
Avomine(Sanofi), Tab.,25mg, Tk. 0.57/Tab.
Promet(opsonin), Tab., 25 mg, Tk. 0.44/Tab. FLUOXETINE
TRIFLUOPERAZINE Indications: See notes above

(See also section 7.2) Interations: See Appendix-2
Side-effects: Drowsiness
Indications: Severe nausea and vomit- Dose: Bulimia Nervosa, 60 mg daily,
ing; for other Indications, see section 7.2 CHILD: Not recommended
effects: See section 7.2; extrapyramidal Proprietary Preparations
Fluoxetine(Albion), Cap., 20mg,Tk. 2.58/Cap.
Modipran(Beximco)Cap.,20mg,Tk. 2.89/Cap.
311
Nodep(General), Cap., 20mg, Tk. 2.81/Cap. Xenobese(Radiant), Cap., 120 mg, Tk.
Nodepress(Kemiko), Cap., 20 mg, Tk. 60.18/Cap.
2.60/Cap.
Oxetin(Decent), Cap., 20mg, Tk. 2.88/Cap.
7.10 DRUGS USED FOR DEMENTIA
Prodep(Sun), Cap., 20 mg, Tk. 3.00/Cap.
Prolert(Square), Cap., 20 mg, Tk. Dementia is defined as a clinical
3.01/Cap.;Oral Solution, 20 mg/5 ml, Tk. syndrome characterized by a loss of
60/50ml previously acquired intellectual function
in the absence of impairment consciou-
METHYLCELLULOSE sness. The commonest causes are
Alzheimer’s disease and Cerebrovasc-
Indications: Adjunct in obesity, ular disease. Dementia is predominantly
ulcerative colitis, constipation associated with the elderly.
Contraindications: Colonectomy Drugs should be avoided in demented
Interactions: See Appendix-.2 patients unless there are specific
Side-effects: Skin rash, itching Indications.
Dose:As an adjunct in obesity, 800-1200 Cautions: dementia patients are highly
mg to be taken with at least 300 ml sensitive to sedative drugs. If medication
warm liquid half an hour before each is needed to treat episodes of confusion
meal or when hungry. or excitement, Thioridazine 25 mg 8
Consitipation, 800-1600 mg to be taken hourly can be given (see section 7.2).
in divided doses with at least 300 ml of Among psychiatric patients, the most
water or liquid significant disorder is the amnesic
syndrome caused by thiamine
Generic Preparation deficiency. In such cases, immediate
Tab. Methyl Cellulose 400mg+Micro treatment with Thiamine 50 mg
Crystalline 220mg intravenously daily should be given to
minimize the damage (see section
ORLISTAT 16.2.3.2).
Anticholinesterase inhibitors some-times
Indications: See notes above improve cognitive
Cautions: Diabetes mellitus; may impair functions.DonepezilGalantamineand
absorption of fat-soluble vitamins Rivastigmine, both reversible
Contra-indications: Chronic malabsorp- acetylcholinesterase inhibitors have
tion syndrome; cholestasis, pregnancy recently been introduced to treat
and breast-feeding. dementia in Alzheimer’s disease.
Interactions: See Appendix-2 Citicolineis an intermediate in the
Side-effects: Liquid oily stool, flatula- generationof phosphatidylcholine from c
nce, increased defecation and fecal holine; it is used for Alzheimer's disease
incontinence and other types of dementia
Dose: 120mg with each main meal, up
to max. 360mg daily. CHILD not ALMITRIN BISMESYLATE WITH
recommended. RAUBASINE
Proprietary Preparations Indications: Cerebral insufficiency

Adiponil(Incepta), Cap.,120 mg, Tk. 40/Cap. characterized by (disorders of memory,
Dietil(Eskayef), Cap., 120 mg, Tk. 40.00/Cap.
Olistat(Square), Cap., 120 mg, Tk.
concentration, etc). Auditory, vestibular
60.18/Cap., 60 mg, Tk.30.00/Cap. and visual disorders of ischemic etiology.
Orlifit(Opsonin), Cap., 120 mg , Tk. Contra-indications: In combination with
50.00/Cap. MAOIS
Ornical(ACI), Cap, 120 mg, Tk. 55.00/Cap. Cautions: Pregnancy; avoid
Slimfast(Healthcare), Cap., 120 mg, Tk. concomitant use of other drug containing
60.00/Cap. Altmitrin
Slimi(UniMed), Cap., 60 mg, Tk. 30.00/Cap.
Side-effects: Sleep disturbances,
palpitations, anxiety, dizziness.
312
GALANTAMINE
Almitrine Bismesylate 30 mg with Raubasine
10 mg Indications:Vascular dementia and
Albasine(Drug Intl), Tab., Tk. 12.05/Tab. Alzheimer's disease
Aruxil(Opsonin), Tab., Tk. 10.00/Tab. Cautions:Parkinson's disease, severe
Duxil(ACI), Tab., Tk. 10.05/Tab. asthma,
Truxil(Square), Tab., Tk.10.03/Tab. Contra-indications:Renal and hepatic
impairment, pregnancy
CITICOLINE(Intermediate compound required for Sideeffects:Nausea,
biosynthesis of membrane phospholipid) anorexia,dizziness,headache,
tremor,fatigue, irritation andinsomnia
Indications: Alzheimer's disease head
trauma, stroke, age-related memory Proprietary Preparation
loss, attention deficit hyperactive Antial(ACI), Tab., 8mg, Tk. 20.14/Tab.; 4mg,
disorder Tk. 12.09/Tab.
Side-effects :Insomnia, headache,
diarrhea, nausea, blurred vision, chest RIVASTIGMINE
pains
Dose: ELDERLY:1000-2000 mg per Indications: Alzheimer’s disease
day for dementia Cautions: Renal impairment, mild to
moderate hepatic impairment (see
Proprietary Preparation Appendix-3); Sick Sinus Syndrome,
Cikolin(Drug Intl), Inj., 500mg/4ml, Tk.
conduction abnormalities; gastric or
140.00/Vial,; Tab., 500mg, Tk. 50.00/Tab.
Citicol(Beximco), Tab., 500mg, Tk. duodenal ulcers (and those at risk of
50.00/Tab.; Inj., 500mg/4ml, Tk. 140/Vial developing ulcers); history of asthma or
Cogniz(UniMed), Tab., 500mg, Tk. 50/Tab. chronic obstructive pulmonary disease;
pregna-ncy (Appendix-5); monitor body-
DONEPEZIL HYDROCHLORIDE weight
Contra-indications: breast-feeding
Indications: Alzheimer’s disease Interactions: See Appendix-2
Cautions: Sick sinus syndrome or other Side-effects: Asthenia, anorexia, weight
supraventricular conduction abnormali- loss, dizziness, nausea, vomiting,
ties; patients at risk of developing peptic drowsiness, abdominal pain, agitation
ulcers; asthma, obstructive airway and confusion, depression, diarrhoea,
disease dyspepsia, headache, insomnia,
Contra-indications: Pregnancy and sweating, malaise, tremor rarely angina
breast-feeding pectoris, gastrointestinal hemorrhage,
Interactions: See Appendix-2 syncope; potential for causing bladder
Side-effects: Nausea, vomiting, diarr- outflow obstruction; convulsions
hea, fatigue, insomnia, muscle cramps, Note:Gastro-intestinal Side-effects may
less frequently headache, dizziness, occur more commonly in women
syncope, bradycardia, rarely sinoatrial Dose: Initially 1.5 mg twice daily,
block, AV block, and convulsions; increased in steps of 1.5 mg twice daily
Dose: 5 mg once daily at bedtime, at intervals of at least 2 weeks according
increase if necessary after one month to to response and tolerance; usual range
10 mg daily; max. 10 mg daily 3-6 mg twice daily; maximum 6 mg twice
daily
Ameloss (Incepta),Tab.,5 mg, Tk. 10/Tab. Proprietary Preparations
Dimenta(Healthcare), Tab., 5 mg,Tk.10/Tab. Demelon(UniMed), Cap., 3 mg, Tk.
Elzer (Square), Tab., 5 mg, Tk. 10.07/Tab. 20.00/Cap.; 1.5 mg, Tk. 20.00/Cap.
Exelon(Novartis), Cap., 3 mg, Tk.
145.00/Cap.; 6 mg , Tk. 145.00/Cap.; 1.5 mg,
Tk. 145.00/Cap.; 4.5 mg, Tk. 145.00/Cap.,
313
Transdermal Patch, 9.5 mg, Tk. 224.00/Vial.,

13 mg, Tk. 223.27/Vial., 4.6 mg, Tk. 224.00/
Exelon Patch 10(I)(LTS Lohmann),
Transdermal Patch, 9.5 mg/24h, Tk.
224.00/Patch
Exelon Patch 5(I)(LTS Lohmann),
Transdermal Patch, 4.6 mg/24h, Tk.
224.00/Patch
Rivacap(Ibn Sina), Cap., 1.5 mg, Tk.
10.00/Cap.
Rivamer(Sun), Cap. , 1.5 mg, Tk.
20.00/Cap.;4.5 mg, Tk. 40.00/Cap.
Rivascol(Albion), Cap. 1.5 mg, Tk. 14.10/Cap.
314
8. ANAESTHESIA
Chapter 8
ANAESTHESIA
8.1 General anaesthesia p.315
8.1.1 Intravenous anaesthetics p.315
8.1.2 Inhalation anaesthetics p.317
8.1.3 Antimuscarinic, anxiolytic drugs for peri-operative use p.318
8.1.4 Analgesics for peri-operative use p.320
8.1.4.1 Opioids p.320
8.1.4.2 Non-opioids p.322
8.1.5 Muscle relaxants p.323
8.1.6 Anticholinesterases used in anaesthesia p.326
8.1.7 Antagonists for respiratory depression p.326
8.1.7 Drugs for malignant hyperthermia p.326
8.2 Local anaesthesia p.327
8.1 GENERAL ANAESTHESIA Etomid (Popular), Inj. (IV Infusion), 2mg /ml,
Tk. 150.57/Amp
Only experienced and authorized KETAMINE[ED]

personnel (anaesthetists) should
administer several drugs with different Indications: Induction and maintenance
action to produce a state of surgical of anaesthesia. It is used mainly for
anesthesia with minimal risk of toxic pediatric patients when repeated doses
effect. are required.
An intravenous anaesthetic is usually Cautions: Patients with a history of
used for induction, followed by cerebrovascular accidents, myocardial
maintenance with inhalation anaesthetic, ischemia, hypertension and raised
often supplemented by other drugs intracranial pressure
administered intravenously. Specific Contraindications : Airway obstruction,
drugs are often used to produce and thyrotoxicosis, cerebral trauma,
maintenance of muscle relaxation when intracranial mass or haemorrhage,
positive pressure ventilation is penetrating eye injuries, increased
employed. intraocular pressure and psychiatric
disorders
8.1.1 INTRAVENOUS ANAESTHETICS Interactions: See Appendix-2
Side-effects: Emergence of delirium,
nightmares, hypertension, tachycardia,
BARBITURATES increased salivation, increased ICP,
nausea and vomiting are common after
ETOMIDATE its sole use.
Dose: By intramuscular injection, 10
Indications: Induction of anaesthesia in mg/kg usually produce 15-30 minutes of
patients with an unstable cardiovascular surgical anaesthesia; diagnostic
system and is safe to use in patients with maneuvers and procedures not involving
porphyria. intense pain, initially 4 mg/kg by
Cautions: It is best avoided in patients intravenous injection over at least 60
with epilepsy or a history of seconds, 2 mg/kg usually produces 5-10
adrenocortical insufficiency minutes of surgical anaesthesia
Dose: Induction 0.2-0.3 mg/kg by By intravenous infusion, for longer
intravenous infusion procedures, induction, bolus dose of 0.5-
2mg/kg; maintenance dose of 10-45
Proprietary Preparation micrograms/kg/min, rate adjusted
according to response.
315
8. ANAESTHESIA
by bolus intravenous injection.

G-Ketamine (Gonoshasthaya), Inj., 50 mg/ml,
KAIN (Renata), Inj. 50 mg/ml, Tk. 110.00/10 Proprietary Preparations
ml vial. Propofol (I) (Fresenius ) Inj. (IV Infusion) 1%,
Ketalar (Popular), Inj.,50 mg/ml, Tk. 115.43/10 Tk.270/10ml Tk. 351.06/20 ml; Tk.779.00/50ml
ml vial Pofol (Popular), Inj., (IV Infusion), 1%, Tk.
Ketaride (Incepta), Inj, 50 mg/ml, Tk. 200.75/20 ml
115.00/10 ml vial Propofol lipuro (I) (B.Braun) Inj., (IV Infusion),
Pentyl(ACI), Inj., 50 mg/ml, Tk. 115.78/10ml 1%, Tk. 585.25/50 ml; Tk.278.69/20ml
vial Propofol (Techno) Inj. (IV Infusion) 1%, Tk.
195.00/20 ml
PROPOFOL Ufol (Incepta), , Inj. (IV Infusion) 1%, Tk.
300.00/20 ml
Indications: Induction of anaesthesia,

total intravenous anaesthesia, sedation THIOPENTONE SODIUM [ED]
during surgery, diagnostic procedures (Thiopental sodium)
and in intensive care.
Cautions: Care must be taken in Thiopentone sodium is a widely used,
patients with cardiac diseases or who rapid onset, ultra-short acting
are hypovolaemic (bradycardia is barbiturates, rapidly reaches the brain
common). Strict aseptic technique must and causes unconsciousness within 30-
be taken during use to avoid bacterial 40 seconds.
contamination. Indications: Induction of general
Contraindications: History of propofol anaesthesia and in the treatment of
allergy, airway obstruction, sedation of status epilepticus.
children and ECT. Cautions: Its potency makes it a highly
Side effects: Profound hypotension and dangerous drug in inexperienced hands.
respiratory depression apnoea more It is very easy to give an over dose to
common and of longer duration than sick and elderly alone. It should never
Thiopentone, hypersensitivity reactions; be given patients in the sitting position.
pain on injection. Should never be given rapidly to any but
Dose: Induction of anaesthesia, by fit and robust. Apparatus capable of
intravenous injection or by intravenous ventilating should always be readily
infusion 1.5-2.5mg/kg (less in the available. Unsuitable for use in out
ELDERLY) at a rate of 20–40 mg every patients
10 seconds. CHILD over 3 years 2.5 Contraindications: Airway obstruction,
mg/kg adjusted as necessary hypersensitivity to barbiturate, severe
Maintenance of anaesthesia, by intrave- shock, uncompensated heart disease,
nous infusion, 4-12 mg/kg/hour or by status asthmaticus.
intermittent injection (25-50 mg repeated Interactions: See Appendix-2
according to response); CHILD over 3 Side-effects: Apnoea, hypotension.
years 9-15 mg/kg/hour Dose: By intravenous injection as a
Sedation during intensive care (with 2.5% solution; the dose required to
assisted ventilation), by intravenous produce anesthesia varies, and the
infusion, 0.3-4 mg/kg/hour for up to 3 response to each patient must be
days; CHILD is not recommended assessed carefully. In adults, initially 3-5
Sedation for surgical and diagnostic mg/kg (reduced in elderly or debilitated)
procedures, initially by intravenous over 15–20 seconds (longer in elderly or
injection 0.5-1.0mg/kg over 1-5 minutes; debilitated), followed by further quantity
maintenance, by intravenous infusion (50–100 mg) as supplementary dose to
1.5-4.5 mg/kg/hour, those over 55 years be given if necessary according to
may require lower dose; CHILD is not response after 30–60 seconds; CHILD
recommended induction 2-4 mg/kg.
Note. Propofol 2% should not be given
316
8. ANAESTHESIA
Genisia (Square), Inj., 500 mg/Vial, Tk. Contraindication: Hepatic impairment.

69.59/Vial Interaction: See Appendix-2
G-Thiopental (Gonoshasthaya), Inj., 1 Side-effects: Profound respiratory
gm/Vial, Tk. 100.00/Vial; 500 mg/Vial, Tk.
64.69/vial
depression in high dose.
Thiaton (Techno), Inj.,1 gm/Vial, Tk. Dose: Using a specifically calibrated
100.00/Vial ; 500 mg/Vial, Tk. 60.00/Vial vaporizer, induction, increased gradually
Thiopen (ACI), Inj., 1 gm/Vial, Tk. 100.68/Vial; from 0.5% to 3%, in oxygen or nitrous
Inj., 500 mg/Vial, Tk. 70.05/Vial oxide-oxygen Maintenance, 1.1 to 1.5%
TPS (Popular), Inj., 1gm/Vial, Tk. 90.00/Vial in nitrous(MAC) oxide-oxygen; an
500 mg/Vial, Tk100.68/Vial additional 0.5-1% may be required when
given with oxygen alone; caesarean
8.1.2 INHALATIONAL ANAESTHETICS section, 0.5-0.75% in nitrous oxide-
oxygen
HALOTHANE[ED]
Halothane is a potent volatile liquid Forane (I) (Abbott) Inhalation anesthetic
Tk.3666.00/100ml
anaesthetic commonly used in clinical
Flurane(Techno), Inhalation anesthetic Tk.
practice. 3,009.00/100ml
Indication: For induction and
maintenance of anaesthesia. NITROUS OXIDE[ED]
Cautions: Patients with intracranial
mass lesion, should be used with great Indications: Used for maintenance of
caution anesthesia and for augmentation
Contraindications: A history of analgesia in case of changing painful
unexplained jaundice or pyrexia in a dressing.
patient following exposure to halothane Cautions: The most obvious problem
is absolute contraindication for its future with nitrous oxide administration is
use in that patient; repeated use of hypoxia. So oxygen concentration of at
halothane within a period of at least 3 least 30 % should be given.
months; severe arrhythmia; Side-effects: Diffusion hypoxia, middle
Side-effects: Respiratory and ear and obstructed intestine, vitamin B12
myocardial depression, hypotension, deficiency and depression of bone
arrhythmias; post operative shivering. marrow.
Dose: Using a specifically calibrated Dose: It is commonly used in a
vaporizer for induction concentration concentration of 50 to 70% in oxygen as
increased gradually up to 2–4 % in part of a balanced anaesthetic
oxygen or nitrous oxide-oxygen; CHILD technique. For analgesia, a mixture with
1.5–2%. Maintenance 0.5–2 % using by 50% oxygen.
MAC.
Proprietary Preparation Nitrous oxide(Linda),Inhalation gas,nitrous
Halosin (ACI), Inhalation anesthetic , oxide 98%,Tk.2875/3.60 kiloliter
Tk.187.00gm/100ml, Tk.1890.45/250ml , Tk. Entonox (Linda) ,Inhalation gas, nitrous oxide
1504.00/200ml 50% + oxygen 50%,Tk1300/kilo liter
Medical compressed gas(Linda),20.4-
ISOFLOURANE 21.4%+Nitrogen,Tk.342.24/6.2cubic
meter
Indication: Same as that of halothane.
Cautions: Heart rate may rise SEVOFLURANE
particularly in younger patients. Systemic
arterial pressure may fall, owing to a Indications: Induction and maintenance
decrease in systemic vascular resistance of anaesthesia. It is particularly useful in
and with less decrease in cardiac output children. Single breath induction.
than occurs with halothane. Respiration Caution: Renal impairment.
is depressed.
317
8. ANAESTHESIA
Contraindications & Side effects: neuromuscular block, by intravenous

Same as other volatile anaesthetics. injection, 0.6-1.2 mg usually used in a
Dose: It has a MAC value of 1.71-2.05. ratio of 2.5 mg neostigmine to 1mg.
2-3% for induction, being higher in
children and reduced in the presence of Proprietary Preparations
nitrous oxide See section 2.2
Proprietary Preparation GLYCOPYRRONIUM BROMIDE

Sevorane(I) (Abbott) Inhalation anesthetic
Tk.15500.00/250 ml
Sevoran(Techno) Inhalation anesthetic Indications: To reduce salivary, trache-
Tk.10500.00/250 ml obronchial, and pharyngeal secretions
and for decreasing the acid secretion. It
8.1.3 ANTIMUSCARINIC AND is also used in conjunction with
ANXIOLYTIC DRUGS FOR neostigmine to prevent the muscarinic
PERI OPERATIVE USE effect of neostigmine.
ANTIMUSCARINIC DRUGS Cautions: thyrotoxicosis, arrhythmia,
hypertension, congestive heart failure
ATROPINE SULPHATE [ED] pregnancy
Contraindications: Pregnancy, breast-
Indications: For drying of secretions feeding, enlarged prostate, glaucoma
and reversal of excessive bradycardia; Side-effects: Fever,dry mouth, difficulty
with neostigmine to antagonize its in urinating, blurred vision.
muscarinic action, acute arrythmias after Dose: Premedication, by intramuscular
myocardial infarction and during or intravenous injection, 200–400
cardiopulmonary resuscitation. micrograms or 4–5 micrograms/kg(max.
Cautions: Marked tachycardia in 400 micrograms); CHILD 1 month–12
thyrotoxicosis, hyperpyrexial patients, in years, 4–8 micrograms/kg (max. 200
glucoma children, in the elderly, reflux micrograms) Intra-operative bradycardia,
oesophagitis, diarrhoea, acute by intravenous injection,200–400
myocardial infarction, hypertension, micrograms or 4–5 micrograms/kg
pregnancy and breast-feeding. (max.400 micrograms), repeated if
Contraindications: In angle-closure necessary; CHILD 1month–18 years, 4–
glaucoma, myasthenia gravis, paralytic 8 micrograms/kg (max.200 micrograms),
ileus, pyloric stenosis and prostatic repeated if necessary.
enlargement. Control of muscarinic side-effects of
Side-effects: Constipation, initial neostigmine in reversal of non-
bradycardia, reduced bronchial depolarising neuromuscular block, by
secretions, urinary urgency and intravenous injection, 200 micrograms
retention, dilatation of the pupils with per 1mg of neostigmine, or 10–15
loss of accommodation, photophobia, micrograms/kg; CHILD 1month–12
dry mouth, flushing and dryness of the years, 10 micrograms/kg (max. 500
skin. micrograms)
Dose: Premedication, by intravenous
injection, 300-600 micrograms Proprietary Preparation
immediately before induction of Seebri Breezhaler (I) (Novartis) Inhalation
anaesthesia, and in incremental doses of Powder Hard Cap., 50 mcg, Tk. 99.50/Cap
100micrograms for the treatment of Supotaria (Incepta), Cap. , 50 mcg, Tk.
20.00/Cap.; Inj., 200 mcg/ml, Tk. 90.00/Amp
bradycardia.
By intramuscular injection, 300-600
micrograms 30–60 minutes before HYOSCINE HYDROBROMIDE
anaesthesia induction; CHILD 20 (Scopolamine Hydrobromide)
micrograms/kg.
for control of muscarinic side-effects of Indications: Used as a sedative,
neostigmine in reversal of competitive amnesic and anti-sialogogue in
318
8. ANAESTHESIA
premedication, antiemetic and in the minor or dental surgery then 5 mg 2

treatment of motion sickness hours before procedure.
Caution: As atropine sulphate. By intravenous injection, into a large vein
Side effects: Excitement, ataxia, 10-20 mg over 2-4 minutes as sedative
hallucinations, behavioral abnormalities, cover for minor surgery or invasive
and drowsiness. medical procedure; premedication 100-
Dose: Premedication, by subcutaneous 200 micrograms/kg.
or intramuscular injection, 200–600
micrograms 30–60 minutes before Proprietary Preparations
induction of anaesthesia (often given See section 7.1
with papaveretum)
MIDAZOLAM
Buscon(Ibn Sina), Inj., 20 mg/ml , Tk.
29.50/Amp. Indications: Premedication before
Colik (ACI), Inj., 20 mg/ml , Tk. 29.90//amp general anaesthesia, induction of
G-Hyoscine (Gonoshasthaya), Inj., 20 anaesthesia, to provide sedative care for
mg/ml, Tk.7.75/Amp. minor surgical or investigative proce-
Hysomide (Opsonin), Inj., 20 mg/ml, Tk. dures; patients in intensive care
29.90/Amp. Cautions and Side effects: same as for
Spasmoson (Jayson), Inj., 20 mg/ml, Tk.
diazepam
15.00/Amp.
Papaveretum and Hyoscine Dose: Premedication, by intramuscular
Inj. Papaveretum 15.4 mg + hyoscine injection, 70-100 micrograms/kg 30-60
hydrobromide 400 micrograms/ml, 1 ml amp. minutes before surgery; usual dose 5 mg
(ELDERLY 2.5 mg)
ANXIOLYTICS Induction of anaesthesia, by slow
(See also section 7.1 & 7.2) intravenous injection, 200 micrograms/kg
(ELDERLY 100-200 microgram/kg;
Benzodiazepines (e.g. Diazepam, CHILD over 7 years 100 microgram/kg)
Lorazepam and Midazolam) are widely Sedation of patients receiving intensive
used. care, by intravenous infusion, initially 30-
100 micrograms/kg given over 5
BENZODIAZEPINES minutes, then 30-150 micrograms/kg per
hour; reduce dose or omit initial dose in
hypovolaemia, vasoconstriction or
DIAZEPAM[ED] [CD] hypothermia.
(See also section 7.1) Sedation for dental, minor surgical and
other procedures, by intravenous inject-
Indications: For premedication including tion, 2 mg initially (half in elderly) over 30
anxiolysis, sedation and amnesia and seconds followed after 2 minutes by
regarded as a drug of first choice in the increments of 0.5-1 mg if sedation not
treatment and prevention of all kinds of adequate; usual total dose 2.5 to 7.5 mg
convulsive condition. (~70 micrograms/kg), elderly 1-2 mg.
Cautions: Marked respiratory
depression; hepatic and renal Proprietary Preparations
impairment particularly the elderly. Dormilat (ACI), Inj, 1mg/ ml , Tk. 55.17/ amp.;
Diazepam injection cannot be diluted 15mg/3ml , Tk. 75.23/3ml amp
Hypnofast (Incepta), Inj, 1mg/ ml, Tk.50/ amp;
and it precipitates when mixed with most
15mg/3 ml, Tk. 90.00/3ml amp.
other agents. Dormitol (Square), Inj, 15mg/3 ml , Tk.
Interactions: See Appendix-2 120.37/3ml amp.;
Side-effects: Pain, thrombophlebitis, Midzo (Renata), Inj, 15mg/3 ml, Tk. 75/3ml
tenderness have occurred following amp,
injection of diazepam. Dormax (Aristo), Inj, 15mg/3 ml , Tk. 75/3ml
Dose: By mouth, 5 mg on night before amp.
319
8. ANAESTHESIA
Milam (Eskayef), Inj, 15mg/3 ml , Tk. 120/3 ml Opifen (Incepta), Inj., 100 mcg/2 ml, Tk.
amp,; 40.00/Amp
Anquil (General), Inj,15mg/3 ml,Tk.75.22/3ml Fentanyl(Renata), Inj, 100 mcg/2 ml, Tk.
Midolam (Opsonin), Inj, 15mg/3 ml , Tk. 40.15/2 ml amp
50.19/5mg amp.; 1mg/ ml , Tk. 75.28/amp,; . ;
MORPHINE SULPHATE [ED] [CD]
8.1.4 ANALGESICS FOR (See section 7.5.1)

PERI OPERATIVE USE
Indications: Moderate to severe acute
8.1.4.1 OPIOIDS pain, chronic pain often in terminal
8.1.4.2 NON-OPIOIDS illness, relief of anxiety in serious and
frightening condition, relief of dyspnoea
8.1.4.1 OPIOIDS in acute left ventricular failure, cardiac
(See also section 7.5.1) ischaemia, premedication before
operation.
FENTANYL[CD] Cautions: Depressant action in all level.
Concern about overdose and monitoring.
Contraindications: Adrenocortical
Indications: For analgesia during
insufficiency, severe liver diseases,
operation; for epidural anesthesia as
hypothyroidism, diverticulitis, and other
adjuvant.
spastic condition of the colon, biliary
Cautions: Analgesic doses of fentanyl
colic, patients treated with MAOIs,
will always cause respiratory depression,
elderly patients, during labour, confusion
truncal rigidity and facilities for its
and vomiting.
treatment must be immediately available.
Side-effects: Overdoses causes
Side-effects: Abdominal pain, asthenia,
respiratory failure, cardiovascular
anorexia, anxiety, diarrhoea, dyspepsia.
collapse and coma.
dyspenoea, gastro esophageal reflux
Dose: Usual adult dose for pain
disease,hypertension,myoclonus,paraest
oral, sublingual, or buccal: 5 to 30 mg
hesia,pharyngitis,rhinitis,stomatitis and
every 3 to 4 hours as needed
vasodilatation.
Extended-release capsules: 100 mg and
Contraindications: Hypersensitive to
200 mg for use only in opioid tolerant
fentanyl citrate or other opioid
patients: To be taken orally 1 to 2 times
medicines.
daily swallowed whole or opened and
Dose: By intravenous injection, with
sprinkled on a small amount of
spontaneous respiration, 50-200 micro-
applesauce immediately prior to
grams, and then 50 micrograms as
ingestion. Maximum dose: 1600 mg
required. For CHILD, 3-5 microgram/kg,
orally daily
and then 1 microgram/kg as required.
IM or subcutaneous: 2.5 to 20 mg every
With assisted ventilation, 0.3–3.5 mg,
3 to 4 hours as needed.
then 100-200 micrograms as required.
IV: 4 to 15 mg every 3 to 4 hours as
CHILD 15 micrograms/kg, then 1–3
needed. Give very slowly over 4 to 5
micrograms/kg as required.
minutes. Starting doses up to 15 mg
every 4 hours have been used. Chest
Durogesic (I) (Janseen,), Transdermal Patch, pain: 2 to 4 mg repeat as necessary.
25micrograms, /h,(Fentanyl 4.2mg/unit Continuous IV: 0.8 to 10 mg/hour.
dose)Tk.650.03/patch.; Maintenance dose: 0.8 to 80 mg/hour.
50 micrograms/h,(Fentanyl 8.4mg/unit Rates up to 440 mg/hour have been
dose);Tk.1293.21/Patch used.
Fentanyl (I), (Rotex) , Inj.,0.1mg/2ml , Tk. IV patient controlled analgesia or
36.76/2mlAmp
Fentanyl HEXAL MAT(I) (Hexel) , Transdermal
subcutaneous patient controlled
patch (matrix), 25 mcg/h, Tk. 370.00/Patch analgesia: 1 to 2 mg injected 30 minutes
Fentyl (Popular), Inj., 100 mcg/2 ml, Tk. after a standard IV dose of 5 to 20 mg.
40.15/Amp. The lockout period is 6 to 15 minutes.
320
8. ANAESTHESIA
The 4 hour limit is 30 mg. pain); lockout period of 10 minutes; 4

Continuous subcutaneous: 1 mg/hour hour limit of 0.25 mg/kg.
after a standard dose of 5 to 20 mg. Dose adjustments: Titrate doses slowly
Epidural: 5 mg one time. May give 1 to 2 upward, taking into consideration the
mg more after one hour to a maximum of dosages received for breakthrough pain,
10 mg. Intrathecal: 0.2 to 1 mg one time to meet the specific needs of a patient.
Intrathecal Continuous: 0.2 mg/24 hours. Factors such as age, disease state,
May be increased up to 20 mg/24 hours. concomitant drug therapy, and tolerance
Rectal: 10 to 30 mg every 4 hours as to narcotics can have variable but
needed. important effects on dose and response.
Usual pediatric dose for pain: Women have been reported to require
Less than or equal to 4 weeks: more morphine than men to achieve a
Use preservative-free formulation: similar degree of analgesia.
Initial:0.05mg/kgIM,IV,or subcutaneously If a patient is not able to take oral
every 4 to 8 hours titrating carefully to morphine, divide the oral dose by half
effect Maximum dose: 0.1mg/kg/dose. and give subcutaneously. If the IV route
Continuous Infusion: 0.01 mg/kg/hour is preferred, the oral dose may be
continuous IV infusion. Do not exceed divided by 3.
infusion rates of 0.015 to 0.02 The potency ration of oral to rectal
mg/kg/hour. morphine is 1:1.
Greater than or equal to 1 month but
less than 12 years: Proprietary Preparations
Oral: 0.2 to 0.5 mg /kg / dose every 4 to See also section 7.5.1
6 hours (tablets/solution) or 0.3 to 0.6
mg/kg/dose every 12 hours (extended NALBUPHINE (Opioid analgesic drug and opioid
release) receptor antagonist )
IM,subcutaneous,IV:0.05 to 0.2mg/kg/
dose (up to 15 mg) every 4 hours as Indications: Used for premedication,
needed. anaesthesia and treatment of pain.
IV/subcutaneous Continuous: 0.025 to Side- effects : Vomiting is thought to be
0.206 mg/kg/hour (sickle cell or cancer less than with morphine, although
pain) or 0.01 to 0.04 mg/kg/hour (postop maximal attainable analgesia is also
pain) less, psychomimetic effects.
Epidural: (use preservative-free Dose: 0.1–0.3 mg/kg IV/IM/SC. Up to
formulation): 0.025 mg/kg/dose every 6 1.0 mg/kg IV has been used during
to 8 hours (postop pain). Maximum per anaesthesia.
24 hours: 5 mg.
Greater than or equal to 12 years: Proprietary Preparations
Premedication for anesthesia IV: 3 to 4 Nabulex(General), Inj. , 20 mg/2 ml, Tk.
mg once, may repeat in 5 minutes if 100.30/2ml Amp
Nalbutin (ACI), Inj., 20 mg/2 ml, Tk.
necessary. Oral: 0.2 to 0.5 mg/kg/dose
100.30/2ml Amp, 10 mg/1 ml, Tk. 60.18/1 ml
every 4 to 6 hours (tablets/solution) or Amp
0.3 to 0.6 mg/kg/dose every 12 hours Nalphin (Acme), Inj., 10 mg/1 ml, Tk. 60.40/1
(extended release).IM, subcutaneous, ml Amp,; 20 mg/2 ml, Tk. 100.30/2 ml Amp
IV: 0.05 to 0.2 mg/kg/dose (up to 15 mg) Radirif (Square), Inj., 20 mg/2 ml, Tk.
every 4 hours as needed. 100.68/2ml Amp
IV/subcutaneous Continuous: 0.025 to Nalbun (Incepta), Inj., 20 mg/2 ml, Tk.
100.00/2 ml Amp,; 10 mg/1 ml, Tk. 60.00/1 ml
0.206 mg/kg/hour (sickle cell or cancer
Amp,;
pain) or 0.01 to 0.04 mg/kg/hour (postop Raltrox (Opsonin), Inj., 10 mg/1 ml, Tk.
pain).Epidural (use preservative-free 60.23/1 ml Amp,; 20 mg/2 ml, Tk. 100.68/2ml
formulation): 0.025 mg/kg/dose every 6 Amp
to 8 hours (pastor pain). Maximum per
24 hours: 5mg. IV patient controlled PETHIDINE HYDROCHLORIDE[ED] [CD]
analgesia: 0.015 mg/kg/dose (postop (See section . 7.5.1)
321
8. ANAESTHESIA
needed for pain relief every 4 to 6 hours

Indications: Same as that of Morphine; not to exceed 400 mg per day.
also for labor analgesia. Tramadol Extended-Release (ER)
Contraindication: Same as that of 16 years and older: Initial: 100 mg once
Morphine. daily. Titrate by 100 mg increments
Side-effects: May cause convulsions, every 2 to 3 days if needed for pain
especially in children. control Maximum: 300 mg/day
Dose: May be given by mouth, IM, IV.
For analgesia: Oral/IM- 50-100mg every Proprietary Preparations
3-4h as necessary.For premedication:IM See section 7.5.1
50-100mg ig given before operation.
As balanced anaesthesia;10-15 mg IV, 8.1.4.2 NON-OPIOIDS
Supplementary necessary every 20-30 (See also section 7.5.2&9.1.1)
min.
In tachypnoea IV upto 25mg. DICLOFENAC
For obstetric use: 100-150 mg IM when
(See section 9.1.1)
labour pain become regular then
repeated every 2-3 h as required.
Indications: Moderate pain of
For epidural anaesthesia as adjuvant;2-
musculoskeletal origin including
200 microgram/kg body weight.
tendinitis and bursitis conditions,
rheumatoid and osteorarthritis.
Side-effects: Gastro-intestinal effects;
See also section 7.5.1
long-term diclofenac treatment can raise
plasma aminotransrferase levels, allergic
TRAMADOL reactions, fluid retention.
Cautions: PUD, bleeding disorder, renal
Indications: Moderate to severe pain disorder.
with CKD, CLD. Dose: 100-200 mg 2 to 4 times daily.
Contraindications: Severe asthma, Depending on the diclofenac formulation
intestinal obstruction, patients taking used and the condition being treated.
narcotic medicines or sedatives.
Side-effects: Headache, dizziness, Proprietary Preparations
drowsiness, constipation, diarrhoea, See section 9.1.1
nausea, vomiting, stomach pain; feeling
nervous or anxious; itching, sweating, IBUPROFEN[ED]
flushing, seizure, shallow breathing (See section 9.1.1)
Dose: Usual ADULT dose for pain: For Indications: Dysmenorrhea,
acute pain 3mg/kg IV, increment of 50- osteoarthritis, rheumatoid arthritis
100mg, until adequate relief is obtained,
and juvenile idiopathic arthritis and fever.
upto 400mg per day. For mild to Contraindication and side-effects:
moderate severe chronic pain not Similar to other NSAIDs.
requiring rapid onset of analgesic effect:
Dose: 10 mg/kg can be administered by
Initial dose: 25 mg every morning mouth every 6–8 hours. Individuals
Titration: Increase in 25 mg increments should not use ibuprofen for more than
as separate doses every 3 days to reach
10 days for the treatment of pain or more
100 mg per day taken as 25 mg 4 times than 3 days for the treatment of a fever
per day. Then the total daily dose may unless directed by a physician. Ibuprofen
be increased by 50 mg as tolerated
should be taken with meals to prevent
every 3 days to reach 200 mg per day stomach upset. Children 6 months to 12
taken as 50 mg 4 times per day. years of age usually are given 5-10
Maintenance: After titration, tramadol 50
mg/kg of ibuprofen every 6-8 hours for
mg to 100 mg can be administered as the treatment of fever and pain. The
maximum dose is 40 mg/kg daily.
322
8. ANAESTHESIA
Proprietary Preparations Single dose: 0.5 mg/kg IV/IM once; not

See section 9.1.1 to exceed 15 mg
Multiple doses: 0.5 mg/kg IV/IM q6hr; not
KETOROLAC to exceed 5 days
(See also section 9.1.1) GERIATRIC
Indications: Moderately severe pain, Moderately Severe Acute Pain
usually after surgery. Short-term (≤5 days) management of
moderately severe acute pain that
Caution: It should be taken at around requires analgesia at opioid level; not
the same times every day. indicated for minor or chronic painful
Contraindication: CHILD under two conditions
years. IV: 15 mg as single dose or 15 mg q6hr;
Side-effects: Somnolence, not to exceed 60 mg/day
dyspepsia, pruritus, oedema, increased IM: 30 mg as single dose or 15 mg q6hr;
blood urea nitrogen, drowsiness, not to exceed 60 mg/day
hypertension, blurred vision, PO: 10 mg once after IV or IM therapy,
bronchospasm, cholestatic jaundice, then 10 mg q4-6hr; not to exceed 40
depression, insomnia, laryngeal/lingual mg/day.
edema.
Dose: ADULT- Moderately Severe Acute Proprietary Preparations
Pain. See section 9.1.1.
Short-term (≤5 days) management of
moderately severe acute pain that PARACETAMOL[ED]
requires analgesia at opioid level; not (See section 7.5.2.)
indicated for minor or chronic painful
conditions. Indications: Mild, moderate, acute pain.
IV: 30 mg as single dose or 30 mg q6hr;
not to exceed 120 mg/day. Side-effects: nausea, vomiting,
IM: 60 mg as single dose or 30 mg q6hr; anorexia and abdominal pain. Dose
not to exceed 120 mg/day. dependent hepatic necrosis.
PO: 20 mg once after IV or IM therapy, Dose: 10–15 mg/kg every 4–6 hours
then 10 mg q4-6hr; not to exceed 40 administered by mouth or rectally is a
mg/day. safe and effective method for controlling
Dosing Considerations: postoperative pain.
Always begin with parenteral therapy; IV :30-40mg/kg
oral administration indicated only as
continuation of IV/IM dosing, if Proprietary Preparations
necessary. Duration of therapy should See section 7.5.2.
not exceed 5 days.
Doses beyond maximum or labeled 8.1.5 MUSCLE RELAXANTS
doses will not provide better efficacy but Muscle relaxants used in anesthesia are
will increase risk of serious adverse also known as neuromuscular
events. blocking drug.By specific blockades of
Decrease daily dose in patients >65 the neuromuscular junction they enable
years, <50 kg, or with moderately adequate relaxation of the muscle of the
elevated serum creatinine. abdomen and diaphragm. They also
Following intravenous therapy, the relax the vocal cord and allow the
recommended dose is one or two tablets passage of tracheal tube.
initially followed by 1 tablet every 4-6
hours.
NON-DEPOLARISING MUSCLE
RELAXANTS
PAEDIARTIC
Moderately Severe Acute Pain
2-16 years Non-depolarizing muscle relaxants (also
323
8. ANAESTHESIA
known as competitive muscle relaxants) ATRACURIUM BESYLATE

compete with acetylcholine for receptor
sites at the neuromuscular junction and Indications: Used in surgery of
their action may be reversed with moderate duration in the presence of
anticholinesterases (e.g. Neostigmine, real or hepatic impairment.
see section 8.1.6). Non-depolarising Cautions and Side-effects: See notes
muscle relaxants may be divided into the above.
aminosteroid group, which includes Dose: By intravenous injection, ADULT
Pancuronium, Pipecuronium and CHILD over 1 month initially 0.3-0.6
rocuronium and Vecuronium, and the mg/kg, then 0.1-0.2 mg/kg as required.
benzylisoquinolinium group, which By intravenous infusion, 5-10 micro-
includes Atracurium, Cisatracurium grams/kg/ minute (300-600 micrograms/
and Gallamine. kg/hour).
Non-depolarising muscle relaxants have
a slower onset of action than Proprietary Preparations
Suxamethonium. These drugs can also Relaxton (Techno), Inj., 25 mg/2.5 ml,
be classified by their duration of action Tk.80.00/2.5 ml
as short acting (10-20 minutes), Tracrium (I) (GSK.), Inj., 25 mg/2.5 ml,
intermediate-acting (40-60 minutes) and Tk.645.49/2.5 ml
long-acting (60-120) minutes), although
duration of action is dose-dependent. CISATRACURIUM
Drugs with a shorter or intermediate
duration of action, such as Atracurium Indications: Same as that of Atracurium
and Vecuronium, are more widely Cautions and Side-effects: See notes
employed than those with a longer above.
duration of action such as Pancuronium Dose: By intravenous injection,
or Pipecuronium. intubation, 150 micrograms/kg;
Non-depolarizing muscle relaxants have maintenance, 30micrograms/kg approx.
no sedative or analgesic effects and are every 20 minutes.
not considered to be a triggering factor CHILD over 2 years, initially, 100 micro-
for malignant hyperthermia. grams/kg; maintenance, 20 micrograms/
Cautions: Allergic cross-reactivity kg approx. every 9 minutes
between neuromuscular blocking agents By intravenous infusion, ADULT and
has been reported; caution is advised in CHILD over 2 years, initially, 3
cases of hypersensitivity to these drugs. micrograms/kg/minute, then 1-2
Their activity is prolonged in patients mg/kg/minute; dose reduced by up to
with myasthenia gravis and in 40% if used with inhalation anesthetist
hypothermia where lower doses are CHILD under 2 years not recommended.
required. Resistance may develop in
patients with burns who may require Generic Preparation
increased doses. Inj. 2 mg/ml 2.5 ml amp; 5 mg/ml 30 ml vial.
Side-effects: Benzyl isoquinolinium non-
depolarizing muscle relaxants (except PANCURONIUM BROMIDE
cisatracurium) are associated with
histamine release, which can cause skin Indications: Neuromuscular relaxation
flushing, hypotension, tachycardia, of fairly long duration (60-90min)and
bronchospasm and rarely, anaphylactoid emergency cases
reactions. Cautions: Hepatic and renal impairment
Interactions: Intensification or prolong- and myasthenia gravis
ation of action of inhalational or intra- Side-effects: See notes above
venous anaesthesia; reduction of action Dose: By intravenous injection, initially
of corticosteroids. for intubation, 50-100 micrograms/kg
then 10-20 micrograms/kg as required.
CHILD initially 60-100 micrograms/kg,
then 10-20 micrograms/kg; NEONATE
324
8. ANAESTHESIA
30-40 micrograms/kg initially then 10-20 Dose: Because of its lack of

micrograms/kg cardiovascular side effects, vecuronium
Intensive care, By intravenous injection can be given in larger doses which
60 micrograms/kg every 60-90 minutes. shorten the time to onset and extend the
duration of action. By intravenous
Propiretory Preparations injection, intubation, 80-100
Panalon (Techno) Inj.,2mg/ml Tk. 275/Amp micrograms/kg; maintenance 20-30
Pancuroniun(I) (Rotex),Inj.,2mg/mlTk.
650/Amp
micrograms/kg according to response;
NEONATE and INFANT up to 4 months,
PIPECURONIUM BROMIDE
initially 10-20 micrograms/kg then
incremental doses to achieve response;
Indications: Operation requiring for long CHILD over 5 months, as ADULT dose
time muscle relaxation (up to 1 year onset more rapid and high
Cautions: Neuromuscular disorders, intubation dose may not be required)
obese patients, hepatic or renal By intravenous infusion, 0.8-1.4
impairment micrograms/kg/minute (after initial
Contraindications: Myasthenia gravis intravenous injection of 40-100
and pregnancy; see also notes above micrograms/kg).
Dose: 100microgram/kg to allow Proprietary Preparations
intubation. Nor Q (Incepta), Inj.,10 mg/Vial, Tk.
185.00/Vial
Proprietary Preparations Vencur(Popular), Tab.,10 mg/Vial, Tk.
Arduan (I) (Richter), Inj. 4 mg/2 ml 200.00/Vial
Tk.1072.52/Amp Vencuron (Techno), Inj.,10 mg/Vial, Tk.
Pycuron(Techno) Inj. 4 mg/2 ml 185.00/Vial; 4 mg/ml, Tk. 80.00/Vial
Tk.475.00/Amp Survec (Healthcare), Inj.,10mg/ml , Tk.
350.00/vial.
Vecuron (ACI), Inj., 4mg/ml, Tk. 82.56/vial
ROCURONIUM BROMIDE
DEPOLARISING MUSCLE
Indications, Cautions and Side-
RELAXANTS
effects: Similar to vecuronium.
Dose: By intravenous injection,
intubation, 600 micrograms/kg; SUXAMETHONIUM CHLORIDE[ED]
maintenance, 150micrograms/kg.
By intravenous infusion, 300-600 micro- Indications: Endoscopies,
grams/kg/hour (after initial intravenous manipulations and electroconvulsive
injection of 600 micrograms/kg). therapy and as an aid to tracheal
CHILD similar to adults; NEONATE not intubation (profound skeletal muscle
recommended. relaxation is requried for short periods)
Cautions: Patients with cardiac,
Proprietary Preparations respiratory or neuromuscular disease;
Esmeron (I) (Organon), Inj. 10mg/ml 5ml vial raised intraocular pressure and hyper
Tk. 4400.00/Vial. kalaemia.
Rocuron IV (Incepta), Inj, 1 gm/100 ml,
Tk.300.00/Vial
Contraindications: Severe liver
diseases, burned patients, degenerating
muscle mass, paraplegia of recent onset
VECURONIUM BROMIDE[ED]
and major limb trauma, family history of
malignant hyperthermia, known low
Indications: Any operation requiring plasma cholinesterase activity and
muscle relaxation of any duration. penetrating eye injury.
Cautions: same as for other Side effects: Postoperative muscle
competitive muscle relaxants; to be pain, myoglobinaemia, tachycardia,
monitored continuously arrhythmia, bronchospasm, prolonged
Side effects: See notes above. respiratory depression, hyperkalaemia,
325
8. ANAESTHESIA
hyperthermia, see also notes above. atropine sulphate 0.6-1.2mg.

Dose: By intravenous injection, ADULT
1 mg/kg (range 0.3-1.5 mg/kg); usual Proprietary Preparations
range 20-100 mg; max. 500 mg/hour; G-Neostigmine (Gonoshasthaya), Inj.,
CHILD 1-12 years, 1-2 mg/kg; INFANT 0.5mg/ml, Tk. 6.00/Amp.
Neos-R (Renata), Inj.,0.5 mg/ml, Tk.
under 1 year, 2 mg/kg By intravenous 8.00/Amp,Tk. 35.00/Amp
infusion of a solution containing 1-2 Neostig (Popular), Inj., 0.5 mg/ml,,
mg/ml (0.1-0.2%),2–5mg/minute; max. Tk.6.07/Amp
500 mg/hour. Prostigmin (Novo Health), Inj., 0.5 mg/ml,
By intramuscular injection, CHILD up to Tk.6.00/Amp
4 mg/kg; max. 150 mg; INFANT up to Stigmin (Techno), Inj., 0.5 mg/ml,
4–5 mg/kg Tk.6.00/Amp.
Stignal (ACI), Inj., 0.5 mg/ml,, Tk. 6.07/Amp
Versia (Square), Inj. 0.5 mg/ml, Tk. 7.04/Amp
G-Suxamethonium (Gonoshasthaya), Inj.,
100mg/2ml, Tk. 7.50/ Amp 8.1.7 ANTAGONISTS FOR
Neosuxa (Popular), Inj., 100 mg/2 ml, Tk. RESPIRATORY DEPRESSION
8.43/ Amp
Rapilax (ACI), Inj., 100 mg/2 ml, Tk. Respiratory depression is a major
17.25/Amp concern with opioid analgesics. It may
Suxalax (Square), Inj. 100 mg/2 ml, Tk. be reversed by Naloxone (analgesia
17.00/ Amp.
may also be reversed). Alternatively, the
Suxonium (Techno), Inj., 100mg/2ml, Tk.8.40/
Amp respiratory stimulant Doxapram may be
used which does not reverse the
analgesic effect of the opioids.
8.1.6 ANTICHOLINESTERASES
USED IN ANAESTHESIA
NALOXONE HYDROCHLORIDE [ED]
Indication: Reversal of opioid-induced
NEOSTIGMINE METHYLSULPHATE[ED] respiratory depression.
Indications: To antagonize the effects Cautions: Cardiovascular disease
of competitive neuromuscular blocking physical dependence on opioids,
drugs and in the treatment of atony of repeated dose or infusion may be
the intestinal tract, atony of the bladder, necessary to reverse effect of opioids
myasthenia gravis, glaucoma and sinus with longer duration of action.
tachycardia. Side effects: Nausea, vomiting,
Cautions: Atropine should always be tachycardia and fibrillation.
given with particular care in the presence Dose: By intravenous injection, 100-200
of asthma and heart disease, must not micrograms (1.5-3 micrograms/kg); if
be used in an attempt to reverse the response is inadequate, increments of
action of Suxamethonium. 100 micrograms every 2 minutes; further
Side effects: Overdose of Neostigmine doses by intramuscular injection after
may cause sudden death due to cardiac 1-2 hours if required.
arrest; restlessness, weakness,
muscular twitching, dysarthria, pin-point Proprietary Preparation
Naloxone Hydrochloride (I) (Mayne Pharma),
pupils, nystagmus, sweating, salivation, Inj. 400 microgm/ml; Tk. 141.87/Vial
nausea and vomiting, hypotesion.
Respiration is embarrassed by
8.1.8 DRUGS FOR MALIGNANT
bronchospasm and excessive secretions
HYPERTHERMIA
and death due to respiratory paralysis
and pulmonary edema may follow.
Dose: Reversal of non-depolarising FLUMAZENIL
neuromuscular blockade, by intravenous
injection over 1 min, 50–70 Flumazenil is a benzodiazepine
micrograms/kg (max. 5 mg) after or with antagonist. Flumazenil has a shorter
326
8. ANAESTHESIA
half-life than that of diazepam and avoid use near eyes or middle ear; in
midazolam; therefore, it may have to be anemia, or congenital or acquired
administered repeatedly. methaemoglobinemia; epilepsy, hepatic
Dose: The drug is given initially in a or respiratory impairment, impaired
bolus of 0.2 mg intravenously and then cardiac conduction, bradycardia;
in 0.1 mg increments until the desired porphyria; reduce dose in elderly or
end-point is reached. A total dose of 0.5 debilitated; patient resuscitative
mg is usually sufficient. By continuous equipment should be available.
intravenous rates up to 1mg/h may be Contraindications: Hypovolemia and
necessary to maintain a patient in a complete heart block.
‘safe’ condition. Side effects: Numbness, pallor, tinnitus,
excitement, restlessness, confusion,
Proprietary Preparation convulsions, respiratory depression,
Anexate(I) (Cenexi), Inj., 0.5 mg/5 ml, Tk. ventricular fibrillation, bradycardia and
2,548.92/5 ml Vial hypotension; hypersensitivity reported.
Dose: Epinephrine, unless otherwise
8.2 LOCAL ANAESTHESIA contra-indicated, is normally used with
lidocaine to delay absorption and
The great advantage of Bupivacaine prolong the action. Infiltration
over other local anaesthetics is its anaesthesia- a 0.5 per cent solution is
longest duration of action of the existing commonly employed. According to
drugs. It has a slower onset of action. patient’s weight and nature of procedure
The degree of motor block increases . max. 200 mg without or 500 mg with
adrenaline. Nerve block -A 1 per cent
BENZOCAINE solution is used with epinephrine, up to
10 ml for single nerves and 15-30 ml for
Indications:For the temporary relief of brachial plexus block. Epidural and
pain due to minor injury or irritation of the caudal block-A solution of 2 per cent
mouth and gums like Toothache, Sore lidocaine with 1:200 000 epinephrine is
gums, Canker sores, Braces, Minor normally used. Spinal block-5 per cent
dental procedures, Dentures hyperbaric solutions. (Not used at
Dose: Apply to the affected area up to 4 present). Intravenous local anaesthesia -
times daily or as directed by a 25-40 ml of 0.5 per cent lidocaine is
doctor/dentist. used for the arm.
Surface anaesthesia, 2–4%.
Proprietary Preparations May be in various forms, (a) Cream
Orogel (Square), Dental Gel, 20%, containing lignocaine 2.5 % with
Tk.50.15/5gm prilocaine 2.5 % ; (b) Antiseptic gel
Oratics (Acme),oralGel, 20%, Tk.40.12/5gm containing anhydrous lignocaine hydro-
chloride 2 % with chlorhexidine gluco-
Benzocaine 14%+Butamben 2%+Tetracaine
2%,
nate 0.25 % in a sterile lubricant basis;
Instasia (Ziska), Gel Tk. 350.00/30gm (c) Anhydrous gel containing anhydrous
lignocaine hydrochloride 2% in a sterile
lubricant water-miscible basis; (d)
LIGNOCAINE HYDROCHLORIDE[ED]
Topical preparation containing anhydr-
(Lidocaine Hydrochloride) ous lignocaine hydrochloride 40 mg/ml;
(e) Ointment, containing lignocaine 5%
Indications: To produce local in a water-miscible base (may include
anesthesia by infiltration, nerve, spinal, propylene glycol).
epidural and caudal block and topical
application; for the control of the Proprietary Preparations
myocardial irritability and ventricular G-Lignocaine (Gonoshasthaya),Inj. 2%,
arrhythmias, particularly in the treatment Jasocaine (Jayson), Inj. 1%, Inj 2%
following myocardial infarction. Jasocaine (Jayson), Gel 2%
Cautions: Wound; atopic dermatitis; Leecain (Gaco), Gel 2 %,
327
8. ANAESTHESIA
Lido (Square), Spray Tk. 300.00/30ml injection, plain or with adrenaline or nor-
Lidocaine (Aristo), Inj, 1%, Tk. 3.06/3.5ml adrenaline, is available in the form of
Amp, Tk. 2.95/2ml Amp. dental cartridges.
Locaine (Aristo), Inj., 2%, Tk. 28.74/50ml
Xylogel (UniMed), Gel 2%, Tk. 100.00/30gm
Xylone (ACI), Inj., 2%, Tk. 3.57/2ml , 4% Tk. BUPIVACAINE HYDROCHLORIDE[ED]
3.75/2ml
Xyloken (Opsonin),Spray, 10gm/100 ml, Tk. Indications: Particularly suitable for
100.30/10ml Tk. 450.00/50ml
continuous epidural analgesia in labour
Z-lidocaine (Ziska), Gel, Tk. 90.00/30gm; Inj,
2%, Tk. 28.65/Amp and for single-dose epidural injections
Lidocaine 2.5% + Prilocaine2.5%, for surgery.
Topican (Popular), Cream, Tk. 130.49/5gm Cautions: Avoid accidental intravascular
Skisia (Healthcare), Cream, Tk. 135.00/5 gm injection; because of its relatively greater
Xylone (ACI), Cream, Tk.130.39/5gm toxicity on the heart and more resistant
to treatment; precaution about over dose
Adrenaline+Lidocaine
and hepatic impairment must be taken.
Indications:Local Anesthetic
Note:Adrenaline must be in low Contraindication: Intravenous regional
concentrationwhen administration with local anaesthesia.
anestheticthe total doseof adrenaline should Interactions: See Appendix-2
not exceed 500microgram Side effects: See under Lignocaine
G-Lidocaine with Adrenaline(20 mcg+20 Hydrochloride.
mg)/ml Inj.,: Tk.50.0/50 ml vial Dose: Adjusted according to patient’s
Jasocaine-A (Jayson), 5 mcg+10 mg)/ml
weight and nature of procedure.
Tk.65.00/50mlvial, (5 mcg+20 mg)/ml
Tk.40.12/50 ml vial Maximum safe dose for bupivacaine is
0.5 mg/kg given at one time or in any 4-
hour period.
EMLA (eutectic mixture of local
Local infiltration-0.25% solution is
anaesthetics)
commonly employed.
Peripheral nerve block- 0.5% solution is
Indications: Analgesia for commonly employed.
venepuncture, venous and arterial Epidural block: 0.25–0.5% (max.30 ml)
cannulation, lumbar puncture, epidural Spinal anaesthesia, 0.5 % anhydrous
injection, superficial skin surgery and bupivacaine in 8 % dextrose solution,
relief of tourniquet pain during IVRA. sterile injection, 2–4 ml
Side-effects: May produce blanching of Note. 0.75% is contraindicated for
the skin; increases in methaemoglobin epidural use in obstetrics.
have been reported several hours after
application. Proprietary Preparations
How to use: Providing analgesia of the Bupi (Popular), Inj., 5%,Tk. 60.23/30 ml
skin 60–90 min after topical application Nerkein (Beximco), Inj., 5%,Tk. 60.00/30 ml
and covering with an occlusive dressing. Ultracaine (Jayson), Inj.5%,Tk. 60.23/30 ml
It may continue to be released from skin Nerkein (Beximco), Inj., Tk. 59.9963/30 ml
depots even after removal of surface Pivacain (ACI), Inj., 0.25%, Tk. 45.31/20ml ;
0.5%, Tk. 60.41/30ml
cream. It is particularly useful in children.
Bupivacaine0.5% + Dextrose8%,
Proprietary Preparations Anespine (Square), Inj., Tk. 30.20/I4 ml Amp
Lidocaine 2.5% + Prilocaine2.5% Bupi Heavy (Popular), Inj. , Tk. 30.11/20 ml;
Topican (Popular), Cream, Tk. 130.49/5gm Tk. 60.23/30 ml
Skisia (Healthcare), Cream, Tk. 135.00/5 gm G-Bupivacaine Heavy(Gonoshasthaya) Inj.,
Xylone Plus (ACI), Cream, Tk.130.39/5gm Tk. 28/4 ml
Emprila (UniMed), Cream, Tk. 100.00/5 gm Pivacain (ACI), Inj., Tk. 30.20/4ml Amp
Sivicaine (Renata), Inj. Tk. 30.11/4 ml Amp
LIGNOCAINE INJECTION FOR Spino (Incepta), Inj. , Tk. 30.00/4 ml Amp
DENTAL USE[ED] Ultracaine Heavy (Jayson), Inj., Tk. 30.11/4
ml Amp.
Vaspine (Healthcare), Inj. Tk. 32.00/4 ml Amp
Note: A large variety of lignocaine
328
9. MUSCULOSKELETAL AND JOINT DISEASES
Chapter 9
MUSCULOSKELETAL AND JOINT DISEASES
9.1 Drugs used in rheumatic disorders and gout p.329
9.1.1 Non-steroidal anti-inflammatory drugs p. 329
9.1.2 Corticosteroids p.340
9.1.2.1 Systemic Corticosteroids p. 340
9.1.2.2 Local Corticosteroids p. 342
9.1.3 Disease-modifying antirheumatic drugs p.342
9.1.4 Drugs for treatment of gout p. 346
9.2 Drugs used in neuromuscular disorders p. 348
9.2.1 Drugs which enhance neuromuscular transmission p.348
9.2.2 Muscle relaxants p.349
9.3 Supplementary drugs used in joint diseases p. 352
9.4 Drugs used in osteoporosisp.353
9.1 DRUGS USED IN RHEUMATIC benefit in the less well defined conditions
DISORDERS AND GOUT of back pain and soft-tissue disorders.
Cautions and Contra-indications:
9.1.1 NON-STEROIDAL ANTI- NSAIDs should be used with caution in
INFLAMMATORY DRUGS the elderly in coagulative defects, and
9.1.2 CORTICOSTEROIDS during pregnancy and breast feeding,.
9.1.2.1 Systemic Corticosteroids In patients with renal, hepatic or cardiac
9.1.2.2 Local Corticosteroids p impairment caution is required since the
9.1.3 DISEASE-MODIFYING use of NSAIDs may result in
ANTIRHEUMATIC DRUGS deterioration of renal function.
9.1.4 DRUGS FOR TREATMENT OF NSAIDs should also be used with
GOUT caution in Crohn’s disease or ulcerative
colitis, as these conditions may be
exacerbated.
9.1 DRUGS USED IN RHEUMATIC
They should be used with cantions in
DISORDERS AND GOUT
patients with a past history of cardiac
failure or hypertension NSAIDs are
9.1.1 NON-STEROIDAL ANTI-INFLA- contraindicated in patients with active
MMATORY DRUGS (NSAIDs) hepatic ulcerations. They should be
avoided in patients with previous
In single doses NSAIDs have analgesic gastrointestinal bleeding or ulcerations
activity comparable to that of and should be withdrawn if
paracetamol (see section on gastrointestinal lesions develop. They
paracetamol), but paracetamol is are also contraindicated when there is a
preferred, particularly in the elderly. previous history of hypersensitivity to
In regular full dosage NSAIDs have both any NSAIDs.
lasting analgesic and anti-inflammatory In severe heart failure, all NSAIDs are
effects, which make them particularly contra-indicated. Diclofenac celecoxib,
useful for the treatment of continuous or etoricoxib are contra-indicated in
regular pain associated with inflamma- cerebrovascular disease, peripheral
tion. Therefore, NSAIDs are more arterial disease, ischaemic heart disease
appropriate than paracetamol in inflam- and mild to severe heart failure.
matory arthritis (e.g. rheumatoid arthritis, Interactions: See Appendix-2.
juvenile chronic arthritis, ankylosing Side-effects: Gastro-intestinal
spondylitis) and in advanced osteoar- discomforts, diarrhoea, and occasionally
thritis (osteoarthrosis). They are also of bleeding and ulceration occur. The
susceptibility to develop these side
329
effects while using a specific NSAID Freemax(Nuvista), Tab. 100 mg, Tk.
varies from patient to patient. 4.96.00/Tab.
Concomitant use of ranitidine or any Intas(Virgo), Tab. 100 mg, Tk. 350.00/Tab.
Lofens(Zenith), Tab. 100 mg, Tk. 1.51/Tab.
other H2 blockers is strongly Mervan(Aristo), Tab. 200mg , Tk. 7.00/Tab.;.
recommended. Other side-effects 100mg, Tk. 4.00/Tab.
include hypersensitivity reactions Movex(Opsonin), Tab. 200 mg , Tk.
(particularly rashes, bronchospasm and 7.00/Tab. ,Tab. 100 mg, Tk. 4.00/Tab.
angioedema), headache, dizziness, Noak(Orion), Tab. , 100mg, Tk. 4.01/Tab.
vertigo, tinnitus, photosensitivity and Nofenac(Drug Intl), Tab. 100mg, Tk. 4.05/Tab.
haematuria. Fluid retention may occur. Nostrin(Monico), Tab. 100mg, Tk. 3.00/Tab.
Orcenac(Organic), Tab. 100 mg, Tk.
Renal failure can be provoked, by 4.02/Tab.
NSAIDs. Hepatic damage, alveolitis, Orifen(Silva), Tab. 100mg, Tk. 2.51/Tab.
pancreatitis sleven-johnson syndrome Ostoflex(Somatec), Tab. 100 mg, Tk.
and toxic epidermal necrosis are other 4.00/Tab.
rare side-effects. Aseptic meningitis has Paino(Eskayef), Tab. 100mg, Tk. 4.00/Tab.
been reported; patients with connecting Ponos(One Pharma), Tab. 100 mg, Tk.
tissue disorders (eg. SLE) may be 3.99/Tab.
Preservin(Ibn Sina), Tab., 100 mg, Tk.
especially susceptible. 5.00/Tab.
Qrip(Sanofi), Tab. 100mg, Tk. 4.01/Tab.
ACECLOFENAC Reservix(Incepta), Tab. 100 mg, Tk.
4.00/Tab.; 200 mg, Tk. 7.00/Tab.
Servex(Novo Healthcare), Tab. 100 mg, Tk.
Indications: Pain and inflammation in
4.00/Tab.
osteoarthritis, rheumatoid arthritis and Tek(Team), Tab., 100 mg, Tk. 3.50/Tab.
ankylosing spondylitis Ternilla(Healthcare), Tab., 100mg, Tk.
Cautions: Avoid in porphyria; see notes 5.00/Tab.
above Tuffox(Eskayef), Tab., 100mg , Tk.
Side-effects: Contra-indications: See Xpain(G.A.Co), Tab. 100 mg, Tk. 3.01/Tab.
Xyfen(Supreme), Tab. 100mg, Tk., 3.00/Tab.
notes above
Zolfin(Beximco), Tab. 100mg, Tk. 4.00/Tab.
Dose: 100 mg twice daily (reduce to 100 Zolonac(Sharif), Tab. 100 mg, Tk. 4.01/Tab.
mg daily in hepatic impairment). Child
not recommended ACEMETACIN
AC PR(Pacific), Tab. 100 mg, Tk. 4.00/Tab. Indications: Pain and inflammation in
Aceclofen(Astra Bio), Tab. 100 mg, Tk. rheumatic disease and other musculo-
4.00/Tab. skeletal disorders, postoperative
Acecol(Ziska), Tab. 100 mg,Tk. 4.00/Tab. analgesia
Acefenac(General), Tab. 100mg, Tk. Cautions: See under indometacin and
4.01/Tab. notes above; driving and performance of
ACF(Decent), Tab., 100mg, Tk. 4.00/Tab.
Aclo(Alco), Tab. 100 mg, Tk. 4.00/Tab.
skilled activities may be affected due to
ACN(Modern), Tab. 100 mg, Tk. 4.00/Tab. dizziness
Alona(Kemiko), Tab. 100 mg, Tk. 4.01/Tab. Contraindications: See notes above
Apitac(Acme), Tab. 100.00 mg, Tk. 4.01/Tab. Dose: 60mg twice daily
Aros(Globe), Tab. 100 mg, Tk. 4.00/Tab.
Avenac(Radiant), Tab. 100mg, Tk. 5.02/Tab. Proprietary Preparation
Ceclofen(Renata),Tab. 100 mg, Tk. 4.00/Tab. Tendonil(Orion), Cap., 60 mg, Tk. 8/Cap.
Celofen(ACI), Tab. 100mg, TK. 4.01/Tab.
Clofenta(Amico), Tab., 100mg, TK. 3.00/Tab.
Ena(Asiatic), Tab. 100mg, Tk.3.00/Tab. CELECOXIB
Fenacin(Nipa), Tab.,100 mg, Tk. 4.00/Tab.
Fixonac(Euro), Tab. 100mg,Tk. 4.00/Tab. Indications: Rheumatoid arthritis,
Flexi(Square), Tab., 200 mg, Tk.7.02/Tab.; advanced osteoarthritis, chronic
100 mg, Tk. 4.02/Tab. musculoskeletal pain, post surgical and
Flexidol(SMC Enterprise), Tab. 100 mg, Tk.
dental pain; adenomatus poliposis coli
3.00/Tab.
330
Cautions:Hypertension, liver failure, Indications: Short term treatment of

renal failure; see notes above mild to moderate pain and inflammation
Contra-indications: known including dysmenorrhoea
hypersensitivity to this drug and Caution, Contra-indications and Side-
sulfonamides; aspirin induced asthma, effects: See notes above
see notes above Dose: 12.5 mg every 4-6 hours or 25 mg
Interactions: See Appendix-2 every 8 hours; max. 75 mg daily;
Side-effects: See notes above; ELDERLY initially max. 50 mg daily;
headache insomnia, abnormal liver CHILD not recommended
function tests
Dose: Rheumatoid arthritis, 100-200 mg Proprietary Preparations
twice a day; osteoarthritis, 100 mg twice Actidex(Incepta), Tab., 25 mg, Tk. 4.00/Tab.
a day; not recommended below 18 years Keto(Acme), Tab., 25 mg, Tk. 4.03/Tab.
Ketron D(ACI), Tab., 25 mg, Tk. 4.03/Tab.
as there is no clinical data available for Kynol D(Eskayef), Tab., 25 mg, Tk. 4.00/Tab.
this age group
Proprietary Preparations DICLOFENAC POTASSIUM

Celenta(Incepta), Cap., 100 mg, Tk. 4.50/Cap.
Celoxib(Ziska), Cap., 100 mg, Tk. 6.75/Cap. Indications: Pain and inflammation in
Cox B(Beximco), Cap., 100mg, Tk. 4.50/Cap.; rheumatic disease and other musculo-
Cap., 200mg, Tk. 8.00/Tab.
skeletal disorders; acute gout; post-
operative pain; migraine
DEXIBRUPOFEN Caution, Contraindications and Side-
effects: See notes above
Indications: Mild to moderate pain and Dose: Rheumatic disease,
inflammation associated with musculoskeletal disorders, acute gout,
osteoarthritis and other musculoskeletal postoperative pain, 75-150 mg in 2-3
disorders; dysmenorrhoea and dental divided doses; CHILD over 14 years, 75-
pain 100 mg in 2-3 divided doses
Caution, Contraindications and Side- Migraine, 50 mg at onset, repeated after
effects: See notes above 2 hours if necessary, then after 4-6
Dose: 600-900 mg daily in 3 divided hours; max. 200 mg daily; CHILD not
doses; (max. 1.2g daily; max. single recommended
dose 400 mg)
Proprietary Preparations A-Fenac K(Acme), Tab., 50mg., Tk. 3.01/Tab.
Anaflam(Asiatic), Tab., 200mg , Tk. 3.00/Tab.; Anuva (Novartis), Tab., 50 mg, Tk. 8.02/Tab.
300mg , Tk. 4.00/Tab.; 400mg , Tk. 5.00/Tab.; Intafenac-K(Incepta),Tab., 50 mg, Tk.
Artoflex(Opsonin), Tab., 300 mg , Tk. 3.00/Tab.
4.02/Tab. Kalinac(Square), Tab., 50 mg, Tk. 4.03/Tab
Dexpro(Orion), Tab., 300 mg, Tk. 4.03/Tab.; NopainDrug Intl), Tab., 25mg, Tk. 2.05/Tab.;
400 mg, Tk. 5.03/Tab. 50mg, Tk. 4.05/Tab
Flamex(ACI) Tab., 200 mg , Tk. 0.88/Tab. ;
Tab., Tab., 400 mg , Tk. 1.43/Tab., Cap.,
300mg, Tk. 4.01/cap.; DICLOFENAC SODIUM
Inflam(Sanofi), Tab. , 200mg, Tk. 3.02/Tab.; (See also 8.1.4.2)
300mg, Tk. 4.03/Tab.; 400mg, Tk. 5.04/Tab.
Purifen(Incepta), Suspn.;, 100 mg/5 ml, Tk. Indications: Acute post-traumatic mus-
60.00/100ml,; Tab, 300 mg, Tk. 3.00/Tab.;
culoskeletal pain, rheumatoid arthritis
400 mg, Tk. 5.00/Tab.
Serifen(Silva), Tab. , 300mg, Tk. 4.02/Tab.; (including JCA), advanced osteoarthritis,
400mg, Tk. 5.02/Tab. acute gout, dysmenorrhoea, and post-
Xflam(Square), Tab. , 400 mg, Tk. 5.03/Tab. operative pain
Cautions, Contra-indications and
DEXKETOPROFEN Side-effects Suppositories may cause
rectal irritation;see notes above
331
Dose: By mouth, 75-150 mg in 2 to 3 Diclonil(Zenith), Tab., 50 mg, Tk. 0.80/Tab.;

divided doses, preferably after meals. Cap, 100 mg , Tk. 3.01/Cap.
Dispersible preparations may be taken Diclovir(Virgo), TR Cap. , 100 mg , Tk.
150.00/Cap.
dissolved in water for rapid control of Dilock(Bristol), Cap., 100mg , Tk. 2.00/Cap.;
pain (for short period only). Slow release Tab. , 100mg, Tk. 3.00/Tab.
(SR) preparations, 100 mg once daily Erdon(Aristo), Gel, 1%, Tk. 12.90/10g, Tk.
after meals (for management of chronic 100.00/50g,; Supp., 50mg , Tk. 15.00/
painful or inflammatory conditions) Supp,;Cap., 300mg , Tk. 3.00/Cap.
By rectum in suppositories, 50 mg once Genac(Globe), Inj., 75 mg /3 ml, Tk.
to thrice a daily 14.00/Amp. ; Tab., 50 mg, Tk. 1.20/Tab.
Intafenac(Incepta), Tab, 50 mg, Tk. 0.75/Tab.
By injections, 75 mg once or twice daily Locopain(Asiatic), TR Cap., 100mg , Tk.
by IM injections into gluteal muscles for 3.00/Cap. ; Tab., 50 mg, Tk. 0.40/Tab.
not more than 3 days. IV injections can Mobife(ACI), Supp, 12.50mg, Tk. 9.00/Supp
be administered (in hospital settings, for 25mg, Tk. 12.00/Supp ,50mg Tk.12.00/supp;
post operative pain relief), 75 mg Tab.,50mg,Tk.0.88/Tab.,Cap100mg,Tk.3.02/C
dissolved in 100 ml Normal Saline by ap.,75mg,Tk.3.02/capSR100mg.,Tk.2.50/Cap.;
slow infusion over 60 minutes, repeated Gel, 1%, Tk. 12.90/10g,
Moov(Astra Bio), Gel, 1%Tk. 13.00/10gm ,
in 4 to 6 hours if necessary Tk. 60.00/25gm; Cap , 100 mg, Tk. 2.50/Cap.
Maximum total daily dose by any or a Movonac(Sharif), Cap. , 100 mg, Tk.
combination of routes is 150 mg 3.01/Cap.; Tab., 50 mg, Tk. 0.81/Tab.
CHILD 1-12 years, for JCA, can be given Neofenac(Modern), Cap. , 100 mg., Tk.
by mouth or by rectum 1-3 mg/kg daily in 3.00/Cap.
divided doses (as 25 mg tablets or 12.5 Novarin(Amico), Gel, 1%, Tk. 12.90/10gm,;
mg suppositories) Cap., 100mg , Tk. 2.50/Cap.
Orfenac(Orion), Cap. , 100 mg, Tk.
3.01/Cap. ; Tab. , 50 mg, Tk. 0.80/Tab.
Orgafen(Organic), Cap. , 100 mg, Tk.
A-Fenac(Acme), Tab., 50.00 mg., Tk. 3.01/Cap.
0.84/Tab.; 100 mg., Tk. 3.01/Tab.; 25 mg., Tk. Panfre(Pacific), Cap. , 100 mg, Tk. 3.00/Cap.
0.55/Tab.; Gel, 1%, Tk. 13.09/10gm; Inj., 75
; Gel, 1%, Tk. 15.00/10gm,; Inj., 75 mg/3 ml,
mg./3 ml., Tk. 14.10/Amp,; Supp, 12.50 mg.,
Tk. 15.00/Vial; Gel, 1%, Tk. 40.15/20gm
Tk. 8.07/Supp, 50.00 mg., Tk. 14.10/Supp
Proflam(Novo Health),Cap., 100 mg, Tk.
Alterin(Euro), Tab., 50 mg, Tk. 1/Tab.; 100
3.00/Cap.; Tab. ,50 mg, Tk. 0.50/Tab.
mg, Tk.3.00/Tab. Refain(Monico), Cap., 100mg, Tk.
Anodyne(Ibn Sina), Tab, 50 mg, Tk. 3.00/Cap.;Inj., 75mg/3ml, Tk. 9.50/Amp.
1.00/Tab.; Cap., 100 mg, Tk. 4.00/Cap.; Gel, Reutren(G.A.Co), Tab., 100 mg, Tk. 3.01/Tab.
1%, Tk. 13.00/10gm,; Inj.,73mg/3ml , Tk. Sifen(Silva), TR Cap., 100mg, Tk. 2.51/Cap.
12.00/Amp. Tenac(Team), Cap., 100 mg, Tk. 3.00/Cap.
Apain(Kemiko), Cap., 100 mg, Tk. 3.01/Cap.
Tolfenac-SR(Globex), Cap., 50 mg, Tk.
Apnac(Supreme), Tab. , 100mg, Tk.
1.00/Tab.
3.00/Tab.; 50 mg, Tk. 0.85/Tab.
Ultrafen(Beximco), Supp., 12.5mg, Tk.
Clofenac(Square), Cap., 100 mg, Tk. 9.00/Supp., 50mg,
4.02/Cap.;Gel, 1%, Tk. 40.27/20gm,; Tab,
Tk. 15.00/Supp.; Tab., 25mg, Tk. 0.54/Tab.;
100 mg, Tk. 4.02/Tab., 50 mg, Tk. 1.51/Tab.;
50mg, Tk. 0.83/Tab.; 100mg, Tk. 3.00/Tab.;
46.50 mg,(dispersible) Tk. 4.02/Tab.; Gel,
Voligel(Beximco), Gel, 1%, Tk. 97.00/50 gm
1%Tk. 12.99/10gm,; Supp, 100 mg, Tk.
Volinac(Square), Gel, 1%, Tk. 100/50gm
20.06/Supp.; 12.5 mg, Tk. 9.06/Supp. ; 50 mg, Volmax(Eskayef), Cap, 100mg, Tk.
Tk. 15.10/supp, 25 mg, Tk. 12.09/Supp,; 3.00/Cap.;
DCF(Decent), Tab., 50mg, Tk. 0.60/Tab. Voltafen(Sharif), Gel, 1%, Tk. 97.29/50g
Diclofen(Opsonin), Inj., 75 mg /3 ml, Tk.
,TK.55.17/25g
15.10/3ml,; Supp, 100 mg, Tk. 20.00/Supp.;
Voltalin(Novartis), Inj., 75 mg/ 3ml, Tk.
12.5 mg , Tk. 9.06/ Suspp,; 25 mg, Tk. 12.09/ 135.00/Amp.; Supp, 100 mg, Tk. 65.00/Supp.;
Suspp,; 50 mg , Tk. 15.05/ Supp,; Gel, 1%,
12.5 mg, Tk. 31.00/Supp.; 25 mg, Tk .
Tk. 12.95/1gm,; Tab, 100 mg, Tk.
35.00/Suspp,; 50 mg, Tk. 58.50/ Suspp,; Tab. ,
3.01/Tab.,25 mg , Tk. 0.52/Tab., 50 mg, Tk
25 mg, Tk. 4.01/Tab.; SR Tab. 50 mg , Tk.
0.88/Tab.
8.50/Tab.; 100 mg, Tk. 18.00/Tab.; SR Tab.
Diclonac(Ziska), Cap. , 100 mg, Tk.
75 mg, Tk. 11.03/Tab.
80.00/Cap.; Tab. , 50 mg , Tk. 83.00/Tab.; Inj.,
VoltalinD(Novartis)Dispersible Tab. 50mg ,
75 mg/3 ml, Tk. 85.00/Amp.
Tk.,8.02/Tab
332
Voltalin Forte(Novartis), Tab., 50 mg, Tk. Side-effects: Dry mouth, taste

8.50/Tab. disturbance, mouth ulcers, flatulence,
constipation, chest pain, paraesthesia,
myalgia, see notes above
Diclofena 75 mg + Lidocaine20 mg/2ml
A-Fenac Plus(Acme), Inj., Tk. 14.10/Amp
Dose: Osteoarthritis, ADULT and ADO-
Apain Plus(Kemiko), Inj, Tk. 15.05/Amp LESCENT over 16 years, 60mg once
Arthrofen Plus(Healthcare), Inj., Tk. daily. Rheumatoid arthritis, ADULT and
23.00/Amp ADOLESCENT over 16 years, 90mg
Clofenac Plus(Square), Inj., Tk. 15.10/Amp once daily. Acute gout, ADULT and
Diclofen Plus(Opsonin), Inj., Tk. 15.10/Amp ADOLESCENT over 16 years, 120mg
Diclonac(Ziska), Inj., Tk. 95.00/Amp once daily
Erdon Plus(Aristo), Inj., Tk. 14.00/Amp
Genac Plus(Globe), Inj., Tk. 15.00/Amp
Intafenac Plus(Incepta), Inj., Tk. 9.50/Amp Proprietary Preparations
Algirex(Ibn Sina), Tab., 120mg, Tk.
MobifenPlus(ACI), Inj.,Tk. 9.57/Amp
14.25/Tab.; 60mg, Tk. 7.00/Tab.; 90mg Tk.
OrfenacPlus(Orion), Inj, Tk. 9.06/Amp
Panlid(Pacific), Inj., Tk. 15.00/Amp 8.00Tab.
ProfenacL(Popular), Inj, , Tk. 9.54/Amp Artorix(Asiatic), Tab., 120mg , Tk. 14.00/Tab.;
60mg, Tk. 7.00/Tab.; 90mg, Tk. 12.00/Tab.
Ronac Plus(General), Inj., Tk. 15.04/Amp
Cox-E(Popular), Tab. , 120mg, Tk. 14.00/Tab.;
Ultrafen L(Beximco), Tk. 15.00/Amp
60mg, Tk. 7.00/Tab.'; 90mg, Tk. 12.00/Tab.
Coxet(Pacific), Tab. , 120 mg, Tk. 14.00/Tab.
ETODOLAC ; 90 mg, Tk. 12.00/Tab.
Coxfree(Kemiko), Tab., 120 mg, Tk.
Indications: Pain and inflammation in 14.04/Tab.; 60 mg, Tk. 7.02/Tab.; 90 mg, Tk.
12.03/Tab.
rheumatoid arthritis and osteoarthritis
Coxia(ACI), Tab., 120mg, Tk. 14.09/Tab.;
Cautions: Avoid in severe renal 60mg, Tk. 7.05/Tab. ; 90mg, Tk. 12.09/Tab.
impairment, see notes above Coxitor(Beacon), Tab. , 60mg , Tk. 7.05/Tab.;
Contraindication: See notes above 90mg , Tk. 12.08/Tab.
Side-effects: Pyrexia, tremor, Coxpain(Novo), Tab. , 120 mg, Tk.
palpitation, dyspnoea, confusion, fatigue, 14.00/Tab.; 60 mg, Tk. 7.00/Tab.; 90 mg, Tk.
paraesthesia, dysuria and pruritus; see 12.00/Tab.
Coxsafe(Sharif), Tab. , 120 mg, Tk.
notes above;
14.00/Tab.; 60 mg , Tk. 7.00/Tab.; 90 mg, Tk.
Dose: ADULT over 18 years, 300-600 12.00/Tab.
mg daily in 1-2 divided doses Ecox(Alco), Tab. , 120 mg, Tk. 14.04/Tab.
Eroflam(Orion), Tab. , 60mg, Tk. 7.02/Tab.;
Proprietary Preparations 90mg, Tk. 12.04/Tab.
Edolac(Opsonin), Tab., 600 mg, Tk. Etocox(General), Tab. , 120mg, Tk.
18.07/Tab.; Cap, 300 mg, Tk. 8.03/Cap. 14.09/Tab.; 60mg, Tk. 7.05/Tab.; 90mg, Tk.
Edopain(Incepta), Cap., 300 mg, Tk. 12.09/Tab.
8.00/Cap.; Tab., 600 mg, Tk. 18/Tab. Etoricoxib(Bristol), Tab., 60mg , Tk.
Etogesic(Acme), Tab., 600 mg, Tk. 6.00/Tab.; 90mg , Tk. 11.00/Tab.; 120mg, Tk.
15.04/Tab. 12.00/Tab.
Panodin(Square), Tab., 600 mg, Tk. Etoriflex(Somatec), Tab., 60 mg, Tk.
15.10/Tab. 7.00/Tab.; 90 mg, Tk. 12.00/Tab.
Etorix(Eskayef), Tab, 120mg, Tk. 14.00/Tab.;
ETORICOXIB 60mg, Tk. 7/Tab.; 90mg, Tk. 12.00/Tab.;
Etosis(Organic), Tab., 120 mg, Tk.
14.05/Tab.; 90 mg, Tk. 12.03/Tab.
Indications: Pain and inflammation in Etovan(Aristo), Tab. , 90mg , Tk. 12.00/Tab.;
osteoarthritis, rheumatoid arthritis and 120mg , Tk. 14.00/Tab.; 60mg , Tk. 7.00/Tab.
acute gout Etoxib(Globe), Tab. , 60 mg, Tk. 7.00/Tab.; 90
Cautions: Monitor blood pressure, mg, Tk. 12.00/Tab.
Oricox(Incepta), Tab. , 120 mg, Tk.
breast-feeding, see notes above
14.00/Tab.; 60 mg, Tk. 7.00/Tab.; 90 mg, Tk.
Contraindications: uncontrolled 12.00/Tab.
hypertension, inflammatory bowel Recox(Renata), Tab., 120 mg, Tk. 14.00/Tab.;
diseases, see notes above 60 mg, Tk. 7.00/Tab.;
333
Ribox(Beximco), Tab., 120mg, Tk. 14.00/Tab.; Advel(Opsonin), Suspn .,100 mg /5 ml, Tk .

60mg, Tk. 7.00/Tab.; 90mg, Tk. 12.00/Tab. 33.71/ 100 ml,; Tab. , 200 mg , Tk. 0.88/Tab. ;
Rito(Opsonin), Tab., 120 mg , Tk. 14.05/Tab.; 400 mg , Tk. 1.43/Tab.
60 mg , Tk. 7.03/Tab.; 90 mg , Tk. 12.05/Tab. Anaflam(Asiatic), Tab., 400mg , Tk. 1.43/Tab.
Setorib(Acme), Tab, 120 mg, Tk. 14.10/Tab.; Bufen SR(Drug Intl), SR Cap. , 300mg, Tk.
60 mg, Tk. 7.04/Tab.; 90 mg, Tk. 12.09/Tab. 4.10/Cap.
Temcox(Team), Tab., 120 mg, Tk. Flamex(ACI), Tab., 400mg, Tk. 1.43/Tab. ;
13.00/Tab.; Tab., 60 mg, Tk. 6.50/Tab.; 90 mg, 200mg, Tk. 0.88/Tab.; Suspn., 100 mg/5 ml,,
Tk. 11.50/Tab Tk. 33.81/100ml,; Cap., 300mg, Tk.
Torbi(Euro), Tab., 120mg, Tk. 14.00/Tab.; 4.01/Cap.
90mg, Tk. 12.00/Tab. Iben(Zenith), Tab., 400 mg , Tk. 1.30/Tab.
Torimon(Nuvista), Tab. , 120 mg, Tk. Ibuprofen(Amico), Tab., 400mg, Tk. 1.43/Tab.
14.04/Tab.; 90 mg, Tk. 12.02/Tab. Inflam-D(Sanofi), Tab., 200mg, Tk.
Tory(Square), Tab. , 120 mg, Tk. 14.1/Tab.; 0.88/Tab.;400mg, Tk. 1.43/Tab.; Suspn., 100
60 mg, Tk. 7.04/Tab.; 60 mg, Tk. 7.04/Tab.; mg/5 ml,, Tk. 33.80/suspn.
90 mg, Tk. 12.09/Tab. Neurofen(Globe), Tab. , 400 mg, Tk.
1.42/Tab.
Reumafen(Beximco), Suspn., 100 mg/5 ml,,
FLURBIPROFEN
Tk. 33.82/100ml,; Tab., 400mg, Tk. 1.43/Tab.
Siflam(Silva), Tab., 400mg, Tk. 1.20/Tab.
Indications: Mild to moderate pain and Trufen(Modern), Tab., 400 mg, Tk. 1.43/Tab.
inflammation in rheumatic disease and Tyflam(Astra Bio), Tab., 400 mg, Tk.
musculoskeletal disorders; dysmeno- 1.43/Tab.
rrhoea; migraine; sore throat; post- Uniflam(Bristol), Tab., 400mg , Tk. 1.00/Tab.
operative analgesia
Caution, Contraindications and Side- INDOMETACIN
effects: Stomatitis; less commonly
fatigue, paraesthesia, confusion and Indications: Pain and moderate to
hallucination, see notes above severe inflammation in rheumatic
Dose: ADULT and CHILD over 12 years, diseases and other musculoskeletal
150-200 mg in 2-4 divided doses, max. disorders; acute gout, acute frozen
300 mg daily shoulder, acute de Queirvain’s disease
of the wrist; dysmenorrhoea; closure of
Proprietary Preparation ductus arteriosus
Urbifen(General), Tab., 50mg, Tk. 3.50/Tab
Cautions & Contraindications:
Epilepsy, Parkinsonism, Psychiatric
IBUPROFEN[ED] disturbances; dizziness may affect
skilled task (e.g. driving); during
Indication: Pain and inflammation in prolonged therapy ophthalmic and blood
rheumatic diseases including juvenile examinations are particularly advisable;
chronic arthritis (JCA) and other avoid rectal administration in proctitis
musculoskeletal disorders; mild to and haemorrhoids, see notes above
moderate pain including dysmenorrhoea; Interactions: See Appendix-2
fever and pain in children Side-effects: Frequently gastrointestinal
Interactions: See Appendix-2 (NSAIDs) disturbances including diarrhoea,
Cautions; Contraindications; Side headache, dizziness and light
effects: See notes above headedness; gastrointestinal ulceration
Dose: 1.2 to 1.6 g daily in 3-4 divided and bleeding; rarely, drowsiness,
doses preferably after food; maximum confusion, insomnia, convul-sions,
dose permitted is 2.4 g daily; psychiatric disturbance, blood disorders
maintenance dose of 0.6-1.2 g daily may (particularly thrombocyto-penia);
be adequate. CHILD 20 mg/kg daily in suppositories may cause rectal irritation
divided doses; maximal dose allowed is and occasional bleeding, see notes
40 mg/kg; not recommended for children above
under 7 kg Dose: By mouth, rheumatic disease, 50-
200 mg daily in divided doses, with food;
334
CHILD not recommended. Acute gout, Festam(Pacific), Gel, 2.5%, Tk. 120.00/30g;
150-200 mg daily in divided doses. Tk. 200.00/50gm
Dysmenorrhoea, up to 75 mg daily Keprofen(Astra Bio), Tab., 50 mg, Tk.
5.00/Tab.
By rectum, in suppositories, 100 mg Keto-A(Acme), Supp., 100.00 mg., Tk.
once or twice daily - not more than 3 12.09/Supp,; Tab. , 100.00 mg., Tk. 5.53/Tab.
days; total daily dose (suppositories ; 50.00 mg., Tk. 3.52/Tab. ; Inj., 100 mg/2 ml,
alone or combined oral and suppository) Tk. 19.64/Amp ; 10gm/100ml, Tk.
max. 200 mg; CHILD not recommended 109.41/10ml, Tk. 281.06/30ml,;
Ketofast(Novo Healthcare), Gel, 2.5%, Tk.
Proprietary Preparations 53.00/20gm
Imet(Pacific), Cap. , 75 mg , Tk. 4.00/Cap.; Ketron(ACI), SR,Cap., 100mg, Tk. 7.05/Cap.;
25 mg, Tk. 1.00/Cap. SR 200mg, Tk. 10.07/Cap.; Tab., 50mg, Tk.
Indo-A(Acme), Cap., 25 mg, Tk. 1.00/Cap.; 3.52/Tab.
25mg, Tk. 0.60/Cap.; 75 mg, Tk. 4.00/Cap. ; Kontrol(Silva), Tab. , 100mg, Tk. 6.02/Tab.
Supp, 100mg., Tk. 7.04/supp,; Kop(Square), Cap., 100 mg, Tk. 11.03/Cap. ;
Indomet(Opsonin), Cap. , 75 mg , Tk. 200 mg, Tk. 20.06/Cap. ; Inj., 100 mg/2 ml,
4.02/Cap. ; 25 mg , Tk. 1.00/Cap. ; Supp, 100 Tk. 35.11/2ml
mg , Tk. 7.06/Supp Kynol(Eskayef),TRCap, 100mg, Tk.
Indomethacin, (Bristol), Cap., 25mg , Tk. 7.00/Cap. ; TR200mg , Tk. 10.00/Cap.
50.00/Cap. Orket(Orion), Inj, 100 mg/2ml, Tk. 15.10/Amp.
Insaid(ACI), Cap., 25mg, Tk. 1/Cap. Profenid(Sanofi), Gel, 2.5%, Tk.
Reumacap(Aristo), Cap., 25mg, TK. 120.36/2.5gm Inj., 50mg/ml, Tk. 50.15/Amp. ;
1.00/Cap.; 75mg , Tk.4.00/Cap. CRCap., 100mg, Tk. 11.03/Cap. ; 200mg, Tk.
Supp, 100mg , Tk. 9.00/Supp 20.06/Cap.
Servimeta(Novartis), Cap.,25 mg, Tk. Profinied(Sanofi), ER Tab., 50 mg, Tk.
1.80/Cap. 6.02/Tab. 100mg, Tk. 9.03/Tab
Keto-SR(Hudson), Cap. 100 mg, Tk. 7.00/Cap
Wakoflex(Incepta), Tab. 100 mg, Tk.
KETOPROFEN 6.00/Tab.; 50 mg, Tk. 3.50/Tab.; Inj. 100
mg/2ml, Tk. 20.00/Amp.
Indications: Pain and mild inflammation
in rheumatic diseases and other KETOROLAC
musculoskeletal disorders; (See also 8.1.4.2)
afterorthopaedic surgery; acute gout;
dysmenorrhoea Indications: Short term management of
Cautions; Contraindications; Side- moderate to severe acute postoperative
effects: Pain may occur at injection site pain
(with occasional tissue damage); Cautions: Reduce dose in elderly and in
suppositories may cause rectal those weighing less than 50 kg; reduce
irritation;see notes above dose and monitor in mild renal
Interactions: See Appendix-2 impairment; hepatic failure, cardiac
Dose: By mouth, in rheumatic disease, impairment, cardiac decompensation,
100-200 mg in 2 divided doses with food; hypertension; peptic ulcer
in pain and dysmenorrhoea 50 mg up to Contraindications: History of
3 times a day; CHILD not recommended hypersensitivity to aspirin, angioedema,
By rectum (in suppositories), rheumatic asthma, complete or partial syndrome of
disease, 100 mg at bedtime; combined nasal polyp; haemorrhagic diathesis,
oral and rectal treatment, maximum total confirmed or suspected cerebro-vascular
daily dose 200 mg; CHILD not bleeding, moderate to severe renal
recommended impairment; pregnancy and breast-
By deep intramascular injection into the feeding
gluteal muscle, 50-100 mg every 6 hours Interactions: See Appendix-2
(maximum 200 mg in 24 hours) for up to Side-effects: Allergic reactions
3 days; CHILD not recommended (including anaphylaxis), fluid retention,
abdominal discomfort, dyspepsia, peptic
Proprietary Preparations ulceration, gastrointestinal bleeding,
pancreatitis; mental and sensory
335
changes, psychotic reactions, convul- Ketoroz(Astra Bio), Inj., 30 mg/ml, Tk.

sions; palpitation, hypertension, brady- 55.00/Amp,; Tab. , 10 mg, Tk. 10.00/Tab.
cardia; purpura, thrombocytopenia, Ketoshot(Nuvista), Tab.,10 mg, Tk.
10.00/Tab.
prolonged bleeding time; dyspnoea, Ketovir(Virgo), Tab. , 10 mg, Tk. 10.00/Tab.
pulmonary oedema; postoperative Ketromin(Pacific),Inj., 30mg/ml, Tk.
wound haemorrhage, haematoma, 60.00/Amp,; 60mg/2ml, Tk. 95.00/Amp,; Tab.,
epistaxis; pain at injection site 10 mg, Tk. 10.00/Tab.
Dose: By mouth, 10 mg every 4-6 hours Kilpan(Decent), Tab., 10mg, Tk. 10.00/Tab.
(ELDERLY every 6-8 hours), max. dose Lactro(Zenith), Tab., 10 mg, Tk. 10.00/Tab.
40 mg daily; max. duration of treatment 7 Minolac(ACI), Inj., 10 mg/ml, Tk. 33.10/Amp,;
30 mg/ml, Tk. 55.38/Amp,; 60 mg/2 ml, Tk.
days 95.65/Amp,; Tab., 10mg, Tk. 10.07/Tab.;
By intramuscular or intravenous Ofpain(Kemiko), Tab., 10 mg, Tk. 10.03/Tab.
injections over not less than 16 seconds, Inj., 30 mg/ml, Tk. 55.00/Amp,; 60 mg/ ml,
initially 30 mg, then 10-30 mg every 4-6 Tk. 95.29/Amp
hours when required (every 2 hours in Oradol(Aristo), Inj, 30 mg/ml, Tk. 95.00/Amp,;
initial postoperative period. Max. dose 90 30mg/ml, Tk. 55.00/Amp,; Tab., 10mg, Tk.
mg daily (ELDERLY and patients 10.00/Tab.
Ostelac(Supreme), Tab. , 10mg, Tk.
weighing less than 50 kg, max. 60 mg 10.00/Tab.
daily); max. duration of treatment 2 days; Pair(Drug Intl), Tab., 10mg, Tk. 10.05/Tab.;
CHILD under 16 years, not Inj., 30mg/ml, Tk. 55.20/Amp
recommended Repopain(Organic), Inj. , 30 mg/ml, Tk.
55.00/Amp,; Tab. , 10 mg, Tk. 10.03/Tab.
Proprietary Preparations Roket(Globe), Inj., 60 mg/2 ml, Tk.
Actifast(SMC Enterprise), Tab., 10mg, Tk. 95.00/Amp,; 30 mg/ ml, Tk. 55.00/Amp,; Tab.
10.00/Tab. , 10 mg, Tk. 10.00/Tab.;
Acupain(Beacon), Tab. , 10mg , Tk. Rolac(Renata), Inj., 30 mg/ml, Tk.
10.06/Tab.; Inj., 30mg/ml, Tk. 55.20/Amp 50.00/Amp,; 60 mg/2ml, Tk. 95.00/Amp,;
Analac(Ziska), Inj. , 60 mg/2 ml, Tk. 10 mg/ml, Tk. 32.13/Amp,; Tab. , 10mg, Tk.
95.00/Amp,; 30 mg/ml, Tk. 275.00/Amp.; Tab. 10.04/Tab.
, 10 mg, Tk. 200.00/Tab. Rotek(Novo Health), Tab., 10 mg, Tk.
Doltro(UniMed), Tab , 10mg, Tk. 100.00/Tab. 10.00/Tab.
Emodol(JaysonTab.,10 mg, Tk. Sanoket(Sanofi), Inj., 30mg/ml, Tk.
10.15/Tab;Inj., 30 mg/ml, Tk. 50.19/amp. 55.38/Amp,; Tab. , 10mg, Tk. 10.03/Tab.;
Etolac(Ibn Sina), Inj. , 60 mg/2 ml, Tk. 60mg/2ml, Tk. 95.29/Amp
100/Amp; 30mg/ml, Tk. 60/Amp, Surgidol(Globex), Tab., 10 mg, Tk. 10.00/Tab.
Kelorac(One Pharma), Inj, 30 mg/ml, Tk. Surpim(Asiatic), Tab., 10mg , Tk. 10.00/Tab.;
55.00/Amp,; Tab., 10 mg , Tk. 10.00/Tab. Inj., 30mg/ml, Tk. 54.00/Amp
Kepros(Monico), Inj., 60mg/2 ml, Tk. Temoket(Team), Tab., 10 mg, Tk. 9.50/Tab.
95.00/Amp, 30mg/ml, Tk. 55.00/Amp,; Tab., Todol(Opsonin), Inj., 30 mg/ml , Tk.
10mg, Tk. 10.00/Tab.; 56.37/Amp,; 60 mg/2ml, Tk. 95.65/Amp,;
Kerolac(G.A.co), Tab., 10 mg, Tk. 10.03/Tab. Tab., 10 mg , Tk. 10.04/Tab.
Ketofast(Veritas), Inj., 60 mg/2 ml , Tk. Tolec(Alco), Inj., 60 mg/2 ml, Tk. 95.00/Amp,;
55.00/amp.;Tab., 10 mg, Tk. 12.00/Tab. 30 mg/ml, Tk. 55.18/Amp,; Tab.,10 mg, Tk.
Ketoflex(Somatec), Tab., 10 mg, Tk. 10.03/Tab.
10.03/Tab. Toradol(Radiant), Tab. , 10mg, Tk.
Ketogate (Pharmacil), Inj, 30 mg/ml, Tk. 30.09/Tab.,Inj, 30mg/ml, Tk. 130.39/Amp
75.23/Amp Toramax(Popular), Tab. , 10.00mg, Tk.
Ketolab(Labaid), Tab. , 10 mg, Tk. 12/Tab. 10.04/Tab.; Inj., 30mg/ml, Tk. 110.00/Amp,;
Ketonaaf(Naafco), Tab. , 10 mg, Tk. 60 mg/2 ml, Tk. 190.00/Amp
10.00/Tab. Torax(Square), Inj., 30 mg/ml, Tk.
Ketonic(Eskayef), Tab, 10 mg, Tk. 10/Tab.; 55.37/Amp,; 60 mg/2 ml, Tk. 95.65/Amp,;
Inj., 30 mg/ml, Tk. 55.00/amp.; 60 mg/2 ml, Tab., 10 mg, Tk. 10.07/Tab.
Tk. 95.00/amp. Toroaid(General), Inj., 30 mg/ml, Tk.
Ketoprix(Sharif), Inj., 30 mg/ml, Tk. 55.17/Amp,; 60 mg/2 ml, Tk. 95.29/Amp,
55.17/Amp,; 60mg/2 ml, Tk. 95.29/Amp,; 10mg, Tk. 10.03/Tab.
Tab., 10 mg, Tk. 10.03/Tab. Torolac(Silva), Tab., 10 mg, Tk. 10.00/Tab.
Ketorin(Orion), Inj., 30 mg/ml, Tk. Troy(Amico), Tab., 10mg , TK. 10.00/Tab.
55.16/Amp.; Tab., 10 mg, Tk. 20.14/Tab. Winop(Acme), Inj., 60mg/2 ml, Tk.
95.65/Amp,; 10mg/ml , Tk. 30.20/Amp,;
336
30mg/ml , Tk. 55.37/Amp,; Tab., 10.00 mg, Interactions: See Appendix-2

Tk. 10.07/Tab. Dose: By mouth, osteoarthritis, 7.5 mg
Xidolac(Beximco), Tab., 10mg(Dispersible once daily with food, increased to 15 mg
Tab), Tk. 12.00/Tab.; 10mg, Tk. 10.00/Tab.;
Inj., 30mg/ml, Tk. 55.00/Amp,;
once daily if necessary. Rheumatoid
Zeropain(Healthcare), Inj. , 30mg/ml , Tk. arthritis and ankylosing spondylitis, 15
60.00/Amp,; 60mg/2ml, Tk. 100.00/Amp,; Tab., mg once daily with food (7.5 mg in
10mg , Tk. 360.00/Tab.; elderly)
By rectum, in suppository, rheumatoid
MEFENAMIC ACID arthritis, 15 mg once daily (7.5 mg in
elderly); ankylosing spondylitis, 15 mg
Indications: Mild to moderate pain in once daily
rheumatoid arthritis (including JCA), Child under15 years not recommended
osteoarthritis, and related conditions;
dysmenorrhoea and menorrhagia
Melcam(Square), Tab., 15 mg, Tk. 4.03/Tab.
Cautions; Contraindications: Contra-
indicated in inflammatory bowel disease;
porphyria; blood tests required during NAPROXEN
long term treatment, see notes above
Interactions: See Appendix-2 Indications: Pain and inflammation in
Side-effects: Drowsiness, diarrhoea; rheumatic disease (including JCA), adv-
thrombocytop-enia; haemolytic anaemia anced osteoarthritis and other
and aplastic anaemia have been musculoskeletal disorders;
reported; convulsion may occur with dysmenorrhoea, acute gout
overdose, see notes above Interactions: See Appendix-2
Dose: ADULT over 18 years,500 mg 3 Cautions; Contra-indications and
times daily preferably after food; CHILD Side-effects: See notes above
12-18 years, acute pain including Dose: By mouth, 0.5-1 g daily in 2
dysmenorrheea, menorrhagia, 500 mg 3 divided doses; CHILD over 5 years, for
times daily JCA, 10 mg/kg daily in 2 divided doses.
Acute musculoskeletal disorders and
Proprietary Preparations dysmenorrhoea, 500 mg initially, then
Amifen (Opsonin), Suspn. , 50mg/5ml, , Tk. 250 mg every 6-8 hours as required;
28.11/60 ml,; Tab., 500 mg , Tk. 5.02/Tab. max. dose after first day 1.25 g daily;
Dysmen (Renata), Tab. , 250 mg, Tk. CHILD under 16 years not recom-
2.80/Tab. ; 500 mg, Tk. 5.00/Tab. mended. Acute gout, 750 mg initially,
Fenamic (Beximco), Suspn., 50mg/5ml, Tk.
15.00/60ml
then 250 mg every 8 hours until attack
Fenaton (Drug Intl), Tab., 500mg, Tk. has passed
5.55/Tab.
Flamic (Globe), Suspn., 50 mg /5 ml, Tk. Proprietary Preparations
40.00/60ml,; Tab. , 250 mg, Tk. 3.00/Tab. ; Anaflex(ACI), CR.Tab., 500mg, Tk.
500 mg, Tk. 5.00/Tab. 14.09/Tab.; Gel, 10%, Tk. 116.35/30gm ,
HPR (Pacific), Suspn., 50mg/5ml, Tk. 62.42/15gm ,; Tab., 250mg, Tk. 5.04/Tab.
45.00/60ml ; Tab., 250 mg, Tk. 3.00/Tab. ; ;SR Tab., 500mg, Tk. 9.06/Tab.
500 mg Tk. 5.00/Tab. Arnex(Silva), Tab. , 500mg, Tk. 6.02/Tab.
Diproxen(Drug Intl), Tab., 250mg, Tk.
4.30/Tab.; Tab., 500mg, Tk. 7.05/Tab.; 500mg,
MELOXICAM
Tk. 10.05/Tab.; Gel, 10%, Tk. 60.20/15 gm
Dolwin(SMC Enterprise), Tab., 500 mg, Tk.
Indications: Pain and inflammation in 7.00/Tab.
rheumatic diseases, ankylosing spon- Eprox(Euro), Tab., 500mg, Tk. 8.00/Tab.
dylitis, acute exacerbations of osteo- Fritt(Somatec), Tab. , 500 mg, Tk.
arthritis (short term management) 7.03/Tab.; 250 mg, Tk. 4.01/Tab.
Gloxen(Globe), Tab. , 250 mg, Tk. 4.00/Tab. ;
Cautions; Contra-indications & Side-
500 mg, Tk. 7.00/Tab.
effects: Avoid rectal administration in H-Nap(Hudson), Tab., 500 mg, Tk.8.00/Tab.
patients with haemor-rhoids;see also Naid(Pacific), Tab. , 500 mg, Tk. 7.52/Tab. ;
notes above 250 mg, Tk. 4.00/Tab.
337
Napix(Modern), Tab. , 500 mg., Tk. 7.00/Tab. Venoxen(Orion), Tab. , 500mg, Tk. 9.03/Tab.
Napren(Alco), Tab. , 500 mg, Tk. 9.03/Tab. ; Vinap(Virgo), Tab. , 500 mg, Tk. 7.00/Tab.
250 mg, Tk. 5.02/Tab. Xenap(Astra Bio), Tab. , 500 mg,
Napro (Aristo), Tab., 250mg, Tk. 4.20/Tab. ; Xenapro(Renata), Tab. , 250mg , Tk.
500mg , Tk. 7.00/Tab. 5.00/Tab.; 500mg, Tk. 8.03/Tab.
Napro A(Acme), Tab., 250.00 mg., Tk. Xpro(Apex), Tab., 500 mg, Tk. 7.00/Tab.
4.03/Tab. ; 500 mg., Tk. 7.04/Tab.; Zenosyn(Sharif), Tab., 500 mg, Tk. 7.02/Tab.
Naprocid(GA.Co), Tab., 250 mg, Tk. 4/Tab.;
500 mg, Tk. 7.02/Tab. Esomeprazole + Naproxen
Naproson(Jayson), Tab.,250 mg, Tk. 4/Tab. AnaflexMax(ACI), DR Tab., 375mg + 20mg,
Naprosyn(Radiant), Suspn, 125mg/5ml, Tk. TK. 8.02/Tab.; 500mg + 20mg, TK. 10.03/Tab.
120.36/50ml,; Tab., 250mg , Tk. 8.02/Tab.; DemovoTM(Delta), Tab. , 20 mg + 375 mg,
500mg, Tk. 15.05/Tab. Tk. 8.00/Tab. ; 20 mg + 500 mg, Tk.
Naprox(Eskayef), Gel, 10%, Tk. 70.00/15gm,; 10.00/Tab.
Tab, 250mg, Tk. 5.00/Tab.; 500mg, Tk. Dinovo TM(Beximco), Tab., 375mg + 20mg,
9.00/Tab. ; Tk. 8.00/Tab.; 500mg + 20mg, Tk. 10.00/Tab.
Naproxen(Albion), Tab. , 250 mg, Tk. Emaprox(Globe), Tab. , 375 mg + 20 mg, Tk.
4.00/Tab.; 500 mg, Tk. 6.89/Tab. 3.00/Tab.; 500 mg+20 mg, Tk. 10.00/Tab.
Naproxen(Amico), Tab., 500mg , Tk. Esona(Navana), Tab., 20 mg + 375 mg, Tk.
7.00/Tab.; 500 mg, Tk. 10.00/Tab.; 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.
Naproxen(Organic), Tab. , 500 mg, Eso-plus(Asiatic), Tab., 500mg + 20mg , Tk.
Tk.7.00/Tab. 10.00/Tab.; 375mg + 20mg , Tk. 8.00/Tab.
Naproxin (Ambee), Tab., 500 mg, Tk. Esoxen(Organic), Tab, 375mg + 20 mg, Tk.
6.92/Tab 8.03/Tab.; 500 mg + 20 mg, Tk. 10.03/Tab.
Naprozen(Zenith), Tab., 250 mg , Tk. Inflect(Kemiko), Tab., 375 mg +20 mg, Tk.
5.00/Tab. 8.02/Tab.; 500 mg +20 mg, Tk. 10.03/Tab.
Napryn(Healthcare), Gel, 10% , Tk. 70.00/15 Locin(Globe ), Tab., 20 mg + 375 mg, Tk.
gm,; Suspn, 125mg/5mg, Tk. 90.00/50ml,; 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.
Tab., 250mg , Tk. 7.00/Tab.; 500mg, Tk. Nameso(Opsonin), Tab, 375mg + 20mg, Tk.
11.00/Tab. 8.00/Tab.; 500mg + 20mg, Tk. 10.00/Tab.
Napsod(UniMed), Tab ,250mg , Tk. Napexa(UniMed), Tab , 375mg + 20mg, Tk.
5.00/Tab.; 500mg, Tk. 9.00/Tab. 12.00/Tab.; 500mg + 20mg, Tk. 16.00/Tab.
Naspro(Popular), Tab. , 250mg, Tk. Napren ES(Alco), Tab. , 20 mg + 375 mg, Tk.
5.02/Tab.; 500mg, Tk. 9.03/Tab. 8.00/Tab. ; 20 mg + 500 mg, Tk. 10.00/Tab.
Naxin(Opsonin), SR Tab. , 500 mg , Napreso(Euro), Tab., 500mg+20mg, Tk.
Tk.14.05/Tab. ; 500 mg , Tk. 9.03/Tab. ; 250 10.00/Tab.
mg, Tk. 5.02/Tab. Napro-A Plus(Acme), Tab. , 375.00 mg. +20
Nipoxen(Nipro JMI), Tab. , 250 mg, Tk. mg, Tk. 8.03/Tab.; 500.00 mg. + 20 mg, Tk.
5/Tab.; SR Tab. , 500 mg, Tk. 14/Tab. 10.03/Tab.
Nuprafen(Beximco), Tab., 250mg, Tk. Naproflex(Somatec), Tab. , 20 mg + 375 mg,
4.20/Tab.; 500mg, Tk. 7.85/Tab. Tk. 8.00/Tab. ; Tab. , 20 mg + 500 mg, Tk.
Nupralgin(Ibn Sina), Tab. , 500mg, Tk. 10.00/Tab.
9.00/Tab.; 250mg, Tk. 5.00/Tab. Naproflex(Somatec), Tab., 375 mg + 20 mg,
NX-1(One Pharma), Tab., 500 mg, Tk. Tk. 8.00/Tab.; 375 mg + 20 mg, Tk. 10.00/Tab.
9.00/Tab. Naprosyn Plus(Radiant), Tab., 375mg/20mg,
Pairox(Asiatic), Suspn, 125 mg/5 ml, Tk. Tk. 16.05/Tab.; 500mg + 20mg, Tk. 20.06/Tab.
30.00/50ml,; Tab., 250mg, Tk. 5.00/Tab.; Naprotec(Sharif), Tab. , 375mg + 20 mg, Tk.
500mg , Tk. 8.00/Tab.; 500mg, Tk. 7.00/Tab. 8.03/Tab.; 500mg + 20 mg, Tk. 10.30/Tab.
Releve(General), Tab. , 500mg, Tk. Naprox Plus(Eskayef), Tab, 500mg + 20mg,
9.03/Tab. Tk. 10.00/Tab.; 375mg + 20 mg, Tk.
Servinaprox(Novartis), Tab. , 250 mg, Tk. 8.00/Tab.;.
7.00/Tab.; 500 mg, Tk. 12.00/Tab. Naproxen Plus(Albion), Tab. , 20 mg + 500
Sonap(Square), Supp, 500 mg, Tk. mg, Tk. 6.89/Tab.
12.09/Supp.; Tab. , 250 mg, Tk. 4.03/Tab. ; Naproxen(Zenith), Tab, 375mg + 20 mg , Tk.
500 mg, Tk. 7.04/Tab. 8.00/Tab.; 500 mg + 20 mg , Tk. 10.00/Tab.;
Susp., 125mg/5ml, Tk. 35.00/50 ml Naproxzia(Amico), Tab., 500mg + 20mg , TK.
Suxen(Supreme), Gel 10%, Tk. 62.00/15gm 10.00/Tab.
Ticoflex(Incepta), Gel, 10%, Tk. 60.00/15gm,; Naprozol(General), Tab, 500mg + 20mg, Tk.
Suspn , 125mg/5mg, Tk. 35.00/50ml,; 250 10.03/Tab.; 375mg + 20mg, Tk. 8.03/Tab.
mg, Tk. 4.00/Tab. ; 500 mg, Tk. 7.00/Tab. Napsec(Drug Intl), Tab., 375+20mg, Tk.
Tofa(Kemiko), Tab., 250 mg, Tk. 4.01/Tab. ; 8.05/Tab.; 500mg+20mg, Tk. 10.05/Tab.
500 mg, Tk. 8.02/Tab.
338
Napxon(Ziska), Tab. , 375 mg + 20 mg, Tk. 16-25 mg or divided per kg, 10 mg; 26-
256.00/Tab.; 500 mg + 20 mg, Tk. 320.00/Tab. 45 kg, 15 mg; over 45 kg, 20 mg. Acute
Nasopain(Julpher), Tab., 20 mg + 375 mg, Tk. musculoskeletal disorders, 40 mg daily
10.0/Tab.; 20 mg + 500 mg, Tk. 12.0/Tab.
Neso(Aristo), Tab., 375mg + 20mg , Tk.
in single or twice daily doses for 2 days,
8.00/Tab.; 500mg + 20mg , Tk. 10.00/Tab. then 20 mg daily for 7-14 days; CHILD
Nesotem(Team), Tab., 500 mg + 20 mg, Tk. not recommended. Acute gout, 40 mg
9.50/Tab.; 375 mg + 20 mg, Tk. 7.50/Tab. initially, then 40 mg daily in single or
Novoxen(Orion), Tab. , 375 mg + 20 mg, Tk. divided doses for 4-6 days; CHILD not
8.02/Tab.; 500 mg +20 mg, Tk. 15.03/Tab. recommended
Nupralgin Plus(Ibn Sina), Tab. , 20 mg + By deep intramuscular injection into
500 mg, Tk. 10.00/Tab. ; 20 mg + 375 mg, Tk.
8.00/Tab.
gluteal muscle, for initial treatment of
Nupralgin(Ibn Sina), Tab. , 500mg + 20 mg, acute conditions, as dose by mouth (on
Tk. 300.00/Tab.; 375mg + 20 mg, Tk. short-term basis); CHILD not
80.00/Tab. recommended
Progesic(Incepta), Tab. , 375 mg + 20 mg,
Tk. 8.00/.Tab.; 500mg+ 20mg, Tk. 10.00/Tab. Proprietary Preparations
Progut-N(Popular ), Tab. , 20 mg + 375 mg, Flexicam(Renata) Cap.,10mg, Tk.1.67/Cap.
Tk. 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab. Inj.40mg/2ml, Tk.14.67/amp.
Solivo(Healthcare), Tab., 375mg + 20mg, Tk. Rheudene(Gaco), Cap 10mg,Tk.1.75/Cap.Inj.
390.00/Tab.; 500mg + 20mg, Tk. 450.00/Tab. 40mg/2ml,Tk.14.67/amp.
Xenap(Astra Bio), Tab. , 20 mg + 500 mg,;
375mg + 20mg, TK. 8.02/Tab.
Xenole(Square), Tab. , 375 mg + 20 mg, Tk. SULINDAC
8.03/Tab.; 500 mg + 20
OXAPROZIN rheumatic disease and other musculo-
skeletal disorders; acute gout
Indications: Treat arthritis. It reduces Cautions; Contraindications: See
pain, swelling, and stiffness of the joints. notes above; history of renal stones;
Cautions; Contraindications&side ensure adequate hydration
effects: See notes above Side-effects: Fever, jaundice, choles-
Dose: ADULT Two 600 mg tablets taken tasis, hepatitis; urine discoloration
once per day. Dose: 200 mg twice daily (may be
reduced according to response); max.
Proprietary Preparations 400 mg daily; limit treatment to 7-10
Dayprox(Eskayef), Tab., 600 mg , Tk. days; CHILD not recommended
7.00/Tab.
Demarin(ACI), Tab., 600 mg, Tk. 7.05/Tab. Proprietary preparations
Clinorel(Opsonin), Tab. , 100 mg , Tk.
PIROXICAM 5.00/Tab.; 200mg , Tk. 9.54/Tab.
Lindac(Popular), Tab. , 200mg, Tk. 9.54/Tab.;
100mg, Tk. 5.02/Tab.
Indications: Pain and inflammation of Sudac(Drug Intl), Tab., 200mg, Tk. 9.00/Tab.;
rheumatic diseases (including JCA) and 100mg, Tk. 5.00/Tab.
other musculoskeletal disorders; acute Sulidac(Eskayef), Tab, 200mg, Tk. 9.50/Tab.;
gout 100mg, Tk. 5.00/Tab.
Cautions & Contraindications:See
notes above
Interactions: See Appendix-2 TENOXICAM
Side-effects: Pain may occur at
injection site (occasional tissue Indications: Pain and inflammation in
damage), see notes above rheumatic diseases and other
Dose: By mouth, rheumatic disease, musculoskeletal disorders
initially 20 mg daily, maintenance 10-30 Cautions; Contraindications & Side-
mg daily in single dose. CHILD over 6 effects:See notes above
years, JCA, less than 15 kg, 5 mg daily; Interactions:See Appendix-2
339
Dose:By mouth, rheumatic disease, 20 exacerbation (to tide over the crisis) and
mg daily; CHILD not recommended. for long term management when other
Acute musculoskeletal disorders, 20 mg drugs fail. In severe life threatening
daily for 7 days; max. 14 days; CHILD conditions a high initial dose of systemic
not recommended steroid is given to induce remission.
By intramuscular or intravenous Thereafter the dose is gradually tapered
injection, for initial treatment for 1-2 to the lowest possible maintenance
days, as dose by mouth; CHILD not dose, or withdrawn altogether, if
recommended possible. Pulse dose of corticosteroids
(for example- methylprednisolone
Proprietary Preparation sodium succinate, up to 1 g intra-
Enocam(Acme), Tab. , 20mg, Tk. 8.03/Tab. venously on consecutive three days) is
Inoten(Opsonin), Tab. , 20mg, Tk. 8.03/Tab. in current use to suppress highly
Mobicam(Beximco), Tab., 20mg, Tk.
8.00/Tab.
inflammatory disease while longer term
Oxicam(ACI), Tab., 20mg, Tk. 8.05/Tab., and slower acting medication is being
20mg, Tk. 8.00/Tab. commenced.Prolonged use of
Tenoflex(Beacon), Tab. , 20mg, Tk. 8.05/Tab. corticosteroids can induce osteoporosis,
Tenopain(Incepta), Tab. , 20mg, Tk. 8.00/Tab. therefore prophylaxis should be
Tenorix(Orion), Tab. , 20mg, Tk. 8.06/Tab. considered in this situation.
Tenoxim(Eskayef), Tab, 20mg, Tk. 8.00/Tab., Prednisolone is the standard oral
20mg, Tk. 8.00/Tab.
Tilkotil(Radiant), Tab. , 20mg, Tk. 17.06/Tab.
steroid preparation for use in rheumatic
Xicotil(Aristo), Tab. , 20mg, Tk. 8.00/Tab. disease. It permits finer dosage
Xten(Square), Tab. , 20mg, Tk. 8.03/Tab. adjustment and therefore is
advantageous over the more potent
TOLMETIN steroids. To manage severe
inflammatory conditions in rheumatoid
arthritis a high initial dose of
prednisolone, e.g. 80 mg daily in divided
rheumatic diseases (including JCA) and
doses, should be administered and this
other musculoskeletal disorders
should be rapidly tapered to total
Cautions; Contraindications & Side-
withdrawal or a minimum maintenance
dose. To minimize side-effects the
maintenance dose of prednisolone
Dose: 0.6-1.8 g daily in 2-4 divided
should be kept as low as possible, e.g. 5
doses; max. 30 mg/kg daily up to 1.8 g;
mg daily or on alternate days.
CHILD, JCA, 20-25 mg/kg daily in 3-4
Recent evidence has suggested that
divided doses;max.30mg/kg upto1.8 g.
prednisolone 7.5 mg daily may
Generic Preparation substantially reduce the rate of joint
Capsule, 200mg, 400mg destruction in moderate to severe
rheumatoid arthritis of less than 2 years
9.1.2 CORTICOSTEROIDS duration. Care should be taken not to
increase the equivalent of prednisolone
7.5 mg daily. Current evidence supports
9.1.2.1 SYSTEMIC
maintenance of this anti-erosive dose for
CORTICOSTEROIDS
2-4 years only to avoid possible long-
9.1.2.2 LOCAL CORTICOSTEROIDS
term adverse effects. After that,
treatment should be tapered off.
9.1.2.1 SYSTEMIC Polymyalgia rheumatica should always
CORTICOSTEROIDS be treated with corticosteroids. The initial
(See also section 5.3.2) dose of prednisolone in polymyalgia
rheumatica is 10 to 15 mg daily.
The use of corticosteroids in rheumatic Treatment should be continued until
disease should be restricted to short remission of disease activity. Thereafter
term management of an acute the dose should be gradually reduced to
340
a maintenance dose of about 7.5 mg and Indications: Shock, cerebral oedema,

this may be continued up to 3 to 6 years. suppression of inflammatory and allergic
Relapse is common if therapy is stopped disorders, rheumatic diseases; diagnosis
within 3 years. of Cushing’s disease, congenital adrenal
Giant cell (temporal) arteritis, hyperplasia
polyarteritis nodosa and polymyositis Cautions: Contraindications; Side-
should be treated with an initial dose of effects: See notes above under
40-60 mg prednisolone daily and Prednisolone; perineal irritation may
reduced to a maintenance dose of 7.5 to follow intravenous administration of
10 mg daily after remission. phosphate ester
Ankylosing spondylitis should not be Dose: By mouth, 0.5-10 mg daily,
treated with long-term corticosteroids. precautions same as for Prednisolone
Pulse doses may rarely be required to By intramuscular or slow intravenous
control active disease that does not injection (as dexamethasone
respond to conventional treatment. phosphate), initially 0.5-20 mg; CHILD
Dexamethasone and Betamethasone 200-500 microgram/kg daily
may be used alternatively for systemic
oral therapy. They have very high Proprietary Preparations
glucocorticoid activity in conjunction with See section 5.3.2
insignificant mineralocorticoid activity,
and are long acting drugs- suitable for METHYLPREDNISOLONE
prolonged therapy.
Indications: Suppression of inflamma-
BETAMETHASONE[ED] tory and allergic disorders; rheumatic
(See section 5.3.2) disorders also see notes above
Cautions; Contra-indications & Side-
Indications: Cerebral oedema, effects: See section 5.3.2
suppression of inflammatory and allergic Interactions: See Appendix-2
disorders, rheumatic disease; diagnosis Dose: By intravenous injection,
of Cushing’s disease, congenital adrenal methylpredni-solone sodium sodium
hyperplasia succinate, slow intravenous injection or
Cautions; Contraindications; Side- infusion, up to 1 gm for not more than
effects: See notes above under three days
Prednisolone By intramuscular injection,methyl-
Dose: 0.5-5 mg daily by mouth prednisolone acetate, 25-100 mg
repeated after 2-3 weeks
See section 5.3.2 Proprietary Preparations
See section 5.3.2
DEFLAZACORT
PREDNISOLONE[ED]
Indications: See section 5.3.2;under (See section 5.3.2)
deflazacort
Cautions; Contraindications; Side- Indications: Rheumatic diseases, not
effects and dose: See section controlled by NSAIDs; suppression of
5.3.2;under deflazacort inflammatory and allergic disorders;
inflammatory bowel disorders; immuno-
suppression
Proprietary Preparations Cautions: Adrenal suppression,
See section 5.3.2 infection, growth retardation in children
and adolescents, peptic ulceration,
DEXAMETHASONE[ED] diabetes mellitus, pregnancy and breast
feeding; special precautions needs to be
(See section 5.3.2) observed in elderly (side effects more
341
serious), in those with history of indicated in infected areas. Occasionally

tuberculosis (reactivation of tuberculosis an acute inflammatory reaction develops
is possible), in osteoporosis (post- after an intra-articular or soft-tissue
menopausal women at special risk). injection of a corticosteroid. This is
Monitoring is required in hypertension, possibly a reaction to the
congestive heart failure, recent microcrystalline suspension of the
myocardial infarction, liver failure, renal corticosteroid used. However, one must
impairment and glaucoma be cautious that sepsis has not been
Contra-indications: Systemic infection introduced into the injection site.Intra-
(unless specific antimicrobial therapy articular corticosteroid injections can
given); avoid live virus vaccine (serum cause flushing and may affect the
antibody response diminished) hyaline articular cartilage. Charcot-like
Side-effects: Musculoskeletal effects arthropathies have also been reported
include proximal myopathy, osteo- (particularly following repeated intra-
porosis, vertebral and long bone articular injections). Intra-articular
fractures, avascular necrosis, tendon injection of corticosteroids to one single
rapture; for other side-effects see under joint should not exceed 4 times in
endocrine section oneyear.
Dose:By mouth, initially 15-30 mg daily Methylprednisolone, Dexamethasone
in divided doses (up to 80 mg daily in Sodium phosphate, and
severe cases), should be taken after Triamcinolone acetonide are useful
meals and preferably covered by an H2 local corticosteroid preparations.
blocker drug (e.g. ranitidine). The dose
should be tapered rapidly to a LOCAL CORTICOSTEROID
maintenance as low as possible (e.g. 5 INJECTIONS
mg daily). See notes above (See section 5.3.2)
Proprietary Preparations Betamethasone,Dexamethasone,
See section 5.3.2 Hydrocortisone acetate,
Methylprednisoloneacetate,Prednisol
9.1.2.2 LOCAL CORTICOSTEROIDS one acetate, Triamcinolone acetonide
Local corticosteroid injections have an Indications: Local inflammation of joints

important role in managing inflamed due to rheumatoid arthritis or advanced
joints and tendon sheaths. In selected osteoarthritis; stenosing tenovaginitis
cases, these long acting local steroid (e.g. de Quervain’s disease of the wrist);
preparations are injected intra-articularly overuse injury (e.g. tennis elbow);
or into the sinuvial sheaths. In compressive neuropathies (e.g. carpal
rheumatoid arthritis, they are given by tunnel syndrome).
intra-articular injections to relieve pain, Cautions; Contraindications & Side-
increase mobility, and reduce deformity effects: See notes above
in one or a few joints. In smaller amounts Dose: See under preparations (section
corticosteroids may also be injected 5.3.2)
directly into soft tissues for relief of
inflammation in conditions such as tennis Proprietary Preparations
elbow or golfer’s elbow or compressive See section 5.3.2
neuropathies. In tendinitis, injections
should be made into the tendon sheath 9.1.3 DISEASE-MODIFYING ANTI-
and not directly into the tendon, RHEUMATIC DRUGS (DMARD)
otherwise rupture of tendon may happen
due to the absence of a true tendon
sheath and a high risk of rapture, the These are drugs, which have the
Achilles tendon should not be injected. capacity to modify the clinical and
Full aseptic preparations are essential. pathological course of rheumatoid
Corticosteroid injections are contra- arthritis and a few related disorders.
342
Prolonged administration is required and control severe rheumatoid arthritis

the effects are slow to appear. These nowadays. Long-term clinical studies
drugs require 4 to 6 months of treatment have clearly demonstrated the efficacy
for a full response. If one of these drugs and safety of this drug. The use of folic
does not lead to objective benefit within acid reduces the incidence of common
6 months, it should be discontinued and side effects, especially gastrointestinal
another may be tried. toxicity, without decreasing the
DMARDs may improve symptoms and effectiveness of methotrexate. Regular
signs of inflammatory joint disease and blood counts and liver function tests
also extra-articular manifestations such should be done during the therapy (at 4-
as vasculitis. They reduce the 6 weekly intervals), but liver biopsy is not
erythrocyte sedimentation rate, and required unless a persistent abnormality
sometimes the titre of rheumatoid factor. of liver function is demonstrated.
These drugs are indicated in rheumatoid Leflunomide is useful in moderate to
arthritis when NSAIDs alone fail to severe rheumatoid arthritis. It is an
provide adequate control. Some immunosuppressant drug and requires
rheumatologists would administer these frequent monitoring of haematological,
drugs early in case of clinically severe renal and hepatic functions. Pregnancy
rheumatoid arthritis. As all these drugs must be excluded before initiating
have potentially serious side-effects they treatment, and effective contraception is
should be administered with caution, essential during treatment and at least
preferably by specialists only. Frequent for 2 years after treatment in women and
monitoring of patients is required. at least for 3 months after treatment in
CHOICE: When choosing among the men.
DMARDs, hydroxychloro-quine or
sulfasalazine can be the first choice as ADALIMUMAB
they have the minimum adverse
reactions among the group. Indication: Rheumatoid
Chloroquine and hydroxychloroquine Arthritis,Juvenile Idiopathic Arthritis,
have a very acceptable toxicity profile. Psoriatic Arthritis,Ankylosing Spondylitis,
Retinopathy is rare if the dose Crohn’s Disease, Ulcerative Colitis (UC):
recommended below is not exceeded. It see under dose
is particularly effective in the early
treatment of mild to moderate and/or Cautions and Contraindications :
seronegative rheumatoid arthritis. Serious infections; monitored
However, this drug should not be used in Infection before, during, and after
psoriatic arthritis. treatment ,discontinue if new serious
Sulphasalazine shares many attributes infection develops; hepatitis B virus—
with chloroquine. It has an acceptable monitor for active infection; heart failure,
toxicity profile and is recommended for malignancy; monitor for nonmelanoma,
early mild rheumatoid arthritis. Side Skin cancer before and during treatment,
effects include rash, gastro-intestinal avoid in pregnancy and breast feeding.
intolerance and, especially in patients Interactions: Avoid live vaccines.
with rheumatoid arthritis, occasional Concomitant other biologic DMARDs
leucopenia, neutropenia, and thrombo- (eg, abatacept or anakinra) or other TNF
cytopenia. These haematological blockers; not recommended.
changes occur usually during the first 6 Immunosuppressants increase risk of
months of treatment. Close monitoring of infection. Concomitant CYP450
blood counts is indicated during the first substrates with narrow therapeutic index
2 months and 6 weekly thereafter. Liver (eg, warfarin, cyclosporine, theophylline);
function tests should also be done at 6 monitor and adjust dose of these drugs.
weekly intervals. Side-effects: Pyrexia, erythema and/or
Methotrexate is an immunosuppressant itching, hemorrhage, pain or swellingat
drug used by rheumatologists widely to injection site, headache, nausea, rash,
343
abdominal pain; Lupus-like syndrome CYCLOSPORINE

The most common adverse reactions (See section 14.2.1)
leading to discontinuation of
Adalimumab in rheumatoid arthritis were Indications: Severe active rheumatoid
clinical flare reaction, rash and arthritis when conventional therapy
pneumonia. Interstitial lung disease inappropriate or ineffective; graft-versus-
Dose: ADULT over 18 years, 40mg on host disease; atopic dermatitis and
alternate weeks; ifnecessary increased psoriasis
to 40mg weekly in patientsreceiving Cautions; Contra-indications & Side-
adalimumab alone; review treatment if effects: See in section on cytotoxic
noresponse within 12 weeksPsoriatic drugs (section 14.1.2.) Additional
arthritis, ankylosing spondylitis, severe cautions in rheumatoid arthritis
axial Contra-indication: In abnormal renal
spondylo arthritis, ADULT over 18 years, function, hypertension not under control,
40mg on alternate weeks; discontinue infections not under control, and
treatment if no response malignancy. Serum creatinine needs to
Within 12 weeksPolyarticular juvenile be measured initially before treatment,
idiopathic arthritis, CHILD 2–18 and monitored every 2 weeks for the first
years, consult product literature 3 months, and thereafter every 4 weeks
Dose: ADULT over 18 years by mouth,
administered in accordance with expert
Advixa(Incepta), Inj.Tk. 15000.00/Vial
advice, 2.5 mg/kg daily in 2 divided
doses initially, then increased if
AZATHIOPRINE
necessary after 6 weeks to max. 4 mg/kg
daily; treatment should be discontinued if
Indications: See notes above; the response is insufficient in 3 months;
transplantation rejection dose should be adjusted according to
Cautions; Contra-indications; Side- the response and should be reviewed in
effects: See in section on cytotoxic 6 months and treatment should be
drugs continued only if benefits are clearly
Dose: By mouth, initially 3 mg/kg daily, outweigh risks. CHILD and under 18
reduced according to response; mainte- years, not recommended
nance dose 1-3 mg/kg daily: withdraw
treatment if no improvement is apparent Proprietary Preparations
in 3 months see section 14.2.2
See section 14.2.1 HYDROXYCHLOROQUINE
CHLOROQUINE[ED] Indications: Active rheumatoid arthritis

(including juvenile chronic arthritis),
systemic and discoid lupus
Indications: Active rheumatoid arthritis,
erythematosus
juvenile chronic arthritis; systemic and
Cautions; Side-effects: See notes
discoid lupus erythematosus;
above
malaria(see also section 1.4.1)
Dose: Initially 400 mg daily in divided
Cautions,Contra-indications and Side
doses; maintenance dose 200-400 mg
effects: See also section 1.4.1
daily; maximum dose 6.5 mg/kg, but not
Dose: Chloroquine base 150 mg daily;
exceeding 400 mg daily. CHILD, up to
maximum 2.5 mg/kg daily; CHILD, up to
6.5 mg/kg daily
3 mg/kg daily; see recommendations
above
See section 1.3 Reconil(Incepta), Tab. 200mg, Tk.12.00/Tab.
Roquin(Zenith), Tab., 200 mg, Tk. 12.00/Tab.
344
Reconil(Incepta),Tab., 200 mg, Tk. 12.00/Tab.

METHOTREXATE[ED]
LEFLUNOMIDE
Indications: Severe active rheumatoid
Indications: Moderate to severe active arthritis; malignant disease
rheumatoid arthritis Cautions; Contraindications & Side-
Cautions: Renal impairment; impaired effects: See notes above and also the
bone marrow function including section on antineoplastic drugs (section
anaemia, leucopenia or thrombo- 14.1.3). Pulmonary toxicity may be a
cytopenia; recent treatment with other special problem in rheumatoid arthritis.
hepatotoxic or myelotoxic DMARD Patients on methotrexate are advised to
(avoid concomitant use); history of contact doctor immediately if he or she
tuberculosis; exclude pregnancy before develops dyspnoea or cough
treatment. Monitor full blood count Dose:By mouth, 7.5 mg once weekly (in
before treatment and every 2 weeks for a single dose, or divided doses of 2.5 mg
6 months then every 8 weeks. Monitor at intervals of 12 hours – to be adjusted
liver function. Monitor blood pressure according to response). Total maximum
Contraindications: Severe immuno- dose is 20 mg weekly
deficiency; severe infections; hepatic
impairment; severe hypoproteinemia; Proprietary Preparations
pregnancy See section 14.1.3
Side-effects: Diarrhoea, nausea, vomi-
ting, anorexia, oral mucosal disorders, SULFASALAZINE
abdominal pain, weight loss; increased
blood pressure; headache, dizziness, Indications: Active rheumatoid arthritis;
paraesthesia, asthenia; dry skin, rash, also ulcerative colitis; see notes above
pruritus, eczema, alopecia; tenosinuvitis; also section 2.5
leucopenia, thrombocytopenia, anaemia; Cautions; Contra-indications & Side-
hepatic dysfunction; severe infection, effects: See notes above. Patients
anaphylaxis receiving sulphasalazine should be
Dose: Initially 100 mg for 3 days, then advised to report any unexplained
maintenance, 10-20 mg daily; CHILD bleeding, bruising, purpura, sore throat,
under 18 years safety and efficacy not fever or malaise that occurs during
established treatment
Dose: Administered on expert advice, as
Proprietary Preparations enteric-coated tablets, initially 500 mg
Motoral(ACI), Tab., 20 mg, Tk. 5.04/Tab. ; daily, increased by 500 mg daily at
100 mg, Tk. 20.13/Tab. intervals of 1 week to a maximum of 2 –
Nodia(Incepta), Tab. , 10 mg, Tk. 3.00/Tab 3 g daily in divided doses
INFLIXIMAB Proprietary Preparations

Reumazin(Aristo), Tab. , 500 mg, Tk.
5.20/Tab.
Indications: For the treatment of Sulfazin(Popular), Tab. , 500 mg, Tk.
Crohn's disease, ulcerative colitis, 5.22/Tab.
psoriasis, psoriatic arthritis, ankylosing Sulfacol(Drug Int.), Tab. , 500 mg, Tk.
spondylitis, and rheumatoid arthritis. 5.00/Tab.
Cautions,Contraindications & Side Salazine(Opsonin), Supp., 500 mg, Tk.
effect: See sec14.1 and same as that of 7.52/Supp.;Tab., 500 mg, Tk. 3.92/Tab.
Zulfidin(UniMed), Tab , 500 mg , Tk.
Adalimumab
7.00/Tab.
Dose: Consult Physician and product
literature
TOCILIZUMAB
Proprietary Preparation Indication: To treat moderate to severe
Remicade(I)(Cilag)Inj., (IV Infusion)
100mg/vial, Tk.32,5,54?vial
rheumatoid arthritis in adults. It is
345
sometimes given together with other for the initial management of these
arthritis medicines. Actemra is used to diseases. Paracetamol is often adequate
treat systemic juvenile idiopathic arthritis to control mild to moderate pain. For
( in children who are at least 2 years old. severe pain and when there is significant
Cautions,Contraindications& Side inflammation a non-steroidal anti-
effect: See sec14.1 and same as that of inflammatory drug (NSAID) is indicated.
Adalimumab Steroids are needed for severe
Dose:Consult Physician and product inflammatory pain. To control the
literature disease process disease modifying anti-
rheumatic drugs (DMADS) are used.
Proprietary Preparation Colchicine is used for acute attack of
Actemra (Roche), Inj.(IV infusion)Tk. gout while allopurinol of urinal and
80mg/4ml,Tk. 12797.21, Tk. fevustat are used for interval treatment
200mg/10ml,Tk.29,756.00/vial. of gout.
Drugs used for treatment of acute attack
TOFACITINIB of gout are different from those used in
long term control (interval treatment) of
Indications: To treat adults with the disease. The latter should not be
moderate to severe rheumatoid arthritis initiated during an acute attack, because
as an alteration to methotrexate, this may exacerbate and prolong the
particularly when there is inadequate acute manifestations of the disese.
response to or intolerance of ACUTE ATTACKS: High doses of
methotrexate. It is may also be useful in NSAIDs with strong anti-inflammatory
treating psoriatic arthritis and ankylosing effects are used to control an acute
spondilitis. attack of gout. Indomethacin 150-200 mg
Cautions and Side-effects: in divided doses (orally or in
Gastrointistinal perforation, headache, suppositories) is a good choice.
diarrhea and nasopharyngitis, Diclofenac, naproxen or piroxicam are
Immunosuppression leading to infection alternatives. Aspirin is not indicated in
(Including tuberculosis) and acute gout. Colchicine is probably as
development of lymphoma and other effective as NSAIDs. It may develop
malignances. toxicity at higher doses, but is
Contraindication: Tuberculosis and any advantageous for heart failure patients,
other active infection. as it does not induce fluid retention.
Dose:Orally-5mg, twice daily, sustained Also, it does not have drug interactions
releases preparation; 11mg daily. with anticoagulants. See NSAIDs.
Colchicine is useful in controlling pain
Proprietary Preparations and inflammation in acute gout.
Jaktor(Beacon), Tab., 5mg,Tk. 48/Tab.
Tocit(Drug Intl), Tab., 5mg, Tk.35/Tab.
Tofacent(Incepta), Tab., Tk. 48/Tab. COLCHICINE
Tofanib(Globe), Tab., 5 mg, Tk. 48.00/Tab.;
11 mg, Tk. 80.00/Tab. Indications: Acute gout; short term
Tofatin(Ziska), XRTab., 11 mg, Tk. prophylaxis during initial therapy with
80.00/Tab.; 5 mg, Tk. 45.00/Tab allopurinol or uricosuric drugs
Cautions: See notes above; gastro-
9.1.4 DRUGS FOR TREATMENT OF intestinal disease; cardiac disease; renal
GOUT impairment; elderly
Contraindications: Blood disorders
Rheumatic diseases are characterized Side-effects: Nausea, vomiting, abdo-
by osteoarticular or muscule pain. Late minal pain, profuse diarrhoea, gastro-
sequel of rheumatic diseases are intestinal bleeding, rash, hepatic and
gradually increasing deformities and loss renal damage
of function of limbs. Analgesics and anti- Dose: Acute gout- 0.5/0.6 mg 2-4 times
inflammatory drugs are therefore needed daily until symptoms are relieved, max. 6
346
mg per course; course not be repeated ALLOPURINOL[ED]

in 3 days
Prevention of gout attack- during initial Indications: Prophylaxis of gout:
treatment with allopurinol or uricosuric prophylaxis for uric acid and calcium
drugs, 0.5 mg twice daily oxalate renal stones
Cautions: Administer prophylactic
Proprietary Preparations NSAID (not aspirin or salicylates) or
Colimax(Square), Tab. , 6 mcg, Tk. 5.02/Tab.
colchicine on initiation of treatment (see
Coluric(UniMed), Tab , 6 mcg, Tk. 7.50/Tab.
Kolchin(Incepta), Tab, 6 mcg, Tk. notes above); ensure adequate fluid
5.00/Tab.; 5 mcg, Tk. 4.00/Tab. intake (2 litres/day); hepatic and renal
impairment. In neoplastic conditions
INTERVAL TREATMENT: Reducing uric treatment with allopurinol should be
acid formation from purines with started before cytotoxic drugs are given
xanthine-oxydase inhibitor allopurinol Contra-indications: Not a treatment of
and febuxostat can do long term control acute gout; see notes above
(interval treatment) of gout. Alternatively, Side-effects: Rashes (if severe-
uric acid excretion can be increased by withdraw therapy, if mild - suspend
using uricosuric a drug such as therapy for a time, then reintroduce
sulfinpyrazone. Treatment with these cautiously but discontinue immediately if
drugs should not be initiated during an rashes recur); fever, lymphadenopathy,
acute attack. Even in quiescent stage, arthralgia, eosinophilia; malaise, head-
initiation of interval treatment may ache, vertigo, drowsiness; taste
precipitate an acute attack of gout. disturbance, hypertension, alopecia,
Therefore, when starting the interval hepatotoxicity, peripheral neuropathy
treatment, a potent NSAID or colchicine Dose: Initially 100 mg daily as a single
should be administered side by side, and dose after food, gradually increase at
should be continued for about one month weekly interval according to plasma
after the hyperuricaemia has been concentration of uric acid to about
corrected. If an acute attack develops 300mg; usual maintenance dose is 200-
during interval treatment, the treatment 600 mg daily, divided into doses not
should be continued while the acute more than 300 mg. CHILD (in neoplastic
attack should be treated on its own conditions, enzyme disorders) 10-20
merit. mg/kg daily
Allopurinol is widely used as it is well Proprietary Preparations
tolerated. It is not indicated for Alurol(Incepta), Tab., 100 mg, Tk. 4.00/Tab.
asymptomatic hyperuricaemia. This drug Duric(Opsonin), Tab., 100 mg , Tk. 4.02/Tab.
has a long half-life, so it may be given as Esloric(Square), Tab., 100 mg, Tk. 4.03/Tab.;
once daily dose. If the dose exceeds 300 mg, Tk. 8.06/Tab.
Purinol(Drug Intl), Tab., 100mg, Tk.
300 mg, it should be given in divided
4.05/Tab.;Tab., 300mg, Tk. 8.05/Tab.
doses. Ucorex(Healthcare), Tab., 100mg , Tk.
Febuxostat is an alternative of allpurinol 4.05/Tab.
and is indicted for chronic hyperuicaemia
where urate deposition has already FEBUXOSTAT
occurred. According to NICE guidance,
febuxostat is recommended as an option Indications: Chronic hyperuricaemia in
for management of chronic gout
hyperurcaemia in gout only for patients Cautions:Administer prophylactic
who are intolerant to allopurinol or for NSAID (not aspirin or salicylates) or
whom allopurinol is contra-indicated. colchicine on initiation of treatment at
Sulfinpyrazone can be used instead of least for 6 months after starting
allopurinol, or in combination with it in treatment with febuxostat (see notes
cases that are resistant to treatment. above); monitor liver function before and
periodically during treatment; thyroid
disorders; ischaemic heart disease;
347
congestive cardiac failure; transplant Cautions: Ensure adequate fluid intake

recipients (about 2-3 litres daily), render urine
Contraindications: Do not start treat- alkaline if uric acid overload is high;
ment during an acute attack of gout peptic ulceration; cardiac disease (may
Side-effects:Gastro-intestinal distur- cause salt and water retension); regular
bances, oedema, rash, headache; blood count advisable
abnormal liver function tests, Contra-indications: history of blood
hyperlipidaemia, cholelithiasis, ECG disorder, nephrolithiasis, acute attack of
abnormalities; taste and smell gout
disturbances, flushing, hypertension, Side-effects: Gastro-intestinal distur-
chest pain, palpitation, dyspnoea, bances, allergic skin reactions, water
cough, bronchitis, dizziness, drowsiness, and salt retention; rarely blood
insomnia, paraesthesia, hyposthaesia; disorders, acute renal failure, hepatitis
apatite and weight changes, diabetes Dose: Initially 100-200 mg daily with
mellitus, increased thyroid stimulating food (or milk), increasing over 2-3 weeks
hormone, decreased libido, erectile to 600 mg daily, continue until serum
dysfunction; increased urinary uric acid level returns to normal limits,
frequency, haematuria, protein-uria, then reduce to maintenance dose
nephrolihtiasis, renal failure; arthralgia,
myalgia, muscle weakness, muscle GenericPreparation
spasm, arthritis, bursitis, dermatitis; Pyrazone(Incepta),Tab.200mg,Tk.40.00/Tab
rarelysevere hypersen-sitivity reactions
including Stevens-Johnson syndrome 9.2 DRUGS USED IN
and acute anaphylaxis NEUROMUSCULAR DISORDERS
Dose: ADULT over 18 years, 80 mg
once daily, if after 4 weeks serum uric 9.2.1 DRUGS WHICH ENHANCE
acid remains above 6 mg/dl, increase NEUROMUSCULAR
dose to 120 mg once daily TRANSMISSION
Proprietary Preparations 9.2.2 MUSCLE RELAXANTS
Barif(Square), Tab., 40 mg, Tk. 12.03/Tab.;
80 mg, Tk. 22.06/Tab. 9.2.1 DRUGS WHICH ENHANCE
Eburic(Beximco), Tab., 40mg, Tk. 12.00/Tab. NEUROMUSCULAR
Feburen(Renata), Tab., 80 mg, Tk. TRANSMISSION
22.00/Tab.; 40 mg, Tk. 12.00/Tab.
Febus(ACI), Tab., 40mg, Tk. 12.04/Tab.;
80mg, Tk. 22.07/Tab. Anticholinesterases are used as first line
Febustat(Incepta), Tab., 40 mg, Tk. treatment in myasthenia gravis. Cortico-
12.00/Tab.; 80 mg, Tk. 22.00/Tab. steroids are only given concomitantly if
Febux(Monico), Tab., 40mg, Tk. 12.00/Tab.; anticholinesterase treatment is failing.
40mg , Tk. 12.00/Tab. Anticholinesterase drugs enhance
Febuxostat(Popular), Tab. , 40mg,
Feluric(Healthcare), Tab., 40mg , Tk. neuromuscular transmission in voluntary
12.00/Tab.; 80mg, Tk. 22.00/Tab. and involuntary muscles in myasthenia
Fostat(Orion), Tab., 40 mg, Tk. 10.03/Tab. gravis. They prolong the action of
Goustat(Acme), Tab., 40.00 mg, Tk. acetylcholine by inhibiting the enzyme
12.03/Tab. acetylcholinesterase.
Goutil(Eskayef), Tab., 40mg, Tk. 12.00/Tab.; Muscurinic side-effects of anticholine-
80mg, Tk. 22.00/Tab
sterases include increased sweating,
Urostat(General), Tab., 40 mg , Tk.
12.04/Tab.; 80mg, Tk. 22.07/Tab.
salivary, and gastric secretion; increased
Xanuric(UniMed), Tab., 120mg, Tk. 34/Tab.; gastrointestinal and uterine motility;
40mg, Tk. 12/Tab.; 80mg, Tk. 22/Tab. bradicardia. Excessive dosage of these
drugs may impair neuromuscular trans-
SULFINPYRAZONE mission and precipitate a ‘cholinergic
crisis’ by causing a depolarising block.
Indications: Gout prophylaxis, hyperuri-
caemia
348
NEOSTIGMINE[ED] Side-effects: See under Neostigmine

Dose: By mouth, 30-120 mg at suitable
Indications: Myasthenia gravis; reversal intervals throughout the day.
of muscle relaxation action (for nondep-
olarizing skeletal muscle relaxants) in
Dostimid(UniMed), Tab.,60 mg, Tk.
general anaesthesia (see also section 22.00/Tab.
8.1.6) Pyrostig(Popular), Tab., 60 mg, Tk. 25.09/Tab
Cautions: Asthma (extreme caution),
bradycardia, recent myocardial infection, 9.2.2. MUSCLE RELAXANTS FOR
epilepsy, hypotension, Parkinsonism, RELIEF OF CHRONIC MUSCLE
vagotonia, peptic ulceration, renal SPASM OR SPASTICITY
impairment, pregnancy and breast-
feeding. Atropine or other antidote to
SKELETAL MUSCLE RELAXANTS
muscarinic effects may be necessary
These drugs are useful for relief of acute
(particularly when neostigmine is given
or chronic skeletal muscle spasm.
by injection), but it should not be given
Diazepam and baclofen act principally
routinely as it may mask the signs of
on the central nervous system while
overdose
dantrolene acts on a peripheral site of
Contraindications: intestinal or urinary
action. Tolperisone, Eperisone,
obstruction
Tizanidine and Clobenzaprine are
Interactions:See Appendix- 2
centrally acting skeletal muscle
relaxants. The underlying cause of
increased salivation, diarrhoea, and
spasticity should be treated
abdominal cramps. Signs of overdose
concomitantly and any aggravating
are increased gastrointestinal defect,
factor removed.
bronchial secretion, and sweating;
involuntary defaecation and micturition;
miosis, nystagmus, bradycardia, hypo- BACLOFEN
tension; agitation, excessive dreaming,
fasciculation and ultimately paralysis Indications: To treat muscle
Dose:By mouth, neostigmine bromide spasms caused by certain conditions
15-30 mg at suitable intervals throughout (such as multiple sclerosis, spinal cord
the day, total daily dose 75-300 mg (see injury/disease). It works by helping to relax
notes above), NEONATE 1-5 mg every 4 the muscles.
hours, half an hour before feed; CHILD Cautions: Psychiatric and nervous
up to 6 years 7.5 mg initially, 6-12 years system disorder; Parkinson's , elderly;
initially 15 mg, usual total dose 15-90 mg respiratory impairment;epilepsy ,peptic
daily ulcer (avoid oralroute in active peptic
By subcutaneous or intramuscular ulceration); diabetes; hypertonic bladder
injection, neostigmine methylsulphate 1- sphincter; avoid abrupt withdrawal,
2.5 mg at suitable intervals throughout hyperactive state, may exacerbate
day, usual total daily dose 5-20 mg; spasticity, andprecipitate autonomic
NEONATE 50-250 micrograms every 4 dysfunction including
hours half an hour before feeds; CHILD hyperthermia,psychiatric reactions and
200-500 micrograms as required convulsions, drowsiness may affect
performance of skilled tasks
Proprietary Preparations (e.g. driving)
See section8.1.5 Contra-indications: For intrathecal
PYRIDOSTIGMINE treatment local or systemic infection
Side-effects:Dry mouth, respiratory
Indication: Myasthania gravis depression, light- headedness, fatigue,
Cautions:See under Neostigmine confusional state, dizziness, headache,
Contra-indications:See under Neostg- insomnia, depression, euphoric mood,
mine myalgia, muscular weakness, ataxia,
349
tremor, nystagmus, hallucination, Rembac(Monico), Tab., 10mg, Tk. 8.00/Tab.

nightmare, cardiac output decreased Restobac(General), Tab., 10mg, Tk. 8.05/Tab.
gastrointestinal disorder, retching, Skelofen(Acme), Tab., 10 mg, Tk. 8.03/Tab.;
5 mg, Tk. 4.51/Tab.
vomiting, constipation, diarrhoea Spaflex(Nuvista), Tab., 10 mg, Tk. 8/Tab.; 5
Dose:By mouth, ADULT over 18 years, mg, Tk. 4.50/Tab.
initially 5mg 3 times daily, gradually Spakem(UniMed), Tab., 10mg, Tk. 8.00/Tab.;
increased; usual maintenance dose up 5mg, Tk. 4.50/Tab.;
to 60mg daily in divided doses (max. 100 Spinafen(Globe), Tab., 10 mg, Tk. 8.00/Tab.;
mg daily); 10 mg , Tk. 8.03/Tab.
CHILD under 18 years, initially 300
micrograms/kgdaily in 4 divided doses, CYCLOBENZAPRINE
increased gradually at weekly intervals
until satisfactory response; usual Indications: It is used as an adjunct in
maintenancedose 0.75–2 mg/kg daily in the symptomatic treatment of painful
divided doses; muscle spasm associated with
CHILD up to 8 years, max. total daily musculoskeletal conditions in non-
dose 40 mg/day; ambulatory patients
CHILD 8–18 years, max. total daily dose Cautions: It may cause drowsiness;
60 mg/day patients affected should not drive or
operate machine
Proprietary Preparations Contraindications: Recent myocardial
Bacifen(Biopharma), Tab., 10mg, Tk. 8/Tab. infarction, enlarged prostate, glaucoma,
Backtone(Pharmacil), Tab., 10mg, Tk.
liver disease
10.03/Tab.
Baclium(Virgo), Tab., 10 mg, Tk. 8/Tab. Interactions: See Appendix-2
Baclodol(Astra Bio), Tab., 10 mg, Tk. 8/Tab. Side-effects: Sedation, dry mouth,
Baclof(Pacific), Tab. , 10 mg, Tk. 9.50/Tab. postural hypotension, confusion
Bacloflex(Somatec), Tab., 10 mg, Tk. 8/Tab. Dose: 10-20mg three times daily given
Baclon(Orion), Tab., 10 mg, Tk. 8.06/Tab.; 5 by mouth (max. daily dose 60mg.) Note:
mg, Tk. 4.54/Tab. Treatment more than 3 weeks is not
Bacmax(Drug Intl), Tab., 5mg, Tk. 4.05/Tab.;
recommended
10mg, Tk. 8.05/Tab.;
Bacofen(Ibn Sina), Tab., 5 mg, Tk. 5.50/Tab.;
10 mg, Tk. 8.00/Tab. Proprietary Preparations
Beclovan(Aristo), Tab. , 10mg , Tk. 8.00/Tab.; Flexor(Incepta), Tab., 5 mg, Tk. 2.00/Tab.; 10
5mg, Tk. 5.50/Tab. mg, Tk. 3.00/Tab.
Beklo(Opsonin), Syrup., 5 mg /5 ml, Tk.
100.00/100 ml,; Tab, 10 mg , Tk. 8.06/Tab.; DANTROLENE SODIUM
25 mg , Tk. 20.08/Tab.; 5 mg , Tk. 4.54/Tab.
Easybak(Euro), Tab., 10mg, Tk. 8.00/Tab.
Fenobac(Eskayef), Syrup., 5 mg /5 ml, Tk. Indications: To treat muscle tightness
100.00/100ml,; Tab, 10mg, Tk. 8.00/Tab.; and cramping (spasms) caused by certain
Flexibac(Beacon), Tab. , 25mg , Tk. nerve disorders such as spinal cord
20.06/Tab.; 5mg , Tk. 5.50/Tab. injury, stroke,cerebral palsy, and multiple
Flexifen(Incepta), Tab., 10 mg, Tk. 8.00/Tab.; sclerosis. It works by relaxing the
25 mg, Tk. 16.00/Tab.; 5 mg, Tk. 4.50/Tab. muscle.It helps
Flexilax(Square), Tab. , 10 mg, Tk. 9.00/Tab.;
Reduce muscle pain and stiffness,
5 mg, Tk. 5.50/Tab.
Liorel(ACI), Tab., 10mg, Tk. 8.05/Tab. ; 5mg,
Cautions: Potentially life-threatening
Tk. 4.53/Tab. hepatotoxicityreported, usually if doses
Lioresal(I)(Novartis), Tab., 10 mg, Tk. greater, test liver function before and at
12.96/Tab.; 25 mg, Tk. 22.46/Tab. intervals during therapy—discontinue
Lospan(Beximco), Tab., 10mg, Tk. 8.00/Tab. ifabnormal liver function tests or
Maxolax(Renata), Tab. , 5 mg, Tk. 5.00/Tab. ; symptoms of liver disorder.drowsiness
10 mg, Tk. 8.00/Tab.
may affect performance of skilled tasks
Muslofen(Organic), Tab., 10 mg, Tk. 8/Tab.
Mylofen(Popular), Tab., 10mg, Tk. 8.00/Tab.; (e.g. driving
Myorel(Healthcare), Tab., 25mg, Tk. 20/Tab.;
5mg, Tk. 5.00/Tab.; 10mg, Tk. 8.00/Tab.
350
Contraindications: Acute muscle Cautions and Side-effects: Muscular

spasm; avoid whenspasticity is useful, weakness
for example, locomotion, Dose: 50-150 mg 3 times daily
hepatic impairment ; injection may be
used in an emergency for Proprietary Preparations
malignant hyperthermia; Myonil(Square), Tab., 50 mg, Tk. 3.01/Tab.
Pregnancy Eprel(Orion), Tab., 50 mg, Tk. 3.01/Tab.
Dose: Initially 25mg daily, may be
increased at weeklyintervals to max. 100 TIZANIDINE
mg 4 times daily; usual dose75mg 3
times daily; CHILD: Consult product Indications: Painful muscle spasm
literature associated with functional disorders of
the spine and spasticity due to multiple
Proprietary Preparations sclerosis, spinal cord injury,
Danlene(Incepta), Cap. , 25 mg, Tk. cerebrovascular accident
10.00/Cap. Cautions: Impaired renal and liver
Relaxo(Ziska), Cap. , 25 mg, Tk. 10.00/Cap.;
function; in pregnancy and breast-
50 mg, Tk. 15.00/Cap.
Trolen(Drug Intl), Cap. , 25mg, Tk. 10.00/Cap. feeding. Monitor liver functions monthly
for 4 months and then in those who
develop unexplained nausea, anorexia
DIAZEPAM[ED][CD]
or fatigue
(See also section 7.1, 7.2 & 7.6.2) Contraindications: Known hypersen-
sitivity to tizanidine, severe hepatic
Indications: Muscle spasm of varied impairment
aetiology, including tetanus; other Interactions:See Appendix-2
indications Side-effects: Fatigue, dizziness, dry
Cautions, Contraindications and Side- mouth, gastrointestinal disturbances
effects: Sedation and occasional slight decrease in blood pressure; also
hypotonia reported; insomnia, transient increase in
Interactions: See Appendix-2 serum transaminases, bradycardia
Dose: By mouth, 5-15 mg in single or Dose: In painful muscle spasm, 2 mg 3
twice daily doses initially, increased to times daily; spasticity due to neuro-
60 mg daily in divided doses if muscular disorders, 6 mg/day in 3
necessary. Cerebral spasticity, in divided doses, then increase stepwise
selected cases, 2-40 mg daily in divided 12 to max. 36 mg daily CHILD not
doses recommended
By intramuscular or intravenous injection
(into a large vein at a rate not more than Proprietary Preparations
5 mg/minute), in acute muscle spasm, Relentus(Beximco), Tab., 2 mg, Tk. 5.00/Tab.
10 mg repeated if necessary after 4 Sirdalud(Novartis), Tab., 2 mg, Tk. 10/Tab.
hours, Tetanus, ADULT and CHILD, by Tizadin(ACI), Tab., 2 mg, Tk. 5.04/Tab.
intra-venous injection, 100-300 Tizalud(Opsonin), Tab., 2 mg, Tk. 5.02/Tab.
microgram/kg repeated every 1-4 hours
TOLPERISONE
See section 7.1
Indications: Spasticity and rigidity of
skeletal muscles due to lesions of the
EPERISONE pyramidal tract, multiple sclerosis, ence-
phalomyelitis; cerebral palsy; muscle
Indications: Spasticity and rigidity of spasm due to back or neck pain
skeletal muscles due to lesions of the Cautions and Side-effects: Muscular
pyramidal tract, multiple sclerosis, ence- weak-ness, somnolence (rarely in
phalomyelitis; cerebral palsy; muscle children)
spasm due to back or neck pain
351
Dose:Oral, 150-450 mg 3 times daily. GLUCOSAMINE

CHILD 3 months to 6 years, 5-10 mg/kg
daily in divided doses, 6-12 years, 1-2 Indications:Mild to moderate osteo-
mg/kg daily in divided doses arthritis of knee and hip
Injections, for ADULTS, 100-200 mg Cautions: Diabetic patients are advised
slowly intravenously or intramuscularly to monitor blood glucose level.
Pregnancy and lactation (enough studies
have not been carried out)
A-Calm(Acme), Tab., 50 mg, Tk. 6.00/Tab.
Musclex(Aristo), Tab., 50 mg, Tk. 5.00/Tab. Contra-indications: known hypersen-
Myolax(Incepta), Tab. , 50 mg, Tk. 12.00/Tab. sitivity to glucosamine sulphate
; 100 mg, Tk. 7.00/Tab. Side-effects: Gastro-intestinal upsets
Myoson(Ibn Sina), Tab. , 100 mg, Tk. (uncommon)
8.00/Tab.; 50 mg, Tk. 4.00/Tab. Dose: By mouth, 1.5g daily in single or
Myoxan(Globe), Tab. , 50 mg, Tk. 4.00/Tab. divided doses
Myoxant(UniMed), Tab , 50 mg, Tk. 5.00/Tab.
Mydoclam(I)(Richter)Tab., 50 mg, Tk.
9.08/Tab.
Glustin(General), Tab., 500 mg, Tk. 3.51/Tab.
Rison(Kemiko), Tab., 50 mg, Tk. 4.01/Tab.
Glupain(ACI), Tab., 500 mg, Tk. 3.02/Tab.
Tolcalm(General), Tab. , 50 mg, Tk.
Joinix(Incepta), Tab., 500 mg, Tk. 3.00/Tab.
4.01/Tab.
Tolmus(Beximco), Tab., 50 mg, Tk. 3.00/Tab.
Tolpa(Biopharma), Tab., 50 mg, Tk. 4.00/Tab. GLUCOSAMINE + CHONDROITIN
Tolson(Opsonin), Tab.,100 mg, Tk. 8.00/Tab.
; 50 mg, Tk. 5.00/Tab.
Indication: Mild to moderate osteo-
Toperin(Eskayef), Tab, 50 mg, Tk. 3.00/Tab.
arthritis of knee, hip, spine and other
Tolperisone Hydrochloride2.5mg& Lidocaine locations
Hydrochloride100mg Caution: See notes above
Myolax Plus(Incepta), Inj., Tk. 34.00/Inj. Contraindications: known hypersen-
sitivity to glucosamine sulphate or chon-
9.3 SUPPLEMENTARY DRUGS USED dritin sulphate
IN JOINT DISEASES Side-effects: Gastro-intestinal upset
Dose: By mouth, glucosamine sulphate
Different biologic agents and nutrition 750-1500mg + Chondroitin sulphate 600-
supplements have been used to treat 1200mg daily in divided doses with
degenerative or inflammatory joint meals
diseases. Glucosamine hydrochloride is
Proprietary preparations
approved in Bangladesh for therapeutic
Glucosamine 250mg + Chondroitin 200mg,
use in osteoarthritisfor its chondro- Arth A(Acme), Tab. ,Tk. 8.07/Tab.
protective properties.The mechanism of Arthrosin(UniMed), Tab , Tk. 8.00/Tab.
action is not understood and there Articulex(Ibn Sina), Tab., Tk. 8.25/Tab.
islimited evidence to show it is Bencart(Benham), Tab., Tk. 8.00/Tab.
effective.Combination product of Bonflex(Eskayef), Tab., Tk. 8.00/Tab.
glucosamine sulphate and chondroitin Carticare(Radiant), Tab. Tk. 19.06/Tab.
Carticel Plus(Opsonin), Tab. , Tk. 8.00/Tab.
sulphate, is also useful in chronic
Cartifit(Globe), Tab. Tk. 8.00/Tab.
management of degenerative arthritis as Cartigen(Somatec), Tab., Tk. 8.03/Tab.
they provide a synergistic chondro- Cartilage Plus (Renata), Tab., Tk. 8.03/Tab.
protective effect.Combination of Cartilex(ACI), Tab., Tk. 8.05/Tab.
glucosamine sulphate and diacerein with Contilex(Square), Tab. , Tk. 8.50/Tab.
similar synergistic chondro-protective Glucium(Biopharma), Tab., Tk. 8.00/Tab.
effects with added benefit of analgesic Glucotin-plus(Drug Intl), Tk. 8.05/Tab.
Glustin(General), Tab., 250 Tk. 8.05/Tab.;
effects has been licensed. Diacerein
Joinix Plus(Incepta), Tab. , , Tk. 13.33/Tab.
works by inhibiting interleukin-1 beta. Jointin(Globex), Tab. , Tk. 8.00/Tab.
Rejoin(Aristo), Tab., Tk. 8.00/Tab.
Synflex(Healthcare), Tab., Tk. 8.50/Tab.
352
GLUCOSAMINE + DIACEREIN followed. Remove joint effusion, if

present, before injecting Sodium
Indications: Osteo-arthritis of knee, hip Hyaluronate. Do not use the same
and other joints syringe for removing joint effusion and
Cautions: Liver disease for injecting Sodium Hyaluronate. It is
Contra-indications: Hypersensitivity to recommended that the patient avoid any
glucosamine or diacerein strenuous activities or prolonged (i.e.,
Side-effects: Gastro-enteritis (dirrhoea), more than 1 hour) weight-bearing
yellow or pink discolouration of urine activities such as jogging or tennis within
Dose: ADULT, orally start with (Glucos- 48 hours following the intra-articular
amine 750 mg +Diacerein 50 mg) daily injection..
for first 2 weeks, then increase to Contraindications : Hypersensitivity to
Glucosamine 1500 mg + Diacerein 100 hyaluronan preparations, knee
mg daily; continue up to 3 years joint infections, infections or skin disease
in the area of the injection sit.
Proprietary Preparations Side-effects: Headache,itching of the
Diacerein 50mg +Glucosamine 750 mg skin large, nonelevated blue or purplish
Arth-A(Acme), Tab. , Tk. 12.03/Tab. patches in
Bontiv(Healthcare), TabTk. 12.00/Tab. theskin,lossofappetite,nausea and/or vo
Cartibon(Popular), Tab. , Tk. 12.00/Tab. mitingstomach painswelling of the
Carticare(Radiant), Tab., Tk. 20.00/Tab.
knee,Most side effects are related to
Cartilex(ACI), Tab., Tk. 12.00/Tab.
Cosarin(Opsonin), Tab.,Tk. 12.03/Tab. local reactions such as injection site
Diacer(Beacon), Tab., Tk. 12.00/Tab. pain, pain, swelling, effusion, or redness
Glucerin(Astra Bio), Tab., Tk. 12/Tab. of the joint.
Glucium(Biopharma), Tab.,Tk. 12/Tab.
Glucotin(Drug Intl), Tab., Tk. 12/Tab. Dose:By intra-articular injection. A
Glustin(General), Tab., Tk. 12.04/Tab. treatment cycle consists of five injections
Joinix(Incepta), Tab., Tk. 12.00/Tab.
given at weekly intervals. Some patients
Jointec(Beximco), Tab.,Tk. 12.00/Tab.
Osticare(Eskayef), Tab, Tk. 12/Tab.; may experience benefit with three
Ostorin(Ibn Sina), Tab., Tk. 12/Tab. injections given at weekly
Rejoin(Aristo), Tab., Tk. 12/Tab. intervals.consult product literatur.
Tilex Max(Square), Tab., Tk. 12/Tab.
SODIUM HYALURONATE Hyalgun(Healthcare), Inj., 20mg/2ml , Tk.
1980.00/2 ml vial
Hyronate(Incepta), Inj., 20mg/2ml , Tk.
Indications: To treat knee pain caused 1500.00/2 ml vial
by osteoarthritis.It is usually given when
other arthritis medications have not been 9.4 DRUGS USED IN
effective. OSTEOPOROSIS
Cautions: Allergic to avian proteins, See section 5.6
feathers, and egg products. Strict aseptic
administration technique must be
353
10. EYE
Chapter 10
EYE
10.1 Administration of drugs to the eye and control of microbial
contamination p. 354
10.2 Anti-infective eye preparations p. 357
10.2.1 Antimicrobials p. 357
10.2.2 Antifungals p. 364
10.2.3 Antivirals p. 365
10.3 Corticosteroids, other anti-inflammatory preparations and
antihistaminesp. 366
10.4 Mydriatics, cycloplegics and treatment of glaucoma p. 373
10.4.1 Mydriatics p.374
10.4.2 Cycloplegics p.374
10.4.3 Drugs for glaucoma p.375
10.5 Local anaesthetics p.380
10.6 Miscellaneous ophthalmic preparations p.382
10.6.1 Tear deficiency, ocular lubricants, and astringents p.382
10.6.2 Diagnostic and perioperative preparations p.384
10.6.3 Antioxidant Vitamin and Anti Cataract Preparations p. 386
10.7 Contact lenses p. 387
10.1 ADMINISTRATION OF DRUGS drugs into the general circulation

TO THE EYE AND CONTROL via conjunctival vessels or from the
OF MICROBIAL nasal mucosa after the excess of
CONTAMINATION the preparation has drained down
through the tear ducts; nasal
Prerequisites of successful therapy in drainage of drugs is much more
ophthalmology: often associated with eye drops
1. Correct application: Good than with eye ointments. For
technique usually requires active example, a beta blocker
participation by the patient. The administered as eye drops may
instruction and initial supervision induce bronchospasm or
by ophthalmologist or qualified bradycardia in susceptible
assistant is needed. individuals. Although the extent of
2. Proper frequency: the systemic absorption following
medications should be given at ocular administration is highly
correct times, which might vary variable.
from once in a day to every 1-15 6. Miscellaneous : Other factors that
minutes. should be kept in mind : Eye drops
3. Sufficient quantity: One drop is must be kept sterile (container tip
all that is needed though typically should not touch the eye), proper
less than 5% of the dose given in storage (protection from high
an eye drop is absorbed temperature, humidity and light)
intraocularly. must be ensured, attention to
4. Compliance:The practical realiza- shaking suspensions and
tion of the prescribed medication expiration date must be noticed.
depends on the reliability of the ROUTES OF ADMINISTRATION
patient.
5. Systemic effects from topical LOCAL
application : Undesirable effects a) Topical : This route should always
may well arise from absorption of be considered before resorting to
354
10. EYE
the systemic route. Frequent b) Anterior peri-ocular injections

application is almost equivalent to i) Subconjunctival injections
i)
subconjunctival injections.
Eye Drops: Method of instillation: • In this route the drug diffuses
Eye drops are generally instilled through the cornea and sclera to
into the pocket formed by gently the anterior and posterior
pulling down the lower eyelid; one chambers and vitreous in higher
drop is all that is needed. concentration.
• When administered in the form of • Because the dose-volume is

eye drops, drugs penetrate the limited (usually not more than 1
globe, probably through the ml), this route is suitable only for
cornea. drugs, which are readily soluble.
• Runoff can be reduced and • Useful for non-compliant patients

contact time prolonged, if it is needing high concentration of
instilled into the lower fornix after antibiotic or steroids. Also used for
gently pulling the lower lid away giving mydriatics.
from the globe. • Injection is painful and if not
• Undesirable systemic side effect carefully given conjunctiva tends to
become scarred.
(by beta blocker) can be reduced
by keeping both eyes closed for 1-
3 minutes after instillation of a drop
• When given at the end of surgery
care should be taken to avoid
and also by pressing on the area retrograde leak into the eye.
of the lacrimal sac for a few ii) Sub-Tenon Injections
minutes.
• When two different preparations in
• More effective than sub-
conjunctival injection.
the form of eye drops are required
at the same time in a day, for • Technically difficult, chances of
example Pilocarpine and Timolol perforation more if adequate care
in glaucoma, dilution and overflow is not taken.
•
may occur when one immediately
follows the other. The patient Less retrograde needle tract reflux
should therefore leave an than sub-conjunctival injection.
interval of at least 5 minutes. c) Posterior Peri-ocular (Peribulbar
•
or Retrobulbar) Injection:
•
Generally it is inadvisable for
patients to continue to wear Technically difficult and more risk
contact lenses, particularly of perforation than the previous
hydrophilic (soft) contact lenses ones.
ii)
when receiving eye drops.
Ointments An eye ointment is
• Usually used to give depot steroid
generally applied by squeezing a (to have prolonged effect
small amount (about 1 cm) of achievable in vitreous, choroids,
ointment into the pocket formed by optic nerve with risk of elevation of
gently pulling down the lower high intraocular pressure in steroid
eyelid; the ointment melts rapidly responder) and to give block
and blinking helps to spread it. before different ocular operations.
Ointments with Vaseline base are
not suitable for daytime use as it d) Intracameral Injection
blurs vision that with Vaseline Usually given to constrict the pupil
base is less problematic then with near the end of cataract surgery.
paraffin base. e) Intravitreal Injection
355
10. EYE
• Mainly indicated for

MICROBIAL INFECTION
Steps needed to control microbial
endophthalmitis contamination:
• Must be given by an expert inside • Strict sterility of the preparations
the operation theatre (OT). for the eye should be ensured.
• Exact calculation of the dose and Care should be taken to avoid
contamination of the contents of
the amount to be injected must be
strictly calculated. the eye drops during use.
• Updated knowledge of the retinal • Eye drops in multiple-application

toxicity of the drugs should be kept containers for domiciliaryuse
in mind. should not be used for more than 4
f) Ocusert: These are suitable weeks after first opening.
plastic devices that gradually
release a specified amount of drug
• Rules for use of eye drops in
hospitals - Eye drops for uses in
over a period. It is not available in hospital wards are normally
our country. discarded one week after first
opening. Separate containers
SYSTEMIC DRUGS should be provided for each
patient. Containers used before an
Infections of the eye not controllable by
operation should be discarded at
local medications need systemic drugs.
the time of the operation and fresh
Infections involving deep structures that
containers to be supplied. A fresh
can not be reached by local
supply should also be provided
applications, and those that pose a
upon discharge from hospital.
danger of systemic spread, require
therapy via bloodstream e.g. • Eye drops used in out-patient
dacryocystitis, orbital cellulitis and departments should be discarded
metastatic endophthalmitis. Gonococcal at the end of each day. In clinics
infections always should be treated for eye diseases (e.g., cornea
systemically to forestall generalized clinic) and in accident and
spread. The same applies to emergency departments, where
Pseudomonas, Haemophilus and the dangers of infection are high,
Chlamydia infections in children. single-application packs should be
Use of steroids in the systemic route is used: if a multiple-application pack
indicated particularly in cases where is used, it should be discarded
ocular disease is a part of general after single use.
•
systemic condition or where the eye is
the target of a systemic response, e.g. Diagnostic dyes (e.g. fluorescent)
in orbital pseudotumor, Graves’ should be used only from single
orbitopathy, giant cell arteritis, rejection application packs or from strips as
of grafted tissue and in certain type of chances of fungal contamination is
posterior panuveitis such as Harada’s very high in our country.
disease, sympathetic ophthalmia,
Behcet’s disease and sarcoidosis. • In eye surgery it is wise to use
For rapid control of intraocular pressure single-application containers.
(IOP) in glaucoma, systemic route is a Prep-arations used during intra-
must. ocular procedures and others that
Most of the needed cytotoxic drugs in may penetrate into the anterior
neoplastic disorders of the eye are chamber must be isotonic and
given by systemic routes. without preservatives and buffered
Systemic form can be given by oral if necessary to a neutral pH. Large
or intravenous routes volume intravenous preparations
are not suitable for this purpose.
356
10. EYE
For all surgical procedures, a tival or systemic administration of

previously unopened container is antibiotics.
used for each patient. Endophthalmitis is a medical
emergency, which also calls for
10.2 ANTI-INFECTIVE EYE specialist manage-ment and often
PREPARATIONS requires parenteral, subconjunctival or
intravitreal adminis-tration of antibiotics.
Treatment by topical applications is
sufficient for most acute superficial eye ANTIBACTERIAL AGENTS
infections. Blepharitis and conjunctivitis
are often caused by staphylococci; Bacterial infections are generally
keratitis and endophthalmitis or other treated topically with eye drops and eye
eye infections may be bacterial, viral, ointments. Systemic administration is
fungal even protozoal (e.g. acanthe- sometimes appropriate in blepharitis.
mebia, crab lice etc). Other than topical, a variety of routes
BACTERIAL BLEPHARITIS is treated (intra-cameral, intravitreal and
by application of antibacterial eye systemic) may be used in intra-ocular
ointment to the lid margins and to the infection.
conjunctival sac to prevent spread of USE IN MIXTURE WITH CORTICO-
infection there. Systemic treatment may STEROIDS. Many antibiotic
occasionally be needed. It is usually preparations also incorporate a
given after culture of organisms from lid corticosteroid. For symptomatic relief
margin and determining their antibiotic and when accurate diagnosis can not
sensitivity. Antibiotic such as be made such mixtures should not be
tetracycline given for 3 months or used. In particular they should not be
longer may be appropriate. But above prescribed for undiagnosed ‘red eye’,
all maintenance of lid hygiene is the which is sometimes caused by the
most important step to improve the herpes simplex virus and may be
condition. difficult to diagnose These preparations
Acute infective conjunctivitis is treated can be used postoperatively after
with antibacterial eye drops and intraocular surgery.
ointment. Initial treatment should not be ADMINISTRATION
started with a sophisticated, newly
discovered broad-spectrum anti- Eye drops: Instillation varies according
infectives, which should be kept to the severity of infection. It varies from
reserved for unresponsive resistant every minute to 2- 3 times a day. Some
cases. A poor response might indicate preparation needs very infrequent
viral or allergic conjunctivitis. instillation to exert antibacterial effect in
Gonococcal conjunctivitis is treated with the maintenance therapy e.g. twice
systemic and topical antibiotics. daily with lomefloxacin and fusidic acid.
Corneal ulcer and keratitis require Eye ointment: Apply either at night (if
specialist treatment in specialized eye drops used during the daytime) or
clinics where facilities of taking swabs 3-4 times daily (if eye ointment used
and scrapping for gram staining, alone).
Potassium Hydroxide preparations and
culture is available. All the facilities are 10.2.1 ANTIMICROBIALS
needed for prompt, precise and (see section1.1)
accurate diagnosis of the cause of the
disorder. Prompt accurate diagnosis
and management save million eyes AZITHROMYCIN DIHYDRATE
from blindness. Treatment options
include specific, broad spectrum or Indications:Trachomatous
fortified topical antibiotics, subconjunc- conjunctivitis caused by Chlamydia
357
10. EYE
trachomatisand purulent bacterial Glophen (Globe), Eye drops, 0.50%, Tk.

conjunctivitis. 34.00/10ml
Side- Icol (ACI), Eye/ Ear drops, 0.50%, Tk. 34.5/10ml
I-guard (Incepta), Eye/Ear drops , 0.50%, Tk.
effects:Oculardiscomfort(including 34.40/10ml
pruritus, burning), blurred vision; less Nidependiol (Pacific), Eye drops, 0.50%, Tk.
commonly eyelid eczema,eyelid 34.00/10ml
erythema, eyelid oedema, conjunctival Ocuclor (General), Eye Oint., 1%, Tk.
hyperaemia,keratitis 8.52/3gm,Tk.. 12.54/5gm, Eye drops, 0.50%, Tk.
Dose: Apply twice daily for 3 days; 34.37/10ml
review if no improvementafter 3 days Ocutrex (Beximco), Eye drops, 0.50%, Tk.
34.50/10ml
Opsomycetin (Opsonin), Eye drops, 0.50%, Tk.
44.71/ 60 ml
Optabac (Popular), Eye drops, 0.50%, Tk.
Azithromycin 1%
34.37/10ml,;
Opthacol (Drug Intl), Eye / Ear Drops, 0.50%, Tk.
AZ(Aristo), Eye drops, Tk. 120.00/2.5ml,; 30.10/10ml
Azicin(Opsonin), Eye drops, Tk. 120/2.5 ml Optichlor(Jayson), Eye drops,Tk. 20.23/10 ml;
Azin, (Acme), Eye drops, Tk. 110.41/2.5ml Oint., 1%, Tk. 12.04/5 gm
Odazyth(ACI), Eye drops, Tk. 110.41/2.5 ml Opticol (Asiatic), EyeOint., 1%, Tk. 8.34/3gm Eye
Romycin(Ibn Sina), Eye drops, Tk. drops, 0.50%, Tk. 34.39/10ml
115.00/2.5ml Ramphen (Kemiko), Eye drops, 0.50%, Tk.
Zibac(Popular), Eye drops, Tk. 110.41/2.5ml 35.00/10ml
Zimax(Square), Eye drops,Tk.110.34/5ml SQ-Mycetin (Square), Eye/Ear drops, 0.50%, Tk.
Zita(Kemiko), Eye drops, Tk. 120.35/2.5 ml 34.5/10ml
Dexamethasone 0.1%+ Chloramphenicol 0.5%
CHLORAMPHENICOL[ED] A-PhenicolD(Acme), Eye drops, Tk. 70.21/5ml
CloramD(Ibn Sina), Eye drops, Tk. 70.00/5ml
Chlormet(Beximco), Eye drops, Tk. 70.00/5ml
Indications: Superficial ocular Chlorodex(Nipa), Eye drops, Tk. 70.00/5ml
infections as it has the broadest Decalor(Jayson), Eye drops,Tk. 50.33/5 ml
spectrum and lowest propensity for Decason(Opsonin), Eye drops,Tk. 70/5ml
generating resistance in organisms (see Denicol(ACI), Eye drops, Tk. 70.00/5ml
also section 1.1.12) Dexaguard(Incepta), Eye drops, Tk. 70.00/5ml
Cautions: Blood dyscrasia secondary Dextor C(Eskayef), Eye drops, Tk. 70.00/5ml
Dexacol(Opso Saline),Eye drops,Tk. 70.00/5ml
to bone marrow hypoplasia can occur
DexagenC(General), Eye drops, Tk. 70.21/5ml
Side-effects: Hypersensitivity, transient Dexonex(Square), Eye drops, 0.5%+0.1%, Tk.
stinging, bitter taste in mouth 70.21/5ml
Dose:4-5 times daily.In severe infection Dexchlor(G.A.Co), Eye drops, Tk. 70.22/5ml
2/4 hourly can be given. Eyephen(Healthcare), Eye drops, Tk. 70/5 ml
Note: Should not be used in patient Glophen(Globe), Eye drops, Tk. 70.00/5 ml
with severe blood dyscrasia, family Nidependiol-D(Pacific), Eye drops, Tk. 70/5ml
Opticol-D(Asiatic), Eye drops, Tk. 70.00/5ml
history of bone marrow depression, new
Orbidex C(Popular), Eye drops, Tk. 70.00/5ml
born. Not recommended for prolonged Sonexa-C(Aristo), Eye drops, Tk. 70.00/5ml
use. Stenicol(Drug Intl), Eye drops, , Tk. 60.20/5ml
Ramdex(Kemiko), Eye drops, Tk. 70.21/5ml
Aristophen (Aristo), Eye drops, 0.50%, Tk. AMINOGLYCOSIDES
34.40/10ml
Chlorovis (Biopharma), Eye drops , 0.50%, Tk. (See also section 1.1.4)
34.40/10ml These antibioticsmay causeirreversible,
Chlorphen (Nipa), Eye drops, 0.50%, Tk.
30.00/10ml, Eye Oint., 1%, Tk. 8.50/3gm
partial or total deafness when given
Cloram (Ibn Sina), Eye drops, 0.50%, Tk. systemically or when applied topically to
34.39/10ml,Eye Oint., 1%, Tk. 13.00/5gm open wounds or damaged skin. This
Conicol (Opsonin), Eye /Ear drops, 0.50%, Tk. effect is dose related and is enhanced
34.40/ 10 ml by renal or hepatic impairment.
Eyephen (Healthcare), Eye drops, 0.50%, Tk. Although this effect has not been
34.00/10 ml reported following topical ocular use,
358
10. EYE
the possibility should be considered Dexamethasone + Neomycin Sulphate

when high dose topical treatment is + Polymixin B Sulphate
given to small children or infants. These
group of drugs are nephrotoxic and Indications: Inflammatory ocular
ototoxic. conditions: Management of
corticosteroid-responsive inflammatory
GENTAMICIN[ED] ocular conditions where bacterial
infection or a risk of bacterial infection
Indications: Effective against many exists.
gram negative organisms (Specially
Pseudomonas aeruginosa) and Proprietary Preparations
Staphy-lococci (see also section 1.1.3). Polydex-N(Aristo), Eye Oint.,Tk. 50.00/3gm,;
Eye drops,Tk. 90.00/5ml
Topical preparation can be
strengthened to 2% to have effective
Prednesolone acetate+Neomycin
concentration in anterior chamber.
sulfate+Polymixin B sulfate
Cautions : Patient with renal toxicity. It
Indications : To treat bacterial
should not be introduced intraocularly
infections of the eyes.
as it can cause corneal endothelial
damage if injected in anterior chamber
and retinal infarction if injected Polyforte(Aristo), Eye drops,Tk.150.00/5 ml
intravitreally. Prolonged use may PoyPred(I)(Allergen),Eye drops,
develop resistance and chances of Tk.188.42/5ml
superinfection. It may retard corneal Poly(Eskayef), Eye drops, Tk. 223.75/5ml
wound healing
Dose :See section 10.2 TOBRAMYCIN
Proprietary Preparations Same spectrum as that of gentamicin

Gentamicin 0.3%, but the effect on pseudomonas is even
Asigen(Asiatic), Eye/Ear drops, Tk. 3210ml better.
Genacyn(Square), Eye/Ear drops, Tk.
32.12/10ml,; Oint. , Tk. 12.09/10gm Proprietary Preparations
Gentacin(Acme), Eye Oint., Tk. 9.78/3.5gm Tobramycin 0.3%
Gisin(Nipa), Eye/Ear drops, Tk. 30.36/10ml Cinarex(Beximco), Eye drops, Tk.
Gentin(Opso Saline), Eye Oint. Tk. 6.79/3 100.00/5ml
gm; Eye drops, Tk. 23.59/10 ml Gentob(General), Eye drops, Tk. 100.00/5ml;
G-Gentamicin(Gonoshasthaya), Eye/Ear Eye Oint.,Tk. 80.00/3gm
drops, Tk. 25.00/10 ml Intobac(Incepta), Eye drops, 0Tk. 90.00/5ml;
Igen(ACI), Eye drops, 32.12/10ml Ocutob(Globe), Eye drops, Tk. 85.00/5 ml
T-Mycin(Aristo), Eye drops, Tk. 100.00/5ml; Eye
NEOMYCIN Oint., Tk. 80.00/3g
Tobi(Asiatic), Eye drops, Tk. 80.00/5ml
Powerful bactericidal antibiotic. It is Tobirax(G.A.Co), Eye drops, Tk. 90.27/5 ml; Eye
added to many antimicrobials and oint., Tk. 60.00/3.5 gm
Tobrabac(Popular), Eye drops, Tk. 85.32/5ml;
steroid preparations
Onit., Tk. 60.00/3 gm
Indications : Acanthamoeba keratitis Tobram(Pacific), Eye drops, Tk. 100.00/5ml
Side-effects : It has the propensity to Tobramin(Nipa), Eye drops, Tk. 90.00/5ml
induce allergy. Tobrel(Healthcare), Eye drop, Tk. 100.00/5 ml
Dose :See section 10.2 Tomin(Kemiko), Eye drops, Tk. 100.00/5ml
Tomycin(Ibn Sina), Eye drops, Tk. 90.00/5ml;
Proprietary Preparations Oint., Tk. 55.00/3gm
Neomycin Sulphate 500 IU + Bacitracin Zinc1 Torcin(Opsonin), Eye drops, Tk. 90.00/5ml
Lac IU/gm, Xitob(Biopharma), Eye drops , Tk. 90.00/5ml
Polymix(Opso Saline), Eye Oint, . Tk.
26.41/3 gm Tobramycin 0.3% + Dexamethasone0.1%,
Polytracin (Ibn Sina), Eye Oint, Tk. Indications :This medication treats or prevents
65.00/5gm only bacterial eye infections
359
10. EYE
CinarexD(Beximco), Eye drops, Tk. 150.00/5ml
CIPROFLOXACIN[ED]
Dexagen(General), Eye drops, Tk.
150.45/5ml,;Oint., Tk. 90.28/3gm
Dextor(Eskayef), Eye drops, Tk. 150.00/5 ml Indications:Corneal ulcer, used for any
Dextrobac(Incepta), Eye drops, Tk. 150.00/5ml eye infection pre and post-operative
Eytex(Nipa), Eye drops, Tk. 150.00/5ml,; Oint., prophylaxis in intraocular surgery. It is
Tk. 90.00/3gm especially useful to combat methicillin
Infladex(Biopharma), Eye drops Tk. 150.00/5ml
resistant Staphylo-cocci,
Orbidex(Popular), Eye drops, Tk. 150.00/5ml,;
Onit., Tk. 90.00/3 gm Pseudomonas, and Gonococci
Steron-T(Acme), Eye drops, , Tk. 130.39/5ml Cautions : CHILD under 1 year of age
Texa(Drug Intl), Eye drops, Tk. 125.40/5ml Side-effects : Local burning sensation,
T-Mycin Plus(Aristo), Eye Oint., Tk. discomfort, foreign body sensation,
115.00/3.5g,;dropsTk. 150.00/5ml conjunctival hyperemia white crystalline
Tobicort(Asiatic), Eye drops, Tk. 150.00/5ml,; precipitate
Oint., Tk. 90.00/3.5gm
Dose :See section 10.2.
Tobidex(G.A.Co), Eye Oint.,Tk. 90.27/3.5 gm,;
drops,Tk. 145.00/5 ml Intensive application (especially in the
Tomin(Kemiko), Eye drops, Tk. 150.00/5ml first 2 days) isrequired throughout the
TomycinD(Ibn Sina), Eye drops, Tk. 150.00/5ml,; day and night.Dose frequency depends
Oint., Tk. 90.00/3.5gm on severity of the infection.
FLUOROQUINOLONES Proprietary Preparations
Ciprofloxacin 0.3%
(See also section 1.1.7) Aprocin(Aristo), Eye/Ear drops, Tk.
Broad-spectrum bactericidal antibiotic 50.00/10ml,; Oint., Tk. 35.00/3gm,;
effective against Staphylococci, Bactin(Ibn Sina), Eye drops, Tk. 50/10ml,
Pseudomonas, Brucella, Haemophilus, Tk. 35.14/5ml,Tk. 90.00/10ml,;
Morexella, N. gonorrhoea, Klebsiella, Cip(Asiatic), Eye Oint., Tk. 32.00/3gm,;
but less effective against Streptococci Eye/Ear drops, Tk.45.00/10ml
and Pneumococci. Civox(Popular), Eye drops, Tk. 35.13/Vial
Floxacin(Navana), Eye drops, Tk. 50/10 ml
They produce effective and long lasting Lox Eye(Apex ), Eye drops, Tk. 35.00/5 ml;
concentration in tears. Ear dropsTk. 50/10 ml
Rocipro(Healthcare),Eye drops,Tk. 75/5 ml
BESIFLOXACIN Beuflox(Incepta), Eye/Ear drops , 0Tk.
Indications:Conjunctivitis caused by 40.00/5ml
susceptible strains of CDC coryneform Ciflocin(Astra Bio), Eye drops, Tk. 40.00/5ml
group G, Corynebacterium Cipcin(Biopharma), Eye drops , Tk.
40.00/5ml
pseudodiphtheriticum, C. striatum,
Ciprin(Nipa), Eye drops, Tk. 50.00/10ml,; Tk.
Haemophilus influenzae, Moraxella 40.00/5ml,; Oint. Tk. 35.00/3gm,;
lacunata, Staphylococcus aureus, S. Neofloxin(Beximco), Eye drops, Tk.
epidermidis, S. hominis, S. lugdunensis, 40.00/5ml
Streptococcus mitis group, S. oralis, S. G-Cipro(Gonoshasthaya), Eye drops, Tk.
pneumoniae, or S. salivarius. 15.00/10 ml
Side-efffects: Redness, blurred vision, Ciproxy(Opso Saline), Eye /Ear drops, Tk.
38.00/10 ml
pain, irritation, pruritus and headache
Ciprox(Opsonin), Eye/Ear drops, Tk.
Dose: One drop in the affected eye(s) 3 40.15/1ml
times a day, four to twelve hours apart Ciprocin(Square), Eye/Ear drops, Tk.
for 7 days. 40.27/5ml
Procin(Kemiko), Eye drops, Tk. 50.14/10ml
Proprietary Preparations Ciprozid(Drug Intl), Eye/Ear drops, Tk.
Besifloxacin 0.6% 40.15/10ml
Besibac(Popular), Eye drops, Tk. 350.00/5 ml Cero(G.A.Co), Eye drops, Tk. 50.15/10
Besiven(Incepta), Eye drops, Tk. 350.00/5ml, ml,Tk. 40.12/5 ml,; Oint., Tk. 35.00/5 gm,
Besiflox(Aristo), Eye drops, Tk. 350.00/5ml CiproA(Acme), Eye drops, Tk. 40.12/5ml,;
Besigen(General), Eye drops, Tk. 351.06/5ml Floxabid(ACI), Eye drops, Tk. 40.12/5ml
Florobex(Ibn Sina), Eye drops., Tk. 350.00/5ml Spectra(Jayson), Eye/Ear drops,Tk.40.12/5
Floxiquin(Asiatic), Eye drops., Tk. 350.00/5ml ml
360
10. EYE
Ciprofloxacin 0.3% + Dexamethasone 0.1% Floxigat(Asiatic), Eye drops0.3% Tk.

Opdex(Nipa ), Eye drops,Tk. 75.00/5 ml 60.00/5ml
Procin-D(Kemiko), Eye/Ear drops,Tk. Gatibac(Popular), Eye drops, 0.3%Tk. 100/5
75.22/5 ml ml
Aprodex(Aristo), Eye/Ear drops, Tk. Gatiflox(Incepta), Eye drops, 0.3%Tk.
75.00/5ml 100/5ml
BactinD(Ibn Sina), Eye/Ear drops, Tk. Gatiflox ES(Incepta), Eye drops, 0.5%,
75.28/5ml Tk.125.00/5ml
BeufloxD(Incepta), Eye/Ear drops , Tk. Gatigen(General), Eye drops, 0.3% Tk.
75.00/5ml 100.30/5ml
Cerodex(G.A.Co), Eye/Ear drops, Gatsina(Ibn Sina), Eye drops, 0.3%Tk.
Tk.75.23/5ml 100.00/5ml
Cipcin-DX(Biopharma), Eye drops , Tk. Tag(Aristo), Eye drops, 0.3%Tk. 100.00/5ml
75.00/5ml T-Get(Opsonin), Eye drops,0.3%Tk. 100/5 ml
Cip-D(Asiatic), Eye/Ear drops, Tk. Zymar(Eskayef), Eye drops,0.3%Tk.
75.00/5ml; 247.72/5ml,
CiproD(Acme), Eye Drops, Tk. 75.22/5ml Zymarin(Eskayef),Eye drops,0.5%Tk.
Ciprozid-DX(Drug Intl), Eye/Ear drops, Tk. 125.00/5ml
75.25/5ml Xegal(Beximco), Eye drops, 0.3%Tk. 90/5ml
Civodex(Popular), Eye/Ear drops, Tk.
75.28/5ml Gatifloxacin , 0.3% + Loteprednol
Dexaflox(General), Eye/Ear drops, Tk. Etabonate0.5%,
75.22/5ml Gatinol(Acme), Eye drops.,Tk. 250.00/5ml
Dexcilo(Pacific), Eye/Ear drops, Tk. Lotenol(Popular), Eye drops, Tk. 250.00/5ml
75.00/5ml Lotepro(Incepta), Eye drops, Tk. 250.00/5ml
Neofloxin D(Beximco), Eye/Ear drops, Tk.
75.00/5 ml Gatifloxacin0.3% +Dexamethasone0.1%,
Opdex(Nipa), Eye/Ear drops,Tk. 75.00/5ml DexagenG(General), Eye drops, Tk.
Procin(Kemiko), Eye/Ear drops, Tk. 120.37/5ml
75.22/5ml Gatison(Aristo), Eye drops, Tk. 120.00/5ml
Rocipro(Healthcare), Eye/Ear drops, Tk. Dexon(Ibn Sina), Eye drops, Tk. 120.00/5ml
75.00/5 ml OrbidexG(Popular), Eye drops, Tk.
120.00/5ml
GATIFLOXACIN
Indications:Bacterial infections (e.g. LEVOFLOXACIN
Bacterial conjunctivitis, Blepharitis and
Blepharo-conjunctivitis) caused by Indications: Postoperative ocular
susceptible strains of the following infection and bacterial conjunctivitis;
organisms: Aerobic Gram-Positive endopthalmitis
Bacteria, Corynebacterium propinquum, Contraindication: Hypersensitivity to
Staphylococcus aureus, levofloxacin
Staphylococcus epidermidis, Side-effects:Transient decreased
Streptococcus pneumonia, Aerobic vision, fever, foreign body sensation,
Gram-Negative Bacteria Haemophilus headache, ocular pain, discomfort,
influenza. photophobia
Cautions: Pregnancy & Breast-feeding. Dose: Day 1&2: 1-2 drops in the
Side-effects: Bad taste in the affected eye(s) every 2 hours while
mouth,blurred vision, eye discharge, awake up to 8 times /day
headache, irritation, pain, dryness, or Day 3 to 7:1-2 drops in the affected
redness of the eyes, itchy eyes, tearing eye(s) every 2 hours while awake up to
and watery eyes. 4 times per day
Dose: Days 1 and 2; 1 drop into the
affected eye(s) every 2 hours while Proprietary Preparations
awake, up to 8 times daily. Asilee(Asiatic), Eye drops, 1.5%, Tk.130/5ml,
Days 3 to7 days; 1 drop up to 4 times Evo(Beximco), Eye drops, 0.5%, Tk.90/5ml,
1.5%, Tk. 130.00/5ml
daily while awake. Genolev(General), Eye drops, 0.5%, Tk.
Proprietary Preparations 90.28/5ml,; 1.5%, Tk. 130.39/5ml,.
Leo(Acme), Eye drops, 0.5%, Tk. 80.55/5ml
Lequin(Apex), Eye drops, 0.5% Tk. 80/5 ml
361
10. EYE
Levomax(Eskayef)Eye drops, 0.5%, Optilom(Healthcare), Eye Drop, Tk. 80/5 ml

Tk.90/5ml Optilom(Healthcare), Eye dropsTk.80/5 ml
Levoquin(Navana), Eye drops,0.5%,Tk.90/5 Safquin(Apex), Eye drops, Tk.60/5 ml
ml
Levolo(Pacific), Eye drops, 0.5% , Tk. 90/5ml MOXIFLOXACIN
Lin(Kemiko), Eye drops, 0.5%, Tk. 90.00/5ml
Locin(Globe), Eye drops, 0.5%, Tk. 90/5 ml
Lovicin(Nipa), Eye drops, 0.5%, Tk. 90/5ml,; Indications: Same asthat of
Leflox(ACI), Eye drops, 0.5%, Tk. 87.00/5ml, Ciprofloxacin with less chances of
1.5%, Tk. 128.00/5ml resistance.;less effective in
Lifcin(Biopharma), Eye drops, 1.5%, Tk. Pseudomonas than Ciprofloxacin
130.00/5ml,; Cautions: Not recommended for
Levoflox(Drug Intl), Eye drops, 0.5%, Tk.
neonates
80.25/5ml
Livacin(GA.Co), Eye drops, Side-effects:Taste disturbances, ocular
0.5%,Tk.90.27/5ml discomfort(including pain, irritation and
Levobac(Popular), Eye drops, 0.5%, Tk. dryness), hyperaemia;
90.00/5ml,; 1.5%, Tk. 130.00/5ml Dose:Varies according to the dose of
Levox(Opsonin), Eye Drops, 0.5%, Tk. infection. ADULT and CHILD over 1
90.00/5ml,; 1.5%, Tk. 130.00/5ml,; month, apply 3-8 times daily(continue
Levosina(Ibn Sina), Eye drops, 0.5% , Tk.
treatment for 2–3 days after
90.00/5ml,; 1.5%, Tk. 130.00/5ml,;
Levoxin(Incepta), Eye drops, 0.5%, infectionimproves; review if no
Tk.130.00/5ml,; 1.5% , Tk. 90.00/5ml improvement within 5 days)
Ovel(Aristo), Eye drops, 1.5%, Tk.
130.00/5ml,; 0.5%, Tk. 90.00/5ml Proprietary Preparations
Resquin(Healthcare) Eye drops,0.5%,Tk. Moxifloxacin 0.05%,
90/5ml Cinagen(Navana),Eye drops, Tk.160/5 ml
Revacin(Reman) Eye drops, 0.5%, Tk.150/5 Eyemox(Acme), Eye drops., Tk. 100.68/5ml
ml; Eye ; 1.5%, Tk. 150.00/5 ml Floromox(Ibn Sina), Eye drops., Tk.
100.00/5ml,;
LOMEFLOXACIN Floxalone(Drug Intl), Eye drops, Tk.
80.25/5ml,;
Indications:Same as that of Floximox(Asiatic), Eye drops, Tk.
Ciprofloxacin.Bactericidal cone in AC 100.00/5ml;
reached by topical application. Glomox(Globe), Eye drops, Tk 100.00/5 ml
Incidence of resistance is less frequent Iventi(Square), Eye drops, Tk. 100.68/5ml,;
Kilgen(G.A.Co), Eye drops, Tk. 100.30/5 ml
than ciprofloxacin. It can be given in Maxiflox(ACI), Eye drops, Tk. 100.68/5ml ,;
children under 14 years of age MFC(Nipa), Eye drops, Tk. 100.00/5ml
Side-effect: Photosensitivity Moxibac(Popular) Eye drops Tk. 100.38/5ml,
Dose : One drop twice daily Moxif(Biopharma), Eye drops, Tk.
Lomefloxacin 0.3%, Moxigen(General), Eye drops, Tk.
Lomebac(Popular), Eye drops, Tk. 70.00/5ml 140.00/5ml
Lomeflox(Aristo), Eye drops, Tk. 70.00/5ml, Moxigram(Apex), Eye drops,Tk.100/5 ml;
Lomegen(General), Eye drops, Tk. Moxikem(Kemiko), Eye drops, Tk.
70.21/5ml 100.30/5ml
Lomequin(Incepta), Eye drops, Tk. Moxilocin(Opsonin), Eye drops,
70.00/5ml Tk.100.38/5ml
Lomexa(Opsonin), Eye drops,Tk. 70.00/ 5ml Moxivin(Healthcare), Eye drops, Tk.
Lumex(G.A.Co), Eye drops, Tk. 65.00/5 ml 100/5ml
Lyflox(Ibn Sina), Eye drops, Tk. 70.00/5ml Moxlocin(Pacific), Eye drops, Tk. 100.00/5ml
Meflocin(Asiatic), Eye drops, Tk. 70.00/5ml Moxquin(Incepta), Eye dropsTk.Tk.
Mexlo(Square), Eye drops,Tk. 70.21/5ml 160.00/5ml
Namicin(Nipa), Eye drops, Tk. 70.00/5ml Odycin(Beximco), Eye drops, Tk. 140.00/5ml
Ocuflox(Biopharma), Eye drops , 0.3%, Tk. Optimox(Aristo), Eye drops,Tk. 150.00/5ml,
70.00/5ml Tk. 130.00/5ml,;
Omeflox(ACI), Eye drops, Tk. 68.00/5ml Visomox(Eskayef), Eye drops, 0.5%, Tk.
Opthaflox(Drug Intl), Eye drops, Tk. 140.00/5ml,;
60.20/5ml
Optiflox(Jayson), Eye drops, Tk. 50.20/5 ml Moxifloxacin with xanthin gum
362
10. EYE
Moxquin XG(Incepta) Eye drops,Tk.150/5ml FUSIDIC ACID

Moxigen(General), Eye drops, 0.50%, Tk.
150.00/5ml Indications: Broad spectrum antibiotic;
Mfc XG(Nipa), Eye drops, , Tk. 145.00/5ml effective mainly against Gram-positive
Moxibac XG(Popular),Eye drops Tk.
organisms especially Staphylococci.
150.00/5ml
Caution: High rate of development of
Dexamethasone Phosphate 0.1% + resistance
Moxifloxacin Hydrochloride 0.5%, Dose: Twice daily application is
Dexamox(Aristo), Eye drops, Tk. 200.00/5ml sufficient for acute conjunctivitis
Moxidex(Popular), Eye drops,Tk. 200.00/5
ml Proprietary Preparations
VisomoxD(Eskayef), Eye drops, Tk. Fucithalmic(I)(Leo), Eye drop 1%.,
200.00/5ml,; Tk.249.78/5g
Fusithal(Aristo), Eye drops, 1%,Tk. 250/5gm
OFLOXACIN
POLYMYXIN B
Indications:Same as that of
Ciprofloxacin Bactericidal; effective particularly
Cautions: Corneal ulcer or epithelial against gram negative organisms
defect (risk of corneal perforation); including Pseudomonas (proteus is
Pregnancy and breast-feeding. resistant). It can not penetrate into the
Side-effects:Ocular discomfort and eye.
irritation; alsoreported facial oedema, Dose :See in section 10.2
keratitis,visualdisturbances,photophobia Proprietary Preparations:
,increased lacrimation, ocular See under Neomycin
oedema,dry eyes, ocular hyperaemia
Dose:See section 10.2. VANCOMYCIN
(See section 1.1.12)
Proprietary Preparations Indications: Active against many
Ofloxacin 0.3%, Gram-positive organisms including
Obactin(Ibn Sina), Eye drops,Tk. 85.00/5 ml Streptococci, Staphylococci,
Vista(Aristo), Eye/ Ear drops, Tk. 85.00/5 ml
Corynebacterium, Clostridium; (Gram-
SULPHACETAMIDE negative bacteria, Mycobacteria and
fungi are resistant)
Bacteriostatic; action on Gram-positive, Dose: For intravitreal injection 1mg in
Gram-negative organisms and 0.1 ml. Intravitreal injection to be given
Chlamydiae . only by experts in the OT for
Indications : Trachoma and inclusion endophthalmitis
conjunctivitis
Side-effects: Irritation, burning, GenericPreparation
conjunctival hyperemia, and allergic Intravitreal injection 1mg/0.1ml
reactions
Dose :See notes above. TETRACYCLINES
Optacid(Reman),Eye Bacteriostatic; effective against wide
drops,20%Tk.45.00/10ml spectrum of Gram-positive and Gram-
Icid(Nipa) Eye drops,20% Tk. 27.00/10ml negative organisms, Chlamydia,
Optimide(Jayson) Eye drop, 20% Tk. Borrelia. Many strains like Proteus,
22.40/10ml Pseudomonas, Staphylococci develop
resistance.They are readily penetrate
PEPTIDE ANTIBIOTICS corneal epithelium
They are usually used in combination
(except vancomycin). TETRACYCLINES[ED]
Indications : Chlamydial infections
(trachoma and inclusion conjunctivitis)
363
10. EYE
Contraindications : Pregnancy and are two important causes of fungal

lactation infection; one is trauma;trauma may be
Side-effects: More chance of super accidental- particularly involving plants
infection and vegetable matter, surgical trauma
Dose :See section 10.2 and Immunosuppression due to
prolong use of antibiotics, topical or
Proprietary Preparations systemic steroid preparations.
Tetracycline hydrochloride1% Superficial mycoses appear on the lids,
A-Tetra(Acme), Eye Oint., Tk.11.55/5gm; lid margins, conjunctiva. Keratomycosis
Tk.8.50/3.5gm
G-Tetracycline(Gonoshasthaya), Eye/Ear
(affection of the cornea) usually follows
Oint. Tk. 8.00/5 gm trauma. One should suspect its
presence in all cases of agricultural
CEPHALOSPORINE trauma. Filamentous fungi are mostly
(See also section1.1.2) found after trauma in our country.
Mycotic endophthalmitis may occur
after perforating injury or intraocular
CEFUROXIME surgery.
It can be administered by intracameral Mycotic infection should be confirmed
injection for the prophylaxis of by simple microscopic examination of
Endophthalmitis following cataract the infected materials (KOH
surgery. preparations and Gram staining).
Indication: Prophylaxis of end
ophthalmitis after cataract surgery POLYENE ANTIBIOTICS
Cautions:Severe risk of infection,
complicated cataracts or combined
operations with cataract surgery, severe AMPHOTERICIN B
thyroid disease, reduced corneal (See also section 1.2.1)
endothelial cells (less than 2000) Most effective broad spectrum antibiotic
Dose:By intracameral injection, ADULT for systemic fungal infection.
over 18 years, 1mg into the anterior Indications: keratomycosis, metastatic
chamber of the eye at the end of and endogenous endophthalmitis.
cataract surgery Effective against yeast and filamentous
fungi (see also section 1.2.1).
Generic Preparation It has numerous side-effects after IV
intracameral injection1.0 mg/0.1 ml use.
Use in ophthalmology is limited to
ANTIBIOTIC STEROID intravitreal injections to be given by
COMBINATIONS experts for fungal endophthalmitis.
Can be used topically after preparing in
Following combination products are conc. of 0.1% to 1% but the preparation
used in different infective conditions. is very much irritant for routine use.
Chloramphenicol+Dexamethsone Generic Preparations
Ciprofloxacin+ Dexamethsone intravitreal injections :Not available
Gatifloxacin+ Dexamethsone
NATAMYCIN
See under Chloramphenicol Can be used topically only; wide
Ciprofloxacin/Gatifloxacin spectrum like amphotericin B.
Indications: Effective against filamen-
tous fungi and Candida albicans. It
10.2.2 ANTIFUNGALS may be supplemented by ketoconazole
(See also section 1.2) Side-effects: It only penetrates
Fungal infection of the eye is one of the superficially into the cornea so it can
important considerations for tropical, not be used for deep fungal infections.
hot & humid countries. Fungi can infect
any part of the eye or its adnexia. There
364
10. EYE
As debridement of corneal epithelium

aids its penetration, it is an important Proprietary Preparation
tool far successful treatment. See Section 1.2.1 under Ketoconazole
Dose :See section 10.2
TRIAZOLES
Natamycin 5%
Natagen(General), Eye drops, Tk. FLUCONAZOLE[ED]
100.30/5ml Indications : Effective against Candida
Natapro(Popular), Eye drops, Tk. 100.00/5ml
and Cryptococcus infections.
Natoph(Ibn Sina), Eye drops, Tk. 100.00/5ml
Nicin(Nipa), Eye drops, Tk . 100.00/5ml Absorption on oral administration is
N-Mycin(Aristo), Eye drops, Tk. 100.00/5ml excellent.
Ocunat(Asiatic), Eye drops, Tk. 100.00/5ml Dose:1-2 drops to be instilled into the
affected eye 5times daily.
AZOLE DERIVATIVES
Fluconazol 0.3%
IMIDAZOLE Naz(Reman) ,Eye drops, Tk. 100.5/5 ml
Nispore(Incepta), Eye drops, Tk. 80/5 ml
The drug is less toxic than polyenes.
Indication: acanthaemeba infection; (See also section 1.2.1 under
because of its action on sterol Fluconazole)
synthesis, this drug should not be used
concurrently with polyenes; (see also VORICONAZOLE
section 12.2.2) (See also section 1.2.1)
Indications : Effective against invasive
CLOTRIMAZOLE[ED] aspergillosis, candidiasis and serious
fungal infections caused by
Scedosporium sp. or Fusarium sp. or
Indications : Wide spectrum against
invasive fluconazole resistant Candida
Aspergillus and Candida; less effective
sp.
against Fusarium. Used topically and
Side-effects:Visual disturbances
systemically against
(change in vision), fever , rash ,
Acanthaemebaalso.
nausea, vomiting, diarrhea ,headache
Proprietary Preparations ,swelling of the extremities , stomach
Clotrimazole 1% pains
Aristen(Aristo), Eye Oint., Tk. 80.00/3g/4 gm Dose:1%, eye drops are well tolerated
Clarizol(Incepta),Eye/Ear drops,Tk 80/10 ml and penetrate into aqueous humor
Fungizol(Reman), Eye Oint Tk.55.5/4gm when administered at hourly or 6-hourly
Eye/Ear drop, Tk.80/10ml. intervals
Fungin(Ibn Sina),Eye drops, 1%, Tk.
80.00/10ml
Generic Preparation
1%, Eye drops not available
KETOCONAZOLE
Candidal infection; well absorbed after
10.2.3 ANTIVIRALS
oral administration; relatively non-toxic.
Indications: Candida albican infections (See also section 1.4)
Cautions: if therapy is to be continued The common viral agents are adeno
for more than 2 weeks; then s-GPT, s- virus, herpes, simplex and zoster virus
GOT enzymes to be monitored. which commonly infect lid, periorbital
Side-effects: Pruritus, nausea, skin, conjunctiva, cornea, retina.
vomiting, diarrhoea, hepatotoxicity. Antiviral agents should not be used for
Dose: 200-800 mg daily with meal. undiagnosed red eye with corneal
Treatment must be maintained over affection as these agents itself might
weeks to months. cause different complications. Antiviral
topical drugs are most effective against
365
10. EYE
herpes simplex. In herpes zoster Proprietary Preparation

infection systemic antiviral drugs are Herplex(Opso Saline), Eye drops, 1 mg/ml,
the drugs of choice. Tk. 45.29/10 ml
ACICLOVIR[ED] TRIFLURIDINE
Acts specifically on virus infected cells; Indications : For the treatment of
relatively non-toxic. It can penetrate primary keratoconjunctivitis and
corneal epithelium and stroma recurrent epithelial keratitis due to
Indications : Stromal herpetic keratitis herpes simplex virus, type 1 and 2.
and disciform keratits Side-effects: Mild, transient burning or
Side-effects : Superficial punctate stinging sensation upon instillation.
keratitis, transient stinging. Other side effects are superficial
Dose : Ointment 5 time a day for punctate keratopathy, epithelial
herpes simplex keratopathy, hypersensitivity reaction,
stromal edema, irritation, keratitis sicca,
Proprietary Preparation hyperemia and increased intraocular
Aciclovir 3% pressure.
Acerux(Opsonin), Eye Oint., Tk. 45.17/3gm; Dose: 1 drop every 2 hrs while awake;
Acyvir(Aristo), Eye Oint., Tk. 125.00/5gm, maximum 9 drops/day until the corneal
Clovir(Ibn Sina), Eye Oint., Tk. 100.00/5gm
Cuvir(General), Eye Oint., Tk. 125.00/5gm
ulcer has completely re-epithelialized
Optivir(Biopharma), Eye Oint., Tk.
100.00/5gm Proprietary Preparation
Sevirax(G.A.Co), Eye oint., Tk. 70.21/5 gm Fludin(Aristo), Eye drops, 1%,Tk. 950/5 ml
Virine(Nipa), Eye Oint., Tk.100.00/5gm;
Cyclovex(Opso Saline), Eye Oint.,Tk. 10.3 CORTICOSTEROIDS, OTHER
33.96/3gm ANTI-INFLAMMATORY
PREPARATIONS. AND
GANCICLOVIR ANTIHISTAMINES
CORTICOSTEROIDS
Indications:Local treatment of herpes (See also section 5.3)
simplex infections
Side-effects: Burning sensation, Corticosteroids can be administered
tingling, superficial punctate keratitis topically to reduce ocular inflammation.
Dose: Apply 5 times daily until healing These drugs, when administered
complete, then apply 3 times daily for a topically, by subconjuctival injection,
further 7 days and systemically have an important
place in treating uveitis and scleritis;
Proprietary Preparations they are also used to reduce post-
Ganciclovir 0.15%
Genclovir(General), Eye Gel, Tk.
operative inflammation following eye
200.61/5gm operations.
Herpigel(Popular), Eye Gel,Tk. 200.00/5 gm Topical corticosteroids should be used
Xoviral(Aristo), Eye Gel, Tk. 200.00/5gm under expert supervision; they should
Zirgan(Ibn Sina), Eye Gel, Tk. 200.00/5gm not be prescribed for undiagnosed ‘red
IDOXURIDINE (IDU) eye’. The greatest danger in their use is
Indications : Herpes simplex keratitis that, by interfering with local defense
(see also section 1.4.1) mechanisms, they may either worsen
Side-effects : Corneal punctate the existing eye infection (particularly
erosions, follicular conjunctivitis, due to virus e.g. herpes simplex
scarring of conjunctiva, delayed wound keratitis or fungus) or aggravate the
healing, superficial pannus, lacrimal condition which may lead to loss of
obstruction, punctal occlusion, contact vision or even loss of the eye.
dermatitis Due to the use of eye drop
Dose : One drop hourly formulations, a ‘steroid glaucoma’ may
be produced in people susceptible to
366
10. EYE
steroid. Other side effects include BETAMETHASONE[ED]

cataract, thinning of the cornea and
sclera (with perforation); delayed Indications: Treatment for local
hypersensitivity reactions. In the inflammation
children Cushing’s syndrome can occur Cautions:See notes above
from systemic absorption due to Dose: Single drop every 1-2 hours until
prolong use. inflammation is controlled; then the
Systemic corticosteroids may be useful frequency is to be reduced; in case of
for various ocular conditions. The risk of eye ointment 2-4 times daily or at night
producing glaucoma is not great, but when used with eye drops
‘steroid cataract can develop if more
than 15mg of prednisolone is given Proprietary Preparations
daily for several years. The longer the B-Cort(Globe), Eye drops, 0.1%, Tk. 30/5 ml
duration, the greater is the risk. Other Betricin(Nipa), Eye/Ear drops, 0.1%, Tk.
risks of systemic steroid administration 29.33/5ml
should also be kept in mind. Eyebet(Incepta), Eye/Ear/Nasal drops ,
0.1%, Tk. 30.00/5ml
One of the great concerns for the use of
topical steroid in our country is that
Betamethasonesodium phosphate 0.1%
there is the increasing tendency for the +Neomycin sulfate0.5%
use of corticosteroids for chronic Indications:Local treatment of eye infection
allergic conjunctivitis. As patients get and bacterial infection
benefit from it, they medicate Dose: ADULT:Apply up to 6 times daily
themselves for prolong period without
having the knowledge of the Aristobet-N(Aristo), Eye,/Ear /Nasal drops,
Tk.35.00/5ml,
complications.
Betacine-N(Ibn Sina), Eye/Ear/ Nasal drops,,
Sub conjunctival injection is short Tk. 35.00/5ml
lasting than subtenon injection, which is BN Eye(Asiatic), Eye, Ear & Nasal Drops,
technically difficult. Sometimes Tk. 32.00/5ml
crystalline suspensions are given in the Methasol(G.A.Co), Eye,/Ear /Nasal drops,
periocular route which stays longer (4-8 Tk. 35.11/5 ml; Eye Oint., Tk. 14.00/5 gm
week or longer) and high conc. can be Optison-N(Opso Saline), Eye/Ear
Nasal/drops, Tk. 22.86/5 ml; Oint., Tk.
achieved within the vitreous cavity,
7.92/3 gm
choroids and optic nerve. Only experts
should consider Intravitreal route.
DEXAMETHASONE[ED]
Indications: Short term treatment for
COMPARISON OF DIFFERENT
local inflammation, Allergic condition if
TOPICAL STEROID PREPARATIONS
other antiallergic are not working
Prednisolone acetate exhibits the ,Uveitis
greatest anti-inflammatory activity on Cautions:See notes above.
the anterior segment of the eye Dose: Apply eye drops every 6 hours
including concentration in the aqueous. daily; in severe conditions every 30
Dexamethasone has a longer half-life minutes until inflammation is controlled;
in ocular tissue then other necessitating then the frequency is to be reduced
less frequent application. The drug can Proprietary Preparations
reach deep ocular tissue. Dexamethasone0.1%(Eye drop),0.05%(Eye
Fluoromethalonehas lower incidence ointment)
of steroid induced glaucoma.
Fluoromethalone alcohol is less Acicot(ACI), Eye drops, TK. 65.00/ 5ml
Celudex(Drug Intl), Eye /Ear drops, Tk.
effective than prednisolone acetate. But
60.20/5ml
fluoromethalone acetate is nearly as D-Cort(Globe), Eye drops, Tk. 70.00/5 ml,
effective as prednisolone acetate. Dexagen(General), Eye drops, Tk.
Loteprednol also has lower propensity 70.21/5ml,Oint.,Tk. 80.00/5ml
to increase intra ocular pressure. Dexacort(Opso Saline), Eye/Ear drops, Tk.
70.00/5 ml
367
10. EYE
Dexasia(Asiatic), Eye Oint., Tk. 35.00/3gm AFM-Plus(Aristo), Eye Oint. , Tk.

Dexon(Ibn Sina), Eye drops, Tk. 130.00/3g,;Eye drops, Tk. 110.00/5ml
70.00/5ml,;Oint. Tk. 60.00/3gm Fluorometholone +Tetrahydrozoline
Dexonex(Square), Eye/Ear drops, , Tk. AFM-T(Aristo), Eye drops, 0.1%+ 0.025%,
70.21/5ml,; Tk.100/5 ml
DM-Sone(Pacific), Eye drops, Tk. 70/5ml Metalone Plus(Incepta), Eye drops, 0.1%+
D-ONE(Nipa), Eye/Ear drops, Tk. 70/5ml 0.025%, Tk. 110/5 ml
Gludex(Kemiko), Eye drops, Tk. 70.21/5ml,; Eylon(Ibn Sina), Eye drops, 0.1%+ 0.025%,
Infladex(Biopharma), Eye drops , Tk. 70/5ml Tk. 100/5 ml
Inflavis(Beximco), Eye drops, Tk. 70/5ml Refemoline(Reman), Eye drops, Tk. 100/5ml
Metadaxan(Incepta), Eye/Ear drops Tk.
70.00/5ml
LOTEPREDNOL ETABONATE
Ocudex(Asiatic), Eye drops, Tk, 70.00/5ml
Orbidex(Popular), Eye drops, Tk. 70.00/5ml, Indications:Treatment of post-
Onit. Tk. 60.00/ operative inflammation following ocular
Sonexa(Aristo), Eye drops, Tk. 70.00/5ml,; surgery
Eye Oint. Tk. 80.00/3gm Cautions:See notes above
Steron(Acme), Eye drops, Tk. 70.21/5ml, Side-effects: Blurred Vision,fluid
Accumulation In Lining Of Eye With
FLUROMETHALONE Swelling,problems With Eyesight,red
Indications: Treatment for local Eye
inflammation Dose:Apply 4 times daily starting 24
Cautions:See notes above hours after surgery; max. duration of
Dose: Apply eye drops every 1-2 hours treatment 14 days
until inflammation is controlled; then the
frequency is to be reduced Proprietary Preparations
Loteprednol Etabonate 0.5%
Proprietary Preparations Lacrison(Beximco), Eye drops, Tk.
Fluorometholone0.1% 175.00/5ml
NGS(Opso Saline), Eye drops,Tk. 67.67/5 ml Loteflam(General), Eye drops, Tk.
Flurom(Apex), Eye drops, Tk. 80/5 ml 175.53/5ml,; Eye Gel, Tk. 150.00/3gm
Otholon(Navana), Eye drops, Tk. 90/5 ml Lotenate(Pacific), Eye drops, Tk. 175.00/5ml
Afm(Aristo), Eye drops, Tk. 100.00/5ml Lotenol(Popular), Eye drops, Tk. 175.00/5
Eylon(Ibn Sina), Eye drops, Tk. 100.00/5ml ml
F-Lon(Drug Intl), Eye drops, Tk. 80.00/5ml Lotepred(Aristo), Eye drops, Tk.
Flucort(G.A.Co), Eye drops, Tk. 95.00/5 ml 175.00/5ml,; Eye Gel , Tk. 200.00/5g
Fluflam(Eskayef), Eye drops, Tk. 100.00/5ml Lotepro(Incepta), Eye drops, Tk. 175.00/5ml
Flumeth(Nipa), Eye drops, Tk. 100.00/5ml Lotrel(Eskayef), Eye Gel, Tk. 200.00/5gm,;
Flurate(Pacific), Eye drops, Tk.100.00/5ml Eye drops, Tk. 175.00/5ml
Flurolon(General), Eye drops, Tk. LPD(Nipa), Eye drops, Tk. 175.00/5ml
100.30/5ml Olopred(Asiatic), Eye drops, Tk. 175.00/5ml
Fluromet(Popular), Eye drops, Tk.
100.00/5ml; Loteprednol Etabonate 0.5% + Tobramycin
Flurone(Biopharma), Eye drops, Tk. 0.3%
100.00/5ml Loteba(Navana), Eye drops, Tk. 200/5 ml
Flurosia(Asiatic), Eye drops, Tk. 100.00/5ml Lacrison(Beximco), Eye drops, Tk.
Metalone(Incepta), Eye drops, Tk. 200.00/5ml
100.00/5ml; Loteflam T(General), Eye drops, Tk.
Metholone(Kemiko), Eye drops, Tk. 200.61/5ml
90.27/5ml Lotemycin(Acme), Eye drops, Tk.l
Rubalon(Beximco), Eye drops, Tk. 200.00/5ml
100.00/5ml LotenolT(Popular), Eye drops, Tk. 200.75/5
Fluorometholone 0.1%+ Gentamicin0.3% ml
Indications: Inflammation associated with Lotepro Plus (Incepta), Eye drops, Tk.
infections in the anterior segment of the eye 200.00/5ml
due to bacteria susceptible to Gentamicin it is Olopred Plus(Asiatic), Eye drops,, Tk.
also indicated in postoperative infection 200.00/5ml
Inflagen(Asiatic), Eye drops., Tk. 130.00/5ml PREDNISOLONE[ED]

Indications: Local inflammation
368
10. EYE
Cautions:See notes above Flurbiprofen and Diclofenac may also

Dose: Apply eye drops every 1-2 be used to induce mydriasis and reduce
hours until inflammation is controlled; surgical miosis. NSAIDs act through
then the frequency is to be reduced inhibition of prostaglandin E2 synthesis.
Unlike topical steroids, they do not
Proprietary Preparations cause increased risk of infection. But all
Prednesolone acetate1% cause burning sensation after
Prednol(Reman),Eye drop,Tk.100/5ml instillation
Bexipred(Beximco), Eye drops, Tk.
100.00/5ml;
Indications:
Biocort(Biopharma), Eye drops ,Tk.
100.00/5ml
• Preoperatively for maintaining
Cortan(Incepta), Eye drops, Tk. 100.00/5ml;. blood aqueous barrier and for
Cortisol(Aristo), Eye drops, Tk. 100.00/5ml;. inhibition of intraoperative miosis
Isolon(Ibn Sina), Eye drops, Tk. 100.00/5ml during cataract surgery
Pednisol(Drug Intl), Eye drops, Tk. (Flurbiprofen and Diclofenac).
•
90.30/5ml;
Predflam(General), Eye drops, Tk. Pre and post operatively to control
100.30/5ml inflammation and for analgesia
Prednicort(Asiatic), Eye drops, Tk. 100/5ml (Diclofenac).
DIFLUPREDNATE • To control inflammation in

Indications: Treatment for the local episcleritis, scleritis, chemical
inflammation, postoparative ocular injury.
inflammation,uveitis.
Cautiona: Glaucoma, any type of
• Allergic conjunctivitis (ketorolac
0.5% is more useful than others)
ocular infection (including herpes)
Side effects:Blurred vision; change in
colour vision, eye discomfort, pain, BROMOFENAC
redness,photophobia,blepharitis,punctat Indication: Treatment of postoperative
e keratitis,increased intra ocular inflammation and reduction of ocular
pressure. pain in patients who have undergone
Dose: 4 times/day for two weeks ocular surgery (cataract extraction, IOL
followed by tapering as clinically implantation etc).
indicated. Dose: Applied to the affected eye(s)
pregnancy Warning: animal studies two times daily beginning 24 hours after
have shown this drug to be embryotoxic ocular surgery and continuing through
and teratogenic. There is no adequate the first 2 weeks of the postoperative
and well controlled studies in pregnant period.
woman. Side-effects: Abnormal sensation in
eye, conjunctival hyperemia, eye
Proprietary Preparations irritation (including burning/stinging),
Difluprednate 0.05%, eye pain, eye pruritus, eye redness,
Diflupred(General), Eye drops, Tk. headache and iritis
180.00/5ml
Dipred(Popular), Eye drops, Tk. 180.00/5 ml
Neopred(Aristo), Eye drops,Tk. 180.00/5ml
Acunac(General), Eye drops,0.09% Tk.
Predasin(Asiatic), Eye drops, Tk.
100.30/5ml
180.00/5ml
BFC(Nipa), Eye drops, 0.09% , Tk. 100/5ml
Bfenac(Popular), Eye drops, 0.09%, Tk.
NON STEROIDDAL ANTI 100.00/5 ml
INFLAMMATORY DRUGS (NSAIDs) Bromnac(Opsonin), Eye drops, 0.09%, Tk.
100.38/ 5 ml
(See also section 9.1.2).
Bromofen(Ibn Sina), Eye drops, 0.09%, Tk.
100.00/5ml
NSAIDs that reduce inflammation BSH(Opso Saline), Eye drops,0.09%
following ophthalmic surgery include Tk.75.19/5ml
Flurbiprofen, Diclofenac and Ketorolac.
369
10. EYE
Catalan(Healthcare), Eye drop, 0.09% , Tk. Proprietary Preparation

110.00/5 ml Ocufen(I)(Allergen), Eye drop. 0.03%,
Eyefen(Acme), Eye drops, 0.09% , Tk. Tk.164.54/5ml
100.30/5ml
Ocubrom(Square), Eye drops, 0.09%,
KETOROLAC TROMETHAMINE
Tk.100.68/5ml,; 0.07%, Tk. 90/5ml
Ocubronac(Asiatic), Eye drops, 0.09%, Tk.
100.00/5ml Dose: 1 drop 3 times daily
Optifen(Globe), Eye drops, 0.09%,
Refenac(Reman),Eye drop 0.09% Ketorolac Tromethamin 0.5%,
Tk.100/5ml Emodol(Jayson), Eye drops, Tk. 70/5 ml
Relye(Biopharma), Eye drops, 0.09% , Tk. Etolac(Ibn Sina), Eye Drops, Tk. 85.00/5ml
100.00/5ml Etorac(Incepta), Eye drops, Tk. 80/5 ml;
Romfen(Eskayef), Eye drops, 0.09%, Tk. Ketromin(Pacific), Eye drops, Tk. 80.00/5ml
90.00/5ml Lopadol(Popular), Eye drops, Tk. 80.30/5ml
Rotarac(ACI), Eye drops, 0.09% Tk. Ofpain(Kemiko), Eye drops, Tk. 80.00/5ml
90.00/5ml; 0.07%Tk.90.00/5ml Ofpain(Kemiko), Eye drops, Tk. 80/5 ml;
Rotarac(ACI), Eye drops,Tk. 95.36/5 ml Oradol(Aristo), Eye drops, , Tk. 80.00/5ml,;
Tk. 110.00/5ml Pair(Drug Intl), Eye drops Tk. 70.25/5ml
Xibrofen(Incepta), Eye drops , 0.09% Tk. Recular(Reman),Eye drop Tk.80.30/5ml
100.00/5ml Surpim(Asiatic), Eye drops, Tk. 80.00/5ml,
Xibrofen(Incepta), Eye drops, Tk. 100/5 ml Todol(Opsonin), Eye drops, Tk. 80.30/0.
Xirom(Aristo), Eye drops, 0.09% Tk. Toroaid(General), Eye drops, Tk.80.24/5ml,;
100.00/5ml Winop(Acme)Eye drops, Tk. 80.24/5ml
Xidolac(Beximco),Eye drops, Tk. 80/5 ml.
DICLOFENAC SODIUM
Preoperative: Up to 1 drop 5 times NEPAFENAC
over the 3 hours preceding surgery Indication: Post-operative ocular pain
Postoperative: 1 drop 3 times and inflammation including cataract
immediately after surgery, thereafter 1 surgery
drop 3-5 times daily Inhibition of surgery induced miosis and
Other indications: 1 drop 4-5 times Prevention of post-operative cystoid
daily macular edema (CME)
Dose:For post-operative pain &
Proprietary Preparations inflammation: 1 drop 3 times daily 1
Diclofenac sodium 0.1%, day prior to cataract surgery and
Anfenac(Nipa), Eye drops, Tk. 80.00/5ml continued on the day of surgery and
Anodyne(Ibn Sina), Eye drops, Tk. 80.00/5ml through the first 2 weeks of the post-
Diclofen(Opso Saline),Eye
drop,Tk.60.15/5ml
operative period.
Diclon (Reman),Eye/Ear drop Tk.78.50/5ml For surgery induced miosis: 1 drop 3
Dinac(Navana ), Eye drops, Tk. 80/5 ml times daily 1 day before surgery & on
Erdon(Aristo), Eye drops, Tk. 80.00/5ml the day of surgery.
Intafenac(Incepta), Eye dropsTk. 80.00/5ml,; For prevention of post-operative
Mobife(ACI), Eye drops, Tk. 75.41/5ml ,; CME: 1 drop 3 times daily 1 day before
Nopain(Drug Intl), Eye drops, Tk. 75.25/5ml surgery and continued on the day of
Profenac(Popular), Eye drops, Tk. 75.28/5ml
surgery and through the first 6 weeks of
the post-operative period.
FLURBIPROFEN SODIUM Side effects: are foreign body
Prevention of miosis: 1 drop half sensation, lid margin crusting, ocular
hourly beginning 2 hour before surgery discomfort, ocular hyperemia etc.
Postoperative inflammation: 1 drop 4
times daily for 2-3 weeks Proprietary Preparations
Prevention of cystoid macular Nepag(General), Eye drops, 0.1%, Tk.
oedema: 1 drop 4 times daily for 3-6 150.00/5ml,; 0.3%, Tk. 225.00/5ml
Nevan(Aristo), Eye drops, 0.1%, Tk.
months
150.00/5ml,; 0.3%, Tk. 225.00/5ml
370
10. EYE
Ocunep(Asiatic), Eye drops, 0.1%, Tk. Side-effects:Transient stinging; also

150.00/5ml reported blurred vision, mydriasis, eye
Opanac(Beximco), Eye drops, 0.1%, Tk. irritation
150.00/3ml,; 0.1%, Tk. 150.00/5ml
Optafenac(Popular), Eye drops, 0.1%, Tk.
Dose :ADULT and CHILD over 12
150.00/5 ml,; 0.3%, Tk. 225.00/5 ml years apply 2–3 times daily (max. 7
days)
ANTIHISTAMINES
Antazoline 0.05%+Tetrazoline 0.04%
See also section 4.8.1 & 11.2.1
Topical Antihistamines (e.g. Proprietary Preparations
Pheniramine Maleate, Zocare(Healthcare), Eye drops , Tk. 115/5 ml
Pyrilaminemaleate, antazoline)usually
combined with a vasoconstrictor (e.g. NAPHAZOLINE HYDROCHLORIDE
Naphazoline, Indications, caution, side-
Phenylephrine).Ketorolac(NSAID),Ketot effect&Dose: same as that of
ifen,Bepotastine Besilate is also used to Antazoline sulfate
treat allergic conjunctivitis .They
decrease itching and normalize Naphazoline hydrochloride0.025% with
vascular permeability in allergic pheniramine maleate0.3%,
conjunctivitis Napcon(ACI), Eye drops,Tk. 70.00/10ml
These drugs are very useful for the Nafamin(Acme), Eye drops, Tk. 125.00/15ml
urban people of our country where
Naphazoline Nitrate 0.005% & Zinc Sulphate
incidence of allergy is more. Prolong 0.02%,
use has little side effect as compared to Naphalon(Reman),Eye drop, Tk.80.30/5ml
steroids. These drugs give temporary Nazin(Aristo), Eye drops, Tk. 80.00/10ml
relief. Oculogen(General), Eye drops, Tk.
Cautions: Hypertension, cardiac 80.24/10ml
arrhythmia.
Dose: 1 drop 5 times daily. BEPOTASTINE BESILATE
Indications : Itching associated
ALCAFTADINE with signs and symptoms of allergic
conjunctivitis.
Indications:For symptoms & signs of Dose: Apply one drop into the affected
allergic conditions of the anterior eye(s) twice a day .
segment of the eye.
Side-effects: Mild irritation, burning & Proprietary Preparations
Bepotastine Besilate1.5%
redness Bepogen(General), Eye drops, Tk.
Dose: 0.25%; one drop once daily 300.90/5ml
Bepotas(Aristo), Eye Drops Tk. 300/5ml
Proprietary Preparations Betasil(Ibn Sina), Eye drops, Tk. 300/5ml
Alcaftadine0.25%, Betastin(Incepta), Eye drops,, Tk. 300/5ml
Acicaft(ACI), Eye drops, Tk. 400/5ml Eyetin(Acme), Eye drops,, Tk. 300/5ml
Alcadin(Popular), Eye drops, Tk. 400/5 ml I- Bestin(Asiatic), Eye drops, Tk. 300/5ml
Alcaft(Healthcare), Eye drop, Tk. 450/5 ml Ocustin(Popular), Eye drops, Tk. 300/5 ml
Alcafta(Incepta), Eye drops, Tk. 400/5 ml Reprove(Healthcare), Eye drops, Tk. 320/5
Caftadin(Aristo), Eye drops , Tk. 400/5 ml ml
Genacaft(General), Eye drops, Tk. 400/5 ml
EMEDASTINE
ANTAZOLINE SULFATE Indications: Seasonal allergic
Indications :Allergic conjunctivitis conjunctivitis
Cautions:Hypertension, Side-effect: Transient burning or
hyperthyroidism, diabetes mellitus, stigning; blurred vision; local oedema;
angle-closure glaucoma; phaeochro- keratitis; irritation; dry eye; infiltrates
mocytoma, cardio-vascular disease, (discontinue); and staining; phyophobia;
urinary retention
371
10. EYE
headache and rhinitis occasionally Prosma(ACI), Eye drops, Tk. 100/5 ml ,;

reported Stafen(Aristo), Eye drops, Tk. 100/5ml
Dose: ADULT and CHILD over 3 years Tofen(Beximco), Eye drops, Tk.100/5 ml,;
Zadit(Popular), Eye drops, Tk. 95.36/5ml,;
apply twice daily.
Proprietary Preparation MAST CELL STABILIZERS

Emadin (I)(Alcon), Eye drops 0.05%,Tk. (See also section 4.4.1 &11.2.1)
327.02/5ml
SODIUM CROMOGLYCATE
EPINASTINE HYDROCHLORIDE
It is a useful drug without major side
Indications: Seasonal allergic effects. Majority of patients in our
conjunctivitis country suffer from allergy; it is strongly
Side-effects: Burning; less commonly recommended for continued use if it is
taste disturbance,headache, indicated for allergy.
conjunctival hyperaemia, dry eye, eye Usually it has preventive role. Its effect
pruritus, visual disturbance, increased builds up gradually and it needs
lacrimation, eye pain, nasal irritation, uninterrupted application for more than
rhinitis one week.
Dose:ADULT and CHILD over 12 When allergic reactions are higher, then
years, apply twice daily; max. duration short-term supplementation of steroid is
of treatment 8 weeks needed.
Indication: Allergic conjunctivitis
Epinastine hydrochloride 0.05%
Dose: 1 drop 4 times a day
Relestat(I)(Allergan) Eye drops,
Tk.296.73/5ml Proprietary Preparations
Alpatin(Beximco), Eye drops, Tk. Aristocrom(Aristo), Eye/Nasal drops, 2%,
150.00/5ml Tk. 65.00/5ml
Epinast(Aristo), Eye drops, Tk. 150.00/5ml Cromolin(Ibn Sina), Eye drops, 4%, Tk.
80.00/10ml
Icrom(ACI), Eye drops, 2%, Tk. 65.45/10ml
KETOTIFEN FUMERATE Itchin(G.A.Co), Eye/Nasal drops, 2%, Tk.
65.00/10 ml; DS4%, Tk. 75.23/10 ml
Indications: Seasonal allergic Mastguard(Incepta), Eye/Nasal drops, 2%,
conjunctivitis Tk. 100.00/10ml
Side-effcts: Transient burning or Nasochrom(Drug Intl), Eye/Nasal drops, 2%,
Tk. 60.20/10ml
stinging, punctate, corneal epithelial Socolate(Pacific), Eye/Nasal drops, 2%, Tk.
erosion; lees commonly dry eye, 65.00/10ml
subconjunctival hemorrhage, Sodicrom(Popular), Eye drops, DS 4%, Tk.
photophobia, headache, drowsiness, 75.28/5 ml; 2%, Tk. 60.23/10ml
skin reaction, and dry mouth also
reported. LODOXAMIDE
Dose: ADULT and CHID over 3 years, It is about 2500 times more potent than
apply twice daily cromoglycate to inhibit mediator
release from mast cell
Proprietary Preparations Indication: Allergic conjunctivitis
Ketotifen 0.025%,
Alarid(Square), Eye dropsTk. 100.3/5 ml,;
Dose: 1 drop 4 times a day. It needs to
Aljen(Apex ), Eye drops, Tk. 95/5 ml be used without interruption
Fenat(Drug Intl), Eye drops, Tk. 95.30/5 ml
Ketof(Ibn Sina), Eye drops, Tk. 100.00/5 ml,; Proprietary Preparation
Ketolac(Nipa), Eye drops, Tk. 80.00/5ml Alomide(I)(Alcon), Eye drop. 0.1%
Ketomar(Incepta), Eye dropsTk. 100/5 ml,; Tk.312.61/5ml
Kofen(Opsonin), Eye drops, Tk. 100/5 ml,;
Masfen(Opso Saline) Eye drops, Tk. OLOPATADINE
75.19/5ml
Inhibits the release of inflammatory
Ocutif(Asiatic), Eye dropsTk. 95/5ml
Ocutifen(General), Eye dropsTk. 95.29/5 ml mediators like histamine, tryptase,
372
10. EYE
PGD2from human conjunctival mast 10.4 MYDRIATICS,

cells thus prevents changes in vascular CYCLOPLEGICS AND
permeability. TREATMENT OF GLAUCOMA
Indication: Seasonal allergic
conjunctivitis
10.4.1 & 2 MYDRIATICS AND
Side-effects: Transient burning and
CYCLOPLEGICS
stinging; distinctive taste
Dose :ADULT and CHILD over 3 years, Anticholinergic agents (Atropine,
apply twice daily; max.duration of Homatropine, Tropicamide etc.) have
treatment 4 months both cycloplegic and mydriatic activity in
variable degree. Atropine is the
Proprietary Preparations strongest agent whose action lasts for
Alacot(Square), Eye drops, 0.1%, Tk. prolong period. Anticholinergic agents
110.34/5ml,; 0.2%, Tk. 150.45/5ml are usually used for refraction, pupillary
Aladay(Eskayef), Eye drops, 0.1%, Tk. dilatation and relief of inflammation. 1%
110.00/5ml,; 0.2%, Tk. 160.00/5ml Atropine (in ointment form) is
Alercon(Acme), Eye drops, 0.2%, Tk.
150.44/5ml,; 0.1%, Tk. 100.30/5m
sometimes preferred for children under
Allet(Healthcare), Eye drops, 0.2% , Tk. 5 years of age for refractive purposes.
180.00/5 ml,; 0.1%, Tk. 110.00/5 ml Direct acting adrenergic agent,
Conrif(Globe), Eye drops, 0.1%, 100.00/5ml phenylephrine usually in a 2.5%
Contova(ACI), Eye drops, 0.1%, Tk. concentration, is one of the most
107.00/5ml ,; 0.2% Tk. 150.00/5ml commonly used mydriatic for diagnostic
Lopadine(Incepta), Eye drops, 0.1%, Tk. purposes. It should be cautiously used
110.00/5ml,; 0.2%, Tk. 150.00/5ml,; 0.2%,
Tk. 200.00/5ml,; in patients with ischaemic heart
Olacing(Pacific), Eye drops, 0.2%, Tk. disease. Phenylephrine does not
150.00/5ml causes cycloplegia
Olarif(Biopharma), Eye drops, 0.1%, Tk. Tropicamide or Phenylephrine is
110.00/5ml.,Eye drops, 0.2%, Tk. 150.00/5ml sufficient for examination of the fundus.
Ologen(General), Eye drops, 0.2%, Tk. Sometimes for maximal dilatation
175.00/5ml; 0.1%, Tk. 100.30/5ml; Tk. combination of Tropicamide and
225.00/5ml
OLON-DS(Kemiko), Eye drops, 0.2%, Tk.
Phenylephrine or Tropicamide and
150.00/5ml Cyclopentolate is used. For refraction
Olopan(Beximco), Eye drops, 0.1%, Tk. in a CHILD, 1% Cyclopentolate is
110.00/5ml, 0.2%, Tk. 160.00/5ml indicated and used commonly due to its
Olopta(G.A.Co), Eye rops, 0.1%, Tk. start duration of actions
100.30/5 ml; 0.2%, Tk. 150.00/5 ml Indications: For relief of inflammation
Olpadin(Aristo), Eye drops, 0.2%, Tk. and to have profound cycloplegia,
175.00/5ml; 0.1%, Tk. 110.00/5ml
Opatin(Opsonin), Eye drops, 0.2%, Tk.
atropine is the drug of choice
150.57/1ml.,0.1%, Tk. 110.00/1ml Cautions: The use of these drugs
OPD(Nipa), Eye drops, 0.1%, Tk. should have restricted use. Patients
110.00/5ml.; 0.2%, Tk. 150.00/5ml should be well informed not to use it in
Optadin(Asiatic), Eye drops, 0.1%, Tk. the normal eyes. Darkly pigmented iris
100.00/5ml; 0.2%, Tk. 150.00/5ml is more resistant to pupillary dilatation.
Patadin(Popular), Eye drops, 0.2%, Tk. Side-effects: A few patients, usually
150.57/5ml,DS 0.1%, Tk. 150.57/5ml
Patalon(Ibn Sina), Eye drops, 0.2%, Tk.
middle-aged or elderly hypermetropic
150.00/5ml, 0.1%, Tk. 110.00/5ml individuals, may develop an attack of
acute angle closure glaucoma following
mydriasis; this constitutes a severe and
sights threatening emergency.
373
10. EYE
374
10. EYE
Tablet 10.4.1 A : List of drugs comparing different effects is given in the table
Mydriasis Mydriasis Cycloplegia Cycloplegia

Drug Maximal Full Maximal Full
effect recovery effect (hr.) recovery
(min) (days) (days)
Atropine 1% 40 10+ 6 14
Hyoscine (0.25% & 0.5%) 30 7 1 7
Homatropine (1% -5%) 60 3 1 3
Cyclopentolate (0.5%- 2%) 60 1 1 1
Tropicamide (0.5% & 1%) 40 0.25 0.5 0.25
Phenylephrine 2.5% & 10% 20 0.25 Nil ---
Cautions: There are risk of systemic side effects with atropine eye drops in infants
under 3 months of age (ointment is used in these case)
Side-effects: Transient stinging, raised intraocular pressure, hyperaemia, oedema,
conjunctivits, contact dermatitis
Tropicamin(Nipa), Eye drops, 1%, Tk.
85.00/5ml; 0.5%, Tk. 60.00/5ml
ATROPINE SULPHATE[ED]
Tropidil(Popular), Eye drops, 1%, Tk.
Tropigen(General), Eye drops, 1%, Tk.
Atropine sulfate 1% 85.26/5ml
Atrogen(General), Eye drops, Tk. Trusil(G.A.Co), Eye drops, 0.5%, Tk. 55.80/5
70.21/10ml,; Tk. 50.14/5ml,; Tk. 70.00/3gm, ml; 1%, Tk. 85.00/5ml
Atropine-OSL(Opso Saline), Eye drops, Tk.
25.95/5 ml; Oint, Tk. 14.05/3 gm Tropicamide 0.8% + Phenylephrine 5%,
G-Atropine(Gonoshasthaya), Eye drops,, Tk. Dilate plus(Incepta), Eye drops, Tk. 80.00/5
27.25/10 ml ml
Mydri-Atropin(Reman), Eye drops. Trophen(Aristo), Eye drops, Tk. 90.00/5ml
Tk. 40/10ml; 30/5ml;Oint.Tk.25/4gm TropidilPlus(Popular), Eye drops, Tk.
80.30/5 ml
CYCLOPENTOLATE Tropigen Plus(General), Eye drops, Tk.
80.24/5ml
Trusil(G.A.Co), Eye drops, , Tk. 85.00/5 ml
Vasotrop(Asiatic), Eye drops, Tk. 90.00/5ml
Mydrate(Beximco),Eye drops,1%,Tk.120/5ml
10.4.3 DRUGS FOR GLAUCOMA

HOMATROPINE HYDROBROMIDE
The complex primary pathologic
Homatropine hydrobromide 2% mechanism in glaucoma consists of an
Homatropine(Reman),Eye drop incompatibility between intraocular
Tk.56.55/10ml pressure (IOP) and pressure tolerance
Hemomin(Nipa), Eye Drops, 2%, Tk. of the tissues of the optic nerve head
56.55/10ml resulting in damage to the optic nerve
Matropin(Aristo), Eye drops, 2%, Tk. fiber. IOP at which this incompatibility
56.70/10ml
does occur varies from elevated IOP to
an IOP totally within the normal range
TROPICAMIDE (IOP not necessarily high always).
Thus the target IOP at which damage to
Proprietary Preparations optic nerve does not occur also varies
Camide(Ibn Sina), Eye Drops, 0.5%, Tk. from just within the normal range to well
60.22/5 ml;1%, Tk. 80.31/5 ml
Dilate(Incepta), Eye drops, 1%, Tk.
below the normal range.
76.00/5ml Approximately two thirds of all
Tropicam(Aristo), Eye drops, 0.5%, Tk. glaucoma are primary. Among the
60.00/5ml; 1%, Tk. 85.00/5ml primary open angle glaucoma is more
Tropicamide OSL(Opso Saline), Eye drops,
1%, Tk. 64.15/5 ml; 0.5%, Tk. 45.11/5 ml
375
10. EYE
prevalent in our country, which needs to utilize the mydriatic side effect of
routine screening for its diagnosis. adrenaline.
Treatment is aimed at reducing IOP to a
target pressure safe and compatible MIOTICS
with the normal functioning of the optic
nerve. It includes the cholinergic agonists
Control of primary open angle Pilocarpine and Carbachol, and the
glaucoma can be achieved and anticholinesterases. They cause
maintained in many cases by drugs constriction of the ciliary muscle, which
only. But if it does not halt the progress helps to open the drainage channels in
of the disease or if there is non- the trabecular meshwork between the
compliance to drugs or if patient is not iridocorneal junction and the canal of
able to bear the cost of treatment, Schlemm. Small pupil is an undesirable
surgery is the treatment of choice. side effect of the drug.
Medical control of IOP can be achieved Among the miotics used for control
by using eye drops containing miotics, of ocular pressure, only pilocapine
beta blockers, sympathomimetic drop in different concentration (1%,
amines and prostaglandin analogues 2%, 4%) is use,stronger
or by systemic or topical therapy with concentration (>-3%) contraindicated
carbonic anhydrase inhibitors (CAI). in closur glucoma.
At first the disease is to be treated with Cautions: darkly pigmented iris of our
a topical beta-blockers and other drugs population may require higher
are to be added as necessary to control concentration of the miotics or more
IOP. frequent administration. When frequent
For cases of acute primary angle administration is needed; care should
closure glaucoma, surgery is the only be taken to avoid overdose. Retinal
immediate and effective treatment detachment has occurred in susceptible
after medical control of IOP (mainly by individuals and those with retinal
miotics, anhydrase inhibitors and disease (especially with long acting
even mannitol infusion). miotics); therefore fundus examination
Among the secondary causes-steroid is to be advised before starting
induced glaucoma, lens induced treatment with a miotic. They should be
glaucoma, glaucoma secondary to used with caution in ischaemic heart
uveitis and trauma are the main disease, hypertension, bronchial
varieties. They should be treated asthma, peptic ulceration, urinary tract
according to the causes. obstruction and Parkinson’s diseases.
In emergency or before surgery, Contraindications: They are
Mannitol should be given by slow IV contraindicated in conditions where
infusion until the intraocular pressure papillary constriction is undesirable
has been satisfactorily reduced. such as acute iritis, anterior uveitis and
Acetazolamide by IV injection may some form of secondary glaucoma.
also be used for the emergency They should be avoided in acute
management of raised intraocular inflammatory disease of the anterior
pressure. segment.
If supplementary topical treatment is Side-effects: Ciliary spasm leads to
required after iridectomy or a drainage headache and browache which may be
operation in either variety of glaucoma, more severe in the initial 2-4 weeks of
a Beta-blocker is preferred to treatment (particularly in patient under
Pilocarpine. This is because the risk 40 years of age). Ocular side effects
that posterior synechiae will be formed include blurred vision
as a result of the miotic effect of
Pilocarpine especially in angle closure
PILOCARPINE[ED]
glaucoma. It is then also advantageous
Indications: Cataract surgery,
penetrating keratoplasty, iridectomy and
376
10. EYE
other anterior segment surgery caution is to be taken in patients with

requiring rapid and complete miosis heart disease or bronchial asthma,
Cautions: Before finishing the surgery Systemic side effects: Bronchospasm,
the injections should be removed by bradycardia (always feel the pulse of
aspiration otherwise chances of the patient before prescribing a beta-
postoperative aseptic inflammation is blocker), hypotension, delayed recovery
more. from hypoglycemia in insulin-dependent
Contraindications: See notes above diabetes mellitus, fatigue, headache,
Dose: Apply eye drops every 5 minute nausea, impotence, decreased libido.
to 4 times daily
BETAXOLOL
Indications : See notes above
Pilocarpine(Opso Saline), Eye drops, 2%,
Tk. 55.85/10ml Contraindications : See notes above
Pilodrop(Reman), Eye drops, 1%.Tk. Side effects :See notes above
74.20/10ml;2% Tk.200/10ml;4%, Dose : Apply eye drops twice daily
Tk.212/10ml;
Asipine(Asiatic), Eye drops, 2%, Tk. Proprietary Preparation
80.00/10ml Betaxolol 0.5%,
Optacarpine(Popular), Eye drops, 2% , Tk. Optibet(Jayson),Eye Drops, Tk.150.56/5ml
200.00/10 ml Glucovis(Beximco), Eye drops, 2.5mg/ml,
Piloma(Opsonin), Eye drops, 2%, Tk. 200.00/ Tk. 200.00/5ml
10ml Optaloc(Popular), Eye drops, 0.5%, Tk.
200.75/5ml
BETA BLOCKERS
(See also section 3.1) LEVOBUNOLOL HYDROCHLORIDE
Indications : See notes above
These blocking agents reduce IOP by Contraindications : See notes above
decreasing the production of aqueous Side effects :See notes above
humour and produce minimal local Dose : Apply eye drops 2 times daily
adverse effects. They are used as eye
drops which includes non-selective beta Proprietary Preparation
blockers (e.g. Timolol, Carteolol, Betagan(I) (Allergan), Eye drop 0.5%
Tk.193.56/5ml
Levobunolol) and cardioselective beta
blockers (e.g. Betaxolol) preparations.
They are used in all types of glaucoma, TIMOLOL MALEATE
irrespective of the state of the angle.
Beta blockers combined with Indications : See notes above
Pilocarpine has a good additive effect. Contraindications : See notes above
In absence of systemic contra- Side effects :See notes above
indications, they are the first choice of
drugs for primary open angle glaucoma. Dose : One drop twice daily
Cautions: Drainage via the lacrimal
duct and absorption from the nasal Proprietary Preparations
mucosa into the systemic circulation Timolol(as maleate) 0.5%,
Aristomol(Aristo), Eye drops, Tk. 70.00/5ml
can produce significantly high blood Asinol(Asiatic), Eye drops, Tk. 67.00/5ml
levels that can lead to systematic side Gemolol(General), Eye dropsTk. 70.21/5ml
effects (to minimize it patient is to be Glumol(Globe), Eye drops, Tk. 70.00/5ml
advised to close the eyes and apply Intramol(Beximco), Eye drop, Tk. 70/5ml
digital pressure over the lacrimal puncta Lotensin(ACI), Eye drops, Tk. 67.45/5ml
for a few minute after instillation). Ocupres(Popular), Eye drops, Tk. 70.26/5ml
Cardioselective agents e.g. Betaxolol, Ticoma(Opsonin), Eye drops, Tk. 70.26/5 ml
Timocare(Healthcare), Eye drops, Tk. 80/5ml
may therefore be preferable to non- Timodrop(Reman), Eye drops,Tk. 50/5ml;
selective agents (Carteolol, Timolat(Ibn Sina), Eye drops, Tk.75/5ml
Levobunolol, Timolol) in the elderly;
375
10. EYE
Timolol - OSL(Opso Saline), Eye drops, Tk. coronary insufficiency,prgnancey,breast

52.63/5 ml feeding &renal impairment
Timopress(Incepta), Eye drops, Tk. 70/5ml Contraindications:Neonate or CHILD
under 2 years, See notes above
SYMPATHOMIMETICS Sideeffects:Eyediscomfort,itching,redn
These drugs are alpha and beta ess, blurred vision, dizziness, dry
adrenergic agonists. mouth, drowsiness, or tiredness
Sympathomimetics increase aqueous Dose: One drop 3 times a day, see
outflow through their alpha agonistic notes above
action and decrease aqueous inflow
through their beta agonist activity. Proprietary Preparations:
Additive effect is poor with Timolol, Brimonidine Tartrate 0.2%
good with miotics (in which case miotic Alphaten(Aristo),Eye drops, Tk. 80/5ml
Bricoma(Opsonin), Eye drops, Tk. 60.38/5ml
should be instilled first).
Brimo(Popular), Eye oint, Tk. 80.30/5ml
Sympathomimetics are the first choice Brimodin(Incepta),Eye drops,Tk. 80/5ml
of drugs in the treatment Primary Open Locular(Square), Eye drops, Tk. 80.30/5ml
Angle Glaucoma (POAG) in patients
who have systemic contraindications to Timolol 0.5% +Brimonidine Tartrate 0.2%
Beta blocker. They are useful in most Bimolet (Ibn Sina), Eye drops, Tk.
secondary glaucoma, but should not be 110.00/5ml
Binzotim(Eskayef), Eye drops, Tk.
used in closed angle glaucoma (as it
550.00/5ml
has mydriatic effect). Brimodin Plus(Incepta), Eye drops,
Adrenaline does not have any effect on Tk.110.00/5ml
ciliary body and is often most effective Brimopres(Popular), Eye drops, Tk.
when used in conjunction with miotics. 110.42/5ml
Side-effects:Severe smarting and Combat(General), Eye drops, Tk.120.00/5ml
redness of the eye Combigan (I)(Allergan), Eye Drops, , Tk.l
741.57/5ml
Cautions: It should be used with
Combipres(Aristo), Eye drops,
caution in patients with hypertension Tk.120.00/5ml
and heart diseases Locoma (ACI), Eye drops, Tk. 120.00/5ml
Locular Plus(Square), Eye drops,
ALPHA 2 AGONISTS Tk.110.34/5ml
Ticoma B(Opsonin), Eye drops, Tk.
(See also section 3.2.6) 83.02/5ml
Wigan(Healthcare), Eye drop, Tk. 120.00/
Alpha2 agonists are used in the
treatment of glaucoma include CARBONIC ANHYDRASE
Apraclonidine and Brimonidine. They INHIBITORS
reduce the production of aqueous and
See also section 3.5.5
increase uveoscleral outflow. In
contrast to beta-blockers they have
These enzyme inhibitors decrease
minimal effects on cardiovascular
intraocular pressure by suppressing the
parameters and do not affect pulmonary
production of aqueous humour.
function. Brimonidine is considered to
be more selective than Apraclonidine
for alpha2 –receptors and as a result ACETAZOLAMIDE[ED]
produces its ocular hypotensive effect
without causing the mydriasis or Indications: Reduction of intraocular
conjunctival blanching seen with pressure in open angle glaucoma,
apraclonidine. secondary glaucoma and
BRIMONIDINE TARTARATE perioperatively in angle-closure
glaucoma
Indications: Open-angle glaucoma or
Cautions: Not generally recommended
ocular hypertension.
for continuous use but if it is to be given
Cautions: Severe cardiovascular
plasma electrolytes and blood count
disease,depression,cerebral or
378
10. EYE
should be monitored; pulmonary Indications: To treat high pressure

obstruction inside the eye due to glaucoma (open
Contraindications: Hypokalaemia, angle-type) or other eye diseases (e.g.,
hyponatraemia, hyperchloraemic acido- ocular hypertension).
sis; severe hepatic impairment; renal Side-effects:Temporary blurred
impairment; Sulphonamide hypersen- vision,burning/stinging/itching/redness
sitivity. of the eye, watery eyes, dry eyes,
Side-effects:Nausea, vomiting, sensitivity of eyes to light, bitter taste, or
diarrhoea, taste disturbances, loss of headache may occur. If any of these
appetite, flushing, headache, dizziness, effects persist or
fatigue, irritability, depression, thirst, Dose: One drop in the affected eye(s)
polyuria, reduced libido, tingling of three times a day
fingers, hand and feet, Steven-Johnson
syndrome, blood dyscrasia, weak Dorzolamide 2% + Timolol 0.5%
diuresis Proprietary Preparations
Long-term use may lead to electrolyte Azopt(Ibn Sina), Eye drops, Tk. 550.00/5ml
disturbances, metabolic acidosis Cozopt(Aristo), Eye drops, Tk. 550.00/5ml
Orozole(Opso saline), Eye drops, Tk.
Dose: For acute control of IOP 250- 550.00/5ml
1000mg IVin divided dose; or 5mg/kg
body weight; action onset of action is
HYPEROSMOTIC AGENTS
within 2 minutes and reaches to
maximum 10-15 minute; Orally, 1g daily
divided into 2-4 doses These agents (e.g.Glycerol, isosorbide
and mannitol) are used as dehydrating
Proprietary Preparation agent or to promote polyuria.
Acemox(Acme), Tab., 250 mg, Tk. 2/Tab.
MANNITOL
BRINZOLAMIDE (See section 3.5.4)
Indication: For short term management
of glaucoma PROSTAGLANDIN ANALOGUES
Caution: Check cardiovascular status
Dose:Apply twice daily increased to Latanoprost and Travoprost most
max. 3 times daily if necessary recently introduced drugs, which
increase uveoscleral outflow.
Brinzolamide 1%
Azopres(Ibn Sina), Eye drops, Tk.500/5 ml BIMATOPROST
Benozole(Popular),Eye drops,Tk. 500/5 ml
Brinzopt(Aristo), Eye drops, Tk. 500/5 ml Indications : Control the of glaucoma,
Genazopt(General), Eye drops,Tk.500/5 ml Cautions: Lashes may grow long that
Xolamid(Opsonin),Eye drops,Tk. 375.94/5ml
Zolamid(Incepta), Eye drops, Tk. 500/5ml
they become ingrown and scratch the
Brinzolamide1% + Brimonidine0.2%, cornea
Indication,Caution & Dose:Same as Contraindication: Should not be used
that of Brinzolamide if the patient is allergic to any ingredient
in bimatoprost drops
Genazopt Plus(General), Eye Drops, Tk. Side-effects:Blurred vision,eyelid
550.00/5 ml redness,eye discomfort, burning
Benozol BR (Popular), Eye drops,Tk. sensation, thickening of the eyelashes.
550/5ml Dose:Apply once daily, preferably in
Brindin(Acme) Eye drops, Tk. 550.00/5 ml the evening; CHILDunder 18 years, not
Zoladin (Aristo), Eye drops, Tk. 550.00/5 ml recommended
Zolamid Plus(Incepta), Eye drops,
Tk.550/5ml
Bimatoprost 0.03%,
DORZOLAMIDE Bimast(Incepta), Eye drops, Tk. 500.00/3ml
375
10. EYE
Bimaprost(Popular), Eye drops, Tk. 500/3ml discomfort, temporary burning

Lumigan(I)(Allegan), Eye drops, sensation during use , thickening of the
Tk.1354.45/3ml eyelashes, restricting urine flow
Bimatoprost0.03% + Timolol 0.5%
Dose:Same as that of latanoprost
Bimator(Square), Eye dropsTk. 500/3ml
Travoprost 0.004%,
LATANOPROST Avatan(Aristo), Eye drops, Tk. 470.00/5ml
Avost(Ibn Sina), Eye drops, Tk. 470.00/3ml
Indications: Patients with open-angle Avro(Drug Intl), Eye drops, Tk. 451.40/3ml
glaucoma or ocular hypertension Travagen(General), Eye drops, Tk.
470.00/3ml
Cautions: Intraocular inflammation,
Travast(Incepta), Eye drops, Tk. 470.00/3ml
aphakica,patients with risk factors for Travolar(Square), Eye drops, Tk.
macular edema, glaucoma,contact lens 470.00/3ml
wearers,pregnancy and lactation
Contraindications:Hypersensitivity to Travoprost 0.004% +Timolol 0.5%
latanoprost, benzalkonium chloride, or Avatan-T(Aristo), Eye drops, Tk. 500/3 ml
any component of the formulation Avost plus(Ibn Sina), Eye drops, Tk.
500/3ml
Side-effects: Blurred vision, burning
Travast Plus(Incepta),Eye drops,Tk.500/3ml
and stinging, conjunctival hyperemia, Travofix Plus (opso saline), Eye drops,
foreign body sensation, itching, Tk.500/3 ml
increased pigmentation of the iris,
punctate epithelial keratopathy, TAFLUPROST
bacterial keratitis
Indications: Control the progression of
Dose: One drop in the affected eye(s)
the open angle glaucoma or occular
once daily in the evening.
hypertension.
Note:Safety and efficacy have not been
Cautiona: Allergic to any ingredient in
determined for use in patients with
tafluprost drug.
angle-closure glaucoma
Side-effects: Blurred vision, burning,
dry or itching of eyes, redness, pain,
Lumigin(I)(Allergan), Eye drops, 0.03%, swelling of the eye or eyelid, increased
Tk.1140.60/3 ml growth of the eye lashes, headache.
Repaprost(Reman), Eye drops0.05%, Dose: One drop in the affected eye
Tk.496.87/2.5 ml once daily in the evening.
Xalaprost(Beximco), Eye drops, 0.03%, Warnings: In pregnancy should be
Tk.460.00/2.5 ml used only if the benefit outweighs the
Xalatan(I)(Pfizer) Eye drops0.05%,
Tk.703.75/2.5 ml
risk to the fetus. Animal studies
revealed reproductive toxicity. But there
Timolol 0.5% + Latanoprost 0.005% is no adequate studies in pregnant
Lotensin plus (ACI), Eye drops, Tk. woman
402.72/5ml
Xalacom(I)(Pfizer) Eye Drops, Tk. 781.94/2.5 Proprietary Preparations:
ml Taflan(Aristo), Eye drops, 1.5 mg/100 ml, Tk.
Xalanol(Beximco),Eye Drops,Tk.495/2.5ml 600.00/3ml
TRAVOPROST 10.5 LOCAL ANAESTHETICS
Indication: For controlling the Topical: Anaesthesia of the

progression of glaucoma conjunctiva and cornea can be obtained
Cautions: Allergic to any ingredient in very readily by the use of drops.
travoprost drops, iritis, uveitis,narrow- The most commonly used are short
angle and neovascular glaucoma acting preparations such as
Side-effects: Blurred vision, eyelid Lignocaine, Oxybuprocaine,
redness, darken eyelashes, eye Proparacaine and Proxymetacain.
380
10. EYE
These act within a few seconds and corneal sutures. It has a temporary
wear off within half an hour. They are disruptive effect on the corneal
adequate for such procedures as epithelium.
subtarsal or corneal foreign body Proxymetacaine causes less initial
removal, and application tonometry, stinging and is useful for children.
lacrimal manipulation and irrigation. Regional anesthetics:Lignocaine,
Oxybuprocaine or a combined with or without adrenaline, is injected
preparation of lignocaine and into the eyelids for minor surgery, while
fluorescein is used for retrobulbar or peribulbar injections are
tonometry.Among other things used for surgery of the globe itself. The
Proparacaine is preferred to be used speed of onset and duration of action is
as excellent topical local anaesthetic for increased by the addition of
those ocular surgery which can be done vasoconstrictor adrenaline and
under topical anaesthesia like cataract absorption into circulation from the site
surgery. of injection is reduced. Bupivacaine
Amethocaine produces a more has prolonged effect than lignocaine.
powerful and prolonged anesthesia and So both is mixed before use if time of
is suitable for use before minor surgical surgery is expected to be prolonged.
procedures, such as the removal of
Tablet 10.5 A : Comparison of Lignocaine & Bupivacaine regarding the
concentration, onset and duration of action
Drug Concentration/ Onset of Duration of action

Maximum dose action
Lignocaine 1%-2% / 500mg 4-6 min 40-60min
120min (with adrenaline)
Bupivacaine 0.25%-0. 75% 5-11min 480-720min (with
adrenaline)
Side-effects:are usually the result of Buprocaine(General), Eye drops, 0.4%, Tk.

excessively high blood concentration 100.30/10 ml
due to inadvertent intravascular Oxycaine(Reman) Eye drops, 0.4%, Tk.
50.43/10ml
injection, excessive dosage, rapid Novocaine(Opso Saline), Eye drops, 0.4%,
absorption or occasionally due to Tk. 31.7/10ml
hypersensitivity, idiosyncracy or
diminished tolerance
PROPARACAINE
CNS reactions include nervousness,
dizziness, blurred vision and tremors, Indication:See notes above.
followed by drowsiness, convulsions, Side effects: See notes above.
unconsciousness and possibly
respiratory arrest. P-caine (Popular), Eye drop. 0.5%,
Cardiovascular reactions are Tk.150/10ml; Tk.125/5ml
hypotension, myocardial depression, Procain(Aristo), Eye drops, 0.5%, Tk.
bradycardia and possibly cardiac arrest. 150/10ml
BUPIVACAINE INJECTION[ED] Note.local anaesthetic should never be

used for the management of ocular
Proprietary Preparation symptoms.
(See section 8.2)
ROLE OF INJECTION OF
OXYBUPROCAINE HCl HYALURONIDASE
375
10. EYE
Hyaluronidase is a spreading factor. It and it is a matter of trial to find which

spreads the anaesthetic agent rapidly product suits the patient best.
around the infiltrated area.
It is mixed with lignocaine. 1 vial Groups Constituents
containing 1500 IU added to a 30ml vial Cellulose Hypromellose 0.5%
of lignocaine for local anaesthesia. derivatives
Polyvinyl Polyvinyl alcohol
Proprietary Preparations alcohol 1.4%
Hyanid(Techno), Inj. 150IU/vial,Tk. 30.09/vial
Mucomimetics Hypromellose 0.3%
+ Dextran 70
10.6 MISCELLANEOUS
OPHTHALMIC Hypromellose eye drops are the most
PREPARATIONS commonly used tear substitutes and are
of benefit when the watery component
10.6.1 TEAR DEFICIENCY, OCULAR is deficient. It may need to be instilled
LUBRICANTS AND frequently (e.g. hourly) for adequate
ASTRINGENTS relief. Ocular surface mucin is often
10.6.2 DIAGNOSTIC AND abnormal in tear deficiency and the
PERIOPERATIVE combination of hypromellose with a
PREPARATIONS mucolytic such as Acetylcysteine can
be helpful.
10.6.1 TEAR DEFICIENCY, OCULAR Agents such as Polyvinyl
LUBRICANTS AND alcohol,Polyacrylic acid,povidone
ASTRINGENTS and dextran help the aqueous layer
Dry eye refers to a deficiency in either spread over the hydrophobic corneal
the aqueous or mucin components of and conjunctival epithelium when the
the precorneal tear film. The most mucus layer is deficient and tear film
commonly encountered aqueous- distribution is patchy. Polyvinyl
deficient dry eye is keratoconjunctivitis alcohol increases the persistence of
sicca, while mucin-deficient dry eyes the tear film and is useful when the
may be seen in cases of ocular surface mucin is reduced
hypovitaminosis A, Stevens-Johnson Sodium chloride eye drops(0.9%) may
syndrome, ocular pemhigoid, extensive be used to irrigate the eye in lid disease
trachoma and chemical burn. Some that may be preventing secretion of the
predisposing conditions should be kept lipid layer by the meibomian glands.It
in mind like- elderly age, can be used as ‘comfort drops’ by
postmanupausal women, patients with contact lens wearers, and to facilitate
drugs like anticholinergics, lens removal.
antimuscarinics, psychotropics, oral Eye ointments containing Paraffin may
contraceptives etc, people in dry dusty be used to lubricate the eye surface,
environment, computer workers etc. especially in cases of recurrent corneal
Chronic soreness of the eyes epithelial erosion. They may cause
associated with reduced or abnormal temporary visual disturbance and are
tear secretion (e.g. in Sjogren’s best suited for application before sleep.
syndrome) often responds to tear Ointments should not be used during
replacement therapy. The severity of contact lens wear.
the condition and patient preference will Zinc sulphate is a traditional astringent
often guide the choice of preparation. that is now little used. As it causes
Ocular lubricants are designed to intense burning on application many
correct deficiencies that may arise in prefer to restrict its use only for angular
the watery component, the mucus layer conjunctivitis.
or the lipid layer of the tear film. Often
more than one component is affected
382
10. EYE
CARBOXYMETHYL CELLULOSE HYDROXYPROPYL METHYL

SODIUM CELLULOSE
Carboxymethyl cellulose sodium 1% Lubric(Incepta), Eye drops, 2%, Tk. 120/3ml
Aquafresh(Popular), Eye drops, Tk. Ocugel(Aristo), Eye drops, 2%, Tk. 120/3ml
250/10ml Optagel(Popular), Eye/Ear drops, 2%, Tk.
Carmelus(Pacific), Eye drops Tk. 120.45/3 ml
275.00/10ml
Drylief(Aristo), Eye drops, Tk. 275.00/5ml
Lubgel(Square), Eye drops, Tk. 275.00/10ml HYPERTONIC SODIUM
Refresh I(Asiatic), Eye drops, Tk. 250/10ml, 5% NaCl ophthalmic preparation for
Sinafresh(Ibn Sina), Eye drops, Tk. decreasing corneal(epithelial) odema
250/10ml 1 drop 4-6 times a day
Tearfresh(General), Eye drops,Tk. 275/10ml,
Tk. 375.00/15ml Proprietary Preparations
Tearon(Beximco), Eye drops, Tk.275/10ml I-Sol(Opso Saline), Eye drops, 5%, Tk.
TR Care(Healthcare), Eye drops, Tk. 250/10 70/10ml
ml NCL(Aristo), Eye drops, 0.9%, Tk.70/5 ml
Lubrimax(ACI), Eye drops, Tk. 275.00/10ml Norsol(Opso Saline), Eye drops, 0.9%,
Tk.25/25 ml
Carboxymethylcellulose Sodium 0.5%+ N-Sol(Popular), Eye drops,0.9%,Tk.20/5 ml
Glycerin 0.9% Hypersol(Beximco) Eye drops,5%
Neotear(Aristo), Eye drops,Tk. 190/10 ml Tk.70/10ml
Eyedew(Acme), Eye drops,Tk. 190/10ml Cordema(Globe), Eye drops, 5%Tk. 70/10 ml
Neotear(Aristo), Eye drops, Tk. 190/10ml
Carmelus(Pacific), Eye drops, Tk. 190/10ml
G-fresh(Ibn Sina), Eye drops, Tk. 190/10ml HYPROMELLOSE
Carboxymethylcellulose Sodium 0.25% + Atier ED (ACI), Eye drops, 0.30%,
Hypromellose 0.3% Tk.70.00/10ml
Aqua(Opso Saline),Eye drops,Tk. Genagel(General), Eye Gel, 0.30%,
142.86/10ml Tk.250.00/10ml
Lubric Extra(Incepta), Eye drops, Hypro(Nipa), Eye drops, 0.50%, Tk.
Tk.210/10ml 80.00/5ml
Isotear(Popular), Eye drops, Tk. 200/10 ml Hypomer(Aristo), Eye Gel, 0.30%,
Ocufresh(square), Eye drops, Tk. 250/10 ml Tk.250.00/10g
Hypersol(Beximco), Eye drops, 0.30%,
Tk.70.00/10ml
CYCLOSPORINE Lubric(Incepta), Eye drops, 2%,
Tk.140.00/10ml
Indication: To increase tear production Ocutear(Asiatic), Eye drops, 0.30%,
in patients whose tear production is Tk.65.00/10ml
presumed to be suppressed due to Tearin(Biopharma), Eye drops,
0.50%,Tk.80/10ml
ocular inflammation associated with dry
Tear(GA.Co), Eye drops,
eye syndrome 0.30%,Tk.90.27/10ml
Side-effects: Ocular burning, Viscogel(General), Eye drops, 2%, Tk.
conjunctival hyperemia, discharge, 120.00/3ml
epiphora, eye pain, foreign body
sensation, Dextran 70 1% + Hypromellose 0.3%,
Dose: 0.05% twice a day Lubtear(Square), Eye drops, Tk. 90.27/10ml
Lubric D(Incepta), Eye drops, Tk.
90.00/10ml
Lacrima(Opsonin), Eye drops, Tk.
Cyporin(Aristo), Eye drops,0.05%,Tk.
70.00/10ml
210/5ml
Glamor(Ibn Sina), Eye drops, Tk. 90.00/10ml
Cyclorin(Ibn Sina), Eye drops, 0.05%,
Syntar(Drug Intl), Eye drops, Tk. 90.30/10ml
Tk.210/5 ml
Sporium (Incepta), Eye drops, 0.05% ,
Tk.210/5ml,; Hypromellose0.360%, Polyethylene
Glycol0.20%, +Glycerin1%
375
10. EYE
Co-fresh (Ibn Sina), Eye drops, Tk. Aquatear(Biopharma), Eye drops, Tk.
250.00/10ml 90.00/10ml
Glypeg (Acme), Eye drops, Tk. 250.00/10ml Artear(Popular), Eye drops, Tk. 90.00/5ml
Oculax(ACI), Eye drops, Tk. 250.00/10ml Bludrop(Healthcare), Eye drops, Tk.
Visitear (Incepta), Eye drops, Tk. 100.00/10 ml
310.00/10ml Eyetear(Drug Intl), Eye drops, Tk. 80.00/10ml
Visin (Popular), Eye drops, Tk. 250.00/10 ml Optear(Ibn Sina), Eye drops, Tk. 90.00/10ml
Povilect(Kemiko), Eye drops, Tk.
SODIUM HYALURONATE 90.00/10ml
Proprietary Preparations Povin(Opsonin), Eye drops, Tk. 100.00/5ml;
Hyloron(Aristo), Eye drops, 0.2%, Tk. Tk. 90.00/10ml
270.00/10 ml; 0.1%, Tk. 220.00/10 ml Protear(Aristo), Eye drops, Tk. 90.00/5ml
Optagel(Popular), Eye drop ,0.2%, Rovidone(ACI), Eye drops, 5%, Tk.90/10ml
Tk.120.45/3ml vial Solotear(Asiatic), Eye drops, Tk. 90.00/10ml
Hyronate (Incepta), Eye drop , 0.1%, Tearex(Beximco), Eye drops, Tk. 90.00/10ml
Tk.220.00/10 ml vial; 0.2%, Tk. 270.00/10 ml Teargen(General), Eye drops, Tk.
90.28/10ml
PARAFFIN
White Soft Paraffin 57.30gm + Liquid Paraffin 10.6.2 DIAGNOSTIC AND
42.50gm + Wool Alcohol 0.20gm/100gm PERIOPERATIVE
PREPARATIONS
Parafresh(IbnSina),Eye Oint.,Tk.250/5gm DIAGNOSTIC
Night Fresh(General) Eye Oint., Tk.250/5gm Stains are used in diagnostic
procedures and for locating damaged
POLYVINYL ALCOHOL areas of the cornea and conjunctiva
Proprietary Preparation due to diseases or injury. Fluorescein
Liquifilm Tear(I)(Allergen), Eye drops, 1.4%, and rose bengal are water-soluble dyes
Tk. 173.46/15 ml
that are taken up by hydrophilic or
POLYETHYLENE GLYCOL0.4% + water-containing substances such as
PROPYLENE GLYCOL 0.3%, the tear film, damaged epithelial cells
Proprietary Preparations (healthy epithelial cells being
Polygel(Ibn Sina), Eye drops, Tk. 150/10 ml hydrophobic) and corneal stroma. Both
Polysol(Apex), Eye drops, Tk. 150/10 ml can be viewed directly, and the
Autotear(Popular), Eye drops, Tk. appropriate interpretation can be made
150.57/10ml of takeup of the yellow or red dye.
Filtear(Incepta), Eye drops, Tk. 210.00/10ml Corneal abrasions, ulcers (particularly
Freshtear(Eskayef), Eye drops, Tk.
200.00/10ml the branching dendritic ulcer of herpes
Glytear(General), Eye drops, Tk. simplex), and keratoconjunctivitis can
200.00/10ml be diagnosed with ease.
I-Fort(Biopharma), Eye drops, Tk. Fluorescein applied primarily as a 2%
150.00/10ml alkaline solution, and with impregnated
Oclube(ACI), Eye drops, Tk. 150.00/10ml paper strips, is used to examine the
Oculant(Square), Eye drops, Tk.
integrity of the conjuctival and corneal
150.45/10ml
Opcol(Acme), Eye drops, Tk. 150.44/10ml
epithelia. Defects in the corneal
Polypro(Pacific), Eye drops, Tk. epithelium will appear bright green in
150.00/10ml ordinary light & bright yellow when a
Polygel(Ibn Sina)Eye drops, Tk. cobalt blue filter is used in the light
150.00/10ml path. Similar lesion in conjunctiva
Syskem(Kemiko), Eye drops, Tk. appears bright orange-yellow in
150.45/10ml
ordinary illumination.
Systear(Aristo), Eye drops, Tk. 200.00/10ml
Tearon(Beximco), Eye drops, Tk. Fluorescein is also used for checking
175.00/10ml fitness of rigid contact lens, though it
cannot be used for soft lenses, which
POVIDONE IODINE absorbs the dye.
Proprietary Preparations In addition Fluorescein is used for
Povidone 5%, performing applanation tonometry and
384
10. EYE
one test of lacrimal apparatus patency Irrigating Solutions

(Jones test). Balanced salt solution (BSS): Most
Rose Bengal is much more efficient for friendly irrigating solution for
the diagnosis of conjunctival epithelial intracameral manoeuvre causing no
damage but it stings excessively unless untoward effect on corneal
a local anaesthetic is instilled endothelium.
beforehand. Devitalized cells stain COMPOSITION: sodium chloride
bright red, while normal cells shows no 0.64%, sodium acetate 0.39%, sodium
change. citrate 0.17%, calcium chloride 0.048%,
As chances of growth of fungus inside magnesium chloride 0.03%, potassium
the container of the dye is higher, it is chloride 0.075%.
unwise to use it for prolong period. It is BSS plus solution has 3 additional
best to use the dye impregnated paper constituents for corneal endothelium
strips. (sodium bicarbonate, dextrose, oxidized
Trypan Blue 0.06% is a selective tissue glutathione)
staining agent (dye) which stains anterior lens Ringer’s solution though not
capsule of the human crystalline lens. The comparable to BSS solution
dye does not penetrate the capsule,
permitting visualization of the anterior capsule
(composition in 1000ml: NaCl-8.6g,
in contrast to the non-stained lens cortex and KCl-0.3g, and CaCl2-0.33g) it can be
inner lens material. used when BSS solution is not found
and is not affordable by the patient.
FLUORESCEIN SODIUM[ED] Presentation: 15ml, 250ml, 500ml
Proprietary Preparation Proprietary Preparations

Flurocin(Reman), Eye drop 2%, Tk.34/4ml Balanced salt solution :
Navsol(Beximco) ,Tk. 250/500ml
TRYPAN BLUE Opso–Rinse(Opso Saline),Tk.35.13/100ml
Visi Blue (Incepta), 0.06%, Tk. 120.01/vial VISCOELASTIC SUBSTANCES
OCULAR PERIOPERATIVE DRUGS Hyroxypropylmethylcellulose
These are discussed in the heading of (HPMC): Most widely used in our
injections that are used intracamerally country as it cheap and plenty
(inside the eye), irrigating solutions that available.
is used both externally and It has good coating ability but less
intracamerally. retentive capacity. It can be autoclaved.
Sodium hyaluronate 1%(Healon)
INTRACAMERAL INJECTIONS (10mg/ml): It has very good retentive
It must be preservative free. The only capability but meticulous removal
established indication for this route is before finishing surgery is strongly
the administration of antibiotics in the indicated otherwise chances of
treatment of endopthalmitis, only minute increased IOP is more. It is very costly
amounts of antibiotic are tolerated which makes its use limited.
within the eye. Through this route
xylocaine and miotics may be used. Proprietary Preparations
Miotics Hyalgun(Healthcare), Inj.,(P.F syringe) 20
Acetylcholine chloride 1% mg/2 ml, Tk. 1,980.00/ Syringe
Hyronate(Incepta), Inj., (P.F syringe) 20mg/2
Pilocarpine nitrate 0.5% (see also sec ml, Tk.1,500.00/Syringe
10.4.3
Mydriatic
OTHER PERIOPERATIVE
Adrenaline injection (1 in 1000) is
diluted with 500ml BSS/ Ringer solution PREPARATIONS
to make and maintain the pupil dilated Apraclonidine 1% for prevention or
during surgery. It is contraindicated in control of postoperative of IOP.
ischaemic heart disease.
375
10. EYE
NSAIDs: Used for maintenance of the problems (purulent or papillary

mydriasis during surgery and for control conjunctivitis).
of postoperative inflammation as stated Note. It is the duty of the
in section10.3 ophthalmologists (as there is great
paucity of optometrist in Bangladesh) to
10.6.3 ANTIOXIDANT VITAMIN make the user well aware of the
AND ANTI CATARACT complications and to instruct them to
PREPARATIONS visit them for checking whether they are
cleaning and disinfecting regularly.
Indications: is indicated for age-related
Prescribing eye medications for contact
eye diseases. This is a antioxidant
lens users:
supplement formulated to provide
Some drugs and preservatives in eye
nutritional support for the eye
preparations accumulate in the soft lens
Dose: One capsule, one or two times
and may induce toxic reactions. Contact
daily or as directed by the physician
lens users are instructed to remove soft
lens before instillation and advised not
Vitamin C 60mg, vitamin E 30mg, lutein 6mg, to wear them during the period of
copper 2mg and zinc 15mg/capsule treatment. Ointments can not be used
Azecol(Incepta), Cap. , Tk. 10.00/Cap in conjunction of contact lens wear.
Eye-q(Nipa), Cap. , Tk. 10.00/Cap. Adverse effects of some systemic
Eyevi(Square), Cap., Tk. 10.00/Cap. drugs on contact lens:
Optavit(Popular), Cap , Tk. 10.00/Cap 1. Oral contraceptives (with high oestro-
I-Gold(Aristopharma), Cap.Tk. 10.00/Cap.
Tioxil(ACI), Cap.Tk. 10.00/Cap
gen content)
2. Those reduce blink rate: anxiolytics,
10.7 CONTACT LENSES hypnotics, antihistamines, muscle
relaxants.
Contact lenses are increasingly gaining
3. Those reduce tear production:
popularity in our country. antihistamines, antimuscarinics,
Indications: COSMETIC: Most people phenolthiazines, some beta-blockers,
specially the young females use it for
diuretics, and tricyclic antidepress-
cosmetic reasons. They prefer it to the ants.
spectacles. 4. Those increase lacrimation:
MEDICAL: There are also its
ephedrine, hydralazine
therapeutic uses 5. Others: aspirin (absorbed by contact
Types in use: lens leading to irritation), rifampicine
1. Rigid (hard or gas permeable)
and sulphasalazines (may discolor
2. Soft (hydrogel) lens the most popular the lens.
type.
Though rapidly gaining popularity it’s
Adenosine 0.2% + Cytochrome C
use might decline in the long run for the 0.05% + Sodium Succinate o.6% +
vision threatening complications Nicotinamide 1.0%
resulting from:
Indications: is used for the treatment
1. Improper cleaning and disinfection of of lens opacification.
the contact lens Proprietary Preparations
2. Improper use of contact lens like Catnil(Acme), Eye drops,Tk. 125.37/5ml
using for prolonged period of the day Catrix(Incepta), Eye drops, Tk. 125.00/5ml
than prescribed, using while sleeping Cytonic(ACI), Eye drops, ,Tk. 120.36/5ml
etc. The advent of Lasik Surgery for Phacovit(Aristo), Eye drops, Tk. 125.00/5ml
the correction of refractive errors will Ractovit(Ibn Sina), Eye drops, Tk.
125.00/5ml
also result in the decline of the
Vitafol(Popular), Eye drops, Tk. 125.00/5ml
popularity of contact lens. Vitalens(General), Eye drops, Tk.
Complications include ulcerative 120.37/5ml
keratitis (specially acanthamoebia
keratitis resulting from ineffective lens
cleaning and disinfection), conjunctival
386
11. EAR, NOSE AND THROAT
Chapter 11
EAR, NOSE AND THROAT
11:1 Ear, nose and throat p. 387
11.1.1 Drugs used in Otitis externa p. 388
11.1.2 Drugs used in Otitis media p.391
11.1.3 Removal of wax p.392
11.1.4 Drug used in Meniere’s disease p. 392
11.2 Drugs acting on the nose p.392
11.2.1 Drugs used in nasal allergy p.392
11.2.2 Topical nasal decongestants p.395
11.2.3 Nasal preparations for the infection and epitasis p.397
11.3 Drugs acting on the oropharynx p. 399
11.3.1 Drugs for oral ulceration and inflammation p. 399
11.3.2 Oropharyngeal anti infective drugs p. 399
11.3.3 Mouthwash and gargles p.401
11:1 EAR, NOSE AND THROAT Otomycosis is a fungal infection of the

ear canal caused by Aspergillus niger,
Otitis externa is the inflammation of ear or Candida albicans. It is seen in hot and
canal. Furuncle is a localized otitis humid climate of tropical and subtropical
externa, which is a staphylococcal countries. The cardinal features of
infection of the hair follicle. Patient otomycosis include intense itching, pain,
usually presents with severe pain and watery discharge with a musty odour,
tenderness in the ear. Treatment and ear blockage. Nystatin is effective
consists of systemic antibiotics, against Candida. Other broad spectrum
analgesics and local heat. antifungals include Clotrimazole and
Diffuse otitis externa is commonly seen Betadine. 2 salicylic acid in alcohol is
in hot and humid climate. It is keratolytic. Antifungal treatment should
characterized by burning sensation in be continued for a week even after
the ear followed by pain which is apparent cure to avoid recurrence. Ear
aggravated by movements of jaw. Ear must be kept dry.
starts oozing thin serous discharge Otitis externa haemorrhagic is a viral
which later becomes thick and purulent. infection characterized by formation of
Common organisms responsible for haemorrhagic blebs on the tympanic
otitis externa are Staph. Aureus, Pseud. membrane and deep meatus causing
pyocyaneus, B. proteus and Esch. Coli. severe pain in the ear and blood stained
But more often the infection is mixed. discharge when the blebs rupture.
Aural toileting is the most important Treatment is directed to relief of pain
treatment. After thorough toileting a with analgesics and antibiotics for
gauze wick soaked in antibiotic-steroid infection. Another viral infection,
preparation is inserted in the ear canal Herpeszoster oticus is characterized
and patient is advised to keep it moist by by formation of vesicles on the tympanic
instilling the same drops twice or thrice membrane, meatal skin, concha and
daily then it can be substituted by ear post-auricalar groove. Treatment
drops. Broad-spectrum systemic consists of intravenous Acyclovir as
antibiotics are used when there is soon as possible.
cellulitis and acute lymphadenitis. Eczematous otitis externa is the result of
Analgesics are used for relief of pain. hypersensitivity to infective organisms or
387
topical ear drops such as Side-effects : Local sensitivity reactions

Chloromycetin or Neomycin. Intense Preparations : Drops for ear/eye/nose
irritation, vesicle formation, oozing and Applications : Apply 2-3 drops every 8
crusting in the canal characterize it. hourly
Treatment is withdrawal of topical
antibiotic causing sensitivity and Proprietary Preparations
application of steroid cream. Eyebet (Incepta), Eye/Ear/Nose drops, 0.1 %,
Seborrhoeic otitis externa is associated Tk. 30/5 ml
with seborrhoeic dermatitis of the scalp. Methasol (Gaco), Eye/Ear/Nose drops, 0.1 %,
Tk. 31.80/5 ml
Itching is the main complaint. Greasy
yellow scales are seen in the external
Betamethasone Sodium Phosphate
canal. Treatment consists of Aural
with Neomycin Sulphate
toileting, application of cream containing
Indications: Otitis externa and other
salicylic acid and sulphur; and attention
infective and inflammatory ear
is to be given to the scalp.
conditions.
Neurodermatitis is caused by compul-
sive scratching due to psychological Contraindications: Perforated ear
factors. Main complaint is intense itching drum,
and may follow infection of raw area left Application: apply 2 to 3 drops every 8
by scratching. Antibiotics can be given. hourly
Ear pack and bandage to the ear are Betamethasone Sodium Phosphate
helpful to prevent compulsive scratching. 0.1% + Neomycin Sulphate 0.5%
Malignant or necrotising otitis externa is
an inflammatory condition caused by
Aristobet-N (Aristo), Eye/Ear/Nasal drops,Tk.
Pseudomonas infection usually in the 35.00/5 ml.,oint Tk. 14.30/3gm
elderly, diabetics or in those on Betacin-N (Ibn Sina), Eye/ Ear /Nasal drops,
immunosuppressive drugs. Early Tk. 35.00/15 gm
manifestations are excruciating pain and Betason-N(Reman), Eye/Ear/Nasal drops
appearance of granulations in the Tk.Tk 32.44/5ml
meatus. Treatment consists of high Betricin-N(Nipa) ,Eye/ Ear /Nasal drops Tk.
doses of intravenous antibiotics such as 35.00/5ml
Tobramycin, Ticarcillin or third Bn (Asiatic), Eye/Ear/Nasal drops,Tk.32/5ml
Methasol-N (Gaco), Eye/ Ear /Nasal drops Tk.
generation cephalosporins such as 35.00/5ml
Moxalactum. Antibiotics are given for 6- Optison-N (Opso Saline), Eye/Ear/Nasal
8 weeks or longer. Diabetes should be drops, Tk. 22.86/5 ml
controlled.
DEXAMETHASONE [ED]
11.1.1 DRUGS USED IN OTITIS (See also section 5.3)
EXTERNA
Indications : Eczematous otitis externa
CORTICOSTEROID PREPARATIONS Cautions : Prolonged use must be
avoided
BETAMETHASONE SODIUM Contraindications : Should not be
PHOSPHATE[ED] used in untreated infection
Side-effects : Local sensitivity reactions
(see section 5.3)
may occur
Preparations : Ear drop / ointment
Indications : Eczematous otitis
Application : Apply 3-4 times daily
externa.
Cautions : Prolonged use must be Proprietary Preparations
avoided Dexamethasone 0.1%
Contraindications : Should not be Acicot (ACI), Eye/Ear drops, Tk. 60/5 ml
used in untreated infection Celudex(Drug Int.), Eye/Ear drops, . 60.20/5ml
388
Dexacort (Opso Saline),Eye/Ear drops, Tk. Preparations : Ear drops containing

70.00/5 ml Chloramphenicol 5%
Dexadron(Reman), Eye/Ear drops,Tk.
Administration : Apply 2-3 drops into
60.23/4ml
D-ONE (Nipa), Eye/Ear drops, Tk. 70.00/5ml
the ear 2-3 times daily
Dexonex(Square), Eye/Ear drops,
Tk.70.21/5ml Proprietary Preparations
Gludex (Kemiko), Eye/Ear drops,Tk. 70.21/5ml Conicol (Opsonin), Eye /Ear drops, 0.50%,
Orbidex (Popular ), Eye/Eardrops,Tk.70/5ml Tk. 34.40/ 10 ml
Metadaxan (Incepta), Eye/Ear drops, Tk. I-guard (Incepta), Eye/Ear drops , 0.50%, Tk.
70.00/5ml 34.40/10ml
Icol (ACI), Eye / Ear Drops, 0.50%, Tk.
34.5/10ml
HYDROCORTISONE [ED] SQ-Mycetin (Square), Eye/Ear drops, 0.50%,
(See also Section 5.3) Tk. 34.5/10ml
Supraphen (G.A.Co), Eye/Ear drops, 0.50%,
Indications : Eczematous otitis externa Tk. 25.57/10 ml0.50%, Tk. 16.10/10 ml
Opthacol (Drug Intl), Eye / Ear drops, 0.50%,
Cautions : Prolonged use must be
Tk. 30.10/10ml
avoided Ramphen (Kemiko), Eye/Ear drops, 0.5%, Tk.
Contraindications : untreated infection 34.27/10 ml
Side-effects : Local sensitivity reactions
Preparations : Ear drops Chloramphenicol 5%+ Lignocaine 1%
Application : Apply 2-4 drops into the Chlorphen (Nipa), Ear drops,Tk.20.23/10ml
Otophenicol (Reman), Ear drops,
ear 3-4 times daily
Tk.25.00/10ml
Supraphen plus (Gaco), Ear drops, Tk.
Hydrocortisone 1% + Neomycine Sulphate+
0.5% + Polymyxine B Sulphate 10,000 units;
CIPROFLOXACIN[ED]
NPH (Reman), Eye/ Ear drpos, Tk 60.23/ 5ml (See also section1.1.5)
Otosporin (GSK),Eye/Ear Drpos,Tk. 60.17/5ml
Polymix-H (Opso Saline), Eye/ Ear drpos,
Indications: Otitis externa, acute otitis
Tk.40/5 ml
Renamycin(Renata) Eye/ Ear oint, media, chronic suppurative otitis media,
Tk.17.49/5ml and prophylaxis during otic surgeries
such as mastoid surgery.
Hydrocortisone 1%+ Gentamicin 0.3%. Contraindications: Known hypersen-
Gentabac HC (Popular), Eye/Ear drops, Tk. sitivity to ciprofloxacin.
51.04/5 ml Cautions: Prolonged use may result in
Gisin-H (Nipa), Eye/Ear drops, Tk. Tk.
overgrowth of non-susceptible
50.00/5ml
Recin HC (Reman,) Eye/Ear drops,Tk.50/10 ml organisms including fungi. The drug
Gento-Hc (G.A.Co), Eye/Ear drops, Tk. should be discontinued if the sign of
60.18/10 ml,; hypersensitivity reaction.
TRIAMCINOLONE ACETONIDE Side-effects: See section1.1.5
(See notes above and section 11.2) Application: Initially apply 2 to 3 drops
every 06 hours; reducing the frequency
of instillation gradually as infection is
ANTIMICROBIAL PREPARATIONS controlled.
CHLORAMPHENICOL[ED] Proprietary Preparations

(See also section 1.1. 12) Ciflox (Reman), Eye/Ear Drops 0.3%, Tk.
35.00/5 gm
Cip (Asiatic), Eye / Ear drops, 0.3%, Tk.45.00
Indications : Bacterial otitis externa 40.15/5 ml
Cautions : Avoid prolonged use Ciproxy (Opso Saline), Eye / Ear drops, 0.3%,
Side-effects : High incidence of Tk. 26.41/10 ml;
sensitivity reactions
389
Neofloxin (Beximco), Eye/Ear drops, 0.3%,Tk. CLIOQUINOLAND FLUMETASONE

40.00/5ml,; /5 ml
PIVALATE
Procin (Kemiko), Eye / Ear drops 0.3%, Tk. Tk.
50.14/10ml
Spectra (Jayson), Eye / Ear drops, 0.2%Tk. Indications: This combination is
40.00/5 ml indicated for the treatment of external
Beuflox (Incepta), Eye/Ear drops , 0.3%, Tk. ear inflammation and infections (otitis
40.00/5ml,; externa) and fungal infections of the
Ciprocin (Square), Eye/Ear drops, 0.3%, Tk.
outer ear (Otomycosis).
40.27/5ml,;
Ciprox (Opsonin), Eye/Ear drops, 0.3%, Tk. Side-effects : Burning sensation,
40.15/1ml,; itching, skin rashes may occur at the site
Ciprozid (Drug Intl), Eye/Ear drops, 0.3%, Tk. of application.
40.15/10ml,;
Cip(Asiatic), Eye/Ear drops, 0.3%, Contraindications: Punctured eardrum,
Tk.45.00/10ml pre-existing tuberculosis of the skin,
fungal or viral infections of the skin,
Ciprofloxacin 0.3% +Dexamethasone 0.1%, hypersensitivity, do not use the ear drop
Aprodex (Aristo), Eye/Ear drops Tk. 75.00/5ml in children under 2 years of age.
BeufloxD (Incepta), Eye/Ear drops, Tk.
75.00/5ml Applications : Apply 2 to 3 drops twice
Cerodex (G.A.Co), Eye/Ear drops, 75.23/5 ml daily for the prescribed period of time
Cip-D (Asiatic), Eye/Ear drops Tk. 75.00/5ml; (usually not longer than 10 days).
Ciprozid-DX (Drug Intl), Eye/Ear drops, Tk.
Civodex (Popular), Eye/Ear drops, Clioquinol 1%+ Flumetasone Pivalate 0.02%
Tk.75.28/5ml Cliomet (Incepta), Ear Drops, Tk. 100.00/5ml
Dexaflox (General), Eye/Ear drops, Tk. Flumetanol (Aristo), Ear Drops, Tk.
75.22/5ml 100.00/5ml
Dexcilo (Pacific), Eye/Ear drops, Tk.75.00/5ml
Neofloxin D (Beximco), Eye /Ear drops, Tk.
75.00/5 ml GENTAMICIN[ED]
Opdex Nipa), Eye drops, Tk. 75.00/5ml (See also section 1.1.3)
Procin D (Kemiko), Eye drops, Tk.75.22/5ml
Indications : Bacterial otitis externa
Ciprofloxacin HCI 0.3%+ Hydrocortisone
Acetate 1%,
Cautions : Avoid prolonged use
Bactin HC (Ibn Sina) Otic Suspn.Tk. Side-effects : Local sensitivity;
90.00/10ml ototoxicity
Ciprocort (Drug Intl), Otic Suspn. Tk. Preparation : Ear drop
90.30/10ml Tk. Application : Apply 2-4 drops 3-4 times
daily
CLOTRIMAZOLE[ED]
(See also section 12.2.2) Proprietary Preparations
Gento (Gaco), Eye/Ear drops, 0.3%, Tk.
31.49/10 ml
Indications : Fungal infection in Recin(Reman), Eye/Ear drops, 0.3%, Tk.
External Auditory Canal 35/10ml
Side-effects : occasional local irritation. G-Gentamicin (Gonoshasthaya), Eye/Ear
Preparations: Clotrimazole 1% in drops, 0.30% , Tk. 25.00/10 ml
polyethylene glycol Genacyn (Square), Eye/Ear drops, 0.30%, Tk.
Applications : Apply 2-3 times daily 32.02/10 ml
Asigen (Asiatic), Eye/Ear drops, 0.30%, Tk.
continuing for at least 14 days after
32.00/10ml
disappearance of infections Genacyn (Square), Eye/Ear drops, 0.30%, Tk.
32.12/10ml,;
Proprietary Preparations Gentabac (Popular), Ear drops, 0.30%, Tk.
(See section 10.2.2) 32.03/10ml
Gisin (Nipa), Eye/Ear drops, 0.30%, Tk.
30.36/10ml
390
Gentamicin Sulphate 0.3%+ +Hydrocortisone 11.1.2 DRUGS USED IN OTITIS

Acetate1%,
MEDIA
Gento-HC (G.A.Co), Otic Suspn., Tk. 60.18/10
ml,;
Gentabac (Popular), Ear drops, Tk. 51.04/5 ml Otitis media is an inflammation of middle
Gisin -H (Nipa), Ear/Ear drops. Tk. 50.00/5ml ear cleft. It is more common in infants
and children especially of lower socio-
LOMEFLOXACIN economic group. Infection enters via
(See also section 1.1.5) eustachian tube. Most common
organisms are Strept. preumoniae, H.
Indications: Otitis externa, acute otitis influenzae, Strept. pyogens, Staph.
media, chronic suppurative otitis media, aureus and Esch. coli. Otitis media with
and prophylaxis during otic surgeries effusion is a condition characterized by
such as mastoid surgery. accumulation of non-purulent effusion in
Contraindications: Known hypersen- the middle ear. The effusion is thick and
sitivity to Lomefloxacin viscid but some times it may be thin and
Side-effects: Photosensitivity serous. The fluid is nearly always sterile.
Application: Initially apply 2 to 3 drops It is commonly seen in school going
every 06 hours; reducing the frequency children. Antibacterial therapy is
of instillation gradually as infection is indicated in all cases of acute and
controlled. chronic suppurative otitis media. The
drugs which are effective in acute otitis
Proprietary Preparations media are Penicillin, Amoxicillin,
Lomecin (Reman) Ear/Eye drop, 0.3%, Tk Cefaclor, Cotrimoxazole,
60.00/5 ml Erythromycin, Cefuroxime Axetil or
Lumex (Gaco) Ear/Eye drop, 0.3%, Tk 60/5 ml Cefixime. Antibacterial therapy must be
continued for minimum 10 days till
OFLOXACIN tympanic membrane regains its normal
(See also section 1.1.5) appearance and hearing returns to
normal. Nasal decongestant e.g.
Indications: It is indicated for the Ephedrine, Oxymetazoline,
treatment of external ear infections (otitis Xylometazoline should be used to
external and certain middle ear relieve eustachian tube oedema and
infections (otitis media) promote ventilation of middle ear.
Contraindications: Known hypersen- Analgesics and antipyretics such as
sitivity to ofloxacin or any other Paracetamol or Aspirin help to relief
component of this preparation, pain and temperature. If there is
Side-effects: mild irritation or mild discharge in the ear, it is dry-mopped
discomfort in the ear may occur. with sterile cotton buds and a wick
Symptoms of an allergic reaction include moistened with antibiotic may be
rash, itching, swelling or trouble inserted. Dry local heat may help to
breathing relieve pain. Treatment of otitis media
Caution: Prolonged use of ear drops with effusion can be given by topical
may result in overgrowth of non- decongestant in the form of nasal drops,
susceptible organisms and secondary sprays or systemic decongestants.
infection respectively. Antimicrobial prophylaxis can be given
for those having recurrent otitis media
Proprietary Preparations associated with upper respiratory tract
Obactin (Ibn Sina), Eye/Ear drops, 0.3%, Tk. infection. In such cases, low dose long
85.00/5 ml term antibiotic or sulphonamide can be
Vista (Aristo), Eye / Eardrops,0.3%,Tk.85/5ml instituted.
Chronic suppurative otitis media
(CSOM) is a long standing infection of a
part or whole of the middle ear cleft.
391
Incidence of CSOM is higher in saline at body temperature. Suction

developing countries because of poor clearance under microscope is a better
socio-economic condition, poor nutrition option. Some times, the wax is too hard
and lack of health education. It is the and impacted to be removed by
single most important cause of hearing syringing or instrumentations. It should
impairment in rural population. CSOM be softened by drops of 5% Sodium
show multiple organisms like Ps. bicarbonate in equal parts of
aerugenosa, B. proteus, E. coli, Staph. glycerine and water instilled two or
aureus and some anaerobes include three times a day for several days.
Bacteroids, B. fragilis and Streptococci. Hydrogen peroxide, liquid paraffin or
It is characterized by ear discharge, olive oil may also achieve the same
which is offensive or non offensive, result. Commercial preparations
mucoid, mucopurulent, purulent or blood containing ceruminolytic agents like para
stained and persistent or intermittent dichlorobenzine 2% can also be used
according to the type of safe or unsafe and syringing can be tried again.
variety of CSOM. Aural toileting can be
done by dry mopping with absorbent 11.1.4 DRUG USED IN MEINERE’S
cotton buds, suction clearance under DISEASE
microscope. Antibiotic ear drops
containing Neomycin, Polymixin,
Chloramphenicol or Gentamicin are BETAHISTINE
used. They are combined with steroids
which have local anti-inflammatory effect Indications: It is commonly prescribed
(see also section 11.1.1). To use ear to patients with balance disorders or to
drops, patients to be lied down with the alleviate vertigo symptoms associated
diseased ear up, antibiotic drops are with Meniere’s disease.
instilled and then intermittent pressure to Side effects: Headache, insomnia,
be applied on the tragus for antibiotic nausea
solution to reach the middle ear. This Contraindications: For people with
should be done 3-4 times a day. The pheochromocytoma, bronchial asthma
patient should be instructed to avoid and peptic ulcer
water entry into the ear during bathing, Doses : ADULTS : 1 to 2 tablets three
swimming and hair washing. Many times per day after meals.
attacks are viral in origin and need only
simple analgesic such as paracetamol Proprietary Preparations
(See also section 7.5.2.1) for relief of Menaril (Incepta), Tab. , 8 mg, Tk. 2.00/Tab.;
16 mg, Tk. 4.00/Tab.
pain. Severe bacterial infection should
Merison(Square), Tab. , 6 mg, Tk. 2.01/Tab.
be treated with systemic antibiotics (See Tiniril (Opsonin), Tab. , 16 mg , Tk. 5.00/Tab. ;
also section 1.1). Surgical treatment is 8 mg , Tk. 2.01/Tab.
the only option for unsafe variety of Vectra (Healthcare), Tab., 16 mg , Tk.
CSOM. 250.00/Tab.; 8 mg , Tk. 150.00/Tab.
Veserc (UniMed), Tab , 16 mg, Tk. 5.00/Tab.;
11.1.3 REMOVAL OF WAX 8 mg, Tk. 3.00/Tab.
Treatment of wax consists of its removal 11.2 DRUGS ACTING ON THE NOSE
by syringing or instrumental
manipulation. Hard impacted wax may 11.2.1 DRUGS USED IN NASAL
sometimes require prior softening with ALLERGY
wax solvents. Syringing should be
avoided in patients with a history of It is an IgE-mediated immunologic
recurrent otitis externa, a perforated ear response to nasal mucosa to air borne
drum, or previous ear surgery. Wax may allergens and is characterized by watery
be removed by syringing with normal nasal discharge, sneezing, nasal
392
obstruction and itching in the nose. also be avoided in pulmonary

Allergens e.g. house mite, pillow or tuberculosis
mattress with plastic sheet, particular Side-effects : Dryness, irritation of nose
foods to which the patient is found and throat and epistaxis, raised intra-
allergic, should be avoided. Drugs used ocular pressure. Smell and taste
in nasal allergy are antihistamines, they disturbances may occur
control rhinorrhoea, sneezing and Dose : 50-100 micrograms (1-2 sprays)
pruritus. Dose and type of into each nostril twice daily in ADULT
antihistamines have to be individualized. and CHILD over 6 years
If one is not effective, another may be
tried from a different class. Proprietary Preparations
Sympathomimetic drugs such as Beclomet (Acme), Nasal Spray, 100 mcg/
Phenylephrine, Oxymetazoline and Actuation, Tk. 120.37/200spray
Xylometazoline are often used to Beconase (G.S.K), Nasal Spray, 50 mcg/
Spray, Tk. Tk. 236.25/100 ml Spray
relieve nasal obstruction. Oral cortico- Becospray (Square), Nasal Spray, 50 mcg /
steroids are very effective in controlling spray, Tk. 130/200 Spray
the symptoms of allergic rhinitis. Topical Decomit (Beximco), Nasal Spray, 50 mcg/
steroids such as Beclomethasone Spray, Tk. 146.00/200 Spray
Dipropionate, Budesonide and
Flunisolide Acetate, Fluticasone, BUDESONIDE
Mometasone, Dexamethasone
Isonicotine used as aerosols are very Indications : Prophylaxis and treatment
effective in controlling the symptoms. of allergic and vasomotor rhinitis; nasal
Sodium cromoglycate stabilises the polyps
mast cells. It is used as 2% solution for Cautions : See under Beclomethasone
nasal drops or spray or as an aerosol Dipropionate
powder. In addition to these following Side-effects: See under
Anti histamine preprations are used in Beclomethasone Dipropionate
nasal allergy: Dose: ADUL and CHILD over 12 years
Chlorpheniramine, Diphenhydramine, 200 micrograms (2 spray) into each
Hydroxyzine, Pheniramin, nostril daily in the morning or 100
Promethazine, Triprolidine. microgram (1 spray) into each nostril
Pseudoepedrine HCl, Desloratadine, twice daily.
Fexofenadine, Levocetirizine,
Loratadine, Acrivastine and Cetirizina Proprietary Preparations
(See section 4.8.1) Budicort (Incepta), Nasal Spray,
100mcg/Spray, Tk. 250.00/120 Spary
Budenide (ACI), Nasal Spray, 100mcg/Spray,
ANTIHISTAMINES USED FOR NASAL TK. 250.75/120 Spary
ALLERGY Pulmicort (Opsonin), Nasal Spray,
(See section 4.8.1) 100mcg/Spray, Tk. 250.00/120 Spary
Rhinocort (Drug Intl), Nasal Spray,
100mcg/Spray, Tk. 250.00/120 Spary
CORTICOSTEROID PREPARATIONS
USED FOR NASAL ALLERGY
CICLESONIDE
(See also section 4.2) Indications: For the treatment of the
symptoms of seasonal allergic rhinitis in
BECLOMETHASONE DIPROPIONATE patients aged 6 years and older and
perennial allergic rhinitis in patients aged
Indications : Prophylaxis and treatment 12 years and older.
of allergic and vasomotor rhinitis Side-effects & Contraindications : see
Cautions : Should be avoided in section 4.2under Ciclesonide
untreated nasal infection and after nasal Dose: spray (50 micrograms/spray) in
surgery till complete healing. It should each nostril once a day. The maximum
393
total daily dosage should not exceed 2 Indication: For the relief of symptoms of
sprays in each nostril seasonal allergic rhinitis in patients 6
years of age and older.
Proprietary Preparations Doses & Administration:
Cicloson , (Incepta), Nasal Spray, 500 The recommended dose is one spray
microgram/ml , Tk. 350.00/120 dose
each nostril twice daily.
Ciclex Nasal, (Opsonin), Nasal Spray, 500
microhgram/ml, Tk. 250.75/120 dose
Flonasin (Square), Nasal Spray, Tk. 320/120
FLUTICASONE PROPIONATE Spray
Zeltas Nasal (Opsonin), Nasal Spray, Tk.
Indications : Prophylaxis and treatment 320/120 Spray
of allergic rhinitis
Cautions : See under Beclomethasone MOMETASONE FUROATE
Dipropionate
Side-effects : See under Beclometha- Indications : Prophylaxis and treatment
sone Dipropionate of allergic rhinitis
Dose: ADULT and CHILD over 12 years, Cautions : See under Beclomethasone
100 micrograms in to each nostril once Side-effects :See under
daily, increased to twice daily if required; Beclomethasone
maximum total 400 microgram daily. Dose : ADULT and CHILD over 12 years
CHILD up to 4-11 years, 50 microgram 100 micrograms in to each nostril once
into each nostril once daily, increased to daily, increased to twice daily if
twice daily if required; maximum total required; maximum total 200 microgram
200 microgram daily daily. When control achieved reduce to
50 micrograms. CHILD upto 6-11 years,
Proprietary Preparations 50 microgram in to each nostril once
Flixonase (GSK), Aqueous (Intra-Nasal)
daily.
Spray, 50 microgram/ Spray, Tk. 293.48/120
Spray
Flonaspray (Square), Nasal Spray, 50 Proprietary Preparations
Meloderm (ACI), Nasal Spray, 50 mcg/spray,
microgram/spray, Tk. 251.5/120 Spray
Fluticon (Acme), Nasal Spray , 50 microgram/ Tk. 250.75/100Spray
Spray Tk. 250.76/120ml,; Metaspray (Square), Nasal Spray, 50
Fluvent (ACI), Nasal Spray, mcg/spray, Tk. 251.5/120Spray
50microgram/spray , Tk. 250.75/120 Spray Momeson (Incepta), Nasal Spray, 50
Lutisone (Incepta), Nasal Spray, 50 mcg/spray, Tk. 250.00/120 spray
M-Son (Drug Intl), Nasal Spray , 50mcg/Spray,
microgram/Spray, Tk. 250.00/120 Spray
Perinase (Beximco), Nasal Spray, Tk. 250.00/120spray
Nasomet (Beximco), Nasal Spray,
50microgram, Tk. 250.00/120 Spay
50mcg/spray, Tk. 250.00/spray
Fluticason furoate Nasonex (Opsonin), Nasal Spray, 50
Avamys(I) (GSK), Aqueou (Intra-Nasal) Spray, mcg/Actuation, Tk. 250.00/120spray
27.5 mcg/Spray, Tk. 386.00/120 spray
Avaspray (Square), Nasal Spray, 27.5 TRIAMCINOLONE ACETONIDE
mcg/spray, Tk. 275/120 spray
Flutica, (Aristo), Nasal Spray, 27.50mcg, Tk.
250.00/120 spray
Indications: Prophylaxis and treatment
Neotison (Incepta), Nasal Spray, 27.5 of allergic rhinitis
mcg/spray, Tk. 250.00/120 spray Cautions: See notes above
Azelastine Hydrochloride Dose: For ADULT apply 110
137microgram+ Fluticasone micrograms (2 spray) in to each nostril
Propionate50microgram once daily; CHILD upto 6-12 years half
of the adult dose.
394
Proprietary Preparations 11.2.2 TOPICAL NASAL

Cenolon (Incepta), Nasal Spray, 550 mcg/ml,
DECONGESTANTS
Tk. 200.00/120 Spray
Cortefin (ACI),Nasal Spray, 55 mcg/ml, Tk.
200.60/120 spray Atmospheric temperature and humidity
T-cort (Opsonin), Nasal Spray, 550 mcg/ml, may cause nasal congestion because
Tk. 200.00/120 spray nasal mucosa is sensitive to it. The
Trispray (Square), Nasal Spray, 550 mcg/ml, nasal sinuses produce huge amount of
Tk. 201120 metered dose mucus in a day and most of it passes
into the stomach through the
MAST CELL STABILIZERS FOR nasopharynx. 0.9% Sodium chloride
NASAL ALLERGY solution given as nasal drops may
relieve nasal congestion by liquefying
OLOPATADINE mucus secretions. Decongestant nasal
drops contain sympathomimetic drugs
Indications: Seasonal allergic rhinitis relieve symptoms of nasal congestion
Side-effects: Epistaxis, nasal ulceration, associated with vasomotor rhinitis and
and nasal septal perforation common cold. Use of these drugs must
Dose : ADULT: two sprays per nostril be for short term, usually not longer than
twice daily. CHILD over 6 years of age 7 days. These drugs exert their effect by
vasoconstriction of the mucosal blood
one spray per nostril twice daily.
vessels, which in turn reduces oedema
Proprietary Preparations of the nasal mucosa. These drugs are of
Alercon (Acme), Nasal Spray , 0.6%, Tk. limited value because they can give rise
400.00/120 doses; to rebound congestion on withdrawal,
Lopadine (Incepta), Nasal Spray, 0.6%, Tk. which is due to a secondary
400.00/120 doses vasodilatation with a subsequent
Olopan (Beximco), Nasal Spray, 0.6%, Tk. temporary increase in nasal congestion.
400.00/120 doses. This in turn makes habits for further use
of the decongestant and that leads to a
SODIUM CROMOGLYCATE vicious cycle of events. An ephedrine
nasal drop, the sympathomimetic
Indications: Prophylaxis for allergic preparation can be used as nasal
rhinitis decongestant. It can give relief of nasal
Side-effects: Local irritation congestion for several hours.
Dose : 4% aqueous nasal spray ADULT Oxymetazoline and Xylometazoline
and CHILD, apply 1 puff into each nostril are more potent sympathomimetic nasal
2-4 times daily decongestant but are more likely to
cause a rebound effect. All of these
Proprietary Preparations preparations should not be used
G-Cromo (Gonoshasthaya), Eye /Nasal drops, concomitantly with mono amino-oxidase
2%, Tk. 50.00/10 ml inhibitor because it may cause
Nacromin(Square), Nasal drops, 2%, Tk. hypertensive crisis. Ipratropium
66.45/15 ml
Opsocrom (Opso Saline), Eye / Nasal drops,
bromide responds well to the treatment
2%, Tk. 48.87/10 ml of non-allergic watery rhinorrhoea.
Aristocrom (Aristo), Eye/Nasal drops 2%, Tk. Inhalation of warm moist air, compounds
65.00/5ml containing volatile substances such as
Itchin (G.A.Co), Eye/Nasal drops, 2%, Tk. menthol and eucalyptus are also
65.00/10 ml; 4%, Tk. 75.23/10 ml useful.
Mastguard (Incepta), Eye/Nasal drops, 2%,
Tk. 100.00/10ml
Nasochrom (Drug Intl), Eye/Nasal drops 2%, EPHEDRINE HYDROCHLORIDE
Tk. 60.20/10ml
Socolate(Pacific), Eye/Nasal drops 2%, Tk. Indications : Nasal congestion
65.00/10ml
395
Caution : Excessive or prolonged use G-con(Kemiko), Nasal drops, 0.025%, Tk.

must be avoided. If should not be used 40.12/10ml , 0.05%, Tk. 45.14/10ml
for infants under 3 months. If irritation Nasalox (General), Nasal drops 0.05%, Tk.
45.13/10ml
occurs it may cause narrowing of nasal Natazol (Ibn Sina), Nasal drops, 0.05%, Tk.
passage 45.00/10ml; 0.025%, Tk. 40.00/10ml
Side-effects: Local irritation, tolerance Nazolin (Beximco), Nasal drops, 0.025%, Tk.
may develop after excessive use; 130.00/10 ml
Rebound congestion is another Oxynex (Opsonin), Nasal drops, 0.025%, Tk.
important side-effect 40.00/10 ml; 0.05%, Tk. 45.00/10 ml;
Administration: Instill 4-5 drops in to 0.05%,Nasal spray. Tk. 80.00/200 MD
Rynex (Incepta), Nasal drops, 0.025%, Tk.
each nostril up to 3-4 times daily
40.00/10ml; 0.025%, Tk. 45.00/10ml; 0.05%,
Nasal spray. Tk. 80.00/200 MD
Proprietary Preparation Xylocon (Square), Nasal drops, 0.03%, Tk.
Remadrin (Reman), Nasal drops, 0.5%,Tk. 40.13/10ml; 0.05%, Tk. 45.13/10ml
45.52/10ml
XYLOMETAZOLINE
IPRATROPIUM BROMIDE
HYDROCHLORIDE
Indications : Rhinorrhoea associated
Indications: Nasal congestion.
with allergic and non allergic rhinitis
Cautions: See under ephedrine
Cautions : Glaucoma, prostatic hyper-
hydrochloride
trophy, pregnancy
Contraindication: CHILD under 3
Contraindication: Avoid spraying near
months
eyes
Side-effects: See under ephedrine
Side-effects: Nasal dryness and
hydrochloride
epistaxis
Administration: ADULT: Instill 4-5
Administration : Apply 2 puffs into each
drops of 0.1% in to each nostril 2-3
nostril 2-3 times daily, CHILD under 12
times daily when required. Maximum
years not recommended
duration 7days
CHILD: Over 3 months instill 2-3 drops
Rinase (ACI), Nasal Spray, 20mcg/spray, Tk. of 0.05% in to each nostril 2-3 times
150.45/120 Spray; daily when required. Maximum duration
Rynaspray(Square) Nasal Spray, 7 days.
20mcg/spray, Tk. 149.21/120 Spray;
OXYMETAZOLINE HYDROCHLORIDE Antazol (Square), Nasal drops,, 0.05%, Tk.
11.04/15ml; 0.10%, Tk. 11.55/15ml
Novin (G.A.Co), Nasal drops, 0.05%, Tk
Indications: Nasal congestion 6.91/10 ml; 0.1%, Tk. 7.53/10 ml
Cautions: See under ephedrine G-Xylometazoline (Gonoshasthaya), Nasal
hydrochloride drops, 0.1%, Tk. 11.25/15 ml
Side-effects: See under ephedrine 11.51/15 ml
Xylomet (Opsonin), Nasal drops,, 0.1%, Tk.
hydrochloride
11.96/10 ml
Administration: See under Xylovin (Opso Saline), Nasal drops, 0.1%, Tk.
xylometazoline hydrochloride 5.47/10 ml; 0.05%, Tk. 5.47/10 ml
Proprietary Preparations Sodium Cromoglycate 2.6mg + Xylometazoline

Afrin (Aristo), Nasal drops, 0.05%, Tk. HCl 0.0325mg/spray
45.00/10ml, 0.025%, Tk. 40.00/10ml
Azolin (Acme), Nasal drops 0.025%, Tk. Antazol plus (Square), Nasal Spray, Tk.
40.12/10ml, 0.05%, Tk. 45.13/10ml 110.5/120 Spray
Confree (Asiatic), Nasal drops, 0.025%, Tk. XylometPlus (Opsonin), Nasal Spray, Tk.
40.00/10ml,;0.05%, Tk. 45.00/10ml 110.00/120 Spray
396
11.2.3 NASAL PREPARATIONS FOR rest, which is essential to cut down the
THE INFECTION AND course of illness. Plenty of fluids are
EPISTAXIS encouraged. Symptoms can be easily
controlled with antihistamines and nasal
decongestants. Analgesics are useful to
Infection of the nasal skin (cellulitis) is
relieve headache, fever and myalgia.
usually invaded by Streptococci or
Antibiotics are only required when
Staphylococci leads to a red, swollen
secondary infection supervenes.
and tender nose. Infection can be
Bacterial rhinitis may be primary which is
treated with antibiotics, hot compression
seen in children and is usually the result
and analgesics. An acute infection of the
of infection with Pneumococcus, Strepto-
hair follicle by the Staphylococcus
coccus or Staphylococcus. A grayish
aureus is called furuncle or boil. The
white tenacious membrane may form in
lesion is small but extremely painful and
the nose. Secondary bacterial rhinitis is
tender. The furuncle may rupture
the result of bacterial infection
spontaneously in the nasal vestibule.
supervening acute viral rhinitis.
Treatment consists of warm
Irritant rhinitis is the form of acute
compression, an analgesic to relieve
rhinitis, caused by exposure to dust,
pain, and topical and systemic
smoke or irritating gases such as
antibiotics directed against
ammonia, formalin, acid fumes etc.
staphylococcus.
Treatment includes particular attention
Vestibulitis is diffuse dermatitis of nasal
to sinuses, tonsils, adenoids, allergy,
vestibule. Causative organism is Staph.
and smoky or dusty surroundings. Nasal
aureus. Treatment consists of cleaning
irrigation with alkaline solution help to
the nasal vestibule of all crusts and
keep the nose free from viscid
scales with cotton applicator soaked in
secretions and also remove superficial
Hydrogen peroxide and application of
infection. Nasal decongestants help to
antibiotic steroid ointment. Treatment
relieve nasal obstruction and improve
should always be continued for a few
sinus ventilation. Antibiotics help to clear
more days even after the apparent cure,
nasal infection and concomitant
as the condition is likely to relapse.
sinusitis.
Septal abscess mostly results from
Nasal polyps are non-neoplastic masses
secondary infection of septal
of oedematous nasal or sinus mucosa.
haematoma. Systemic antibiotic should
Nasal stuffiness leading to total nasal
be started and continued at least for 10
obstruction, partial or total loss of smell,
days.
headache due to associated sinusitis,
Acute rhinitis can be viral, bacterial or
sneezing and watery nasal discharge
irritatant type. Viral rhinitis is known as
due to associated allergy, Polyp
common cold (coryza). The infection is
protruding from the nostril may be the
usually acquired through air borne
presenting symptom. Conservative
droplets. Several viruses such as
treatment may include antihistamines
adenovirus, rhinovirus, coxsackie virus
and control of allergy. A short course of
are responsible. There is burning
steroid nasal drop or spray is often
sensation at the back of the nose soon
helpful to produce significant shrinkage
followed by nasal stuffiness, rhinorrhoea
in the early stages of polyp. The
and sneezing. Patient feels chilly and
reduction of the oedema can be
there is low-grade fever. Initially nasal
maintained by the continuing treatment
discharge is watery and profuse but may
with the same spray. If the condition
become mucopurulent due to secondary
does not respond to medical therapy,
bacterial invasion. Secondary invaders
endoscopic clearance of the polyp
include Strep. haemolyticus, should be carried out immediately.
Pneumococcus, Staphylococcus, H. Acute inflammation of the sinus mucosa
influenzae, Kleb. pneumoniae and M. is called acute sinusitis. Most common
catarrhalis. Treatment consists of bed cause of acute sinusitis is viral rhinitis
397
followed by bacterial invasion. Sinus stenosis, aplastic anemia, leukemia,

mucosa is the continuation of nasal purpura, hemophilia, scurvy, vitamin K
mucosa and infections from nose can deficiency etc. Most of the times,
travel directly. Infected water can enter bleeding occurs from the Little’s area
the sinuses through their ostia during and can be easily controlled by pinching
swimming and diving. Trauma may the nose with thumb and index finger for
permit direct infection of sinus mucosa. about 10 minutes. This compresses the
Infection from the molar or premolar vessels of the Little’s area. If the
teeth or their extraction may be followed bleeding is profuse or site of bleeding is
by acute sinusitis. Sinusitis is common difficult to localize then packing should
in cold and wet climate. Atmospheric be done. For this, use ribbon gauze
pollution, smoke, dust and overcrowding soaked with liquid paraffin. One or both
also predispose to sinus infection. The cavities may need to be packed. Pack
bacteria most frequently responsible for can be removed after 24 hours if
acute suppurative sinusitis are Strep. bleeding has stopped. Some times it has
pneumoniae, H. Influenzae, Moxacella to be kept for 2-3 days. Systemic
catarrhalis, Strep. pyogens, Staph. antibiotics should be given to prevent
aureus and Kleb. pneumoniae. sinus infection (see section1.1).
Anaerobic organisms and mixed Bismuth idoform paraffin paste (BIPP)
infections are seen in sinusitis of dental pack is used for packing cavities after
origin. Constitutional symptoms and surgery and epistaix as mild disinfectant
signs consist of fever, headache, pain, and astringent.
tenderness, redness and oedema of
chick and nasal discharge. Conservative AMOXYCILLIN
treatment includes antimicrobial drugs (See section 1.1.1.3)
such as Ampicillin, Amoxycillin,
Erythromycin, Doxycycline or
AMPICILLIN
Cotrimoxazole, Sparfloxacin etc.
Nasal decongestant drops such as 1% (See section 1.1.1.3)
Ephedrine or 0.1% Xylo- or
Oxymetazoline are used as nasal drops PHENOXYMETHYL PENICILLIN
or sprays. Steam inhalation with steam (See section 1.1.1.2)
alone or medicated with Menthol or
Tincture benzoin provides symptomatic PREPARATIONS FOR NON-INFECTED
relief and encourages sinus drainage. INFLAMMATORY NASAL
Paracetamol can be given for the relief CONDITIONS
of pain and headache. Local heat to the
affected sinus is often soothing and BETAMETHASONE SODIUM
helps in the resolution of inflammation. PHOSPHATE
Most cases of acute maxillary sinusitis
respond to medical treatment. Surgical
treatment is done only when medical Indications : Non-infected inflammatory
treatment fails. conditions of the nose
Bleeding from inside the nose is called Cautions : Should be avoided in the
epistaxis. It is fairly common and is seen presence of untreated nasal infection
in all age groups and often presents as and also after nasal surgery. Should also
an emergency. It is the sign and not a be avoided in pulmonary tuberculosis
disease so attempt should be made to Side-effects : Dryness and irritation of
find out any local or constitutional cause. the nose
Causes are trauma, infections, foreign Preparation : Drops (for nose, eye, ear)
bodies, neoplasm of nose, atmospheric Betamethasone sodium phosphate 1%
changes such as high altitude, Application : 2-3 drops into each nostril
hypertension, arteriosclerosis, mitral 2-3 times daily
398
Proprietary Preparations paste is also used in the treatment of

(See section 11.1.1) apthous ulcer.
Systemic Corticosteroid must be
PREPARATION FOR NASAL reserved for severe conditions such as
INFECTION & EPISTAXIS pemphigus vulgaris. To relieve pain
lidocaine (lignocaine) 5% ointment or
lozenges are applied to the ulcer, but
BETAMETHASONE SODIUM
care must be taken not to use this
PHOSPHATE & NEOMYCIN before meals as this might lead to
SULPHATE choking. Carbenoxolone gel or
mouthwash may be of some value.
Indications: Nasal infection and Carmellose gelatin paste may relieve
epistaxis some discomfort arising from ulceration
Application: Apply 2-3 drops in to by protecting the ulcer site. For mild oral
nostril 2-3 times daily and perioral lesion salicylates may be
used.
Proprietary Preparations Benzydamine mouth wash or spray may
See section 11.1.1 be useful in palliating the discomfort
associated with a variety of ulcerative
11.3 DRUGS ACTING ON THE condition. It has also been found to be
OROPHARYNX effective in reducing the discomfort of
post irradiation mucositis.
11.3.1 DRUGS FOR ORAL
ULCERATION AND 11.3.2 OROPHARYNGEAL ANTI
INFLAMMATION INFECTIVE DRUGS
The causes of ulcers of the oral cavity Viral infection is most common. These
are trauma, (physical, chemical or are herpes simplex. Herpangina is a
thermal). Infection, (viral, bacterial, coxsackie viral infection mostly affecting
fungal), immune disorders, (aphthous children. They usually persist for about a
ulcer), neoplasm, skin disorders, blood week. Herpetic gingival stomatitis is also
disorders, nutritional deficiencies, known as orolabial herpes, is caused by
gastrointestinal diseases and drug herpes simplex virus. It may be primary
therapy. First of all diagnosis must be and secondary. Primary infection affects
made because majority of these children and secondary or recurrent
conditions require specific treatment herpes mainly affects adults. Most
along with the local treatment. Mouth commonly it involves the vermilion
ulcer for more than 3 weeks duration border of the lip which is known as
need urgent diagnosis and treatment to herpes labialis. Treatment is mostly
exclude carcinoma. Aim of local symptomatic. Acyclovir, 200 mg, five
treatment is to give protection to the times a day for 5 days helps to cut down
ulcerated area, relieving pain and the course of recurrent herpes labialis.
reducing inflammation. A saline or Acute ulcerative gingivitis is also called
compound Thymol glycerin mouthwash Vincent’s infection caused by Borrelia
may relieve pain. Antiseptic vincenti. Treatment is systemic
mouthwashes such as Chlorhexidine or antibiotics (Penicillin see section 1.1.1
Povidone iodine mouth wash is or Erythromycin see section 1.1.4 and
beneficial for healing of recurrent Metronidazole (see section 1.1.8).
apthous ulcer. Topical Corticosteroid Frequent mouth washes (with sodium
therapy may be useful for some form of Bicarbonate solution) and attention are
oral ulceration. It is most effective in the to be given to dental hygiene.
treatment of apthous ulcer, thrush or Moniliasis (Candidiasis) is caused by C.
other types of candidiasis. Amelexanox albicans, and occur in the form of thrush
399
and chronic hypertrophic candidiasis. Cautions: Renal impairment,

The condition is seen in infants and pregnancy, breast-feeding; adequate
children. Adults are also affected when hydration must be maintained with
they are suffering from malignancy and infusion
diabetes or taking broad-spectrum Side-effects: Rashes, gastrointestinal
antibiotics, cytotoxic drugs, steroid or disturbances, increased bilirubin and
radiation. Thrush can be treated by liver enzymes, increases blood urea
topical application of Nystatin or and creatinine
Clotrimazole. Hypertrophic form usually Dose: Tab. 200 mg 5 times daily for 5
requires excision surgery. days. Child under 2 years, half of adult
Acute pharyngitis is also very common. dose. For streptococcal infections,
Streptococcal pharyngitis is treated with required systemic penicillin
Penicillin.
Diphtheria is to be treated with Proprietary Preparations
diphtheria antitoxin and Penicillin or (See Section 1.4.)
Erythromycin.
Gonococcal pharyngitis responds to PENICILLIN
conventional doses of Penicillin or (See section 1.4.)
Tetracycline.
Fungal pharyngitis of the oropharynx can Indications: Acute ulcerative gingivitis
occur as an extension of oral thrush; (Vincent’s infection) responds to
Nystatin is the drug of choice. systemic metronidazole (see section
Aphthous ulcer is an autoimmune 1.1.8)
process that may be caused by
nutritional deficiency (Vitamin B12, Folic DRUGS USED IN OROPHARYNGEAL
acid and Iron), viral infection, hormonal ULCERS
changes or stress. Treatment consists of
(See also Dental Practitioner’s
topical application of Steroids and
Formulary)
cauterization with 10% Silver nitrate. In
severe cases 250 mg of Tetracycline
dissolved in 50 ml of water is given as FOR APHTHOUS ULCER
mouth rinse and then to be swallowed,
four times a day. Local pain can be AMLEXANOX
relieved with lignocaine viscous.
Oral mucosal lesions (erythema Indications: Aphthous ulcers in people
multiforme) consist of vesicles or bullae with normal immune systems.
which may involve lips, buccal mucosa
and tongue. The disease is self-limiting Proprietary Preparations
and management is mainly supportive. Amlexanox 5%,
Steroid preparations are used to treat Apsol(Square), Oral Paste, Tk. 75.50/5gm
the severe cases. Amlex (ACI), Oral Paste, TK. 75.23/5gm
Sorex (Eskayef), Oral Paste, Tk. 75.00/5gm
(See also Dental Practitioner’s Formulary)
Erythromycin (See Section 1.1.5)
Nystatin (See Section 1.2.1) FOR FUNGAL INFECTION
Penicillin (See Section 1.1.1) Amphotericin (see section 1.2), Nystatin (see
Tetracycline (See Section 1.1.6) section 12.2.2&1.2.3)
ACYCLOVIR[ED] MICONAZOLE GEL[ED]

(See section 1.4.) See section 12.2.2
Indications: Herpes simplex and Indications: Oropharyngeal candidiasis.

varicella-zoster
400
Dose: 5-10 ml after food 4 times a day. CHLORHEXIDINE GLUCONATE[ED]

Retain near oral lesions before
swallowing. Continue treatment until 48 Indications: Oral hygiene and plaque
hours until lesions have healed. inhibition
Caution: If desquamation occurs then it
Miconazole oral gel 2%
must be discontinued
A-Migel(Acme), Oral Gel, Tk. 52.16/15gm Side-effects: Mucosal irritation.
Candoral (Beximco), Oral Gel, Reversible brown staining of teeth and
Tk.52.00/15gm parotid gland swelling may occur
Dakrin (General), Oral Gel, 2%, Tk. Dose: Rinse mouth with 10 ml, for about
60.18/15gm 1 minute twice daily.
Fungidal (Square), Buccal Tab. , 10 mg, Tk. Preparations: Chlorhexidine gluconate
5.03/Tab. ;
Gelora (Square), Oral Gel, Tk. 60.18/15gm
0.2% mouth wash
Mic (Globe), Cream, Tk. 35.00/10 gm
Micoral (ACI), Oral gel, Tk. 100.30/30gm Proprietary Preparations
,Tk. 60.18/15gm Chlorhexidine gluconate 0.2%
Mycon (Aristo), Oral Gel ,Tk. 60.00/15gm ORAL-C(Unimed), Mouthwash,Tk. 75/125 ml
Mycosina (Ibn Sina), Oral Gel, Tk. 60.00/15gm Fresh Breath (Greenland), Mouth wash, Tk.
Oragel (UniMed), Oral gel, Tk. 50.00/15gm 40.00/100ml
Ormico (Pacific), Oral GelTk. 60.00/15gm Oralon (ACI), Mouth Wash, Tk. 60.00/100ml
Orocare (Novo Healthcare), Oral Gel, Tk.
50.00/15gm POVIDONE IODINE[ED]
Oroconazol (Incepta), Oral Gel, Tk.
50.00/15gm
Orogurd (Eskayef), Oral Gel, Tk. 60.00/15gm
Indication : Oral hygiene
Cautions : Pregnancy and breast-
feeding
11.3.3 MOUTHWASH AND
Contraindications : Patients with
GARGLES
thyroid disorders or those receiving
lithium therapy
Mouthwash freshens the mouth and it Side-effects: Idiosyncratic mucosal
has got a mechanical cleansing action. irritation and hypersensitivity reactions. It
Sodium chloride and Thymol may interfere with thyroid function tests
Glycerins are also very useful and with tests for occult blood
mouthwash. Hydrogen peroxide is an
oxidizing agent and is very much useful Proprietary Preparations
in the treatment of acute ulcerative Povidone Iodine 1%
gingivitis (Vincent’s infection). Since the Arodin (Aristo), Gargle & Mouthwash , Tk.
organisms involved in these cases are 35.00/100 ml; Tk. 35.00/100ml;
anaerobes, mouthwashes containing Betadine (Mundipharma), Gargle &
Mouthwash, Tk. 60.00/50 ml; Tk. 95/100 ml
Hydrogen peroxide are useful. It
Cleanser(General), Gargle & Mouthwash, Tk.
produces a mechanical cleansing action 25/100 ml
due to frothing when it comes in contact Povisep (Jayson), Gargle & Mouthwash, Tk.
with oral debris. A Chlorhexidine 35/100 ml
mouthwash may be used for oral Povin (Opsonin), Gargle & Mouthwash, Tk.
infection or when tooth brushing is not 18.86/100 ml 25.09/ 100 ml;
possible. Chlorhexidine has a specific Viodin (Square), Gargle & Mouthwash, Tk. Tk.
effect for inhibition of the formation of 35.11/100ml;
Cleanser (General) Gargle & Mouthwash, 1%,
plaques on teeth. For mucosal infection Tk. 25.07/100ml
povidone iodine mouthwash may be Piodin(Pharmasia) Gargle & Mouthwash, Tk.
used. As significant amount of iodine 25/100 ml
may absorb so it should not be used for
not more than 14 days. Thymol
mouthwash to be used as mouth wash.
401
MENTHOL, THYMOL , EUCALYPTOL, Thymol 0.063gm + Eucalyptol 0.091gm +

Menthol 0.042gm /100ml
METHYL SALICYLATE
Lister Zero (General), Mouthwash,
Tk.145.00/250ml,Tk,30.00/75ml
Indications : Antiseptic mouth wash
Lister Total Care Anticavity Mouthwash
Menthol 0.042 gm + Thymol 0.064 gm + (General), Mouthwash30.00/75ml
Eucalyptol0.092gm + Methyl Salicylate Sodium Fluoride0.02%,
0.060gm/100m; Listacare (General), Mouthwash, Tk.
80.00/120ml; Tk. 145.00/250ml; Tk.
Alconil Mouthwash (Ziska), Mouthwash, Tk. Flurodent(Nipro Jmi) ,Mouthwash, Tk.
85.00/120ml,; , Tk. 150.00/250ml 80.00/120ml;
Listcare Gold (General), Mouth Wash Tk. Oralis Cavicare(Opsonin) Mouth wash, Tk.
145.00/250 ml; Tk. Tk. 80.00/120ml,; Tk. 80.24/120ml; Tk. 145.43/250 ml
30.00/75ml
Listcare r zero (General), Mouth Wash Tk BENZOCAINE
145.0 Tk. 30.00/75ml 0/250ml,; Tk. 80.00/120
ml Indications : Used to reduce pain
Listoral Cool Mint (ACI), Mouth Wash, Tk. caused by teething, cold sores, canker
75.51/120 ml; Tk. 140. 95/250 ml sores, and toothaches.
Listoral Original (ACI), Mouth Wash, Tk.
75.51/120 ml; Tk. 140.95/250 ml Proprietary Preparations
Orostar Cool Mint (Square), Mouth wash, Tk. Orogel (Square), Oral Gel, 20%, Tk.50.15/5gm
Tk. 75.51/120ml ml; Tk. 140.95/250ml ml Oratics (Acme), Oral Gel, 20%, Tk.40.12/5gm
Orostar Original (Square), Mouth wash, Tk.
80.24/120ml,; Tk. 150.45/250ml ml
SODIUM FLUORIDE0.02%,
Orostar plus (Square), Mouth wash,Tk.
85.26/120ml; Tk. 150.45/250 ml
Oralis(Opsonin) Mouth wash,Tk. 75.22/120ml; Proprietary Preparation
Tk. 140.42/250 ml Listacare Whiting Plus(General), Mouthwash,
Oroclean Coolmint(Incepta) Mouth wash,Tk. 0.02%, Tk. 80.00/120ml; Tk. 145.00/250ml;
75.00/120ml; Tk. 140.00/250 ml Tk. 30.00/75ml
Oroclean Original Incepta) Mouth wash,Tk.
75.00/120ml; Tk. 140.00/250ml
402
12. SKIN
Chapter 12
SKIN
12.1 Management of skin conditionsp.403
12.2 Anti-infective skin preparations p.404
12.2.1 Topical antibiotics p.405
12.2.2 Antifungalsp.407
12.2.3 Antiviralsp.413
12.2.4 Antiparasiticsp.414
12.3 Topical corticosteroidsp.415
12.4 Systemic corticosteroids p.422
12.5 Antihistamines, antipruritics and topical local anaestheticsp.421
12.6 Preparations for eczema and psoriasisp.429
12.7 Acne and rosaceap.432
12.8 Miscellaneous skin preparationsp.435
12.8.1 Disinfectants and cleansersp.437
12.8.2 Sunscreen and camouflagers, shampoos and some other scalp
preparationsp.440
12.1 MANAGEMENT OF SKIN vehicles deliver topical therapy, most

CONDITIONS frequently in the form of creams and
ointments,solutions, lotions, emollients,
General guidelines for topical gels, powders, soaps and paints. The
therapy: Whilst systemic administration choice of vehicle may be as important as
of drugs is often necessary in the active drug. Either the vehicle or its
dermatology, many common skin active ingredient(s) may cause local
diseases can be effectively managed toxicity.
using the wide range of topically applied Ointments: Ointments are greasy
physical or pharmacological modalities semisolid preparations, which are
that are available. Topical treatment normally anhydrous and insoluble in
offers the potential to achieve high water. They are petrolatum-based
concentrations of a drug in the skin with vehicles, capable of providing occlusion,
minimal exposure of other organs. hydration, and lubrication. Some
This can greatly increase efficacy and ointments contain emulsifying agents
also safety relative to systemic such as polyhydric alcohols (macrogols,
administration. When side effects do polyethylene glycol), or cetostearyl
occur, they are most likely to take the alcohol (e.g. emulsifying ointment). The
form of localized reactions. Some factors latter have the advantage of being less
that affect penetration of topical agents greasy, with good solvent properties,
include: concentration of medication, and are easily washed off.
thickness and integrity of the stratum Ointments require fewer preservatives
corneum, frequency of application, than other vehicles since they contain no
occlusiveness of the vehicle, and water and do not sustain growth of
compliance. microorganisms.Ointments are
Vehicle: Topical medication must be particularly suitable for chronic dry
applied to the skin in a suitable vehicle. lesions. They often have mild anti-
This term encompasses all the inflammatory effect.
constituents of the formulation apart from Creams: Creams are emulsions of oil
the active pharmaceutical agent. Various and water and are generally well
403
12. SKIN
absorbed into the skin. They may actions are short lasting and they should
contain an antimicrobial preservative be applied frequently even after
unless the active ingredient has improvement. They are useful in dry and
sufficient intrinsic bactericidal and eczematous conditions, and to a lesser
fungicidal activity. They are emollient, extent in psoriasis. It should be applied
lubricant and mildly occlusive (but less in the direction of hair growth.
so than ointments). Generally creams Preparations containing an antibacterial
are cosmetically more acceptable than ingredient should be avoided unless
ointments because they are usually infection is present.
greasy and easier to apply. Gels: Gel consists of active ingredientsin
Solutions: A solution involves the suitable hydrophilic or hydrophobic
dissolution of two or more substances bases.Gels are popular because of their
into homogenous clarity. The liquid clarity and ease of both application and
vehicle may be aqueous, removal. They are suitable for facial or
hydroalcoholic,or nonaqueous (alcohol, hairy areas because after application
oils, or propylene glycol). Collodions are little residue is left behind. Nevertheless,
liquid preparations consisting of cellulose they lack any protective or emollient
nitrate in organic solvent. They properties. If they contain high
evaporate rapidly to leave a flexible film concentrations of alcohol or propylene
which can hold medicaments in contact glycol, they tend to be drying or cause
with the skin. They are most frequently stinging. Gels require preservatives.
used to apply salicylic and lactic acids to They generally have a high water
warts. They may also be used as content.
protectives to seal minor cuts and Powders:Powders absorb moisture and
abrasions. They are easy to apply and decrease friction. Because they adhere
water repellent, but inflammable. poorly to the skin, their use is mainly
Lotions: Lotions are liquid formulations limited to cosmetic and hygienic
which are usually simple suspensions or purposes. Generally, powders are used
solutions of medication in water, alcohol in the intertriginous areas and on the
or other liquids. The applied lotion leaves feet. Adverse effects of powders include
the skin feeling cooler via evaporation of caking (especially if used on weeping
the aqueous component. Lotions are skin), crusting, irritation, and granuloma
easier to apply and allow for uniform formation. They are occasionally used to
coating of the affected area, and are deliver drugs such as antifungal agents
often the favorite preparation in treating applied to the feet.
children. Lotions are more drying than Paints: Paints are liquid preparations,
ointments, and preparations with alcohol either aqueous, hydroalcoholic or
tend to sting eczematized or abraded alcoholic (tinctures), which are usually
skin. Lotions are suitable for application applied with a brush to the skin or
to large surface areas due to their ability mucous membranes and then
to spread easily. Aqueous suspensions evaporate.
of powders which require shaking prior
to each application are known as shake 12.2 ANTI-INFECTIVE SKIN
lotions. Examples include calamine PREPARATIONS
lotion, steroid lotions, and emollients
containing urea or lactic acid. General considerations: Both topical
Emollients: Soothe, smooth and and systemic antibiotics are commonly
hydrate the skin and they are indicated used in dermatological conditions
for all dry or scaling disorders. Their according to requirements. Systemic
antibiotics are commonly prescribed for
404
12. SKIN
deeper bacterial infections.

Fusidic acid 2%+Betamethasone valereate
0.1%:
12.2.1 TOPICAL ANTIBIOTICS Facid(Eskayef), Cream, Tk. 160/10 gm
Fusigal(Sharif), Cream, Tk. 160/15 gm
Topical antibiotics play an important role Xzema(Orion), Cream, Tk.201.35/10gm
in the management of many common
dermatologic conditions. Fusidic Acid 2%+Hydrocortisone Acetate1%
Fusidate-H(Aristo),Cream,Tk.125/10gm
Fortison(Incepta),Cream, Tk.125/10gm
AZELAIC ACID Fusitrim(Asiatic),Cream, Tk. 125/10gm
Fusibac-H(Drug Int.),Cream,Tk.125.40/10gm
Indications; Side-effects; Fusicort(Opsonin), Cream, Tk.125.47/10 gm
Facid HC(Eskayef),Cream,Tk.125/10gm
Cautions, Contraindications; Dose: Fucort(Novo), Cream,Tk.125/10gm
See Section 12.7. Fusitop(Square), Cream,Tk. 125/10gm
See Section 12.7. Dose:Apply 3 times daily to uncovered lesions
for up to 2 weeks. Apply less frequently to
covered lesions.
CLINDAMYCIN
GENTAMICIN[ED]
Indications; Side-effects;
Contraindications; Dose: See Section (See also section 1.1.4)
12.7.
Indications: Bacterial infections
Proprietary Preparation Side-effects: Contact dermatitis, cross-
See Section 12.7. reactivity with other aminoglycosides
Contra-indications: known hypersen-
sitivity to gentamicin
ERYTHROMYCIN
Dose:Apply 3-4 times a day for7-10
days.
Indications; Side-effects;
Cautions, Contraindications; Dose: Proprietary Preparations
See section 12.7. Genacyn(Square), Oint., 0.10%, Tk.
12.09/10gm
Proprietary Preparation Gentin(Opsonin),Cream,0.3%,Tk.12.54/10 gm
See Section 12.7. Monamycin(Amico), Cream, 0.3%, Tk
12.00/10gm; Tk. 18.45/15gm
FUSIDIC ACID Gentamicin 0.3%+ Hydrocortisone Acetate1%

(See section1.1.12) Gento HC(G.A.Co),Cream, Tk. 60.18/10g
Indications: Staphylococcal skin
Dose: Apply 2-3 times daily.
infections, erythrasma, pitted keratolysis.
Cautions: Pregnancy & lactation;avoid
contact with eye as it causes irritation of METRONIDAZOLE[ED]
conjunctiva (See also section 1.3.2)
Side-effects: Rash, irritation,hypersen-
sitivity reaction, pruritus, urticaria, Indications: Acne rosacea, vaginal
burning sensation in skin, contact infections
dermatitis, dry skin Cautions: Pregnancy, breastfeeding,
Dose: ADULT & CHILD: apply 2% avoid unnecessary prolonged exposure
cream/ointment 3-4 times daily until to sunlight
improvement occurs Contra-indications: known hypersen-
sitivity to metronidazole
Proprietary Preparations Side-effects: Skin redness, dryness,
Fusidic Acid / Sodium Fusidate burning, irritation, or stinging
Facid(Eskayef), Cream, 2%, Tk. 90.00/15gm Dose: For vaginal infections:twice daily
Fusidate(Aristo), Oint., 2%, Tk.85.00/20gm; for 5 consecutive days
405
12. SKIN
For acne: Wash the affected skin area Cautions: Ototoxicity may occur if large
with mild soap about 15-20 minutes areas may be treated, renal impairment,
before applying the medication. Apply a pregnancy, children
thin layer of gel and rub it gently into the Contraindications:Known hypersen-
affected area sitivity, perforated eardrums
Side-effects:Allergic contact dermatitis,
Proprietary Preparation cross-sensitization with other
Flamyd(Incepta), Gel, 0.75%, Tk.50/30 gm aminoglycosides, local irritation and
itching
MUPIROCIN
Neomycin 3.5 mg + bacitracin400 IU +
Indications: Bacterial skin infections, polymyxin 5000 IU/gm
particularly impetigo, folliculitis, Neocin Plus(Opsonin), Oint, Tk. 30.20/10gm
impetiginized eczema, burns, Poyban(Popular) Oint, Tk. 30.11/10 gm
lacerations, and leg ulcer; and to Neogen plus(General) Oint, Tk. 30.20/10 gm
eliminate nasal staphylococcal carriage, Nebaskin Plus(Pacific) Tk. 30.00/10 gm
even MRSA Nuba Plus(Biophrma)TK.30.11/10 gm
Nebanol Plus(Square)Tk.30.20 /10 gm
Cautions: Moderate to severe renal Dose: apply 3-4 times daily for 7-10 days.
impairment, avoid contact with eyes,
pregnancy, lactation, child < 3 months Bacitracin Zinc250 IU + Neomycin Sulphate5
Side-effects: Pain, burning, and itching, mg/gm(Powder)
an uncommon cause of postoperative B-mycin(G.A.Co), Powder, Tk. 10.03/5 gm
ACD following dermatologic surgery. Neocitrin(ACI), Powder, Tk. 10.37/5gm
Dose: Apply 2-3 daily times for a Nebanol(Square), Powder, Tk. 20.13/10gm
Nenol(Alco), Powder, Tk. 15.55/5gm
maximum of 10 days Neocitrin(ACI),Powder,
Tk.10.37/5gm,Tk.20.14/10gm
Proprietary Preparations Neotracin(Acme), Powder, Tk. 10.18/5gm, Tk.
Mupirocin 2% 20.13/10gm
Bactrocin(Supreme), Oint., Tk.140.42/10gm Tybac(Somatec), Powder,Tk. 15.43/5 gm
Bactoderm(UniMed), Oint., Tk. 140.00/10g Dose: Apply 3-4 times daily for 7-10 days.
Bactroban(GSK), Oint, Tk. 146.74/10gm
Dermupin(Acme), Oint., Tk. 140.42/10gm Bacitracin Zinc 500 IU + Neomycin Sulphate
Dermoban(Opsonin), Oint.,Tk. 130.49/10gm 5mg/gm(ointment)
Mupi(Alco), Oint., Tk. 140.42/10gm; B-mycin(GA Co.), Oint., Tk. 17.36/10 gm
Tk.80.24/5gm Monabacin(Amico), Oint., TK. 18.50/10gm
Muron(Drug Intl), Oint.,Tk. 130.45/10 gm Nebanol(Square), Oint. Tk. 44.2/20gm
Muroderm(General), Oint., Tk. 140.96/10gm Nebazin(Incepta), Oint., Tk. 43.9.00/20gm
Mupiron(Eskayef), Oint., Tk.220/20gm; Neo-B(Drug Intl), Oint., Tk. 32.60/15 gm
140.00/10gm; Neobacin(Kemiko), Oint.,Tk. 44.03/20gm
Mupiderm(Healthcare), Oint., Tk. 140/10 gm
Muderm(Globe), Oint., Tk. 140/10 gm Neomycin Sulphate3.5 mg + Polymyxin B
Systope(ACI), Oint., Tk. 140.42/10gm sulphate10000IU + Pramoxine
Sinaban(Ibn Sina), Oint., Tk. 140.00/10gm Hydrochloride10gm/gm
Trego(Incepta), Oint., Tk.140/10gm Nuprin(Alco), Cream, Tk. 75.23/10gm Tk.
Tigocin(Pacific), Oint., Tk.140/10gm 140.42/30gm ,Tk. 40.12/5gm
Nepranol(Square) cream, Tk. 75.50/10gm
NEOMYCIN
(See also section 1.1.4) NITROFURAZONE
Indications: Effective against several Indications: Prevention or treatment of

gram-negative and several gram positive surface bacterial infections of wounds,
bacteria. It is useful for treating minor burns, and cutaneous ulcers, before skin
wounds and cutaneous infections. It is grafting
used in combination with bacitracin Contraindications: Hypersensitivity,
toachieve optimal staphylococcal and cross-sensitivity with other nitrofuran
streptococcal coverage derivatives
406
12. SKIN
Side-effects: Sensitization, generalized ulcers, pressure sores, infection in skin

allergic skin reactions graft donor sites and extensive
Dose: 0.2% ointment/cream: Apply 2 abrasions
times daily for 7 days Cautions: Hepatic and renal
impairment, pregnancy, breast-feeding,
Proprietary Preparation neonates
Furasep(Beximco), Cream, 0.2%, Tk.17/20g Contraindications: Pregnancy and
breast-feeding, sensitivity to
POLYMYXIN B sulfonamides and should not be
recommended in neonates
Indications: Bacterial skin infections, Side-effects: Allergic reactions, burning
especially gram negative infections. sensation, itching, rashes, leucopenia,
Usually used in combination with other may develop if drug is used for
topical antibiotic agents to broaden their prolonged period. Hemolysis in glucose-
coverage 6-phosphate dehydrogenase (G6PD)
Cautions: Treatment of large areas may deficiency patients, methemoglobinemia
cause ototoxicity particularly in children, Dose:Apply once or twice daily
in elderly and in renal impairment
Side-effects: Skin rash, urticaria, Proprietary Preparations
eosinophilia, fever, nephrotoxicity Silver Sulfadiazine1%
Burna(Square), Cream, Tk. 40.13/25gm
Dose: In combination with bacitracin or Burnless(Sharif), Cream, Tk. 225.68/250g;
as triple antibiotic ointment Tk. 35.11/25g
with bacitracin and neomycin: apply 1-3 Burnrid(Globe), Cream, Tk. 40.00/25 gm
times a day Burnsil(Beximco), Cream., Tk.45.00/25gm
Dazine(Alco), Cream, Tk. 50.15/25gm
Proprietary Preparations Eburn(Pacific), Cream, Tk. 50.00/25gm
see under neomycin Neozine(Opsonin), Cream, Tk. 225.85/250
One g ointment contain Oxytetracycline HCl gm., Tk. 30.11/25 gm,Tk. 399.00/500 gm,Tk.
30mg and Polymixin 10,000 IU 260.78/250gm
Sibalyn(ACI), Cream, Tk. 40.12/25gm
Renamycin(Renata), Oint. Tk.44/3.5g; Silvadazin(Aristo), Cream, Tk. 60.00/25g, Tk.
Tk.12.62/5g 225.00/ 250g & Tk. 425.00/500g
Tetraderm(Rephco), Oint.Tk. 12.43/5g Silvec(Drug Intl), Cream, Tk. 50.00/25 gm
Silverax(Healthcare), Cream, Tk.57.00/25 gm
Silverzine(G.A.co), Cream, Tk. 40.12/25
RETAPAMULIN gmTk. 202.90/250 gm Tk. 401.20/500 gm
Silzin(Kemiko), Cream, Tk. 50.00/25gm
Indications: Impetigo due to S. aureus
or S. pyogenes in adults and children 9 12.2.2 ANTIFUNGALS
months of age or older (See also section 1.2)
Cautions: Pregnancy & lactation
Side-effects: Pruritus, paresthesia, Compound topical preparations:
irritation, pain at the site of application, Combination of an imidazole and a weak
allergic contact dermatitis corticosteroid may be of value in the
Dose: Apply twice daily for 5 days treatment of eczematous intertrigo and a
severely inflamed patch of ringworm.
Pamulin(Navana), Oint., 1%, Tk. 200/10gm
The combination of nystatin and a weak
Retabac(Square), Oint., 1%, Tk. 200/10gm corticosteroid may be of use in the
Retapex(Incepta), Oint., 1%, Tk. treatment of intertrigo associated with
200/10gm,Tk. 300/15gm candida. Combination agents have a
higher rate of treatment failure and
SILVER SULFADIAZINE[ED] disease relapse.
Choices of anti-fungal formulation
Indications: Treatment & prophylaxis of :Lotions or sprays are suitable for
infection in burn wounds, infection in leg application to large and hairy areas.
407
12. SKIN
Ointments are generally used on dry Proprietary Preparations

areas. Creams are suitable for moist Butefin (Square), Cream,1%,Tk.40.13/10gm
areas. Fintop(Drug Intl), Cream, 1%,Tk. 40.15/10 gm
Tenafin(Beximco), Cream, 1%,Tk.50/15gm
BENZOIC ACID + SALICYLIC ACID

CICLOPIROX OLAMINE
(WHITFIELD’S OINTMENT)[ED]
Indications: Tinea pedis, Tinea cruris,
It is a combination of 6% benzoic acid
Tinea corporis due to Trichophyton
which has fungistatic action and 3%
rubrum, Trichophyton mentagrophytes,
salicylic acid which has keratolytic
Epidermophyton floccosum and
action.
Microsporum canis, Candidiasis
Indications: Superficial fungal
(moniliasis) due to Candida albicans,
infections, pityriasis versicolor
Tinea (pityriasis) versicolor due to
Cautions: Avoid contact with eyes
Malassezia furfur
Contra-indications: Known hypersen-
Side-effects: Mild burning, stinging,
sitivity to any component of Whitfield’s
itching, swelling, or other signs of skin
ointment
irritation,Redness of skin
Side-effects : Mild inflammatory lesions. Proprietary Preparations
Dose: Apply twice daily to the affected Candirox(Incepta), Cream, 10 mg/gm Tk.
area for at least 4 weeks 110.00/10 gm
Clopirox(Square), Cream, 10 mg/gm Tk.
Proprietary Preparations 80.24/10gm
Ointments containing Benzoic acid 6% and
Salicylic acid 3% :
Albi-Whitfield(Albion), Oint., Tk.9/20gm CLOTRIMAZOLE[ED]
Bensal(G.A.Co), Oint., Tk. 5.56/10 gm; Tk.
25.00/25 gm Indications: Dermatophytes, pityriasis
BS(Acme), Oint. Tk. 665.00/Kg versicolor, cutaneous and vaginal
G-Benzosal(Gonoshasthaya), Oint., candidiasis
Tk.12.50/25 gm
Cautions: Pregnancy & lactation,
Saliben(Amico), Oint.Tk. 667/1kg;Tk.
25.00/20gm hepatic and renal impairment, avoid use
Whitefield(Asiatic), Oint. Tk. 13/30gm around the eyes
Contra-indications: known
BUTENAFINE hypersensitivity to clotrimazole
Side-effects: Erythema, burning,
irritation, stinging, contact dermatitis,
Indications: Dermatophytoses,pityriasis
peeling, blistering edema, pruritus, and
versicolor
urticaria at the site of application
Cautions: Lactation, avoid contact with
Dose: Apply twice daily for 2-4 weeks.
mouth, eyes, and other mucous
Intravaginal clotrimazole tablets:
membranes, child less than 12 years of
(See section 6.2.2)
age
Contraindications: Pregnancy, known Proprietary Preparations
hypersensitivity to butenafine Clotrimazole 1%
Side-effects: Burning, stinging, contact Afun(Square), Cream, Tk.35.11/10gm Tab.,
dermatitis, erythema, irritation, itching Cantina(Kemiko), Cream, Tk. 35.11/10gm
Dose:Cream:For tinea pedis: once daily Clodal(Globe), Oint., Tk. 25.00/10gm
for 4 weeks, or twice daily for 1 week Cloderm(General), Cream,Tk. 35.20/10gm
Closten(Alco), Cream, Tk. 25.08/10gm
For tinea elsewhere: once daily for 2
Clotrim(Acme),Cream, Tk. 30.10/10gm, Tk.
weeks 18.37/5gm
For pityriasis versicolor: once daily for 2 Clotrimazole(Amico), Cream,Tk.35.00/10gm,
weeks Tk. 60.00/20gm
Clotzol(Sharif), Cream, Tk. 29.08/10g
Clozox(UniMed), Cream, Tk. 25.00/10gm
408
12. SKIN
Dermasim(ACI), Cream, Tk. 35.21/10gm,; Tk. Econate Plus(Incepta), Cream, Tk.40/10gm

40.12/15gm,; Tk. 68.20/20ml Ecoren-T(ACI), Cream, Tk Tk. 41.27/10gm
Fungin(Ibn Sina), Cream, Tk. 35.00/10gm Ecostat(Sharif), Cream, Tk. 34.10/10g
Kanis(G.A.Co), Cream,Tk. 30.09/10 gm Ecotrim(Beximco), Cream, Tk. 34.50/10gm
Lotrimin(Novo Health), Solu., Tk.25.00/10mg Ecozol Plus(Opsonin), Cream, Tk. Tk.
Neosten(Beximco), Cream, Tk. 45.00/20gm 34.13/10 gm
Tinatrim(GSK), Cream, Tk. 35.20/10gm Elocon(Amico), Cream, Tk. 40.00/10gm
Tinazol(Popular), Cream, Tk. 25.09/10gm Enazol(Biopharma), Cream, Tk. 40.00/10gm,;
Triderm(Healthcare), Cream, Tk. 35/10 Etriam(Eskayef), Cream, Tk. 40.00/10gm
gm,Tk. 45.00/20 mg Exinil(Acme), Cream,Tk.40.00/10gm
Trimazole(Opsonin), Cream,Tk. 25.09/10gm; Fungicort(Ibn Sina), Cream, Tk. 40.00/10gm
Solution, Tk. 68.00/5ml Pevisia(Asiatic), Cream, Tk. 40.00/10gm
Pevisone(Sanofi), Cream, Tk. 55.00/10 gm,;
Tk. 75.51/10 gm
ECONAZOLE
Pevitin(Square), Cream, Tk. 45.00/10gm
Spectazole(Healthcare), Cream, Tk. 40/10gm
Indications:Dermatophytoses, pityriasis
versicolor, mucocutaneous candidiasis FENTICONAZOLE
Cautions: avoid use around the eyes
Contraindications: known hypersen-
Indications: Vulvovaginal candidiasis.
sitivity to econazole, porphyria,
Cautions: Pregnancy, lactation
pregnancy
Contra-indications: Known hypersen-
Side-effects: Erythema, burning,
sitivity to imidazole derivatives
stinging, contact dermatitis, and pruritus.
Side-effects:Transient burning,
Dose:1% cream:1-2 times daily for 2-4
sensitization
weeks
Dose: One applicator full (about 5 g) is
Vaginal candidiasis: See section 6.2.2
administered into the vagina by a re-
usable applicator (morning and evening
Econazole1% for three days).
Conacream(Supreme), Cream,
Tk.28.00/10gm ProprietaryPreparations
Ecoderm(Rephco), Cream, Tk.28/10gm Fentizol(Square), Vaginal Tab. , 600 mg, Tk.
Ecolet(Amulet), Cream, Tk. 32/10 gm 120.00/Tab.
Econal(Kemiko), Cream, Tk. 32.10/10gm Fentigal(Sharif), Cream, 2%, Tk. 195.59/30g;
Econate(Incepta), Cream, Tk.32.00/10 gm Vaginal Tab, 600 mg, Tk. 120.00/Tab.
Econate-G(Incep,Cream, Tk. 70.00/30gm
Ecoren(ACI), Cream, Tk.30.20/10gm FLUCONAZOLE[ED]
Ecozol(Opsonin), Cream,Tk. 70.48/30 gm,
Tk.12/10gm (See section1.2.1)
Pevaryl(Sanofi) Cream, Tk.32.59/10 gm
Spectazole(Healthcare),Cream, Tk. 35/10gm Indications:Candidiasis, dermatophy-
tosis (tinea), onychomycosis, pityriasis
ECONAZOLE WITH versicolor, cryptococcal meningitis,
TRIAMCINOLONEACETONIDE sporotrichosis
Cautions, Side-effects & Dose: See
Steroid-responsive inflammatory section1.2.1 under Fluconazole
dermatoses with econazole-sensitive Interactions:See Appendix -2
mycotic and/or bacterial superinfections
Dose: Apply 1-2 times daily for 2 weeks
Anfasil(Silva), Cap., 50mg, Tk.7.03/Cap .;
Tab., 150mg, Tk. 20.08/Tab.
Proprietary Preparations Canazole(ACI), Suspn, 50mg/5ml, Tk.
Econazole 1% + Triamcinolone Acetonide0.1% 78.53/35ml; Tab., 150mg, Tk. 22.15/Tab.;
Aristocort Plus(Aristo), Cream, Tk. 20/5g, Tk. 50mg, Tk. 8.05/Tab.; 200mg, Tk. 25.08/Tab.
40.00/10g Candid(Amico), Cap., 150mg, Tk. 22/Cap.;
Avison(Orion), Cream, Tk. 40.00/10gm 50mg , Tk. 8.00/Cap.; Tab., 150mg, Tk.
Dicot(Drug Int), Cream, Tk. 40.15/10 gm 22.00/Tab.
Ecocort(Globe), Cream, Tk. 40.00/10 gm Candidal(Radiant), Cap., 50mg , Tk;.
Ecolon(Supreme), Cream, Tk. 40.00/10gm 8.02/Cap.; 150mg , Tk. 22.57/Cap.
409
12. SKIN
Candinil(Healthcare), Cap., 150mg , Tk. Fungata(Biopharma), Cap., 150mg, Tk.

264.00/Cap.; 200mg , Tk. 300.00/Cap.; 50mg 22.08/Cap.,50mg, Tk. 8.03/Cap.; Suspn.,
, Tk. 240.00/Cap.; Suspn, 50mg/5ml , Tk. 50mg/5ml Tk. 78.29/35ml
78.00/35 ml. Funzole(Monico), Cap., 150mg, Tk.
Conaz(Orion), Cap., 150 mg, Tk. 22.14/Cap.; 22.00/Cap.; 50mg, Tk. 8.00/Cap.; Suspn.,
50 mg, Tk. 8.06/Cap. 50mg/5ml, Tk. 78.00/35ml
Derma(Alco), Cap., 150 mg, Tk. 20.06/Cap.; F-Zol(Popular), Cap. , 150mg , Tk.
50 mg, Tk. 8.02/Cap. 22.08/Cap.;50mg, Tk. 8.03/Cap.; 200mg, Tk.
Dermicon(Asiatic), Cap., 150mg , Tk. 25.00/Cap.; IVInfusion, 200mg/100ml, Tk.
22.00/Cap.; 50mg , Tk. 8.00/Cap. 200.00/100 ml,; Suspn., 50mg/5ml, Tk.
Diflu(Aristo), Cap., 200mg , Tk. 5.00/Cap.; 78.29/35ml
150mg , Tk. 22.00/Cap.; 50mg , Tk. 8.00/Cap.; Galfin(General), Cap, 150mg, Tk. 22.15/Cap.;
Suspn, 50mg/5ml, Tk. 78.00/35ml 50mg, Tk. 8.05/Cap.
Flucoder(Eskayef), Cap, 50 mg, Tk. Iluca(Ibn Sina), Cap., 150 mg, Tk.
8.10/Cap., 150mg , Tk. 22.00/Cap., 200mg , 23.00/Cap.; 50 mg, Tk. 9.00/Cap.
Tk. 25.00/Cap.; Suspn, 50mg/5ml, Tk. Innocan(Pharmacil), Cap., 150mg , Tk.
78.00/35ml 22.00/cap.; 50mg , Tk. 9.00/Cap.
Flucon(Opsonin), Cap. , 150 mg , Tk. Lucan(Renata), Cap. , 150 mg, Tk.
22.08/Cap.;200 mg , Tk. 25.00/Cap.;50 mg, 25.00/Cap.; 50 mg, Tk. 22.08/Cap.; 50mg, Tk.
Tk. 8.06/Cap.; Suspn, 50 mg /5 ml, Tk. 8.03/Cap.; Suspn, 50mg/5ml, Tk. 78.30/35ml
78.52/35ml. Mycoder(UniMed), Tab , 150mg, Tk.
Fluconaaf(Naafco), Cap. 50 mg, Tk. 20.00/Tab.; 50mg, Tk. 7.00/Tab.
7.50/Cap. Nispore(Incepta), Cap. , 150 mg, Tk.
Fluconal(Acme), Suspn, 50mg/5ml., Tk. 22.00/Cap.; 200 mg, Tk. 25.00/Cap.; 50 mg,
78.53/35ml,; Tab. , 150 mg, Tk. 22.15/Tab.; 50 Tk. 8.00/Cap.; Suspn, 50mg/5ml, Tk.
mg, Tk. 8.07/Tab. 78.00/35ml
Fluconazole(Biogen), Cap., 50mg, Tk. Olif(Kemiko), Cap., 150 mg, Tk. 22.06/Cap.;
7.00/Cap.; 150mg , Tk. 22.00/Cap.; 50mg , Tk. 50 mg, Tk. 8.02/Cap.
24.00/Cap. Omastin(Beximco), Cap., 150mg, Tk.
Flucostan(Ziska), Cap. , 50 mg, Tk. 22.00/Cap.; 200mg, Tk. 25.00/Cap.; 50mg, Tk.
10.00/Cap. 8.00/Cap.; IV.Infusion, 200mg/100ml, Tk.
Fluda(Novo Health), Cap. , 150 mg, Tk. 200.00/100 ml,; Suspn, 50mg/5ml, Tk.
22.00/Cap.; 50 mg, Tk. 8.00/Cap. 78.00/35ml
Flufun(Astra Bio), Cap. , 150 mg, Tk. Onicon(Zenith), Suspn, 50 mg/5 ml , Tk.
22.00/Cap.; 50 mg, Tk . 8.00/Cap. 65.24/35ml,; Tab., 50 mg , Tk. 6.00/Tab.
Flugal(Square), Cap. ,150 mg, Tk. Orcon(Team), Cap., 50 mg, Tk. 7.50/Cap.
22.14/Cap.; 200 mg, Tk. 25.17/Cap.; 50 mg, Pileus(One Pharma), Cap. , 150 mg , Tk.
Tk. 8.07/Cap.; Suspn, 50 mg/5 ml, Tk. 22.00/Cap.; 50 mg, Tk. 7.99/Cap.
78.53/35ml. Segal(Supreme), Cap, 150mg, Tk.
Flukzol(Sharif), Cap. , 50 mg, Tk. 8.03/Cap. 22.00/Cap.,50mg, Tk. 8.00/cap.; Suspn.,
Fluma(Modern), Cap.,150 mg., Tk. 50mg/5ml, Tk. 78.00/35ml
20.00/Cap.; 50 mg., Tk. 8.00/Cap. Xeroder(Beacon), Cap., 150mg , Tk.
Flumyc(Euro), Cap., 150mg, Tk. 22.00/Cap.; 22.15/Cap.,50mg , Tk. 8.05/Cap.; IV.Infusion,
50mg, Tk. 8.00/Cap. 200mg/100ml, Tk. 200.60/100ml
Flunac(Drug Intl), Cap. , 50mg, Tk. 8.05/Cap.;
150mg, Tk. 20.10/Cap.; Suspn., 50mg/5ml,
GRISEOFULVIN[ED]
Tk. 70.25/35ml
Flunol(Somatec), Suspn, 50 mg/5 ml, Tk. (See section 1.2.2)
78.30/35ml,Cap., 150 mg, Tk. 22.00/Cap.; 50
mg, Tk. 8.00/Cap. Indications: Superficial fungal
Flunova(Nipa), Cap. , 150 mg, Tk. infections, especially tinea capitis.
22.00/Cap.; 50 mg, Tk. 8.00/Cap. Griseofulvin is not used as a first-line
Flutinex(Organic), Cap.,150 mg, Tk.
22.06/Cap.; 50 mg, Tk. 8.03/Cap.; Suspn., 50
therapy for fungal infections other than
mg / 5 ml, Tk. 78.24/35ml tinea capitis.
Fluvin-OD(GSK), Tab. , 150 mg, Tk. Cautions, Contra-indications& Side-
21.75/Tab.,50 mg, Tk. 8.06/Tab effects: See section 1.2.2
Fluzo(Pacific), Tab. , 150 mg, Tk. 22.00/Tab.; Interactions: See Appendix- 2
50 mg, Tk. 8.00/Tab. Dose: ADULT: 10 mg/kg/day, CHILD: 5–
Fluzole(Globe), Tab. , 150 mg, Tk. 22.00/Tab.; 10 mg/kg/day, for tinea corporis: 2-4
50 mg, Tk. 8.00/Tab.
weeks, for onychomycosis: over 1 year
410
12. SKIN

Grisovin FP(GSK), Tab. , 500 mg, Tk. Miconazole Cream 2%,
5.88/Tab Fungidal(Square),Cream, Tk. 35.24/10gm
Fulcinex(ACI), Suspn., 2.5gm/100ml, Tk. Mic(Globe), Cream, Tk. 35.00/10 gm
23.49/60mlTab., 500mg, Tk. 5.60/Tab. Micoderm(Drug Intl), Cream, Tk. 40.00/10gm,;
Grisozen(Zenith), Tab., 500 mg,Tk.6.68/Tab. Miconex(ACI), Cream, Tk. 39.00/10gm
G-G VIN(Gonoshasthaya), Tab., 500 mg, Tk. Skimico(Pacific), Cream, Tk. 35.00/10gm
4.00/Tab. Topicazole(Incepta), Cream, Tk. 35.00/10gm
Unigal(Opsonin), Cream, Tk. 35.27/10 gm,Tk.
60.18/ 15 gm
ITRACONAZOLE G-Miconazole(Gonoshasthaya), Cream, Tk.
(see section 1.2.1) 18.25/5 gm; Tk. 34.50/10 gm
Indications: Onychomycosis, systemic Miconazole with hydrocortisone

mycoses such as blastomycosis, steroid-responsive inflammatory dermatoses
Dose:apply 2 times daily for 2-4 weeks.
histoplasmosis, and aspergillosis,
candidiasis, dermatophytoses (tinea) Proprietary Preparations
Cautions Contraindications& Side- Miconazole 2%+ Hydrocortisone1%
effects: See section 1.2.1 Gemison(General), Cream, Tk. 40.27/10gm
Interactions: See Appendix-2. Unigal(Opsonin), Cream, Tk. 40.15/10mg
Dose: See section 1.2.1 Mic HC(Globe), Cream, , Tk. 40.00/10gm
FungidalHC(Square), CreamTk. 40.27/10gm
Micosone(ACI), Cream, Tk. 40.27/10gm,;
Proprietary Preparations Oint., Tk. 40.27/10gm
See section 1.2.1 Micozole(G.A.co), Cream, Tk. 40.12/10 gm
Topicazole(Incepta), Cream, Tk. 40.00/10gm
KETOCONAZOLE Miki(Orion), Cream, Tk. 40.27/10gm
Miconil(Nipa), Cream, Tk. 40.00/10gm
(see section1.2.1) MHC(Sharif), Cream, Tk. 40.12/10g
Indications: Deep fungal infections

MICONAZOLE GEL[ED]
,dermatophyte infections not responding
to topical therapy (tinea pedis, tinea
cruris, and tinea corporis), candidiasis, Indications: Oropharyngeal candidiasis.
seborrhoeic dermatitis,and extensive Dose: 5-10 ml after food 4 times a day.
pityriasis versicolor Retain near oral lesions before
Cautions, Contraindications, Side swallowing. Continue treatment until 48
effects : See section1.2.1 hours until lesions have healed
underKetoconazole
Dose: Ketoconazole 2% cream:
Miconazole Oral Gel 2%
Apply 1-2 times daily A-Migel(Acme), Oral Gel, Tk. 52.16/15gm
Candoral(Beximco), Oral Gel, Tk.52.00/15gm
Proprietary Preparations Dakrin(General), Oral Gel, Tk.60.18/15gm
Ketocon(Opsonin), Tab. , Tk. 8.06/Tab. ; Fungidal(Square), Buccal Tab.,10 mg, Tk.
Shampoo, Tk. 176.19/60 ml 5.03/Tab. ; Cream, Tk. 35.24/10gm
Ketofun(Amico), Tab., TK. 8.30/Tab. Gelora(Square), Oral Gel, Tk. 60.18/15gm
Nizoder(UniMed), Cream, Tk. 50.00/15gm,; Orogurd(Eskayef),Oral Gel, Tk. 60.00/15gm;
Shampoo, Tk. 230.00/100ml Orocare(Novo),Oral Gel, Tk. 50.00/15gm
Micoderm(Drug Intl),Oral Gel, Tk.50.20/15gm
MICONAZOLE[ED] Micoral(ACI), Oral gel., Tk. 100.30/30gm.,Tk.
60.18/15gm
Mycon(Aristo), Oral Gel , Tk. 60.00/15gm
Indications:Dermatophytoses, pityriasis Mycosina(Ibn Sina), Oral Gel,Tk. 60.00/15gm
versicolor, mucocutaneous candidiasis Oragel(UniMed), Oral gel, Tk. 50.00/15gm
Side-effects: Irritation, burning, Ormico(Pacific), Oral Gel, Tk. 60.00/15gm
maceration, allergic contact dermatitis Oroconazol(Incepta), Oral Gel, Tk.
Dose: Apply 1-2 times daily for 2-4 50.00/15gm
weeks
411
12. SKIN
NYSTATIN[ED]
(See also section 1.2.3&6.2.2) Indications: Onychomycosis tinea
capitis in children older than 4 years of
Indications: Cutaneous and mucocu- age, selected cases of tinea corporis,
taneous candidiasis tinea pedis, or tinea cruris that are
Cautions: Pregnancy, lactation widespread, severe, or resistant to
Side-effects:burning, pruritus, rash, topical treatment and pityriasis versicolor
eczema, rarely pain on application Cautions,Contra-indications& Side-
Dose:Oral candidiasis (thrush): apply effects: See section1.2.1
four to five times daily for 2 weeks Interactions: See Appendix-2.
Powder, cream, ointment, or gel: diarrhea, stomach upset, loss of
For cutaneous candidiasis: apply 2-4 taste,toxic epidermal necrolysis and
times daily for 2 weeks erythema multiforme.
Dose: Oral;See section1.2.1
Proprietary Preparations Topical preparatio;For tinea pedis
Candex(Square), Suspn., 1 Lac Unit/ml, Tk. (interdigital): twice daily for 1 week
46.84/30ml For tinea pedis (plantar): twice daily for 2
Fefun(Amico), Suspn., 1 Lac IU/ ml , weeks
Tk.22.00/12ml For tinea elsewhere: once or twice daily
Fungistin(Beximco), Suspn., 1 Lac IU/ ml, Tk. for at least 1 week, up to 4 weeks
22.81/12ml
Mycocin(Ibn Sina), Suspn., 1 Lac IU/ ml, Tk.l
For pityriasis versicolor: once or twice
22.50/12ml,Tab., 5 Lac UnitTk.5.75 daily for 2 weeks
Naf(Opsonin), Suspn, 1.25 Lac IU /1.25 ml, For systemic use:See section1.2.2
Tk. 20.47/1.25ml
Nyscan(ACI), Suspn 1 Lac IU/ ml,Tk. Proprietary Preparations
20.44/12ml Terbinafine 1%
Nyst(Somatec), Suspn., 1 Lac IU/ ml,, Tk. Bacron(Biopharma), Oint.,Tk. 140.00/10gm
22.65/12ml Derbicil(Incepta), Cream, Tk. 50.00/5gm
Nystat(Acme), Suspn., 1 Lac IU/ ml,, Tk. Derfin(Alco), Cream, Tk. 30.09/10gm
22.79/12ml,Tab.,5LacIU Tk.6.27 Finater(Popular), Cream, Tk. 50.19/
Ornys(Kemiko), Suspn.,1 Lac IU/ ml,, Tk. Infud(General), Cream, Tk. 50.34/5gm
20.46/12ml Mycofin(Eskayef), Cream, Tk. 50.00/5gm
Zenistin(Zenith), Suspn., 1 Lac IU/ ml, Tk. Mycofree(Drug Intl), Cream, Tk. 80.00/20 gm
20.00/12ml Skinabin(ACI), Cream, Tk. 50.34/15gm ;
Terbex(Beximco), Cream, Tk. 35.00/5gm
Terbifin(Aristo), Cream, Tk. 52.00/5g;
OXICONAZOLE
Termider(Biopharma), Cream, Tk.50.19/10gm
Xfin(Square), Cream, Tk. 50.34/5gm
Indications: Dermatophytoses, pityriasis
versicolor (See section1.2.2 for systemic
Cautions: Pregnancy and breast preparation)
feeding
Contra-indications: known hypersen- TIOCONAZOLE
sitivity to oxiconazole
Side-effects: Pruritus, burning,
Indications: Fungal nail infection,
irritation, erythema, maceration, and
dermatophytoses, tinea versicolor
fissuring
Cautions: Avoidcontact with eyes and
Dose: 1% cream:Apply once daily for 2-
mucous membrane.
4 weeks
Contraindications: Pregnancy, known
Proprietary Preparation hypersensitivity to tioconazole
Oxifun(Square), Cream, 1%, Tk. Interactions: See Appendix-2.
50.35/10gm,Lotion, 1%, Tk. 135/30ml Side-effects: Occasional local
irritation,local edema, dry skin, nail
TERBINAFINE discoloration; periungual inflammation;
(See section1.2.1) rash; exfoliation.
Dose: Apply to nails and surrounding
412
12. SKIN
skin twice daily.Pityriasis versicolor: up crystalline nephropathy

to 7 days.Tinea pedis: up to 6 weeks Dose: Oral: See section
Dermatophytoses in other sites, 1.4.1.Topical:Apply to lesions every 4
candidiasis, erythrasma: 2-4 weeks hours for 5-10 days; should be started at
Onychomycosis:6-12 months first sign of attack.
Proprietary Preparations Proprietary Preparations:

Ticonazole 1% ACYCLOVIR 5%
Conasyd(Renata), Cream, Tk. 63.00/10 gm Acerux(Opsonin), Cream, Tk. 40.15/50mg;
Suconal(Supreme), Cream, Tk. 47.54/10 gm Clover(Ibn Sina),Tk. 40.00/5gm;
Tiozol(Incepta), Oint., Tk. 70.00/10 gm Novirax(Drug Intl), Cream, 10gm, Tk.
Tycon(Acme), Cream , Tk. 47.86/10 gm;. 40.15/5gm
Suclovir(Supreme), Cream, Tk. 45.00/5gm
Virux(Square) Tk.70/10gm;Tk.40.27/6gm
TOLNAFTATE
Simplovir(Incepta), Cream,Tk. 40.00/5 gm
Indications: Dermatophytosis and Acyclovir BP 5% & Hydrocortisone 1%

pityriasis versicolor. NoviraxHC(Drug Intl), Cream, 10gm, Tk.
Contraindications: known sensitivity to 70.00/10gm
tolnaftate. ViruxHC(Square), Cream, 50 mg/gm, Tk.
70/10gm;
Side-effects: Itching, burning, rarely
contact dermatitis.
(For oral and injectable preparationSee
Dose:Apply twice daily for 2-4 weeks.
section 1.4.1.1)
Tinaderm(I)(Schering), Solun 1%, DOCOSANOL
Tk.158.81/bot
Indications: Cold sores/fever blisters
12.2.3 ANTIVIRALS (herpes labialis)
(See section 1.4.1) Cautions:Do not use in or near the
eyes: avoid applying directly inside the
A major antiviral drug, acyclovir is mouth
frequently used to treat cutaneous Contra-indications: Known
herpes simplex herpes zoster and hypersensitivity to docosanol
chicken pox. Intralesional injection of Side-effects: Headache, skin irritation,
interferon alfa-2b is administered for burning, dryness, itching, allergic
chondylomata acuminata. Improvement reactions
of psoriasis in AIDS patients with oral Dose: Apply 5 times a day at the first
zidovudinehas been reported. sign of recurrence of herpes simplex
labialis for 5-7 days.
ACYCLOVIR[ED] Proprietary Preparation
(See section 1.4.1.1) Lafrost(Incepta),Cream 10%,Tk.50.00/5g
Indications: Herpes simplex, herpes VALACICLOVIR

zoster, recurrent erythema multiforme
Caution: avoid contact with eyes and
Indications: Herpes simplex, herpes
mucus membranes
zoster
Contraindications: Renal impairment,
Cautions,Contraindications,Side-
effects&Dose: See section 1.4.1
Side-effects:Transient stinging or
Dose:See section 1.4.1.1
burning, occasionally erythema or drying
of the skin
See section 1.4.1.1
Oral or intravenous acyclovir:
nausea, vomiting, diarrhea, headache,
reversible renal impairment due to a
413
12. SKIN
12.2.4 ANTIPARASITICS ADULT: Apply 10% cream/lotion 2-3

times on skin.
CHILD < 3 years: Apply 10%
BENZYL BENZOATE[ED] cream/lotion onto the skin once daily for
3 days.
Indication: Scabies.
Cautions: Avoid contact with eyes and Proprietary Preparations
mucous membrane. It should not be Crodex(GACO), Cream, 10%, Tk. 60.18/20
used on broken or secondary infected gm
skin. Breast-feeding must be stopped till Cronix(UniMed), Lotion , 10%, Tk.
the product has been washed off. Drying 80.00/60ml
effect in elderly.
Contraindications: Broken or irritated IVERMECTIN
skin, neonates, pregnancy (See section 1.5.1.6)
Side-effects: Skin eruption, burning
sensation, especially on genitalia and Indications: Scabies, Filariasis caused
excoriation. by Wuchereria bancrofti (lymphatic
Dose: Apply 3 times at 12 hourly filariasis), pediculosis (head lice),
intervals over the whole body below the onchocerciasis, strongyloidosis and
neck. Wash off 12 hours after the last trichuriasis.
application. Cautions: Bronchial asthma
Contraindications: Bronchial asthma,
Proprietary Preparations known hypersensitivity to ivermectin,
Benzyl Benzoate25% pregnancy
Ascab(Hudson), Emulsion,Tk. 12.13/60ml; Tk. Side-effects:Nausea, vomiting or
18.00/100ml
Ascabiol(Sanofi),Emulsion,Tk. 32.16//100ml
decreased appetite, diarrhoea or
Benosol(Amico), Emulsion, TK. 35.25/100ml constipation, muscle or joint pain,
Benzolet(General) Lotion, 35.26/100ml, swelling of the lymph nodes, fever,
Tk.125.00 /450ml tiredness, dizziness, tremor, itching, eye-
Benzyl(Acme), Lotion, Tk. 126.50/450 ml lid swelling or eye redness.
G-B. Benzoate(Gonoshasthaya), Lotion,Tk. Dose: For scabies, strongyloidosis &
25.00/100 ml head lice : 200 microgram/kg single
Scabex(Supreme), Emulsion, Tk. 32/100 ml
Scabisol(Jayson), Emulsion, Tk.35.11/100 ml
dose, repeat after 7-14 days if
necessary.
Ivermectin should be administered as a
single dose with a full glass (240 ml) of
CROTAMITON water on an empty stomach (1 hour
before breakfast).
Indication: Scabies.
Cautions:Should not be applied in the Proprietary Preparations
eyes or mouth ; acutely inflamed skin or Alice Lotion(Square), Lotion, 0.5%, Tk.
raw or weeping surfaces and pregnancy. 130.00/60gm
Contraindications: known
hypersensitivity to crotamiton, acute (See also section 1.5.1.6for oral
exudative dermatitis. prepartion)
Side-effects: Pruritus, contact
dermatitis, rash, irritation, warm MONOSULFIRAM
sensation.
Dose: ADULT:Apply 10% cream/lotion Indications: Scabies.
to the whole body from below the chin Cautions : Avoid alcohol before and 48
first after bathing and drying. A second hours after application.
application is done after 24 hours. May Side-effects: Dizziness, headache,
need to be used once daily for 5 days for fatigue and erythematous rash
it to be effective. Dose: Monosulfiram is first diluted with
Pruritic skin disorders: 2-3 parts of water, and the solution is
414
12. SKIN
applied all over the body (except face Elimate(Incepta), Cream, Tk. 40.00/30gm
and scalp) after a bath, and it should be Licerin(Drug Intl), Cream, Tk. 40.15/30 gm;
rubbed in well once a day on two or Tk. 25.10/15 gm
Lorix(Opsonin), Cream, Tk. 55.37/30gm,Tk.
three consecutive days. 20.00/15gm
Mecabis(Asiatic), Cream,Tk.
Proprietary Preparation 40.00/30gm,Cream, Tk. 25.00/15gm
Tetrasol(ACI), Solution, 25%, Tk. Neeper(Kemiko), Cream, Tk. 28.08/15gm; Tk.
68.20/30ml ml 40.12/30gm
Noscab(Beximco), Cream, Tk. 35.00/25gm
Perls(Globe), Cream, Tk. 40.00/30 gm
PERMETHRIN[ED Perma(Alco), Cream, Tk. 35.11/30gm , Tk.
24.07/15gm
Indication: Scabies and head lice, Permet(Gaco), Cream, Tk. 25.08/15 gm
pediculosis pubisScabies with intractable Permin(Acme), Cream,Tk. 40.27/30gm,Tk.
pruritus. 25.17/15gm
Permisol(ACI), Cream, Tk. 45.14/30gm , Tk.
Cautions: Avoid contact with eyes; it 30.09/15gm
should not be used on broken or Perosa(Eskayef), Cream,Tk. 50.00/30gm
secondary infected skin, pregnancy or Scabex(Square), Cream, Tk. 50.15/30gm,Tk.
lactation, history of asthma, 30.1/15gm
Side-effects: Burning, stinging, pruritus, Scabfre(Pacific), Cream, Tk. 50.00/30gm
erythema, tingling, rarely rashes and Scaper(Biopharma), Cream, Tk.
oedema 29.00/15gm,Tk. 50.00/30gm
Scarin(Ibn Sina), Cream,Tk. 45.00/30gm,Tk.
Dose: Scabies: 30.00/15gm
Apply over all skin surfaces from neck to Skilin(General), Cream,Tk. 30.00/15gm, Tk.
toe (excluding head), and wash off after 55.00/30gm
8-12 hrs. Unix(UniMed), Cream, Tk. 40.00/30gm
Adults and children > 12 years: a full 30
gm tube. Permethrin 5% & Crotamiton 10%
Children aged 6-12 years: up to 1/2 of a Elimate Plus(Incepta), Lotion, Tk100.00/60ml
Lorix Plus(Opsonin), Lotion,Tk. 60.38/60 ml
30 gm tube Permisol(ACI), Lotion, 5% +10 ml, Tk.
Children aged 1-5 years: up to 1/4 of a 100.00/60ml
30 gm tube Unix-C(UniMed), Lotion, Tk. 100/60 ml
Children aged 2 months to 1 year: up to
1/8 of a 30 gm tube PRECIPITATED SULFUR
Repeat after 7 days if necessary.
Head lice:Apply 30-60 ml of 1% lotion
Indication:Scabies, particularly in
(cream rinse) to wash and towel-dried
pregnancy
hair and allow to remain for 10 minutes.
Cautions: Avoid contact with the eyes.
Rinse with water. Treatment may be
Side-effects: Noxious odor and
repeated after 7-10 days if lice or nits are
mild skin irritation.
detected at hair-scalp junction.
Dose: Apply for 24 hours, then wash off,
Pediculosis pubis:Adult: apply sufficient
and repeat daily for 5 days
amount of 1% lotion (cream rinse) or 5%
cream to thoroughly saturate the pubic Proprietary Preparations
area. Allow to remain for 10 minute and Coal Tar Solution 12%+ Salicylic Acid2% +
then rinse with water. Precipitated Sulphur4%
Soritar(Unimed), Scalp Oint. Tk. 200/30 gm
Permethrin5%
12.3 TOPICAL CORTICOSTEROIDS
Arotrix(Aristo), Cream, Tk. 28.00/15gm; Tk.
50.00/30g
Delice(Amico), Cream, Tk. 40.00/30gm, CORTICOSTEROID (TOPICAL)
Tk.25.00/15gm
Deorix(Popular), Cream, Tk. 40.15/30 gm
Dermanix(Novo Health), Cream, Tk. Indications : Dermatitis and
50.00/30gm papulosquamous diseases:atopic
415
12. SKIN
dermatitis, diaper dermatitis, dyshidrotic eczema, contact dermatitis,

eczema, erythroderma, lichen planus, neurodermatitis, anogenital and senile
lichen simplex chronicus, nummular pruritus, lichen planus and psoriasis
dermatitis, pityriasis rosea, psoriasis Cautions: Should not be used in or near
(intertriginous), psoriasis (plaque or the eyes: see notes above
palmoplantar), seborrheic dermatitis Contraindications: Disorders of
Bullous diseases: calcium metabolism, children below 18
Bullous pemphigoid, cicatricial years of age, erythrodermic, exfoliative
pemphigoid, epidermolysis bullosa and pustular psoriasis, severe renal
acquisita, pemphigus foliaceus insufficiency, severe hepatic disorders,
Connective tissue and it is not to be used in ophthalmic
diseases:dermatomyositis, lupus conditions; see notes above
erythematosus Interactions:See Appendix-2.
Other dermatologic uses:behçet's Side-effects: See notes above
disease, pyoderma gangrenosum, Dose: Apply a thin film once or twice
alopecia areata, acne keloidalis nuchae, daily to cover completely the affected
cutaneous T cell lymphoma (patch- area
stage), granuloma annulare, lichen
planopilaris, lichen sclerosis et Proprietary Preparations
atrophicus, morphea, pruritus (perianal, Betamethasone (as diproprionate) 0.1% +
vulvar, scrotal), sarcoidosis, vitiligo Clotrimazole 1%
Betavate CL(Drug Intl), Oint.Tk. 29.10/10gm
Cautions: if secondary infection occurs Bet-CL(Acme), Cream, Tk. 29.20/10gm; Oint.,
during treatment, appropriate systemic Tk. 29.08/10gm
or local antimicrobials should be added. Betnovate CL(GSK), Oint, Tk. 29.39/10gm
Interactions: SeeAppendix-2. Betson(Opsonin), Cream, Tk. 25.09/ 10 gm;
Systemic Side-effects:Suppression of Oint., Tk. 29.31/ 10 gm
hypothalamic-pituitary-adrenal axis, Derson(Kemiko), Oint., Tk. 29.08/10gm
iatrogenic Cushing’s syndrome, growth Oni(Square), Cream, Tk. 35.11/10gm
Topibet(Eskayef), Cream, Tk. 30.00/10gm
retardation in infants and children
Local side-effects:Epidermal atrophy, Dose:Apply twice daily, tinea cruris/corporis:
steroid-induced acne, prominent for 2 weeks, tinea pedis: for 4 weeks
vasculature, striae, purpura, allergic or
irritant contact dermatitis, tachyphylaxis, Betamethason Dipropionate9.75mg +
glaucoma/cataracts, facial Clotrimazole 150mg + Gentamicin15mg
hypertrichosis, folliculitis, miliaria, genital Bet-CG (Acme), Cream, Tk. 75.00/15gm
Aristoderm (Aristo), Cream, Tk. 75/15gm.
ulceration, exacerbation or increased
susceptibility to bacterial, fungal, and
viral infections, reactivation of Kaposi’s BETAMETHASONE VALERATE[ED]
sarcoma, perioral dermatitis, rosacea,
delayed wound healing, skin atrophy Indications: See notes above
especially on thin skin areas such as the Cautions, Contraindications, Side-
face or skin flexures. Absorption through effects: See notes above
the skin can cause pituitary adrenal axis Dose: Apply 2-3 times daily till
suppression and Cushing’s syndrome. remissions occur
Contraindications: Infants under 1 year
of age,known hypersensitivity to the Proprietary Preparations
topical corticosteroid, bacterial, Betamethasone (asValerate)
Bet-A(Acme), Oint., 0.05%, Tk. 35.00/15 gm;
mycobacterial, fungal, viral infection, Cream, 0.1%, Tk. 33.00/15 gm
infestation, ulceration Betaderm(Incepta), Oint., 0.05%, Tk. 35.00/15
Dose:apply 1-2 times daily. gm
Betaval(Healthcare), Cream, 0.1%, Tk.
BETAMETHASONE DIPROPIONATE[ED] 33.00/15 gm; Oint., 0.1%, Tk. 35.00/15 gm
Betnelan(GSK.), Cream, 0.1%, Tk. 39.36/20
gm; Oint., 0.1%, Tk. 42.23/20 gm
Indications: Atopic eczema, nummular Betson(Opsonin), Cream, 0.05%, Tk.
416
12. SKIN
33.56/15 gm; Oint., 0.05%, Tk 35.14/15 gm inflammatory skin disorder ( recalcitrant

Diprobet(Square), Cream, 0.05%, psoriasis)
Tk.33.56/15gm; Oint.,0.05%,Tk. 35.14/15gm Cautions:See notes above
Mexiderm(Biopharma), Cream, 0.05%,
Tk.25.09/15gm; Oint.,0.05%,Tk.30.11/15 gm
Contraindications:See notes above
Sinacort(Ibn Sina), Cream & Oint., 0.1%, Tk. Side-effects: See notes above
20.00/10 gm Dose: Apply sparingly to the affected
area once or twice daily until
Betamethasone (as valerate)0.1% + Neomycin improvement occurs. As with other
sulphate 0.5% : highly active topical steroid
Albevate-N(Albion), Oint., Tk. 18.47/5 gm preparations, therapy should be
Aristobet-N(Aristo), Oint., Tk. 14.30/3 gm;
Betaderm N(Incepta), Oint., Tk. 22/15 gm
discontinued when control is achieved.
Betameson-N(Square),Cream,Tk.22.08/5gm If a longer course is necessary, it is
Betamycin(Supreme), Oint., Tk.15.30/5 gm recommended that treatment should not
Betaval N(Healthcare),Oint., Tk.18.54/15gm; be continued for more than four weeks
Cream, Tk. 18.51/5 gm without the patient's condition being
Betavate-N(Drug Intl),Cream, Tk. 21.55/10gm observed.
Betnovate-N(GSK), Cream, Tk. 16.29/5 gm; Clobetasol propionate scalp solution:
Oint., Tk. 16.31/5 gm
Betson-N(Opsonin), Cream, Tk.18.51/5 gm
Apply required quantity of spray of
Mexiderm-N(Biopharma), Cream, Tk. 15.06/5 clobetasol scalp solution once or twice
gm; OintTk.16.06/5 gm daily to the affected areas of the scalp
Neobet(Acme), Cream, Tk. 22.08/10 gm; and gently rub in. The total dose applied
Oint., Tk. 22.63/5 gm should not exceed 50 ml weekly. If
Neocort(Ibn Sina), Oint., Tk. 18.53/15 gm necessary, the solution may be
Relitch(Drug Intl), Oint., Tk. 30.00/15 gm massaged into the scalp using the tips of
Betamethasone valerate 0.05% + Lidocaine
the fingers. Therapy should be
Hydrochloride 2.5% + Phenylephrine discontinued if no response is noted
Hydrochloride 0.1% rectal ointment after one week or as soon as the
Relief of symptoms of itching, irritation, lesion heals. It is advisable to use
discomfort or pain for local non-infective anal clobetasol propionate scalp solution for
or perianal conditions associated with external brief periods only.
haemorrhoids
Proprietary Preparations Aclobet(Acme), Cream, 0.05%, Tk. 45.13/10
See section 2.7.2 gm;Oint.,0.05%, Tk. 50.14/10gm
Clobederm(Drug Intl), Cream, 0.05%, Tk.
50.20/10gm.; Oint., 0.05%, Tk. 50.00/10gm
CLOBETASONE BUTYRATE
Clonate(Kemiko), Oint., 0.05%, Tk.
50.14/10gm,; Cream, 0.05%, Tk.58.17/10gm
Indications, Cautions, Side-effects: Clobesol(Aristo), Cream, 0.05% , Tk. Tk.
See notes above. 58.00/10 gm; Oint., 0.05%, 68.00/10 gm
Dose: Apply to the affected area up to 4 Clovate(ACI), Oint., 0.05%, Tk. 68.20/10 gm
times daily until improvement occurs, Comol(Sanofi), Oint., 0.05%, Tk.68.20/10 gm
Darmacort(Ibn Sina), Cream, 0.05%, Tk.
when the frequency of application may 50.00/10gm,; Oint., 0.05%, Tk. 52.00/10gm
be reduced Dermasol(Square), Cream, 0.05%, Tk.
70.48/20gm,; Oint., 0.05%, Tk. 75.5/20gm
Proprietary Preparations Dermex(Opsonin), Cream, 0.05%, Tk.
Eumovate(GSK), Cream, 0.05%, Tk. 43.97/10 gm;, Oint., 0.05%, Tk. 48.88/10 gm
41.48/10gm; Skin Oint, 0.05%, Tk. 41.50/10gm Dermovate(GSK), Cream, 0.05%, Tk.
Ezex(Square), Cream, 0.05%, Tk. 59.06/10gm,Oint., 0.05%, Tk. 69.13/10gm
75.51/25gm; Oint., 0.05%, Tk. 75.51/25gm Dersole(Sharif), Cream, 0.05%, Tk.
Miclo(General), Cream, 0.05%, Tk. 45.13/10g,Oint., 0.05%, Tk. 50.14/10gm
40.27/10gm,; Oint., 0.05%, Tk. 40.27/10gm Eclo(General), Cream, 0.05%, Tk.
58.00/10gm,; Oint., 0.05%, Tk. 68.00/10gm
CLOBETASOL PROPIONATE Exovate(Beximco), Cream., 0.05%, Tk.
45.00/10gm,; Oint., 0.05%, Tk. 50.00/10gm
Nyclobate(Incepta), Cream, 0.05%, Tk.
Indications : Severe resistant 45.00/10gm,Tk. 70.00/20gm; Oint., 0.05%, Tk.
417
12. SKIN
50.00/10gm, Tk. 75.00/20gm Cream Tk. 150.00/30g

Protasol(Asiatic), Cream, 0.05%, Tk.
45.00/10gm; Oint., 0.05%, Tk. 50.00/10gm
DESONIDE
Skinovate(Gaco), Cream, 0.05%, Tk.
35.11/10 gm
Synovate(Popular), Cream, 0.05%, Tk. Indications: Mild to moderate atopic
85.32/25mg,Tk. 50.19/10mg; Oint., 0.05%, Tk. dermatitis in patients 3 months of age
85.32/25 gm and older
Temovate(Healthcare), Cream, 0.05%, Tk. Cautions:Use only externally and avoid
58.00/10gm; Oint., 0.05%, Tk. 68.00/10 gm
Topiclo(Eskayef), Cream., 0.05%, Tk.
contact with the eyes. It should not be
45.00/10gm,; Oint., 0.05%, Tk. 50.00/10gm used on the underarm or groin areas of
Xderm(Biopharma), Oint., 0.05%, Tk. pediatric patients.
50.19/10gm; Cream, 0.05%, Tk. 45.17/10gm Contraindications: Pregnancy,
Xenocort(Orion), Cream, 0.05%, Tk. lactation, known hypersensitivity
40.27/10gm; Oint., 0.05%, Tk. 50.35/10gm Side-effects: See notes above
Xenovate(UniMed), Cream, 0.05%, Tk. Dose:Gel should be applied as a thin
58.00/10gm; Oint., 0.05%,Tk. 68.00/10g, Tk.
150.00/30g
layer to the affected areas two times
daily and rubbed in gently.
Clobetasol propionate scalp solution 0.05%
Clovate(ACI), Scalp Solu., 0.05%, Tk. Proprietary preparation
206.00/30 ml Solu. 0.05%, Tk. 200.60/30ml Desotop(ACI)Gel, 0.5%,Tk.50.19/15gm
DermasolS(Square), Scalp Solu, 50 mg/100
ml, Tk. 200.61/25ml ml
DIFLORASONE DIACETATE
Dermovate(GSK), Scalp Lotion,0.05%,Tk.
250.00/30ml
Nyclobate(Incepta), Scalp Application, 50 Indications, Cautions,
mg/100 ml, Tk. 200.00/30 ml; Shampoo, 50 Contraindications, Side-effects: See
mg/100ml, Tk.350.00/60 ml notes above
Dose: Apply to the affected areas as a
Clobetasol propionate0.05% +Salicylic acid
ointment3% /cream
thin film from 1-2 times daily depending
Topiclo S(Eskayef), Oint, 0.05% + 3%, Tk. on the severity of the condition
70.00/10 gm
Clobesol(Aristo), Oint., Tk. 70.00/10gm Proprietary Preparations
Closalic(Ziska), Oint., Tk. 70.00/10gm Eczena(Square),Cream, 0.05%,
Topiclo(Eskayef), Oint., Tk. 120.00/20gm,Tk. Tk.70.48/10gm;Oint., 0.05%, Tk. 70.48/10 gm
70.00/10gm
Topiclo(Eskayef), Oint., Tk. 120.00/20gm, Tk. FLUCINOLONE ACETONIDE
70.00/10gm,
Xenosal(UniMed), Oint., Tk.150.00/30g
Indications: Inflammatory skin disorders
Clobetasol Propionate 0.5mg + Neomycin such as eczema, psoriasis; also see
Sulphate 5mg + Nystatin 1lac unit/gm notes above
AclobetN(Acme), Oint.,Tk. 65.45/15gm,; Cautions: Children, elderly, hepatic
Cream, Tk. 60.18/15gm failure, prolonged use on the face, avoid
ClonateNN(Kemiko), Cream, Tk. 75.22/15gm
ClovateN(ACI), Cream, Tk. 65.20/10g ,; Oint.,
contact with eyes
Tk. 70.21/15gm Interactions: See notes above
Comol-NN(Sanofi), Oint., Tk. 65/15 gm; Contra-indication: See notes above
Cream, Tk. 65/10 gm Side-effects:See notes above
DermasoN(Square), Cream, , Tk. Dose:Apply 2 times a day
70.21/15gm,; Oint., Tk. 75.22/15gm
DermexN(Opsonin), Cream, Tk. 55.21/10gm Proprietary Preparations
ExovateN(Beximco), Cream.,Tk. 90.00/25gm Skinalar(ACI), Oint., 0.03%, Tk. Tk.
NyclobateNN(Incepta), Cream, Tk. 60/10gm; 38.12/5gmgm ;Cream, 0.03%, Tk. 38.12/5gm
Tk. 80.00/20gm gm
TopicloNN(Eskayef), Oint., Tk. Dermidex(Amico), Cream, 0.03%,
65.00/15gm,Tk. 65.00/15gm 25mg/100gm, TK. 30.00/5gm
Vesol N(Novo Health), Cream, Tk. 60/10gm
Xenoderm(UniMed), Oint., Tk. 150.00/30g,;
418
12. SKIN
Flucinolone+Neomycin
Skinalar-N(ACI), Cream, 0.025%+0.5%, Tk. Proprietary Preparations
40.12/5 gm;Oint.,0.025%+0.5%, Tk.40.12/5gm Halobetasol Propionate0.05%
Flucinolone Acetonide0.01% + Halobet(Square), Cream, Tk. 90.27/10gm,;
Hydroquinone4% + Tritinoin0.05%, Oint., Tk. 90.27/10gm
Amela (Ibn Sina), Cream, Tk.. 200.00/30gm Halocort(ACI), Cream, Tk. 135.41/15gm ,Tk.
FLUTICASONE PROPIONATE 90.27/10gm; Tk. 135.41/15gm,Tk. 90.27/10gm
Ulticort(Incepta), Cream, Tk.120.00/15gm
Indications: Inflammatory skin disorder
such as eczema and dermatitis; see HALOMETASONE
notes above
Cautions, Contraindications, Side- Indications: See notes above
effects, Dose: See notes above Cautions: Continuous therapy should
not exceed 2 to 3 weeks
Proprietary Preparations Contraindications : Viral infection of the
Cutisone(General), Oint., 0.05%, Tk. skin, syphilitic skin affections, tuber-
50.34/10gm, Cream, 0.05%, Tk. 96.65/10gm culosis of the skin, acne vulgaris, known
Cutivate(GSK), Cream, 0.05%, Tk. hypersensitivity to halomethasone
115.78/10gm,; 0.005%, Tk. 80.04/10gm
Fluticare(Ibn Sina), Cream, 0.05%, Tk.
Side-effects: Burning sensation, itching
96.00/10g; 0.01%, Tk. 50.00/10gm and signs of inflammation at the site of
Flutiderm(Drug Intl), Oint., 0.005%, Tk. application
90.30/10gm Dose: Apply twice daily
Fluvate(Opsonin), Oint., 0.005%, Tk.
50.19/10gm Proprietary Preparations
Lutisone(Incepta)Oint., 0.05%, Tk. Sicorten(Novartis), Cream 0.05%; Oint.
50.00/10gm 0.05%; Tk. 77/5gm
Ticas(Square), Cream, 0.05%, Tk. Sicorten Plus(Novartis), Cream.
90.61/10gm Halometasone + Triclosan 0.1%.
Ticason(Asiatic), Cream, 0.05%, Tk. 83/5gm
Tk.90.00/10gm; 0.005%, Tk. 40.00/10gm Halometasone + Triclosan 0.1%:
Steroid-responsive inflammatory dermatoses.
HALCINONIDE
HYDROCORTISONE[ED]
Indications: Short-term treatment for
severeresistant inflammatory skin Indications: Corticosteroid-responsive
disorder such as recalcitrant dermatoses
psoriasis(See also notes above)
Cautions, Contraindications, Side- Proprietary Preparations
effects: See notes above Hydrocortisone1%
Cortider(Eskayef), Cream, Tk. 35.00/10 gm
Dose: Apply to the affected areas 2-3 Cortimet(Medimet), Cream, 1gm, Tk.28/10gm
times daily Genacort(General), Oint., Tk. 15.06/5 gm
CHILD: Apply minimal amount Hydrocort(Alco), Cream, Tk. 28.00/10 gm
necessary for effective therapy Intasone(Incepta), Cream, Tk. 30.00/10 gm
Topicort(Square), Cream, Tk. 40.00/10 gm
Proprietary Preparations Zocort(ACI), Cream, Tk. 38.14/15 gm
Cinon(Ambee), Cream, 0.1 %, Tk.16/5 gm
Dermalog(Jayson), Cream, 0.1 %, Tk. Hydrocortisone 1% + Miconazole 2%:
30.34/10gm, Topical treatment of inflamted dermatoses,
Zemalog (Gaco), Cream, 0.1%, Tk. 18/5 gm where inflammation coexists.
Fungidal(Square), Cream, Tk. 40.27/10gm
Gemison(General), Cream, Tk. 40.27/10gm
HALOBETASOL PROPIONATE MHC(Sharif), Cream, Tk. 40.12/10g
Mic HC(Globe), Cream, Tk. 40.00/10gm
Indications, Cautions, Miconil(Nipa), Cream, Tk. 40.00/10gm
Contraindications, Side-effects: See Micosone(ACI), Cream,Tk. 40.27/10gm,;
notes above Oint., Tk. 40.27/10gm
Micozole(G.A.co), Cream, Tk. 40.12/10 gm
Dose: Apply 1-2 times daily for 2 weeks
419
12. SKIN
Miki(Orion), Cream, Tk. 40.27/10gm TRIAMCINOLONE ACETONIDE

Topicazole(Incepta), Cream, Tk. 40.00/10gm
Unigal(Opsonin), Cream, Tk. 40.15/10mg
Indications: Short-term treatment only
Hydrocortisone 1% + Pramoxine 2.5% for severeresistant inflammatory skin
cream:Inflammatory and pruritic manifestations disorder such as recalcitrant psoriasis;
of corticosteroid-responsive dermatoses, minor also see notes above
skin irritations, anal itching or hemorrhoids, Oral paste: Mouth ulceration
insect bites etc
Dose: Apply onto lesion without rubbing
until a thin film appears, apply 2-3 times
CLOTRIMAZOLE+HYDROCORTISONE a day preferably after meals
(seealso under clotrimazole in section
12.2.2.) Proprietary Preparations
Triamcinolon Acetonide0.1%,
Indications,Cautions;Contra- Aristocort(Aristo),Oint., Tk. 25.00/10g; Tk.
indications& Side effects:See notes 25.00/10g
Cortefin(ACI), Oint., Tk. 25.08/10gm; Cream,
above.
Tk. 25.17/10gm;
Dose: Apply 2-3 times daily on affected Skinaderm(Kemiko), Oint., Tk. 20.06/10gm
and surrounding areas, for Stelone(General), Oint., Tk. 25.16/10gm
dermatophytoses: 3-4 weeks, Trialon(Drug Intl), Cream, Tk. 25.00/10 gm;
candidiasis: 1-2 weeks Oral Paste, Tk. 100.30/10 gm;
Proprietary Preparations NYSTATIN+NEOMYCIN+GRAMICIDIN

Clotrimazole 1% + Hydrocortisone 1% +TRIAMCINOLONE ACETONIDE:
Clotison(Biopharma), Cream, Tk.30.11/10gm
Neosten HC (Beximco), Cream,Tk. 35/10 gm;
Tk. 55.00/20 gm Atopic eczema, contact eczema,
HTrimazole(Opsonin),Cream,Tk.35.63/10gm follicular eczema, infantile eczema,
Clori HC(Amulet), Cream, Tk. 35.00/10 gm anogenital pruritis (anal and vulval
pruritis), nummular eczema, post-
MOMETASONE FUROATE traumatic infective eczema, seborrhocic
or flexural eczema, neurodermatitis,
Indications: Severe inflammatory skin psoriasis.
disorders such as eczemas unrespon- Dose: Apply 2-3 times daily for 2-4
sive to less potent corticosteroid; weeks.
psoriasis
Cautions, Contra-indications & Side- Proprietary Preparations:
Nystatin 10,000 units, Neomycin Sulphate
effects: See notes above 2.5mg, Gramicidin 0.25mg, Triamcinolone
Dose: 1% cream/ointment: apply thinly Acetonide 1mg/g
once daily (to scalp in case of lotion). Do Tetracomb(Pharmasia), Cream, Tk. 22.00/5
not use for more than 3 weeks in gm; Tk. 35.00/10 gm;Oint., Tk. 22.00/5 gm; Tk.
children 35.00/10 gm
Proprietary Preparations Triamcinolone acetonide intralesional

Momentasone Furoate 0.1% injection:Alopecia areata, discoid lupus
Momtec(Sanofi), Cream, Tk.100/5 gm; Tk. erythematosus, keloids, localized
180/10 gm hypertrophic, infiltrated, inflammatory
Elocan(General), Oint., Tk.100.38/5 mg
Momeson(Incepta), Cream, Tk. 100.00/5gm,;
lesions of granuloma annulare, lichen
Mometa(Popular), Cream, Tk. 180.68/10gm, planus, lichen simplex chronicus
Tk. 100.38/5gm (neurodermatitis), and psoriatic plaques;
Momtas(Globe), Cream, Tk. 180.00/10 gm necrobiosis lipoidica diabeticorum.
Soneta(Aristo), Cream , Tk. 100.00/5g, Tk. Cautions, Contraindications, Side-
500.00/30g,; Oint., Tk. 100.00/5g, Tk.550/50g effects: See notes above.
(See section 5.3.2)
420
12. SKIN
Cinchocaine Hydrochloride + Esculin + Proprietary preparations

Hydrocortisone + Neomycin Sulphate see section 5.3.2
Internal and external haemorrhoids, anal METHYLPREDNISOLONE[ED]
fissure, anal pruritus, perianal eczema,
preoperative and postoperative Indications, Cautions,
treatment of haemorrhoidectomy, Contraindications, Side-effects: See
postpartum haemorrhoidal conditions, section 5.3.2
and as prophylaxis in between
haemorrhoidal attacks. Proprietary preparations
See section 5.3.2
(See section 2.7.2)
Dose:Apply 2 times daily in the painful PREDNISOLONE[ED]
pruritic area and after each stool.
Indications, Cautions, Contra-
12.4 SYSTEMIC indications, Side-effects: See section
CORTICOSTEROIDS 5.3.2
(see section 5.3.2) Proprietary preparations
See section 5.3.2
[ED]
BETAMETHASONE
TRIAMCINOLONE
Indications, Cautions,
Contraindications &Side-effects: See Indications, Cautions, Contra-
section 5.3.2 indications, Side-effects: See section
5.3.2
See also section5.3.2 Proprietary preparations
See section 5.3.2
DEFLAZACORT
12.5 ANTIHISTAMINES,
Indications, Cautions, ANTIPRURITICS AND TOPICAL
Contraindications & Side-effects: See LOCAL ANAESTHETICS
section 5.3.2 (See also sec.4.8.1)
Proprietary preparations H1 antihistamines are first-line therapy
see section 5.3.2 for chronic idiopathic and physical
urticarias. They may be useful in treating
DEXAMETHASONE[ED] other conditions with histamine-driven
pruritus. Limited evidence supports the
Indications, Cautions, use of antihistamines in the treatment of
Contraindications, Side-effects: See atopic dermatitis. Certain special patient
section 5.3.2 populations, including children, the
elderly, and patients with renal or hepatic
Proprietary preparations impairment, may require dosage
See also section 5.3.2 adjustments when using H1
antihistamines. H2 antihistamines may
HYDROCORTISONE[ED] be a useful adjunct to H1 antihistamine
therapy in refractory cases of chronic
Indications, Cautions, idiopathic urticaria/angioedema and
Contraindications, Side-effects: See pruritus.
section 5.3.2 First generation (sedating)
antihistamines consist of Hydroxyzine,
421
12. SKIN
Pheniramine, Chlorpheniramine, 25.00/15 ml;Syrup, 5 mg/5 ml, Tk. 30.00/60

Diphenhydramine, Promethazine, ml ;Tab. , 10 mg, Tk. 3.00/Tab.
mebhydrolin and mepyramine. Second Beticin(Bios Pharma), Tab. , 10 mg, Tk.
2.25/Tab.;Tab. , 10 mg, Tk. 2.25/Tab.
generation (less-sedative) are Celozin(Leon), Tab. , 10 mg, Tk. 2.50/Tab.
Fexofenadine, Cetirizine, Levoceti- Cetirizine(Albion), Syrup, 5 mg/5 ml, Tk.
rizine, Loratadine, Desloratadine, 16.00/60 ml ;Tab., 10 mg, Tk. 2.50/Tab.
Ebastine, Mizolastine, and Rupatadine Cetirizine(APC ), Syrup, 5 mg/5 ml, Tk.
Indications: Acute urticaria, chronic 16.00/60 ml ;Tab., 10 mg, Tk. 2.50/Tab.
idiopathic urticaria, physical urticarias Cetizin(Acme), Tab., 10 mg, Tk. 3.00/Tab.
and dermatographism, atopic dermatitis Cetriben(Benham), Tab.,10 mg, Tk. 2.50/Tab.
Cetri-Mak(Maks ), Tab.,10 mg, Tk. 2.50/Tab.
systemic mastocytosis, pruritus Cetrin(Drug ), Tab. ,10 mg, Tk. 3.00/Tab.
associated with other conditions Cetriz(Astra), Tab., 10 mg, Tk. 2.50 /Tab
Cautions: patients taking Cetrol(Doctor TIMS), Tab.,10 mg, Tk.
benzodiazepines, other non psychiatric 3.00/Tab.
agents, older ages Citin(Opsonin), Syrup, 5 mg/5 ml, Tk.
Contraindications: known 18.80/60 ml;Tab., 10 mg, Tk. 1.89/Tab.
hypersensitivity to antihistamines CTZ(Delta), Tab. ,10 mg, Tk. 1.00/Tab.
CZ(Organic), Tab. ,10 mg, Tk. 2.50/Tab.
Interactions: See Appendix-2 Dyno(Rephco), Tab. ,10 mg, Tk. 2.00/Tab.
Side-effects:First generation anti- Dyzin(Amico ), Syrup, 5 mg/5 ml, Tk. 16.00/60
histamines:significant sedation. Second ml ;Tab. , 10 mg,Tk. 2.50/Tab.
generatio: somnolence and cognitive G-Cetirizine(Gonoshasthaya), Tab., 10 mg,
impairment; hyperexcitability, dry mouth, Tk. 2.00/Tab.
constipation, dysuria, erectile Noler, (Alco ), Syrup, 5 mg/5 ml, Tk. 16.00/60
dysfunction,tachycardia, blurred vision ml; Tab. ,10 mg, Tk. 2.50/Tab.
Nosemin(Ibn Sina), Syrup, 5 mg/5 ml, Tk.
20.00/60 ml ;Tab. , 10 mg, Tk. 3.00/Tab.
CETIRIZINE Ontin(Eskayef), Syrup, 5 mg/5 ml, Tk.
20.00/60 ml ;Tab, 10 mg, Tk. 2.50/Tab.
Indications, Cautions, Procet(Somatec), Syrup, 5 mg/5 ml, Tk.
20.00/60 ml ;Tab., 10 mg, Tk. 2.50/Tab.
Contraindications, Side-effects: See Rhinil(Aristo), Syrup, 5mg/5ml, Tk. 20.00/60ml
notes above ;Tab.,10 mg, Tk. 2.50/Tab.
Dose:ADULT: 10 mg once daily or 5 mg Rinzin(Globex), Tab. ,10 mg, Tk. 3.00/Tab.
twice daily Riz(Orion Pharma), Syrup, 5 mg/5 ml, Tk.
Syrup:CHILD 12 years and above: 10 ml 20.00/60 ml ;Tab.,10 mg, Tk. 3.00/Tab.
(2 teaspoonful) daily Sarcet(White Horse), Tab.,10 mg, Tk.
CHILD 6 - 11 years: 5 ml (1 teaspoonful) 2.50/Tab.
Setir(Amulet), Tab.,10 mg, Tk. 2.00/Tab.
daily Sistin(Supreme), Syrup, 5 mg/5 ml, Tk.
CHILD 6 months - 5 years: 2.5 ml (1/2 16.00/60 ml;Tab.,10 mg, Tk. 2.50/Tab.
teaspoonful) daily Trizin(Navana), Syrup , 5 mg/5 ml, Tk.
16.00/60 ml;Tab., 10 mg, Tk. 1.00/Tab.
Acitrin(ACI), Tab. , 10 mg, Tk. 3.00/Tab;
CHLORPHENIRAMINE[ED]
Paed. drops, 2.5 mg/ml, Tk. 25.00/15 ml;
Syrup, 5 mg/5 ml, Tk. 30.00/60 ml
Alatin(Concord), Tab.,10 mg, Tk. 2.00/Tab. Indications, Cautions,
Alatrol, (Square), Contraindications, Side-effects: See
Paed.drop,125mg/1.25ml,Tk.25.00/15 notes above and see section 4.8.1.
ml;Syrup,5 mg/5 ml, Tk. 25.00/15 ml;Tab. ,10 Dose:ADULT:4 mg every 4-6 hourly
mg, Tk. 3.00/Tab.
Allernil(Kemiko), Syrup, 5 mg/5 ml, Tk.
Maximum 24 mg daily
25.00/60 ml ;Tab. ,10 mg, Tk. 2.50/Tab.
Antrin(Central), Tab.,10 mg, Tk. 2.50/Tab. Proprietary Preparations
Arcet(JMI), Syrup, 5 mg/5 ml, Tk. Antista(Square), Syrup, 2 mg/5 ml, Tk.
25.00/60ml;Tab. ,10 mg, Tk. 2.00/Tab. 21.78/100 ml
Asitrol(Asiatic), Syrup, 5 mg/5 ml, Tk. Biocin(Biopharma), Syrup, 2 mg/5 ml,Tk.
16.00/60 ml Tab. ,10 mg, Tk. 2.00/Tab. 21.78/100 ml ;Tab. ,4 mg, Tk. 0.20/Tab.
Atrizin(Beximco,), Paed.drop, 2.5 mg/ml, Tk. Centagan(Central), Syrup, 2 mg/5 ml, Tk.
422
12. SKIN
9.50/60 ml ;Tk. 12.00/100 ml Delotad(Organic), Tab. , 5 mg, Tk. 2.50/Tab.

Chlorpheniramine(Popular ), Tab., 4 mg, Tk. Derat(Pacific), Tab., 5 mg, Tk. 1.88/Tab.
0.20/Tab. Des(Opsonin), Syrup, 2.5 mg/5 ml, Tk.
Clomin(Alco ), Syrup, 2 mg/5 ml, Tk. 18.86/60 ml;Tab., 5 mg, Tk. 1.89/Tab.
13.00/100 ml Desatrol(Navana), Syrup, 2.5 mg/5 ml, Tk.
Cloramin(Orion ), Syrup, 2 mg/5 ml, Tk. 25.08/60ml; Tab.,5 mg, Tk. 2.51/Tab.
21.78/100 ml Desgud(Leon), Tab., 5 mg, Tk. 3.00/Tab.
Cytacin(Albion), Tab. , 4 mg, Tk. 0.20/Tab. Deslor(Orion ), Syrup, 2.5 mg/5 ml, Tk.
G-Antihistamine(Gonoshasthaya), Tab., 4mg, 30.00/60 ml ;Tab., 5 mg, Tk. 3.50/Tab.;
Tk. 0.20 /Tab ;Syrup, 2 mg/5 ml, Tk. Deslor Kidz (Orion ), Paed.drops,
17.00/100 ml; Tk. 11.70/60 ml 50mg/100ml, Tk. 25.00/15 ml
Hisnul(Somatec), Syrup, 2 mg/5 ml, Tk. Desloratadine(Albion), Tab., 5 mg, Tk.
21.78/100 ml 2.50/Tab.
Histacin(Jayson), Inj. 10 mg/ml, Tk. Deslorin(ACI), Syrup, 2.5 mg/5 ml , Tk.
3.34/Amp.;Syrup, 2 mg/5 ml, Tk. 14.90/60 25.09/60 m;Tab., 5mg, Tk. 2.50/Tab.
ml;Tk. 21.78/100 ml; Tab., 4 mg,Tk. 0.29/Tab. Desodin(Eskayef), Tab, 5 mg, Tk. 3.00/Tab.
Histaco(Supreme), Syrup, 2 mg/5 ml, Tk. Desolet(Amulet), Tab., 5 mg, Tk. 2.50/Tab.
11.70/60 ml; Tab. , 4 mg, Tk. 0.20/Tab.;Tab. , Desta(White Horse), Tab , 5 mg, Tk. 2.50/Tab.
4 mg,Tk. 0.20/Tab. Destin(Unimed), Syrup, Tk. 25.00/60 ml;
Histal(Opsonin), Syrup, 2 mg/5 ml, Tk. Tab., 5 mg, Tk. 2.50/Tab.
10.34/60 ml Lara(Hudson), Tab.,5 mg, Tk. 2.50/Tab.
Histalex(Acme), Syrup, 2 mg/5 ml, Tk. Momento(Beximco,), Syrup, 2.5 mg/5 ml, Tk.
21.78/100 ml;Tab., 4 mg, Tk. 0.3/Tab. 25.00/60 ml ;Tab. , 5 mg, Tk. 2.50/Tab.
Histam(Maks ), Syrup, 2 mg/5 ml, Tk. Neocilor(Incepta), Syrup, 2.5 mg/5 ml, Tk.
11.70/60 ml ;Tk. 21.75/100 ml 25.00/50 ml; Tab. , 5 mg, Tk. 2.50/Tab.
Hitagen(General), Syrup, 2 mg/5 ml, Tk. Neolor(Supreme), Tab., 5 mg, Tk. 2.50/Tab.
14.03/100 ml;Tk. 8.03/60 ml;Tab., 4 mg, Tk. Orinex(Acme), Tab., 5 mg, Tk. 2.51/Tab.
0.20/Tab. Relergy(General), Tab., 5 mg, Tk. 2.51/Tab.
Penamin(APC ), Tab., 4 mg, Tk. 0.20/Tab. ; Sarinex(Delta), Tab., 5 mg, Tk. 2.50/Tab.
Syrup, 2 mg/5 ml, Tk. 11.70/60 ml Sedno(Square), Syrup, 2.5 mg/5 ml, Tk.
Pheramin , (Amico) , Tab. , 4 mg, Tk. 25.10/60 ml; Tab., 5 mg, Tk. 2.51/Tab.
0.20/Tab.
Piriton(GSK), Syrup, 2 mg/5 ml, Tk. 19.13/100
DIMETHOTHIAZINE MESYLATE
ml ;Tab. 4 mg,Tk.0.18/Tab.
Safamin(Benham), Syrup, 2 mg/5 ml, Tk.
21.00/100 ml Indications: See notes above
Sinamin(Ibn Sina), Syrup, 2 mg/5 ml, Tk. Cautions: ELDERLY (above 65 years),
21.78/100 ml ;Tab., 4 mg, Tk. 0.20/Tab. hepatic and renal impairment. Also see
notes above
DESLORATADINE Contraindications, Side-effects:See
notes above
Indications, Cautions, Dose:ADULT: 20 mg 3 times a day up to
Contraindications, Side-effects:See 120 mg daily in 3 divided doses
notes above and section 4.8.1
Dose:ADULT and CHILD over 12 years: Generic Preparation
Tablet:One tablet (5 m g) once daily. Tablet, 20 mg
CHILD 2-5 years:Syrup: 2.5ml
(1/2teaspoonful) daily DIPHENHYDRAMINE
Proprietary Preparations Indications, Cautions,

Alertadin(Beacon), Tab. , 5 mg, Tk. Contraindications, Side-effects: See
2.50/Tab.; Tab. , 5 mg, Tk. 2.50/Tab.
Aslor(Drug int.), Tab. , 5 mg, Tk. 2.50/Tab.
notes above and see section 4.8.1
Benlor (Benham), Tab. , 5 mg, Tk. 3.00/Tab. Dose: Allergic conditions are controlled
Clarex(Asiatic), Tab. , 5 mg, Tk. 2.50/Tab. with 25 to 50 mg (12.5 to 25 ml of syrup)
Deen(Kemiko), Tab. , 5 mg, Tk. 2.50/Tab. 3 to 4 times a day.
Delosia(Pharmasia), Syrup, 2.5 mg/5 ml, Tk. CHILD 6 to 12 years of age: 10 mg (5 ml
28.00/60 ml ;Tab. , 5 mg, Tk. 2.50/Tab. of syrup) 3 to 4 times a day.
Delot(Apex ), Syrup, 2.5 mg/5 ml, Tk. 25.00/60 CHILD 1 to 6 years of age: 5 mg (2.5 ml
ml; Tab. , 5 mg, Tk. 2.00/Tab.
of syrup) 3 to 4 times a day.
423
12. SKIN
The maximum daily dose should not notes above and see section 4.8.1
exceed 300 mg in adults and children Dose:Oral: 120 mg once daily in adults,
30 mg twice daily in children 6 – 11
Proprietary Preparations years
Adryl(Square), Syrup, 10 mg/5 ml, Tk.
40.00/100 ml Proprietary Preparations
Cufnot(Maks ), Syrup, 10 mg/5 ml, Tk. Alafree(Apex ), Tab., 180 mg, Tk. 8.00/Tab.;
22.00/100 ml 120 mg, Tk. 6.50/Tab.
Diphenhydramine(Albion), Syrup, 10 mg/5 Alagra(Alco), Tab., 120 mg, Tk. 6.00/Tab.;
ml, Tk. 15.00/100ml Susp., 30 mg/5 ml, Tk. 48.00/50 ml ;Tab., 180
Dorenta(Eskayef), Syrup, 10 mg/5 ml, Tk. mg, Tk. 8.50/Tab. ; 30 mg, Tk.3.00/Tab.; 60
30.00/100 ml ;Tab, 50 mg , Tk. 2.50/Tab. mg, Tk. 3.50/Tab.
Dytan(Supreme), Syrup, 10mg/5ml, Tk. Alanil(Acme), Susp., 30 mg/5 ml, Tk.48.00/50
30.00/100ml ml ;Tab., 120 mg, Tk. 6.50/Tab.;180 mg, Tk.
Pedeamin(Beximco), Syrup, 10 mg/5 ml, Tk. 8.00/Tab.
38.00/100 ml Alerfast(Biopharma),Tab.,120 mg, Tk.6/Tab.
Pedilar(Popular ), Syrup, 10 mg/5 ml, Tk. Axodin(Beximco), Susp., 30 mg/5 ml, Tk.
45.17/100ml 55.00/50 ml ; Tab., 120 mg, Tk. 7.00/Tab. ;
Pediphen(Somatec), Syrup, 10 mg/5 ml, Tk. 180 mg, Tk. 9.00/Tab. ;60 mg, Tk. 5.00/Tab.
38.00/100 ml Axofen(Aristo), Susp., 30 mg/5 ml, Tk.
Phenadryl(Acme), Syrup, 10 mg/5 ml, Tk. 48.00/50 ml; Tab., 180 mg, Tk. 9.00/Tab.; 120
38.00/100 ml mg, Tk. 7.00/Tab.
Rymin(Opsonin), Syrup, 10 mg/5 ml, Tk. Dinafex(Eskayef), Susp., 30 mg/5 ml, Tk.
24.06/100 ml 48.00/50 ml ;Tab., 60 mg, Tk. 3.50/Tab.; 180
mg, Tk. 8.00/Tab. ;120 mg, Tk. 6.50/Tab.
EBASTINE Fenadin(Renata), Susp., 30 mg/5 ml, Tk.
48.19/50 ml; Tab., 120 mg, Tk. 7.02/Tab.; 180
mg, Tk. 9.03/Tab. ;30 mg, Tk. 2.51/Tab.;
Indications: Allergic rhinitis and chronic 60mg, Tk. 3.50/Tab.
idiopathic urticaria Fenargic(Rangs), Tab., 120mg, Tk. 7/Tab.
Cautions: Should be exercised in Fenaxo(Kemiko), Tab., 120 mg, Tk. 7/Tab.;
patients with history of liver and kidney 180 mg, Tk. 9.00/Tab.;60 mg, Tk. 5/Tab.
impairment, QT interval prolongation, Fenofex(Incepta), Susp., 30 mg/5 ml, Tk.
during pregnancy and breastfeeding 48.00/50 ml ; Tab., 120 mg, Tk. 7.00/Tab.;
180 mg, Tk. 9.00/Tab.; 60 mg, Tk. 3.50/Tab.
Side-effects : Headache, dry mouth,
Fexo(Square), Susp., 30 mg/5 ml, Tk.
drowsiness, inflammation of 48.19/50 ml;Tab., 60 mg, Tk. 3.51/Tab.; 180
pharynx/nose/sinus, abdominal pain, mg, Tk. 8.04/Tab.; 120 mg, Tk. 6.53/Tab.
indigestion, weakness, nosebleed, Fexocon(Concord), Susp., 30 mg/5 ml, Tk.
nausea and sleeplessness 48.00/50 ml ; Tab., 120 mg , Tk. 6.50/Tab. ;
Dose: 10 and 20 mg once-daily 180 mg, Tk. 8.00/Tab.
Fexodin(Pacific), Susp., 30 mg/5 ml, Tk.
Proprietary Preparations 45.26/50 ml ;Tab., 120mg, Tk. 5.26/Tab.
Ebanex(Opsonin), Tab., 10mg, Tk. Fexofast(Drug Int.), Susp., 30 mg/5 ml, Tk.
4.51/Tab;.Syrup, 5 mg/5 ml, Tk. 60.15/50 ml 48.00/50 ml ; Tab., 120 mg, Tk. 7.00/Tab;.
Ebaril(Incepta), Syrup, 5 mg/5 ml, Tk. 180 mg, Tk. 9.00/Tab.
60.00/30 ml ;Tab. , 10 mg, Tk. 6.00/Tab. Fexofen(Somatec), Susp., 30 mg/5 ml, Tk.
Ebatin(Popular), Syrup, 5 mg/5 ml, Tk. 48.18/50 ml;Tab., 60 mg, Tk. 6.02/Tab.;120
60.00/30ml; Tk.80.00/50ml;Tab., 10mg, Tk. mg, Tk. 7.03/Tab.
6.02/Tab. Fexofenadine(Albion), Tab., 180 mg, Tk.
Ebatrol(Delta), Tab.,10 mg, Tk. 5.00/Tab. 9.00/Tab.; 120 mg, Tk.7.00/Tab.
Stiba(Eskayef), Syrup, 5 mg/5 ml, Tk. Fexomin(Ibn Sina), Susp., 30 mg/5 ml, Tk.
60.00/30 ml ;Tab, 10 mg, Tk. 6.00/Tab. 48.00/50 ml ; Tab., 120 mg, Tk. 7.00/Tab;.
Tebast(Square), Syrup, 5 mg/5 ml, Tk. 60mg, Tk. 5.00/Tab.
80.00/50 ml ;Tab. 10 mg, Tk. 6.00/Tab. Fexon(Astra), Tab., 120 mg, Tk. 6.50/Tab.;
Tab., 180 mg, Tk. 8.00/Tab.
Fexona(Globe), Suspn. 30 mg/ 5 ml, Tk.
FEXOFENADINE 48.00/50 ml; Tab. 120 mg, Tk. 6.50/Tab.; 180
mg, Tk. 8.00/Tab.; 60 mg, Tk. 3.50/Tab.
Indications, Cautions, Fexotab(Veritas), Tab., 120 mg, Tk.
7.00/Tab.; 180 mg, Tk. 9.00/Tab.
Contraindications, Side-effects:See
424
12. SKIN
Fexten(NIPRO JMI), Tab., 120mg, Tk. LEVOCETIRIZINE

6.05/Tab.; 60mg, Tk. 5.00/Tab.; Suspn.,
30mg/5ml, Tk. 48.14/100ml
Fixal(Opsonin), Susp., 30 mg/5 ml, Tk. Indications, Cautions,
36.23/50 ml;Tab., 120 mg, Tk. 5.29/Tab.; Contraindications, Side-effects:See
180mg, Tk. 6.79/Tab.;30 mg, Tk. 2.64/Tab.; notes above and see section 4.8.1
60mg, Tk. 3.77/Tab. Dose:Oral:ADULT: 5 mg once daily in
Fixen(Sharif), Tab., 120 mg, Tk. 7.00/Tab. the evening. Maximum dose 5 mg daily
Flufex(Doctor TIMS), Tab., 120 mg,Tk. 7/Tab.
Furia(Organic), Susp.,30 mg/5 ml,
CHILD: 6-11 years: 2.5 mg once daily
Tk.48.00/50ml; Tab., 120 mg, Tk. 7.00/Tab.; maximum dose 2.5 mg daily
180 mg, Tk. 9.00/Tab.; 60 mg, Tk. 3.50/Tab.
Nosedex(Orion), Susp., 30 mg/5 ml, Tk. Proprietary Preparations
40.15/40 ml ;Tab., 120 mg , Tk. 6.53/Tab. Acitrin-L(ACI), Oral solution, 2.5 mg/5 ml, TK.
Odafen(Navana), Tab., 120 mg, Tk. 6.50/Tab.; 55.00/60ml ,; Tab., 5mg, TK. 3.01/Tab.
180 mg, Tk. 8.50/Tab.; Suspn., 30 mg/5 ml, Alcet(Healthcare), Tab., 5mg, Tk.
Tk. 48.15/50ml 450.00/Tab.; Syrup, 2.5mg/5ml, Tk. 50/60 ml
Ritch(ACI), Susp., 30 mg/5 ml, Tk. 48.00/50 Clarigen(Drug Intl), Tab., 5mg, Tk. 2.05/Tab.
ml ;Tab., 60 mg , Tk. 5.02/Tab.; 180 mg , Tk. Curin(Beximco), Tab., 5mg, Tk. 3.50/Tab.
9.03/Tab. ; 120 mg, Tk. 7.03/Tab. Lecet(Pacific), Tab. , 5mg, Tk. 3.00/Tab. ;
Telfast(Sanofi), Susp., 30 mg/5 ml, Tk. 5mg , Tk. 2.00/Tab.
48.00/50 ml ;Tab., 180 mg, Tk. 10.00/Tab. ; Lerex(Asiatic), Tab., 5 mg, Tk. 2.00/Tab.
120 mg, Tk. 8.00/Tab. Levocet(Alco), Tab. , 5 mg, Tk. 2.01/Tab.
Telfex(Pharmasia), Susp., 30 mg/5 ml, Tk. Levorex(Popular), Tab. , 5mg, Tk. 2.01/Tab.
48.00/50 ml ;Tab., 120 mg, Tk. 6.50/Tab. Levotiz(Euro), Tab., 5mg, Tk. 2.5/Tab.
Vifas(Healthcare), Tab., 180 mg, Tk. Lozin(Kemiko), Tab., 5 mg, Tk. 3.01/Tab.
10.00/Tab.; 60 mg, Tk. 5.00/Tab.; 120 mg, Tk. LVC(Organic), Tab. , 5 mg, Tk. 3.01/Tab.
8.00/Tab. Polan(Globe), Tab. , 5 mg, Tk. 3.00/Tab.
X-din(Benham), Tab., 120 mg, Tk. 7.00/Tab.; Purotrol(Square), Syrup, 2.5 mg / 5 ml, Tk.
180 mg, Tk. 9.00/Tab. 35.14/50 ml ;Tab., 5 mg, Tk. 3.51/Tab.
Xofena(Asiatic), Tab., 120 mg, Tk. 7.00/Tab.; Rinotin(Biopharma), Tab., 5 mg,Tk. 2.01/Tab.
180 mg, Tk. 9.00/Tab. Seasonix(Incepta), Syrup 2.5 mg/5 ml, Tk.
40.00/60 ml ;Tab., 5 mg, Tk. 3.50/Tab.
Sinacet(Ibn Sina), Syrup, 2.5 mg/5 ml, Tk.
HYDROXYZINE 50.00/60 ml .;Tab., 5 mg, Tk. 4/Tab.
Verizin(Sharif), Tab. , 5 mg, Tk.2.00/Tab.
Indications, Cautions, Verizin(Sharif), Tab., 5mg, Tk. 2.00/Tab.
Contraindications, Side-effects: See Vocet(Apex ), Tab. , 5 mg, Tk. 2.00/Tab.
notes above and see section 4.8.1
Dose:ADULT: 25mg at night, increased LORATADINE
if required up to 25mg 3-4 times daily
CHILD 6 - 12 years: Initially 15–25 mg Indications, Cautions,
(1½ teaspoonfuls - 2½ teaspoonfuls) at Contraindications, Side-effects:See
night, increased if necessary to 50–100 notes above and see section 4.8.1
mg daily in 3–4 divided doses Dose:ADULT: 10 mg once daily
CHILD 6 months - 6 years: Initially 5–15 CHILD: 2-5 years: 5 mg once daily
mg (½ teaspoonfuls - 1½ teaspoonfuls)
at night,increased if necessary to 50 mg Proprietary Preparations
daily in 3–4 divided doses Alaron(ACI), Susp., 5 mg/5 ml, Tk.
30.11/60ml; Tab. , 10 mg, Tk. 3.01/Tab.
Proprietary Preparations Aleze(Unimed), Tab. , 10 mg, Tk.
Artica(ACI), Tab., 25 mg, Tk. 2.00/Tab.; 2.50/Tab.;Susp., 5 mg/5 ml , Tk. 26.00/60 ml
10mg, Tk. 1.25/Tab.; Syrup, 10 mg/5 ml, Tk. Eladin(Jayson), Susp., 5 mg/5 ml , Tk.
40.15/100 ml 26.40/60 ml ;Tab. 10 mg, Tk. 3.05/Tab.
Xyril(Opsonin), Tab., 10 mg, Tk.0.77/Tab.;25 Encilor(Incepta), Tab. , 10 mg, Tk. 3/Tab.
mg, Tk. 1.32/Tab.;Syrup, 10 mg/5 ml, Tk. Tab., 10 mg, Tk. 4.00/Tab.
26.41/100 ml Itchlor(Nipro JMI), Susp., 5 mg/5 ml , Tk.
30.12/60 ml ; Tab. , 10 mg, Tk. 3.03/Tab.
Kevil(Kemiko), Susp., 5 mg/5 ml , Tk.
30.00/60 ml ;Tab. 10 mg, Tk. 3.00/Tab.
Lodin, (Amico ), Tab. , 10 mg, Tk. 3.00/Tab.
425
12. SKIN
Lora(Opsonin), Tab., 10 mg, Tk. MIZOLASTINE

1.89/Tab.;Susp., 5 mg/5 ml , Tk. 22.64/60 ml
Loradin(Aristo), Tab. , 10 mg, Tk. 3/Tab.
Lorat(Drug Int.), Tab. , 10 mg, Tk. 3/Tab. Indications: See notes above
Loratadine ,(Albion), Susp., 5 mg/5 ml , Tk. Cautions: CHILD under 12 years,
30.00/60 ml ; Tab. , 10 mg, Tk. 3.00/Tab. pregnancy, lactation, see notes above
Loratin(Techno), Tab., 10 mg, Tk. 3/Tab. Contraindications, Side-effects:See
Loratin(Square), Susp., 5 mg/5 ml, Tk. notes above
30.11/60 ml ; Tab. , 10 mg, Tk. 3.01/Tab.
Loratin Fast(Square), ODT Tab. , , 10 mg ,
Dose: ADULT and CHILD above 12
Tk. 3.01/Tab. years: 10 mg once daily
Lorfast(Biopharma), Tab. , 10 mg, Tk.
3.01/Tab.; Susp., 5 mg/5 ml, Tk. 26.10/60 ml Proprietary Preparations
Lorin(General), Susp., 5 mg/5 ml , Tk. Mastel(ACI), Tab., 10 mg, Tk. 6.52/Tab.
30.11/60 ml;Tab. 10 mg, Tk. 3.01/Tab. Rhinor(Opsonin), MR Tab., 10 mg, Tk.
Oradin(Eskayef), Susp., 5 mg/5 ml, Tk. 5.02/Tab.
30.00/60 ml; Tab, 10 mg, Tk. 4.00/Tab.
Orin(Acme), Tab., 10 mg, Tk. 3.00/Tab.; PHENIRAMINE
Susp., 5 mg/5 ml , Tk. 40.00/100 ml; Tk.
26.1/60 ml
Pretin(Beximco), Tab., 10 mg , Tk. 3.00/Tab. Indications, Cautions,
Silora(Ibn Sina), Tab., 10 mg, Tk. 2.50/Tab. Contraindications, Side-effects: See
MEBHYDROLIN Dose:Syrup:ADULT: 2 teaspoonful (10
ml) 3-4 times daily
CHILD up to 1 year: ½ teaspoonful (2.5
ml) twice daily
Contraindications, Side-effects: See
CHILD (1-5 years): ½ - 1 teaspoonful
(2.5-5 ml) thrice daily
Dose:ADULT and CHILD over 10 years:
CHILD > 5 years: 1-2 teaspoonful (5-10
2-6 tablets daily
ml) 3-4 times daily
Syrup:CHILD 2-6 years: 5 ml (1
Oral:ADULTS: 1-2 times daily, up to 45
teaspoon full) once daily or 2.5 ml (half
mg 3 times a day; Maximum dose
teaspoon full) twice daily
3mg/kg/day.
CHILD 6 months to less than two years:
2.5 ml (half teaspoon full) once daily Proprietary Preparations
Aerovil(Beximco), Syrup, 15 mg/5 ml, Tk.
Proprietary Preparations 20.07/100 ml
Aexidal(Albion), Tab. , 50 mg, Tk. 1.50/Tab. Alervil(Incepta), Syrup, 15 mg/5 ml , |Tk.
Bexidal(Beximco), Tab.,50 mg,Tk. 3/Tab. 20.00/100ml; 15 mg/5 ml, Tk. 25.00/75ml
Dayhista(Medimet), Tab., 50mg, Tk. 2/Tab. Amarin(Opsonin), Syrup, 15 mg/5 ml, Tk.
Mebastin(Incepta), Tab., 50 mg,Tk. 2/Tab. 20.00/100 ml ; Tab. , 22.7 mg , Tk. 0.47/Tab.,
Mebidal(Eskayef), Tab., 50 mg,Tk. 3/Tab. Inj., 45.5mg/2ml, Tk. 7.48/2ml Amp
Mebolin(Acme), Tab., 50 mg, Tk. 2.01/Tab. Avil(Sanofi), Inj., 45.5mg/2ml, Tk. 7.55/2 ml
Medrolin(Opsonin),Tab.,50mg, Tk.1.51/Tab Amp; Syrup, 15 mg/5 ml, Tk. 25.08/75 ml;
Tab., 75mg, Tk. 2.02/Tab., Tab., 22.7mg, Tk.
MEPYRAMINE (PYRILAMINE) 1.51/Tab.
Fenimex(Asiatic), Inj., 45.50mg /2ml, Tk.
7.50/2 ml Amp
Indications, Cautions, Pevil(ACI), Tab., 22.7mg, Tk. 0.46/Tab.
Contraindications, Side-effects:see
notes above
PROMETHAZINE[ED]
Dose:Apply to affected area 2 to 3 times
daily for up to 3 days
Proprietary Preparation Contraindications, Side-effects:See
Anthisan(Aventis), Cream 2% Tk.34.90/15g notes above and section 4.8.1
Dose:ADULT: 25-50 mg daily IM or slow
IV. Maximum 100 mg daily
CHILD 2-5 years: 5-15 mg daily in 1-2
426
12. SKIN
divided doses Rupafen(Somatec), Tab. 10 mg, Tk. 10/Tab.

CHILD 5-10 years: 10-25 mg daily in 1-2 Rupaler(Alco), Tab., 10 mg, Tk. 10.00/Tab.
divided doses Rupamin(Ibn Sina), Tab., 10mg, Tk.10/Tab.
Rupanex(Sharif), Tab., 10 mg, Tk.
10.03/Tab.
Proprietary Preparations Rupastin(Acme), Tab., 10 mg, Tk. 10.03/Tab.
Allphen(Medimet), Syrup, 5mg/5 ml, Tk. Rupatan(Novo), Tab., 10 mg, Tk. 10.00/Tab.
24.00/100ml; Tk. 12.00/50ml Rupatid(NIPRO JMI), Tab., 10 mg, Tk.
Avomine(Sanofi), Tab. , 25mg, Tk. 0.57/Tab.
10.03/Tab.
Histavil(Pacific), Elixir, 5 mg/5 ml, Tk.
Rupatrol(Square), Tab, 10 mg, Tk.
10.00/60ml
10.03/Tab.
Otosil(Opsonin), Syrup, 5 mg/5 ml, Tk.
Rupenta(Orion), Tab., 10 mg, Tk. 10/Tab.
14.73/60 ml; 5 mg/5 ml, Tk. 24.55/100 ml ; Rupex(Incepta), Oral Solution, 1 mg/ml, Tk.
Tab., 10 mg , Tk. 0.31/Tab., 25 mg , Tk.
75.00/60ml; Tab., 10 mg, Tk. 10.00/Tab.
0.44/Tab. Rupin(Ziska), Oral Solution, 1 mg/ml, Tk.
Phenerex(Jayson), Inj., 25 mg/1mL, Tk.
60.00/60 ml; Tab., 10 mg, Tk. 10/Tab.
33.80/1ml Amp.; 50 mg/2mL, Tk. 41.80/2 ml
Rupoma(General),Oral Solution, 1 mg/ml, Tk.
Amp.; Syrup, 5mg/5mL, Tk. 24.03/100ml 60.00/60 ml; Tab, 10mg, Tk. 10.00/Tab.
Phenergan(Sanofi), Elixir, 5 mg/5 ml, Tk. Rutipa(Euro), Tab., 10mg, Tk. 10.00/Tab.
28.05/Vial., Tab, 10mg, Tk. 0.68/Tab.
Promalex(Modern), Syrup, 5 mg/5 ml, Tk.
18.70/60ml; 5 mg/5 ml, Tk. 23.95/100ml ANTIPRURITICS AND TOPICAL
Promergan(G.A.Co), Syrup, 5 mg/5 ml, Tk. LOCAL ANAESTHETICS
12.04/60 ml
Promezin(Beximco), Syrup, 5 mg/5 ml, Tk.
15.50/100 ml
Pruritus may be caused by systemic
Prozen(Zenith), Tab., 25 mg, Tk. 0.42/Tab. disease such as drug hypersensitivity,
obstructive jaundice, endocrine disease,
malignant disease as well as by skin
RUPATADINE
diseases e.g psoriasis, eczema, urticaria
and scabies. An emollient may be of
Indications: Allergic rhinitis and chronic value where the pruritus is associated
urticaria in adults and children over 12 with dry skin.
years
Side-effects: Somnolence, headaches
and fatigue CALAMINE
Dose:ADULT and CHILD above 12
years: 10 mg once daily Indications : Topical soothing relief of
itching, pain, and discomfort due to
Proprietary Preparations minor skin irritations, such as those
Alarup(Popular), Tab., 10mg , Tk. 10.00/Tab. caused by eczemas, prickly heat
Dipa(Drug Intl), Tab., 10mg, Tk. 8.03/Tab. (miliaria), sunburn, napkin rash,
Duvent(Beximco), Oral Solution, 1 mg/ml, Tk. cosmetic rashes, pruritis of dry skin
60.00/60 ml; Tab., 10mg, Tk. 10.00/Tab. including as well as symptomatic relief of
Largix(ACI), Oral Solution, 1 mg/ml, Tk.
75.00/60ml; Tab., 10mg, Tk.10.00/Tab.
itchiness in Chickenpox viral infection
Minista(Radiant), Tab., 10mg , Tk. 12.04/Tab. Cautions: Avoid contact with the eyes
Nerupa(Team), Tab., 10 mg, Tk. 9.50/Tab. and other mucous membranes such as
Paftrol(Navana), Tab., 10 mg, Tk. 10.03/Tab.; mouth, nose and genital region. Do not
Oral Solution, 5mg/5 ml, Tk. 60.00/50ml apply to abraded, blistered, inflamed,
Rosela(Healthcare), Tab., 10mg, Tk. 12/Tab. raw or oozing areas of the skin. Do not
Rubest(Benham), Tab., 10 mg, Tk. 10/Tab. use on open wounds or burns
Rufast(Opsonin), Tab., 10 mg, Tk. 10/Tab.
Rufecta(Biopharma), Tab., 10mg, Tk. 10/Tab.
Contraindications: known
Rupa(Aristo), Tab., 10mg , Tk. 10.00/Tab., hypersensitivity to calamine
Oral Solution, 1 mg/ml, Tk. 75.00/60ml, Dose: apply sparingly to the affected
Rupaday(Eskayef), Oral Solution, 1 mg/ml, parts and surrounding skin areas 2-3
Tk. 74.99/60 ml; 1 mg/ml, Tk. 74.99/60 ml; times daily
Tab, 10mg , Tk. 10.00/Tab.,
Rupadin(Beacon), Tab., 10mg , Tk. Proprietary Preparations
10.03/Tab., Oral Solution, 1 mg/ml, Tk. Calamilon(United Chem),Lotion,Tk.20/100ml
75.00/60 ml
427
12. SKIN
Calamine15 gm + +Zinc Oxide5 gm/100 ml 6mg , Tk. 10.00/Tab.

Calamine(Amico), Lotion, 0.15g/ml, Tk.
38.00/100ml
DIPHENHYDRAMINE
Calzirin(Opsonin) Lotion, Tk. 23.06/100ml
Indications: Temporarily relief of pain

CAPSAICIN
and itching associated with insect bites,
minor burns, sunburn, minor skin
Indications: postherpeticneuralgia, irritations, minor cuts, scrapes, rashes
diabetic neuropathy, reflex due to poison ivy, poison oak, and
sympatheticdystrophy, Raynaud poison sumac.
phenomenon, nostalgia paresthetica, Indications, Cautions,
arthralgias, plantar warts, diabetic Contraindications and Side-
neuralgia,and hemodialysis-related effects:See section 4.8.1
pruritus Dose: ADULT & CHILD above 2 years:
Cautions: Pregnancy apply to the affected area 3 to 4 times
Contra-indications: Broken skin, known daily
hypersensitivity
Side-effects: Burning sensation,
pruritus, erythema, coughing, and Proprietary Preparations
sneezing, superficial erosions Adryl(Square), Syrup, 10 mg/5ml, Tk.
Dose: Apply 3-5 times daily for a 40.13/100ml
maximum of 4-6 weeks Didryl(G.A.Co), Syrup, 10 mg/5ml, Tk.
45.31/100 ml
Difin(Nipa), Syrup, 10 mg/5ml, Tk.
40.00/100ml
Ostocin(General),Cream,Tk.50.34/20gm
Diphenhydramine(Albion),Syrup, 10 mg/5ml,
Topicacin(Incepta), Cream,Tk.50.00/20gm
Tk. 15.00/100ml
Dorenta(Eskayef), Tab., 50 mg, Tk. 2.50/Tab.;
CROTAMITON Syrup, 10 mg/5ml, Tk. 40.00/100ml,; 10
(see section 12.2.4) mg/5ml, Tk. 40.00/100ml
Dytan(Supreme), Syrup, 10 mg/5ml, Tk.
20.00/100ml
DOXEPIN Pedeamin(Beximco), Syrup, 10 mg/5ml, Tk.
45.00/100ml,; 10 mg/5ml, Tk. 38.00/100ml
Indications:Short-term (up to 8 days) Pedilar(Popular ), Syrup, 10 mg/5 ml, Tk.
management of moderate pruritus in 45.17/100ml
Pediphen(Somatec), Syrup, 10 mg/5 ml, Tk.
adult patients with atopic dermatitis or 38.00/100 ml
lichen simplex chronicus Phenadryl(Acme), Syrup, 10 mg/5ml, Tk.
Cautions: Children and elderly 38.11/100ml
Contraindications:known hypersensi- Rymin(Opsonin), Syrup, 10 mg/5ml, Tk.
tivity to doxepin 45.00/ 100 ml
Side-effects: Local burning, stinging,
irritation, tingling, sedation, allergic Diphenhydramine Hydrochloride + Zinc
Acetate
contact dermatitis Bendil(Alco), Cream, 20 mg + 1 mg/gm, Tk.
Dose: ADULT and CHILD over 12 years: 55.17/30gm; 20 mg + 1 mg/gm, Tk.
apply thinly 3–4 times daily; usually a 22.00/5gm; Tk. 35.11/10gm
maximum of 3 g per application; total Togent(Square), Cream, 20 mg + 1 mg/gm,
maximum dose is 12 g daily; coverage Tk. 35.24/10gm
should be less than 10% of body surface
area. TOPICAL LOCAL ANAESTHETICS
Proprietary Preparations Indications:Topical anaesthesia of the

Adnor(Apex), Cap., 75 mg, Tk. 5.00/Cap.
Doxiderm(Incepta), Cream, 5% Tk. 120.00/30
skin prior to minor superficial cosmetic
gm; Tab., 3 mg, Tk. 6.00/Tab.; 6mg, Tk. procedures, postherpetic neuralgia,
10.00/Tab. pruritus
Slipaid(Beacon), Tab., 3 mg, Tk. 6.00/Tab.; Cautions: Local anesthetic ointments
428
12. SKIN
are absorbed through the rectal mucosa, inflamed areas. Care should be taken to
therefore its excessive application avoid contact with normal tissue and the
should be avoided. These preparations eyes
should not be used for more than 3 days. Contraindications: Pregnancy
Not suitable for young children Interactions:See Appendix-2
Contra-indications:Hypersensitivity to Side-effects: Irritant contact dermatitis
lidocaine or preservatives,pregancy, and staining of clothing, skin, hair, and
significant hepatic or renal impairment, nails
myasthenia gravis, hyperthyroidism Dose:The most common approach is to
Side-effects:Erythema, edema, start with a lower concentration of
abnormal sensation, allergic reaction anthralin, such as 0.1% or 0.25%. The
Dose:Up to 2 g for a minimum of 1 anthralin is left on the treatment area for
hour, maximum of 5 hours 10–20 minutes daily. The contact time is
increased weekly until the total contact
Proprietary Preparation time prior to washing is 1 hour
Jasocaine(Jayson) Gel lidocaine, 2% Tk.
80.00/30g Proprietary Preparations
Dithranol0.1%+Boric 2%+Salicylic Acid 1%
12.6 PREPARATIONS FOR ECZEMA Gacozema(G.A co), Oint. Tk. 28.00/6 gm
AND PSORIASIS Ring Fight(Millat), Oint Tk, 10.00/12 gm
Pimecrolimus by topical application is AZATHIOPRINE

used in mild to moderate atopic (see also section 14.2.1)
eczema. For short term use to treat sign
and symptoms and for intermittent use to Indications: Organ transplantation,
prevent flares. Tacrolimus is used in severe rheumatoid arthritis,
moderate to sever atopic eczema. Both immunobullous dermatoses,SLE, DLE,
drugs whose long term safety and place psoriasis
in therapy is still being evaluated and Caution:Renal impairment
they should not usually be considered Contra-indications:Pregnancy, known
first line treatments unless there is a hypersensitivity to azathioprine, active
specific reason avoid or reduce the use clinically significant infections. Allopurinol
of topical corticosteroids. use: the dose of azathioprine should be
General Principle of Topical reduced significantly
Corticosteroid therapy in Psoriasis: Interactions: See Appendix-2
Topical corticosteroids are most useful Side-effects: Bone marrow suppression,
for localized psoriasis or psoriasis of the neutropenia, rarely agranulocytosis and
scalp. Localized plaque psoriasis pancytopenia; human papilloma virus,
generally requires a high-potency or herpes simplex, scabies
superpotent topical corticosteroids twice Transaminase elevation, hepatotoxicity
daily, followed by a maintenance Teratogenecity
regimen, to obtain and preserve Dose:1–2 mg per kg body weight per
remission. Regardless of the choice of day, often concurrent with high-dose
topical corticosteroid, psoriasis usually prednisone.
recurs after discontinuation of
corticosteroid treatment. Proprietary Preparations
(see under section 12.3) See section 14.2.2
ANTHRALIN (DITHRANOL) CALCIPOTRIOL

(Vitamin D3 analogue)
Indications: Chronic plaque psoriasis,
alopecia areata Indications: Mild to moderate plaque
Cautions: Should not be used on the psoriasis affecting up to 40% of skin
face or on acute eruptions or excessively area
429
12. SKIN
Cautions: More than 100 mg should not infected skin

be applied to the body considering the Contra-indications: known hypersen-
risk of hyperpigmentation, should not be sitivity to tar preparations, pregnancy
used on the face, in children under 6 Interactions : See Appendix-2
years of age Side-effects: Staining of clothing, tar
Contra-indications: Known folliculitis, acneiform eruptions, irritant
hypersensitivity to calcipotriol, patients dermatitis, burning, and stinging, allergic
with known disorders of calcium contact dermatitis, atrophy,
metabolism. telangiectases, pigmentation, exfoliative
Interactions: See Appendix-2 dermatitis, and keratoacanthomas.
Side-effects: Pruritis, skin Dose:Goeckerman technique: A 2–5%
irritation(especially if accidentally tar preparation is applied to the skin, and
transferred to face), burning and stinging a tar bath is taken at least once a day
sensation, dry skin, erythema, rash, Ingram technique: a daily coal tar bath in
hypercalcemia a solution such as 120 mL liquor
Dose:ADULT: Apply to the affected area carbonis detergens to 80 L of warm
once to twice daily. Application of the water. This is followed by daily exposure
cream can be reduced to once daily to UV light for increasing periods.
when appropriate. Maximum weekly Proprietary Preparation
dose should not exceed 100 g. Soritar(Unimed),Cream, 10%,Tk.300/50 gm
CHILD over 12 years: apply to the
affected area twice daily. Maximum CYCLOSPORINE
weekly dose should not exceed 75 g. (See also section 14.2.2)
CHILD aged 6 to 12 years: apply to the
affected area twice daily. Maximum Indications: Treatment resistant
weekly dose should not exceed 50 g. psoriasis, disabling psoriasis;lichen
planus, severe atopic dermatitis
Proprietary Preparations Cautions Monitored regularly serum
Dovonex(Drug Intl), Oint., 0.005%, Tk.
200.00/10gm
creatinine, blood pressure, oedema,
Dyvon(Square), Cream, 0.05 %, Tk. hypertension, and immuno-suppression
351.06/20gm Contraindications:Impaired Renal
Planex(Incepta), Oint, 0.005% Tk.200.00/10g function,uncontrolled hypertension,
Calcipotriol0.005 %, + Betamethasone hypersensitivity to cyclosporine,
Dipropionate 0.05% pregnancy and lactation
Apply once daily to the affected areas. Interactions:See Appendix-2
Treatment on the body may be Side-effects:Nausea, vomiting,
continued for up to 8 weeks. Treatment abdominal discomfort,
on the scalp may be continued for up to diarrhea;nephrotoxicity;Hypertension;tre
4 weeks. The maximum daily dose is 15 mor, headache, paresthesia,
g per day, or 100 g per week, in total of hyperesthesia,hyper-trichosis, gingival
all products containing calcipotriol. hyperplasia,myalgia, lethargy,
arthralgia,hyperkalemia, hyper-uricemia
Proprietary Preparation hypomagnesemia, hyper-lipidemia
Dyvon Plus(Square), Oint. Tk. 381.14/20gm; Dose:2.5 to 5 mg/kg/day
Planex Plus(Incepta), Oint., Tk. 380.00/20gm
COAL TAR Proprietary Preparations

see section 14.2.2
Indications: Chronic psoriasis, either
alone or in combination with exposure to METHOTREXATE[ED]
ultraviolet light, atopic dermatitis, (See also section 14.1.3)
seborrheic dermatitis
Cautions: Coal tar preparations should Indications: Extensive, severe plaque
not be applied to the inflamed, broken or psoriasis not responsive to conventional
430
12. SKIN
therapy erythrodermic psoriasis, or a history of melanoma, and invasive

psoriatic arthritis not responsive to squamous cell carcinoma, children
conventional therapy, lack of response to Side-effects: Nausea, mental effects
phototherapy cutaneous lupus erythema- including insomnia, nervousness, and
tosus, immunobullous dermatoses depression Other effects include
see also section 9.1.3 and 14.1.3 oedema, dizziness, headache,
Cautions:Renal impairment;diabetes vesiculation, bulla formation,
mellitus onycholysis, acneiform eruption, and
Contra-indications:Pregnancy, severe skin pain
lactation,hepatic impairment Dose: It is given both by mouth and
Side-effects: Nausea, vomiting applied topically. To repigment,
megaloblastic anemia, neutropenia, vitiliginous areas, methoxalen is given in
thrombocytopenia, bone marrow a dose of up to 600 microgram per kg
suppression,stomatitis,acute body-weight by mouth 2 to 4 hours
pneumonitis, reactivation of before measured periods of exposure to
TB,teratogenecity UVA twice a week, at least 48 hours
Dose:Baseline laboratory investigations apart. To be applied topically to
before starting methotrexate include a repigment small, well-defined vitiliginous
complete blood cell count (CBC); platelet lesions, preparations containing up to
count; liver function testing; serologic 1% have been used but dilution to 0.1 or
assessment for hepatitis A, B, and C 0.01% may be necessary to avoid
antibodies, renal function assessment; adverse cutaneous effects. The
pregnancy and HIV screening (where surrounding skin should be protected by
indicated), chest X-ray an opaque sunscreen.
Initiation of methotrexate therapy For the treatment of psoriasis a similar
typically involves use of a single 5- to 10- schedule is use to that outlined above for
mg test dose. If the test dose is tolerated vitiligo. A dose of up to about 600
and laboratory studies are satisfactory, microgram per kg by mouth 2 hours
weekly therapy may commence using a before UVA is usually given twice a
typical starting dose of 7.5–10 mg/week, week. It may also be use tropically with
depending on the severity of disease, UVA exposure for the treatment of
overall health, and ideal body weight of psoriasis.
the patient. The dose may be increased
by 2.5–5.0 mg every 4–8 weeks until Proprietary Preparations
adequate control is achieved or toxicity Meladinine(I)(CLS Pharma), Tab. 10mg
ensues. When improvement has Tk.14.14/Tab. Paint 1% Tk. 599.58/24ml
Oxsoralen(I)(ICN), Cap., 0.367g,
stabilized, the dose may be tapered in Tk.25.67/Cap. Lotion, 1% + 1.19%,
2.5-mg decrements to a point at which Tk.909.35/bottle
disease activity increases slightly Vitilen Lotion(Ziska) Lotion 1% Tk. .
398.00/30ml
see section 14.1.3 PIMECROLIMUS
METHOXSALEN Indications: Atopic dermatitis in patients

over 2 years of age
Indications: Idiopathic vitiligo, severe, Cautions: UV lightexposure,
disabling, psoriasis not adequately erythroderma, immunosuppression
responsive to conventional topical Contraindications:known
therapy; selected cases of atopic hypersensitivity to pimecrolimus.
eczema and polymorphic light eruptions Interactions : See Appendix-2
Cautions: Diseases associated with Side-effects:Burning sensation, pruritus,
light sensitivity such as porphyria, liver skin infection ,folliculitis , herpes simplex,
diseases molluscum contagiosum;
Contraindications: Aphakia, melanoma Dose:Apply a thin layer of cream only to
431
12. SKIN
the affected skin areas twice daily, hypothyroidism,hyperlipidaemia, hepatic

or renal dysfunction
Proprietary Preparation Side-effects: Hair loss, dry skin and lips,
Elidel(I) (Novartis), Cream, 10 mg/gm, Tk. hypertriglyceridemia, burning, stinging,
1406.7/15 gm Interactions:See Appendix-2
TACROLIMUS ACITRETIN
Indications:Moderate to severe atopic Indications: See notes above

dermatitis Side-effects:See notes above
Cautions: UV lightexposure Contraindications:See notes above
Contra-indications:Pregnancy and Dose: Initiate at 25–50 mg daily and
breast feeding, known sensitivity to escalate and titrate to response.
tacrolimus
Interactions : See Appendix-2 Proprietary Preparations
Side-effects: Burning, pruritus, allergic Soricap(UniMed), Cap., 10mg, Tk.
reactions, anaphylactoid reaction, 40.00/Cap. ;25mg, Tk.75.00/Cap.
angioedema, anorexia. Soritec(ACI), Cap., 10mg, Tk. 45.14/Cap.;
Dose:Apply a thin layer of ointment to Cap., 25mg, Tk. 85.26/Cap.
the affected skin twice daily. Stop using
when signs and symptoms of atopic SYSTEMIC ISOTRETINOIN
dermatitis resolve.
Indications: See section 12.7 Cautions,
Proprietary Preparations Contraindications & Side-effects:See
Tacrolimus 0.03% notes above
Remus(Square), Oint., 0.03%, Tk. 80.55/m;
0.10%, Tk. 200.61/5gm
Dose: See section 12.7
Tacrol(Acme), Oint., 0.03%, Tk. 80.55/5gm;
0.10%, Tk. 200.61/5gm; 0.03%, Tk. Proprietary Preparations
151.02/10gm See section 12.7
Tacrolim(Incepta), Oint., 0.03%, Tk.
80.00/5gm; 0.01%, Tk. 200.00/5gm
12.7 ACNE AND ROSACEA
Vitilimus(UniMed), Oint., 0.10%, Tk.
1000.00/30g; 0.03%, Tk. 450.00/30g
TOPICAL RETINOIDS
SYSTEMIC RETINOIDS
Indications: Acne, photoaged skin, and
Retinoids are synthetic derivatives of melasma, tazarotene in psoriasis
vitamin A. These include: acitretin, involving less 20% of body surface area,
isotretin, etretinate, tazarotene, bexarotene in cutaneous T-cell
adapalene, bexarotene etc lymphoma
Indications: Psoriasis (severe plaque- Cautions: Pregnancy,who are planning
type, generalized or localized pustular on becoming pregnant should not use
psoriasis), combination therapy in retinoid
psoriasis with UVB or PUVA, or with Contra-indications: Known
cyclosporine or with biologic therapies, hypersensitivity to topical retinoids
Disorders of keratinization e.g., Darier's Side-effects: Erythema, peeling,
disease, pityriasis rubra pilaris, dryness, tightness, and burning
ichthyosis spectrum, keratodermas sensation
Cautions: Care should be taken to avoid Interactions:See Appendix-2
contact with eyes, mucus membranes Note:It should not be applied near the
and open sores eyes, the mouth, paranasal creases of
Contra-indications: Pregnancy or the nose, and mucous membranes
woman who is likely to become
pregnant, nursing mothers,leukopenia, ADAPALENE
432
12. SKIN
Contraindications: Known
Indications: Mild to moderate acne hypersensitivity to benzoyl peroxide or
Cautions, Contra-indications & Side- any components of the preparation
effects: See notes above Interactions: See Appendix-2
Dose: Applied to theaffected areas of Side-effects:Irritant contact dermatitis
skin, once daily at night-time Dose: Apply once daily to affected areas
of face after washing. Treatment is
Proprietary Preparations usually started with 2.5% or 5.0%
Aclene(Drug Intl), Cream, 0.1%,Tk. preparations. The frequency of
60.20/10gm application is then gradually increased
Adgar(ACI), Gel, 0.30%, TK. 80.24/10 gm;
0.1%, TK. 60.18/10 gm
as the initial irritant reaction subsides
Apalene(Incepta), Cream,Tk. 60.00/10 gm
Adapel(Healthcare),Tk. 60.00/10 gm Proprietary Preparations
Fona(Square), Gel, Tk. 160.48/10 gm;Cream, Benzac(Drug Intl), Cream , 4%, Tk. 150.45/15
0.10%, Tk. 60.4/10 gm,; 0.30%, Tk. 80.55/10 gm
gm Brevoxyl(I)(GSK), Cream, 4%, Tk.332.41/40
Pimplex(Biopharma), Cream, 0.1%, Tk. gm
60.00/10 gm Caress(Renata), Cream, 2.5%,Tk.45/15 gm
Oxigel(UniMed), Cream, 5%, Tk. 200/20 gm ;
5%, Tk. 400.00/50 gm; 2.5%, Tk. 150/20 gm
Adapalene 0.1%+ Benzoyl Peroxide 2.5% Clindamycin1% + Benzoyl peroxidel5%:
Acleneplus(Drug Intl), Gel, 0.1%,Tk. Duac(I)(Stiefel), Gel,TK.697.85/25gm
150.00/10gm Benoxiclin(UniMed), Gel, Tk. 350.00/20gm
Acnegel(Acme), Gel, Tk. 160.48/10 gm Clindax(Opsonin), Cream, Tk. 150.00/1gm
Adaben Duo(Incepta), Gel, Tk. 200.00/.20gm Duac(GSK), Gel, Tk. 750.00/30gm
Fona Plus(Square), Gel, Tk. 160.48/10gm
Freshlook Gel(Ziska)Gel, Tk. 160/10g CLINDAMYCIN (Topical)
Nomark(Opsonin), Gel, Tk. 160.00/10 gm
(See also section1.1.12)
AZELAIC ACID Indications:Acne vulgaris characterized
by inflammatory lesions such as papules
Indications:Mild-to-moderate and pustules, erythrasma, rosacea,
inflammatory acne vulgaris, post- periorificial dermatitis, folliculitis
inflammatory hyperpigmentation Cautions:Do not apply to from eyes,
Cautions:Pregnancy, breast feeding; nose, mouth and other mucous
Contra-indications: Known hypersensi- membranes
tivity to azelaic acid Contra-indications:Known
Side effects:Pruritus, burning, stinging, hypersensitivity to clindamycin
erythema, dryness, rash, peeling, Interactions: See Appendix-2.
irritation, dermatitis, and contact Side-effects:Erythema, desquamation,
dermatitis burning sensation, eye irritation,
Dose: Apply a thin film gently but tenderness, dryness, contact dermatitis
thoroughly into the affected areas twice
daily, in the morning and evening for 4 Dose: Apply a thin film to the affected
weeks areas twice daily, in the morning and in
the evening for 6 weeks
Azelec(Acme), Cream, 20%, Tk. 75.51/10gm Proprietary Preparations
Tk. 40.27/5gm Clindamycin Cream2% ,Lotion1%
Clocin(Healthcare), Cream, Tk. 73.00/20 mg
BENZOYL PEROXIDE Clindax(Opsonin),lotionTk. 125.85/25ml,
Cream, , Tk. 70.26/ 20 gm
Daclin(ACI), Lotion, Tk. 125.38/25ml ml
Indications: Mild to moderate acne Clinex(Aristo), Lotion, Tk. 125/25 ml
vulgaris, more effective on non-inflamed Lindamax(Eskayef), Lotion, Tk. 125.00/25ml
lesions ml
Cautions: Open sores or broken skin Clindacin(Incepta), Lotion, Tk.,125.00/25ml ml
433
12. SKIN
Cream, Tk. 70.00/20gm Dose: 0.3 to 0.5 mg/kg/day initially, then

0.5 to 1.0 mg/kg/day, for at least 4-6
Clindamycin 1.2% + Tretinoin0.025%, months. A lag period of 1–3 months may
Cinamycin Plus(Ibn Sina),Gel, Tk.150/15gm
Clinacyn T(Beximco), Gel, Tk.150/15gm
occur before the onset of the therapeutic
Clindacin Plus(Incepta), Gel, Tk.150/15gm effect. A flare-up of disease during the
ClindaxPlus(Opsonin),Cream, Tk. 120.45/ 10 first few weeks of treatment and the
Clinex Plus(Aristo), Gel, Tk. 150.00/15 gm evolution of acne cysts into lesions
Clinface(Square), Gel, Tk. 151.02/15 gm resembling pyogenic granuloma may be
Dalacin Plus(Drug int.), Gel, Tk. 150.45/15 observed
Lindamax Plus(Eskayef),Gel,Tk. 120/15gm
ERYTHROMYCIN (Topical) Isotretinion(I)(Pharmathen), Cap., 10 mg, Tk.
21.66/Cap.; 20 mg, Tk. 34.95/Cap.
Reticap(UniMed), Cap., 10mg, Tk.
Indications: Mild to moderate acne 40.00/Cap. ; 20mg, Tk. 75.00/Cap.
vulgaris, bacterial skin infections Roaccutane(I)(R.P. Scherer), Cap., 10 mg, Tk.
susceptible to erythromycin 96.54/Cap.; 20 mg, Tk. 101.45/Cap.
Contra-indications:Known
hypersensitivity to erythromycin TAZAROTENE
Side-effects: Erythema, desquamation, Indications:Stable plaque psoriasis mild
burning sensation, eye irritation, to moderate acne
tenderness, dryness, oily skin Cautions, Contra-indications& Side-
Dose: Apply to the affected areas twice effects: See notes above.
daily in the morning and evening. Before Dose:For psoriasis:Apply once a day, in
applying thoroughly wash with warm the evening, for at least 8-12 weeks.
water and soap, rinse and pat dry all For acne:apply a thin film gel 0.1%
areas to be treated in the evening onca a day for 6-8 weeks.
Tazarotena 0.10%
A-Mycin(Aristo),Lotion,3%, Tk.
Soritene(Beximco),Cream, Tk. 151/25 gm
Tk.120.00/25ml,; ml
Tazoskin (Incepta), Cream, Tk. 140/20 gm
Eromycin(Square), Lotion, 3%, Lotion, 3%,
Tk.120.37/25ml
MacrocinT(Sanofi), Solu., 20 mg/ml, Tk. TRETINOIN (ALL-TRANS RETINOIC
200.61/100 ml ACID)
ISOTRETINOIN (Topical) Indications: Acne vulgaris in which

comedones, papules and pustules
Indications; Cautions, Side- effects predominate, hyperpigmentation,
and Dose:See under Tretinoin. roughness and fine wrinkling of
photodamaged skin due to chronic sun
Proprietary Preparations exposure
Isotretinion 0.05% Cautions, Contra-indications, Side-
Aknill(Incepta), Gel,Tk. 130.00/10gm effects:See notes above
Isotrex (I)(Stiefel),Gel, Tk. 265.13/10gm
Retigel(Unimed), Gel, Tk. 200/20gm
Dose: Once daily, before retiring, to the
skin where lesions appear, using enough
to cover the entire affected area lightly.
ISOTRETINOIN (Systemic) The therapeutic effects will not usually
be observed until after 6-8 weeks of
Indications:Acne: nodulocystic acne, treatment
recalcitrant acne, especially if there is
any scarring tendency Proprietary Preparations
Cautions, Contraindications, Side- Cosmotrin(Beximco), Cream, 0.025%, Tk.
effects: See section 12.6 under 45.00/10 gm
systemic retinoids Nilac(Square), Gel, 0.03%, Tk. 45.16/10 gm
434
12. SKIN
Retin-A(Sanofi), Cream, 0.5%, Tk. 65/15 gm; 12.8 MISCELLANEOUS SKIN

Tk.100/30g;Tk. 26.40/5 gm
PREPARATIONS
Trena(ACI), Gel, 0.03%, Tk. 45.31/10 gm
Tretinoin(Albion), Cream, 0.025%, Tk. 45/10
gm ALUMINIUM CHLORIDE
HEXAHYDRATE
ORAL ANTIBIOTICS FOR ACNE Indications:Palmoplanter hyperhidrosis
Cautions: For external use only. Do not
Tetracycline:See section 1.1.6.Initially apply to broken, irritated or recently
250–500 mg 1–4 times a day, with shavedd skin. Avoid contact with eyes,
gradual reduction of the dose, depending mouth, nose and lips. Avoid direct
on clinical response contact with clothing and polished metal
Doxycycline: See section 1.1.6. 50–100 or jewellery surfaces
mg once or twice a day, depending on Contraindications: known hyper-
the disease severity. sensitivity to aluminium chloride
Minocycline: See section 1.1.6. 50–100 hexahydrate
mg once or twice a day, depending on Side-effects:Skin irritation: burning,
the severity of disease. stinging, redness, swelling, tingling or
Erythromycin: See section 1.1.5 initial itching of treated skin areas
dose is 250–500 mg 2–4 times a day, Dose:Apply at night after drying the
reduced gradually after control is affected areas carefully. Wash off in the
achieved. morning. Do not re-apply the product
Clindamycin: See section 1.1.5the during the day. Initially the product may
initial dose is 150 mg three times a day, be applied every night until sweating
reduced gradually as control is achieved. stops during the day. The frequency of
application may be reduced to twice a
HORMONAL TREATMENT FOR ACNE week or less, if excess sweating is
stopped during the day.
CO-CYPRINDIOL(a mixture of cyproterone
acetate with ethinyl estradiol) Generic Preparation
solution 20%
Co-cyprindiol Some women with
moderately severe hirsutism acne FINASTERIDE
vulgaris in women,unresponsive to
( See section 5.4.3)
systemic antibiotics
Cautions: Pregnancy,predisposition to
Indications:Male pattern hair loss
thrombosis and as for combined oral
(androgenetic alopecia) in men only.
contraceptives; see also section6.3
Cautions:Hepatic impairment
Contraindications, Side-effects:
Contra-indications:Known hypersen-
See under combined oral
sitivity to finasteride, women and
contraceptives. See section 6.3
paediatric patients
Dose:1 tablet daily for 21 days starting
on day 1 of menstrual cycle and
Side-effects: Decreased libido, erectile
repeated after a 7 day interval, usually
dysfunction, ejaculation disorder and
for several months; withdraw when acne
decreased volume of ejaculate
or hirsutismremits.
Dose: 1 mg once daily. In general, daily
use for three months or more is
necessary before benefit is observed.
Giane (Renata),Tab .cyproterone
Continued use is recommended to
acetate 2mg, ethinylestradiol 35
sustain benefit. Withdrawal of treatment
microgram,Tab.9.50/Tab
leads to reversal of effect within 12
months
See section 5.4.3
435
12. SKIN
of Minoxidil. A dose of 1 ml Minoxidil

L-LYSINE cutaneous solution should be applied to
the total affected areas of the scalp twice
Indications: Treatment and prevention daily. The total dosage should not
of infection in cuts, wounds abrasion, exceed 2 ml. If fingertips are used to
surgical incisions and burns. For the facilitate drug application, hands should
treatment of decubitus or stasis ulcers, be washed afterwards. It should be used
advance chronic wounds, infected twice daily for four months or more
traumatic lesions etc before evidence of hair growth can be
Contraindications: Known hypersen- expected
sitivity to L-lysine
Side-effects: Slight itching sensation Regain(Renata), Solun., 2%, Tk. 500/60ml,;
Dose: Apply as often as required, 5%, Tk. 600/60ml
preferably at an interval of 24, 48, 72 Splendora(Square), Solun., 5%, Tk.
hrs. The affected areas should be 601.81/60ml
cleaned with normal saline and/or Trugain(Ziska), Solun., 2%, Tk. 348.00/60ml,;
surgically if necessary till the wound bed 5%, Tk. 398.00/60ml
looks red/few bleeding points appear in Xenogrow(Incepta), Solun., 5%,Tk.600/60 ml,;
2%, Tk. 500/60 ml
the cleaned wound bed. Then gel should
be applied liberally. The areas may be
covered with a moist dressing and/or a PARAFFIN
bandage
Light Liquid Paraffin + White Soft
Proprietary Preparations Paraffin
Colagel(Incepta),Gel 15%,Tk.80/25g Indications: Prevention & treatment of
Limogel(Beximco), Oint., 15%, Tk. 80/25gm itchy, irritating dry skin conditions,
eczema & psoriasis
MINOXIDIL Cautions: Not to be used in eye
Contraindications:Known
Indications:Androgenetic alopecia in hypersensitivity to paraffin
men and women aged between 18 and Dose: Apply to the affected area and rub
65. in well. It is especially effective after
Cautions:Before using Minoxidil, the washing body areas because the sebum
user should determine that the scalp is content of the stratum corneum may be
normal and healthy. Patients with known depleted after washing resulting in
cardiovascular disease or cardiac excessive moisture loss
arrhythmia should contact a physician
before using Minoxidil. Minoxidil contains Proprietary Preparations
alcohol, which will cause burning and Emolent(Square), Cream,Tk.160.00/25gm
irritation of the eye. In the event of
accidental contact with sensitive PODOPHYLLOTOXIN
surfaces (eye, abraded skin and mucous
membranes) the area should be bathed Indications: Anogenital warts
with large amount of cool tap water Contra-indications: Pregnancy, known
Contraindications:Known hypersen- hypersensitivity to podophyllotoxin
sitivity to minoxidil, pregnancy. Side-effects:Erythema, erosions, and
Side-effects: Hypertrichosis (unwanted tenderness
non-scalp hair including facial hair Dose: Apply with a protective inert
growth in women), local erythema, ointment to surrounding skin and wash
itching, dry skin/scalp flaking, and off 4–6 hours after application.
exacerbation of hair loss have been Treatment is generally at weekly
reported commonly intervals
Dose:Hair and scalp should be
thoroughly dry prior to topical application Proprietary Preparation
436
12. SKIN
Wartix(Incepta), Cream 0.15% conceal warts. Repeat procedure once

or twice daily as needed (until wart/callus
PRIMROSE OIL is removed) for up to 12 weeks
Indications: Atopic dermatitis, Proprietary Preparations

Salicyclic acid
premenstrual syndrome symptoms Acnecare(General), Gel,0.5%,Tk.100.30/10
(PMS), cyclical mastalgia gm
Contraindications:known Kerasol(Incepta), Cream,12%,Tk.
hypersensitivity to primrose oil 110.00/30gm.,6%, Tk. 65.00/30 gm
Side-effects: Diarrhoea, abdominal pain Salidex(Eskayef), Cream, 6%, Tk. 42.00/15
Dose:One or two capsules two to three gm
times daily Salicid(Square), Cream, 12%, Tk. 100/30gm
Salicylic Acid 16.7% + Lactic Acid16.7%,

Salitic (Ziska), Solun, Tk. 250.00/
Eprim (Square),Cap.Tk.5.00/Cap
SALICYLIC ACID[ED] UREA

Indications: Ichthyosis and dry skin
Indications: Chronic atopic dermatitis, conditions, eczemas, psoriasis
lichen simplex, psoriasis, seborrhoeic Cautions:Not to be used in eyes
dermatitis, ichthiosis,warts, corns and Contraindications:Known hypersen-
calluses sitivity to urea
Side-effects:Burning and irritation, if
Salicylic acid + Urea ointment: applied to inflamed, broken or exudative
Debridement and promotion of normal skin eruptions, local irritation and
healing of hyperkeratotic surface lesions, oedema
particularly where healing is retarded by Dose:Wash affected areas well, rinse off
local infection, necrotic tissue, fibrinous all traces of soap, dry, and apply
or purulent debris or eschar. Urea is sparingly twice daily
useful for the treatment of hyperkeratotic Proprietary Preparations
conditions such as dry, rough skin, Urea10%
dermatitis, psoriasis, xerosis, ichthyosis, Aqua Care(Drug Int.) Cream,Tk. 32.02/30 gm
eczema, keratosis pilaris, keratosis Equra(Square),Cream,Tk.32.02/15 gm
palmaris, keratoderma, corns and Eukrim(Beximco), Cream, Tk. 30.00/15 gm
calluses Eudrate(Incepta),Cream,Tk.30.00/15 gm
Cautions:Surrounding skin to be Eucera(Unimed), Cream, Tk. 75.00/30 gm
protected; avoid broken skin; not suitable
for application to face, anogenital region 12.8.1 DISINFECTANTS AND
or large areas. Avoid contact with eyes, CLEANSERS
do not inhale vapors
Contraindications:Diabetes, poor ALCOHOL (70%)
peripheral blood circulation, irritated skin
or any area that is infected or reddened, Indication: Skin preparation before
known hypersensitivity injection
Side-effects:Skin irritation, prolonged Cautions:Fflammable, patients suffering
use may cause salicylism from severe burns. Avoid broken skin
Dose:For viral warts and calluses: Contraindications: broken skin
Wash the affected area, the wart/callus
may be soaked in water for 5 minutes.
Dry thoroughly and apply one drop at a CHLORHEXIDINE GLUCONATE[ED]
time with applicator to sufficiently cover
each wart/callus, then let dry again. Self- Indications :For the disinfection of clean
adhesive cover-up discs may be used to and intact skin. For pre-operative
437
12. SKIN
surgical hand disinfection, hand 130.39/250ml;

disinfection on the ward prior to aseptic
procedures or after handling CHLOROXYLENOL
contaminated materials. For disinfection
of the patients' skin prior to surgery or Indications:For application to the skin
other invasive procedures. for use in cuts, bites, stings, abrasions,
Cautions: External use only. and for use as an antiseptic hand cream.
Dose:ADULT:preoperative surgical hand Contraindications: Allergic skin
disinfection: Dispense 5 ml of solution reactions, dermatitis, eczema or other
and spread thoroughly over both hands skin complaints.
and forearms, rubbing vigorously. When
dry apply a further 5 ml and repeat the Proprietary Preparations
procedure. Antiseptic hand disinfection Dettol(Reckitt), Liquid 4.80%, Tk.40.00/100ml;
on the ward: Dispense 3 ml of solution 2.4% Tk.33.00/50ml, Tk.208.00/75ml
and spread thoroughly over the hands
and wrists rubbing vigorously until dry.
Disinfection of patients skin:prior to CETRIMIDE
surgery apply the solution to a sterile
swab and rub vigorously over the Usually used in combination with other
operation site for a minimum of 2 antiseptics such as chlorhexidine
minutes. Chlorhexidine Gluconate is also Indications: Skin disinfection.
used for preparation of the skin prior to Cautions: Avoid contact with eyes,
invasive procedures such as avoid use in body cavities.
venepuncture. Side-effects: Skin irritation.
Germiso (Square), Hand Rub, 0.5% , Tk.
Cetrimide + Chlorhexidine Gluconate
130.39/200ml; 0.5%, Tk. 40.00/50ml
Handirub (Eskayef), Solu, , Tk.
Decon (Greenland), Solu, Tk. 200.00/1000ml;
100.00/200ml; Tk. 40.00/50ml;
Tk. 30.00/112ml; Tk. 690.00/5000ml; Tk.
Handiwash(General), Solu, 0.5%, Tk.
110.00/500ml; Tk. 22.00/56ml
130.39/200 ml;Tk. 40.00/50 ml; ml Tk.
G-Antiseptic(Gonoshasthaya), Solun.,
130.00/250ml;
Tk.20.00/100 ml
Handscrub (Greenland), Solun., 20%, Tk.
Kevilon(Opsonin), Cream, Tk. 18.80/30 gm
250.00/250ml
Savlon (ACI), Solun, Tk.1745.23/5L Tk.
Hexicor (ACI), Solun., 4%, Tk. 45.14/25ml
185.00/100l; Tk. 712.14/5Litre; Tk.
Hexicord (ACI), Solun., 4% Tk. 30.09/10ml;
125.38/500ml; Tk. 44.00/112ml; Tk.
Tk. 275.83/250ml; Tk. 65.2/50ml
32.00/56ml; Tk. 220.66/1Litre ; Cream, Tk.
Hexiscrub(ACI), Skin Cleanser, 4%, Tk.
100.00/60gm; Tk.
250.00/250 ml Tk. 300.00/250ml
34.10/60gm,Tk.50.00/100gm,Tk. 12.09/15gm ;
Hexitane (ACI), Cream, 1%, Tk. 90.00/60ml
Tk. 25.08/30gm
Kevirub (Opsonin), Solun., Tk. 105.72/250
Welon (Eskayef), Solun, Tk. 145.00/1Litre; ,
ml; Tk. 31.12/50 ml
Tk. 85.00/500ml
Pedicord (Greenland), SolutnTk. 30.00/10ml
Safetisol (Silva), Solun., , 0.5%, Tk. GENTIAN VIOLET[ED]
105.40/300ml
Sanityza (Incepta), Solu., 0.5%, Tk. Indications: Fungal skin infections,
130.00/250ml; Tk. 40.00/50ml e.g., oral candidiasis (oral thrush),
Chlorhexidine Gluconate,
Handirub(Eskayef), Hand Rub ,Tk. 40.00/50
vulvovaginal candidiasis (vaginal thrush),
ml; Tk. 100.00/200 ml superficial bacterial skin infections such
Handisol (Greenland), Solu, Tk. 70.00/100ml; as infected eczema, boils, and chronic
Tk. 130.00/250ml; Tk. 40.00/50ml (long-standing) leg ulcers
Xisol(Aristo), Hand Rub Solution, Tk.30/50ml; Cautions: Avoid contact with eyes,
Tk. 105.00/250 ml avoid use in body cavities.
Hexisol(ACI), Hand Rub,(with dispenser) Tk. Side-effects: Irritation of mucous
140.00/250 ml; 0.50%, Tk. 130.00/250
ml;0.50%, Tk. 40.00/50 ml;Tk. 30/10ml, Tk.
membranes if used at high
215.65/500ml, 196.33/500ml, Tk. concentrations, staining of clothes
438
12. SKIN
directly to the affected area. The site

Proprietary Preparation may be covered with gauze or adhesive
Viola(Hudson), Solun., 2%, Tk.12.00/60ml. bandage
Tk.22.00/100ml ointment:apply ointment directly to the
affected area after being cleaned and
HYDROGEN PEROXIDE dried. May be covered with a dressing or
bandage
Indications: Skin disinfection,
particulate cleansing and deodorizing Proprietary Preparations
wounds and ulcers Apodin (Globe), Oint., 5%, Tk. 15.00/10 gm ;
Cautions: Large or deep wounds, avoid Solu., 10%, Tk.600.00/1L; 10%, Tk.
80.00/100ml
normal skin Arodin ( Aristo), Solu., , 1g/100ml, Tk.
Contra-indications: Deep wounds 35.00/100ml; Oint., 5%, Tk. 22.00/10g; Tk.
40.00/25g; 10%, Tk. 100.00/100ml, Tk.
Proprietary Preparation 500.00/1 Litre;
Caress(Renata),Cream,Tk.43.50/15gm Betadine(Mundipharma), Oint., 5%, Tk.
POVIDONE-IODINE[ED] 75.00/15 gm; Tk. 196.00/125 gm; Surgical
Scrub, 7.5%, Tk. 100.00/50 ml; Tk.165.00/100
ml; Tk. 650.00/500 ml
Indications:Solution:pre-operative and Cleanser(General), Solu., 10%, Tk.
post-operative skin disinfection of 85.00/100ml; Tk. 625.00/1000ml;
surgical sites, as an antiseptic of Povicidal (Drug Intl), Oint.5%Tk. 40.00/25 gm
hydrotherapy equipments, for the Poviclean (Greenland), Solun., 10%, Tk.
treatment of acne vulgaris of the face 100.00/100ml; Tk. 600.00/1000ml
and neck and pyogenic skin conditions, Povid (Acme), Solu, 10%, Tk. 176.66/500ml;
Tk. 341.28/1000ml; Tk. 36.27/100ml
bacterial and myotic skin infections. Povidex (Healthcare), Oint., 5%, Tk.
Ointment:treatment and prevention of 55.00/100 gm; Cream, 6%, Tk. 50.00/10 gm
infections in cuts and abrasions, minor Povidine (Alco), Oint., 5%, Tk. 34.10/15gm
surgical procedures, and other topical Povidon (Eskayef), Solun., 10%, , Tk.
lesion, as an adjunct to systemic 55.00/30ml; 100.00/100ml;; Tk. 700.00/1 Lit. ;
therapy, in the treatment of primary or Oint., 5%, Tk. 40.00/20gm
secondary topical infections, decubitus Povidone (Amico), Cream, 6%, TK.
300.00/125gm; TK. 40.00/10gm; TK.
or stasis ulcer, pyoderms and infected 65.00/20gm; TK. 80.00/25gm; 22.00/5gm
traumatic lesions. Solu., 10%, TK. 3500.00/5Litre; , TK.
Gargle and Mouth-Wash:for infected 55.00/30ml; TK. 700.00/1 Lit.; TK.
inflammatory conditions of the mouth 90.00/100ml;.
and pharynx caused by bacterial Povidon-I (Ziska), Solu, 10%, Tk. 100.00/100
infections and in dental surgery ml
Cautions: Application of povidone iodine Povin (Opsonin), Solun.,, 5%, Tk. 25.09/ 100
ml; Oint., 5%, Tk. 15.10/1gm; Solu.,10%, Tk.
to large wound or severe burns may 700.00/5ml
produce systemic adverse effects such Povisep(Jayson), Surgical Scrub, 7.5%, Tk.
as metabolic acidosis, hypernatraemia, 5,000.00/5 Liter;Solun, 10%, Tk. 100.00/100
pregnancy, breast-feeding and renal ml ; Tk. 700.00/1 Litre; Tk. 3250.00/5 Liter;Tk.
impairment 55.00/30 ml; 5%, Tk. 25.00/20 ml; Tk.
Contraindications:Avoid regular use in 80.00/100 ml;Powder , 5%, Tk. 30.00/10 gm
patient with thyroid disorders or those Provia (Asiatic), Solun., 10%, Tk.
30.00/100ml
receiving lithium therapy and who shows Provia(Asiatic), Solun.,10%, Tk. 30/100 ml
hypersensitivity to iodine .,Solun., 10%, Tk. 110.00/50 ml; Tk. 190/100
Side-effects:Idiosyncratic mucosal ml; Tk. 550/500 ml; Tk. 1000/1 Litre ;5%, Tk.
irritation and hypersensitivity reactions 100/50 ml; Tk. 150/100 ml; Tk. 450/500ml; Tk.
rarely, may interfere with thyroid-function 800.00/1 Litre
tests Topidin (Pacific), Oint., 5%, Tk. 35.00/25gm
Dose:Solution:Apply the full strength as Viodin (Square), Oint., 5%, Tk. 50/25gm;
Solu., 10%, Tk. 25.08/15ml; Tk.
often as required as a paint or wet soak. 100.3/100ml; Tk. 702.11/1L
For minor wounds and infection apply Viodin(Square), Solu.,10%, Tk. 60/100 ml; Tk.
439
12. SKIN
15.00/15 ml; Tk. 341.28/1 Litre ;Oint., 5%Tk. sitivity to any of the sunscreen
40/20 gm components, children under the age of 6
months
ZINC OXIDE Dose:Sunscreen should be applied 15–
30 minutes before sun exposure to allow
Indications:Totreat or prevent skin sufficient time for the protection to
irritations (e.g., burns, bed sore, cuts, develop, and reapplied every 2 hours.
poison ivy, diaper rash). Protects chafed Sunscreen should be reapplied after
skin due to diaper rash and helps seal prolonged swimming or vigorous activity
out wetness leading to sweating. If swimming or
Cautions: For external use only. Avoid perspiring heavily, a water-resistant or
contact with the eyes waterproof product should be used.
Contraindications:Known
hypersensitivity to any component of the
preparation
Side-effects:Usually well-tolerated. Padimate O 8% + Avobenzone 2% +
Extremely low frequency of Oxybenzone 3% + Titanium dioxide 2%
hypersensitivity reaction SolaScren(Incepta) lotion SPF 28, Tk.
Dose: Apply thin layer topically every 8 400.00/60ml
hourly. Change wet and soiled diapers,
promptly cleanse the diaper area, allow AZELAIC ACID
to dry and apply ointment liberally as See section 12.7.
often as necessary, with each diaper
change, especially at bedtime or any
time when exposure to wet diapers may HYDROQUINONE
be prolonged
Indications:Melasma, freckles, senile
Proprietary preparations lentigines and other unwanted areas of
Zinc Oxide 40% melanin hyperpigmentation
De-rash(Square), Oint., Tk. 50.20/25 gm
Happynap (Drug Int.,), Oint., Tk. 90.00/50 gm Fluocinolone acetonide 0.1 mg +
Napguard(Incepta), Oint.,Tk. 50.00/25 gm
Q-Rash(Beximco), Oint., Tk. 50.00/25 gm
Hydroquinone 40 mg + Tretinoin 0.5 mg
Rashguard(Popular), Oint., Tk. 40.15/20 gm Cream:Moderate to severe melasma of
Softi(Eskayef), Oint., Tk. 90.00/50 gm the face, in the presence of measures for
sun avoidance, including the use of
12.8.2 SUNSCREENS, sunscreen
CAMOUFLAGERS, Cautions:Where there is itching or
SHAMPOOS AND OTHER vesicle formation or excessive
SCALP PREPARATIONS inflammatory response, further treatment
is not advised. If no bleaching or
lightening effect is noted after 2 months
SUNSCREENS of treatment, the medication should be
discontinued. Contact with the eyes and
Indications:Photodermatoses including lips should be avoided. Hydroquinone
those caused by radiotherapy, should not be applied to cut or abraded
photosensitisation, solar urticaria, acute skin
solar dermatitis, drug-induced Contraindications:known hypersens-
photosensitivity, acute lupus itivity to hydroquinone
erythematosus, cutaneous albinism, Side-effects:Irritant dermatitis, contact
vitiligo, polymorphic light eruption dermatitis, postinflammatory
Cautions:Application to broken skin pigmentation, and cutaneous
should be avoided. Contact with the ochronosis.
eyes and other mucous membranes Dose:hydroquinone should be applied to
should be avoided. the affected area and rubbed in well
Contraindications:known hypersen-
440
12. SKIN
twice daily. Most discolorations begin to SHAMPOOS AND SOME OTHER

lighten after 4 weeks of treatment but it SCALP PREPARATIONS
may take longer
Hydroquinone 4%, + Octyldimethyl P- Dandruff is a mild form of seborrhoeic
aminobenzoate 8% + Dioxybenzone3%, dermatitis. This can be treated with
+ Oxybenzone: 2% frequent use of a mild detergent
Apply once or twice daily, preferably at shampoo, generally once or twice
night weekly. Shampoos containing
antimicrobial agents such as pyrithion
Hydrosy(Supreme)Cream;Tk. 80/10gm
zinc and selenium sulphide have
Spotclen Plus(Incepta), Cream; Tk. 80/10g beneficial effects. Ketaconazole
Fluocinolone acetonide 0.1 mg + shampoo is most effective.
Hydroquinone 40 mg + Tretinoin 0.5 mg Corticosteriod gels and lotions can also
cream: be used. Shampoos containing coal tar
Apply once daily at night. It should be and salicylic acid are useful. Infants may
applied at least 30 minutes before be treated with olive oil or arachis oil
bedtime. A thin film of the cream should (groundnut oil, peanut oil). Applications
be applied to the hyperpigmented areas must be followed by shampooing,
of melasma including about ½ inch of keratolytic agents e.g. lactic acid,
normal appearing skin surrounding each glycolic acid and salicylic acid are
lesion. Cream is for short-term (up to 8 employed to treat multiple hyperkeratotic
weeks) treatment of moderate to severe and scaling cutaneous eruptions. Lactic
melasma of the face. It is not for long- acid and salicylic acid are applied
term (more than 8 weeks) or topically for the treatment of
maintenance (continuous) treatment of hyperkeratotic skin disorders. Glycolic
melisma acid is used for the treatment of xerosis,
ichthymosis and photo-aging
Proprietary Preparations Ketoconazole 2% shampoo:
Melatrin(Ziska), Cream,Fluocinolone Apply daily for 5 consecutive days. As
Acetonide 0.01%, Hydroquinone 4% ,Tretinoin prophylaxis, apply at least 2-3 times a
0.05% Tk. 200.00/30g week, then monthly (see section1.2.1
Nospot(Eskayef), Cream, Fluocinolone under Ketoconazole)
Acetonide 0.01% , Hydroquinone 4% ,Tretinoin
0.05% Tk. 200.00/30 gm
Spotclen(Incepta),Cream; Hydroquinone 4% Proprietary Preparations
Tk. 50/10g Ketoconazole 2% shampoo
Trimela(Incepta), Cream, Fluocinolone Dancel(Incepta), Shampoo, Tk. 230/100ml
Acetonide 0.01% , Hydroquinone 4% ,Tretinoin Ketocon(Opsonin), Shampoo,Tk.176.19/60ml
0.05% Tk. 200.00/30 gm Ketozol(Aristo), Shampoo , Tk. 175/60ml
Nizoder(UniMed), Shampoo, Tk. 230/100ml
CAMOUFLAGERS Betamethasone(as diproprionate)0.05% +

Salicylic Acid 2%
Disfigurement of the skin can be very Betamesal(Incepta), Scalp Lotion, Tk.
150.00/30ml
distressing to patients and have a very Betamesal(Incepta), Scalp Lotion,Tk.
marked psychological effects. These 150.00/30 ml
preparations can be very effective in Diprosal(Arist), Lotion, Tk. 150.00/30ml
concealing scars and birthmarks. The Ecsota(ACI), Scalp Lotion, Tk. 150.00/30ml
patches in vitiligo are very disfiguring Prosalic(Square), Lotion, Tk. 150.45/25ml
and thus dermablend cover cream, Salison(Globe), Oint., Tk. 70.00/10 gm
dermacolour camouflage cream and Dose:Apply twice daily
kermomask masking powder are of great
cosmetic value.
441
12. SKIN
CLOBETASOL PROPIONATE Side-effects:Burning/stinging, pruritus,

SHAMPOO edema, folliculitis, acne, dry skin, irritant
dermatitis, alopecia, urticaria, skin
Indications:Moderate to severe forms of atrophy, Systemic absorption can cause
scalp psoriasis in subjects 18 years of reversible HPA axis suppression
age and older
Cautions:Treatment should be limited to Dose:Apply into the dry (not wet) scalp
4 consecutive weeks because of the once a day in a thin film to the affected
potential for the drug to suppress the areas only, and leave in place for 15
hypothalamic-pituitary-adrenal axis. The minutes before lathering and rinsing
total dosage should not exceed 50 g per Proprietary Preparations
week; breast feeding Dermasol(Square), Scalp Solution, 0.05%, Tk.
Contraindications:Pregnancy, children 200.61/25ml
younger than 18 years of age
Dermovate(GSK), Scalp Lotion, 0.05%, Tk.
250.00/30ml
Nyclobate(Incepta), Scalp Application, 0.5%,
Tk. 200/30ml; Shampoo, 0.5%, Tk. 350/60ml
442
13. IMMUNOLOGICAL PRODUCTS AND VACCINES
Chapter 13
IMMUNOLOGICAL PRODUCTS
AND VACCINES
13.1 Immunity, immunization schedule and storage p. 443
13.1.1 Active and passive immunity p.443
13.1.2 Storage and use p. 445
13.1.3 EPI and immunization schedule p.446
13.2 Vaccines and antisera p.447
13.3 Immunoglobulins p. 460
13.4 International travel p. 462
13. IMMUNOLOGICAL disease. Some vaccines may produce

PRODUCTS discomfort at the site of injection and
AND VACCINES mild fever and malaise. Vaccines that
have been incorporated into national
Vaccination’ and ‘immunization’ are the immunization systems have been well
two terms that are now-a-days being studied and are relatively safe. Although
used almost synonymously. But uncommon there can serious untoward
vaccination denotes only the reactions related or unrelated to the
administration of a vaccine, whereas, vaccine and these should always be
immunization means the result of reported to the proper health authority.
vaccination which resulted in providing Anaphylactic reactions are very rare but
immunity which is mostly used to can be fatal. For full details of side-
indicate active but may also related to effects, the product literature should
passive treatment modules. always be consulted.
Caution: Most of the vaccines are safe
to receive. However, vaccination may be
13.1 IMMUNITY, IMMUNIZATION
postponed if the individual is suffering
SCHEDULE AND STORAGE
from an acute illness. It is not necessary
to postpone immunisation inpatients with
13.1.1 ACTIVE AND PASSIVE minor illnesses without fever or systemic
IMMUNITY upset. If alcohol or disinfectant is used
for cleansing the skin it should be
ACTIVE IMMUNITY allowed to evaporate before vaccination
Vaccines may consist of: to prevent possible inactivation of live
i) a live attenuated form of vaccines.
a virus (e.g. measles vaccine) or When 2 or more vaccines are required,
bacteria (e.g. BCG vaccine); they should be given simultaneously at
ii) Inactivated preparations of different sites, preferably in a different
the virus (e.g. influenza vaccine) or limb; if more than one injection is to be
bacteria (e.g. Pertussis, VI Typhoid given in the same limb, they should be
vaccine) or administered at least 2.5 cm apart (also
iii) extracts of or detoxified exotoxins see under BCG Vaccines). When 2 live
produced by a micro-organism (e.g. vaccines cannot be given at the same
tetanus vaccine, diphtheria vaccine). time, they should be separated by an
Side-effects: some vaccines e.g. interval of at least 4 weeks.
poliomyelitis produce very few reactions If Post-immunisation pyrexia develops
like VAPP or VDPV, while others e.g. after childhood immunisation, and the
measles may produce very mild form of infant seems distressed, a dose of
443
paracetamol (infant aged 2–3 months, contraindications. A definite severe

the dose of paracetamol is 60 mg) can reaction to a preceding dose is a
be given and, if necessary, a second contraindication to further doses.
dose can be given 4–6 hours later. Some viral vaccines contain small
Ibuprofen (50 mg for 2-3 months aged quantities of antibiotics such as
infants or as per physician’s advice) can neomycin or polymyxin (or both); such
be used if paracetamol is not suitable, vaccines may need to be withheld from
but if a second dose of ibuprofen is individuals who are extremely sensitive
required, it is given 6 hours after the first to these antibiotics. Hypersensitivity to
dose. The parent should be warned to egg contra-indicates influenza vaccine
seek medical advice if the pyrexia (residual egg protein present) and, if
persists. evidence of previous anaphylactic
Predisposition to neurological reactions, also contraindicates
problems immunization with yellow fever vaccine.
In children who have had a seizure Live vaccines should not be routinely
associated with fever without administered to pregnant women
neurological deterioration, immunisation because of possible harm to the fetus
is recommended; advice on the but where there is a significant risk of
management of fever (see above) exposure (e.g. to poliomyelitis or yellow
should be given before immunisation. fever), the need for vaccination
When a child has had a convulsion not outweighs any possible risk to the fetus.
associated with fever, and the Vaccination is usually not given in the
neurological condition is not first trimester of pregnancy. In case of
deteriorating, immunisation is Rubella vaccines, it is recommended not
recommended. Children with stable to conceive within one month of
neurological disorders (e.g. spina bifida, vaccination.
congenital brain abnormality, and Live vaccines should not be given to
perinatal hypoxic-ischaemic individuals with impaired immune
encephalopathy) should be immunised responses whether caused by disease
according to the recommended (e.g., HIV) or as a result of radiotherapy
schedule. When there is a still evolving or other immunosuppresive drugs or
neurological problem, including poorly immunodeficiency due to genetic
controlled epilepsy, immunization should anomalies. These should not be given to
be deferred and the child referred to a those suffering from malignant
specialist. Immunisation is conditions such as leukaemia and
recommended if a cause for the tumors of the reticuloendothelial system.
neurological disorder is identified. If a The intramuscular route should not be
cause is not identified, immunisation used in patients with bleeding disorders
should be deferred until the condition is such as haemophilia or
stable. thrombocytopenia.
See also Cautions under individual VACCINES and HIV INFECTION. HIV-
vaccines positive subjects with or without
For individuals with bleeding symptoms can receive the following live
disorders, see under administration vaccines:
of vaccines, below. Measles, BCG, MMR (but not while
Contra-indications: Most vaccines severely immunosuppressed), Rubella;
have some basic contraindications to And the following inactivated vaccines:
their use, and the product literature DPT, HIB, Hepatitis A, Hepatitis B,
should always be consulted. In general, Inactivated Polio, Meningococcal,
vaccination should be postponed if the Rabies, Tetanus & Typhoid.
subject is suffering from an acute illness HIV positive subjects should not be
or if there is a known case of immunized with live vaccines such as
immunodeficiency. Minor infections BCG and yellow fever vaccines. HIV
without fever or systemic upset are not infected individuals, including children,
444
who are receiving anti-retroviral therapy PASSIVE IMMUNITY

(ART), are clinically well and
immunologically stable should be Immunity with immediate protection
vaccinated. Neonates born to women of against certain infective organisms can
unknown HIV status should be be obtained by injecting preparations
vaccinated. made from the plasma of immune
Note: Live vaccines should be individuals with adequate levels of
postponed until at least 3 months after antibody to the disease for which
stopping corticosteroids and 6 months protection is sought. (See under
after stopping chemotherapy. immunoglobulins, section13.3). Passive
False contra-indications: It is important immunity lasts only for a few weeks.
to remember that immunization should Where necessary, passive immunization
not be postponed due to conditions can be repeated. Antibodies of human
wrongly considered to be origin are usually termed
contraindications for immunization. It is immunoglobulins. The term antiserum
particularly important to immunize is applied to material prepared in
children suffering from malnutrition. Low animals. Because of serum sickness and
grade fever, mild respiratory infections other allergic-type reactions that may
and other minor illness should not be follow injections of antisera, this therapy
considered as contraindication. has been replaced wherever possible by
Diarrhoea should not be considered a the use of immunoglobulins. Reactions
contraindication to oral poliomyelitis are theoretically possible after injection
vaccine (OPV). Table below shows the of human immunoglobulins but reports of
conditions which are NOT such reactions are very rare.
contraindications to immunization.
13.1.2. STORAGE AND USE
Table 13. A: Conditions which are
NOT contraindications to
immunization Care must be taken to store all vaccines
and other immunological products under
*Minor illness such as upper the conditions recommended in the
respiratory infections or diarrhoea product literature, otherwise the
preparation may become denaturated
with fever < 38.5C
and totally ineffective. Refrigerated
*Allergy, asthma, or other atopic
storage is usually necessary; many
manifestations, hay fever or
vaccines need to be stored at 2-8C and
“snuffles”
are not allowed to freeze. Vaccines
*Pre-maturity, small-for-date infants
should be protected from light. Opened
*Malnutrition
multi-dose vials that have not been fully
*Child being breast-fed used should be disposed of within six
*Family history of convulsions hours or at the end of the session
*Treatment with antibiotics, low-dose whichever come first if no preservative is
corticosteroids or locally acting (e.g. present. When vaccines containing a
topical or inhaled) steroids preservative WHO multi dose vial policy
*Dermatoses, eczema or localized will be used.
skin infection Particular attention must be paid to the
*Chronic diseases of the heart, lung, instructions on the use of diluents and
kidney and liver ampoules of vaccine should always be
*Stable neurological conditions, such adequately shaken before use to ensure
as cerebral palsy, spinabifida and uniformity of the material to be injected.
Down’s syndrome Administration of Vaccines: Vaccines
*History of jaundice after birth containing aluminum adjuvants (DPT,
DT, Hepatitis B vaccine) should be
injected intramuscularly. The preferred
445
site for intramuscular injection in infants 14 weeks

Hib penta, PCV, OPV and
and young children is the anterolateral ID IPV
aspect of the upper thigh since it 9 months MR
provides the largest muscular mass. In
15 months
older children the deltoid has achieved to 18 MR
sufficient size to offer a convenient site months
for intramuscular injection. Similarly in
adult women, the deltoid is From early 2014, Bangladesh has
recommended for routine intramuscular conducted vaccination of children 9
administration of TT. Passive immunity is month to below 15 years aged target
also obtained through fetal transfer of population for MR vaccination.
antibodies from vaccinated mothers (e;g *WHO recommends that a child be given
with TT vaccine or other vaccines) or via OPV dose soon after birth
breast milk to infants.
Note: The buttock should not be used Table 13C: TT immunization schedule
routinely as an immunization site for for child bearing age women
infants, children, or adults because of
the risk of injury to the sciatic nerve. Dose When to give Duration
Since the depth of gluteal fat in adult of
women is usually more than 3.5 cm, protection
which is typically the length of the TT-1 15 years completed None
injecting needle, injecting vaccines into TT-2 At least 4 weeks 3 years
the buttock may result in poor absorption After TT-1
of the vaccine from fatty tissues. TT-3 At least 6 months 5 years
after TT-2
If alcohol or other disinfecting agent
TT-4 At least 1 year after 10 years
is used to wipe the injection site, it must TT-3
be allowed to evaporate, otherwise
inactivation of a live vaccine may occur. TT-5 At least 1 year after Up to
TT-4 reproductiv
13.1.3 EPI & IMMUNIZATION e period
SCHEDULE
Note. Minimum time interval between
(For immunization schedule see also
doses must be maintained but no
Appendix-8a, 8b & 8c)
maximum limit is to be considered.
EPI IN BANGLADESH Booster doses of EPI in Bangladesh:
In Bangladesh, the EPI has not yet
In Bangladesh EPI was formally addressed the issue of booster doses of
launched on 7th April 1979 and the EPI vaccines. The first priority is to
targeted diseases were Tuberculosis, ensure that infants are completely
Diphtheria, Whooping cough, Tetanus, immunized against target diseases at the
Poliomyelitis and Measles. The country youngest age possible. Global
adopted the goal of ‘Universal Child immunization policy suggests that where
Immunization’ (UCI) in 1985 resources are limited, booster doses
should not be considered until coverage
Table 13B: Bangladesh EPI levels for fully immunized infants are
Immunization Schedule for children. above 80%.
Bangladesh introduced HepB vaccine in
AGE Vaccine the year 2003 in a phase wise manner.
During 1st phase seven districts and one
Birth BCG and OPV* City Corporation, during 2nd phase 25
Hib penta, PCV. ID IPV and districts and 5City Corporation and
6 weeks during last phase national wide
OPV
replication by including 32 districts.
10 weeks Hib penta, PCV and OPV
Now this vaccine is a component of Hib
446
penta vaccine (DPT, HepB and vaccines prepared from the toxin of
Hib) become part of national EPI Corynebacterium diphtheriae. These are
vaccination program. All cost of the more effective and cause fewer
vaccine was covered by Gavi during reactions if adsorbed onto a mineral
phasing but now Bangladesh uses this carrier. Adsorbed diphtheria vaccines
vaccine for maintaining co financing are recommended for the routine
policy developed by Gavi where modest immunization of babies and are usually
amount payment to UNICEF for Hib given in the form of a triple vaccine,
penta vaccine since 2009. Adsorbed Diphtheria, Tetanus, and
Pertussis vaccine. Recently, another
13.2 VACCINES AND ANTISERA tetravalent vaccine Adsorbed
Diphtheria, Tetanus pertussis and
Hepatitis B has been made available.
BCG (Bacillus Calmette-Guerin)
VACCINE[ED]
a) Diphtheria vaccines with pertussis and
tetanus (triple vaccine) :
BCG vaccine is a dried vaccine prepared
from a live attenuated strain known as
ADSORBED DIPHTHERIA,
the Bacillus Calmette-Guerin strain,
PERTUSSIS AND TETANUS VACCINE
which is derived from Mycobacterium
(DPT VACCINE) OR
bovis. It contains an amount of viable
DIPHTHERIA-PERTUSSIS-TETANUS
bacteria such that inoculation, in the
COMBINED VACCINE[ED]
recommended dose, of tuberculin
negative persons results in an
acceptable tuberculin conversion rate Indications: Protection against
Indication: Prevention or primary TB Diphtheria, Pertusis and Tetanus
infection, especially with severe Contraindications: personal history of
manifestation (miliary TB and TB epilepsy
meningitis) Side-effects: Transient rise in
Special Caution: Children born to HIV temperature, restlessness, irritability,
seropositive mother crying or loss of appetite may sometimes
Contraindications: Congenital or occur a few hours after vaccination.
acquired immunosuppression affecting These usually do not call for treatment.
cellular immunity. BCG is also Rarely anaphylaxis may occur.
contraindicated in subjects with Convulsion, infantile spasms and
generalized septic skin conditions (in the encephalopathy have been reported as
case of eczema, a vaccination site free rare complication, which are actually due
from lesions should be chosen) to the pertussis component
Side-effects: Adenitis, lymph node Dose: Primary immunization of children,
suppuration 0.5 ml by intramuscular injection at 6
Dose: ADULT and CHILD  1 year, weeks followed by second dose after 4
0.1ml; < 1 year 0.05 ml weeks and third dose after another 4
Route of Administration: by weeks (see Appendix-8a)
intradermal injection.
Proprietary Preparation DPT Vaccine is available from EPI
BCG vaccine is available in EPI only centers only. From 2009 this vaccine is
BCG Medac(I)(Medac),Inj.,Tk.8620.80 in combination with Hepatitis B and Hib
as Hib penta form and using 3 doses in
Bangladesh for infant age 6 weeks, 10
DIPHTHERIA VACCINES[ED] weeks and 14 weeks.
b) Diptheria vaccines with pertusis,
Protection against diphtheria is tetanus and Hepatitis B:
essentially due to antitoxin, the
production of which is stimulated by
447
Children who have experienced an

DPT VACCINE WITH HEPATITIS B encephalopathy of unknown aetiology
after a previous vaccination with vaccine
Prepared from diptheria and tetanus containing pertussis should not be
toxoids, inactivated pertusis bacteria and vaccinated. In these circumstances, the
purified HBsAg. The vaccine is vaccination course should be continued
presented as a liquid suspension. with diphtheria, tetanus, hepatitis B, and
Indications: Protection against Hib vaccines. As with other vaccines,
Diphtheria, Pertusis, Tetanus and vaccination should be postponed in
Hepatitis B of infants from 6 weeks children suffering from acute febrile
onwards illness.
Contra-indications: as with DPT triple Side-effects: Diarrhoea, vomiting, fever,
vaccines. It should not be administered injection site reactions (erythema,
intradermally which may result in induration, pain), feeding disorders,
reduced immune response sleepiness, irritability and rash.
Side-effects: as with DPT triple Dose: Primary immunization of children,
vaccines 0.5 ml by intramuscular injection at 6
Dose: primary immunization of children, weeks followed by second dose after 4
0.5 ml by intramuscular injection at 6 weeks and third dose after another 4
weeks followed by second dose after 4 weeks. Reinforcing vaccination of
weeks and third dose after another 4 toddlers (13–24 months after birth): one
weeks. booster dose of 0.5 ml.
Route of Administration: By Route of Administration: By
Intramuscular injection at upper outer Intramuscular injection at upper outer
quadrant of thigh quadrant of thigh or alternatively in the
deltoid region in children 13–24 months
Proprietary Preparation after birth.
Not available in the market.
Generic Preparation
Intra-muscular injection, 0.5ml/vial.
DPT VACCINE WITH HEPATITIS B
AND HAEMOPHILUS INFLUENZA
TYPE B HAEMOPHILUS INFLUENZA TYPE B
POLYSACCHARIDE, CONJUGATE TO
TETANUS PROTEIN
Prepared from diphtheria and tetanus
toxoids, Bordetella pertussis inactivated
cellular suspension, hepatitis B surface Produced from vaccine of purified
antigen (HBsAg), and Haemophilus polyribosyl ribitol phosphate capsular
influenza type b conjugated polysaccharide (PRP) of Hib, covalently
oligosaccharide. The vaccine is bound to tetanus toxoid.
presented as a liquid suspension. Contra-indications: known hypersen-
Indications: Protection against sitivity to any component of the vaccine,
Diphtheria, Pertusis, Tetanus, Hepatitis or having shown signs of hypersensitivity
B and invasive illness caused by H. after a previous dose of this vaccine or
influenza type b. of infants from 6 weeks any injection containing Haemophilus
onwards Influenza type B.
Contraindications: Should not be Indication: Active immunisation against
administered to children with known Haemophilus influenza type b infection in
hypersensitivity to any vaccine children aged from 2 months to 5 years.
component or to children having shown Dose: One dose each at 2, 4, and 6
signs of hypersensitivity after previous months of age. The first dose may be
administration of diphtheria, tetanus, given as early as 6 weeks of age. One
pertussis, hepatitis B, or Hib vaccines. booster dose given at 15through 18
months of age.
448
Proprietary Preparation TETRAct-HIB(I) (Sanofi Pasteur):Suspension

ActHIB(I)(Sanofi Pasteur):0.5ml solutions for for injection intramuscular or subcutaneous
intramuscular injection. route.
TETRAct-HIB has been discontinued in
This standalone Hib vaccine (ActHIB) is Bangladesh. With the introduction of
not marketed anymore. But this HIB hexavalent vaccine (HEXAXIM) all these
antigen is available in combination with antigens of above four diseases are
other antigens like diphtheria, tetanus, found along with antigens of polio and
acellular pertussis, inactivated polio and hepatitis b.
hepatitis b in HEXAXIM.
DIPHTHERIA VACCINE WITH
TETANUS
DPT VACCINE WITH HAEMOPHILUS
INFLUENZA TYPE B ADSORBED DIPHTHERIA AND
TETANUS VACCINE (DT VACCINE)
Prepared from Diphtheria and tetanus
toxoids, inactivated whole cell Bordetella Prepared from diphtheria formal toxoid
pertussis and Haemophilus influenza and tetanus formal toxoid adsorbed on a
type b polysaccharide conjugated with mineral carrier.
tetanus protein. The vaccine is Contraindications: Should not be
presented as a liquid suspension. administered intradermally
Indications: Protection against Side-effects:See general discussion
Diphtheria, Pertussis, Tetanus and Dose :Primary immunization of children
invasive illness caused by H. influenzae omitting pertussis component, 0.5 ml by
type b. of infants from 6 weeks onwards. intramuscular injection at 2 months,
Booster dose is given 1 year after the followed by second dose after 4 weeks
3rd injection of the primary vaccination. and third dose after another 4 weeks.
Reinforcement at school entry, 0.5 ml
Contraindications: Neurological
disease, strong reaction occurring within
TYPHOID VACCINE
48 hours following a previous
vaccination: fever≥ 40°C, persistent
crying syndrome, febrile or non-febrile Typhoid fever is a very common disease
convulsion, hypotonus – hypo reactivity in our country that affects adults and
syndrome, hypersensitivity appearing children alike. Due to poor nutritional
after a previous vaccination against status, and lowered body immunity,
diphtheria, tetanus and pertussis and majority of our children are especially
known allergy to any of the ingredients of prone to suffer from the complications of
the vaccine. typhoid fever (e.g., gastro-intestinal
Side-effects: same as above. haemorrhage, intestinal perforation,
Dose: Primary immunization of children, bronchitis, septicaemia, cholecystitis,
0.5 ml by intramuscular injection at 6 orchitis, meningitis etc.) resulting in an
weeks followed by second dose after 4 overall child morbidity and mortality
weeks and third dose after another 4 rates. So use of typhoid vaccine may be
weeks. Reinforcing vaccination of encouraged in our country.
toddlers (13–24 months after birth): one
booster dose of 0.5 mL. POLYSACCHARIDE TYPHOID
Route of Administration: Antero-lateral VACCINE
region of the thigh (middle third) by
intramuscular or subcutaneous route. This new type of vaccine contains the
fraction of capsular polysaccharide of Vi
Proprietary Preparation antigen of Salmonella typhi. It is given by
intramuscular or deep subcutaneous
449
injection; further doses are needed every 3 injections at 1-2 months apart
2 to 3 years. followed by a booster 12 months
Indications: Active immunisation after 3rd dose.
against typhoid fever for adults and • If not vaccinated before 6 months:
children older than two years of age. a) 6-12 months: 2 injections 1-2
Contraindication: Intravascular months apart followed by a booster
administration may cause anaphylactic 12 months after last injection.
reaction, Known allergy to any b) 1- 5 years: Only one single
ingredients of the vaccine injection.
Special Caution: has not been Now this vaccine is a component of Hib
evaluated in children under 2 years of penta vaccine become part of national
age. Postpone vaccination in subjects EPI vaccination program.
suffering from acute febrile illness. Consult product literature
Dosage and administration: A single
dose of 0.5 ml containing 25 g of the Vi Route of administration: intramuscular
polysaccharide of Salmonella typhiis
recommended for both children and Proprietary Preparations
adults. Subjects who remain at risk of Combined Vaccine
typhoid fever should be revaccinated Diphtheria, Tetanus, Pertussis (Acellular,
using a single dose of vaccine every 2 to Component), Poliomyelitis (Inactivated)
3 years. and Haemophilus Type b Conjugate
Consult product literature Vaccine,hepatites B
This vaccine is not incorporated in EPI Indication: This vaccine is indicated in
program. the joint prevention of invasive infections
Side-effects: See notes above caused by Haemophilus influenzae type
Storage: store between 2 to 8C(in a b (meningitis, septicaemia, cellulitis,
refrigerator). Do not freeze arthritis, epiglottitis, etc), diphtheria,
tetanus, pertussis and poliomyelitis.
Proprietary Preparations Contraindication: Hypersensitivity to
Typhim VI(I)(Sanofi),Inj.,(P.F any of the active substances of the
Syringe)Tk.707.4/syringe vaccine; febrile or acute disease;
Vaxphoid(Incepta);Inj. Tk 300.00/vial
evolving encephalopathy.
Dose:3 doses of vaccine are given in 1-
HAEMOPHILUS INFLUENZAE TYPE B or 2-month interval from 2 months of age
VACCINE by IM route followed by a booster
injection during the 2nd year of life.
Indications: prevention of infants from 2
months of age against invasive Proprietary Preparations
infections caused by H. influenzae type b Diphtheria, Tetanus, Pertussis (Acellular,
(meningitis, septicaemia, cellulitis etc.). It Component), Poliomyelitis (Inactivated)
does not provide protection against Haemophilus Influenzae Type b Conjugate
and Hepatitis B
infections due to other types of H. HEXAXIM(I)(Sanofi Pasteur)Inj.
influenzae nor against meningitis caused (P.Fsyringe))0.5ml Tk 3510/syringe
by other microorganisms. Infanrix - Hexa(I) (Glaxo) Inj. (P.F syringe)
Contra-indications: known allergy to 0.5ml Tk 3300.00/syringe
one of the ingredients of the vaccine,
particularly tetanus protein or allergy INACTIVATED INFLUEANZAE
appearing after a previous injection of VACCINE
conjugate H. influenzae type b vaccine.
The influenza vaccination is an annual
Dose : vaccination using a vaccine specific for a
•Infants between 2-6 months: given year to protect against the highly
variable influenza virus. Each seasonal
influenza vaccine contains antigens
450
representing three (trivalent vaccine) or C, although group Y is gaining

four (quadrivalent vaccine) influenza importance. In recent years, also group
virus strains: one influenza type A W135 meningococci have caused an
subtype H1N1 virus strain, one influenza outbreak in the “African meningitis belt”
type A subtype H3N2 virus strain, and as well as in Saudi Arabia. Current
either one or two influenza type B virus internationally marketed meningococcal
strains. Influenza vaccines may be vaccines are either bivalent (groups A
administered as an injection, also known and C) or tetravalent (groups A, C, Y and
as a flu shot, or as a nasal spray. W135). The vaccines are purified, heat-
Indications: Prophylaxis of influenza, stable, lyophilized capsular polysaccha-
especially in those who run an increased rides from meningococci of the respec-
risk of associated complications. It is tive serogroups. These vaccines are
indicated in adults and children from 6 very safe, and significant systemic
months of age. reactions have been extremely rare.
Dose: Travellers to areas affected by meningo-
Trivalent Influenza Vaccine coccal outbreaks are advised to be
Adults: 0.5 ml trivalent influenza vaccine. vaccinated. For pilgrims to the Hajj and
Pediatric population: Children from 36 Ramadan Omrah, Saudi Arabia
months onwards: 0.5 ml trivalent requires visitors obtain a tetravalent
influenza vaccine. Children from 6 vaccine (A, C, Y and W135) at least ten
months to 35 months: Dosages of 0.25 days prior to their arrival in the country.
ml trivalent influenza vaccine.
Quadrivalent Influenza Vaccine MENINGOCOCCAL A, C, W, Y
Adults: 0.5 ml quadrivalent influenza VACCINE
vaccine. Pediatric population: Children
from 6 months onwards: 0.5 ml Indications: indicated for the active
quadrivalent influenza vaccine. immunisation of children from 2 years of
Contra-indications: Hypersensitivity to age, adolescents and adults against
the active substances, to any of the meningococcal disease caused by
excipients, to egg, to chicken protein, meningococci of serogroups A, C, W-
formaldehyde, gentamicin sulphate or 135 and Y. The vaccine is particularly
sodium deoxycholate. recommended for subjects at risk, for
Side effects: The most common local example those living in or visiting areas
adverse reactions and general adverse where the disease is epidemic or highly
events were pain and redness at the endemic. It is also recommended for
injection site, muscle aches, fatigue, and subjects living in closed communities
headache. and close contacts of patients with
disease caused by meningococci of
serogroups A, C, W-135 and Y.
Influvax(Incepta) Inj., 0.5mi/vialTk. 700.00/vial
Vaxigrip Enfant(I)( Sanofi Pasteur) Inj., Caution: Seroconversion rate of
(P.Fsyringe) Tk593.41/syringe Children below 2 years is lower for the
Vaxigrip(I) (Sanofi Pasteur), Inj. P.Fsyringe) serogroup C and to a lesser extent for A,
Tk. 750/ syringe. W135 and Y. However, seroconversion for
Vaxigriptetra(I) (Sanofi Pasteur) QuadriValent the serogroup A is acceptable in children
Influenza Vaccine (Split-virion, inactivated), 0.5 from age 6months onward.
ml PFS Tk1125/ syringe.
Side-effects: Erythema, slight induration
and tenderness hyperthermia and mild
MENINGOCOCCAL VACCINE erythema at the site of injection.
This vaccine is not incorporated in EPI
Meningococcal Meningitis and septicae- program as yet.
mia are caused by various serogroups of
Neisseria meningitidis. Endemic disease Proprietary Preparation
occurs worldwide and is mostly caused Ingovax(Incept)Inj.0.5ml, Tk.600/vial, Tk.
by meningococci of serogroups A, B, or 1000.00/Vial
451
preferably into deltoid region or higher

ADULT and CHILD over 1 year 0.5mL as a anterolateral thigh, ADULT and CHILD
singledose; CHILD 3 months–1 year 2 doses over 9 years, 3 doses of 0.5 mL, the
of 0.5mL separated by an interval of 1 month
Meningococcal A, C, Y and W 135 conjugate
second 2 months and the third 6 months
vaccine after the first dose
Menactra(I) (Sanofi), 0.5 ml, /doseTk.
3803.94/vial Cervarix(I)(GSK),suspension of virus-like
particles of human papillomavirus type
HUMANPAPILLOMAVIRUS VACCINES 16 (40 micrograms /mL), type 18 (40
micrograms/ mL) Prefilled syringe 0.5ml
Tk. 2100/ 0.5ml
Human papillomavirus vaccine is used
Dose: prevention of premalignant genital
in females for the prevention of cervical
lisions and cervical cancer, by
cancer and other pre-cancerous lesions
intramuscular injection into deltoid
caused by human papillomavirus. This
region, for females aged 9 dose of
vaccine is available as a bivalent vaccine
vaccine is recommended at 0, 6 months
or quadrivalent. Quadrivalent is licensed
schedule. For women aged 15 years
for use in females for the prevention of
above, 3 dose of vaccine is
cervical cancer, genital warts and pre-
recommended at 0, 1, & 6 months
cancerous lesions caused by human
schedule.
papillomavirus types 6, 11, 16, and 18.
Bivalent vaccineis licensed for use in
females for the prevention of cervical POLIOMYELITIS VACCINES[ED]
cancer and other pre-cancerous lesions
caused by human papillomavirus types There are 2 types of vaccines against
16 and 18. poliomyelitis : poliomyelitis vaccine, live
The vaccines may also provide limited (oral) (Sabin) and poliomyelitis vaccine,
protection against disease caused by inactivated (injectable) (Salk).
other types of human papillomavirus. Oral poliomyelitis vaccine (OPV) is
The two vaccines are not composed of the three types of
interchangeable and one vaccine attenuated strains of poliovirus types 1,
product should be used for an entire 2, and 3. Because of its low cost, ease
course. of administration, superiority in
Human papillomavirus vaccine will be conferring intestinal immunity, and the
most effective if given before sexual potential to infect household contacts
activity starts. Consult product literature. secondarily, it is used in the EPI, as the
vaccine of choice for eradication of
poliomyelitis.
HUMANPAPILLOMAVIRUS VACCINES
Dose: 2-3 drops (as guided by the
manufacturer) from a multi-dose
Indications: See notes above container constitute a single dose.
Cautions:See section 13.1.1 Usually 3 such doses are given at
Contraindications: See section 13.1.1 intervals of 4 weeks on 3 occasions at
Side-effects:See section 13.1.1 the same time as routine immunization
Dose: under the preparation against diphtheria, tetanus and
pertussis. Note:EPI is now follow multi
Gardasil(I) (MSD),suspension of virus-like
dose vial policy for IPV vial and the
particles of human papillomavirus vaccine can be used up to 28 days after
type,6(40micrograms/mL), type 11(80 opening the vial following certain
micrograms/mL), type 16 (80 conditions. The IPV vaccine is supported
micrograms/mL),type 18 (40 by Gavi and exempted from Gavi co
micrograms/mL).0.5ml vial,Tk.4254.15/vial financing policy due to global unique
Dose: prevention of premalignant genital need of polio eradication...
lesions, cervical cancer and genital Contra-indications: See general
warts, by intramuscular injection discussion. The efficacy of the vaccine
452
may be impaired if given in subjects much less frequently associated with

having diarrhoea or vomiting. measles vaccines than with other
Side-effects: vaccine related paralysis conditions leading to febrile episodes.
might occur on very rare occasions. Contraindications:See general
discussion
Oral polio vaccine is available from EPI Proprietary Preparations
centers only. The SEAR countries Measles containing vaccine measles and
including Bangladesh certified as polio rubella (MR) available in EPI centers
free from March 2014, as per WHO only.
recommendation to eradicating polio Rubavax(Incept)Inj.,0.5mi/vial
from the world all OPV using countries Tk.400/vial
like Bangladesh need to incorporate at
least one dose of IPV in routine EPI MEASLES, MUMPS AND RUBELLA
during DPT3 contact. Bangladesh (MMR) VACCINE
decided to incorporate one dose of IPV
with OPV3/Hibpenta3 dose from the A combined measles/mumps/rubella
month of October 2014. From March (MMR) vaccine aims to eliminate rubella
2015 Bangladesh introduced IPV with (and congenital rubella syndrome),
Hib penta 3rd dose. But due to the global measles, and mumps. Ideally, every
shortage of IPV vaccine as per SAGE child should receive two doses of MMR
recommendation from November 2017 vaccine by entry to primary school.
the country using intradermal IPV at 6th Infants between 9 and 12 months of age:
week and 14 week. The IPV vaccine The first dose of MMR vaccine may be
cost is covered by Gavi due to global given to infants from 9 months of age.
unique need to eradicate polio by 2021. Individuals 12 months of age or older:
The dose is 0.5 ml. A second dose
MEASLES VACCINE[ED] should be given according to official
recommendation.
MEASLES VACCINE, LIVE Contraindications: See general
discussion; hypersensitivity to neomycin
Measles Vaccine, Live is a preparation or to any other component and egg,
containing a suitable modified strain of children who have received another live
live measles virus grown in cultures of vaccine by injection within 3 weeks, if
chick embryo cells or in other suitable given to women, pregnancy should be
approved cell cultures. It is prepared avoided for 3 months after vaccination
immediately before use by reconstitution Side-effects: malaise, fever or rash may
from the dried vaccine with the liquid occur following the first dose of MMR
stated on the label to give a suspension. vaccine, most commonly about a week
The vaccine does not contain any added after immunization and lasting about 2-3
antimicrobial preservative. days. Paracetamol can be given to
Dose: Two doses of 0.5 ml reconstituted reduce the fever followed if necessary by
vaccine is administered subcutaneously a second dose 4-6 hours later. After a
(SC) at the anterolateral part of mid-thigh second dose of MMR vaccine, adverse
at the age of 9 months and 15 months. reactions are considerably less common
Note: Administration of measles vaccine than after the first dose.
(measles containing vaccine) to children Post-vaccination meningoencephalitis
may be associated with a mild measles- was reported (rarely and with complete
like syndrome with a measles-like rash recovery) following immunization with
and pyrexia about a week after injection. MMR vaccine containing Urabe mumps
Much less commonly, convulsions and, vaccine. This strain has been
very rarely, encephalitis have been discontinued in most developed
reported. Convulsions in infants are countries including UK. No cases have
453
been confirmed in association with the This TT immunization schedule should

Jeryl Lynn mumps vaccine. include a first dose given at the first
Dose: 0.5 ml by deep subcutaneous or contact, a second dose at least 4 weeks
intramuscular injection (consult after the first dose, and a third dose
manufacturer’s literature) given 6-12 months after the second dose
(or next pregnancy). Protective antibody
Proprietary Preparations levels are attained in 80-90% of women
Priorix(I) (GSK), Inj.,Tk. 600.00/0.5ml vial after the second dose and in 95-98% of
Trimovax(I)(Sanofi Pasteur),Inj. This vaccine is women after the 3rd dose. This basic
currently not available.
course will provide protection for at least
5 years. Fourth and fifth dose of TT
TETANUS VACCINE (TETANUS given later will prolong the duration of
TOXOID) [ED] immunity for 10 and 20 years (or life
long) respectively. Since women who
Tetanus toxoid (TT) is prepared from received only three doses of DPT in
tetanus toxin produced by the growth of infancy may not respond well to one
Clostridium tetani. The toxin is converted booster dose of TT, it is prudent to give
to tetanus toxoid by treatment with them two doses of TT (during
formaldehyde solution and adsorbed on pregnancy) with an interval of 1 month,
to aluminium salts to increase its and complete the full immunization with
antigenicity. one dose of TT one year later (or in a
Note: An advantage of the adsorbed subsequent pregnancy).
preparation is that antitoxins InBangladesh from 1993 for child
(immunoglobulins) do not neutralize bearing age women (15 to 49 years) TT-
them. So they can be given concurrently five doses schedule recommended
unlike the plain tetanustoxoid (where a 6 which are as follows: The TT1 is at 15
weeks wait is necessary to allow years, TT2 four weeks after TT1, TT3 six
theantitoxin levels to fall). TT is stable months after TT2, TT4 one year after
and can withstand exposure to room TT3 and TT5 one year after TT4. If an
temperature for months and to 37C for infant received three doses of Hib penta
a few weeks without significant loss of in that case when she reaches 15 years
potency. But usually it is preserved at a of age will receive only three doses of TT
temperature between 2 and 8C. In that instead of five doses if there is valid
condition the expiration date is not later document for vaccination. Here at 15
than 2 years after date of issue from years she will receive TT3, after one
manufacturer’s cold storage. TT is a year TT4 and TT5 one year after TT5.
highly effective vaccine and induces the Contra-indications: See general
formation of specific antitoxins, which discussion and individuals who had
neutralize the toxin. Antitoxin, which developed transient thrombocytopenia or
passes to the foetus across the placenta neurological complications previously
following active immunization of the after administering any dose of tetanus
mother, prevents neonatal tetanus. In toxoid
EPI TT is used to prevent neonatal Side-effects: local reactions such as
tetanus by immunizing women. tenderness, erythema, induration
Dose: When most women of child- oedema and nodule at the injection site.
bearing age have not previously Headache, circulatory reactions,
immunized with TT in their infancy or sweating, chills, fever, dyspnoea, muscle
adolescent or when there is little or no and joint complaints. GI discomfort,
documentation of past immunization, exanthema, blood disorders
implementation of a TT five dose Interactions: immunosuppressive
schedule for women of childbearing age therapy, see also Appendix-2
is of the utmost importance (Appendix-
8b). Proprietary Preparations
454
T. VaccinumTetani(I)(Biomed), Inj., should be given according to the

Tk.64.73/0.5ml amp national vaccination schedule.
TT Vax (Popular), Inj.TK.80.00/0.5ml Vial The rapid schedule is more appropriate
Vaxitet(Incepta),Inj.,Tk.60/0.5ml amp;(1’s) Tk.
80/0.5mlAmp(10’s)
for Bangladesh.
Special Dosage Recommendations:
Dosage recommendation for
HEPATITIS B VACCINE[ED] neonates born of mothers who are
HBV carriers:
Hepatitis B vaccine contains inactivated The 0, 1, and 2 months immunization
hepatitis B virus surface antigen (HbsAg) schedule is recommended, and should
adsorbed on Aluminium hydroxide start at birth. Concomitant administration
adjuvant. It is made biosynthetically of HBIg is not necessary, but when HBIg
using recombinant DNA technology. The is given simultaneously with Hepatitis B
vaccine is safe and immunogenic even vaccine, a separate injection site must
when administered at birth (Maternal be chosen.
anti-HBsAg antibody does not interfere
with the response to the vaccine), and The vaccine should be injected
highly efficacious. Over 90% of intramuscularly in the deltoid region in
susceptible children develop a protective adults, anterolateral thigh is the
antibody response (over 10 IU/ml) preferred site in infants and children. It
following three doses of vaccine. Infants should not be injected into the
of HBsAg–positive carrier mothers buttock(vaccine efficacy reduced);
respond less well to the vaccine since it subcutaneous route used for patients
is delivered after infection has occurred. with haemophilia.
A combined DTP and Hepatitis B Contra-indications : The Hepatitis B
vaccine is also available for infants. Vaccine should not be administered to
Immunization schedule subjects with known hypersensitivity to
Primary immunization : A series of three any component of the vaccine, or to
intramuscular injections is required to subjects having shown signs of
achieve optimal protection. hypersensitivity after previous
Two primary immunization schedules administration.
can be recommended : Special warnings and cautions for
• A rapid schedule, with immunization use:
at 0, 1 and 2 months, will confer Because of the long incubation period of
protection more quickly and is Hepatitis B it is possible for
expected to provide better patient unrecognized infections to be present at
compliance. the time of immunization. The vaccine
• Schedules which have more time may not prevent Hepatitis B infection in
between second and third doses, such cases.
such as immunization at 0, 1 and 6 Dose: 3 doses of 1 ml (20 mcg) by
months, may take longer to confer intramuscular injection for adults and
protection, but will produce higher children over 15 years. 0.5 ml (10 mcg)
anti-HBs antibody titres. for children under 15 years.
The birth dose should be followed Now this vaccine is a component of Hib
by 2 or 3 additional doses to penta vaccine become part of national
complete the primary series. A EPI vaccination program.
birth dose of hepatitis B vaccine
can be given to low birth weight Proprietary Preparations
(<2000g) and premature infants. Engerix –B (GSK); prefilled syringe 1 ml TK
For these infants, the birth dose 6.08/ syringe.
Hepa-B(Incepta),Inj.. 0.5 ml
should not count as part of the
dose/vialTk.400.00/0.5ml vial;1mldose/vial
primary 3 dose series; the 3 doses Tk.500.00 /1mlvial.
of the standard primary series
455
Hepavax(Popular)Inj., Tk.400.00/0.5ml Avaxim80(I)(Sanofi),Inj.,(P.Fsyringe)

vial;vial.Tk500.00/1mlvial Tk.1110/0.5ml Syringe
Preva(Incepta)Inj.,0.5mlvialTk.
With DPT and influenza vaccine 600.00/0.5ml;1ml/via;Tk. 1000/1ml
Easyfive(Popular) Inj.,Tk.1000/0.5mlvial
HEPATITIS A VACCINE PNEUMOCOCCAL VACCINES
Indication: This is effective for Pneumococcal vaccines protect against

prevention of HAV in adults and children. infection with Streptococcus pneumoniae
In view of the endemicity and an (pneumococcus).
increasing risk of morbidity and mortality, Pneumococcal vaccination is
the use of the vaccine may be of recommended for individuals at
significant value in our community. increased risk of pneumococcal infection
Immunisation against HAV is especially as follows:
recommended for: age over 65 years; asplenia or splenic
• Occupationally exposed persons dysfunction asthma treated with
(especially fecal materials) such as continuous or frequent use of a systemic
healthcare professionals, laboratory corticosteroid; chronic heart , renal
personnel, laundry & cleaning staff diseaseand liver disease; diabetes
in hospitals & staff at day-care mellitus requiring insulin or oral
centers. hypoglycemic drugs; HIV infection,
• Travellers/armed forces/aid workers prolonged systemic corticosteroid
• Food-handlers. treatment for over 1 month at dose
• Injectable drug users/ equivalents of prednisolone. ADULT and
haemophiliacs as well as subjects CHILD over 20 kg, 20mg or more daily;
with chronic liver conditions due to child under 20 kg,1 mg/kg or more daily);
Hepatitis B, D.C or E viruses or presence of cochlear implant; conditions
alcohol. where leakage of cerebrospinal fluidmay
Dosage and administration: The occur; CHILD under 5 years with a
vaccine is available in 1ml dose for history of invasive pneumococcal
adults and 0.5 ml dose for children. disease; at risk of occupational exposure
Child dose is 0.5 ml at a given date to metal fume (e.g.welders).
followed by a booster dose 6-12 months Where possible, the vaccine should be
later by intramuscular administration into given at least 2weeks before
the anterolateral part of thigh in young splenectomy, cochlear implant surgery,
children and deltoid region in older chemotherapy, or radiotherapy; patients
children. Adult dose is 1 ml at a given should begiven advice about increased
date followed by a booster dose 6-12 risk of pneumococcal infection. If it is not
months later administered by practical to vaccinate at least 2weeks
intramuscular injection into the deltoid before splenectomy, chemotherapy, or
region. radiotherapy,the vaccine should be given
Consult product literature at least 2 weeks afterthe splenectomy or,
This vaccine is not incorporated in EPI where possible, at least 3 months after
program. completion of chemotherapy or
Contraindications:See general radiotherapy. Prophylactic antibacterial
contraindications therapy against pneumococcal infection
Side-effects: usually mild including should not be stopped after
transient soreness, erythema and immunization
induration at the injection site.
PNEUMOCOCCAL VACCINE
Avaxim160(I)(Sanofi),Inj.(P.F
syringe)Tk.1524.00/0.5ml syringe
456
Indications: Immunisation against Pneumococcal 13valent Conjugate

pneumococcal infection and see also Vaccine
notes above Prevnar 13(I)(Pfizer.), Inj. 0.5ml(Prefilled
Cautions:See also section 13.1and note syringes)Tk.5,308,50/syringe
above Dose: by intramuscular injection. To be
Contraindications: See section 13.1 administered as a four-dose series at 2,
Pregnancy,Breast-feeding and children 4, 6, and 12-15 months of age. For
under 6 weeks old. adults of 18 years of age and older,
Side-effects: See section 13.1 Prevnar 12 is given ad a single dose.
Revaccination: In individuals with higher
concentrations of antibodies to Pneumococcal polyvalent Vaccine
pneumococcal polysaccharides, Pneumovax
revaccination with the 23-valent 23(I)(MSD),Inj.,25microgram/dose,Tk.1768.93/
vial
pneumococcal polysaccharide vaccine
more commonly produces adverse
reactions. Revaccination is therefore not RABIES VACCINE[ED]
recommended,except every 5 years in
individuals in whom the antibody One of the most important elements in
concentration is likely to decline rapidly the effective control of human rabies is
(e.g. asplenia, splenic dysfunction and the use of efficacious vaccines. Vaccines
nephrotic syndrome). If there is doubt, produced in neural tissues have been in
the need for revaccination should be existence for over 100 years. However, it
discussed with a haematologist, is the availability and use of cell culture
immunologist, or microbiologist. For 13 and purified embryonated egg rabies
valent pneumococcal conjugate vaccine vaccines that have dramatically
,severe allergic reaction (e.g., decreased the number of human deaths
anaphylaxis) to any component of 13 throughout the world, most notably in
valent pneumococcal conjugate vaccine countries where canine rabies is
or any diphtheria toxoid-containing endemic.
vaccine. Side-effects: mild, local in less than 5%
Dose: See under preparations of the patients. Headache; lethargy, mild
allergic skin reactions and slight
Proprietary Preparations elevation in temperature may be seen in
Pneumococcal polysaccharide some sensitive patients.
vaccine Cautions: immunosuppressive therapy
Pneumo 23(I)(Sanofi Pasteur),Inj. (0.5ml and excessive alcohol should be avoided
Prefilled Syringe) during immunization.
Dose should be given by intramuscular Presentation: presented as 1 dose vial
or subcutaneous route. This vaccine is This vaccine is not incorporated in EPI
indicated for adultand child over 2 years program.
of age. Pneumo 23 is currently not
available in the market. Proprietary Preparations
Rabipur(I)(Chiron),Inj.2.5I.U.; Tk.850.00/vial
Rabix-VC(Incepta),Inj.Tk.500.00/vial
Pneumococcal polysaccharide Rabivax(Popular)Inj. 2.5I.U/0.5ml
conjugate vaccine (adsorbed) Tk.500.00/vial
Synflorix(I)(GSK), Inj. .(P.F syringe) Verorab(I) (Sanofi Pasteur), Inj. 0.5ml.Tk.
Tk.1936.49/0.5ml Syringe; 850/0.5ml syringe
Dose:by intramuscular injection,
CHILD 6 weeks–5 years, consult product VARICELLA VACCINE
literature
Note. Deltoid muscle is preferred site of
Varicella (Chicken Pox) vaccine is a
injection in young children; anterolateral
lyophylised preparation of the live-
thigh is preferred site in infants
attenuated OKA strain of varicella-zoster
virus.
457
Indication: Effective for prevention of weeks of age (preferably before 16

chicken pox in healthy infants (from the weeks)
age of 9 months onwards), children,
adolescents and adults. Proprietary Preparations
Dosage and administration: 0.5 ml of Rotarix(GSK); Oral applicator,
the reconstituted vaccine contains one Tk.1473.95/Oral applicator.
(I)
Rotateq (MSD), Oral susp, Tk.1490.35/Tube
immunising dose. CHILD dose from the
age of 9 months up to 12 years of age, 1 YELLOW FEVER VACCINE
single dose. ADULT dose from 13 years
of age and up, 2 doses with an interval Live yellow fever vaccine is indicated for
of 6-8 weeks; The vaccine should be those travelling to, passing through or
given by subcutaneous injection. The living in an endemic area and for
upper arm (deltoid region) is the laboratory staff who handle the virus or
preferred site of injection. who handle clinical material from
Contra-indication: Pregnancy (avoid suspected cases. The immunity which
pregnancy for 3 months after probably lasts for life is officially
vaccination) and during breast feeding. accepted for 10 years starting from 10
This vaccine is not incorporated in EPI days after primary immunization and for
program. a further 10 years immediately after
revaccination.
Proprietary Preparations Pregnancy: Live yellow fever vaccine
Varilrix (GSK), Inj. 0.5 ml, TK. 2350/ Vial should not be given during pregnancy
because there is a theoretical risk of fetal
ROTAVIRUS VACCINE infection. If exposure cannot be avoided
during pregnancy, then the vaccine
Rotavirus vaccine is a live, oral vaccine should be given if the risk from disease
that protects young children against in the mother outweighs the risk to the
gastro-enteritis caused by rotavirus fetus from vaccination
infection. Breast-feeding: Should not be given to
The recommended schedule consists of nursing mothers,seek specialist advice if
2 doses, the first at 2 months of age, and exposure to virus cannot be avoided.
the second at 3 months of age. The first
dose of rotavirus vaccine must be given YELLOW FEVER VACCINE, LIVE
between 6–15 weeks of age and the
second dose should be given after an Indications: Immunization against
interval of at least 4 weeks; the vaccine yellow fever
should not be started in children 15 Contra-indications: See section
weeks of age or older. (13.1.1)also children under 6 months;
Indications: Protection against gastro- history of thymus dysfunction.
enteritis caused by rotavirus. Pregnancy : See notes above.
Cautions: Vaccination should be Breast-feeding: See notes above.
postponed in subjects suffering from Side-effects: See section (13.1.1);also
diarrhea or vomiting; immunosuppressed associated viscerotropic disease and
close contacts. neurotropic disease
Contraindications: See section Dose: ADULT and CHILD over 9
(13.1.1);also predisposition to, or history months,0.5ml (see also notes above)
of, intussusception Consult product literature.
Side-effects: See section (13.1.1) Route of administration:Subcutaneous
Dose: By mouth, CHILD over 6 weeks, 2
doses of 1.5 ml, separated by an interval Proprietary Preparations
of at least 4 weeks; first dose must be Stamaril(I)(Sanofi Pasteur)j.0.5ml reconstituted
given between 6–15 weeks of age; vaccine. Tk 2250/ P.Fsyringe
course should be completed before 24
JAPANESE ENCEPHALITIS VACCINE
458
Pregnancy and lactation: As with all

Japanese encephalitis (JE) is a serious live attenuated vaccines, pregnancy
viral infection and is one of the main constitutes a contra-indication. JE
causes of childhood encephalitis in south vaccination is contraindicated in
eastern and southern Asia. It is caused breastfeeding women.
by Japanese encephalitis virus (JEV)
and is transmitted mainly by the
mosquito Culex tritaeniorhynchus. Whilst Proprietary Preparations
the majority of infections are mild and Imojev(I)(Sanofi Pasteur)j. 0.5ml reconstituted
vaccine. Tk 2040.28 P.F/syringe
remain undetected, between 30,000 –
50,000 cases of encephalitis are
estimated to occur each year resulting in ANTITOXINS OR ANTISERA
at least 10,000 – 15,000 deaths, these
figures likely to be underestimates. Half Antitoxins or antisera are prepared in
of survivors develop serious neurological animals such as horses. Originally these
sequelae and disability is common in the were used for passive immunization.
remainder. Administration of antiserum frequently
Indication:JE vaccine is indicated for gives rise to serum sickness and
prophylaxis of Japanese encephalitis anaphylactic shock. These are gradually
caused by the Japanese encephalitis being replaced by human immuno-
virus, in subjects from 12 months of age globulin preparations that are much
and over. safer.
Administration: it is administered via
the subcutaneous route. TETANUS ANTITOXIN (ATS)
Dose:
Primary vaccination: Subjects 12 months Tetanus Antitoxin is prepared from
of age and over: a 0.5 mL single serum of horses that have been
injection. immunized against the toxins of the
Booster: Paediatric population: A tetanus bacilli. It is used to confer
booster dose should be given after passive immunity against tetanus.
primary vaccination in order to confer Presentation: Solution of enzyme
long term protection. The booster dose refined globulin is available in ampoules
should be given preferably 12 months of 1,500 IU and 10,000 IU
after primary vaccination and can be Uses: immediate protection is its
given up to 24 months after primary advantage and short-lived immunity is its
vaccination. Adult population: There is disadvantage. They are used for
no need for a booster dose up to 5 years emergency prophylaxis and treatment of
after the administration of a single dose tetanus.
of JE vaccine. Doses and administration: For
Contra-indication: JE vaccine should prophylaxis : 1,500 IU intramuscularly (or
not be administered to anyone with a subcutaneously) as soon a possible after
history of severe allergic reaction to any injury;routine use of tetanus antitoxin
component of the vaccine. Vaccination after an injury has been discarded
must be postponed in case of febrile or because of the very short-lived immunity
acute disease. Congenital or acquired it offers and the possible anaphylaxis
immune deficiency impairing cellular reactions following its administration. For
immunity, including immunosuppressive treatment previouslya large dose
therapies. JE vaccine must not be 1,00,000 IU intravenously at the start
administrated to persons with and a repetition of the same dose in one
symptomatic HIV infection or with or two days and is followed by a further
asymptomatic HIV infection when 15,000 IU weekly (until symptoms abate)
accompanied by evidence of impaired was used. But now a small dose of only
immune function. 3,000 IU is given intravenously for
459
patients of all ages soon after diagnosis Proprietary Preparations

without any repetition Human gama globulin(I) (Chiron), Inj.16%.
Side-effects: Frequent hypersensitivity Tk.133.82/2ml amp
Octagam(I)(Octapharma), Inj. 2.5gm/50ml.
reactions Tk.6157.88/50ml
Cautions: Patients should be asked Pentaglobin(I)(Biotest)) Inj. 50mg/ml,10ml vial;
about previous history of serum reaction, Tk.4478.28/vial
history of asthma, urticaria, allergy or Humaglobin(I)(Bioplazma),Inj.100ml
eczema. An intradermal test dose of 0.1 Tk.31386.48/vial
ml of a 1 in 10 dilution may be given to Rhophlac(I)(Lilly) Inj.(prefilled
elicit sensitivity. Preparation is to be kept pen)Tk.3050.00/2 ml pen
Normoglobin(Incepta) Inj.,10ml Tk.
ready to face the reaction after injection. 2800.00/vial.
These are Adrenaline, antihistamine and
hydrocortisone injection ampoules,
DISEASESPECIFIC
disposable syringe and airway tube etc
IMMUNOGLOBULINS
Vaxitet-IG(Incepta), Inj.TK408.00/Vial Specific human immunoglobulins or
hyper immune immunoglobulins are
13.3 IMMUNOGLOBULINS prepared from the plasma of selected
donors who have recently recovered
Human immunoglobulins have replaced from an infection or who have been
immunoglobulins of animal origin immunized against a specific infection.
(antisera) which were frequently That is why they have high levels of the
associated with hypersensitivity. specific antibody required, e.g,Hepatitis-
Injection of immunoglobulins produces B Immunoglobulin (HBIg), Rabies
immediate protection lasting for several Immunoglobulin (RIg) (See under Rabies
weeks. Human immunoglobulins are of vaccine), Tetanus Immunoglo-bulin
two types: Normal Human (TIg).
Immunoglobulin (NHIg) and Specific
Immunoglobulin. TETANUS IMMUNOGLOBULIN (TIG)[ED]
NORMAL HUMAN Presentation: Purified immunoglobulin

IMMUNOGLOBULIN[ED] obtained from the sera of healthy human
(GAMMA GLOBULIN) donors known to have high levels of
tetanus antitoxin following active
Normal Human Immunoglobulin is immunization with tetanus vaccine. Each
prepared from a pool of at least 1000 vial contains 250 IU of tetanus antitoxin
donations of human plasma. It contains in 1.0 ml solution.
antibody to measles, mumps, varicella, Uses: For passive immunization against
hepatitis A and other viruses that are tetanus, in conjunction with adsorbed
currently prevalent in the general tetanus vaccine as soon as practicable
population. It is used to prevent measles after a tetanus susceptible person has
in highly susceptible individuals and to sustained wound. Also for the treatment
provide temporary protection (up to 12 of tetanus
weeks) against hepatitis A infection for Doses and administration:
travellers to endemic areas and to a) Prevention of tetanus following
control institutional and household injury
outbreaks of hepatitis A infection. ADULTS: TIG should be administered by
Live vaccines should not normally be IM injection usually in a dose of 250 IU.
given for 12 weeks after an injection of Persons not immunized or inadequately
NHIg and if a live vaccine has already immunized with tetanus vaccine are
been given NHIg injection should be susceptible to tetanus and all wounds
deferred for 2 weeks. are prone to tetanus infection. In cases
of doubt a person should be regarded as
460
inadequately immunized. Administration administration of the immunoglobulin.

of immunoglobulin does not obviate the USE IN PREGNANCY AND
need for debridement of and wound LACTATION : Accurate information is
cleansing, nor does it contraindicate the not available on the safety of TIG in
use of antibiotics. The prophylactic pregnancy and lactation
immunization schedule against tetanus
should be carried out as soon as Proprietary Preparations
possible after a person has sustained a Protet(Incepta) Inj. 250IU/ml; Tk. 975.00/vial.
Wound. Passive immunization with Tetuman Berna(I)(Swiss Serum). Inj.
250IU/ml; Tk.541.73/vial
immunoglobulin should be accompanied
by simultaneous active immunization
with adsorbed tetanus toxoid. If more RABIES IMMUNOGLOBULIN (RIG)[ED]
than 24 hours have elapsed since the
wound was sustained or if there is a risk Indications: Rabies Immunoglobulin
of heavy contamination with Clostridium provides passive immunization against
tetani 2 ml (500 IU) should be given rabies for prevention of rabies in patients
irrespective of immunization history. TIg after contact with a rabid animal or an
and adsorbed tetanus toxoid should be animal presumed to be rabid. Anti rabies
administered with separate syringes and serum itself does not constitute an anti
into separate sites. Tetanus toxoid in rabies treatment and should always be
single solution is unsuitable for used in conjunction with rabies vaccine.
administration concurrently with TIg. A Dosage and administration: The
single dose of TIg usually provides a recommended dose for both ADULTS
protective level of tetanus antitoxin over and CHILD is 40 IU/kg of body weight. If
0.01 IU per ml serum, for a period of 4 anatomically feasible, as much as
weeks. Long-term immunity against possible of the dose should be infiltrated
tetanus is conferred by giving further around and into the wound(s). The
doses. remainder should be administered
CHILDREN: As for adults intramuscularly (into the gluteal region)
b) Treatment of tetanus : in a single injection.
ADULTS: 30-300 IU /Kg given IM However, for children, particularly in the
CHILDREN: As for adults case of multiple wounds, it has been
Contra-indications: TIG should not be proposed to dilute the dose 2-3 times in
given intravenously. The administration a 0.9% sodium chloride solution to
of immunoglobulin may be contra- obtain a sufficient quantity of equine
indicated by a history of anaphylaxis rabies immunoglobulin to infiltrate the
resulting from administration of a wound(s) correctly.
previous dose of human gamma Contra-indications: Known history of
globulin. allergic symptoms to horse proteins.
Cautions:TIG should not be given Nevertheless, the lethal risk associated
concurrently with tetanus toxoid in single with rabies overcomes any potential
solution. Although anaphylaxis is rare, contraindication.
facilities for its management should Drug interactions: For treatment
always be available during vaccination. associating rabies immunoglobulin and
Side-effects: Local reaction, consisting rabies vaccine, the rabies vaccine
of a small area of inflammation and should be injected in a contra lateral
tenderness, may occur after anatomic site (i.e., on opposite side)
administration of the immunoglobulin, using a different syringe. As a general
but this rarely constitutes more than rule, corticosteroids, liable to attenuate
temporary inconvenience. Constitutional the immune response, should be
upsets, and particularly anaphylactic avoided.
reactions are uncommon. Patients with Pregnancy and Lactation: The safety
antibody deficiency syndromes may be of rabies immunoglobulin when used
liable to have local reactions after during pregnancy has not been
461
established in clinical trials in human up to date. In Non-European areas

beings. Considering the lethal risk surrounding the Mediterranean, in Africa,
associated with rabies, pregnancy may the Middle East, Asia and South
not be a contraindication to the America, certain special precautions are
administration of rabies immunoglobulin required (see also Appendix-8C)
subsequent to exposure. Food hygiene In areas where sanitation
Side-effects: Immediate or delayed is poor, good food hygiene is important
hypersensitive type reactions may be to help prevent hepatitis A, typhoid,
developed on administration of rabies cholera, and other diarrhoeal diseases
immunoglobulin. The observed (including travellers’ diarrhoea). Food
immediate reactions are hypotension, should be freshly prepared and hot, and
dyspnoea, and urticaria. Delayed uncooked vegetables (including green
reactions consist of inflammatory salads) should be avoided; only fruits
reaction, fever, pruritis, rash or urticaria, which can be peeled should be eaten.
adenopathy and arthralgia. Only suitable bottled water, or tap water
that has been boiled or treated with
Proprietary preparation: sterilising tablets, should be used for
Rabix-IG(Incepta), 1000 IU/5ml, Tk 1000/Vial drinking.
13.4 INTERNATIONAL TRAVEL Yellow fever immunizationis

recommended for travel to the endemic
A vaccination plan should be zones of Africa and South America.
established, taking into account the Many countries require an International
traveler’s destination, overall state of Certificate of Vaccination from
health and current immune status, the individuals arriving from, or who have
duration and type of travel. been travelling through, endemic areas;
Smallpox: No country any longer other countries require a certificate from
requires a certificate of vaccination all entering travellers (consult the
against smallpox. Department of Health handbook, Health
Cholera: Cholera Vaccine is no longer Information for Overseas Travel, www.
recommended for international travel dh.gov.uk).
due to low risk of cholera in travelers and
the limited benefit of available vaccines. VACCINE AGAINST CHOLERA AND
In rare circumstances when an unofficial ETEC-DIARRHOEA
demand may be anticipated,
confirmation of non-requirement of Preparation: The vaccine is composed
cholera vaccine may be given on official of Vibrio cholerae O1 Inaba and Ogawa,
notepaper signed and stamped by the classic and El Tor strains (heat/formalin
medical practitioner. inactivated), cholera toxin B subunit,
sodium dihydrogen phosphate, disodium
Oral cholera vaccine (see p. 816) should hydrogen phosphate, sodium chloride,
be considered for backpackers and sterile water.
those travelling to situations where the Indication: Protection against cholera
risk is greatest (e.g. refugee camps). and ETEC-diarrhoea. The vaccine is
Regardless of vaccination, travellers to recommended for adults and children
areas where cholera is endemic should from 2 years of age visiting the disease
take special care with food hygiene (see prone areas.
below Contraindication: Children under 2 years
No particular immunization is required old; Known allergy allergic to any
for travelers to the United States, ingredient of the vaccine or to
Europe, Australia, or New Zealand formaldehyde; acute stomach disorder or
although all travelers should have infection with fever
immunity to tetanus and poliomyelitis
and childhood immunization should be
462
Side-effect: Gastrointestinal symptoms advice given by an Emergency

including stomach pain, diarrhoea, Committee under the International
nausea and vomiting. Health Regulations (IHR) that was
Dose and administration: For cholera: convened to assess whether the
Basic immunisation comprises 2 doses international spread of polio in 2014, As
of vaccine for adults and children over per declaration by DG WHO the
the age of 6. Children from 2 to 6 years temporary recommendation for the
of age should receive 3 doses. Doses States infected with WPV1, cVDPV1 or
are to be administered with an interval of cVDPV3, with potential risk of
1-6 weeks. For ETEC: adults and international spread (WPV1; States
children comprises 2 doses of vaccine infected with cVDPV2s, with potential
with an interval of 1-6 weeks between risk of international spread; and States
doses. no longer infected by WPV1 or cVDPV,
but which remain vulnerable to re-
Proprietary preparation: infection by WPV or cVDPV. To ensure
Dukoral(I)(SBL Vaccine AB):Oral suspension 3 all residents and long-term visitors (i.e.
ml(vaccine) and Sodium hydrogen carbonate within four weeks), who have not
effervescent granules 5.6g (buffer). Tk
1500/dose.
received a dose of OPV or IPV in the
previous four weeks to 12 months,
Poliomyelitis: On 5 May 2014, the receive a dose of oral polio vaccine at
Director–General of WHO declared the least by the time of departure as this will
international spread of wild polio virus a still provide benefit, particularly for
Public Health Emergency of International frequent travelers.
Concern. The declaration followed
463
14. DRUGS USED IN MALIGNANT DISEASES AND FOR IMMUNOSUPPRESSION
Chapter 14
DRUGS USED IN MALIGNANT DISEASES
AND FOR IMMUNOSUPPRESSION
14.1. Cytotoxic drugs p.464

14.1.1 Alkylating drugs p.468
14.1.2 Cytotoxic antibiotics p. 470
14.1.3 Antimetabolites p. 471
14.1.4 Vinca alkaloids and etoposide p. 473
14.1.5 Other antineoplastic drugs p. 474
14.2 Drugs affecting the immune response p. 484
14.2.1 Antiproliferative immunosuppressants p.485
14.2.2 Corticosteroids and other immunosuppressants p. 485
14.2.3 Rituximab p. 487
14.2.4 Interferons p. 487
14.2.5 Aldesleukin p. 488
14.2.6 BCG immunotherapeutics p. 488
14.3 Sex hormones and hormone antagonists in malignant diseases p. 488
14.3.1 Estrogens p. 489
14.3.2 Progestogens p. 489
14.3.3 Androgens p. 490
14.3.4 Hormone antagonist’s p.490
14.3.4.1 Breast cancer p.490
14.3.4.2 Prostate cancer and gonadorelin analogue p. 491
14.3.4.3 Somatostatin analogues p. 493
14.1 CYTOTOXIC DRUGS treatment or as adjuvant (Chemotherapy

following local treatment for early
14.1.1 ALKYLATING DRUGS cancer) treatment.
14.1.2 CYTOTOXIC ANTIBIOTICS Drug combination may have the
14.1.3 ANTIMETABOLITES advantage in certain tumors of enhanced
14.1.4 VINCA ALKALOIDS AND response and reduced development of
ETOPOSIDE drug resistance and increased survival.
14.1.5 OTHER ANTINEOPLASTIC However, for some tumors, single-agent
DRUGS chemotherapy remains the treatment of
choice. Cytotoxic drugs may be given
with a curative intent or to palliate the
Along with its anti-cancer activity
symptoms or it may aim to prolong the
cytotoxic drugs have also the potential
survival.
for damage to normal tissue. Intermittent
combination chemotherapy principle has
been established to give cancer SIDE EFFECTS OF CYTOTOXIC
chemotherapy. Several drugs were DRUGS
combined together, chosen on the basis
of different mechanisms of actions and A number of cytotoxic drugs will cause
non-overlapping toxicities. In an severe local tissue necrosis if leakage
increasing number of cases into the extravascular compartment
chemotherapy may be combined with occurs. In addition, if there is rapid cell
radiotherapy or surgery or both as either destruction with extensive purine
neoadjuvant (Pre-surgery chemotherapy catabolism, urates may precipitate in the
for early and locally advanced cancer) renal tubules and they cause kidney
464
damage. All cytotoxic drugs produce compounds have particular toxic effects
severe nausea and vomiting. Some which are specific for them.
Note: Cytotoxic drugs should be administered under the supervision of a physician

with sufficient experience in cancer chemotherapy at medical institutions in which
appropriate medical treatment can be made in case of emergency.
Nausea and vomiting: Severe vomiting doses should be reduced or therapy

can be produced by the platinum-based delayed if bone marrow has not
drugs such as dacarbazine, high doses recovered. Bone marrow toxicity with
of cyclophosphamide, cisplatin and decreased leucocyte production and
taxane. Moderately emetogenics are thus decreased resistance to infection,
doxorubicin, intermediate and low dose impaired wound healing, depression of
of cyclophosphamide, mitoxantrone and growth in children, sterility,
high dose of methotrexate (0.1 – 1.2 teratogenicity, loss of hair, and damage
g/m2). The less severe or mild emesis is to the gastrointestinal epithelium.
found with fluorouracil, etoposide, Fever in a neutropenic patient should
methotrexate (less than 100 mg/m2), the receive parental broad-spectrum
Vince alkaloids and abdominal antibiotics. Appropriate culture and
radiotherapies. sensitivity tests should be done as soon
To prevent emesis a specific (5HT3) as possible.
serotonin antagonist, Granisetron is Colony-stimulating factors, G-CSF is
used. The 5HT3 antagonists are highly sometimes successful in selected
effective in controlling The addition of patients depending on the duration and
Lorazepam to antiemetic therapy is severity of the neutropenia.
sometimes helpful to prevent anticipatory Alopecia: many but not all the cytotoxic
symptoms. drugs are capable of causing hair loss.
Hyperuricemia: which can result in uric Hair always regrows on completion of
acid crystals form in the urinary tract with chemotherapy.
associated renal dysfunction is a major Pregnancy: most cytotoxic drugs are
complication of treatment for non- teratogenic and should not be
Hodgkin’s lymphoma, leukaemia and administered during pregnancy,
myelo-proliferative diseases. Patients especially during first trimester.
should be adequately hydrated. Breast-feeding: most cytotoxic drugs
Increased urinary volume decreases the are avoided during breast feeding.
concentration of urate in urine and thus Consult product literature
minimizes the problem. Alkalinisation of Cardio-toxicity: this is a rare side effect
urine should be initiated to maintain of chemotherapy, usually associated
urine pH at least 7. Other than this, with doxorubicin. It is dose-related and
Allopurinol should be started 24 hours can largely be prevented by keeping the
before treating such tumors, and should total dose within the safe range.
be continued for 7-10 days; the dose of Neuro-toxicity: this occurs
Mercaptopurine or Azathioprine should predominantly with the plant alkaloids
be reduced if Allopurinol needs to be and platinum analogues. It is dose-
given concomitantly. related and chemotherapy usually
Bone Marrow Suppression: is caused stopped before the development of the
by all the cytotoxic drugs except significant polyneuropathy. This is only
vincristine and bleomycin. It commonly partially reversible.
occurs 7-10 days after administration, Sterility: some anticancer drugs,
but also delayed in certain drugs, such especially alkylating agents, may cause
as carmustine, Lomustine, and sterility. This can be irreversible. In male
Melphalan. To overcome these problem storage of sperm is the only important
peripheral blood counts must be consideration when chemotherapy is
checked before each treatment, and given with curative intentions.
465
Interactions: See Appendix-2 a dose equal to (or higher than) the dose
of methotrexate
Drugs to prevent cytotoxic-induced
side-effects Proprietary Preparations
Biofo (Incepta), Tab. 25 mg, Tk. 25.00/Tab.;5
mg, Tk. 9.00/Tab.
Methotrexate-induced mucosities and Folinex (Beacon), Inj. , 10mg /ml, Tk.
myelosuppression 500.00/50 ml
Calcium Folinate PhaRe(I) (Haupt) Inj.,10mg
/ml, Tk. Tk.4239.61/50mlvial,Tk.2119.80/20ml
Folinic acid (calcium folinate) is used to vail
counteract the folate-antagonist action of Folcasin (I)(Actavis) Inj. , 10mg /ml, Tk.
methotrexate. When folinic acid and 477/100 ml vial
fluorouracil are used together in
metastatic colorectal cancer the CALCIUM LEVOFOLINATE
response-rate improves compared to (Calcium levoleucovorine)
that with fluorouracil alone (see also
section 15.1.2.1). Indications: Same as that of calcium
Levofolinic acid: The calcium salt of folinate
levofolinic acid is the single isomer of Cautions: Same as that of calcium
folinic acid. It is used as folinic acid. The folinate
dose of levofolinic acid is half of folinic Side-effects: Same as calcium folinate
acid. Dose: As an antidote to methotrexate
(usually started 24 hours after the
CALCIUM FOLINATE beginning of methotrexate injection),
(Calcium leucovorin) usually 7.5 mg, by intramuscular
injection or by intravenous injection or by
Indications: Methotrexate induced intravenous infusion every 6 hours for 10
mucositis and myelosuppression doses
Cautions: Avoid simultaneous Suspected methotrexate overdose,
administration of methotrexate, not immediate administration of levofolinic
indicated for pernicious anemia or other acid at a rate not exceeding 160
megaloblastic anemia due to vitamin mg/minute in a dose which is a least
B12 deficiency; pregnancy and 50% of the dose of methotrexate
breastfeeding
Interactions: Antiepileptic; plasma Proprietary Preparation
concentration of phenobarbital, Leucovorine(I) (Mayne),Inj. 50mg/ml
phenytoin and primidone possibly Tk.377.09/vial, Tk.15mg/2ml, Tk.228.78/vial
reduced (see also Appendix-2)
Contraindication: Intrathecal injection. PLATINUM-INDUCED NEUTROPENIC
Side-effects: Rarely pyrexia after INFECTION AND NEPHROTOXICITY
parental use
Dose: As an antidote to Methotrexate Granulocyte colony-stimulating factor
(usually started 24 hours after the and granulocyte macrophage-colony
beginning of methotrexate infusion), stimulating factor are used for the
usually up to 120 mg in divided doses reduction of risk of infection associated
over 12-24 hours by intramuscular or with neutropenia.
intravenous injection or intravenous Recombinant human granulocyte-colony
infusion, followed by 12-15 mg stimulating factor (rhG-CSF) stimulates
intramuscularly or 15 mg by mouth every the production of neutrophils and may
6 hours for the next 48 –72 hours. reduce the duration of chemotherapy-
Suspected methotrexate overdose, induced neutropenia and thereby reduce
immediate administration of Folinic acid the incidence of associated sepsis; there
at a rate not exceeding 160 mg/minute in is yet no evidence that it improves
overall survival. Filgrastim
466
(unglycosylated rhG-CSF) and Interactions: Possible exacerbation of

lenograstim (glycosylated rhG-CSF) neutropenia with fluorouracil
have similar effects; both have been Note: use not recommended in the
used in a variety of clinical settings but period from 24 hours before to 24 hours
they do not have any clear-cut routine after chemotherapy - for further details
indications. Prolonged use may be consult product literature.
associated with increased risk of Contraindications: Severe congenital
malignancy. Molgramostim neutropenia with abnormal cytogenetics
(Recombinant human granulocyte Side-effects: Musculoskeletal pain,
macrophage colony stimulating factor) transient hypotension, disturbances in
stimulates the production of all liver enzymes and serum uric acid;
granulocytes and monocytes. It has thrombocytopenia; urinary abnormalities
more side-effects than granulocytes including dysuria; allergic reactions
colony stimulating factor and is (more common after intravenous
ineffective in congenital neutropenia. infusion), proteinuria, haematuria, and
Interactions: See Appendix-2 transient decrease in blood glucose
reported; cutaneous vasculitis also
FILGRASTIM reported, also splenic enlargement,
hepatomegaly, headache, diarrhoea,
(Recombinant human granulocyte colony anaemia, epistaxis, alopecia,
stimulating factor, G-CSF) (see also osteoporosis and rash, reactions at
section 15.1.4) injection site; rarely reported,
Indications: Incidence of febrile exacerbation of rheumatoid arthritis,
neutropenia in cytotoxic chemotherapy adult respiratory distress syndrome
for malignancy (except chronic myeloid Dose: Cytotoxic-induced neutropenia,
leukemia and myelodysplastic preferably by subcutaneous injection or
syndromes); reduction in duration of by intravenous infusion (over 30
neutropenia (and associated sequel) in minutes), ADULT and CHILD, 50,00,000
myeloablative therapy followed by bone units/kg daily started not less than 24
marrow transplantation; mobilization of hours after cytotoxic chemotherapy,
peripheral blood progenitor cells for continued until neutrophil count in
harvesting and subsequent autologous normal range, usually for up to 14 days
infusion; severe congenital neutropenia, (up to 38 days in acute myeloid
cyclic neutropenia, or idiopathic leukaemia)
neutropenia and history of severe or
recurrent infections (distinguish carefully Proprietary Preparations
from other haematological disorders, See section 15.1.4 under filgrastim
consult product literature); persistent
neutropenia in advanced HIV infection LENOGRASTIM
Cautions: Reduced myeloid precursors; (Recombinant human granulocyte-colony
monitor leucocyte count (discontinue stimulating factor, rhG-CSF)
treatment if leucocytosis, consult product
literature); monitor platelet count and Indications: For reduction in the
haemoglobin; regular morphological and duration of neutropenia and associated
cytogenetic bone marrow examinations complications following bone marrow
recommended in severe congenital transplantation for nonmyeloid
neutropenia (possible risk of malignancy or following treatment with
myelodysplastic syndromes or cytotoxic chemotherapy associated with
leukaemia); monitor the spleen size, the significant incidence of febrile
osteoporotic bone disease (monitor bone neutropenia; mobilization of peripheral
density if given for more than 6 months); blood progenitor cells for harvesting and
does not prevent other toxic effects of subsequent infusion
high dose chemotherapy; pregnancy, Cautions: See under filgrastim;
breastfeeding premalignant myeloid conditions
467
Dose: Cytotoxic induced neutropenia, by dose is given with oxazaphosphorine

subcutaneous injection, ADULT 19.2 treatment and repeated 4 and 8 hours
million units/sq.m. daily started the day after treatment
after completion of chemotherapy,
continued until neutrophil count is stable Proprietary Preparations
in the acceptable range (max. 28 days) Ifomes (Beacon), Inj.,400 mg/Vial, Tk.
190.00/Vial
Mesna (Techno), Inj., 400 mg/Vial , Tk.
Proprietary Preparation 240.00/Vial
See section 15.1.4 under Lenograstim Uromitexan (I) (Baxter), Inj., 400 mg/4 ml, Tk.
4474.50/4 ml Vial
Amifostine is used recently for the
reduction of risk of infection related to 14.1.1 ALKYLATING DRUGS
neutropenia in patients undergoing
treatment with cisplatin and
cyclophosphamide and for the reduction BUSULFAN
of nephrotoxicity due to cisplatin. It is (Busulphan)
also used recently to protect against
xerostomia during radiotherapy for head Indication: Chronic myeloid leukemia.
and neck cancer. Caution: See section 14.1; acute
porphyria, pregnancy, breast feeding,
UROTHELIAL TOXICITY hepatic impairment, monitor cardiac and
liver function
Side-effects: See section 14.1;
Hemorrhagic cystitis is a common
thrombocytopenia, hyperpigmentation of
manifestation of urothelial toxicity which
skin
occurs with the Oxazaphosphorines,
Dose: ADULT: induction of remission,
Cyclophosphamide and Ifosfamide; it
60 micrograms/kg to max 4 mg/m 2 daily
is caused by the metabolite acrolein.
until the leucocyte count is 50% of the
Mesna reacts specifically with this
original level; maintenance, 0.5-2 mg/m2
metabolite in the urinary tract, preventing
daily. CHILD: not recommended
toxicity. Mesna is used routinely
(preferably by mouth) in patients
Generic Preparation
receiving ifosfamide, cyclophosphamide Tablet. 2 mg.
by intravenous route at a high dose
(more than 2 g) or in those who
CHLORAMBUCIL[ED]
experienced urothelial toxicity when
given cyclophosphamide previously.
Indications: Chronic lymphocytic
leukemia, low-grade non-Hodgkin’s
MESNA
lymphoma; ovarian carcinoma
Caution: See section 14.1 and avoid in
Indications: See notes above. porphyria
Contraindications: Hypersensitivity to Side-effects: See section 14.1
thiol-containing compounds Dose: Used alone, usually 100-200
Side-effects: Nausea, vomiting, colic, micrograms/kg daily for 4-8 weeks
diarrhoea, fatigue, headache, limb and
joint pains, depression, irritability, rash, Note: Chlorambucil is administered
hypotension and tachycardia either as a single agent or combination
Dose: Calculated according to with prednisone.
oxazaphosphorine (cyclophosphamide
or ifosfamide) treatment. When given by Proprietary Preparation
mouth, dose is given 2 hours before Leukeran (I) (GSK), Tab. 2 mg
oxazaphosphorine treatment and
repeated 2 and 6 hours after treatment;
when given by intravenous injection, the
468
CYCLOPHOSPHAMIDE [ED] Dose: 8-10 g/m2 IV fractionated equally

to single daily dose for 5 consecutive
Indications: Breast, lung, ovary, testis days or a 24 hours infusion of 5-6 g/m2;
and bladder carcinomas. Bone and soft use in combination with Mesna (60% of
tissue sarcomas,Hodgkin’s and Non- total dose of Ifosfamide)
Hodgkin’s lymphomas. acute and
chronic lymphocytic leukemias,
Holoxan(I) (Baxter), Inj., Tk. 3049.8/1 gm Vial;
neuroblastoma and Wilm’s tumor of Tk. 4810.58/2 gm Vial
childhood, multiple myeloma. Ifamide(Techno), Inj., Tk. 2,400.00/1gmVial
Cautions: Hepatic and renal impairment ,Tk. 4,500.00/2gmVial
risk of cardiotoxicity; diabetes mellitus; Xifos (Beacon), Inj.,Tk. 1800.00/1gmVial, Tk.
avoid in acute porphyria 3200.00/2gmVial
Interactions: Anticoagulants,
pentostatin (avoid concomitant use), LOMUSTINE
muscle relaxants (enhance the effect of
suxamethonium) (See also Appendix-2) Indications: Primary and metastatic
Side-effects: See section 14.1 brain tumor, and advanced Hodgkin’s
Dose: High dose therapy: 20- disease
40mg/kg as a single I.V. dose given at Cautions: See section 14.1
10-20 days intervals. Medium dose Side-effects: See section 14.1, nausea
therapy: 10-15 mg/kg as a single I.V. and vomiting are common, permanent
dose weekly. Low dose therapy: 2-6 bone marrow damage may occur with
mg/kg as a single I.V. dose or in divided prolonged use
oral dose for 7 days & maintenance 100- Dose: used alone, 120-130 mg/m2 PO
200 mg daily. CHILD not recommended once every 6-8 weeks

Cyclomide (Techno ), Inj, 1 gm/ Vial, G-Lomustin (Gonoshasthaya),Tab. 10mg,
Tk.1,200.00/Vial Tk.60/Tab.
Cyclotox (Beacon), Inj., 1 gm/
Vial,Tk.650/Vial; Inj., 200mg/ Vial,
Tk.180.00/Vial TEMOZOLOMIDE
Cyphos (Drug Intl), Inj. , 200mg/ vial, Tk.
150.00/vial Indications: Newly diagnosed
Endoxan(I) (Baxter), Inj., 200mg,/vial Tk. glioblastoma multiforme in adults (in
3114.2/Vial; 500mg/vial, Tk. 20.52/Vial; 1gm, combination with radiotherapy) and
Tk. 1374.56/Vial; Tab., 50mg, Tk. 1718/Tab.
subsequently as
G-Cyclophosphamide (Gonoshasthaya),
Tab., 50 mg, Tk. 6/Tab. monotherapy, Second-line treatment of
Neoclomide (Healthcare), Inj., 200mg/vial, malignant glioma in adults.
Tk.; 197.00/vial, 500mg/vial, Tk. 464.00/vial,; Cautions: Pneumocystis jiroveci
Tab., 50mg, Tk. 31.00/Tab. pneumonia; consult product literature for
monitoring and prophylaxis requirements
IFOSFAMIDE Interactions: See Appendix-2
Side-effects: See section 14.1and notes
Indications: Tumors of testis, pancreas, above; oral mucositis, thromboembolism,
ear; nose & throat, ovary, bone, breast, tumor lysis syndrome.
lungs, GI Tract, kidneys; lymphomas and Dose: Consult product literature
soft tissue sarcomas
Cautions: See section 14.1; reduce the Proprietary Preparation
Temonix (Beacon), Cap., 100mg, Tk.
dose in hepatic and renal impairment, 600.00/Cap.; 250mg , Tk. 1300.00/Cap.
acute porphyria
Zolomide (Techno), Cap., 100mg, Tk.
Interactions: See Appendix-2 650.00/Cap., 250mg, Tk. 1500.00/Cap
Side-effects: See the side-effects of
cytotoxic drugs
469
14.1.2 CYTOTOXIC ANTIBIOTICS patent IV site through sidearm of a

running IV over 2 to 5 minutes; courses
may be repeated after 3 to 6 weeks.
BLEOMYCIN [ED]
Indications: Squamous cell carcinoma, Rubicin (Beacon), Inj., 20mg/vial, Tk. 600/Vial
lymphomas, germ cell tumors of testis
and ovary and certain solid tumors DOXORUBICIN HCL [ED]
Cautions: See section 14.1; renal
impairment; irritant to tissue
Indications: Lymphoma, leukemia,
breast cancer, ovarian cancer, sarcomas
Pulmonary-fibrosis, Pigmentation, hyper
and varieties of solid tumors
pyrexia
Cautions: Hepatic and renal impairment
Dose: Over 80 years, 15 mg/week, total
caution in handling - irritant to tissue
100mg; 70-79 years, 30 mg/week, total
(See section 14.1)
150-200 mg; 60-69 years, 30-60
mg/week, total 200-300 mg; under 60
years, 30-60 mg/week, total 500 mg; all
extravasation at the infusion site can
are given I.V. or in infusion
cause local necrosis, cumulative dose
Proprietary Preparation related cardiac damage, leading to
Bleocin (I)(Nippon), Inj. 15000unit/vial Tk. arrhythmias and heart failure
2063.99/vial Dose: 60-75 mg/m2 I.V. every 3 weeks.
30 mg/m2 I.V. one days 1 and 8 every 4
DACTINOMYCIN weeks (in combination). 15-20 mg/m2
(Actinomycin D) instilled into bladder weekly for 4 weeks
Indications: Gestational trophoblastic
neoplasms, Wilm’s tumor, Sindroxocin(I) (Actavis), Inj., 50mg/vial, Tk.
rhabdomyosarcoma and Ewing’s 1765.91/vial; Inj., 10 mg/Vial, Tk.908.75/vial
sarcoma of childhood Adribin (Healthcare), Inj. , 10mg/5ml, Tk.
Cautions: See section 14.1; caution in 350.00/vial,; 50mg/25ml Inj., Tk. 1100.00/vial
handling- irritant to tissue Dobixin(Drug Intl), Inj. , 10mg/5 ml, Tk.
Side-effects: See section 14.1 275.00/vial,; 50mg/25 ml, Tk. 900.00/vial
Doxorubicin HEXAL(I) (Hexel), Inj., 10 mg/5
Dose: CHILD: 0.40-0.45 mg/m2 (up to
ml, Tk. 307.00/5 ml Vial; 100 mg/50 ml, Tk.
maximum of 0.5 mg) IV daily for 5 days 1,725.00/50 ml Vial; 200 mg/100 ml, Tk.
every 3-5 weeks. 3,080.00/100 ml Vial; 50 mg/25 ml, Tk.
ADULT: 0.40-0.45 mg/m2 IV on days. 1-5 1,096.00/25 ml Vial
every 2-3 weeks. 0.5 mg IV daily for 5 Doxorub (Techno ), Inj., 10 mg/Vial, Tk.
days every 3-5 weeks. 406.00/10 ml vial ; 50 mg/Vial, Tk. 1,590.00/50
ml vial
Xorubion (Beacon), Inj., 10 mg/Vial, Tk.
Generic Preparation
300.00/10 mlvial; 50 mg/Vial, Tk. 1,000.00/50
Injection. 100 microgram/vial. ml Vial
DAUNORUBICIN HYDROCHLORIDE EPIRUBICIN HYDROCHLORIDE
Indications: Acute leukemia. Indications: Breast cancer

Cautions: Hepatic and renal Cautions: Hepatic impairment; caution
impairment; caution in handling-irritant to in handling - irritant to tissue (see section
tissue (see section 14.1) 14.1)
Side-effects: See section 14.1 and Side-effects: See section 14.1;
similar to those of Doxorubicine cardiotoxicity
Dose: 30 to 45 mg/m2 IV for 3 days; Dose: 70 to 90 mg/m2 as a bolus
using extravasation precautions; to be injection repeated every 3 to 4 weeks;
injected into a recently established bolus injection over 2 to 5 minutes or as
470
a continuous infusion through a central Xitabin (Beacon), Tab., 500mg, Tk.125/Tab.

venous catheter
CYTARABINE
Erubin (Beacon), Inj.,10mg/5ml , Tk. 915/5 ml
Indications: Acute myeloid leukemia
vial ; 50 mg/25 ml, Tk. 3,700/25ml vial
Episindan(I) (Sindan), Inj. 2 mg/ml, Tk. and, chronic myelogenous leukemia and
3,866.00/25ml vial; Tk.971.00/5ml vial non-Hodgkin’s lymphoma
Pharmorubicin(I) (Pharmacia), Inj. 50 mg/Vial, Cautions: See section 14.1; hepatic
Tk. 3118,91/Vial impairment
Epirubicin Pha Res(I) (Thymoorgan) Inj., 10 Side-effects: See section 14.1; bone
mg/ 5 ml vial, Tk. 1420.40/5 mlvial ; 50 mg/25 marrow toxicity, gastrointestinal
ml, Tk. 4545.29/25ml
disturbance, intra -hepatic cholestasis
and central nervous system toxicity
MITOMYCIN Dose: 100-200 mg/m2/day continuous IV
infusion for 5-10 consecutive days –
Indications: Upper gastrointestinal and Induction or 100 mg/m2 IV or SC twice a
breast cancer week for 5 days every 28 days.
Cautions: Hepatic impairment; caution MAINTENANCE DOSE:
in handling - irritant to tissue; (see • 40-50 mg/m2 intrathecally every 4
section 14.1) days per week.
Side-effects: See section 14.1 ;delayed • 1,000 mg to 3,000mg/m2 IV over 1
bone marrow toxicity, lung fibrosis and hour every 12 hours for up to 12
renal damage. doses.
Dose: 20 mg/m2 I.V. on day every 4-6
weeks. 2 mg/m2 I.V. on days 1-5 and 8- Proprietary Preparations
12 every 4-6 weeks. 30-40 mg instilled Cytabin (Beacon), Inj. , 100mg/5ml , Tk.
into bladder weekly for 4-8 weeks then 180.00/Vial,; Inj., 500mg/5ml , Tk.
monthly for 6 months 900.00/Vial,; 1gm/10ml , Tk. 1550.00/Vial.
Cytarabine (I) (Choongwa) Inj. 100mg/5ml
Mitomycin-C Kyowa (I) (Kyowa) Inj. 10mg/vial, FLUDARABINE PHOSPHATE
Tk.729.20/vial, Inj. 2mg/2ml, Tk.193.28/vial
Indications: B-cell chronic lymphocytic

14.1.3 ANTIMETABOLITES
leukemia, low-grade Non-Hodgkin’s
lymphoma, acute myeloid leukaemia-
CAPECITABINE Refractory and relapsing case.
Cautions: vaccination-during and after
Indications: Colorectal cancer, breast treatment with fludarabine phosphate,
cancer and other gastrointestinal tract vaccination with live vaccines should be
malignancy. avoided; renal impairment.
Side-effects: See section 14.1, hand- Contraindication: Hypersensitivity to
foot syndrome. the active substance or to any of the
Interactions: See Appendix-2. excipients; renal impairment with
Dose: 2500 mg/m2 per day in 2 to 3 creatinine clearance < 30 ml/ min;
divided doses for 2 weeks followed by 1 Hemolytic anemia; Pregnancy; Lactation;
week rest, to be taken with food below 18 years of age
Side-effects: Myelosuppression,
Proprietary Preparation opportunistic Infections, cough, fever,
Cabita (Drug Intl), Tab.500mg, Tk.100/Tab. fatigue, weakness, nausea, vomiting,
Tysinior (Genvio), Tab. 500 mg, Tk.120/Tab.;
150 mg, Tk.60/Tab.
diarrhea, hematological disorders
Xelobine(Healthcare),Tab., Dose: 25 mg/m² body surface area
500mg,Tk.150/Tab given daily for 5 consecutive days every
Xeloda (I) (Roche), Tab., 500 mg, Tk. 28 days by the Intravenous route for up
317.50/Tab. to 6 cycles.
471
Proprietary Preparation pulmonary oedema, alopecia,

Fludara(I) (Genzyme), Inj., 50mg/2ml, Tk. hypotension.
7422/Vial Dose: IV 1 g/m2 over a period of 30
minutes once weekly for 7 weeks
FLUOROURACIL[ED] followed by 1-week rest. Subsequent
courses of treatment are administered at
Indications: Breast and gastrointestinal the dose of 1 g/m 2 per week for 3 weeks
cancer, palliation of inoperable malignant followed by 1-week rest
neoplasm colonic cancer
Cautions See section 14.1 Proprietary Preparations
Contraindications: In handling-irritant Cytogem, (Drug Intl), Inj. (IV Infusion),,
to tissues 1gm/Vial, Tk. 4500.00/Vial
Gemcitabin Aqvida(I) (Actavis) Inj(I.V
Interactions: Antibacterials such as
Infusion), 1gm/vial, Tk.7029.50/Vial;
metronidazole inhibit the metabolism 200mg/vial, Tk.2196.72/vial
(increase toxicity), filgrastim possibly Gemcitabin HEXAL (I) (Ebewe) Inj.,
exacerbates neutropenia (IV Infusion), 40mg/ml, 975.00/5mlvial, Tk.
Ulcer healing drugs such as cimetidine 3,937/25ml
inhibit metabolism (increase plasma Gemcitabin medac(I) (Medac) Inj.,
concentration) (IV Infusion), 200mg/vial, Tk.2,482.81/Vial;
100mg/vial, Tk.12,411.03/vial
Side-effects: Same as the side-effects
Gemcitabin PhaRes(I) (Thymoorgn) Inj.,
of cytotoxic drugs; bone marrow (IV Infusion), 200mg/vial, Tk.2,450/Vial;
suppression, gastrointestinal ulceration, 1gm/vial, Tk.7080/vial
bleeding, severe diarrhoea, leucopenia, Gemcitin (Techno), Inj., (IV Infusion),
thrombocytopenia, stomatitis 200mg/vial,Tk.7287.50/25ml,1,987.50/5mlvial
Dose: Systemic - 500 mg/m2 IV on days Gemoxen (Beacon), Inj. (IV Infusion), ,
1-5 every 4 weeks. 450-600 mg/m2 IV 200mg/vial , Tk. 1400.00/5mlVial,; 1gm/vial,
Tk. 5000.00/25mlVial
weekly. 200-400 mg/m2 IV daily as a
Gemzar(I) (Lilly)Inj., (IV Infusion), 200mg/vial,
continuous IV infusion. 1000 mg/m 2 IV Tk.2,478.34/Vial; 1g/vial, Tk.8671.92/vial
daily for 4 days as a continuous IV Gitrabin(I) (Actavis) Inj., (IV Infusion),
infusion every 3-4 weeks 200mg/vial, Tk.1848.08/Vial; 1gm/vial
Intra-cavitary- 500-1000 mg for Tk.5850.50/vial
pericardial effusion. 2000-3000 for
pleural or peritoneal effusion MERCAPTOPURINE
Intra-arterial - 800-1200 mg/m2 as a
continuous infusion on days 1-4 followed Indications: Acute lymphatic leukemia
by 600 mg/m2 as a continuous infusion and acute non-lymphocytic leukemia.
on days 5-21 May be useful treatments for chronic
myeloid leukemia (CML), non-Hodgkin’s
Proprietary Preparation lymphoma, polycythemia vera,
Drucil (Healthcare), Inj. , 250mg/5ml, Tk. inflammatory bowel disease and
100.00/vial,; 500mg/10ml, Tk. 150.00/vial
Fluracil (Drug Intl), Inj., 500/10 ml, Tk.
psoriatic arthritis
100.00/vial Cautions: Same as the side-effects of
Fluroxan (Beacon), Inj., 250mg /5 ml, Tk. cytotoxic drugs reduce the dose in mild
60.00/vial,; 500mg/10 ml , Tk. 100.00/vial and moderate renal impairment; max.
5-Fu PhaRes(I) (Haurt) Inj., 50mg/ml, Tk. 2.5 mg in 24 hours and avoid in severe
457.15/10mlVial impairment
GEMCITABINE Side-effects: Same as the side-effects
of cytotoxic drugs
Indications: Advanced pancreatic Dose: Oral dose is 70 to 100 mg/m2/day
cancer: metastatic breast cancer (by mouth 2.5 mg/kg daily); 75% of the
Cautions: See section 14.1; standard dose to be reduced if
Side-effects: See section 14.1; renal allopurinol is co-administered. A
and hepatic impairment, myelotoxicity, common IV dose is 500-1000 mg/m2/day
472
for 2-3 days. Dose adjustment of 6-MP Dose: Oral doses up to 40mg/m2 are
administered by IV is not necessary with well absorbed. Parenteral doses vary
concomitant administration of allopurinol from 20-40 mg/m2 every 1 to 2 weeks to
200 to 500 mg/m2 every 2 to 4 weeks
Proprietary Preparations As an adjuvant treatment for
Leukin (Beacon) Tab. 50 mg.Tk. 20/Tab. osteosarcoma, doses of 12,000 to
Puri Nethol (I) (GSK), Tab. 50 mg,
Tk.40.76/Tab
15,000 mg/m2 have been given with
leucovorin rescue the usual adult
intrathecal dose is 10 to 15 mg in 7 to 15
METHOTREXATE [ED]
ml of preservative-free saline. Doses
greater than 80 mg/week should be
Indications: Choriocarcinoma, accompanied by leucovorin rescue
hydatidiform mole, all acute lymphocytic
leukemia, prophylaxis and treatment of Proprietary Preparations
meningeal lymphocytic leukemia, breast G-Methotrexate (Gonoshasthaya), Tab.,
cancer, epidermal tumors of the head 2.5mg, Tk. 4.00/Tab.
and neck, lung cancer, non-Hodgkin’s Meth (Drug Intl), Tab., 10mg, Tk. 12.00/Tab. ;
lymphoma, T-Cell lymphoma, psoriasis 2.5mg, Tk. 4.00/Tab.
Methotrax (Delta), Tab., 10 mg, Tk. 15/Tab.;
and rheumatoid arthritis . Methotrexate
Tab. , 2.5 mg, Tk. 5.00/Tab.
may be a useful treatment for multiple Methox (Popular), Tab. 2.5, Tk. 5.52/Tab.; 10
myeloma, rhabdomyosarcoma and mg, Tk. 15.06/Tab.
cancer of the bladder, brain, cervix, Metorax (Renata), Tab.,10mg, Tk. 15.00/Tab.
esophagus, kidney, ovary, prostate, Tab., 2.5 mg, Tk. 5.50/Tab.
stomach and testis Mtrex(Techno), Inj., 50 mg, Tk 110/Amp.
Cautions: See section 14.1 ; hepatic Trexonate (Beacon), Tab. , 10 mg, Tk.
15/Tab.; Tab., 2.5 mg, Tk. 5/Tab.; Inj., 50 mg,
and renal impairment
Tk.130/Amp.
Interactions: Analgesics such as aspirin
reduce the excretion, avoid concomitant
RALTITREXED
use of azapropazone, diclofenac,
ibuprofen, indomethacin, ketoprofen,
meloxicam, naproxen and Indications: Advanced colorectal cancer
phenylbutazone and probably other Caution: Hepatic and renal impairment
NSAIDs increase the risk of toxicity (see Contra-indication: Pregnancy and
also Appendix-2 and notes below). breastfeeding
Antibacterials such as co-trimoxazole Side-effect: See section 14.1;
and trimethoprim increase the antifolate myelosuppression and gastrointestinal
effect of methotrexate, penicillin and disturbance
sulphonamides decrease the excretion Interaction: See Appendix-2
of methotrexate and increase the risk of Dose: consult with an oncologist
toxicity.
Antiepileptics such as phenytoin Generic Preparation
Injection 2mg/vial
increase the antifolate effect and thus
increase the toxicity.
Antimalarial such as pyrimethamine 14.1.4 VINCA ALKALOIDS AND
increase the antifolate effect. ETOPOSIDE
Ciclosporin increases the toxicity.
Corticosteroids increase the risk of ETOPOSIDE
hematological toxicity.
Uricosuric-probenecid reduces the Indications: Particularly useful in lung
excretion of methotrexate and increases cancer, testicular and ovarian cancer,
the risk of toxicity gestational choriocarcinoma, Hodgkin’s
Side-effects: Same as the side-effects and non Hodgkin’s lymphomas, acute
of cytotoxic; myelosuppression myelogenous leukemia, acute
myelomonocytic leukemia, Kaposi’s
473
sarcoma, neuroblastoma, Ewing’s Interactions: See Appendix-2

sarcoma, Wilm’s tumor and Dose: commonly used doses range from
rhabdomyosarcoma, cancer of breast, 0.5 to 1.4 mg/m2 every 1 to 4 weeks.
bladder and prostate. Continuous infusion regimens of 0.5 mg
Cautions: See section 14.1 to 0.5 mg/m2/day for 4 days have been
Contraindications: Severe hepatic used
impairment
Side-effects: See section 14.1: Proprietary Preparations
myelosuppression, alopecia, peripheral Criston (Beacon), Inj., 1 mg/Vial, Tk.
neuropathy; it is also irritant to tissue, 350.00/Vial ; 2 mg/Vial, Tk. 580.00/Vial
Vincrist (Techno ), Inj., 1 mg/Vial, Tk.
nausea and vomiting 460.00/Vial
Dose: 120-240 mg/m2/day for 3 to 5 Vincristine(I)(Phamachemie) 1 mg/Vial, Tk.
days; given orally 371.95/Vial ; 2 mg/Vial, Tk. 526.92/Vial
Vinstin (Drug Intl), Inj. ,2mg/vial, Tk.
Proprietary Preparations 400.00/Vial
Eposid (Techno), Inj., 100 mg/vial, Tk.530/Vial
Eposin(I)(Pharmachemie),Inj.,100mg/vial, Tk. VINORELBINE
584.07/Vial
Toposar (Drug Intl), Inj.,100mg/5 ml, Tk.
350.00/5ml vial Indications: Used for different malignant
Topoxin (Beacon), Inj.,100mg/5 ml,Tk. conditions (Acute leukemias, lymphomas
400.00/5ml Vial and breast and lung cancer)
VINBLASTINE SULPHATE [ED] Cautions and Side-effects: See section
14.1
Indications: Advanced Hodgkin’s Interactions: See Appendix-2.
lymphomas and also to treat the Dose: Consult with oncologist
carcinomas of bladder, breast, Kaposi’s
sarcoma and certain other malignant Proprietary Preparations
Vinorelbin Sandoz(I) (Ebewe), Inj (I.V
conditions, mycosis fungoides Infusion)10 mg/ ml, Tk. 1247.00/Vial;
Cautions: Hepatic impairment. Caution 4,370.00/5 ml, Vial
in handling; (see under section 14.1) Vinorelbin Actavis(I) (Actavis), Inj(I.V
Contraindications: Intrathecal injection Infusion), 10 mg/ ml, Tk. 10246.93/5mlVial;
Side-effects: See under section 14.1;
irritant to tissue, leucopenia 14.1.5 OTHER ANTINEOPLASTIC
Dose: 6 to 10mg/m2 every 2 to 4 weeks DRUGS
in combination with other drugs
Crisantaspase is the enzyme
Velvin (Beacon), Inj.10mg/vial , Tk. 850.00/vial
asparaginase produced by Erwinia
chrysanthemi. It is given IM or S/C
exclusively in Acute Lymphoblastic
VINCRISTINE SULPHATE[ED]
Leukaemia. Side-effects include nausea
and vomiting and can cause
Indications: Vincristine is an essential anaphylactic reactions, CNS depression,
part of combination chemotherapy and liver damage.
regimens for ALL and play an important
role in the treatment of both Hodgkin’s ALTRETAMINE
and non Hodgkin’s lymphomas and
certain other tumors. Indications: Advanced ovarian cancer
Cautions: Same as the side-effects of where other regimen have failed
cytotoxic drugs; hepatic impairment. Cautions: Hepatic and renal
Caution in handling impairment; to be careful in handling;
Contraindications: Intrathecal injection regular neurological examinations is be
Side-effects: Same as the side-effects recommended. (See section 14.1)
of cytotoxic drugs; irritant to tissue, Side-effects: See section 14.1 and
paresthesia, motor weakness. notes above; peripheral and central
474
neurotoxicity, rash, renal and hepatic Proprietary Preparations

toxicity Decarbazine (I) (Mayane), Inj. 200 mg/20 ml.
Dose: 260 mg/m2/day in 4 divided dose Tk.1126.96/20ml vial
Decarbazine Medac(I) (Medac), Inj.,
(after meals and at bedtime) for 14 days 200mg/20ml vial,Tk.7962.35/vial
to 21 days of a 28 day cycle; given for up
to 12 cycle. Temozolomide is structurally related to
dacarbazine and is licensed for the
Generic Preparation second line treatment of malignant
Capsule 100mg
glioma. It is an oral preparation.
BORTEZOMIB
Temonix(Becon),Cap.,100mg.TK.600/Cap.;
250mg.Tk.1300/cap
Indication: Relapsed multiple myeloma
and mantle cell lymphoma
Cautions: Pregnancy, liver disease, DASATINIB
kidney disease
Contraindication: Pregnancy Indication: Chronic phase chronic
Side-effects: Peripheral neuropathy, myeloid leukaemia, acute
myelosuppression, neutropenia, lymphoblastic leukemia
thrombocytopenia, asthenia Caution: Same as the side-effects of
Dose: 1.3 mg/m2 (with or without cytotoxic drugs; Hepatitis B infection.
dexamethasone) administered by Risk of cardiac dysfunction, susceptibility
intravenous bolus on days 1,4,8 and 11 to QT interval prolongation, pulmonary
of a 21-day cycle for a maximum of eight arterial hypertension
cycles in heavily pretreated patients with Side-effects: Same as the side-effects
relapsed/refractory multiple myeloma. of cytotoxic drugs; amnesia, asthma,
cholecystitis, cholestasis. drowsiness,
Proprietary Preparations erythema nodosum, gynaecomastia,
Bortez (Beacon), Inj. , 1mg/vial Tk. hepatitis, hypersensitivity reactions,
7500.00/Vial hypocalcemia, hypotension, irregular
Velcade (I) (Janseen)Inj.,1mg/vial Tk.
menstruation, nail disorders,
14204.90/vial.
oesophagitis, pancreatitis,
photosensitivity, pigmentation,
proteinuria, rhabdomyolysis, seizures,
DACARBAZINE AND TEMOZOLOMIDE syncope, thrombophlebitis, transient
ischaemic, hepatic failure, hepatitis
DACARBAZINE Breactivation, hyperuricemia, interstitial
lung disease, nausea, ,
Indication: Metastatic malignant thromboembolism, thrombosis, tumor
melanoma, soft tissue sarcoma, lysis syndrome
Hodgkin’s disease Dose: It is given orally 100 mg once
Caution: Hepatic and renal impairment, daily, then increased if necessary up to
pregnancy, breastfeeding 140 mg once daily in case of Chronic
Side-effects: Same as the side-effects phase chronic myeloid leukemia;
of cytotoxic drugs myelosuppression, whereas orally 140 mg once daily, then
severe nausea and vomiting; rarely liver increased if necessary
necrosis due to hepatic vein thrombosis; up to 180 mg once daily for Acute
irritant to skin and tissues lymphoblastic leukemia
Dose: It is given IV in doses of 150-250
mg/m2/day for 5 days, to be repeated at Proprietary Preparations
intervals of 4 weeks, or 250 mg/m 2 body Dasanix (Beacon), Tab. 100 mg. Tk.400/ Tab..
20 mg. Tk.80/ Tab.
surface daily for 5 days, to be repeated
at intervals of 3 weeks.
475
ERLOTINIB Dose: 80 mg once daily orally for dose

adjustment due to side-effects-consult
Indications: metastatic or locally product literature
advanced non-cell small cell lung
cancer, advanced unresectable
Tagris 80 (Beacon), Tab. 80 mg. Tk.80/ Tab.
metastatic prostate cancer Osicent 80 (Incepta), Tab. 80 mg. Tk.500/
Cautions: See section 14.1; hepatic Tab.
impairment; renal impairment; pregnancy
& breast feeding IBRUTINIB
Side-effects: Same as the side-effects
of cytotoxic drugs
Indications: Treatment of relapsed or
Dose: Non-small cell lung cancer, 150
refractory mantle cell lymphoma; chronic
mg once daily. Pancreatic cancer, 100
lymphocytic leukemia and Waldenstr m’s
mg once daily in combination with
macroglobulinemia
gemcitabine
Cautions: Family history of congenital
Note: Erlotinib monotherapy is not short QT syndrome, increased
recommended for maintenance lymphocytes increased risk of
treatment in people with locally leukostasis, consider withholding
advanced or metastatic non-small-cell treatment temporarily and monitor
lung cancer who have stable disease closely, patients at risk from further
after platinum-based first-line shortening of QTcinterval, personal
chemotherapy. history of congenital short QT syndrome,
risk of hemorrhagic events—withhold
Proprietary Preparations ibrutinib treatment for at least 3 to 7 days
Erlocent (Incepta), Tab., 100 mg, Tk. before and after surgery depending on
550.00/Tab.; 150 mg, Tk. 700.00/Tab. risk of bleeding; hepatic and renal
Erlonix (Beacon), Tab. , 100 mg , Tk. impairment, pregnancy & breastfeeding.
550.00/Tab.; 150 mg , Tk. 700.00/Tab. Side-effects: Arthralgia, atrial fibrillation,
Erloren (Renata), Tab., 100 mg, Tk. blurred vision, bruising, constipation,
600.00/Tab.; 150 mg, Tk. 750.00/Tab.
Erlotin (Healthcare), Tab., 100mg , Tk.
dehydration, diarrhea, dizziness, dry
750.00/Tab.; 150mg Tk. 1000.00/Tab. mouth, epistaxis, haemorrhage,
Tarceva(I) (Roche), Tab., 150 mg, Tk. headache, musculoskeletal pain,
3987.95/Tab.; 100 mg, Tk. 3606.00/Tab. peripheral oedema, petechiae, pyrexia,
Tercenib (Techno), Cap. , 150 mg, Tk. rash, respiratory tract infection, sepsis,
750.00/Cap.; 100 mg, Tk. 650.00/Cap. sinusitis, skin infection, subdural
haematoma, urinary tract infection,
OSIMERTINIB Leukostasis, oral mucositis,
thromboembolism, tumour lysis
Indications: locally advanced or syndrome
metastatic epidermal growth factor Dose: For treatment of relapsed or
receptor T790M mutation-positive non- refractory mantle cell lymphoma; 560 mg
small-cell lung cancer once daily orally and for treatment of
Cautions: Elderly; history of interstitial chronic lymphocytic leukemia and
lung disease; radiation pneumonitis Waldenstr m’s macroglobulinemia, orally
requiring steroid treatment, risk factors 420 mg once daily
for QTc interval prolongation; pregnancy
& breastfeeding. Proprietary Preparations
Side-effects: Diarrhoea; dry skin Ibrutix (Beacon), Cap., 140 mg, Tk.
600.00/Cap.
disorders; interstitial lung disease ; nail
Ibrucent 140 (Incepta), Cap., 140 mg Tk.
disorders, pruritus, rash; stomatitis; QTc 500.00/Cap.
interval prolongation. Ibrunib(Julphar), Cap., 140 mg.
476
EVEROLIMUS HYDROXY CARBAMIDE
Indications: Advanced renal cell Indication: Chronic myeloid leukemia.

carcinoma, prevention of organ rejection Cautions and Side-effect : See section
after renal and kidney transplant, breast 14.1; bone marrow depression
cancer in post-menopausal women with Contraindications: Pregnancy &
advanced hormone-receptor positive breastfeeding
Cautions: Hepatic impairment, renal Dose: Consult with oncologist
impairment, pregnancy, breastfeeding.
Side-effects: change in ability to taste Proprietary Preparations:
food, dry mouth, weakness, difficulty Hydrea(I)(Squibb),Cap.500mg, Tk.19.83/Cap
falling asleep, nose bleed, muscle Hydronix(Beacon),Cap. 500mg, Tk.15.00/Cap
Mylostat (Drug Int) Cap. 500mg,
cramps Tk.15.00/Cap
Dose: Renal cell carcinoma,
neuroendocrine tumors of pancreatic IMATINIB
origin, hormone-receptor-positive breast
cancer. ADULT over 18 years, 10mg
once daily; consult product literature Indication: Chronic myeloid leukemia
Cautions: Cardiac disease; risk factors
Proprietary Preparations for heart failure; history of renal failure;
Afinitor(I) (Novartis), Tab., 5 mg, Tk. monitor for fluid retention; monitor liver
5813.00/Tab.; 10 mg, Tk. 8943.00/Tab.; function; monitor growth in children
Certican(I) (Novartis), Tab., 0.25 mg, Tk. Side-effects: See section 14.1;oedema,
125.00/Tab.; 0.50 mg, Tk. muscle pain, headache, nausea,
250.00/Tab;0.5mgTK.375/Tab vomiting diarrhoea
Xevirol (Beacon), Tab. , 5mg , Tk.
Dose: 400 mg/day till the disease
1500.00/Tab.
persists (Literature advised for at least
GEFITINIB one year)
Indication: Non-small cell lung cancer Glivec(I) (Novartis), Cap. 100 mg, Tk.
Cautions: Breastfeeding, interstitial lung 1666.00/Cap.
disease, hepatotoxicity and liver Enliven (Orion), Cap, 100 mg, Tk.
125.85/Cap.
impairment
Imanix (Beacon), Tab., 100mg , Tk.
Contraindication: Pregnancy and 100.00/Tab. ; 400mg , Tk. 300.00/Tab.
breastfeeding (must be discontinued Tyrokin (Renata), Tab., 400MG, Tk.
while receiving Gefitinib therapy) 300.00/Tab.
Side-effects: Anorexia mild or Tyronib (Healthcare), Tab., 400mg , Tk.
moderate, conjunctivitis, blepharitis, and 350.00/Tab.; 100mg , Tk. 100.00/Tab.
dry eye, corneal erosion, Keratitis
(0.12%), hemorrhage, diarrhea,
vomiting, hepatobiliary disorders, skin LAPATINIB
reactions, nail disorder, cutaneous
vasculitis, proteinuria, cystitis
Indications: Metastatic breast cancer
Dose: 250mg tablet once a day
and other solid tumors. It is used in
combination therapy for HER2-positive
Gefinix (Beacon), Tab. 250 mg, Tk.250/Tab. breast cancer
Geficent (Incepta), Tab. , 250 mg, Tk. Cautions: Hepatotoxicity, pregnancy
120.00/Tab. category D, renal impairment
Contraindication: Same as that of
HYDROXYCARBAMIDE/HYDROXYU cautions
REA Side-effects: Fast or pounding
heartbeats, extreme dizziness or tired
feeling, feeling like you might pass out,
477
severe diarrhea, dry cough, feeling short Contraindications: Same as that of

of breath, white patches or sores inside cautions, not recommended in patients
the mouth or on lips, nose bleeding (see with severe hepatic impairment
section 14.1) Side-effects: Changes in hair colour,
Dose: 1,250 mg given orally once daily hypertension which usually occurs
on Days 1-21 continuously in during the first few weeks of treatment,
combination with capecitabine 2,000 appetite loss, hyperglycemia,
2
mg/m /day (administered orally in 2 hypocalcemia, hypomagnesemia,
doses approximately 12 hours apart) on hypophosphatemia, increased AST, ALT
Days 1-14 in a repeating 21-day cycle and protein in the urine, edema, rash,
fatigue, and myelosuppression
Proprietary Preparation Interactions: See Appendix -2
Lapacent (Incepta), Tab. , 250 mg, Tk. Dose: 800 mg orally once daily without
300.00/Tab. food (at least 1 hour before or 2 hours
Tykerb (I) (Novartis), Tab. , 250 mg, Tk.
after a meal). Baseline moderate hepatic
356.49/Tab.
Tykerb(I) (GSK),Tab., 250 mg TK.356.59/Tab
impairment – 200 mg orally once daily
NILOTINIB Votrient(I) (GSK) Tab.,800 mg Tk.625.69/Tab
Indications: Chronic myeloid PERTUZUMAB

leukemia where Philadelphia
chromosome is positive Indications: It is indicated for the
Cautions: Prolongs the QT interval; treatment of HER2-positive metastatic or
concomitant use of drugs that prolong locally recurrent unrespectable breast
QT interval; hypokalemia, cancer in combination with trastuzumab
hypomagnesemia, or long QT and docetaxel, in patients who have not
syndrome received previous anti-HER2 therapy or
Side-effects: Headache with chest chemotherapy. Pertuzumab is given by
pain and severe dizziness, fainting, intravenous infusion; resuscitation
fast or pounding heartbeats,fever, facilities should be available and
chills, body aches, flu symptoms, treatment should be initiated by a
sores in mouth and throat, blood in specialis
urine or stools; severe pain in upper Cautions: See section 14.1; a history of
stomach spreading to back; congestive heart failure, impaired left
Q-Tinterval prolongation; ventricular function uncontrolled
hypertension, edema hypertension, recent myocardial
Dose: Consult product literature infarction, serious cardiac arrhythmia,
prior anthracycline exposure, or
Proprietary Preparation radiotherapy to the chest area assess for
Tasigna(I) (Novartis), Cap. 200 mg, signs and symptoms of congestive heart
Tk.3040/Cap. failure (including left ventricular ejection
fraction) before and during treatment—
PAZOPANIB consult product literature, and withhold
treatment if necessary
Indications: Renal cell carcinoma and Contraindication: Pregnancy, breast
soft tissue sarcoma feeding, hepatic and renal impairment
Cautions: Hypertension, including Side-effects: See section 14.1; also
hypertensive crisis, thrombotic (when used in combination with
microangiopathy; thrombocytopenic trastuzumab and docetaxel) decreased
purpura, hemolytic uremic syndrome; appetite, diarrhoea, constipation,
decreased LVEF and congestive heart dyspepsia, left ventricular dysfunction,
failure oedema, dyspnoea, cough, pleural
effusion, nasopharyngitis, insomnia,
478
peripheral neuropathy, headache, disease reversible thyroid dysfunction

dizziness, taste disturbance, pain, and Stevens-Johnson syndrome
malaise, pyrexia, chills, upper Dose: ADULT over 18 years, 400 mg
respiratory-tract infection, paronychia, twice daily.
neutropenia (including febrile
neutropenia), leucopenia, anaemia, Proprietary Preparation
myalgia, arthralgia, increased Sofenib (Renata), Tab., 200 mg, Tk.
300.00/Tab.
lacrimation, rash, nail disorder, pruritus, Sonib (Drug Intl), Tab., 200 mg, Tk.
dry skin; infusion-related reactions 250.00/Tab.
including severe hypersensitivity Soracent (Incepta), Tab., 200 mg, Tk.
reactions; less commonly interstitial lung 275.00/Tab.
disease Soranix (Beacon), Tab., 200 mg , Tk.
Dose: Consult physician and product 275.00/Tab.
literature
SUNITINIB
Perjeta (I) (Roch) Inj., (IV Infusion),420mg/14ml
Indications: Advanced kidney cancer. It
vial,Tk 211695/vial
Pertuza(Incepta), Inj., (IV Infusion),420 mg/14 is also used in gastrointestinal stromal
ml, Tk. 70000.00/14 ml Vial tumor , after failure of imatinib, and for
the treatment of unrespectable or
metastatic pancreatic neuroendocrine
RUXOLITINIB
tumour
Cautions: Increased risk of bleeding;
disease-related splenomegaly or
monitor for thyroid dysfunction;
symptoms in adult patients with primary
congestive heart failure, high blood
myelofibrosis (also known as chronic
pressure, QT-interval prolongation;
idiopathic myelofibrosis), post
consider dental check-up before initiating
polycythaemia vera myelofibrosis or post
treatment, pregnancy and breastfeeding
essential thrombocythaemia
Side-effects: Fatigue, hand-foot skin
myelofibrosis.
reaction, hypertension, paraesthesia,
Cautions, Contraindications & Side
hypothyroidism, arthralgia, increased
effects: See section 14.1 and consult
lacrimation, epistaxis
product literature
Dose: 50 mg once daily for
Dose: Consult physician and product
gastrointestinal stromal tumor and
literature
advanced renal cell carcinoma
Proprietary Preparation Proprietary Preparation
Jakvi (I) (Novertis),Tab.5mg Tk. 3891.67/Tab.
Sunitix(Beacon),Cap,50mg,Tk.1800/Cap.
SORAFENIB TEMOZOLOMIDE
Indication: Malignant glioma
Indications: Advanced renal cell Cautions: Same as the side-effects of
carcinoma, hepatocellular carcinoma, cytotoxic drugs ; hepatic and renal
thyroid cancer impairment; caution in handling
Caution: Major surgical procedures, Contraindication: CHILD under 3 years
cardiac ischemia, susceptibility to QT- not recommended
interval prolongation, hepatic Side-effects: See notes above
impairment, pregnancy and breast- Dose: Consult product literature
feeding
Side-effects: Decreased blood flow to Proprietary Preparations:
the heart and heart attack, bleeding Temonix (Beacon), Cap. , 100 mg, Tk.
problems, high blood pressure, hand- 600.00/Cap.; 250 mg, Tk. 1,300.00/Cap.
foot skin reaction, Interstitial lung Zolomide (Techno), Cap. , 100 mg, Tk.
650.00/Cap.; 250 mg, Tk. 1,500.00/Cap
479
PLATINUM COMPOUNDS Cautions: See section 14.1; renal

impairment
The platinum compounds are complexes Interactions: Antibacterials such as
of platinum with ligands which can be aminoglycosides, vancomycin and
displaced by nucleophilic (electron rich) capreomycin increase the risk of
atoms to form strong bonds with nephrotoxicity and possibly ototoxicity;
covalent characteristics. Thus, like the diuretics increase the risk of
alkylating agents, the platinum agents nephrotoxicity and ototoxicity.
form strong chemical bonds with thiol Side-effects: See section 14.1;
sulfurs and amino nitrogens in proteins myelosuppression
and nucleic acids. Doses: Common IV dose is 360 to 400
Cisplatin requires a “Day-care setting” mg/m2 every 4 weeks. Doses of 400 to
and is given intravenously. It is of value 550 mg/m2 have been given. Carboplatin
in patients with metastatic germ cell can also be administered in higher doses
tumors (Teratoma, seminoma). It can (e.g. 1500 mg/m2) in combination with
also be used in bladder, lung, upper GIT other antineoplastic drugs
and ovarian cancer though for ovarian
cancer carboplatin is more preferable.
Carboplat (Beacon), Inj.,(I.V infusion)
Cisplatin requires intensive intravenous 10mg/ml, Tk. 1,400.00/15mlVial ; Tk.
hydration and treatment may be 3,800.00/45 ml Vial
complicated by severe nausea and Carbotin (Techno ), Inj. (I.V infusion)10mg/ml,
vomiting. This is generally toxic giving Tk. 4,637.50/45ml; Tk.1,550.00/15mlVial
rise to nephrotoxicity, ototoxicity, Carboplatin HEXAL(I) (Hexel), Inj. (I.V
peripheral neuropathy. infusion) 10mg/ml ,Tk. 1,166.00/15 ml Vial;
Tk. 3,069.00/45 ml Vial; Tk. 423.00/5 ml Vial
Carboplatin has activity equivalent to
Carboplatin sindan(I) (Sindan) Inj. (I.V
that of cisplatin but used especially in infusion) 10mg/ml, Tk.4146.14/45ml vial; Tk.
ovarian cancer and lung cancer 5156.47/60ml vial
(Particularly small cell type). It is Carboplatin Phares (I) (Thymoogan) Inj. (I.V
administered intravenously on an out infusion) 10mg/ml, Tk.4700/45ml vial;
patient basis and it is better tolerable lTk.2400/15mlVial
than cisplatin. The dose of carboplatin Carboplat (Beacon), Inj., 150mg/15ml, Tk.
1400.00/vial,; 450mg/45 ml , Tk. 3800.00/vial
is determined according to the renal
Carplatin (Drug Intl), Inj., 150mg/15ml, Tk.
function rather than the body surface 1400.00/vial,; 450mg/45 ml, Tk. 3700.00/vial
area. Though the myelosuppression is Cytocarb (Healthcare), Inj. , 150mg/15ml, Tk.
more severe than cisplatin but the 1600.00/vial,; 450mg/45ml, Tk. 4400.00/vial
nephrotoxicity or ototoxicity with
carboplatin is less severe. CISPLATIN[ED]
Oxaliplatin is administered
intravenously for the treatment of Indications: Teratoma, seminoma
metastatic colorectal cancer in ( metastatic germ cell tumors) and also
combination with fluorouracil and folinic bladder, lung, upper GIT cancer
acid. Along with sensory peripheral Cautions: See section 14.1 ; renal
neuropathy which id dose limiting other impairment; to be monitored renal
side effects eg. GIT disturbance, function and haemoglobin parameter
ototoxicity, myelosuppression are also Interactions: Antibacterials such as
common. Manufacturers advise for close aminoglycosides, vancomycin and
monitoring of the renal functions. capreomycin increase the risk of
nephrotoxicity and possibly ototoxicity;
CARBOPLATIN diuretics increase the risk of
nephrotoxicity and ototoxicity
Indications: Ovarian cancer and lung Side-effects: See section 14.1 severe
cancer(particularly small cell type) nausea and vomiting, nephrotoxicity,
ototoxicity, peripheral neuropathy.
480
Dose: Doses may vary from 20 to 40 Sindaoxplatin(I) (Sindan), Inj., 50 mg/Vial, Tk.
mg/m2/day for 3 to 5 days every 3 to 4 4377.00/vial
weeks or from 20-120 mg/m2 given as a Xaloplat (Beacon), Inj., 100 mg/vial, Tk.
5,500.00/vial; 50 mg/vial, Tk. 3,000.00/vial
single dose every 3-4 weeks intra
peritoneal dose of 100 to 270 mg/m 2
have been given in combination with IV PROCARBAZINE [ED]
sodium thiosulfate
Indications: Is mainly used in the
Proprietary Preparations treatment of Hodgkin’s disease, with
Cesalin (Techno), Inj. (I.V infusion) , Tk. other combination eg. MOPP (Mustine,
225.00/10mgVial;Tk. 1,060.00/50mgVial Oncovin, Procarbazine and
Cisplat (Healthcare), Inj. (I.V infusion) , Prednisolone)
1mg/ml, Tk. 300.00/10mlVial, Tk.
Cautions: See section 14.1and notes
957.08/50mlVial
Cisplatin (I) (Pfizer), Inj. (I.V infusion) 1mg/ml above; renal impairment; reduce the
Tk. 1124/50 ml Vial, Tk. 502/10 ml Vial, dose in moderate impairment
Tk.3836/45mlvial Interactions: Alcohol ingestion may
Cisplatin HEXAL PI(I) (Hexel), Inj. (I.V cause a disulfiram-like reaction; it can
infusion) 1mg/ml Tk. 313.00/20 ml; Tk. cause hypertension, because it is a
987/100 ml weak MAOI. See also Appendix-2
Cisplatin Pha Res(I) (Thymoogran), Inj. (I.V
Side effects: See section 14.1; nausea,
infusion), 1mg/ml Tk.1330/100ml Vial;
Neoplat (Drug Intl), Inj. (I.V infusion) , 1mg/ hypertension, tachycardia, diplopia,
ml, Tk. 250.00/Vial, Tk. 800.00/50 ml Vial photophobia, myelosuppression and skin
Platinex (Beacon), Inj. (I.V infusion) 1mg/ ml , rash above
Tk. 250.00/10mlVial, Tk. 815.00/50ml Vial Dose: Initially 50 mg daily, increased by
Sinplatin (I) (Sindan), Inj. (I.V infusion), 1mg/ 50 mg daily to 250-300 mg daily, in
ml, Tk.1548/50mlVial divided doses; maintenance (on
Sinplatin(I) (Actavis), Inj. (I.V infusion) 1mg/
remission) 50-150 mg daily to a
ml, Tk.1114.47/50mlVial; Tk.370.00/10ml vial
cumulative total of at least 6g
OXALIPLATIN Generic Preparation
Capsule 50 mg.
Indications: Metastatic colorectal
cancer in combination with FU and folinic TAXANES
acid
Cautions: Renal impairment
CABAZITAXEL
Contra-indications: Peripheral
neuropathy and functional impairment
Side-effects: See section14.1 and notes Indications: In combination with
above prednisone, for the treatment of patients
Dose: Consult with oncologist with hormone-refractory metastatic
prostate cancer (mHRPC) previously
Proprietary Preparations treated with a docetaxel-containing
Eloxatin(I) (Aventis), Inj. 50 mg/Vial, Tk. treatment regimen
6230.74/Vial Cautions: Severe hypersensitivity can
Oxaliplat (Healthcare), Inj. , 100 mg/Vial, Tk.
5498.84/Vial; 50 mg/Vial, Tk. 2998.84/Vial
occur and may include generalized rash/
Oxaliplatin Aqua Vida(I) (Aquvida) , Inj., 100 erythema, hypotension and
mg/20mlvial,Tk.6249.77/vial.,50mf/10ml.Tk.36 bronchospasm. Discontinue cabazitaxel
93.05/vial immediately if severe reactions occur
Oxaliplatin medac(I) (Medac) , Inj., 100 and administer appropriate therapy
mg/vial, Tk. 5387.32/vial Contraindications: In patients with
Oxalotin (Techno), Inj., 100 mg/vial, Tk. neutrophil counts of ≤1,500 cells/mm3; a
7,900.00/vial ;50 mg/vial,Tk. 5,962.50/vial
Oxiplat (Drug Intl), Inj. 100 mg/Vial, Tk.
history of severe hypersensitivity
5000.00/Vial; 50 mg/Vial, Tk. 2500.00/Vial reactions to cabazitaxel or to other drugs
formulated with polysorbate 80
481
Side-effects: The most common (10%) Docetex (Techno), Inj., .,(IV.infusion) 20

grade 1–4 adverse reactions were mg/0.5 ml, Tk. 5,000.00/Vial ; 80 mg/2 ml, Tk.
anemia, leukopenia, neutropenia, 18,000.00/Vial
Docexan (Beacon), Inj., .,(IV.infusion) 20
thrombocytopenia, diarrhea, fatigue, mg/0.5 ml, Tk. 3,200.00/Vial;80 mg/2 ml, Tk.
nausea, vomiting, constipation, asthenia, 11,000.00/Vial
abdominal pain, hematuria, back pain, Taxotere(I) (Sanofi), , Inj.,(IV.infusion) 20
anorexia, peripheral neuropathy, pyrexia, mg/ml, Tk. 27724.13/4mlVial
dyspnea, dysgeusia, dyspepsia, cough,
arthralgia, and alopecia. The most PACLITAXEL
common (_5%) grade 3–4 adverse
reactions in patients who received Indications: Primary ovarian cancer
cabazitaxel were neutropenia, (advanced or residual disease following
leukopenia, anemia, febrile neutropenia, laparotomy) in combination with
diarrhea, fatigue, and asthenia cisplatin; metastatic ovarian cancer
Dose 25 mg/m² as a 1-hour IV every 3 where standard platinum-containing
weeks, in combination with oral therapy has failed; advanced or
prednisone 10 mg administered daily metastatic breast cancer (in combination
with trastuzumab) when an anthracycline
not appropriate; metastatic breast
Jevtana(I) (Sanofi), Inj., 60 mg/1.5 ml, Tk.
142687/Vial carcinoma where standard
anthracycline-containing therapy has
failed or is inappropriate; non small cell
DOCETAXEL
lung cancer (in combination with
cisplatin) when surgery or radiation
Indications: Advanced or metastatic therapy not appropriate
breast cancer, non-small cell lung Cautions, Contraindications and Side-
cancer, gastric cancer, head and neck effects: See section 14.1; bradycardia
cancer, ovarian cancer; or asymptomatic hypotension,
Cautions: Monitor liver function - dose myelosuppression, peripheral
reduced according to liver enzymes; neuropathy and cardiac conduction
avoid in severe hepatic impairment defects with arrhythmias (which are
Contraindications: Patients with nearly asymptomatic). It also causes
serious bone marrow depression, alopecia, muscle pain, nausea and
complication of infection, suspected of vomiting from mild to moderate.
infection Interactions: See Appendix-2
Interactions:Erythromycin,ketoconazole Dose: Consult with oncologist
,Ciclosporin may cause possible Proprietary Preparations
interactions; see also Appendix-2 Paclitaxel Actavis(I) (Actavis), Inj(I.V Infusion),
Side-effects: Neutropenia, nausea and 6mg/ ml, Tk. 5081.88/16.7 ml Vial;
vomiting are common, but brief. Fluid Tk.13855.01/43.33ml vial
retention severe hypersensitivity (Nano particle Albumin bound)
reactions with flushing, hypotension with Nab Xelpac (Beacon), Inj. (I.V Infusion),, 6mg/
ml,, Tk. 25000.00/16.7mlVial
or without dyspnoea. Ontaxel (Drug Intl), Inj., (I.V Infusion),, 6mg/
Dose: ADULT dose is 60-100 mg/m2 ml, Tk. 2500.00/16.7mlVial, Tk.
(body surface area), IV drip infused over 7500.00/50mlVial
1 hour once a day at intervals of 3-4 Paclitaxel Aqvida(I) (oncotec) Inj(I.V Infusion),
weeks 6mg/ ml, Tk. 4599.78/16.7mlVial; Tk.
2012.40/5mlVial
Proprietary Preparations Paclitaxel medac(I) (Medac) Inj(I.V Infusion),
Docetaxel Aqvida(I) (oncotec) Inj.,(IV.infusion) 6mg/ ml,Tk/13,552.94/50ml; , Tk.
20 mg/ml, Tk. 3,593.58/Vial; Tk. 6,707.25/16.7ml Vial; Tk.2,647.69/5 ml Vial
10780.73/4mlVial Paclitaxel Pha Res(I) (Haupt), Inj (I.V
Docetaxel Pha Res(I) (Thymoorgan) Infusion), 6mg/ ml, Tk. 4522.25/16.7 ml Vial;,
Inj.,(IV.infusion) 20 mg/ml, Tk. 3,900/Vial; Tk. 1,978.48/5 ml Vial
11,730..00/4ml, Vial
482
Paclitaxel Sandoz(I) (Ebewe), Inj(I.V Infusion),

6mg/ ml , Tk. 2,826.00/16.7 ml, Vial; Tk.
TOPOTECAN
1,205.00/5mlVial
Paclitex (Techno), Inj(I.V Infusion), 6 mg/ml,
Tk. 2,650.00/5mlVial ; Tk. 11,500.00/50mlVial Indications Metastatic, ovarian cancer
Paxel (Healthcare), Inj. (I.V Infusion), 6mg/ ml when first line or subsequent therapy
3 Tk. 12000.00/50mlVial ,; 30mg/5ml, Tk. has failed
2320.20/5mlVial, Tk. 6148.50/16.7mlVial Cautions: Renal impairment, pregnancy
Xelpac (Beacon), Inj. (I.V Infusion), 6mg/ ml,
and breastfeeding
, Tk. 4500.00/16.7mlVial, Tk.
9900.00/50mlVial,; Tk. 1700.00/5mlVial Contraindications: Hepatic impairment,
pregnancy and breastfeeding
Side-effects: See sec section14.1;
TOPOISOMERASE I INHIBITORS
gastrointestinal effects, asthenia,
alopecia and anorexia.
IRINOTECAN HYDROCHLORIDE Dose:1.5 mg/m2/day for 5 days as single
agent
Indications: Carcinoma of the colon or
rectum in combination with fluorouracil Proprietary Preparations
Cautions: See section 14.1; raised Topotecan PhaRes (I) (Thymoorgan),Inj.,(IV
serum bilirubin concentration. Avoid in infusion) 1mg/ml, Tk.9500/4ml vial
severe hepatic impairment
Contraindications: Chronic IBS, bowel TRABECTEDIN
obstruction, plasma bilirubin
concentration more than 1.5 times the Indications: Treatment of advanced soft
upper limit of reference range; avoid tissue sarcoma Ifosfamide has failed or
conception for at least 3 months after is contra-indicated and in combination
cessation of treatment with pegylated liposomal doxorubicin for
Side-effects: Same as the side-effects the treatment of relapsed platinum-
of cytotoxic drugs; acute cholinergic sensitive ovarian cancer.
syndrome and delayed diarrhoea Cautions: See section 14.1.; renal
Dose: 350 mg/m2 administered as an IV impairment, p and breastfeeding.
infusion over a 30 to 90 minute period Contr-indications: See section 14.1.;
every three weeks as single agent in hepatic impairment, pregnancy and
5FU refractory cases, and 180 mg/m 2 in Side-effects: See sec section14.1;
combination with 5FU and Folinic acid as gastrointestinal effects, pyrexia;
first-line therapy hypokalaemia, dehydration, increased
blood creatine kinase; myalgia,
Proprietary Preparations arthralgia, back pain
Campto(I) (Pfizer), Inj.(I.Vinfusion), 20 mg/ ml, Dose: Consult Product literature
Tk. 11,957.63/5 ml Vial; Tk. 4985.59/2ml
Vial..Tk.10943.97/5mlvial Proprietary Preparation
Irinotecan medac(I) (Medac), Inj.(I.Vinfusion),
Yonediles(I) (Bexter) Inj. (IV Infusion) 1
20 mg/ ml, Tk. 9,101.42/5mlVial ; Tk.
mg/vial Tk. 129200.63/Vial
4,137.01/2mlVial
Irinotecan PhaRes(I) (Thymoorgan),
Inj.(I.Vinfusion), 20 mg/ ml, Tk. TRASTUZUMAB
4946.21/5mlVial
Irinotecan Sandoz(I) (Ebewe), Inj.(I.V Indications: As a single agent is
infusion), 20mg/ ml, Tk. 1,398.00/2 mlVial ;
indicated for the treatment of metastatic
Tk. 2,800.00/5 ml Vial
Irinotecan (I) (Sindan), Inj.(I.Vinfusion), 20 breast cancer in HER2 over expressions
mg/ ml, Tk. 6928.70/5mlVial Cautions: History of hypertension,
Irinotesin (I) (Actavis), Inj.(I.V infusion), pregnancy
20mg/ml, Tk.6326.38/5ml vial; Tk.2588.06/2ml Contraindications: Severe dyspnoea
vial and breastfeeding
Irinox (Beacon), Inj.,(I.V infusion), 20mg/ml,, Side-effects: Chills, fever, anaphylaxis,
Tk. 4000.00/5ml vial , Tk. 2000.00/2mlvial
urticaria, angioedema, gastrointestinal
483
symptoms, asthenia, arthralgia, Proprietary Preparations

hypotension Avastin(I) (Roche), Inj.,(IV Infusion) 100 mg/4
Dose: 4 mg/kg IV as a loading dose over ml, Tk. 38652.50/4ml, Vial; 400mg/16ml.
Tk.98,899.00/vial
90 min followed by 2 mg/kg over 30 min Bevacimab (Healthcare), Inj., (IV Infusion),
weekly 100mg/4ml, Tk. 25000.00/vial.,400mg/16ml,
Tk. 80000.00/vial.
Proprietary Preparations Bevastim (Beacon), Inj.,(IV Infusion)
Herceptin(I) (Roch) Inj., (IV Infusion) 440 100mg/4ml, Tk. 20000.00/vial., 400mg/16ml,
mg/Vial, Tk. 1,023,77.68/Vial Tk. 75000.00/vial.
Trastunix (Beacon), Inj. (IV Infusion), Bevixa (Incepta), Inj., (IV Infusion),
440mg/Vial Tk. 80,000.00/Vial 400mg/16ml, Tk. 75,000.00/vial,100mg/4ml ,
Zumab (Techno), Inj.,(IV Infusion) 440 Tk. 20,000.00/vial
mg/Vial, Tk. 1,26,000.00/Vial
14.2. DRUGS AFFECTING THE
TRETINOIN IMMUNE RESPONSE
Indication: Acute promyelocytic 14.2.1 ANTIPROLIFERATIVE

Leukaemia. IMMUNOSUPPRESSANTS
Caution: Monitor Retinoic Acid 14.2.2 CORTICOSTEROIDS AND
Syndrome OTHER
Contraindications: Pregnancy & IMMUNOSUPPRESSANTS
nursing mother as it is highly teratogenic 14.2.3 RITUXIMAB
Side-effects: RAS, acute respiratory 14.2.4 INTERFERONS
distress, edema, hepatic or renal failure 14.2.5 ALDESLEUKIN
Interactions: See Appendix-2 14.2.6 BCG IMMUNOTHERAPEUTICS
Dose: ADULT and 45 mg/m2 daily in
two divided doses. Duration of treatment IMMUNOSUPPRESSANT THERAPY
is 90 days
Immunosuppressants are used to
Vesanoid(I) (catalent), Cap. 10 mg, Tk. suppress rejection of transplanted
232.00/Cap. organs and tissues (kidney, bone
marrow etc.); to suppress graft-versus-
BEVACIZUMB host disease in bone marrow
transplants; to treat a variety of chronic
Indications: used in combination with inflammatory and auto-immune diseases
I.V 5FU based chemotherapy, first-line which includes ITP, some forms of
treatment of patient with metastatic Haemolytic Anaemia, GN, Myasthenia
carcinoma of colon and rectum Gravis, SLE, Rheumatoid Arthritis, etc.
Contraindications: Should not be PREGNANCY: Transplant patients
indicated for at least 28 days following maintained with azathioprine should not
major surgery; the incision should be discontinue it on becoming pregnant;
fully healed prior to initiation of the because there is no evidence of
chemotherapy azathioprine’s teratogenicity. There is
Side effects: Serious and in some case less experience of ciclosporin in
fatal hemorrhage has occurred with non- pregnancy but it does not appear to be
small cell lung cancer treated with any more harmful than azathioprine.
chemotherapy; gastrointestinal Tacrolimus and mycophenolate mofetil
perforation and impaired wound healing; are contraindicated in pregnancy by the
hypertensive crisis, nephrotic syndrome, manufacturers themselves.
congestive heart failure
Dose: 5mg/kg given once every 14 days
as an IV infusion until disease
progression is detected
484
14.2.1 ANTIPROLIFERATIVE Side-effects: Gastrointestinal

IMMUNOSUPPRESSANTS discomfort, hypertension, edema,
dyspnoea, cough, rhinitis, dizziness,
insomnia, headache, tremor, infection,
AZATHIOPRINE
leucopenia, anemia, thrombocytopenia,
leukocytosis, polycythemia, electrolytes
Indications: Transplant recipient and disturbances, hyperglycemia, renal
autoimmune diseases damage, haematuria, acne,
Cautions: Monitor blood count weekly lymphoproliferative disease
for 4 weeks; thereafter reduce the Dose: Renal transplantation: by mouth,
frequency of monitoring to at least every 1 g twice daily starting within 72 hours of
three months; the doses to be reduced in transplantation or by intravenous
hepatic and renal impairment; elderly infusion, 1 g twice daily within 24 hours
patients and pregnancies of transplantation for up to maximum 14
Interactions: See Appendix-2. days
Contraindication: Hypersensitivity to Cardiac transplantation: by mouth 1.5 g
azathioprine or mercaptopurine twice daily within 5 days of
Side-effects: Hypersensitivity reactions, transplantation.
dose-related bone marrow suppression, Note: Patients should be warned to
nausea hair loss and increased report immediately any signs or
susceptibility to infections and colitis in symptoms of bone marrow suppression
patients also receiving corticosteroids e.g. infection, inexplicable bruising or
Dose: By mouth, by intravenous bleeding
injection over at least 1 minute (followed
by 50 ml sodium chloride intravenous Proprietary Preparations
infusion) or by intravenous infusion; Cellcept(I) (Roche), Tab., 500 mg, Tk.
Autoimmune conditions: 1-3 mg/kg daily, 98.07/Tab.
adjusted according to response; Mycophenolat-Mofetil sandoz(I) (Sandoz),
Suppression of transplant rejection, Tab., 500 mg, Tk. 67.46/Tab.
initially up to 5 mg/kg then 1-4 mg/kg Mycotil (Techno), Tab., 500 mg, Tk.
55.00/Tab.
daily according to response Myfortic(I) (Novartis), Tab., 180 mg, Tk.
79.00/Tab.; 360 mg, Tk. 157.00/Tab.
Proprietary Preparations Phenocept (Renata), Tab., 500 mg , Tk.
G-Azathiopine (Gonoshasthaya), Tab., 50 65.00/Tab.
mg, Tk. 8.00/Tab.
Imuran(I) (GSK), Tab., 50 mg, Tk.
1,244.64/Tab. 14.2.2 CORTICOSTEROIDS AND
OTHER
MYCOPHENOLATE MOFETIL IMMUNOSUPPRESSANTS
Indications: Prophylaxis of acute renal, Corticosteroids have great clinical

cardiac or hepatic transplant rejection value in the treatment of acute
Cautions: Blood count every week for 4 lymphoblastic leukemia, malignant
weeks then twice a month for 2 months lymphomas etc. It is also active in
then every month in the first year elderly endocrine cancers. Glucocorticosteroids
patients, risk of hemorrhage, ulceration also serve a function in the treatment of
and perforation; delayed graft function; several frequently occurring side effects
susceptibility to skin cancer of malignancies as well as general
Interactions: Anion exchange resin palliative therapy. The corticosteroids
colestyramine reduces absorption; are also powerful immunosuppressants,
antacids reduce absorption of the drug that are used to prevent organ transplant
Contraindications: Breastfeeding, rejection, and in high dose to treat
pregnancy (exclude before starting and rejection episodes. Corticosteroids may
avoid for 6 weeks after discontinuation) cause osteoporosis, iatrogenic Cushing’s
syndrome, suppress response to
485
infection and allow diseases such as and breastfeeding. One has to keep in
septicemia or tuberculosis to reach an mind about Nephrotic syndrome, atopic
advanced stage before being recognized dermatitis, psoriasis and rheumatoid
(see also section 5.3; 9.1.2; 10.3&12.3) arthritis.
Basiliximab and Daclizumab are given Note: contains polyethoxylated castor oil
with ciclosporin and corticosteroid which has been associated with
immunosuppressant regimens; their use anaphylaxis- observe for at least 30
should be confined to specialist centers. minutes after starting infusion and at
frequent intervals thereafter
BASILIXIMAB Contraindications: Uncontrolled
hypertension or infections
Indications: Prophylaxis of acute Interactions: See Appendix-2
rejection in allergic renal transplantation. Side-effects: Commonly dose-
Cautions: breastfeeding and pregnancy dependent increase in serum creatinine
(contraception during treatment and up and urea during first few weeks and less
to 16 weeks after last dose) commonly renal structural changes on
Contraindications: Known long-term administration; oedema,
hypersensitivity to Basiliximab or any pancreatitis, neuropathy, confusion,
other component of the formulation paresthesia, convulsions, amenorrhea;
Side-effects: Severe hypersensitivity muscle weakness, cramps, myopathy,
reactions and cytokine release syndrome gynaecomastia; thrombocytopenia,
have been reported. see section 14.1 haemolytic-uraemic syndrome;
Dose: By intravenous injection or by hypertrichosis, tremor, hypertension
intravenous infusion,20mg within 2 hours (specially in heart transplant patients)
before transplant surgery and20mg 4 hepatic dysfunction, fatigue, gingival
days after surgery; withhold second dose hypertrophy, gastrointestinal
if severe hypersensitivity or graft loss disturbances, and burning sensation in
occurs; CHILD and ADOLESCENT 1–17 hands and feet, hyperkalaemia,
years, body-weight under 35 kg,10mg hyperuricaemia, hypomagnesaemia
within 2 hours before transplant surgery Dose: Organ transplantation, used
and10mg 4 days after surgery; body- alone, 10-15 mg/kg by mouth before 4-
weight over 35 kg,adult dose 12 transplantation followed by 10-15
mg/kg daily for 1-2 weeks
Proprietary Preparation postoperatively then reduced to 2-6
Simulect(I) (Novartis), Inj.,(I.V infusion) 20 mg/kg daily for maintenance (dose
mg/vial, Tk.102884.00/Vial should be adjusted by monitoring blood
concentrations and renal function); dose
CYCLOSPORIN to be lower if given concomitantly with
another immunosuppressant; if
Indications: As the notes above and necessary one third oral dose can be
under atopic dermatitis, psoriasis and given by intravenous infusion over 2-6
rheumatoid arthritis hours
Cautions: Monitoring of kidney function Bone marrow transplantation, prevention
is very important. Dose-dependent and treatment of graft-versus-host
increase in serum creatinine and urea disease, 3-5 mg/kg daily by intravenous
during first few weeks may necessitate infusion over 2-6 hours from day before
dose reduction in transplant patients or transplantation to 2 weeks
discontinuation in non-transplant postoperatively (12.5-15 mg/kg daily by
patients; liver functions to be monitored mouth) then 12.5 mg/kg daily by mouth
based on serum bilirubin and liver for 3-6 months then tailed off ( may take
enzymes; monitor blood pressure; up to a year after transplantation)
discontinue if hypertension develops. Nephrotic syndrome, by mouth, 5 mg/kg
Monitor serum potassium especially in daily in 2 divided doses; CHILD 6 mg/kg
marked renal impairment; pregnancy daily in 2 divided doses according to
486
proteinuria and serum creatinine angioedema, bronchospasm and

measurements; discontinue after 3 dyspnoea; See also section 14.1
months if no improvement in Dose: 375 mg/m2 administered for once
glomerulonephritis or glomerulosclerosis weekly for 4 weeks (at day 01, day 08,
(after 6 months in membranous day 15, and day 22). In diffuse NHL it
glomerulonephritis) should be administer along CHOP at day
1 of each chemotherapy.
Imural (Techno ), Cap., 100 mg, Tk. Proprietary Preparations
60.00/Cap. Mabthera(I) (Roche), Inj.(IV infusion) 500
Sandimmun Neoral(I) (R.P. Scherer) Cap., 25 mg/50 ml, Tk.63,521,79/Vial; 100mg/10 ml,Tk.
mg, , Tk. 59.00/Cap.; 50 mg, Tk. 12,661.55/Vial
117.00/Cap.; 100 mg, Tk. 234.00/Cap. Relyto (Incepta), Inj.(IV infusion) 100 mg/10
Sporium (Incepta), Solu, 10 gm/100 ml, Tk. ml, Tk. 13,000.00/10 ml; 500 mg/50 ml vial, Tk.
2,385/10 gm 60,000.00/50 ml
Rituxim (Beacon), Inj.(IV infusion) 100mg/10
TACROLIMUS ml, Tk. 11000.00/10 ml; 500mg/50 ml , TK.
55,000/vial
Indications: Used to prevent body from

14.2.4 INTERFERONS
rejecting a heart, liver, or kidney
transplant. It may be used along with
other medicines and see also notes The interferons are a family of proteins
above that are produced by cells in response to
Cautions: See section 14.1 and; Monitor viral infections or stimulation with
blood pressure, ECG, fasting blood- double-stranded RNA, antigens or
glucose concentration Interactions: See mitogens. They may be produced
Appendix-2 through recombinant DNA technology.
Contraindications: Pregnancy The interferons can interfere with a
breastfeeding; hypersensitivity to subsequent viral challenge, and they
macrolides; avoid concurrent have many immunomodulating and
administration with Ciclosporin antiproliferative effects.
Side-effects: See section14.1 and
Neurotoxicity and nephrotoxicity. INTERFERON ALFA
cardiomyopathy, disturbances of glucose
metabolism Indications: AIDS-related Kaposi's
Dose: consult product literature sarcoma, hairy cell leukemia, follicular
lymphoma, chronic myelogenous
Proprietary Preparation leukemia, lymph or liver metastasis of
Tacrolimus Sandoz(I) (Sandoz), Cap., 1 mg, carcinoid tumor, chronic hepatitis B,
Tk. 42.82/Cap.; 5 mg, Tk. 174.80/Cap. 0.5mg, chronic hepatitis C, adjunct to surgery in
Tk.24.82/Cap
malignant melanoma and maintenance
of remission in multiple myeloma; see
14.2.3 RITUXIMAB also the notes above
Cautions: Consult product literature
RITUXIMAB Interactions: See also Appendix-2.
Contraindications: Consult product
Indications: Chemotherapy-resistant literature.
advanced follicular lymphoma. Side-effects: Nausea, influenza-like
Cautions: For full details consult product symptoms, lethargy, myalgia,
literature; pregnancy, angina, arrhythmia hypotension arrhythmia, Severe
and heart failure. bronchospasm, nephrotoxicity and
Contra-indications: Pregnancy and hepatotoxicity have been reported.
breastfeeding Dose: For chronic hepatitis B: Interferon
Side-effects: Rash, pruritus, fever and alfa-2a is given in a dose of 2.5 to 5
chills, nausea and vomiting,
487
million units/m2 body surface 3 times a 14.2.6 BCG

week by SC injection for 4 to 6 months; IMMUNOTHERAPEUTICS
For chronic hepatitis C: Interferon alfa-2a BCG IMMUNOTHERAPEUTICS
is given in a dose of 3 to 6 million
units/m2 body surface 3 times a week for Indications: For the treatment of
4 to 6 months followed by 3 million units superficial transient cell carcinoma of the
3 times a week for an additional 6 urinary bladder; for intravesical use in
months the treatment and prophylaxis of primary
or recurrent carcinoma in situ of the
Proprietary Preparation urinary bladder
Roferon-A(I) (Roche), Inj., 3 MIU, Tk.
Cautions: Pregnancy, lactation,
2,391.53/0.5ml prefilled syringe; 4.5 MIU, Tk.
3,531.70/0.5ml prefilled syringe pneumonitis, hepatitis, and other organ
Interon (Beacon), Inj., 4.5MIU, Tk. 1200.00/. dysfunction outside of gastrointestinal
0.5ml prefilled syringe tract with granulomatous inflammation
on biopsy, respiratory distress
PEG INTERFERON ALFA Contraindications: Receiving
immunosuppressive therapy (with drugs
Indications: Combine with ribavirin for or radiation) or with compromised
chronic hepatitis C; as monotherapy if immune systems because of the danger
ribavirin not tolerated or contra-indicated of a systemic BCG reaction, pyrexia of
Interactions: See Appendix-2 unknown origin, urinary tract infection
Side-effects: Same as that of interferon caused by bacteria
alfa Interactions: Drug combination
Dose: Consult with oncologist containing bone marrow depressants
and or immunosuppressants and or
Proprietary Preparations radiation may impair the response of the
Optipeg-A(Incepta), Inj.,( P.F Syringe), 180 drug
mg/0.5ml Syringe , Tk. 9,800.00/ Syringe;135 Side-effects: Most common local
mg/0.5ml Syringe , Tk. 8,800.00/ Syringe reactions are transient dysuria and
Peg Intron(I) (Schering), inj., 80 mcg/vial, Tk. urinary frequency, transient fever, skin
12698.94/0.5 ml Vial
Pegasys (I) (Roche), Inj. 180 mcg/ml, Tk.
rash, arthralgia, or migratory arthritis,
25,051.25/Vial; 135 mcg/ml, Tk. . systemic BCG reactions
22,576.23/Vial Dose: Induction treatment comprises 6
Pegferon (Healthcare), Inj180mcg/0.5ml weekly intravesical treatment with BCG
Syringe Tk. 15000.00/ Syringe Immunotherapeutic, each treatment
Pegin (Beacon), Inj., ( P.F Syringe), 135 mg/ dose comprises 3 vials of the BCG
0.5ml Syringe , Tk. 8,800.00/P Syringe ;180 Immunotherapeutic. After a 6 weeks
mg/ 0.5ml Syringe , Tk. 9,800.00/ Syringe
,
pause, another dose of 3 vials of the
BCG Immunotherapeutic should be
given intravesically once weekly for 1-3
14.2.5 ALDESLEUKIN
weeks. 3 weekly doses should definitely
be given to patients who still have
Aldesleukin is a preparation of evidence of bladder cancer.
recombinant interleukin-2 has had some
action on metastatic renal cell carcinoma
14.3. SEX HORMONES AND
unresponsive to other therapy at the
HORMONE ANTAGONISTS
expense of profound toxic effects due to
IN MALIGNANT DISEASES.
vascular leakage causing pulmonary
oedema and hypotension. Bone marrow, 14.3.1 ESTROGENS
hepatic, renal, thyroid and CNS toxicity 14.3.2 PROGESTOGENS
are also severe. 14.3.3 ANDROGENS
14.3.4 HORMONE ANTAGONISTS
488
Tumors derived from hormone-sensitive 14.3.2 PROGESTOGENS

tissues may be hormone-dependent.
Their growth can be inhibited by
MEDROXYPROGESTERONE
hormones, with opposing actions, by
ACETATE
hormone antagonists or by agents that
inhibit the synthesis of relevant
hormones. Hormones and hormone Indications: Second or third line therapy
analogues have inhibitory actions on in breast cancer
particular tissue and can play an Cautions: Diabetes, hypertension,
important role in the treatment of breast, cardiac or renal disease
prostate, and endometrial cancer. The Contraindications: Pregnancy,
objective of the hormone therapy is to undiagnosed vaginal bleeding, hepatic
provide excellent relief of symptoms for a impairment or active liver disease,
period of years. Response to the severe arterial disease, breast and
treatment and toxicity to be carefully genital tract cancer
monitored and treatment to be changed Side-effects: Acne, urticaria, fluid
if progression occurs or side-effects retention, weight changes,
exceed benefit. gastrointestinal disturbances, changes in
libido, breast discomfort, premenstrual
symptoms, irregular menstrual cycles;
14.3.1 ESTROGENS
also depressions, insomnia,
somnolence, alopecia, hirsutism,
Diethylstilbestrol (Stilbestrol), a anaphylactoid reactions
synthetic non-steroidal estrogen has Dose: By mouth, endometrial, prostate
been used in the palliation of prostate and renal cancer, 100-500 mg daily;
and breast cancer. Dose-related side- breast cancer, various doses in the
effects include nausea, fluid retention range 0.4-1.5 g daily
and arterial and venous thrombosis. By deep intramuscular injection into
Impotence and gynecomastia occur in gluteal muscle, various doses in range 1
men and withdrawal bleeding may occur g daily down to 250 g weekly
in women. Hypercalcemia and bone pain
may also occur in breast cancer. Proprietary Preparations
Stilbestrol should be used with caution in See section: 5.4.2.2
cardiovascular disease, hepatic and
renal impairment; it is contraindicated in
NORETHISTERONE
pregnancy.
Indication: Breast cancer
FOSFESTROL TETRA SODIUM
Cautions: See under medroxyproges-
terone acetate
Indication: Prostate cancer Contra-indications: See under
Caution: Cardiovascular disease, medroxyprogesterone acetate
hepatic and renal impairment Side-effects: See under medroxy-
Side-effects: Nausea and vomiting, progesterone acetate; more virilizing and
after intravenous injection peritoneal greater incidence of liver disturbances
irritation and pain on bony metastasis and jaundice; exacerbation of epilepsy
Dose: By slow intravenous injection, 0.6- and migraine
1.2 g daily for at least 5 days; Dose: Breast cancer, 40 mg daily,
maintenance, initially up to 240 mg 3 increased to 60 mg daily if required
times daily for 7 days then reducing over
14 days to 120-360 mg daily in divided Proprietary Preparations
doses See section: 5.4.2.2
Honvan (I) (Astamedica) Tab. 50mg,
MEGESTROL
Tk.20.82/Tab.Inj. 60 mg/ml.
489
Indication: Breast cancer effects are hot flushes, nausea and

Cautions: See under medroxy- vomiting. Other adverse effects include
progesterone acetate; susceptibility to edema, vaginal bleeding, pruritus,
thromboembolism increased tendency to
Contraindications: See under thromboembolism. Treatment with
medroxyprogesterone acetate tamoxifen delays the growth of
Side-effects: See under medroxy- metastases and increases survival; if
progesterone acetate; vomiting, tolerated it should be continued for at
weight gain, fever, gas, decreased sexual least 5 years.
ability/desire, weight gain, changes in Toremifene, is an antiestrogen which
appetite, has properties similar to tamoxifen is
Dose: Breast cancer, orally 160 mg used for hormone-dependent metastatic
once daily. breast cancer in post-menopausal
patients. It is given by mouth, 60 mg
Proprietary Preparations daily.
Apegestrol (Techno), Tab. 160 mg, Tk. Aminoglutethimide act predominantly
70.00/Tab by blocking the conversion of androgen
Apetiz (Aristo), Tab.,160 mg, Tk. 90.00/Tab.
Meexia compress (I) (Doppel) Tab. 160 mg,
to estrogens in the peripheral tissues.
Tk. 88.00/Tab Aminoglutethimide is used as second-
Megestol (Ziska), Tab.,160 mg, Tk. 60/Tab line treatment for prostate cancer.
Mezest(Beacon), Tab. 160 mg, Tk. Toxicity may include drowsiness, drug
90.00/Tab., Tab. 40 mg, Tk. 35.00/Tab fever, and morbilliform eruption; these
side-effects are generally reversible. It
14.3.3 ANDROGENS causes induction of hepatic enzymes
and may require modification of doses of
Testosterone esters are occasionally still other drugs.
used as second or third line therapy for Anastrozole and Letrozole are
metastatic breast cancer. inhibitors of aromatase system used in
the treatment of breast cancer. Recently
14.3.4 HORMONE ANTAGONISTS introduced Formestane and
Exemestane, steroidal aromatase
inhibitors are used to treat advanced
14.3.4.1 BREAST CANCER
postmenopausal breast cancer. They are
14.3.4.2 PROSTATE CANCER AND
more tolerated than aminoglutethimide
GONADORELIN ANALOGUE
and corticosteroid replacement therapy.
Trilostane is also used for
14.3.4.1 BREAST CANCER postmenopausal breast cancer. It is well
tolerated. Diarrhea and abdominal
The management of patients with breast discomfort are their main side effects. It
cancer involves surgery, radiotherapy, may cause adrenal hypofunction and
drug therapy, or a combination of these. need corticosteroid replacement therapy.
All women with invasive breast cancer Goserelin, a good gonadorelin analogue
should be considered for the adjuvant is also indicated for advanced breast
therapy, which is determined by cancer in post-menopausal women.
assessment of risk of recurrence,
estrogen receptor status of primary ANASTROZOLE
tumor and menopausal status.
Tamoxifen is an estrogen antagonist
Indications: Early breast cancer in
with actions similar to clomiphene. It is
postmenopausal women as adjuvant
given in the adjuvant endocrine therapy
treatment (treatment following surgery
of early breast cancer and is also given
with or without radiation), first-line
for the palliative treatment of advanced
treatment for hormone receptor-positive
disease. Tamoxifen is generally well
or hormone receptor unknown, locally
tolerated and the most frequent adverse
490
advanced or metastatic breast cancer in Intez(Genvio), Tab., 2.5 mg, Tk. 40.00/Tab.
postmenopausal women. Lenor (Eskayef), Tab. 2.5 mg, Tk. 40.00/Tab.
Cautions: Renal and hepatic impairment Lerozol (Square), Tab., 2.5 mg, Tk.
40.27/Tab.
Contraindications: Pregnancy and Letrogen (Ibn Sina), Tab., 2.5 mg, Tk. 40/Tab.
breastfeeding, not for premenopausal Letrol (Renata), Tab. , 2.5 mg, Tk. 40.15/Tab.
women Lexel (Beacon), Tab. 2.5 mg, Tk. 40.00/Tab.
Side-effects: Arthralgia, arthritis, bone Loreta(Popular), Tab. , 2.5 mg, Tk. 40.00/Tab.
fractures, bone pain, rash (including Ovazol (ACI), Tab., 2.5 mg, Tk. 40.00/Tab.
Stevens-Johnson syndrome)
Dose: 1 mg tablet taken once a day TAMOXIFEN[ED]
and consult product literature
Proprietary Preparations Caution: Increased risk of
Anastrol (Beacon), Tab.,1mg, Tk.50.00/Tab.
thromboembolic events when used with
Aromatin(Aristo), Tab., 1mg, Tk. 50.00/Tab.
cytotoxics, cystic ovarian swelling,
premenopausal women, hypercalcemia
EXEMESTANE in bony metastasis
Contraindications: Pregnancy and
Indication: To treat breast cancer in breastfeeding
postmenopausal women. It is often given Interactions: See Appendix-2
to women whose cancer has progressed Side-effects: Hot flushes, vaginal
even after taking tamoxifen therapy for bleeding or suppression of menstruation
2 to 3 year, See notes above in some premenopausal women, vaginal
Cautions: Renal and hepatic impairment discharges, pruritus vulvae,
Interactions: see Appendix-2 gastrointestinal disturbances, headache,
Contraindications: Pregnancy and alopecia, rashes, uterine fibroids; visual
breastfeeding disturbances, leucopenia, sometimes
Side-effects: See notes above anemia and thrombocytopenia
Dose: 25 mg daily Dose: Breast cancer, 20 mg daily for at
least 5 years
Proprietary Preparation Anovulatory fertility, 20 mg on day 2, 3, 4
Exemestane(I)(Doppel)Tab.25mg.Tk 176/Tab
and 5 of cycles; if necessary the daily
dose may be increased to 40 mg then 80
LETROZOLE mg for subsequent courses; if cycles
irregular, start initial course on any day,
Indications: Advanced breast cancer in with subsequent course starting 45 days
post-menopausal women in whom anti- later or on day 2 of cycle if menstruation
estrogen therapy has failed occurs
Caution: severe renal impairment
Contraindications: Severe hepatic Proprietary Preparations
impairment, pre-menopausal women G-Tamoxifen (Gonoshasthaya), Tab., 10 mg,
Side-effects: Hot flushes, TK.6.00/Tab.; 20 mg, Tk.10.00/Tab.
gastrointestinal disturbances, chest pain, Tamolex (Beacon), Tab., 10 mg, Tk.
8.00/Tab.; 20 mg, Tk. 16.00/Tab.
cough, dizziness, fatigue, headache,
Tamona (Beximco), Tab., 10 mg, Tk.
infection, musculoskeletal pain, 10.07/Tab.; 20 mg, Tk. 16.07/Tab.
peripheral edema, rash, pruritus Tamoxen (General), Tab., 10 mg, Tk.
Dose: 2.5 mg daily until tumor 10.04/Tab.; 20 mg, Tk. 16.06/Tab.
progression is evident
14.3.4.2 PROSTATE CANCER AND
Proprietary Preparations GONADORELIN
Endofree (Incepta), Tab. , 2.5 mg, Tk. 40/Tab. ANALOGUES
Femara(I) (Novartis). Tab. 2.5 mg, Tk.
375/Tab.
Femzole (Beximco), Tab. 2.5 mg, Tk. Hormonal treatment in metastatic cancer
40.00/Tab. of the prostate is aimed to deplete
491
androgen. Analogues of gonadotropin- therapy. Bicalutamide is used alone in

releasing hormones, such as Buserlin, patients with locally advanced,
Goserelin, Leuprorelin or Triptorelin metastatic prostate cancer.
can under certain circumstances be
made use of advanced prostate cancer ABIRATERONE ACETATE
and in some cases of advanced breast
cancer in pre-menopausal women.
Indications: It is used in combination
The standard treatment is bilateral sub-
with prednisone for the treatment of
capsular orchidectomy, which commonly
patients with metastatic castration-
results in response lasting 12-18
resistant prostate cancer (mCRPC) who
months. Alternatively, a gonadorelin
have received prior chemotherapy
analogue may be given.
containing docetaxel
Gonadorelin analogues are expensive
Cautions: Cardiovascular disease;
and require parenteral administration.
control hypertension and correct
Initially these analogues stimulate then
hypokalemia before treatment. Monitor
depress lutenising hormone released by
blood pressure, serum potassium and
pituitary. During the first 2 weeks of
symptoms of fluid hepatic impairment
treatment there is surge of testosterone
retention at least monthly; diabetes;
secretion associated with progression
hepatic impairment; renal impairment
with prostate cancer. In susceptible
Interaction: See appendix-2
patients this tumor progression may
Side-effects: see notes above
cause spinal cord compression, ureteric
Dose: 1 g once daily
obstruction or increased bone pain.
Note: Consult product literature for dose
When such problems are anticipated,
of concurrent prednisone or prednisolone
orchiectomy or concomitant use of an
anti-androgen such as cyproterone Proprietary Preparations
acetate or flutamide are suggested; anti- Zytix (Beacon), Tab., 250mg, Tk.700/Tab.
androgen treatment to be started 3 days Zytiga(I) (Patheon) ,Tab., 250mg,
before the gonadorelin analogues and Tk.1665.82/Tab
to be continued for 3 weeks.
Cautions: Men at risk of tumor flare BICALUTAMIDE
should be monitored closely during the
metabolic bone disease in women; the Indications:See notes above
injection site should be rotated. Cautions&side-effect: See notes
Side-effects: hot flushes, sweating, above
sexual dysfunction, vaginal dryness or Dose:Consult with Oncologist
bleeding, and gynecomastia or changes
in breast size. Sign and symptoms of Proprietary Preparations
prostate and breast cancer may worsen Bical (Beacon), Tab., 50 mg, Tk. 80.00/Tab.
initially. Other side-effects include Bicalon (Drug Intl), Tab., 50 mg, Tk.
hypersensitivity reactions injection site 30.00/Tab
reactions, headache, visual
disturbances, dizziness, arthralgia, DEGARELIX
gastrointestinal disturbances, weight
changes, sleep disorders. Degarelix is a gonadotrophin-releasing
ANTI-ANDROGENS: Cyproterone hormone antagonist
acetate, Flutamide, and Bicalutamide Indications: Used to treat advanced
are anti-androgens which can be used to hormone-dependent prostate cancer.
cover the tumor flare which may occur Cautions: Susceptibility to QT-interval
after commencing gonadorelin analogue prolongation (avoid concomitant use of
administration. Cyproterone acetate drugs that prolong QT interval); monitor
and Flutamide are also used alone in bone density; diabetes
patients with metastatic prostate cancer Contraindication: Hepatic and Renal
refractory to gonadorelin analogue impairment
492
Side-effects: Nausea; dizziness,

headache, drowsiness, insomnia, FLUTAMIDE
asthenia; influenza-like symptoms; hot
flushes, sweating (including night Indication: Advanced prostate cancer
sweats), weight gain; injection-site Cautions: Cardiac disease, hepatic
reactions; sexual dysfunction, anaemia, impairment, abdominal pain,
musculoskeletal pain, tinnitus, urticaria, unexplained influenza-like syndromes
alopecia, and rash Interactions: See appendix-2
Dose: By subcutaneous injection into Side-effects: See notes above
the abdominal region, ADULT over 18 Dose: 250 mg 3 times daily
years, initially 240mg (administered as 2
injections of 120m Proprietary Preparation
Proscan (Renata), Tab., 250 mg, Tk. 12/Tab.
Firmagon 80(I) (Feering), Inj., 80mg/syring 14.3.4.3 SOMATOSTATIN
Tk.18344/00; 120mg/syringe, ANALOGUES
Tk.21775/syringe
Octreotide and Lanreotide, the recently
LEUPRORELIN
introduced analogues of somatostatin,
hypothalamic release inhibiting hormone.
Indication: Advanced prostate cancer; They are indicated for the relief of
also see notes above symptoms carcinoid tumors and
Cautions & side-effect: See notes acromegaly.
above
Interactions: See appendix-2
OCTREOTIDE
Dose: Consult with oncologist
Sandostatin(I) (Novertis), Inj. 0.05 mg/ml, Tk.
1400.00/20mg
Lucrin Depot 3.75mg PDS(I) (Abbvie) Inj.
(P.F.Syringe),
11.25/syringe,Tk.37512./Syringe
493
15. ANEMIAS AND OTHER BLOOD DISORDERS
Chapter 15
ANEMIAS AND OTHER BLOOD DISORDERS
15.1 Iron Deficiency Anemia p.494
15.1.1 Oral Iron p.494
15.1.2 Parenteral Ironp.497
15.1.3 Drugs Used in Megaloblastic Anemia p.499
15.1.4 Drugs Used in Hypoplastic, Haemolytic and Renal Anemias p.500
15.1.5 Drugs Used In Neutropenia p.502
15.1.6 Drugs Used In Autoimmune Thrombocytopenic Purpura. p.503
15.1.7. Thalassaemia p.503
15.2 Blood and Blood Components p.504
15.2.1 Whole Blood p.505
15.2.2 Concentrate Red Cell (Packed Cell) p. 506
15.2.3 Washed RBCs p. 506
15.2.4 Fresh Plasma or Fresh Frozen Plasma (FFP) p. 506
15.2.5 Platelet Rich Plasma or Platelet Concentrates p. 507
15.2.6 Cryoprecipitates p. 507
15.2.7 Drug used in Platelate disorder p. 508
15.1 IRON DEFICIENCY ANEMIA preparations in a single dose repletion.

15.1.1 ORAL IRON In addition to administration of iron, it is
15.1.2 PARENTERAL IRON important to increase the dietary intake
of haem sources of iron (iron from
animal foods) which are better absorbed
Iron deficiency is the most common
than non haem sources (iron from
nutritional disorder in Bangladesh. Two
vegetable sources). Increased
main reasons are low dietary intake, and
consumption of iron rich animal food
low biological availability of dietary iron.
would also assist absorption of dietary
These are often accentuated by the
iron.
prevalence of intestinal worms,
Prophylactic treatment is justifiable in
especially hookworm. The most
pregnancy only for women who have
vulnerable groups are pregnant and
additional risk factors for iron deficiency
lactating women, young children, and
e.g. poor diet, menorrhagia, after
adolescent girls.
subtotal or total gastrectomy, and in the
The widespread prevalence of iron
management of low birth weight infants
deficiency anemia makes it almost
such as premature babies, twins and in
mandatory to provide iron prophylaxis for
infants delivered by caesarian section.
pregnant and lactating women. In fact,
iron requirements of pregnant women
cannot be met through dietary intake. It 15.1.1 ORAL IRON
may also be worthwhile to provide iron
prophylaxis for adolescent girls to Ferric salts are much less well absorbed
prepare them to meet the iron demand of than ferrous salts .Choice of preparation
future pregnancies. is usually decided by incidence of side
Treatment of choice for iron deficiency is effects and cost, Haemoglobin
oral preparation. In severe cases of iron regeneration rate is little affected by the
deficiency anemia or in those cases that type of salts used provided sufficient iron
are inaccessible or non-compliance is given and in most patients the time
parenteral preparation of iron can be factor is not critical.
given through intramuscular route or IV For iron deficiency the oral dose of
494
elemental iron should be 100mg to Interactions: See Appendix. 2

200mg daily. Usually it is given as dried Side-effects: Large doses may produce
Ferrous sulfate 200mg then 3 times daily gastrointestinal irritation, vomiting,
(200mg dried Ferrous Sulfate = 65mg diarrhoea; continued administration may
elemental iron). A dose of 200mg of result in constipation
ferrous sulfate once or twice daily is Dose: ADULT Therapeutic-Ferrous iron,
used in prophylaxis and for mild iron 120-180mg in single or divided doses;
deficiency anemia. If side effects Prophylaxis-60 mg iron daily
develop, dose is reduced or alternate CHILD: Therapeutic- upto 1 year 36
iron salt may be used. Side effect of mg;1-5yrs,72 mg; 6-12yrs,120 mg iron
ferrous sulfate is not greater than with daily in divided doses.
another iron salt when compared on the Indications of (iron preparations with)
basis of equivalent amount of elemental folic acid-see under folic acid under
iron. vitamins
Table: Iron content of different iron
salts: Proprietary preparations
Irofol(General), Suspn., 100mg/5ml, Tk.
Iron salt Amount Content of 32.18/200ml
(mg) Ferrous Iron
(mg) Ferrous Fumarate + Folic Acid
Ferrous 200mg 65mg Aristofol (Beximco), Tab., Tk. 0.47/Tab.
fumarate Feroplus TR (Pacific), Cap., Tk. 2.37/Cap.
Irofol(General), Cap Tk.0.53/Cap
Ferrous 300mg 35mg.
Irolic(Ziska), Tab. , Tk. 3.20/Tab.
gluconate
Sinaferon(Ibn Sina), Cap , Tk. 0.19/Tab.
Ferrous 100mg 35mg
Suprafol(Supreme), Cap, Tk. 2.30/Cap.
succinate
Zenifol Plus(Zenith), Tab. , Tk. 0.39/Tab.
Ferrous sulfate 300mg 60mg
Ferrous 200mg 65mg
sulfate,dried FERROUS GLUCONATE[ED]
Therapeutic Response Indication: Iron deficiency anemia

The haemoglobin concentration should Cautions, Interactions, Side-effects:
rise by about 100mg to 200 mg per See under Ferrous Sulfate
100ml over 3 to 4 weeks (or 1-2 g per Dose: Two tablets (300mg Ferrous
liter). Treatment will be continued after Gluconate tab. = 35mg iron) daily before
the haemoglobin concentration has risen food for prophylactic purpose.
to normal for a further 3 months in order 4-6 tablets daily in divided doses before
to maintain the iron stores. food in adults for therapeutic purpose.
CHILD : 6-12 years, 1-3 tablets daily for
MODIFIED RELEASE CAPSULE prophylactic & therapeutic purpose
AND TABLETS
Feridex(ACI), Syrup300mg/5ml
These preparations are likely to carry the Tk.32.22/200ml
iron in the first part of the duodenum into
an area of the gut where conditions of FERROUS SULPHATE[ED]
iron absorption are poor. So, small
amount of iron is available in these
Indications: Iron deficiency anemia
circumstances and the incidence of side
Cautions: Pregnancy, history of peptic
effects is also low.
ulcer
Interactions: See Appendix- 2
FERROUS FUMARATE[ED] Side-effects: Nausea, vomiting,
Indications: Iron-deficiency anemia abdominal discomfort or pain, diarrhoea
(prophylaxis and treatment) and constipation
Cautions: History of peptic ulcer Dose: 100 to 200mg elemental iron/day
495
in kg/day as a liquid preparation in Pem DS(Astra Bio), Syrup, Tk. 30.00/5ml

infants and children Polimine(Asiatic), Syrup, Tk. 20.00/50ml
DURATION OF THERAPY: To restore Polyron(ACI), Syrup, Tk. 40.12/100ml;
normal level 4 - 5 weeks is required Iron Polymaltose Complex
For replenishment of iron stores further Folic Acid, Thiamine Hydrochloride, Riboflavin,
3-6 months therapy with smaller doses is Pyridoxine Hydrochloride, Nicotinamide, Zinc
required. Sulphate Monohydrat
Proprietary preparations Alneed Gold(Incepta), Cap. , Tk. 6.00/Cap..

Aristoferon (Beximco), Syrup, 200 mg/5 ml, Asivit ZI(Asiatic), Syrup, Tk. 50.00/100ml; Tk.
Tk. Tk. 40.25/200ml 90.00/200ml
Bioron (Biopharma), Syrup, 200 mg/5 ml, Bicozin-I(Square), Syrup, Tk. 50.35/100ml
Tk.26.10/200 ml Biovit Plus(Biopharma), Syrup, Tk.
Dicalat (Albion), Syrup, 200 mg/5 ml, 50.19/100ml
Tk.24.50/200 ml; Tk. 15.00/100 ml Biozinc-I(Ibn Sina), Syrup, Tk. 50.19/100 ml
Feosphate (Asiatic), Syrup, 200mg/5ml, Tk. Fecon(Alco), Cap. , Tk. 3.01/Cap
26.75/200ml Feona Z(Delta), Cap. , Tk. 3.50/Cap.
Feroplus(Pacific), Syrup, 200 mg/5 ml, Tk. Tk. Feviz Plus(Popular ), Cap.,Tk. 6.02/Cap.
26.00/200ml Feziplex(Acme), Syrup, Tk. 50.20/100 ml
Ferreton-S(Supreme), Syrup, 200 mg/5 ml, Folvit(Eskayef), Cap, Tk. 3.00/Cap
Tk. 26.00/200 ml Folvit CI(Eskayef), Cap, Tk. 3.25/Cap.
Ferroglobin(Acme), Syrup, 200 mg/5 ml, Tk. Heptamin(Orion), Cap. , Tk. 3.01/Cap.
Tk. 26.00/200ml Irobest(Nipro JMI), Tab. , Tk. 3.00/Tab.
G-Iron(Gonoshasthaya), Syrup, 200 mg/5 ml, Irotrex Plus(Amico ), Syrup, Tk. 50.00/100
Tk. 25.10/200 ml Itop-BZ(Pharmasia), Syrup, Tk. 50.19/100 ml
Hemobin(Zenith), Syrup, 200mg/5ml, Tk. Livita(ACI), Syrup, Tk. 50.34/100ml
13.90/100ml; , Tk. 24.00/200ml Orofer(UniMed), Tab , Tk. 3.50/Tab., Syrup ,
Ironic(Bios Pharma), Syrup, 200 mg/5 ml, Tk. Tk. 50.00/100ml
25.00/200 ml Reoplex Plus(Rephco), Syrup, Tk. 30/50 ml;
Makferon(Maks ), Syrup, 200 mg/5 ml, Tk. 50/100 ml; Tk. 85/200 ml;Tk.180/450 ml
Tk.25.00/200 ml Tk. 90.34/200 ml
Sinaferon(Ibn Sina), Syrup, 200mg/5ml , Tk. Xvit(Beacon), Cap. , Tk. 3.50/Cap
40.00/200ml Zepiron(Ibn Sina), Cap. , Tk. 5.00/Cap.
Ziliron-B(Square), Cap. Tk. 4.52/Cap.
IRON(III) HYDROXIDE POLYMALTOSE
COMPLEX COMBINATION PREPARATION
SPECIALLY DESIGNED FOR
Indications: Iron deficiency anemia PREGNANCY & LACTATION
(prophylaxis and treatment)
Contraindications: Haemochromatosis, Indications: For the treatment and
thalassemia or haemosiderosis; prophylaxis of iron, folic acid and zinc
hypersensitivity to iron deficiency especially during pregnancy
Side-effects: Nausea, vomiting, and lactation.
abdominal discomfort or pain, diarrhoea Cautions: Failure to respond to
and constipation treatment may indicate other causes of
Dose: ADULT 10ml daily. anemia and should be further
CHILD: 6-12 years 10ml daily; 2-6years investigated. Iron and zinc chelates with
5ml daily.Premature infants and infants tetracycline and absorption of all three
1.11mg elemental iron/kg body weight agents may be impaired. The absorption
of zinc may be reduced in the presence
Proprietary preparations of iron. Absorption of iron may be
Iron Hydroxide Polymaltose impaired by penicillamine and by
Compiron(Incepta), Paed.Drops, Tk. antacids. Separating administration of
50.00/30ml; Syrup, Tk. 50.00/100ml; Tk. each product by several hours, interval
90.00/200ml
Hemofix(Beximco), Tab., Tk. 4.00/Tab.
can reduce such potential interactions.
Ipec(Aristo),Syrup,,Tk 40.00/100 ml In patients with renal failure, a risk of
Iromia(Opsonin), syrup, Tk. 37.59/200 ml zinc accumulation could exist.
496
Contraindications: Patients Ferrous Sulphate 150 mg + Folic Acid 500

hypersensitive to the product or those microgram
with iron overload
Side-effects: Dark stools are usual Defaz(Acme), Cap.Tk. 3.01/Cap., Tab.
Fecon-Z(Alco), Cap.,Tk. 2.94/Cap.
during iron therapy, and nausea and Feofol TR(Eskayef), Cap, Tk. 2.41/Cap.
other symptoms of gastrointestinal Feraz(Amico), Cap., Tk. 2.50/Cap.
irritation, such as anorexia, vomiting, FeridexTR(ACI), Cap., Tk. 2.35/Cap.
discomfort, constipation, and diarrhea is Fero (Amico), Tab., Tk. 0.37/Tab.
sometimes encountered. Zinc may also Fero Plus (Amico), Tab., TK. 0.38/Tab.
produce gastrointestinal upset. These Fero TR (Amico), Cap., Tk. 2.37/Cap.
sustained or timed-release capsules are Ferospan(Drug Intl), TR Cap. 2.41/Cap
Folin SR (Somatec), Cap.,Tk. 2.38/Cap.
designed to reduce the possibility of HefolinSR(Beximco), Cap., Tk. 2.40/Cap
gastrointestinal irritation. There have Hemofol- TR(Benham), Cap.,Tk. 2.36/Tab.
been rare reports of allergic reactions Ifol Plus(Albion), Cap. , Tk. 2.40/Cap
Dose: 1 capsule a day, in more severe
cases, 2 capsule a day
Ferrous sulphate+ Folic Acid + Zinc
Carbonyl Iron, Folic Acid & Zinc Animet(Asiatic), Cap., Tk. 3.00/Cap.
Concivit Z (Nipro JMI)Cap.TK.2.84/Cap Apefol-TR(APC),Cap.,Tk. 2.90/Cap.
Enazif(Virgo), Cap. , Tk. 4.00/Cap Biofez(Jayson), Cap., Tk. 3.01/Cap
Preneed Cl(Incepta), Cap. , Tk. 4.00/Cap. Defaz (Acme), Cap.,Tk. 3.01/Cap.,
Zeefol (Eskayef), Cap, Tk. 3.00/Cap., Tk. Fecel (Asiatic), Cap., Tk. 3.00/Cap.
4.00/Cap., Fecel TR(Asiatic), Cap., Tk. 3.00/Cap.
Zifocap (Nuvista), Cap. , Tk. 5.38/Cap. Ferix (Renata), Cap. , Tk. 4.00/Cap.
Iron+ Zinc+ Folic Acid+Vitamin-B Complex, Ferocit Z(Acme), Cap. , Tk. 2.94/Cap
+Vitamin-C Ferofol-Z(Central), Cap., Tk. 2.90/Cap.
Carbomet(Somatec), Cap., Tk. 3.01/Cap. Feroplus Z(Pacific), SR Cap., Tk. 2.90/Cap.
EPL(Globe), Cap., Tk. 3.50/Cap. Feropreg(Amico), Cap., Tk. 3.00/Cap.
Famina(Silva), Cap.,Tk. 3.51/Cap. Ferrolin TR(Orion), Cap., Tk. 2.92/cap..
FeconBC (Alco), Cap. , Tk. 2.94/Cap. Fer-Z(Organic), Cap. , Tk. 3.01/Cap.
Feocron Plus(Novo Health), Cap., Tk. Fezin(Rephco), CR Cap., Tk. 3.00/Cap.
3.50/Cap., Folized(General), Cap., Tk. 3.11/Cap.
Fer-V(Organic), Cap.,Tk. 3.51/Cap. Glory(Orion ), Cap., Tk. 3.01/Cap.
Folvit(Eskayef), Cap., Tk. 3.25/Cap. Hemo Plus(Zenith), cap. , Tk. 3.00/cap.
Ipec Super(Aristo), Cap. Tk. 6.00/Cap. Hemo Z(Astra), Cap., Tk. 2.90/Cap.
Maxiron(Apex), Cap. , Tk. 3.50/Cap. Hemofix(Beximco), Tab., Tk. 4.00/Tab.
Xinoplex(Silva), Syrup, Tk. 90.33/200ml ; Tk. Hemofix FZ(Beximco,), Tab. , Tk. 5.00/Tab.
50.19/100ml Ifozin-SR(Ibn Sina), Cap. , Tk. 3.05/Cap.
Zilvit(Eskayef), Cap, Tk. 3.50/Cap., Tk. Ipec-Plus(Aristo), Tab., Tk. 3.50/Tab.
3.50/Cap. Itop-Z(Pharmasia), Cap., Tk. 3.02/Cap.;
Tk.3.51/Cap.
Prenat(Healthcare), Cap. , Tk. 4.00/Cap.
IRON AND FOLIC ACID[ED]
Prenat Cl(Healthcare), Cap. , Tk. 4.00/Cap.
Suprafol TR(Supreme), Cap., Tk. 2.30/Cap.
Feofol (Eskayef), Cap, Tk. 2.50/Cap. Suprafol ZTR(Supreme), Cap, Tk. 2.70/Cap.
Feofol TR (Eskayef), Cap, Tk. 2.41/Cap. ZeefolCl(Eskayef), Cap, Tk. 3.00/Cap.
Fer (Organic), Cap., Tk. 2.51/Cap. Zepiron(Ibn Sina), Tab. Tk. 3.50/Tab.
Fero TR (Amico), Cap., 2.37/Cap. Zif(Square), Cap. , Tk. 3.01/Cap.
Prenat Plus(Healthcare), Cap., Tk. 4.00/Cap. Zif-CI(Square), TR.Cap.,Tk. 3.01/Cap.
Zeprion Plus(Ibn Sina), Cap. Tk. 5.00/Cap Ziliron(Square), Tab. Tk. 3.01/Tab.
Ziliron B(Square), Cap., Tk. 4.54/Cap. Fecon (Alco), Cap. , Tk. 2.41/Cap.
These preparations are used for the 15.1.2 PARENTERAL IRON

prevention of iron and folic acid
deficiencies in pregnancy.
When oral iron therapy fails due to lack
of patient co-operation or there is severe
COMPOUND PREPARATION gastrointestinal side effects or continuing
497
severe blood loss or mal absorption iron IM Injection: given into the upper outer
is administered parenterally. Iron quadrant of the buttock alternating the
sorbitol citrate: (only by Intramuscular sides on successive injection;
route) is a colloidal solution of a complex Administered daily to weekly until the
of Iron, sorbitol and citric acid, stabilized total amount required is given. Each
with dextran and sorbitol contain 5% dose should not exceed 2ml;
(50mg/ml.) Of iron. Iron sucrose (iron The skin is moved aside at the site of
hydroxide sucrose complex): a complex injection and kept taut to prevent
ferric hydroxide with sucrose containing leakage back of the dark staining fluid
2% (20mg/ml) of iron given in severe I.V. Injection
iron deficiency anemia. Undiluted method
The total iron dextran dose is given as a
PARENTERAL IRON PREPARATIONS single bolus in a series of injection in a
manner similar to I/M administration
Iron can be administered parenterally as Total dose infusion method
Iron dextran,Iron sucrose, Ferric The dose is diluted in a liter of isotonic
carboxymaltose, saline or dextrose. The maximum
Indications: Intolerance to oral iron, concentration of iron used should not
gastrointestinal disease e.g. ulcerative exceed 2.5g (50ml iron dextran/100ml
colitis or Crohn’s disease, peptic diluent)
ulceration The infusion is initially run slowly e.g. at
Impaired iron absorption: gastrectomy, the rate of 15drops/min. If there is no
gastroenterostomy, sprue and coeliac reaction, then the dose can be increased
disease to 45 to 60 drops/min, until the infusion is
When rapid replenishment of iron stores completed.
is required (severe iron deficiency Side-effects: Anaphylactic reactions;
anemia in late pregnancy) Delayed reactions: pyrexia, arthralgia,
Chronic blood disease e.g. persistent myalgia, regional lymphadenopathy,
menorrhagia and repeated epistaxis of exacerbation of joint pain in rheumatoid
hereditary haemorrhagic telangiectasia. arthritis
Side-effects: Flushing, nausea, urticaria
shivering, general aches and pains, Generic preparation
Cosmofer(I) (Pharmacosmo)Inj., 100mg/2ml
dyspnoea and syncope
Amp
Delayed reactions: Arthralgia, fever,
lymphadenopathy, exacerbation of
rheumatoid arthritis FERRIC CARBOXYMALTOSE
Contraindications: Patients with history A ferric carboxymaltose complex
of asthma, cardiac abnormalities e.g. containing 5% (50mg/mL) of iron
angina, arrhythmia, acute renal failure,
severe liver disease Indications, Contraindications and
Dose :By slow intravenous injection or
IRON DEXTRAN
by intravenous infusion, ADULT and
CHILD over 14 years, calculated
Iron dextran is a colloid of ferric according to body-weight and iron deficit,
dihydroxide with dextran. consult product literature
From all parenteral preparations the iron
complex is taken up by macrophages of Proprietary preparations
the reticuloendothelial system, from Ferinject(I)(Vifor) Inj., iron (as ferric
where iron is released to circulating carboxymaltose) 50mg/ml.Tk.996.74/2mlVial
transferrin which then takes it to the Tk.3,114,.80/10ml vial
marrow. Fematos (General), Inj., 100mg/2 ml, Tk.
Indications, Contraindications and 400.00/2ml,; 500mg/10 ml, Tk. 700.00/10ml
Ferisen ,(Healthcare), Inj, 100mg/2ml, Tk.
Side-effects: See notes above 410.00/2ml ,; 500mg/10ml, Tk. 710.00/10 ml
498
Maltofer(Incepta), Inj. , 500mg/10ml, Tk. establish the cause of megaloblastosis

700.00/10ml,; 100mg/2ml, Tk. 400.00/2ml; as administration of folic acid may
1gm/20 ml, Tk. 1300.00/20ml precipitate the onset of subacute
combined degeneration of spinal cord. In
IRON SUCROSE cases of undiagnosed megaloblastic
A complex of ferric iron and anemia, it will be better to start combined
isomaltosides containing10% (100 therapy with both B12 and folic acid.
mg/ml) of iron Vitamin B12 should be given as a
prophylaxis after these operations to
Indications: Iron deficiency anaemia, prevent B12 deficiency. Dietary
see notes above deficiency of vitamin B12 is very
Dose:By deep intramuscular injection uncommon with persons consuming a
into the gluteal muscle or by slow mixed diet. It may, however, occur in
intravenous injection or by intravenous persons consuming completely
infusion, calculated according to body- vegetarian diet.
weight and iron deficit, consult product Apart from dietary intake, all other
literature. CHILD under 14 years, not causes of B12 deficiency are attributable
recommended to malabsorption. There is little place of
oral administration of Vitamin B12 in the
Proprietary preparations treatment. Vitamin B12 should be
Anofer(Monico), Inj, 20 mg/ml,, Tk. administered by injection.
300.00/5mlAmp
For prophylaxis in haemolytic states or in
Defiron, (Square), Inj, 20 mg/ml, Tk.
350.00/5mlAmp renal dialysis, it will be sufficient to give
Feofer(Eskayef), Inj, 20 mg/ml, Tk. 5mg daily or even weekly depending on
600.00/10ml Amp; Tk. 350.00/5 ml vial the diet and the state of haemolysis.For
Ferimax(Incepta), Inj, 20 mg/ml, prophylaxis during pregnancy, the dose
Tk.300.00/5ml; Tk. 600.00/10 ml Amp,; of folic acid should be 200-500
Feristar(Renata), Inj, 20 mg/ml, Tk.325.00/5 microgram daily.
ml
To prevent recurrence of neural tube
Feroven(Orion), Inj, 20 mg/ml, Tk. 327.26/5
mlAmp defect in a child with spina bifida or if
Hemofer(Popular), Inj, 20 mg/ml, there is a history of neural tube defect in
Tk.325.00/5ml a previous child, women who wish to
Inofar(Aristo), Inj, 20 mg/ml ml, Tk.300/5 ml become pregnant or who are at risk of
vial becoming pregnant should be advised to
Irosuc(ACI), Inj, 100 mg/5 ml, Tk. 350/5ml take folic acid supplements at a dose of
vial
5mg daily. Supplementation should be
Kidifer(General), Inj, 20 mg/ml Tk.
327.26/5mL continued up to 12 weeks pregnancy.
Maxifer(Globe), Inj, 20mg/ml, Tk. 300/5ml vial Women receiving antiepileptics therapy
Sucraven(Ibn Sina), Inj, 20 mg/ml, Tk. need individual counseling before
350.00/5ml vial starting folic acid therapy.
Unifer (Ziska), Inj, 100 mg/5 ml, Tk.326/5 ml Different Vitamin B12 preparations (see
vial section 16.2.3.2)
Veniron (Beximco), Inj., 20mg/ml, Tk. 300/5
ml
Xenofer (Beacon), Inj, 20 mg/ml Tk. 350.00/5 CYANOCOBALAMIN
ml (See section 16.2.3)
Xoferon(Novo Health), Inj, 100 mg/5 ml, Tk.
325.00/5 ml vial
Indications: B12 responsive
megaloblastic anemia and pernicious
15.1.3. DRUGS USED IN anemia, prophylaxis in total gastractomy
MEGALOBLASTIC ANEMIA or total ileal resection, malabsorbtion
syndrome, coeliac disease and tropical
The cause of most Megaloblastic anemia sprue
is either lack of B12 or folic acid. Before Contraindications: Leber’s disease,
starting treatment it is essential to tobacco amblyopia
499
Dose: ADULT 250-1000 microgram IM or until a hematological response has

on alternate days for 1-2 weeks or for 10 been obtained maintenance 5mg every
days, then 250microgram weekly until 1-7 days.
blood picture is normal. For Prophylaxis in chronic haemolytic states
maintenance, 1000 microgram every or in renal dialysis, 5mg daily or even
month. weekly depending on the diet and the
CHILD: Initially as for adult; subsequent rate of haemolysis.
doses according to hematological For prophylaxis in pregnancy 200-500
response. microgram daily.
CHILD: initially daily for 2 days, upto 1
Proprietary preparations year 500microgram /kg body wt., 1-5
Cynomin(Jayson), Inj., 250 microgram/ml, Tk. years 5 mg, 6-12 years, 10mg;
3.51/1 ml amp.; 1 mg/ml, Tk. 3.03/1ml amp;
Tk. 32.00/10 ml amp
maintenance half the initial dose
G-Vitamin(Gonoshasthaya), Inj., 1 mg/ml,
Tk.4.00/1 ml amp Proprietary preparations
Folac(Ambee) , Tab., 5 mg, Tk.0.24/Tab
Folicasia(Pharmasia), Tab., 5 mg,
FOLIC ACID[ED] Tk.0.27/Tab.
Folic-Son(Bristol), Tab. , 5mg , Tk. 0.27/Tab.
Hemolytic anemia may be complicated Folate(Ad-din), Tab., 5mg, Tk. 0.30/Tab.
by folate deficiency. Drugs that inhibit Folus(Monico), Tab., 5mg, Tk. 0.30/Tab.
Folison(Jayson), Tab., 5 mg, Tk. 0.34/Tab.
dihydrofolate reductase such as Folic(Amico), Tab., 5mg , TK. 0.35/Tab.
methotrexate, trimethoprim or that Terovit(G.A.Co), Tab., 5 mg, Tk. 0.31/Tab
interfere with the absorption and storage
FOLINIC ACID
of folate in tissues such as certain
Anticonvulsants, oral contraceptives are
capable of lowering the concentration of It is a synthetic tetrahydrofolic acid.
folate in plasma and at times may cause Indication: The principal use of folinic
a megaloblastic anemia. acid is to circumvent the action of
Indications: Folate deficient inhibitors of dihydrofolate reductase,
megaloblastic anemia. Standard such as methotrexate.
treatment to bring about a hematological Cautions: Never be used for the
remission and replenish body stores; treatment of pernicious anemia or other
prophylaxis in chronic haemolytic states megaloblastic anemias secondary to a
or in renal dialysis deficiency of vitamin B12. It is not
Interactions: See Appendix -2 indicated in folic acid deficiency
Side-effects: Oral folic acid is usually is Contraindications: Pernicious anemia
not toxic even with the doses as high as or other megaloblastic anemia
15 mg/day. Nausea, anorexia, secondary to a deficiency of vitamin B12
abdominal distension and flatulence may Side-effects:it’s use can result in an
develop apparent response of the hematopoietic
Cautions : Should never be given alone system, but neurological damage may
in pernicious anemia and other vitamin occur or progress if already present
B12 deficiency states; because it may
precipitate sub-acute combined Proprietary preparations
degeneration of the spinal cord (see section 14.1.1)
Contraindications: Pernicious anemia
and other vitamin B12 deficiency states 15.1.4 DRUGS USED IN
Dose: Initially 5mg daily for 4 months. HYPOPLASTIC,
Maintenance dose, 5mg every 1-7 days HAEMOLYTIC AND RENAL
depending on underlying disease. Child ANEMIAS
upto 1 year, 500 microgram/kg daily over
1year as ADULT dose. Pyridoxine, antilymphocyteimmuno-
ADULT Initially 5 mg daily for 4 months globulin and various corticosteroids are
used in hypolastic and hemolyticanemia.
500
Antilymphocyte globulin given by EPOETIN ALFA

intravenous infusion produces a
response in 50% of acquired cases. Proprietary preparations
Higher response rates have been Epoetin(Incepta), Inj.,( P.F Syringe), 2000
reported when ciclosporin is given as IU/0.2 ml, Tk. 1025.00/ /Syringe; 3000 IU/0.3
well. Pyridoxine is indicated in both ml, Tk. 1480.00/ Syringe;4000 IU/0.4 ml, Tk.
idiopathic, acquired and hereditary 1935.00/ Syringe;.5000 IU/0.5 ml, Tk. 2160.00/
Syringe
sideroblastic anemias. Corticosteroids
Eporen(Square), Inj., (P.F Syringe),
indicated in the management of a wide 2000IU/0.2 ml, Tk. 1103.31/ Syringe;
variety of haematological disorders. 3000IU/0.3 ml , Tk. 1454.37/ Syringe;
They include conditions with an immune 5000IU/0.5 ml, Tk. 2106.32/ Syringe
basis such as autoimmune haemolytic Eposis(Beacon), Inj Inj., (P.F Syringe), .,
anemia, immune thrombocytopenias, 10000IU/ml, Tk. 4000.00/ syringe.;
neutrope-nias and major transfusion 2000IU/0.50ml, Tk. 1028.08/syringe.;
3000IU/0.75ml, Tk. 1484.45/syringe.;
reactions.
4000IU/0.40ml, Tk. 1935.80/syringe;
5000IU/0.5ml, Tk. 2166.5/syringe.
ERYTHROPOIETINS Eprex(I)(Cilag) Inj., (P.F Syringe), 2000 IU/0.5
ml, Tk. 1619.33/ Syringe; 3000 IU/0.3 ml, Tk.
1,647.74/ Syringe; 4000 IU/0.4 ml, Tk.
EPOETIN BETA AND ALFA 2982.98/ Syringe; 10000IU/ml, Tk. 5250.60/
Syringe;
Indications: Anemia associated with Initer(Healthcare), Inj., (P.F Syringe), 1,000
IU/0.5ml , Tk. 681.99/syringe. ; 10,000 IU/1ml ,
erythropoietin deficiency in chronic renal
Tk. 5001.72/syringe.; 2,000 IU/0.5ml , Tk.
failure, to increase the yield of 1136.75/syringe.
autologous blood in normal individuals Nipotin(Aristo), Inj., (P.F
and to shorten the period of anemia in Syringe)5000IU/0.5ml, Tk. 2150.00/ syringe.;
patients receiving platinum-containing 10000IU/ml, Tk. 4200.00/ syringe.;
chemotherapy 2000IU/0.2ml, Tk. 1100.00/ syringe
Cautions: Patient with depression or 3000IU/0.3ml, Tk. 1400.00/ syringe
4000IU/0.4ml, Tk. 1900.00/ syringe)
psychiatric disorder, epilepsy, severe
Recogen(ACI), Inj., 10000IU/1ml, Tk.
renal or hepatic impairment, cardiac 3900.00/ syringe.; 2000IU/0.5ml, Tk. 1000.00/
disorder, myelosuppression, poorly syringe.; 3000IU/0.75ml, Tk. 1300.00/
controlled thyroid dysfunction. Monitor syringe.; 5000IU /0.5ml, Tk. 2000.00./ syringe
closely blood pressure, haemoglobin and
electrolytes. Interrupt treatment if blood Dose: Anemia in adults receiving cancer
pressure uncontrolled. Sudden stabbing chemotherapy, by subcutaneous
migraine like pain is warning of injection (max. 1 ml per injection site),
hypertensive crisis. Exclude other initially 150 units/kg 3 times weekly,
causes of anemia e.g. folic acid or increased if appropriate rise in
vitamin B12 deficiency. Monitor platelet haemoglobin (or reticulocyte count) not
count for 1st 8 weeks, convulsions, achieved after 4 weeks to 300 units/kg 3
malignant disease, liver failure, times weekly; discontinue if inadequate
pregnancy and breast-feeding response after 4 weeks at higher dosel
Contra-indication: Uncontrolled reduce dose by 25-50% if haemoglobin
hypertension rise exceeds 2g/100ml per month;
Interactions: See Appendix -2 suspend if haemoglobin exceeds
Side-effects: Hypertensive crisis, 14g/100ml until it falls below 12g/100ml;
generalized tonic clonic seizures, dose and reinstate with dose at 25% below
dependent increase in platelet count, previous dose; continue epoetin for 1
convulsions, skin reactions, anaphylaxis. month after end of chemotherapy
Dose: See under preparations (consult also product literature).
Note: Although Epoiten alfa and beta Note: subcutaneous injection contra-
are clinically indistinguishable the indicated in patients with chronic renal
prescriber must specify which is required failure.
501
EPOETIN BETA 15.1.5 DRUGS USED IN

NEUTROPENIA
Recormon(I)(Roche), Inj., 2000 IU,.Tk.
Recombinant human granulocyte colony
1,335.36/Syringe; 5000 IU, . Tk. 3,249.02/Inj.
Syringe; 10000 IU, Tk. Tk. 6,654.55//Syringe stimulation factor (rG-CSF) stimulates
the production of neutrophils. It may
Dose: Subcutaneous injection, Initially reduce the duration of chemotherapy
60 units/kg weekly in 1-7 divided doses induced neutropenia and can reduce the
for 4 weeks. Adjust according to incidence of associated sepsis.
response at interval of 1-2 weeks Pregnancy There have been reports of
maximum 720 units/kg weekly. IV toxicity inanimal studies and
injection over 2 minutes, initially 40 manufacturers advise not to
units/kg 3 times weekly for 4 weeks. usegranulocyte-colony stimulating
Increased according to response to 80 factors duringpregnancy unless the
units/kg 4 times weekly max. 720 potential benefit outweighs therisk.
units/kg weekly (consult also product Breast-feeding There is no evidence for
literature) the use of granulocyte-colony stimulating
factors during breast feeding and
METHOXY POLYETHYLENE manufacturers advise avoiding their use.
GLYCOLEPOETIN BETA Interactions: See Appendix-2
FILGRASTIM
Indications: Treatment of symptomatic
anaemia associated with chronic renal
failure (CRF) in adults and paediatric Indications :Neutropenic fever, neutron-
patients (both dialysis and non-dialysis). penia in cytotoxic chemotherapy for
malignancy, in myeloablative therapy
Proprietary preparations followed by bone-marrow transplant-
Mircera(I)(Roche), Inj., 75 microgram/0.3 ml, tation, idiopathic neutropenia and history
Tk. 10,601.76/Syringe; 0.100mg/0.3 ml, Tk. of severe or recurrent infections;
14,153.14/syringe. 14153.14/syringe; 50 persistent neutropenia in advanced HIV
microgram/0.3 ml, Tk. 7081.00/ Syringe infection(see also section 14.1)
Cautions:Treatment should be
Dose :Consult with Physician and discontinued if leucocytosis occur;
product literature monitoring of platelet count and
haemoglobin and cytogenic bone
DARBEPOETIN ALFA marrow examinations recommended in
severe congenital neutropenia;
Indications:Treatment of symptomatic monitoring of spleen size, bone density
anaemia associated with chronic renal is a must if given the drug for more than
failure (CRF) in adults and paediatric 6 months. Caution must be taken in case
patients (both dialysis and non-dialysis) of pregnancy and breast-feeding
and symptomatic anaemia in adult Contra-indication: Severe congenital
cancer patients with non-myeloid neutropenia
malignancies receiving chemotherapy. Interactions: See appendix -2
Side-effects: Musculoskeletal pain,
Proprietary preparations disturbances in liver enzymes and serum
Darbetin (Healthcare), Inj. , 100mcg/0.5ml , uric acid, thrombocytopenia, dysuria,
Tk. 9090.28/Vial,; 25mcg/0.42ml , Tk. allergic reactions, haematuria, hepatom-
2840.71/Vial; 40mcg/0.4ml , Tk. 4545.15/Vial;
egaly, epistaxis, alopecia, osteoporosis
60mcg/0.3ml , Tk. 5505.31/Vial
Dose :Consult with Physician and Dose: Cytotoxic induced neutropenia,
product literature drug is to be administered by
subcutaneous injection or intravenous
infusion (over 30 minutes), ADULT and
502
CHILD, 500,000 units/kg daily started granulocyte-colony stimulating factor)

not less than 24 hours after cytotoxic Indications: Same as that of lenograstin
chemotherapy, continued until neutrophil Cautions and side-effects: See notes
count in normal range, usually for up to above and under filgrastim; also acute
14 days and up to 38 days in acute leukaemia andmyelosuppressive
myeloid leukemia. chemotherapy;
Dose: By subcutaneous injection,
Proprietary preparations ADULT over 18 years, 6mg(0.6 mL) for
Filastin(Incepta), Inj.,(P.F syringe) 300 each chemotherapy cycle, starting
microgram/0.5 ml, Tk. 2,890.00/Syringe 24hours after chemotherapy
Filgrast(Beacon), Inj., (P.F syringe) 300
microgram/0.5 ml, Tk. 2500.00/Syringe
Grastim(Square), Inj.,(P.F syringe) 300 Proprietary Preparation
Pegfilastin(Incepta), Inj.,(P.F syringe)
microgram/0.5 ml, Tk. 3961.87/0.5 /Syringe
Neupogen(I)(Roche), Inj., 30 MIU, Tk. 6mg/0.60ml, Tk. 15000.00/syringe
8,000.00/Vial Pegfilgrast(Beacon), Inj.,(P.F syringe)
6mg/0.60ml, Tk. 15000.00/Vial
Zarzio(I)(Sandoz), Inj., 30 MIU/0.5 ml, Tk.
21,000.00/0.5 ml Prefilled Syringe Pegneufil(Healthcare), Inj.,(P.F syringe)
6mg/0.60ml, Tk. 20300.00/syringe
Filgen(Aristo), Inj.,(P.F syringe) 30MU/0.5ml ,
Neulasti (I)
Tk. 3500.00/0.5 ml Syringe
(Roch),Inj.,(P.Fsyringe),6mg/0.6ml,Tk.50800/s
Neufil(Healthcare), Inj.,(P.F syringe)
yringe
120mcg/0.2ml, Tk. 1450.00/0.2
Syringe;30MU/0.5ml , Tk. 3919.99/ Syringe
Ropenia(ACI), Inj.,(P.F syringe) 30MU/0.5ml, 15.1.6 DRUGS USED IN
Tk. 3200.00/0.5 ml Pre-filled Syringe AUTOIMMUNE THROMBOCY-
TOPENIC PURPURA (ITP)
LENOGRASTIM
(Recombinant human granulocyte-colony First line treatment of ITP is
stimulating factor, rhG-CSF) corticosteroids. Other therapy that has
been tried in refractory cases. These
Indications: For reduction in the drugs include Azathioprine(see section
duration of neutropenia and associated 14.2.2)
complications following bone marrow Cyclophosphamide(see section 14.1.1)
transplantation for nonmyeloid Vincristine(see section
malignancy or following treatment with 14.1.4),Ciclosporin(see section
cytotoxic chemotherapy associated with 14.2.1),Danazol (see section 6.5.2)
the significant incidence of febrile Intravenous immunoglobulins (see
neutropenia; mobilization of peripheral section13.3) have also been used in
blood progenitor cells for harvesting and refractory cases or where a temporary
subsequent infusion rapid rises in platelets in needed. For
Cautions: See under filgrastim; patients with chronic severe
premalignant myeloid conditions thrombocytopenia refractory to other
Dose: Cytotoxic induced neutropenia, by therapy, tranaxaemic acid (see section
subcutaneous injection, ADULT 19.2 3.11) may be given to reduce the
million units/sq.m. daily started the day severity of haemorrhage.
after completion of chemotherapy,
continued until neutrophil count is stable 15.1.7 THALASSAEMIA
in the acceptable range (max. 28 days)
Thalassaemia is an inherited impairment
Granocyte(I) (Sanofi Winthrop), Inj. 34
of hemoglobin production, in which there
MIU/vial, Tk. 5961.54/Vial is partial or complete failure to
synthesize a specific type of globin
chain. Failure to synthesize beta chains
PEGFILGRASTIM is the most common type (beta-
(Pegylated recombinant methionyl thalassaemia). The anemia is crippling
human and the probability of survival for more
503
than a few years without transfusion is low.
Table:Treatment of beta – thalassaemia major (see below in the table)
Problem Management
Erythropoietic failure Allogenic bone marrow transplantation from HLA
compatible sibling
Hypertransfusion to maintain Hb>100g/lit
Iron overload Iron therapy forbidden; desferrioxamine therapy
Splenomegaly causing mechanical Splenectomy
problems, excessive transfusion
required
Beta-thalassaemia minor is diagnosed by haemoglobin electrophoresis. This type of

thalassaemia often does not need treatment.
DESFERRIOXAMINE 15.2 BLOOD AND BLOOD

COMPONENTS
Indications: Acute iron poisoning, iron 15.2.1 WHOLE BLOOD
overload with repeated blood transfusion 15.2.2 CONCENTRATE RED CELL
e. g. thalassemia, aplastic anemia. (PACKED CELL )
Side-effects: Gastrointestinal disturban- 15.2.3 WASHED RBCS
ces, arrhythmia, hypotension, anaphy- 15.2.4 FRESH PLASMA OR FRESH
laxis, dizziness, convulsion, skin reaction FROZEN PLASMA (FFP)
and pain on IM injection 15.2.5 PLATELET RICH PLASMA OR
Caution: Impaired renal and hepatic PLATELET CONCENTRATES
function;eye and ear examinations 15.2.6 CRYOPRECIPITATES
required before 15.2.7 DRUG USED IN PLATELATE
treatment and annually during treatment, DISORDER
pregnancy, breast feeding
Dose: Subcutaneous infusions of Blood and blood components are
Desferrioxamine in a dose of 20-40 considered drugs because of their use in
mg/kg over 12 hours are given on 5-7 treating diseases. The transfusion of
nights each week; it may also be given blood cells is also transplantation in that
through the infusion line at the time of the cells must survive and function after
blood transfusion upto 2g per unit of transfusion in order to have therapeutic
blood effects. The modern transfusion service
suggests very little use of whole blood
Proprietary preparation for adult practice.
Desferal(I)(Novartis), Inj. 500 mg, Tk.
258.11/Vial DECISION MAKING AND
PRECAUTIONS REGARDING
DEFERASIROX TRANSFUSION
Indications, Side effects, Caution: Blood transfusion is necessary in

Same as that of Desferrioxamine medical, surgical and obstetrical
Dose: Consult product literature practice to save life.
A clinician drawing blood for cross
Asunra(I)(Novartis), Dispersible Tab. 100 mg,
matching has to identify the patient at
Tk. 50.00/Tab.; Tk. 187.00/Tab. the bed side; label the sample and has
Ferasirrox(uniMed )Tab.250mgTk 85.00/Tab to write down the request form after
Feripon(Drug Intl), Tab., 500mg, Tk. identifying the patient; The clinician must
18.10/Tab. be ensured that the information
504
requested by the transfusion laboratory (EBV), Cytomegalovirus (CMV) and

is to be given on both the sample and HTLV. There is also limitation of test
request form. The person administering procedure, kits or reagents to detect
blood should identify the patient at the diseases do not have less sensitivity and
bedside; must be ensured that the specificity.
patient identification and the Following transfusion of blood or its
identification of the unit match; to be components there is a chance of
checked that the ABO and Rh D groups immediate and delayed adverse effects,
of the patient and units are identical; which may be immune or non-immune
must inspect the units for evidence of type. There are also adverse effects due
damage; to be ensured that the checking to cold blood component transfusion e.g.
procedures are validated by another hypothermia, painful venous spasm,
member of the nursing or medical staff; cardiac arrhythmia, reduction in oxygen
to be completed the necessary carrying capacity and aggravation of
documentation, indicating the detailed citrate toxicity. Metabolic effects of
identification of the units transfused. transfusion are citrate toxicity, potassium
FOLLOW-UP DURING AND AFTER toxicity, acid load and iron over load.
TRANSFUSION Some of the immediate and delayed
The blood pack from collection prior to effects are listed below.
transfusion cold chain should be strictly Immediate immune effects: IHTR,
maintained. Before transfusion cold FNHTR, allergic reaction, anaphylaxis;
refrigerated blood should be left for half Immediate non-immune effects:
an hour to return to room temperature. bacterial contamination; circulatory over
During transfusion, physician should be load; physical RBC damage; depletion
keen enough to find out signs and and dilution of coagulation factors &
symptoms of immediate haemolytic platelet; air embolism and phlebitis;
transfusion reaction (IHTR) by observing Delayed immune effects: DHTR,
fever, chills, facial flushing, pain at alloimmunization; post transfusional
transfusion site, chest pain, back or flank purpura (PTP); GVH disease; delayed
pain, hypotension, abdominal pain, non-immune effect; iron overload
nausea, dyspnoea, vomiting, urticaria,
haemoglobinaemia and haemoglobin- 15.2.1 WHOLE BLOOD
uria. During follow-up for delayed
hemolytic transfusion reaction (DHTR) Fresh whole blood contains all
the physician has to monitor the patient constituents of blood- RBC, Plasma,
constantly and to observe whether the WBC, and Platelets and clotting factors
patient has developed fever, anemia, but refrigeration causes depletion of
mild jaundice, haemoglo-binemia, WBC, platelet and clotting factor.
haemoglobinuria, shock and renal Indications: in massive acute
failure. hemorrhage where all components are
Complications and side-effects of required in large amounts; multiple
transfusion injuries; road traffic accidents; severe
The decision to transfuse must be based gastrointestinal bleeding e.g. rupture
on weighing the therapeutic benefits esophageal varices, haematemesis and
against potential risks to the recipient. malena; obstetrical causes e.g. rupture
Transfusion always carries increased uterus, rupture ectopic pregnancy, post
risk of transmission of diseases partum hemorrhage
transmitted by blood e.g. malaria, Cautions: Avoid cold blood, micro
syphilis, HBV, HCV and HIV. All aggregate or prolonged transfusion
communicable diseases are not possible Side-effects: volume overload, acid
to be screened out e.g. kalaazar, overload, potassium toxicity, citrate
filariasis, toxoplasmosis, brucellosis, toxicity, (see also complications of
trypansomiasis and certain viral transfusion)
infection-Epstein Bar Virus Note. exchange transfusion should be
505
given in hemolytic disease in neonates to febrile reactions and most of the

(HDN); per operative blood loss allergic reactions. Preparation contains
Contraindications: Severe chronic 60-80% RBCs and 20-40% saline.
anemia; anemia associated with risk of Indications: Prevention of febrile non-
circulatory overload like chronic renal haemolytic transfusion reaction (FNHTR)
failure, heart failure, pregnancy at term caused by antibodies to leucocytes and
APPROXIMATE VOLUME:500 ml per HLA antigens in sensitized patients
unit receiving multiple transfusions;
STORAGE TEMPERATURE:2º to 6ºC prevention of sensitization of potential
SHELF LIFE:14 days in ACD, 21 days in recipients of tissue transplantation who
CPD, 35 days in CPDA1 require blood transfusion; patient with
DOSAGE EFFECT:1 unit whole blood IgA deficiency and anti-IgA antibodies.
raises the hemoglobin 10 g/L APPROXIMATE VOLUME:250-300 ml
approximately. per unit
STORAGE TEMPERATURE:2 to 6ºC
15.2.2 CONCENTRATE RED SHELF LIFE:24 hours
BLOOD CELLS (RCC) OR DOSAGE EFFECT: one unit raises the
PACKED CELL hemoglobin 10 g/L approximately.
Packed cells are prepared by removing Side-effects: Bacterial contamination
approximately 80 percent of the plasma and hyperkalaemia; see also
from a unit of whole blood. Regulations complication of transfusion
require that the final haematocrit of an
RCC unit not exceed 80%. Significant 15.2.4 FRESH PLASMA OR FRESH
reduction in the levels of acid, citrate, FROZEN PLASMA (FFP) [ED]
and potassium in units prepared just
before transfusion. This reduces the risk Prepared from the supernatant of one
of acid level, citrate toxicity and unit of whole blood by the process of
potassium load in patients with cardiac, centrifugation and fractionation. The
renal, or liver diseases. plasma is then frozen within 6 hours of
Indications: RCC is indicated for collection for FFP. The product is free
increasing the RBC mass in patients from RBC and contains therapeutic
who require increased oxygen carrying levels of all the plasma clotting factors,
capacity and correction of anemia in including factors V and VIII, but no
patients with increased risks of volume platelets. Transfusion is ABO and Rh
overload like in pregnancy, heart failure group specific.
(CCF), renal failure, elderly patient and Indications: Non specific hematological
thalassaemia. replacement after massive transfusion in
APPROXIMATE VOLUME: 250-300 ml Disseminated Intravascular Coagulation
per unit (DIC); after cardiopulmonary bypass;
STORAGE TEMPERATURE: 2 to 6ºC liver diseases; rapid anticoagulant
SHELF LIFE:14 days in ACD, 21 days in reversal; to prevent or arrest bleeding;
CPD, 35 days in CPDA1 hemophilia; as volume expander in
DOSAGE EFFECT: One unit raises the nephrotic syndrome and burns; acute
haemoglobin 10 g/L approximately. liver disease
Side-effects: See notes above. APPROXIMATE VOLUME:150-250 ml
Cautions: Potassium toxicity(see notes per unit
above) STORAGE TEMPERATURE: below -20
to -30C
15.2.3 WASHED RBCS Shelf life:one year when stored below -
30C, but when kept at 20C its shelf-
The washing process removes about 90 life is shorter than one year.
percent of contaminating leukocytes due Dosage effect: increase factor levels 20–
506
30% per dose of 10-15ml/kg of body be within 6 hours

weight Side-effects: Alloimmunisation to
Cautions: FFP should be thawed platelet antigens and platelet
at37C water bath with a stirrer, with refractoriness, febrile reactions, allergic
frequent agitation by hand. It should reactions, granulocytopenia; see also
never be thawed under hot water tap. complications of transfusion
Administer within half an hour after
thawing as the activity of coagulation 15.2.6 CRYOPRECIPITATE (ANTI
factors V and VIII is rapidly lost on HEMOPHILIC FACTOR)
standing. FFP is given intravenously
through transfusion set, at a flow rate not Cryoprecipitate is the cold–precipitated
greater than 10-ml/min. Special care to concentration of factor VIII, the
be taken in patients with history of antihaemophilic factor. It is prepared
bronchial asthma or previous severe from FFP thawed slowly at 4ºC. The
reaction to plasma product contains most of the factor VIII
Side-effects: Urticaria and anaphylac- and part of the fibrinogen from the
toid reactions, circulatory overload, non- original plasma. Significant factors of
haemolytic febrile transfusion reaction, cryoprecipitate are factor XIII and Von
alloimmunisation to plasma protein, Willebrand factor. Transfusion is ABO
reactions produce by vasoactive compatible. A unit of cryoprecipitate
substancesand transmission of diseases contains on average 80 IU of factor VIII.
Indications: treatment of moderate to
15.2.5 PLATELETS CONCENTRATES severe factor VIII deficiency
(haemophilia A);afibrinogenemia; Von
Platelet concentrates can be prepared Willebrand disease;disfibrinogenemia;
manually or by using a blood cell intractable bleeding in uraemia; factor
processor; they can be obtained from a XIII deficiency
single donor or pooled from several APPROXIMATE VOLUME:10-25 ml per
donors. Manually prepared concentrates unit of whole blood
are available as single platelet concen- STORAGE AND SHELF LIFE:stable for
trates harvested from one unit of blood one year when kept at a temperature
or as pooled platelet concentrates below 30C
harvested from four to six units of blood. DOSAGE EFFECT:The dose of factor
Transfusion is ABO and Rh compatible. VIII for treatment of haemophilia A and
Concentrates contain platelets, plasma IV Willebrand’s disease is calculated
with negligible amount of RBC and using formula: D = BW × I/2; (D is the
WBC. dose in IU, BW body weight in kg, and I
Indications: Correction of the desired increment in i.u./dl).
thrombocytopenia due to decreased Cautions: Administer as soon as
function, production or consumption of possible and not later than one hour
platelet; as in aplastic anemia; acute after thawing.
leukemia following chemotherapy or Side-effects: urticaria and
irradiation in malignancy; cardiopul- anaphylactoid reactions; bleeding
monary bypass; massive transfusion; tendency due to very high fibrinogen
exchange transfusion; neonatal concentration achieved after infusion of
thrombocytopenia; DIC; ITP; dengue a large number of cryoprecipitate units,
haemorrhagic fever (DHF) reactions produced by vasoactive
APPROXIMATE VOLUME:50-70 ml per substances, transmission of diseases
unit of whole blood
STORAGE TEMPERATURE:20 to 24C Proprietary preparations
DOSAGE EFFECT:increase count 5,000 Alphanate(I)(Grifols)Inj., 250IU Tk.9970.00/vial
–10,000 per unit Haemoctin(I(Biotest-pharma),Inj. 10%
250 IU, Tk.5196.79/vial
Cautions: Require optimum temperature
and constant agitation;transfusion must
507
15.2.7 DRUGS USED IN PLATELET and efficacy have not been established
DISORDERS in combination with direct acting antiviral
agents used without interferon for
treatment of chronic hepatitis C infection.
ELTROMBOPAG Cautions: Hepatotoxicity: Monitor liver
function before and during therapy.
Eltrombopag is a thrombopoietin Thrombotic/Thromboembolic
receptor agonists Complications: Portal vein thrombosis
Indications: For the treatment of has been reported in patients with
thrombocytopenia in adult and pediatric chronic liver disease receiving. Monitor
patients 1 year and older with chronic platelet counts regularly.
immune (idiopathic) thrombocytopenia Side-effects: Nausea, diarrhea, upper
(ITP) who have had an insufficient respiratory tract infection, vomiting,
response to corticosteroids, increased ALT, myalgia, and urinary
immunoglobulins, or splenectomy., tract infection. , upper respiratory tract
thrombocytopenia in patients with infection, and nasopharyngitis. anemia,
chronic hepatitis C to allow the initiation pyrexia, fatigue, headache, nausea,
and maintenance of interferon-based diarrhea, decreased appetite, influenza-
therapy. patients with severe aplastic like illness, asthenia, insomnia, cough,
anemia who have had an insufficient pruritus, chills, myalgia, alopecia, and
response to immunosuppressive peripheral edema.
therapy, used only in patients with ITP Dose: Consult product literature
whose degree of thrombocytopenia and
clinical condition increase the risk for Proprietary preparations
bleeding Eltrom 25(Julpher) Tab. , 25 mg, Tk.
600.00/Tab.
Contraindication: Should be used only ETP(Beacon), Tab. , 25 mg , Tk. 511.33/Tab.;
in patients with chronic hepatitis C 50 mg , Tk. 909.02/Tab.
whose degree of thrombocytopenia Revoldae(I)(Novartis), Tab. , 25 mg, Tk.
prevents the initiation of interferon based 916.00/Tab.
therapy or limits the ability to maintain
interferon-based therapy. Safety
508
16. NUTRITION
Chapter 16
NUTRITION
16.1 Electrolytes and intravenous nutrition p.509
16.1.1 Electrolytes. p. 509
16.1.2 Intravenous nutrition p. 511
16.1.3 Glucose solutions. p. 512
16.1.4 Dextrose (glucose) saline. p. 513
16.1.5 Plasma and plasma substitutes. p. 514
16.2. Oral nutrition p. 515

16.2.1 Foods for special diet p. 515
16.2.2 Minerals p. 516
16.2.2.1 Calcium and calcium supplements p. 516
16.2.2.2 Hypercalcaemia p. 521
16.2.2.3 Magnesium p. 521
16.2.2.4 Phosphate supplements and phosphate binding
Agent’s p. 521
16.2.2.5 Flouride (See Dental Practitioner’s Formulary) p.522
16.2.2.6 Iodine p. 522
16.2.2.7 Zinc p. 522
16.2.3 Vitamin preparations p. 523
16.2.3.1 Vitamin A p. 524
16.2.3.2 Vitamin B complex p. 524
16.2.3.3 Vitamin C p. 528
16.2.3.4 Vitamins D p. 528
16.2.3.5 Vitamin E p. 530
16.2.3.6 Vitamin K p. 531
16.2.3.7 Multivitmine and mineral preparations p. 531
16.2.3.8 Antioxidant vitamin preparation p. 533
509
16. NUTRITION
16.1 ELECTROLYTES AND volume; CHILD 200mlafter every loose

INTRAVENOUS NUTRITION motion
Electrolytes and IV solutions are given to Proprietary Preparations

meet normal fluid and electrolyte See section 2.4
requirements or to replenish substantial
deficits or continuing losses, when the NORMAL SALINE [ED]
patient is nauseated or vomiting and is (Sodium chloride 0.9%)
unable to take adequate amounts by
mouth. Indication : Electrolyte imbalance
In an individual patient the nature and Cautions: Restrict intake in impaired
severity of the electrolyte imbalance renal function of large doses may give
must be assessed from the history and rise to sodium accumulation and
clinical and biochemical examination. oedema
Sodium, potassium, chloride, Dose: See notes above. Usual strength
magnesium, phosphate and water of Sodium chloride is 0.9%; this strength
depletion can occur singly and in being available in normal saline for
combination with or without disturbances injection
of acid base balance. IV infusion of 0.9% sodium chloride as
isotonic solution
Isoline IV (General), Inj. (IV Infusion), 0.9%,
16.1.1 ELECTROLYTES Tk. 74.22/100 ml
Normal Saline (Opso Saline), Inj. (IV
Normal Saline: Sodium chloride (0.9%) Infusion), 0.9%, Tk. 87.14/1000ml; Tk.
in isotonic solution provides the most 67.64/500 ml
Normalin IV (Popular), Inj. (IV Infusion), 0.9%,
important extracellular ions in near
Tk. 47.14/100 ml, Tk. 56.17/250 ml, Tk.
physiological concentration and is 67.64/500 ml, Tk. Tk. 87.39/1000ml,, Tk.
indicated in sodium depletion, which may 117.29/2000ml
arise from such conditions as gastro- Normasol (Libra), IV Infusion, 0.90%, Tk.
enteritis, diabetic ketoacidosis, ileus and 117.29/2000ml; Tk. 47.88/100ml; Tk.
ascites. In a severe deficit of from 4 to 8 53.63/250ml; Tk. 67.85/500ml; Tk.
litres, 2 to 3 litres of isotonic sodium 87.30/1000ml
Salinor (ACI), Inj. (IV Infusion), 0.9%, Tk.
chloride may be given over 2-3 hours;
50.14/100 ml
thereafter infusion can usually be given Saloride (Beximco), Inj. (IV Infusion), 0.9%,
at a slower rate. Tk. 67.80/500 ml; Tk. 53.60/250 ml; Tk.
Compound sodium lactate: 87.39/1000 ml; Tk. 48.06/100 ml
(Hartmann’s Solution) can be used Salpac (Orion ),Inj. (IV Infusion), 0.9%, Tk.
instead of isotonic sodium chloride 47.87/100 ml; Tk. 67.44/500ml; Tk.87.39/1000
solution during surgery or in the initial ml
Solo (Square), IV Infusion, 0.90%, Tk.
management of the injured or wounded
40.25/50ml; Tk. 48.06/100ml; Tk.
patients. 67.85/500ml; Tk. 87.39/1000ml;
Xenosol (Beacon), Inj. (IV Infusion), 0.90%,
Tk. 108.32/500 ml; Tk.85.26/250 ml;
ORAL REHYDRATION SALTS (ORS) Tk.74.22/100 ml
[ED]
ORAL BICARBONATE
Indications: Fluid and electrolyte loss in
diarrhea. Sodium bicarbonate is given by mouth
Dose: According to fluid loss, usually for chronic acidotic states such as
200–400mL solution after every loose uraemic acidosis or renal tubular
motion; INFANT 1–1½ times usual feed acidosis. The dose for correction of
metabolic acidosis is not predictable and
the response must be assessed; sodium
510
16. NUTRITION
bicarbonate 4.8 g daily (57 mmol each of determine whether further infusions are
Na+ and HCO3 –) or more may be required and to avoid the development of
required. For severe metabolic acidosis, hyperkalaemia; especially liable to occur
sodium bicarbonate can be given in renal impairment.
intravenously
POTASSIUM CHLORIDE [ED]
Sodinate (Opsonin),Tab., 600mg, Tk.6.02/Tab
Indications: Electrolyte imbalance and
Sodicarb(Popular),Tab., 600 mg, Tk. 6.02/Tab
Compound Sodium Lactate Infusion also for oral potassium supplements
(Hartmann’s Solution for injection) Cautions: For IV infusion the
Intravenous infusion contains sodium chloride concentration of solution should not
0.6%, sodium lactate 0.32%, potassium usually exceed 3.2 g.
chloride 0.04%, and calcium chloride 0.027%. Side-effects: Rapid infusion is toxic to
heart
Proprietary Preparations Dose: By slow IV infusion, depending on
Electrosal (Popular), Inj., (IV Infusion), Tk. the deficit or the daily maintenance
71.30/500ml, Tk. 92.00/1000ml
requirements
Glucohart (Popular), Inj., (IV Infusion), Tk.
62.97/500ml, Tk. 81.28/1000ml
Hartman (Orion), Inj., (IV Infusion), Tk. Proprietary Preparations
71.09/500 ml; Infusion, Tk. 92.00/1000 ml KT (Jayson), Inj., 150 mg/ml, Tk. 15.00/Vial;
Hartmann's (Popular), Inj., (IV Infusion), KCL (Opsonin), Inj., 150 mg/ml, Tk10.03/ /Vial
Tk.92.00/1000ml,
Hartsol (Libra), Inj., (IV Infusion ) Tk. POTASSIUM CHLORIDE AND
71.30/500ml; Tk. 91.99/1000ml GLUCOSE IV INFUSION
Lactoride (Beximco), Inj., (IV Infusion), Tk.
92.00/1000ml;Tk. 71.30/500ml
Lactoring (Square), Inj., (IV Infusion), Tk. Usual strength for IV infusion, potassium
71.3/500ml;Tk. 91.99/1000ml chloride 0.3% with 5% of anhydrous
Ringer’s Solution For Injection: glucose.
Intravenos infusion contain: Calcium
Chloride (dihydrate) 322microgram, POTASSIUM CHLORIDE AND SODIUM
Potassium Chloride 300microgram. CHLORIDE IV INFUSION
Calcium chloridae 8.6mg/ml. providing
the following ions (in mmol/litre), Usual strength for IV infusion, potassium
Ca2+ 2.2, K+ 4, Na+ 147, Cl– 156 chloride 0.3% (3 g/litre) and sodium
chloride 0.9% (9 g/litre).
Ringer’s Solution (Opsosaline), IV Infusion
Tk. 45.17/500ml
POTASSIUM CHLORIDE, SODIUM
CHLORIDE AND DEXTROSE IV
INFUSION
INTRAVENOUS POTASSIUM
Usual strength for IV infusion: Sodium
IV infusion of potassium chloride +
chloride 0.18% with 4% anhydrous
sodium chloride and potassium chloride
glucose (dextrose monohydrate) and
+ glucose are used to correct severe
required amount of potassium chloride to
hypokelamia and depletion and when
provide 10-40 mmol of potassium
sufficient potassium cannot be taken by
ion/litre.
mouth. Potassium chloride containing
ampoules of 1.5 g (20 mmol K+ in 10 ml),
may be added to 500 ml of sodium 16.1.2 INTRAVENOUS NUTRITION
chloride or glucose IV infusion and given
slowly over 2-3 hours with specialist When the patient can not take food
advice and ECG monitoring in difficult through the alimentary tract, nutrients
cases. Repeated measurements of are to be given through IV infusion. It
plasma potassium are necessary to may be in addition to oral or tube
511
16. NUTRITION
feeding-which is known as supplemental Amino Acid with D-Sorbitol & Electrolytes

parenteral nutrient, or IV nutrient may be Powersol (General), Inj. (IV infusion), Tk.
the sole source of nutrition-total 351.06/500 ml
Protinex (Eskayef), Inj.(IV infusion),Tk.
parenteral nutrition (T.P.N) 350/500 ml
Indication for IV nutrition: Repotyn (ACI), Inj. (IV infusion),, Tk.
Undernourished patients for surgery, 352.38/500ml
chemotharpy, or radiation therapy; Xemocid (Beacon), Inj. (IV infusion),, Tk.
severe or prolonged disorder of 501.50/500ml;
gastrointestinal tract; trauma or burns;
prolonged coma or refused to eat; and Human milk based Amino Acid
some patients with hepatic or renal Protinex (Easkayef) Inj. (IV infusion)
Tk.280/500ml
failure.
Total parenteral nutrition (T.P.N): Amino acid
Solution is infused through a central Amilac (Biopharma), Inj.(IV infusion), Tk.
venous catheter inserted under full 350.00/500ml
surgical procedures.T.P.N requires the Aminomax (Globe), Inj. (IV infusion), Tk.
use of solution containing amino acid, 400.00/500ml;
glucose, fat, electrolyte, trace elements, Aminoplex (Acme), Inj. (IV infusion), Tk.
402.72/500ml
and vitamins . Aminosin (Ibn Sina), Inj. (IV infusion), Tk.
Partial Parenteral nutrition (P.P.N): 350/500 ml
Is given as infusion through a peripheral Aminosol (Opso Saline), Inj.(IV infusion), Tk.
vein. It is used as supplementary 264.15/500 ml
nutrition for periods of up to a month; to Amisol (Popular), Inj.(IV infusion),, Tk.
correct serious deficits appropriate 200.75/250ml, Tk. 351.32/500ml
biochemical test are to be carried out Clinosol (Opsonin), Inj.(IV infusion), Tk.
352.38/500 ml
before starting the infusion. Nutrition and Esamin (Monico), Inj.(IV infusion), Tk. .
electrolyte status is to be monitored 350.00/500ml
throughout treatment. Nurisol (Novo Health) Inj.(IV infusion), Tk. .
351.00/500ml
AMINO ACID Nutrilve (Healthcare), Inj. (IV infusion), Tk.
350/500 ml
Nutrimin (Beximcoi), Inj. (IV infusion), Tk.
Ideally all essential amino acid should be 410.00/500ml
included with a wide variety of non- Powersol (General,), Inj. (IV infusion), Tk.
essential ones to provide sufficient 351.06/500ml
nitrogen together with electrolytes. Proliv (Orion), Inj. (IV infusion), Tk.130.49/100
Available solution vary in their ml
Prosol (Incepta),Inj.,(IV Infusion), Tk. 350/500
composition of amino acids; they often
ml
contain energy source(usually glucose) Protemin (Easkayef), Inj.(IV infusion), Tk.
and electrolytes. 351.32/500 ml
Repotyn (ACI),Inj.(IV infusion),Tk. 351.32/500
Amino acid +Glucose +Electrolyte ml
Aminosin plus (Ibn Sina), Inj. (IV infusion), Vigosol (Square), Inj.(IV infusion),Tk.
Tk. 400/500 ml 352/500ml
Amisol Gold (Popular), Inj. (IV infusion), Tk
Tk. 260.98/250ml, Tk. 401.51/500ml
Clinosol Gold (Opsonin), Inj. (IV infusion), 16.1.3 GLUCOSE (DEXTROSE
Tk. 402.72/500 ml MONOHYDRATE) SOLUTION
Nutrimin D (Beximco), Inj. (IV infusion),Tk.
410/500 ml Dextrose solutions (5 are mainly used to
Proliv-Plus (Orion), Inj. (IV infusion),, Tk. replace water deficits and should be
402.72/500 ml
Protinx (Easkayef) Inj. (IV infusion)
given alone when there is no significant
Tk.750/500ml loss of electrolytes. Average water
Repotyn Max (ACI) Inj. (IV infusion) Tk. requirements in a healthy adult are 1.5 to
401.20/500ml 2.5 liters daily and this is needed to
balance unavoidable losses of water
512
16. NUTRITION
through the skin and lungs and to

provide sufficient for urinary excretion. Sodium chloride and glucose solutions
Excessive loss of water without loss of are indicated when there is combined
electrolytes is uncommon, occurring in water and sodium depletion. A 1 :1
fever, hyperthyroidism and in uncommon mixture of isotonic sodium chloride and
water-losing renal states such as 5% glucose allows some of the water
diabetes insipidus or hypercalcaemia. (free of sodium) to enter body cells
Glucose solutions are also given in which suffer most from dehydration while
regimens with calcium, bicarbonate and the sodium salt with a volume of water
insulin for the emergency management determined by the normal plasma
of hyperkalaemia. They are also given, sodium ions remains extracellular.
after correction of hyperglycemia, during Combined sodium, potassium, chloride
treatment of diabetic ketoacidosis, when and water depletion may occur in severe
they must be accompanied by continuing diarrhoea or persistent vomiting. In that
insulin infusion. case replacement is carried out with
sodium chloride intravenous infusion
GLUCOSE 0.9% and glucose intravenous infusion
(DEXTROSE MONOHYDRATE) [ED] 5% with potassium as appropriate.
IV infusion of sodium and glucose:
Indications: Fluid replacement, normal strength sodium chloride 0.18%
provision of energy and 4% of anhydrous glucose.
Side-effects: Venous irritation and
thrombophlebitis
Dextrose Anhydrous + Sodium Chloride
Dose: Dose of water replacement ADS (Libra), Inj., (IV Infusion), 10% +
described above. Energy source, 1-3 0.225%, Tk. 106.95/1000ml; Tk.80.50/500ml
liters daily of 20-50% solution APN (Opso Saline), Inj., (IV Infusion),, 100 mg
+ 2.25 mg/ml, Tk. 64.90/1000 ml
Proprietary Preparations Baby Saline (Libra ), Inj., (IV Infusion), 5% +
Dexaqua (Beximco ), Inj. (IV Infusion) DS 0.225 % ml, , Tk. 55.20/100 ml, 10 gm + 225
10%, 78.20/500ml ml;Tk105.80/1000ml; ml ; mg/100 ml Tk. 72.24/500 ml
5%, Tk. 71.30/500ml ml; Tk. 92.99/1000ml; ml Baby Sol (Opso Saline), Inj., (IV Infusion), 5%
Dextropac (Orion ),Inj(IV Infusion), 25%, Tk. + 0.225%,Tk. 72.23/500ml
73.22/250 ml ;Tk. 48.14/100 ml , 10%, Tk. Baby Sol Junior (Opso Saline), Inj., (IV
78.20/500 ml ;Tk. 105.80/1000 ml ; 5%, Tk. Infusion), 5% +0.45% Tk, 73.38/500 ml
71.30/500 ml ; Babysol (Opso Saline) Inj., (IV Infusion), 50
Dextrose (Opso Saline), Inj., (IV Infusion,) mg + 2.25 mg/ml, Tk. 72.23/500 ml
10%, Tk. 105.48/1000 ml; Tk. 77.96/500 ml; Babysol Junior (Opso Saline), Inj (IV
25%, Tk. 21.7/100 m;Tk. 45.29/250 ml; Tk. Infusion), 50mg+4.5mg/ml, Tk. 73.38/500 ml
6.89/25 ml;5%, Tk. 100.89/1000 ml; Tk. Dexoride (Beximco), Inj., (IV Infusion),5% +
71.08/500 ml 0.9%, Tk. 101.00/1000 ml ;Tk. 75.90/500 ml
Glucolin (Popular I), Inj (IV Infusion,) DS Dextrosal (Orion) , Inj., (IV Infusion), 5% +
10%, Tk. 78.20/500ml ml,; Tk. 105.80/1000 ml, 0.9%, Tk. 75.89/500 ml; Tk.101.19/1000 ml
5%, Tk. 71.30/500 ml, Tk. 92.00/1000 ml Dextrosal-Baby (Orion ), Inj., (IV Infusion),,
Infudex (Square), Inj., (IV Infusion), 10%, Tk. 5% + 0.225%, Tk. 72.24/500 ml
105.8/1000ml; Tk. 78.2/500ml; ;5%, Tk. Dextrose Monohydrate + Sodium Chloride
92/1000ml; Tk. 71.3/500ml Dextrose+sodium chloride (Opso Saline),
Infusol (Beacon), Inj., (IV Infusion), 10%, Tk. Inj., (IV Infusion), 50 mg + 9 mg/ml, Tk.
125.38/500ml 75.66/500 ml;
Libott (Libra ), Inj., (IV Infusion), 10%, 500ml, Dextros-ISO (Orion ), Inj., (IV Infusion), 4.3%
Tk. 78.20/500ml; ml; Tk. 105.80/1000ml ml; + 0.18%, Tk. 71.30/500 ml ; Tk. 94.08/1000 ml
25%, Tk. 73.22/250ml; 48.14/100ml 5%, Dextros-Mini (Orion ), Inj., (IV Infusion), 5% +
91.99/1000ml; ml Tk. 71.3/500ml 0.45%, Tk. 73.60/500 ml
Nutridex (Beximco), Inj., (IV Infusion,) 25%, Electrodex-10 (Orion), Inj., (IV Infusion), 10%
Tk. 37.55/100 ml; Tk. 61.08/250 ml; + 0.225%, Tk. 66.07/500 ml ; Tk. 87.52/1000
ml bag solution
Glucosal (Popular), Inj., (IV Infusion), 0.9gm +
16.1.4 DEXTROSE (GLUCOSE) 5gm/100ml,Tk.75.89/500 ml,Tk.101.19/1000ml
SALINE
513
16. NUTRITION
Glucosal M (Popular ), Inj., (IV Infusion), plasma or blood loss may be wasteful;
0.18gm + 4.3gm/100ml, Tk. 71.09/500 ml, Tk. plasma substitutes are more appropriate.
94.08/1000 ml
Infusol Plus (Beacon), Inj., (IV Infusion), 5gm
+ 900 mg/100 ml, Tk. 115.35/500 ml HUMAN ALBUMIN SOLUTION
Isodex (Square), Inj., (IV Infusion),, 5 gm +
180 mg/100 ml Tk. 91.34/1000ml Indications: Albumin solutions are used
Isoride (Beximco), Inj., (IV Infusion), 4.3% + for the treatment of severe
0.18 %, Tk. 91.30/1000 ml; Tk. 71.09/500 ml
hypoproteinaemia, particularly when
Libott-M (Libra ), Inj.,(IV Infusion), 10% +
0.18 %, Tk. 71.30/500 ml; Tk. 94.09/1000 ml associated with a low plasma volume. A
Libott-S (Libra ), Inj., (IV Infusion), 5% + 0.9% solution of protein derived from human
Tk. 76.22/500 ml; Tk.101.20/1000 ml plasma, serum or normal placenta; at
Libott-S Jr (Libra ), Inj., (IV Infusion), 5.% g+ least 95% of the protein is albumin. The
0.45%, Tk. 73.60/500 ml solution may be isotonic; concentration
Neosol (Beximco), Inj (IV Infusion), 5% + varies from 4-5% to 15-25%
0.225%, Tk. 55.20/250 ml
Cautions: Cardiac or circulatory disease
Neosol DS (Beximco), Inj (IV Infusion), 5% +
0.45%, Tk. 55.20/250 ml; Tk. 73.60/500 ml (to avoid rapid rise in blood pressure and
Pedisol (Popular), Inj (IV Infusion), 0.225gm + cardiac failure administer slowly and
0.50gm / 100ml, Tk. 80.50/500 ml, Tk. monitor cardiovascular and respiratory
64.69/100 ml function)
Pedisol DS (Popular), Inj., (IV Infusion), Contra-indications: Cardiac failure;
0.225gm + 10gm / 100ml, Tk. 80.50/100 ml severe anaemia
Solodex (Square), Inj., (IV Infusion),, 0.9% +
Side-effects: Allergic reactions with
5%, Tk. 101.20/1000ml,Tk. 75.89/500ml
SolodexBabyIV (Square), Inj., (IV Infusion) nausea, vomiting, increased salivation,
0.225%+ 5%, Tk. 72.45/500ml; fever, tachycardia, hypotension and
SolodexJR (Square), Inj., (IV Infusion), 0.45% chills reported
+ 5%, Tk. 73.6/500ml;
INFUSION FLUIDS FOR PARENTERAL Albumin Human (I) (Octapharma), IV Infusion
FEEDING 20% Bottles 50ml, 100ml; Tk.3806.34/100ml;
Tk.1903.17/50ml
Albutein (I) (Therapeutic Corp). IV Infusion
Purified soybean oil(Fat emuision) 5%.Tk.3144.37/250ml; 25%, Tk.2676.83/
Fatisol (Popular), IV Inj., 10.00gm/100ml, Tk. 50ml; Tk.5281.80/100ml 20%.Tk 2052/50ml;
380.00/100ml, Tk. 580.00/250ml, Tk. 4046.61/100ml
910.00/500ml Albutein(I)(Grifol) IV.Infusion
Intralipid (I) (Fresinuis)Iv.Inj.10% Tk 5%.Tk.3144.37/250ml; 25%, Tk4,796.14/
1200/500ml bottle 50ml; Tk.9628.00/100ml 20%.Tk 2052/50ml;
Glucose Solution 19% 526ml + amino acid 7694.00/100ml
solution300ml+ fat emulsion Biotest Human Albumin (I) (Biotest.), IV
(intralipid20%)200ml Infusion 20%; Tk.2802/50ml.
Kabiven(I) (Fresenius )IV infusion(three chmber Human Albumin(I) (Bioplazma) IV Infusion
in one)Tk.2,780/Bag,(885ml+ a 300ml+ 255ml) 20%; Tk.5863.34/100ml; Tk.2968.56/50ml vial
Human Albumin Baxter (I) (Baxter) IV Infusion
Tk. 2,650.00/ 20%; Tk.4211.56/50ml; Tk.7195.23/ 100ml
PLASMA ISOTONIC SOLUTIONS

16.1.5 PLASMA AND PLASMA
SUBSTITUTES Indications: Acute or sub-acute loss of
plasma volume in case of burns,
Albumin solutions are used for the pancreatitis, trauma and complications of
treatment of severe hypoproteinaemia, surgery and plasma exchange
particularly when associated with a low Usual concentration is Human Albumin
plasma volume. Concentrated albumin Solution 4.5%
solutions may also be used to obtain a
diuresis in hypoalbuminaemic patients. HUMAN PLASMA CONCENTRATED
The use of albumin solutions in acute SOLUTIONS (20-25%)
514
16. NUTRITION
Indications: Severe hypoalbuminaemia Indications: For short-term blood

associated with low plasma volume and volume expansion
generalised oedema where salt and Cautions: See notes for Dextran 40
water restriction with plasma volume Side-effects: See notes for Dextran 40
expansion are required; adjunct in the Dose: By intravenous infusion, after
treatment of hyperbilirubinaemia by moderate to severe haemorrhage or in
exchange transfusion in the newborn the shock phase of burn injury (initial 48
hours), 500-1000 ml rapidly initially
PLASMA SUBSTITUTES followed by 500 ml if necessary
Plasma substitutes should be used to Generic Preparation

Dextran-70 6% in Normal Saline (IV Infusion)
maintain plasma volume in conditions
500 ml bag.
like burns or peritonitis where there is
loss of plasma protein, water and
electrolytes over periods of several days GELATIN
or weeks. In these conditions, plasma or
plasma protein fractions containing large Indication: Low blood volume
amounts of albumin should be given. Cautions: Used with caution in patients
Dextrans, Gelatin and Hetastarch, with cardiac disease or renal impairment
pentastarch (etherified starches) are Side-effects: Hypersensitivity reactions
the plasma substitutes generally used may occur, transient increase in bleeding
which are metabolised slowly. time may occur
Dextran 70 by IV infusion is used Dose: By IV infusion, initially 500-1000
predominantly for volume expansion. ml of a 3.5-4% solution
Dextran 40 IV infusion is used in an
attempt to improve peripheral blood flow Generic Preparation
in ischaemic disease of the limbs. IV Infusion 3.5-4% Modified Gelatin Solution
DEXTRAN 40 HETASTARCH, HEXASTARCH AND

PENTASTARCH (ETHERIFIED
STARCH)
Indications: Peripheral local slowing of
the blood flow; prophylaxis of post-
surgical thromboembolic disease Indications: They are used at the outset
Cautions: Plasma substitutes should be to expand and maintain blood volume in
used with caution in patients with cardiac shock arising from conditions such as
disease or renal impairment. Monitoring burns or septicaemia
urine output is necessary during Cautions: Should not be used to
treatment. Care should be taken to avoid maintain plasma volume in conditions
haematocrit concentration from failing such as burns or peritonitis where there
below 25-30% and the patient should be is loss of plasma protein, water and
monitored for hypersensitivity reactions electrolytes over periods of several days
Side-effects: Hypersensitivity reactions or weeks. In these situations, plasma or
may occur including, rarely, severe plasma protein functions containing large
anaphylactoid reactions amounts of albumin should be given
Dose: By IV infusion, initially 500-1000 Side-effects: hypersensitivity reactions,
ml; further doses are given according to severe anaphylactoid reactions
the patient’s condition
Haes Steril(I) (Fresenius), IV Infusion, 6%Tk.
Generic Preparations 607.77/500ml
IV Infusion 10% Saline in Dextrose 5% Plasmex (Beacon), IV Infusion, ,6% Tk.
10% Solution Normal Saline 650/500ml
Voluven(I) (Fresenius), IV Infusion, ,6% Tk.
DEXTRAN 70 [ED] 631/500ml
515
16. NUTRITION
Dried skimmed milk (g) 25

Sugar (g) 100
16.2. ORAL NUTRITION
Vegetable oil (g) 30
Electrolyte mineral solution (ml) 20
16.2.1 FOODS FOR SPECIAL DIET Water to make 1000 ml
Contains 75 Kcal and
0.9 g protein per 100 ml
Malnutrition is one of the most important
health problems of Bangladesh (2) Catch Up (b) :
population. Apart from the highly Dried skimmed milk (g) 80
prevalent nutritional diseases, Sugar (g) 50
particularly affecting mothers and Vegetable oil (ml) 60
children, malnutrition is the underlying Electrolyte mineral solution (ml) 20
Water to make 1000 ml
cause of many associated diseases from
Provides 100 Kcal and
which millions suffer almost every day. 2.9 protein per 100 ml
The most prevalent nutritional diseases
or states are protein energy malnutrition, (3) Catch Up (c) :
nutritional anaemias (particularly iron Dried skimmed milk (g) 90
deficiency), riboflavine deficiency and Sugar (g) 65
vitamin C deficiency. The most Vegetable oil 85
Electrolyte mineral solution (ml) 27
important cause of this malnutrition is
Water to make 1000 ml
poor dietary intake and intake of Provides 135 kcal and
unbalanced diet. Therefore, any 3.3 g protein per 100 ml
formulation of prescription of medicinal
remedies must be combined or even (a) Comparable starter formulas can be
preceded by advice on dietary made from 35 g whole dried milk, 100 g
improvement to balance the diet of the sugar, 20 g oil, 20 ml of
electrolyte/mineral solution and water up
consumer.
to 1000 ml.
There are preparations that have been
modified to eliminate a particular (b) Comparable catch up formulas can be
constituent from food or are nutrient made from 110 g of dried whole milk,
mixtures formulated as substitutes for 50g sugar, 30 g oil, 20ml of
the food, for patients, who either cannot electrolyte/mineral solution and water to
tolerate or cannot metabolize certain 1000ml.
OR
common constituents of food.
880 ml of fresh cows milk, 75 g sugar, 20 ml oil
and 20 ml electrolyte mineral solution and
PHENYLKETONURIA water up to 1000ml.
Phenylketonuria which results from the (c) For use in special circumstances in case
of low weight gain or possible
inability to metabolize phenylalaine, is inadequate feeding
required to restrict its dietary intake to a RECIPE FOR ELECTROLYTE/ MINERAL
small amount sufficient for tissue SOLUTION :
building and repair. Aspartmine Potassium Chloride 224 g 24 mmol
contributes to phenylalaine intake and Tripotassium Citrate 81 2 mmol
should be avoided. Magnesium Chloride 76 3 mmol
Zinc Acetate 8.2 300 µmol
Copper sulphate 1.4 45 µmol
COELIAC DISEASE Water make up to 2500 ml
Coeliac disease, which results from an
intolerance of gluten, is managed by 16.2.2 MINERALS
completely eliminating gluten from the
diet. IRON
Recipes for Treatment of Severe PEM:
WHO has suggested the following three
Oral iron
recipes :
(1) Starter Recipes (a) :
516
16. NUTRITION
Iron salts should be given by mouth iron. The incidence of side-effects due to
unless there are good reasons for using ferrous sulfate is no greater than with
another route. Ferrous salts show only other iron salts when compared on the
marginal differences between one basis of equivalent amounts of elemental
another in efficiency of absorption of iron.
iron. Haemoglobin regeneration rate is Iron preparations are a common cause
little affected by the type of salt used of accidental overdose in children. For
provided sufficient iron is given, and in the treatment of iron overdose,
most patients the speed of response is Parenteral iron
not critical. Choice of preparation is thus Iron can be administered parenterally as
usually decided by the incidence of side- iron dextran, iron sucrose, ferric
effects and cost. The oral dose of carboxymaltose, iron isomaltoside 1000,
elemental iron for iron-deficiency or ferumoxytol. Parenteral iron is
anaemia should be 100 to 200mg daily. generally reserved for use when oral
It is customary to give this as dried therapy is unsuccessful because the
ferrous sulfate, 200 mg (: 65mg patient cannot tolerate oral iron, or does
elemental iron) three times daily; for not take it reliably, or if there is
prophylaxis of irondeficiency anaemia, a continuing blood loss, or in
dose of ferrous sulfate 200 mg once or malabsorption. Parenteral iron may also
twice daily may be effective. For have a role in the management of
treatment of iron-deficiency anaemia in chemotherapy-induced anaemia, when
children and for prophylaxis of iron- given with erythropoietins, in specific
deficiency anaemia in babies of low birth patient groups.
weight, see BNF for Children.
Therapeutic response The haemoglobin (See also section 15.1.1)
concentration should rise by about 100–
200 mg/100mL (1– 2 g/litre) per day or 2 16.2.2.1 CALCIUM & CALCIUM
g/100mL (20 g/litre) over 3–4 weeks. SUPPLEMENTS
When the haemoglobin is in the
reference range, treatment should be 16.2.2.2 HYPERCALCAEMIA
continued for a further 3 months to 16.2.2.3 MAGNESIUM
replenish the iron stores. Epithelial tissue 16.2.2.4 PHOSPHATE SUPPLEMENTS
changes such as atrophic glossitis and AND PHOSPHATE BINDING
koilonychia are usually improved, but the AGENTS
response is often slow. 16.2.2.5 FLOURIDE (See Dental
Side-effects: Gastro-intestinal irritation Practitioner’s formulary)
can occur with iron salts. Nausea and 16.2.2.6 IODINE
epigastric pain are dose related, but the 16.2.2.7 ZINC
relationship between dose and altered
bowel habit (constipation or diarrhoea) is Dietary intake of calcium is generally yet
less clear. Oral iron, particularly deficiency signs are not very overt.
modified-release preparations, can Dietary requirement varies with age and
exacerbate diarrhoea in patients with physiological status is relatively greater
inflammatory bowel disease; care is also in childhood and pregnancy and lactation
needed in patients with intestinal due to increased demand and in old age
strictures and diverticular disease. due to impaired absorption. In
Iron preparations taken orally can be osteoporosis, a calcium intake double
constipating, particularly in older patients the recommended amount reduces the
and occasionally lead to faecal bone loss.
impaction. If side-effects occur, the dose
may be reduced; alternatively, another CALCIUM SALTS
iron salt may be used, but an
improvement in tolerance may simply be Indications : Deficient dietary intake as
a result of a lower content of elemental in childhood, rickets, pregnancy and
517
16. NUTRITION
lactation, in old age due to impaired Caldil (Drug Intl), Tab. , 500mg, Tk. 4.00/Tab
absorption, osteomalacia, osteoporosis, Calfor (Asiatic), Tab. 500 mg, Tk.2.50/Tab
hypocalcaemic tetany, neonatal tetany, Calmet (Somatec), Tab. 500 mg,Tk. 3.00/Tab.
Calmi (Alco), Tab. , 500 mg, Tk. 4.01/Tab.
systolic cardiac arrest Calos (Modern), Tab. , 500 mg, Tk. 4.00/Tab.
Contra-indications: Conditions Calsil (Silva), Tab. , 500mg, Tk. 4.00/Tab.
associated with hypercalcaemia and Calsto (Monico), Tab., 500mg, Tk. 2.00/Tab.
hypercalcuria Caltonic (Globex),Tab. 500 mg, Tk. 4.00/Tab.
Cautions: Renal impairement, Carben (Benham), Tab. 500 mg, Tk. 3.50/Tab.
sarcoidosis. Concurrent administration Carbocal (Globe), Tab. , 500 mg, Tk.
with thiazide diuretics may increase the 2.20/Tab.
Casalt (Kemiko), Tab., 500 mg, Tk. 4.01/Tab.
risk of hypercalcaemia Cenet (Central), Tab. 500 mg, Tk. 1.60/Tab.
Side-effects: Mild gastrointestinal Costin (General), Tab. , 500mg, Tk.
disturbances, bradycardia, arrhythmia 4.00/Tab.
and irritation after injection Eurocal (Euro), Tab., 500 mg, Tk. 4.5/Tab.
Dose: By mouth up to 29 ml calcium Forbon (SMC Enterprise), Tab. , 500 mg,
daily in divided doses as calcium Tk. 3.00/Tab.
gluconate, lactate or pentothenate. By Gravite (Bios ),Tab., 500 mg, Tk. 2.40/Tab.
Ipical (Ibn Sina), Tab. , 500 mg, Tk.
very slow injection IV of calcium 3.50/Tab.
gluconate 1-2 g (2.25-4.5 mmol of Ipical (Ibn Sina), Tab.,500 mg,Tk. 3.50/Tab.
Ca+++); CHILD half the adult dose by Jasocal (Jayson), Tab., 250 mg,Tk. 1.50/Tab.,
slow IV route 500mg, Tk. 2.01/Tab.
Kidcal (Acme), Chewable Tab., 250 mg, Tk. .
CALCIUM CARBONATE 1.51/Tab.
Maxical (Orion), Tab. , 500 mg, Tk. 3.52/Tab.
Med-Cal (Medimet), Tab., 500 mg,
Proprietary Preparations Tk.2.00/Tab.
A-Cal (Acme), Tab., 250 mg, Tk. Miracal (Navana), Tab., 500 mg, Tk.
1.00/Tab.;Tab., 500 mg, Tk. 3.51/Tab. 4.00/Tab.;Tab., 250 mg, Tk. 2.00/Tab.
Acical (ACI), Tab., 500 mg, TK. 4.01/Tab. ; Monocal (Concord),Tab.,500 mg, Tk.
250 mg, TK. 3.01/Tab. 4.00/Tab.
Ambeecal (Ambee) ,Tab., 500 mg, Tk. Mycal (Organic),Tab.,500 mg, Tk. 3.01/Tab.
2.01/Tab Myocal (Nipa), Tab. , 500 mg, Tk. 3.00/Tab.
Aristocal (Beximco), Tab., 500mg , Tk. Naafcal (Naafco), Tab.,500 mg , Tk. 4.00/Tab.
4.00/Tab. Neocal (White Horse), Tab. , 500 mg, Tk.
Bonec (Orion ), Tab., 500 mg, Tk. 3.51/Tab. 2.50/Tab.
Boni (Delta), Tab., 500 mg, Tk. 3.00/Tab. Oracal (Amico), Tab., 500mg , TK. 2.00/Tab.
Bpcal (Bristol), Tab. , 500mg , Tk. 2.00/Tab. Orthocal (Biopharma), Tab. 500 mg, Tk.
Cal (Pacific), Tab. , 250 mg, Tk.3.00/Tab. ; 4.00/Tab.
500 mg, Tk. 5.00/Tab. ; Orthocal (Biopharma), Tab., 500mg , Tk.
Calbo (Square), Tab. , 500 mg, Tk. 5.00/Tab. 4.00/Tab.
; 250 mg, Tk. 3.01/Tab. Oscal (UniMed),Tab. 500 mg, Tk. 3.50/Tab.
Calbon (Aristo), Tab., 500mg , Tk. 5.00/Tab. Ostacid (Rangs), Tab., 500 mg, Tk.
Calcarb (Alco ), Tab., 500 mg, Tk. 4.00/Tab. 3.50/Tab.
Calcibo (Astra Bio), Tab. , 500 mg, Tk. Ostimet (Virgo), Tab. , 500 mg, Tk. 3.00/Tab.
3.00/Tab Ostocal (Eskayef), Tab. 500 mg, Tk.4.00/Tab.
Calcibost (Sharif), Tab., 500 mg, Tk. Ostocal (Eskayef), Tab, 250 mg, Tk.
3.01/Tab. 2.00/Tab.; 500 mg, Tk. 3.00/Tab.
Calcicar (Incepta), Tab., 500 mg, Tk. Ostogen (Opsonin), Tab. , 250 mg , Tk.
2.50/Tab. 2.01/Tab., 500 mg , Tk. 3.26/Tab.
Calcid (Opsonin), Tab., 400 mg, Tk. Protebon (Beacon), Tab.500 mg, Tk. 2.01/Tab
2.01/Tab. Rejuven (Novo Health), Tab. , 250 mg, Tk.
Calcifil(G.A.Co), Tab., 500 mg, Tk. 3.27/Tab. 1.50/Tab.; 500 mg, Tk. 3.00/Tab.
Calcin (Renata), Tab. , 500 mg, Tk. 5.00/Tab. Rocal (Healthcare), Tab.,500mg , Tk.
Calciton (Chemist), Tab. 500 mg, Tk. 2/Tab. 2.00/Tab
Calcium (Albion), Tab., 250 mg, Tk.2/Tab.; Sandocal (Novartis),Tab,500 mg, Tk. 5/Tab.
500 mg, Tk. 2.00/Tab. Sucal (Supreme), Tab.500 mg, Tk. 3.25/Tab.
Calcizen DS (Zenith), Tab. , 500 mg , Tk. Sycal (MST), Tab., 500 mg, TK. 2.50/Tab.
2.01/Tab Tumy (Eskayef), Tab, 250 mg, Tk. 1.50/Tab.
Caldical (Ziska), Tab., 500 mg, Tk. 2.50/Tab.
518
16. NUTRITION
Xcid (Square), chewable Tab. 1000 mg , Tk. Calcinate (G.Aco), Inj. 100mg,Tk.3.50/amp
2.01/Tab. Pantoson (Jayson), Inj. 100mg, Tk.3.85/amp
Xtracal (Pharmasia), Tab.,500 mg, Tk. 4/Tab.
CALCIUM AND VITAMIN C
CALCIUM GLUCONATE[ED]
Indications: Increased demand for
Proprietary Preparations calcium and vitamin C e.g pregnancy,
Calcium ambee (Ambee), Inj. 500mg/5 ml, Tk. lactation, period of rapid growth, old age,
6.22/5 ml Amp.
Calcium-Jayson (Jayson), Inj., 10%, Tk.
infectious disease, convalescence;
9.74/10 ml Amp.; Tk. 9.15/5 ml Amp. treatment for calcium and vitamin C
G-Calcium Gluconate (Gonoshasthaya), Inj., deficiency; adjuvant in colds and
10%, Tk. 9.16/5 ml Amp. influenza
Contra-indications: Hypersensitivity to
CALCIUM LACTATE drug, hypercalciuria, sever renal failure
Cautions: Impaired renal function;
Proprietary Preparations reduce dosage or discontinue therapy if
Caltate (G.A.Co), Tab., 300 mg, Tk. 0.71/Tab. necessary
Calcitate (Ambee), Tab. 300 mg, Tk. Side-effects:Mild gastrointestinal
0.29/Tab. disturbance
Calson (Hudson), Tab. 300 mg, Tk. 0.29/Tab. Dose: ADULT 1 tablet daily; CHILD; half
Calcizen (Zenith), Tab., 300 mg, Tk.
tablet daily
0.30/Tab.
Lactocal(Acme) Tab., 300 mg, Tk. 0.30/Tab
Calac (Opsonin), Tab. , 300 mg , Tk. Proprietary Preparations
0.31/Tab. Acical-C (ACI), Tab. Tk. 11.03/Tab.
G-CALCIUM LACTATE (Gonoshasthaya), C-4 (Alco ), Tab. , Tk. 8.02/Tab.
Tab., 300 mg, Tk. 0.40/Tab.. C4(Alco)Tab.,Tk. 8.00/Tab
CaC-1000 (Novartis), Effervescent Tab.,
Tk.15.00/Tab.
CALCIUM OROTATE Calbo-C (Square), Tab., Tk. 7.88/Tab.
Cavic C(Incepta), Effervesent Tab. , Tk.
Calborate(Square) Tab. , 400 mg, Tk. CavicPlus (Incepta), Effervescent Tab. , Tk.
8.03/Tab., 740mg, Tk. 12.03/Tab. 10.00/Tab.
Calcin (Renata), Tab.,400 mg, Tk. 8.00/Tab., Ostocal (Easkayef) Tab., Tk. 8.00/Tab.
740mg, Tk. 12.00/Tab. Ostogen C (Opsonin) Tab., Tk. 8.06/Tab.
Caldil (Drug Intl), Tab.,400mg, Tk. 8.05/Tab. Ostogen C Plus (Opsonin) Tab.,Tk.
Calofast (Eskayef), Tab, 400mg , Tk. 7.064/Tab
8.00/Tab.; 400mg , Tk. 8.00/Tab. Ultracal-C (Popular), Tab., Tk. 10.54/Tab.
Calorate (Beximco), Tab., 740mg,
Tk.10.00/Tab, 400mg, Tk. 8.00/Tab.
CALCIUM WITH VITAMIN D3
Cden (Sanofi), Tab. , 740mg, Tk. 12.00/Tab.
Effical (Globe), Tab. , 400 mg, Tk. 8.00/Tab.
Intracal(Incepta), Tab. , 400 mg, Tk. Indications: Calcium is necessary for
8.00/Tab.; 740 mg, Tk. 10.00/Tab. many normal functions of body,
O-Cal (Acme), Tab. , 740 mg , Tk. 10.00/Tab. especially bone formation and
Orcical (Ibn Sina), Tab., 400mg, Tk. maintenance.Vitamin D is important for
8.00/Tab. ; 740mg, Tk. 10.00/Tab.
the absorption of calcium from the
Ortical (Opsonin), Tab., 400 mg, Tk.
6.02/Tab. stomach and for the functioning of
Protebon (Beacon), Tab. , 400mg , Tk. calcium in the body.Calcium and vitamin
8.02/Tab. D combination is used to prevent or to
Rotacal(ACI), Tab., 400mg, Tk. 8.00/Tab. ; treat a calcium deficiency.
740mg, Tk. 12.00/Tab. ;
A-Cal D(Acme), Tab., 500 mg + 200 IU, Tk.
CALCIUM PENTOTHENATE 6.50/Tab. 500 mg+400IU,Tk.7.50/Tab
Acical-D (ACI), Tab. 500 mg + 200 IU, Tk.
7.00/Tab.
Calci (Opsonin), Inj. 100mg, Tk.3.52/amp
519
16. NUTRITION
Adcal D (Amulet), Tab. , 500 mg + 200 IU, Tk. Carben -D (Benham), Tab. , 500 mg + 200 IU,
4.00/Tab. Tk. 4.00/Tab.
Ambeecal-D (Ambee), 500 mg + 200 IU, Tk. Carbocal (Globe), Tab. , 500 mg + 200 IU, Tk.
3.31/Tab 7.00/Tab.
Apocal D (Apex ), Tab. , 500 mg + 200 IU, Carbocal-D (Globe), Tab., 500 mg + 200 IU,
Tk. 4.00/Tab. Tk. 5.00/Tab.
Aristocal D (Beximcoi), Tab. , 500 mg + 200 Casalt-D (Kemiko), Tab. , 500 mg + 200 IU,
IU, Tk. 5.00/Tab. Tk. 5.00/Tab.
Beucal D (Julpher), Tab., 500 mg + 200 IU, Corabon (Nuvista), Tab. , 500 mg + 200 I.U.,
Tk. 5.00/Tab. Tk. 10.03/Tab.
Boni D (Delta), Tab. , 500 mg + 200 IU, Tk. Coralcal-D, (Radiant), Tab., 500mg + 200IU,
4.00/Tab. Tk. 11.00/Tab.; DX 600mg + 400IU, Tk.
BPcal (Bristol), Tab. 500mg + 200 IU, Tk. 15.05/Tab.
3.30/Tab.;600 mg + 400 IU, Tk. 3.30/Tab. DOS (Central), Tab. , 500 mg + 200 IU, Tk.
Cadmin (General), Tab. , 500 mg + 200 IU, 4.00/Tab.
Tk. 3.32/Tab., Eurocal (Euro), Tab., 500mg + 200IU, Tk.
Cadolin (Jayson), Tab. , 500 mg + 200 IU, Tk. 6.5/Tab.
5.00/Tab FizyCal (Incepta), Effervesent Tab. 600 mg +
Cal D (Pacific), Tab., 500 mg + 200 IU , Tk. 400 IU,, Tk. 15.00/Tab
7.00/Tab. Ipical-D (Ibn Sina), Tab., 600mg+400 IU, Tk.
Calbo D (Square), Tab. , 500 mg + 200 IU, Tk. 8.00/Tab. ; 500mg + 200 IU, Tk. 5.00/Tab
7.00/Tab. Labcal D (Labaid), Tab. , 500 mg + 200 IU,
Calbo D vita (Square), EffervesentTab., 600 Tk. 7.00/Tab.
mg + 400 IU, Tk. 15.05/Tab Maxical (Orion), Tab. 500mg + 200 IU,, Tk.
Calbon-D (Aristo), Tab. , 500 mg + 200 IU, Tk. 8.85/Tab.
7.00/Tab. Miracal-D (Navana), Tab., 500 mg + 200 IU,
Calcibo-D (Astra), Tablet, 500 mg + 200 IU, Tk. 5.00/Tab.
Tk. 4.00/Tab. ., Monocal D (Concord), Tab. , 500 mg + 200
Calcibost-D (Sharif), Tab. , 500 mg + 200 IU, IU, Tk. 5.00/Tab.
Tk. 4.01/Tab., Mycal (Organic), Tab., 500mg + 200 IU, Tk.
Calci-D (Rephco), Tab. , 500 mg + 200 IU, Tk. 6.00/Tab. ; 600 mg + 400 IU, Tk. 6.00/Tab.
2.00/Tab. Myocal-d (Nipa), Tab. , 500 mg + 200 IU,
Calci-D plus (Rephco), Tab. , 500 mg + 400 Tk. 7.00/Tab.
IU, Tk. 4.30/Tab. Naafcal-D(Naafco), Tab. , 600 mg + 400 IU,
Calcifil (G.A.Co), Tab.,500 mg + 200 IU, Tk. Tk. 8.00/Tab.; 500 mg + 200 IU, Tk.
4.02/Tab.; 7.00/Tab.
Calcin-D (Renata), Tab. , 500 mg + 200 IU, Novacal-D (Leon), Tab. , 500 mg + 200 IU, Tk.
Tk. 7.00/Tab., 4.00/Tab.
Caldical-D (Ziska), Tab., 500 mg + 200 IU, Nutribon (Veritas), Tab., 500 mg + 200 IU, Tk.
Tk.4.00/Tab. 6.00/Tab.
Caldil Plus (Drug Int.,), Tab. , 500 mg + 200 Oceancal (General), Tab. , 600mg + 400IU,
IU, Tk. 6.00/Tab. Tk. 15.00/Tab.
Caldivit (G.S.K), Tab. , 500 mg + 200 IU, Tk. Onecal(One Pharma), Tab., 500 mg + 200 IU ,
3.52/Tab. Tk. 4.99/Tab.
Caldolin (Chemist), Tab. , 500 mg + 200 IU, Oracal-D (Amico), Tab. , 500 mg + 200 IU,
Tk. 5.00/Tab Tk. 5.00/Tab.
Calfor D (Asiatic), Tab. , 500 mg + 200 IU, Tk. Orthocal-D, (Biopharma), Tab., 500mg +
6.00/Tab. 200IU, Tk. 6.00/Tab.;
Calget (Getwell), Tab.500mg + 200 IU, Tk. Oscal (UniMed), Tab. ;500 mg + 400 IU, Tk.
7.00/Tab. 5.00/Tab. 600 mg + 400 IU,Tk.6.00/Tab
Calmet D (Somatec), 500 mg + 200 IU, Tk. Ostacid-D (Rangs), Tab., 500 mg + 200 IU,
Calmi-D(Alco), Tab. , 500 mg + 200 IU, Tk. Tk. 4.00/Tab.
5.02/Tab. Ostimet (Virgo), Tab. , 500 mg + 200 IU, Tk.
Calsil (Silva), Tab. , 500 mg + 200 IU, Tk. 5.00/Tab.
5.00/Tab. Ostium-D (APC), Tab., 500 mg + 200 IU, Tk.
Calsto (Monico), Tab., 500mg + 200IU, Tk. 3.50/Tab.
5.00/Tab. Ostocal D (Eskayef), Tab, 500 mg + 200 IU,
Caltonic-D (Globex), Tab. , 500 mg + 200 IU, Tk. 7.00/Ta
Tk. 5.00/Tab. Ostogen D (Opsonin), Tab., 600 mg + 400 IU,
Calvimax (Incepta), Tab., 500 mg + 200 IU, Tk. 6.00/Tab. ; 500 mg + 200 IU, Tk. 5.02/Tab.
Tk. 5.00/Tab. Protebon D (Beacon), Tab., 500 mg + 200 IU,
Tk. 7.00/Tab.
520
16. NUTRITION
Rejuven (Novo Health), Tab. , 500 mg + 200 pregnancy and lactation; deficiency state of
IU, Tk. 4.00/Tab. calcium and vitamin D
Rocal- D Vita (Healthcare),Tab., 600 mg + Contra-indications, Side-effect, Cautions:
400 IU, Tk. 15.00/Tab. See under calcium and vitamin-C
Rocal-D (Healthcare), Tab., 500 mg + 200 IU, Dose: 2 tablets per day, preferably 1 tablet in
Tk. 8.00/Tab. the morning and 1 tablets in the evening
Sandocal D (Novartis), Tab., 500 mg + 200
IU, Tk. 7.00/Tab. Proprietary Preparations
Starcal D (Nipro JMI), Tab., 500 mg + 200 IU, Acical-M (ACI), Tab., Tk. 5.04/Tab.
Tk. 6.00/Tab. ; 500 mg + 400 IU, Tk. 8.00/Tab. Apocal DM (Apex ), Tab., Tk. 4.00/Tab.
Sucal-D (Supreme), , 500mg+200IU, Tk. Aristocal M (Beximco), Tab., 500 mg, Tk.
4.00/Tab. 5.5/Tab.;
Sycal-D (MST), Tab., 500 mg + 200 IU, TK. Boni M (Delta), Tab., Tk. 4.00/Tab. .
4.00/Tab. Bontoni (Globex), Tab., Tk. 5.00/Tab.
Temcal (Team), Tab., 500 mg + 200 IU, Tk. Cadmin Plus (General), Tab., Tk. 4.04/Tab.
6.50/Tab.; Cal D Plus (Pacific), Tab., Tk. 8.00/Tab.
Ultracal-D (Popular ), Tab., 500 mg + 200 IU, Calbon M (Aristo), Tab., Tk. 5.00/Tab.; Tk.
Tk. 5.00/Tab. 5.00/Tab.
Xtracal-D (Pharmasia), Tab., 500 mg + 200 Calbon Plus (Aristo), Tab., Tk. 5.50/Tab.
IU, Tk. 4.00/Tab. Calboplex (Square), Tab., Tk. 5.02/Tab.
Calcium (Coral Source) + Vitamin D3 Calcin-M (Renata), Tab., Tk. 5.50/Tab.
Calcium Forte (Albion), Tab. , 500 mg + 200
CalcoralD(Popular), Tab. , 500 mg + 200 IU, IU, Tk.3.30/Tab
Tk. 10.00/Tab. ; DX600mg + 400IU, Tk. Calcium Forte Plus (Albion), Tab. , Tk.
15.00/Tab. 3.50/Tab.
Cora(ACI), Tab., 500mg +200IU, Calcium- M (APC), Tab., Tk. 4.00/Tab.
Tk.10.00/Tab.; 600mg+ 400IU, Tk. Calcium-C Forte (Albion), Tab., Tk. 8.00/Tab.
15.00/Tab. Calcium-fort Plus (Albion), Effervescent Tab.,
Coral (Ibn Sina), Tab. , 500mg+ 200IU, Tk. Tk.7.86/Tab
8.00/Tab. ; 600mg+ 400IU, Tk. 10.00/Tab Calmi-M (Alco), Tab., Tk. 5.50/Tab.
Coralex(Acme),Tab., 500 mg + 200 IU Calsil M (Silva), Tab., Tk. 5.50/Tab.
10.00/Tab Calvimax Plus (Incepta), Tab., Tk. 5.00/Tab.
Fossical (Aristo), Tab., 500mg +200IU, Tk. Ipical-M (Ibn Sina), Tab. , Tk. 6.00/Tab.
10.00/Tab.; DX 600mg + 400IU , Tk. Miracal-M (Navana), Tab., Tk. 5.36/Tab.
15.00/Tab. Oracal-M (Amico ), Tab., Tk. 4.00/Tab.
Marincal(Incepta), Tab. , 500mg +200IU, Tk. Oscal-M (Unimed), Tab., Tk. 5.00/Tab.
10.00/Tab. Ostocal-M (Easkayef) Tab. , Tk. 5.00/Tab.
Oceancal- D (General), Tab. , 500mg + Protebon M (Beacon), Tab., Tk. 5.03/Tab.
200IU, Tk. 10.00/Tab.; DX 600mg + 400IU, Tk. Rocal-M (Healthcare), Tab., Tk. 9.00/Tab.
15.00/Tab. Xtracal-M (Pharmasia), Tab., Tk. 3.52/Tab.
Okical (UniMed) 500mg+ 200IU, Tk.
10.00/Tab. ; 600mg+ 400IU, Tk. 15.00/Tab 16.2.2.2 HYPERCALCAEMIA
Ostocal GX (Eskayef), EffervesentTab, 600
mg + 400 IU, Tk. 15.00/Tab.
Reef (Healthcare), Tab., 600 mg + 400 IU, Tk. Treatment of acute severe
50.00/Tab.; 500 mg + 200 IU, Tk. 24.00/Tab. hypercalcaemia is needed when calcium
SB-Cora (Sunman-Bardem), Tab. , 500mg level is 3.0 mmol/l loop diuretics can be
+200IU, Tk. 10.00/Tab. given which enhances calcium
Seacal(Drug Intl), Tab. , 500mg + 200IU, Tk. reabsorption, bisphosphonates or
10.00/Tab
plicamycin can be given in acute cases.
Calcium+vitaminC+vitaminD Because of its toxicity plicamycin is not
Calbo fort (Square) Effervesent Tab., Tk. the drug of choice for the treatment of
8.06/Tab. hypercalcaemia. (See also Section 5.6)
Cavic-C Plus (Incepta), Tab.,Tk. 8.00/Tab.
Ostovit (Eskayef), Effervesent Tab., Tk. 16.2.2.3 MAGNESIUM
8.00/Tab.
CALCIUM + MINERALS Indications: To prevent convulsion in

patients with pre-eclampsia, eclampsia,
Indications: Prevention and treatment of tetanus and acute uremia
osteoporosis; nutritional supplement;
521
16. NUTRITION
Contra-indications: Heart block or hyperphosphataemia complicating renal

myocardial damage failure
Side-effects: Excessive administration 16.2.2.5 FLOURIDE
of magnesium results in hypermag- (See Dental Practitioner’s Formulary)
nesaemia manifested by nausea,
vomiting, flushing of the skin, thirst,
16.2.2.6 IODINE
hypotension, drowsiness, confusion, loss
of tendon reflexes, respiratory depre-
ssion, cardiac arrest Indications: Endemic Goiter due to
Dose: Seizure prophylaxis in pre- iodine deficiency is widespread in
eclampsia and eclampsia: a loading Bangladesh. The commonly affected
dose of 4 g or 16 mmol (100 ml) over up groups are adolescent girls, school age
to 20 minutes followed by a maintenance children, and pregnant and lactating
dose of 2 g or 8 mmol (50 ml) per hour. mothers.
Recurrence of seizure may require and Dose: The recommended adult intake is
additional I.V. bolus of 2-4 g or 8-16 about 150 microgram.
mmol (50-100 ml). For seizure Cautions: An intake over 2000 IU is
prophylaxis, treatment should continue considered excessive and may cause
during labour and for at least 24 hours toxicity in individual cases. Excessive
after delivery consumption may cause iodine-induced
hyperthyroidism.
G-Mag Sulph (Gonoshasthaya), Inj.4% PROPHYLAXIS
Tk.3.00/5ml,
Magsum (Renata)Inj.2.5g/5ml,Tk.18.06 Iodination of salt: To provide 150
Nlepsin (Beximco), I.V. Infusion, Mag.sulph
4%+Nacl 0.45/%+Dextrose 5%,Tk.70.8/100ml
µg/day which requires iodination of salt
with potassium iodate at the rate of 15
parts per million. To provide for storage
16.2.2.4 PHOSPHATE
and cooking losses, Bangladesh
SUPPLEMENTS AND
program for control of goiter put iodine at
PHOSPHATE BINDING 15 parts per million.
AGENTS
Indications: Patients who have been I-Cap (Drug Intl), Cap. 200mg
suffering from hypophosphataemic
Vitamin D resistant rickets. Phosphate 16.2.2.7 ZINC
infusion is occasionally needed in the
debilitated patients taking IV nutrition
Indications: Subclinical zinc deficiency
deficient in potassium phosphate
to prevent growth retardation in children
supplements and in severe diabetic
ketoacidosis.
Dose: Whole grain cereals are good
sources of zinc but most of the zinc are
Side-effects: Diarrhoea is the common
present in bran and germ and lost during
problem during the treatment with
milling. Legumes are also good sources.
potassium phosphate supplements and
Requirement is about 15 microgram.
the dose should be reduced at that time.
Cautions: essential to monitor closely
plasma concentration of phosphate and ZINC SALTS [ED]
other electrolytes
Phosphate binding agents: Aluminum Indications: See notes above
containing and calcium containing Side effect: abdominal pain, dyspepsia
antacids are used as phosphate binding
agents in the management of Proprietary Preparations
Baby Zinc (Acme), Tab., 20 mg, Tk. 1.76/Tab.
522
16. NUTRITION
Bimuty (Pacific), Tab., 20 mg, Tk. Zeal (Jayson), Syrup, 10 mg/5 ml,
1.50/Tab.;DS Syrup, 10 mg/5 ml, Tk. Tk.30.00/100 ml
29.80/100ml Zedex (Beximco), Syrup, 10 mg/5 ml, Tk.
Biozinc (Ibn Sina), Syrup, 10 mg/5 ml, Tk. 30.00/100 ml
35.00/100 ml Zemin (Euro), Syrup, 20 mg/5 ml Tk.
B-Zn (Benham), Syrup , 10 mg/5 ml, Tk. 55.00/100ml
35.00/100 ml Zep (Alco), Syrup,10 mg/5 ml, Tk.35.11/100 ml
C-Zinc (Central), Syrup, 10 mg/5 ml, Tk. Zep Junior (Alco), Syrup, 10 mg/5 ml, Tk.
30.00/100 ml 27.47/100 ml
Dispazinc (ACI), Tab. , 20 mg , Tk. 2.01/Tab. Zesup (Square), Syrup, 10 mg/5 ml, Tk.
Dz-20 (Julpher), Syrup, 20 mg/5 ml, Tk. 35.11/100 ml;, Syrup, 20 mg/5 ml, Tk.
50.00/100 ml 50.20/100 ml
Ezy Xinc (Eskayef), Tab., 20 mg Tk. 1.75/Tab. Zico (General), Syrup, 10 mg/5 ml, Tk.
G-Zinc (Gonoshasthaya), Syrup, 10 mg/5 32.00/100ml
ml, Tk. 24 .00/100 ml;Tab. , 20 mg, Tk. Zido (Novo Health), Syrup, 20 mg/5 ml, Tk.
1.00/Tab. 35.00/100ml
Kidizinc (Virgo), Syrup, 20 mg/5 ml,, Tk. Ziflu (Incepta), Syrup, 10 mg/5 ml, Tk.
35.00/100ml 30.00/100 ml
Kidzin (Sharif), Syrup, 10 mg/5 ml, Tk. Zikid (Globe), Syrup, 10 mg/5 ml, 35.00/100ml
35.11/100 ml Zinc (Asiatic), Syrup, 10 mg/5 ml,
Leozinc(Leon), Syrup, 10 mg/5 ml, Tk. Tk.28.00/100 ml , 20 mg/5 ml Tk. 30.00/100ml;
32.00/100 ml Zinc (Alco), Tab. 20mg, Tk. 1.75/Tab.
Mazic (Renata), Tab. , 20 mg, Tk. Zinc (Square), Tab., 20 mg, Tk. 2.01/Tab.
1.50/Tab.;DS Syrup, 20 mg/5 ml, Tk. Zinc Sulphate (Albion), Syrup,10 mg/5 ml,
55.00/100 ml; 4 mg/5 ml, Tk. 38.00/100 ml; 10 Tk.30.00/100 ml
mg/5 ml, Tk. 35.00/100 ml Zinc Sulphate (APC), Syrup,10 mg/5 ml,
Naafzinc (Naafco), Syrup, 20 mg / 5 ml, Tk. Tk.30.00/100 ml
45.00/100ml; Tab. , 20 mg, Tk. 1.75/Tab. Zincare (Jayson), Tab., 20 mg, Tk. 2.00/Tab.
Nid (Opsonin), Tab., 20 mg, Tk. 1.14/Tab.; Zinc-DT (Alco ), Tab., 20 mg, Tk. 1.75/Tab.
Syrup 10 mg/5 ml, Tk. 26.32/100 ml Zincol (Somatec), Syrup, 10 mg/5 ml, Tk.
Nipozin (Nipro JMI), Syrup, 10 mg/5 ml, 30.00/100 ml
Tk.35.00/100 ml Zincoral (Ziska), Syrup, 10 mg/5 ml, Tk.
Novo Zinc (Novo Health), Tab. , 20 mg, Tk. 30.00/100ml
2.00/Tab. Zinga (Biopharma), Tab.,20mg Tk.
Oralzin (Aristo), Syrup, 10 mg/5 ml, Tk. 2.01/Tab.;Syrup, 10 mg/5 ml, Tk. 35.00/100 ml
28.00/50ml,Tk., 30.00/100 ml Zinofa (Modern), Syrup, 10 mg/5 ml,, Tk.
Orazinc (Navana), Tab., 20 mg, Tk. 1.51/Tab.; 30.00/100ml
Syrup, 10 mg/5 ml, Tk. 20.08/50 ml; Tk. Zipol (Apex), Syrup, 20 mg/5 ml, Tk.
30.11/100 ml 45.00/100 ml , Syrup, 10 mg/5 ml, Tk.
Orgazinc (Organic), Syrup, 10 mg/5 ml, Tk. 30.00/100 ml
35.00/100 ml Ziqui (Monico), Syrup, Syrup, 10 mg/5 ml,,
Pedi-Z (Supreme), Syrup, 10 mg/5 ml,, Tk. Tk. 35.00/100ml
30.00/100ml Zis Acme), Syrup, 10 mg/5 ml, Tk. 38.00/100
Pem (Astra Bio), Syrup, 10 mg/5 ml, Tk. ml
30.00/5ml Zismo (Kemiko), Syrup, 10 mg/5 ml, Tk.
Pep (Orion), Syrup, 4mg/5 ml, Tk. 33.00/100 35.00/100 ml
ml, 10 mg/5 ml, Tk. 38.00/100 ml;Tk. Ziton (Drug Intl), Syrup10 mg/5 ml, Tk.
60.18/200 ml;, 20 mg/5 ml, Tk. 57.00/100 30.10/100ml
ml;Tab., 20 mg, Tk. 2.75/Tab. Zixol (UniMed), Syrup , 10mg/ 5ml, Tk.
Peptin Ds (Nipa), Syrup10 mg/5 ml Tk. 30.00/100ml
35.00/100ml Zn (Amico), Syrup, 10 mg/5 ml, Tk. 35.00/100
SMC Zinc (SMC Enterprise), Tab. , Tab. ml;Syrup, 20 mg/5 ml, Tk. 50.00/100 ml ,Tab.,
20mg, Tk. 1.75/Tab 20mg , TK. 2.00/Tab.
Soluzinc (Popular), Tab., 10 mg/5 ml, Znkid (Delta), Syrup,10 mg/5 ml, Tk.
Tk.30.11/100 ml 30.00/100 ml
Temzinc (Team), Syrup, 10mg/5ml, Tk. ZS (Decent), Syrup, 20mg/5ml, Tk.
33.00/100ml 30.00/100ml
Tiny-Z (Pharmasia), Syrup,10 mg/5 ml, Z-sil (Silva), Syrup, 10 mg/5 ml, Tk.
Tk.30.00/100 ml 25.09/100ml
Xinc (Eskayef), Syrup, 10 mg/5 ml, ZT (Beacon), Tab., 20 mg, Tk. 1.51/Tab.
Tk.35.00/100 ml; 55.00/200ml; 50.00/150ml
Tab, 20 mg, Tk. 2.75/Tab. 16.2.3 VITAMIN PREPARATIONS
523
16. NUTRITION
membrane, desquamation, bone and

16.2.3.1 VITAMIN A joint pain, liver damage and coma.
16.2.3.2 VITAMIN B COMPLEX
16.2.3.3 VITAMIN C 16.2.3.1 VITAMIN A
16.2.3.4 VITAMINS D
16.2.3.5 VITAMIN E Indications: Vitamin A deficiency states,
16.2.3.6 VITAMIN K such as night blindness, impaired dark
16.2.3.7 MULTIVIT AND MINERAL adaptation, follicular hyperkeratosis of
PREPARATIONS the skin, Bitot's spot and keratomalacia
16.2.3.8 ANTIOXIDANT VITAMIN in the eye
PREPARATION. Cautions: Hypervitaminosis A can occur
in infants and children given massive
16.2.3 VITAMIN PREPARATIONS doses for long periods and early
pregnancy
Vitamin A deficiency is widespread Side-effects: overdose can cause rough
particularly among the pre school skin, dry hair, enlarged liver, raised ESR,
children and pregnant and lactating raised serum calcium and serum alkaline
mothers. phosphatase concentrations
For prophylaxis it is advised to give Dose: For treatment of xeropthalmia,
200,000 I.U. of vitamin A every 6 months CHILD under 1 year, immediately
to all children 1-6 months that are at risk 100,000 IU; next day 100,000 IU; 2-4
and to all infants 6-11 months, 100,000 weeks later 100,000 IU
particularly along with the vaccination of For CHILD over 1 year, 200,000 IU
measles and polio. For lactating immediately; next day 200,000 IU; 2-4
mothers, 200,000 I.U. orally at delivery weeks later 200,000 IU.
or during the first 8 weeks postpartum if In severely protein energy malnutrition :
breast-feeding to raise the level of Monthly until PEM resolves under 1
vitamin A in the breast milk to protect the year, 100,000 IU; and 200,000 IU when
breast-fed infants; or first 6 weeks if not the child is over a year
breast-feeding to protect the mother.
Because of the epidemiological evidence Proprietary Preparations
A-Forte (Globe), Cap. 50,000 IU; Tk.1.90/cap;
of involvement of vitamin A and carotene
A-Vit (Globe),Cap 1,00,000 IU,Tk. 2.83/Cap,
in the prevention of cancer vitamin A has 2,00,000,IU Tk./Cap Tk.4.04/Cap
been incorporated in special anti-oxidant Ovit-A (Opsonin) Cap 50,00 IU,Tk. 1.93/Cap,
preparations, which are widely used in 2,00,000,IU Tk./Cap Tk.6.33/Cap
Bangladesh. The available evidences Ratinol Forte (Drug Intl), Cap. 50,000 IU;
are still controversial and inconclusive Tk.1.93/Cap
and may not justify the cost in its use. RE-gel(Renata)Cap.50,000IU;
Tk.1.90/Cap,1,00,000Tk.3.00/cap,2,00,000Tk.
Bangladeshi physicians should carefully
4.00/Cap
scrutinize these evidences before Vis (Pacific), Cap. 50000 IU, Tk. 1.90/Cap.
suggesting them for use. Consumption
of high doses of vitamin A during
16.2.3.2 VITAMIN B COMPLEX
pregnancy has been reported to cause
birth defects. Supplements of vitamin A
should not be taken without the advice of Deficiency of certain vitamin of B-group
a doctor. is very common in Bangladesh. There is
Toxicity from consumption of pre-formed widespread prevalence of clinical signs
vitamin A (not carotinoids) can occur of riboflavin deficiency. Sub-clinical
with chronic consumption of doses of 10 deficiency of other B-group vitamin
times higher than the recommended remain unquantified but likely to be very
dietary allowances. Dose dependent common. Folic acid deficiency is very
toxicity include headache, vomiting, common amongst pregnant women.
diplopia, dryness of the mucus Vitamin B1 deficiency may not be
common due consumption of parboiled
524
16. NUTRITION
rice. Pyridoxine deficiency is rare but Ribomin (Ad-din), Tab. 5 mg, Tk. 0.23/Tab.
may occur during isoniazide therapy and Ribosina (Ibn Sina), Tab.,5 mg, Tk. 0.30/Tab.
is characterised by peripheral neuritis. Rivin (Supreme), 5 mg, Tk. 0.30/Tab.
Riboson (Jayson), Tab., 5 mg, Tk. 0.30/Tab.
THIAMINE B1 [ED] NICOTINIC ACID (B3)
THIAMINE HYDROCHLORIDE Indications: Prevention and treatment

of pellagra, as vasodilator in peripheral
Indications: Beriberi, diabetic vascular disease, Vincent’s infection,
neuropathy, polyneuritis after infectious hypercholesterolaemia and hypertrigly-
diseases, mental disorders associated ceredamia
with alcoholism, Wernickes’ syndrome, Contra-indications: Pregnancy, breast-
and anorexia nervosa feeding
Dose: ADULT : daily requirements 3-6 Side-effects: Flushing, dizziness,
mg; neuritis 25-100 mg by IM injection palpitations, pruritus, nausea, vomiting,
daily followed by 10-15 mg orally daily rarely impaired liver function and rashes.
for a few months. In acute deficiency, Cautions: Diabetes mellitus, gout, liver
100-200 mg daily by IM or IV daily disease and peptic ulcer
followed by 100-200 mg orally. Neuralgia Dose: 100-200 mg daily
50-150 mg by injection every alternate
days. Anorexia same as Neuritis Proprietary Preparation
CHILD : 5-20 mg orally and parenterally Nicoson (Jayson), Tab., 500mg; 50mg
Niconic (Pacific), Tab. , 50 mg, Tk.
A-B1 (Acme), Tab., 100 mg, Tk. 0.74/Tab.
Beovit (Square), Tab. 100 mg, Tk. 0.86/Tab. PYRIDOXINE (B6) [ED]
Berin (GSK), Tab.10 mg, Tk. 2.66/Tab.
B-One (Alco ), Tab. , 10 mg, Tk. 0.74/Tab.
G-Vitamin B1 (Gonoshasthaya), Tab., 10
Indications: Peripheral neuritis,
mg, Tk.0.63 /Tab isoniazid induced peripheral neuritis,
Thianomin (Rephco), Inj., 25 mg/ml, premenstrual syndrome, pregnancy,
Tk.2.60/1ml Amp. radiation sickness, idiopathic
Thiason (Jayson), Inj., 100 mg/ml , Tk. sideroblastic anaemia, B6-deficiency
3.55/1ml Amp.Tk. 16.24/10 ml Amp. anaemia, other deficiency states and
Thiosina (Ibn Sina), Tab., 10 mg, Tk. convulsions in children
0.84/Tab.
Thiosina (Ibn Sina), Tab.,100 mg
Contra-indication: In patients receiving
Tivit (ACI), Tab., 100 mg, Tk. 0.74/Tab. levodopa
Tone (Orion), Tab. , 10 mg, Tk. 0.73/Tab. Cautions: Drug interaction with
Vita-1 (Pacific), Tab., 100 mg, Tk. 0.73/Tab. levodopa but does not occur if dopa
Vitaone (Zenith), Tab., 100 mg, Tk. 0.73/Tab. decarboxylase inhibitor is also given
Dose: ADULTS and deficiency states,
[ED] 20-25 mg up to three times daily.
RIBOFLAVINE B2
Isoniazid neuropathy, prophylaxis 10 mg
Indications: Angular stomatitis, daily
cheilosis, glossitis, seborrhoeic Idiopathic sideroblastic anaemia, 100-
dermatitis, photophobia, anaemia and 400 mg in divided doses
neuropathy Premenstrual syndrome, 50-100 mg
Dose: ADULT and CHILD 5-10 mg daily daily
CHILD: Convulsion 20-100 mg daily.
Riboflavin (Amico), Tab., 5 mg, TK. 0.13/Tab. Proprietary Preparations
Riboflavin (Amico), Tab., 5 mg, Tk. 0.13/Tab. Pyrol (Jayson), Tab. , 25 mg, Tk. 0.50/Tab.
G-Vitamin B2 (Gonoshasthaya),Tab, 5 mg, G-Vitamin B6 (Gonoshasthaya), Tab. , 25
Tk. 0.18/Tab. mg, Tk. 0.25/Tab.
Ribozen (Zenith), Tab. 5 mg, Tk, 0.23/Tab. Sixvit (Beacon), Tab. , 20mg , Tk. 1.30/Tab.
525
16. NUTRITION
to 500 microgram every one to three

CYNOCOBALAMIN B12 months as maintaince therapy
(See section 15.1.2)
Colamin (Rangs), Tab., 0.5mg, Tk. 4.00/Tab.
Indications: Pernicious anaemia and Maclon (White Horse), Tab. , 0.5 mg, Tk.
other B12 responsive macrolytic 4.00/Tab.
anaemias; prophylaxis in total Mb (Acme), Tab., 500 microgram, Tk.
gastrectomy or total ileal resection, 4.01/Tab., Inj., 500 microgram / ml, Tk.
malabsorption syndrome, coeliac 30.11/Amp
Mecobal (General), Tab. , 500 microgram,
disease, tropical sprue etc
Tk. 4.02/Tab.;Inj., 500 microgram / ml, Tk.
Contra-indications: Leber’s disease, 30.00/Amp.
tobacco amblyopia (use hydroxoco- Mecol (Aristo), Tab. , 0.5mg, Tk. 4.00/Tab.
balamin) Mecolagin (Incepta), Tab. , 500 microgram,
Dose: ADULT: 250-1000 microgram IM Tk. 4.00/Tab. ;Inj., 500 microgram / ml, Tk.
on alternate days for 1-2 weeks (or for 30.00/Amp.
10 times) then 250 microgram weekly Mecolin (Drug Int), Tab. , 500 microgram, Tk.
4.00/Tab.
until blood count is normal. Maintenance,
Mecopen (Eskayef), Tab, 500 microgram,
1000 microgram every monthly Tk. 4.00/Tab.
CHILD: initially as for adult, subsequent Methicol (Square), Tab. , 500 microgram, Tk.
dosage according to haematological 4.01/Tab.; Inj., 500 microgram / ml, Tk.
response (for detail see manufacturers’ 30.11/Amp.
literature) Nervex(Orion), Tab. , 500 microgram, Tk.
4.02/Tab.
Nerviton(Opsonin), Tab., 500 microgram, Tk.
3.02/Tab.;Inj., 500 microgram / ml, Tk.
(See section 15.1.2) 22.64/Amp.
Neural (Healthcare), Tab., 0.5 mg, Tk.
MECOBALAMIN 4.25/Tab.
Pedial (Globe), Tab., 0.5 mg, Tk. 4.00/Tab
Phyton (ACI), Inj., 5mg/ml, Tk. 30.11/Amp. ;
Indications: Diabetic and alcoholic Tab. , 0.5mg , Tk. 4.02/Tab.
neuropathy; drug induced neuropathy; Remylin (Ibn Sina), Tab., 500 microgram, Tk.
lumbago; intercostals neuralgia and 4.50/Tab.
other neuropathies). Megaloblastic
anemia due to vitamin due B12 deficiency VITAMIN B-COMPLEX
(injection only) PREPARATIONS
Cautions: The methylcobal Tablet
should not be used for months. Indications: B-complex deficiency
Methylcobal injection should be states during pregnancy, lactation,
discontinued if symptoms of prolonged antibiotic therapy,
hypersensitivity, such as eruption occur; convalescence
infrequently pain and induration at the Dose: prophylectic 1-2 cap. daily Other
site of injection. preparations - see under individual drugs
Dose: By mouth 500 microgram three
times daily.The dose should be justed
VITAMIN B-COMPLEX [ED]
according to the age of patient and the
severity of symptoms
Injection 500 microgram administered Nicotinamide20mg + Pyridoxine Hydrochloride
intramuscularly or intravenously three 2mg+ Riboflavin2mg + Vitamin B1 5mg
times a week in peripheral neuropathies.
In megaloblastic anemia the usual adult Adcovit (Team), Syrup., Tk. 62.19/200ml
dose is 500 microgram administered Aduvit (Pacific), Cap. , Tk. 0.52/Cap.,
intramuscularly or intravenously three Syrup, Tk. 35.00/100ml; Tk. 60.00/200ml
times a week. After about 2months of Aristoplex (Beximco), Syrup, Tk.
35.64/100ml; Tk. 42.90/200ml
adminstration, dose should be changed Aristovit (Beximco), Tab., Tk. 0.62/Tab.
526
16. NUTRITION
Aritone (Incepta), Syrup, Tk. 55.00/100m; Tk. Ziskavit (Ziska), Cap. , Tk. 137.00/Cap., Tab.
95.00/200ml , Tk. 55.00/Tab.
Asivit (Asiatic), Tab., Tk. 0.52/Tab. Zismo B(Kemiko), syrup, Tk. 85.26/200ml;
B-50 Forte (Square), Inj., Tk. 10.03/Inj.; Cap. Tk.50.14/100ml
Tk. 1.25/Cap., Syrup, Tk. 62.19/200ml
Beconex (Renata), Syrup, Tk. 35.00/100ml; Cyanocobalamin200 mcg + Pyridoxine
Tk. 62.00/200ml Hydrochloride200 mg + Vitamin B1100
Benvit -B (Benham), Tab.Tk. 0.51/Tab. mg(Tab)
Big B (Amico ), Tab. Tk. 4.00/Tab.
Biovit (Biopharma), Syrup, Tk. 35.00/100ml; Cyanocobalamin 1 mg + Pyridoxine
Tk. 62.00/200ml Hydrochloride100 mg + Vitamin B1100 100
Combivit (Orion), Inj , Tk. 10.03/Inj. mg/3 ml(Inj)
Complavit (G.S.K), Syrup, Tk. 18.40/100 ml Asibion (Asiatic), Tab., Tk. 7.00/Tab.
Flavit (Amico), Syrup, TK. 20.65/100ml; TK. B126(Popular), Tab. , , Tk. 5.00/Tab
38.00/200ml; TK. 19.80/syrup Berin plus(GSK), Tab. , , Tk. 4.45/Tab.,
Genaplex (General), Syrup, Tk. 20.75/100 ml; Getbion (Getwell), Tab., Tk. 8.00/Tab.
Tk. 37.75/200 ml; Kvit (Kemiko), Inj., Tk. 25.07/3 ml Amp.;
G-Vitamin B Complex (Gonoshasthaya) Tab. Tab., Tk. 6.00/Tab. ,
Tk. 0.45/Tab; Syrup, Tk.18.00/100 ml; Miovit (Somatec), Tab. , Tk. 7.00/Tab.
Tk.36.00/200 ml .,Inj., Tk. 10.00/2 ml Myelin (Opsonin), Inj.,Tk. 25.09/3ml Amp;
Hiposul (G.A.Co), Inj., Tk. 10.03/Amp; Syrup, Tab., Tk. 5.02/Tab.
Tk. 38.3/200 ml; Tab., Tk. 0.43/Tab. Neobion (Aristo), Inj., Tk. 26.00/3 ml Amp;
Kidizinc (Virgo), Syrup, Tk. 50.00/100ml Tab., Tk. 8.00/Tab.
Kvit-B (Kemiko), Inj., Tk. 10.03/2ml Amp.; . Nerbo (Sharif), Tab. , Tk. 7.00/Tab.
Miovit (Somatec), Tab. , Tk. 4.01/Tab. Nerviplex (Jayson), Inj., Tk. 25.10/3 ml Amp.;
Nerbo (Sharif), Tab. , Tk. 4.00/Tab Tab., Tk. 4.01/Tab.
Nervin (Jayson), Inj., Tk. 10.00/2 ml Amp. Neubin (Ziska), Tab. , Tk. 240.00/Tab., Inj.,
Neucos-B (Radiant), Tab. , Tk. 11.00/Tab. Tk. 250.00/Amp
Neurobest (Renata), Inj., Tk. 30.00/Amp. ; Neucos-B (Radiant), Tab. , Tk. 11.03/Tab
Tab. Tk. 5.00/Tab. Neuralgin (Ibn Sina), Tab. , Tk. 5.00/Tab.,
Neuvital (UniMed), Tab , Tk. 5.00/Tab. Inj. , Tk. 26.00/3 ml Amp
Nipaplex (Nipa), Syrup, Tk. 62.00/200ml Neurep (Biopharma), Tab., Tk. 7.00/Tab.
Nutrivit-B(ACI) Tk. 62.19/200ml Tk. NeurexB (Silva), Tab. , Tk. 5.00/Tab.
35.65/100ml Neuroaid (Novo Health), Tab, Tk. 5.00/Tab.
Nutrovita (Asiatic), Syrup, Tk. 20.91/100ml; Neuro-B (Square), Inj., Tk. 25.10/Amp.; Tab.
Tk. 38.17/200ml; Cap., Tk.. 0.58/Cap. Tk. 5.00/Tab
Opsovit (Opsonin), Tab., Tk. 0.62/Tab.;Syrup, Neurobest (Renata), Inj. Tk. 30.00/3 ml Amp.;
Tk. 25.59/100 ml; Tk. 42.77/200 ml; Tab. , Tk. 8.00/Tab
Orgabion(Organic), Tab. , Tk. 7.00/Tab. Neurocare (Beximco), Tab., Tk. 8.00/Tab.
Orioplex (Orion), Syrup, Tk. 35.65/100ml; Tk. Neurotonic (Globex), Tab. , Tk. 5.00/Tab.
62.19/200ml; Tab. , Tk. 0.51/Tab Neuvital (UniMed), Tab. , Tk. 5.00/Tab
Polyvit-B (Albion), Cap. , Tk. 0.57/Cap. ; Nevrona (One Pharma), Tab., Tk. 4.99/Tab.
Syrup, Tk. 20.00/100 ml; Tk. 38.60/200ml Nugesic (Orion ), Inj, Tk. 25.00/Amp. ; Tab.
Renovit (Healthcare), Inj. , Tk.140/3 ml Amp., Tk. 8.00/Tab.
Tab., Tk. 8.00/Tab. Nuropa (Nipa), Tab. Tk. 7.00/Tab.
Sinafort B (Ibn Sina), Syrup, Tk. 55.00/200ml; Orgabion, (Organic), Tab. , Tk. 4.10/Tab.
Tab.,Tk. 27.90/Tab. Pacibion (Pacific), Tab., Tk. 7.00/Tab
Solvit (Eskayef), Tab, Tk. 0.62/Tab., Povital (ACI), Inj., Tk. 25.17/3ml Amp; Tab,
Solvitone (Eskayef), Syrup, Tk. 35.54/100ml; Tk. 8.00/Tab.
Tk. 35.54/100ml; Tk. 62.00/200ml; Rejubion (Beacon), Inj., Tk. 25.17/3ml Amp.;
Supra (Drug Intl), Syrup, Tk. 50.2/100ml Tab, Tk. 8.00/Tab.
Tab.Tk. 0.62/Tab. Renep (Alco), Tab. ,Tk. 5.02/Tab.
Univit Plus (Aristo), Tab., Tk. 1.50/Tab Solbion (Eskayef), Tab., Tk. 8.00/Tab., Inj,
Vitagrow (Incepta), Syrup, Tk.80.00/100 ml Tk. 25.00/3 ml Amp.;
Vitamin B-Complex (Popular), Tab. , Tk. Supra B (Drug Intl), Tab. , Tk. 8.00/Tab.
0.44/Tab. TPC (Acme), Inj. Tk. 25.17/3 ml Amp.; Tab.,
VitasilB (Silva), Syrup, Tk. 20.06/100ml; Tk. Tk. 7.00/Tab.
38.14/200ml; Tab., Tk. 0.44/Tab. Tri-B (White Horse), Tab. , Tk. 7.00/Tab
V-Plex (Acme), Syrup Tk. 35.54/100ml; Tribion (Globe), Tab. , Tk. 7.00/Tab., Inj., Tk.
Tk.62.00/200 ml Tab., Tk. 0.44/Tab; Cap., Tk. 25.00/3 ml Amp
0.56/Cap. Univit Plus (Aristo), Tab., Tk. 2.00/Tab.
Virobion (Virgo), Tab. , , Tk. 5.00/Tab.
527
16. NUTRITION
Vitabion (Incepta), Tab. , Tk. 0.16/Tab., Inj. , ASCORBIC ACID[ED]

Tk. 25.00/3 ml Amp.
Vitalex (Supreme), Syrup, Tk. 20.75/100ml ,
Tk. 38.00/200ml; Cap, Tk. 0.56/Cap. Indications: Prevention and treatment
V-nerve (Monico), Inj., Tk. 25.00/3 ml Amp of scurvy
Cyanocobalamin2 mg + Folic Acid 2.5 mg + Dose: Prophylactic, 25-75 mg daily;
Pyridoxine Hydrochloride25 mg therapeutic, not less than 250 mg daily in
divided doses
PFC (Aristo), Tab.,Tk. 6.00/Tab.
Vita(Novo Health), Tab. , Tk. 3.00/Tab.
Vgard (Opsonin), Tab. , Tk. 4.03/Tab.
Vicard (Popular), Tab. , Tk. 6.00/Tab
Ascobex (Beximco), Tab., 250 mg, Tk.
1.89/Tab.
Vit B Complex + Zinc+Iron
Ascorbic (Apex), Tab., 250 mg, Tk. 1.30/Tab.
Alneed Gold (Incepta), Cap. , Tk. 6.00/Cap.
Ascoson (Jayson), Tab., 250 mg, Tk.
Beconex zi (Renata), Syrup, Tk. 30.00/50ml;
1.32/Tab.; Syrup, 100 mg/5 ml, Tk. 33.34/100
Tk. 50.00/100ml
ml; Inj., 500 mg/5 ml, Tk. 5.99/Amp.
Bicozin I (Square), Syrup, Tk. 90.61/200ml;
C-bon (Ambee), Tab., 250 mg , Tk.1.3 / Tab
Biozinc-I (Ibn Sina), Syrup, Tk. 45.17/100ml
Cecon (Acme), Tab., 250 mg, Tk. 1.32/Tab.
Bizi (Globe), Syrup, Tk. 50.00/100ml
Ceegram (Incepta), Tab., 1000 mg, Tk.
B-Plus (Somatec), Syrup, Tk. 62.18/200ml
10.00/Tab.
Livita(ACI)Tk. 50.34/100ml
Ceemet (Medimet), Tab., 250mg, Tk.1.20/Tab.
Vitaflower-Z (Organic), Syrup, Tk.
Ceevit (Square), Tab., 250 mg, Tk. 1.90/Tab.;
50.15/100ml
Effervescent Tab., 1000 mg, Tk.
Vitazin I(Aristo), Syrup, Tk. 30.00/50ml; Tk.
10.34/Tab.500mg,Tk.3.50
45.00/100ml; Tk.90.00/200ml
Cevalin (Biopharma), Tab., 250 mg, Tk.
Vitonic (Beximco), Syrup, Tk. 50.00/100ml;
1.31/Tab.
Tk. 80.00/200ml
Cevion (Healthcare), Tab., 1000 mg, Tk.
Feviz (Popular ), Syrup, Tk. 50.19/100 ml,
8.10/Tab.
Chewce (Navana), Syrup, 100 mg/5 ml, Tk.
Vit B Complex + Zinc
33.34/100 ml; Tab., 250 mg, Tk. 1.31/Tab.
Bicozin (Square), Syrup, Tk. 95/200ml; Tk.
Citamin (Supreme), Tab. , 250 mg, Tk.
55/100ml;
1.30/Tab
Buzz (Nipa), Syrup, Tk. 50.00/100ml; Tk.
C-Lemon (Zenith), Tab.,250 mg , Tk. 1.14/Tab
85.00/200ml ., Tab.Tk. 2.00/Tab.
C-On (Rephco), Tab., 250 mg, Tk. 0.70/Tab.;
Hizin (Monico), Syrup, Tk. 45.00/100ml
Inj., 500 mg/5 ml, Tk. 4.75/Amp.; , Tk.
OzinkB (One Pharma), Syrup, Tk.
5.00/Sachet
44.99/100ml
G-Vitamin (Gonoshasthaya), Tab., 250 mg,
Temzic Plus(Team), Syrup, Tk. 83.00/200ml
Tk. 1.30/Tab.
UnivetPlus(Aristo), Tab.,2.00
Hi-C (Eskayef), Syrup, 100 mg/5 ml, Tk.
VitalexZ (Supreme), Syrup, Tk. 85.00/200ml;
33.32/100ml
Tab.3.00/Tab
Juci (Eskayef), 100 mg/5ml, Tk. 10.00/sachet;
Xinc B (Eskayef), Syrup, Tk. 95.00/200ml;
ChewableTab., 250 mg, Tk. 1.89/Tab., 500
Tab., Tk. 3.00/Tab., Tk. 55.00/100ml;
mg, Tk. 3.57/Tab.
Xinoplex (Silva), Syrup, Tk. 45.16/100ml
Kvit-C (Kemiko), Tab., 250 mg, Tk. 1.30/Tab.
Zicovit-B (Globex), Syrup,45.00/100ml
Lemovit (Ziska), Inj., 500 mg/5 ml, Tk.
Zivit (Alco), Syrup, Tk. 100.30/200m; Tk.
60.00/Amp; Tab. , 250 mg , Tk. 1.31/Tab.
60.18/100ml; Tk. 100.30/200ml; Syrup, Tk.
Lemovit-C (Ziska), Tab., 500mg, Tk.
60.18/100ml
1.31/Tab.
Zn-B (Amico), Syrup, TK. 50.00/100ml
Livit-C (Orion), Syrup, 100 mg/5 ml, Tk.
33.34/100 ml
16.2.3.3 VITAMIN C Nutrivit-C (ACI), Paed. drop, 100 mg/ml, Tk
30.20/15 ml; Tab., 250 mg, Tk. 1.90/Tab.;
Vitamin C therapy is essential in scurvy. Syrup, 100 mg/5 ml, Tk. 33.45/100 ml; Tab.,
1000 mg , Tk. 12.04/Tab.
Prescribers sometimes prescribe Vitamin Rapid C (Popular), Tab., 1000 mg, Tk.
C in colds and in injuries for rapid wound 10.07/Tab.; Syrup, 100 mg/5 ml, Tk.
healing; but the available incidences are 33.45/100 ml
not conclusive and may not rationalize Suvic (Amico), Tab., 250 mg, Tk. 0.75/Tab.
its use. Vasco (Opsonin), Syrup, 100 mg/5 ml , Tk.
33.35/ 100 ml
VC-250 (Aristo), Tab., 250 mg, Tk. 1.90/Tab.
528
16. NUTRITION
Veesina, (Ibn Sina), Tab., 250 mg, Tk. Contra-indications: Renal dysfunction;
1.89/Tab. hypercalcaemia, metastatic calcification
Vita-C (Central), Tab., 250 mg, Tk. 1.30/Tab. Side-effects: Symptoms of overdose
Vitamin-C (Albion), Syrup, 100 mg/5 ml , Tk.
33.22/100 ml; Tab., 125 mg, Tk. 0.89/Tab.;
include anorexia, lassitude, nausea,
Tab., 1000 mg, Tk. 10.00/Tab. vomiting, diarrhoea, weight loss,
Vasco (Opsonin), Tab. ,250mg Tk. 1.90/Tab. polyuria, sweating, headache, thirst,
vertigo and raised concentrations of
16.2.3.4 VITAMIN D calcium and phosphate in plasma and
urine
Dose: ADULT and CHILD: Simple
The term Vitamin D is used for a range
Vitamin D deficiency, 400 IU
of compounds, which possesses the
(10microgram) daily; deficiency caused
property of curing and preventing rickets.
by intestinal malabsorption or chronic
They include ergocalciferol, Vitamin D2
liver disease, upto 40,000 IU (I mg) daily.
obtained by irradiating the plant sterol
Renal osteodystrophy, upto 200,000 IU
and Cholecalciferol (vitamin D3) the
(5 mg) daily. Rickets and osteomalacia
major form in nature.
1000-5000 IU daily
The exposure of skin in sunlight converts
Oily solution of cholecalciferol
provitamin D (7-dehydrocholesterol) to
200,000 IU/ml ampoule : injectable IM
previtamin D3 in the skin.
or drinkable.
Vitamin D is particularly toxic and is not
In Rickets for prevention : 200,000 I.U.
excreted in urine and should be
or 1 ampoule every 4 months, which
prescribed only when there is definite
may be, increased to 400,000 IU i.e. 2
indication. The proprietary infant milk
ampoules. In pregnancy, 1 ampoule at 6
formulas should be carefully checked so
months. Prevention should be started
that not more than 200 IU of Vitamin D is
early and continue to the 5th year of life.
consumed by formula fed infants daily.
In Rickets- Curative: 1 ampoule every 2
Infants fed on breast milk should be
weeks for one month and then 1
exposed to sunlight regularly.
ampoule every 4 months or 600,000 IU
Toxic symptoms include anorexia, loss
i.e. 3 ampoules renewed some months
of weight, nausea, headache,
later, as per the severity of the case.
depression and irritability.
Hypocalcaemia caused by tetany : Same
as for preventing Rickets.
VITAMIN-D PREPARATIONS Osteoporosis and Osteomalacia:
200,000 IU i.e. 1 ampoule every 15 days
Ergocalciferol (Calciferol or Vitamin D2). for 3 months.
Cholecalceferol (Vitamin D3). Renal Osteodystrophy, 200,000 IU i.e. 1
Alfacalceferol (1a- ampoule or more daily or as advised by
hydroxycholecalciferol). the physician.
Calcitriol (I, 25, dihydrxy cholecalciferol).
Dihydrotachysterol. Proprietary Preparations
Aristo D3 (Aristo), Inj, 2 Lac IU, Tk.
ERGOCALCIFEROL (D2) / 120.00/Amp
Calciferol (Renata), Inj., 2 Lac IU,
CHOLECALCIFEROL (D3) [ED]
Tk.120/Amp.
Colical (Opsonin), Inj., 2 Lac IU, Tk.
Indications: Rickets, osteomalacia, 90.23/Amp.
osteoporosis, abnormal calcium and D-Cap (Drug Intl), Soft Cap. , 20000I.U, Tk.
phosphorus metabolism, intestinal 20.00/Cap., 40000I.U, Tk. 35.00/Cap.,
malabsorption or liver diseases and 800I.U, Tk. 4.00/Cap.
Defrol (Acme), Syrup, 25 mcg/5ml, Tk.
renal osteodystrophy; hypocalcaemia of 75.00/100ml; Tab, 1000 IU, Tk. 2.00/Tab.
hypoparathyroidism; as adjunct to Deon-3 (Rephco), Inj., 2 Lac IU, Tk. 90/Amp.
treatment of lupus vulgaris and D-Rise (Beximco), Cap., 40000IU, Tk.
tubercular adenopathies. 35.00/Cap., 20000IU, Tk. 20.00/Cap., Tab.,
2000IU, Tk. 2.50/Tab.,
529
16. NUTRITION
Kvit (Kemiko), 2 Lac IU,, Tk. 90.27/Amp Dose : Renal osteodystrophy, ADULT,
K-Vit D (Kemiko), Inj., 2 Lac IU, Tk.90/Amp. initially 250 nanograms daily or on
MaxD (Ziska), Cap. , 20000 IU, Tk. alternate days, increased if necessary in
320.00/Cap., Tab. , 1000 IU, Tk. 100.00/Tab.
Osteo (Incepta), Inj. , 2 Lac IU, Tk.
steps of 250 nanograms at intervals of 2-
90.00/Amp.; Syrup, 25 mcg/5ml, Tk. 4 weeks; usual dose 0.5-1 micrograms
75.00/15ml; Tab. , 1000 IU, Tk,. 6.00/Tab. daily; CHILD not established.
VitaminD3B.O.N(I) (Crinex) Inj. , 2 Lac IU, Tk. Established postmenopausal osteopor-
151.50.00/Amp osis, 250 nanograms twice daily (monitor
plasma calcium and creatinine).
ALFACALCIDOL Proprietary Preparations
(1a-hydroxycholecalciferol )
Calcitrol (Square), cap, 0.25 microgram, Tk.
Alfacalcidol or 1 -hydroxcholecal-ciferol 10.03/Cap.
is the active form of vitamin-D3, which is Caloren (ACI), Inj., 1 microgram/ml , Tk.
150.00/ Amp
formed in the kidney tissues by Caltrol (Pacific), Cap., 0.25 microgram, Tk.
hydroxylation of D3. 7.52/Cap.
Indications: Patients with severe renal Colitrol (Incepta), Cap. , 0.25 microgram, Tk.
impairment i.e. renal osteodystrophy, 10.00/Cap.; Inj., 1 microgram/ml, Tk.
postmenopausal osteoporosis 155.00/Amp.
Contra-indications; Side-effects & Dicaltrol (Drug Intl), Cap., 0.25 microgram,,
Cautions: See under ergocalciferol. Tk. 10.05/Cap.
Encatrol (Globe), Cap., 0.25 microgram, Tk.
Dose: Renal osteodystrophy - ADULT, 10.00/Cap.
initially 0.25 microgram daily or on Improcal (Opsonin), Cap., 0.25 microgram ,
alternative days, increased if necessary Tk. 7.03/Cap.
in steps of 0.25 microgram at intervals of Liquical, (Beacon), Cap., 0.25 microgram,, Tk.
2-4 weeks; usual dose 0.5–1 microgram 10.06/Cap.
daily; CHILD, not established Lucent (Renata), Cap., 0.25 microgram,, Tk.
Established postmenopausal osteopo- 10.00/Cap.
Ostriol(Nipro JMI), cap, 0.25 microgram, Tk.
rosis–0.25 microgram twice daily 10.00/Cap.
(monitor plasma calcium and creatinine Promocal (Navana), Inj., 1 microgram/ml, Tk.
level, if possible) 155.00/Amp
Rocaltrol (Radiant), Cap., 0.25 microgram,
Tk. 20.00/Cap.
Bon One Tab. 0.5 microgram(I) (Teijin), Tab., Calcitriol + Calcium
0.5 microgram, Tk. 9.35/Tab. Citritol (Opsonin), Tab., Tk. 6.00/Tab.
One Alpha (I) (Leo), Cap., 0.25microgram, Tk. DicaltrolPlus (Drug Intl),Cap., Tk. 10.05/Cap.
8.65/Tab.
16.2.3.5 VITAMIN E
CALCITRIOL The requirement of Vitamin E has not
(1,25 - dihydroxycholecalciferol) been definitely established in man.
Indications: See under Alfacalcidol. There is now substantial evidence that
Cautions; Conta-indications & Side- supplementation of Vitamin E reduces
effects: See under Ergocalciferol. the incidence of coronary heart disease
Dose: Hypocalcaemia in dialysis in doses of 200-400 mg. Deficiency of
patients with chronic renal failure, by Vitamin E in Bangladesh has not been
intravenous injection (or injection reported. Recently a possible public
through catheter) after haemodialysis, health requirement has been suggested
initially 500 nanograms (approx. 10 as 40-60 mg daily; an increase of about
nanograms/kg) 3 times a week, 3-4 folds from the old recommended
increased if necessary in steps of allowance.
250-500 nanograms at intervals of 2-4
weeks; usual dose 0.5-3 micrograms ALPHA TOCOPHERYL ACETATE
3 times a week; CHILD not
established
530
16. NUTRITION
Indications : Malabsorption syndrome, 16.2.3.6 VITAMIN K

sprue, and neuromuscular abnormalities
due to very low Vitamin E concentration Vitamin K is necessary for the production
as found in young children with of blood clotting factors and proteins
congenital cholestasis. As an adjunct to needed for the normal calcification of
specific hormone therapy in sterility, bones.
habitual or imminent abortion; Because Vitamin K is fat soluble,
intermittent claudication, premature patients with malabsorption, especially in
infants biliary obstruction or hepatic disease
Dose : ADULT 3-15 mg daily, CHILD 1- may become deficient. For oral
10 mg/kg, 100-200 mg/daily administration to prevent Vitamin K
deficiency in malabsorption syndrome a
water soluble preparation Menadiol
Alfa-E (Aristo), Tab., 200mg , Tk. 4.00/Tab.
Biovit E (Biopharma), Tab., 400mg , Tk. sodium phosphate may be used in does
5.00/Tab. about 10 ml daily. Vitamin K is used for
E-Cap (Drug Intl), Cap. , 200mg, Tk. prophylaxis against haemorragic disease
4.05/Cap., 400 mg, Tk. 6.05/Cap. of the newborn.
Ecovit (Globe), Cap., 200 mg, Tk. 4.00/Cap., Oral coumarin anticoagulants act by
400 mg, Tk. 6.00/Cap. interfering with vitamin K metabolism in
E-fill (General), Cap. , 200mg, Tk. 4.04/Cap.,
the hepatic cells and their effects can be
400mg , Tk. 6.04/Cap.
Efynal (Healthcare), Tab., 200mg , Tk. antagonized by giving vitamin K.
6.50/Tab. Phytomenadione is natural vitamin K.
E-gel (Renata), Cap. , 200 mg, Tk.
4.01/Cap., 400 mg, Tk. 6.02/Cap. VITAMIN-K [ED]
E-Soft (Pacific), Cap. , 200 mg, Tk.
4.00/Cap., 400 mg, Tk. 6.00/Cap.
E-Tab (Acme), Tab. , 200 mg, Tk. 3.27/Tab. Indications: Hypoprothrombonaemia;
Evit (Square), cap, 200 mg, Tk. 4.03/Cap., prophylaxis and treatment of haemmo-
400 mg, Tk. 6.04/Cap. rragic diseases of the newborn.
Formula E (Beximco), Tab., 200 mg, Tk. Cautions: Anaphylactic reaction may
3.82/Tab. occur with parenteral administration
Inovit (Incepta), Cap. , 200mg, Tk. Contra-indications: Synthetic
4.00/Cap., 400 mg, Tk. 6.00/Cap.
Lifil (Acme), Cap. , 200 mg, Tk. 4.01/Cap.,
analogues of vitamin K should be
400 m., Tk. 6.01/Cap. avoided in newborn because of the risk
Liqu-E (Beacon), Cap., 200mg , Tk. 4.02/Cap. of kernicterus
Nature (UniMed), Tab , 400 mg, Tk. Dose: ADULT, ORALLY 10-20 mg, max.
7.00/Tab., 200 mg, Tk. 5.00/Tab. 40 mg in 24 hours. CHILD &
Nutrivit -C (ACI), Tab., 200mg, Tk. 3.82/Tab. NEONATES, 1 mg, over 3 months, 5-10
Ovit-E (Opsonin), Cap. , 200 mg , Tk. mg
4.00/Cap., 400 mg, Tk. 6.00/Cap.
Polyvit (Albion), Tab., 200 mg, Tk. 4.00/Tab By injection, ADULT, 10-20 mg IM, or
Tocomin (Amico), Tab., 200 mg, Tk. 3.00/Tab. slow IV, max. 40 mg in 24 hours. CHILD
Vanila (Eskayef), Tab., 200mg, Tk. 3.80/Tab., & NEONATES 1 mg IM; over 3 months
Vegecap-E (Nipro JMI), Cap., 200 mg, Tk. 5-10 mg IM
5.00/Cap.; 400 mg, Tk. 7.00/
Vitamin E + Vitamin C Konakion(I)(Roche),Inj.2mg/0.2ml,
EC (Orion), Tab. , 200 mg + 250 mg, Tk. Tk.68.26/vial
6.02/Tab. Babykion (Chemist), Inj. 0.2 ml; Tk. 20/0.2 ml
E-Cap Plus (Drug Intl), Cap. , 200mg+250mg, Kayon (Globe),Cap., 1 mg, Tk. 15.00/Cap.
Tk. 4.05/Cap. K MM(Incepta), Inj. , 2 mg/0.2 ml, Tk.
Egren (Supreme), Tab. , 200mg+250mg, Tk. 45.86/0.2 ml Amp; 10 mg/ml, Tk. 19.89/Amp
4.00/Tab. K-One (Square), Inj., 2 mg/0.2 ml, Tk.
Protecor (Opsonin), Tab. , 200 mg + 250 mg, 19.94/0.2ml Amp
Tk. 6.00/Tab.
531
16. NUTRITION
16.2.3.7 MULTIVITAMIN AND Aztrum Gold (Apex), Tab., Tk. 6.00/Tab.

Benvit - M (Benham), Tab., Tk. 1.80/Tab.
MULTIVITAMIN WITH
Bextram (Beximco), Tab., Tk. 5.00/Tab
MINERAL PREPARATIONS Bextram Gold (Beximco), Tab., Tk. 7.00/Tab.
Bextram KIDZ (Beximco), Syrup,Tk.80/100 ml
In view of the prevalence of multiple Bextram Silver (Beximco), Tab., Tk. 7.00/Tab.
vitamin and mineral deficiencies together Bextram Teen HM (Beximco),Tab.,Tk. 6/Tab.
it is sometimes impossible to diagnose Bextram Teen HR (Beximco), Tab.,Tk. 6/Tab.
Biovit Gold (Biopharma), Tab., Tk. 7/Tab.
cases of specific deficiencies. It may be
Biovit Silver (Biopharma), Tab., Tk.6.02/Tab.
worthwhile to treat such cases with Biovit-M (Biopharma), Tab., Tk. 1.80/Tab.
formulation containing multiple vitamins Central Gold (Central), Tab., Tk. 6.50/Tab.
or with combined multivitamin and Century Forte (UniMed), Tab., Tk. 6.00/Tab.
minerals. . Century Select (UniMed), Tab., Tk. 6.00/Tab.
Indication: it is used as dietary Cytaplex M (Central), Tab. , Tk. 1.50/Tab.
supplement Envit-M (Ibn Sina), Tab., Tk. 1.50/Tab.
Equate (Asiatic), Tab., Tk. 1.00/Tab.
Evagren (Incepta), Tab., Tk. 4.00/Tab
MULTIVITAMINS Filwel Gold (Square), Tab., Tk. 6.02/Tab.
Filwel Silver (Square), Tab., Tk. 6.02/Tab.
Indications: Multivitamin deficiencies in Flavit-M (Amico), Tab., Tk. 1.50/Tab.
Goldage (Orion ), Tab., Tk. 6.02/Tab.
infants and children as in malabsorption
Goldpac (Pacific), Tab., Tk. 6.52/Tab.
syndrome and other gastrointestinal Hygea Gold (Somatec), Tab., Tk. 6.02/Tab.
diseases; growth retardation and during I Care (Pacific), Tab., Tk. 7.52/Tab.
antibiotic therapy Kidovit (Amico), Syrup, Tk. 65.00/100 ml
Dose: usual dosage, 10-15 drops once Kvit Gold(Kemiko), Tab., Tk. 6.00/Tab.
or twice daily Kvit-M (Kemiko), Tab., Tk. 1.50/Tab.
Life Gold(Alco), Tab., Tk. 6.00/Tab.
Proprietary Preparations Life Silver (Alco), Tab., Tk. 6.00/Tab.
Babivit (Alco) Paed Drops Tk. 15.05/15 Livwel (Square), Syrup,Tk. 160.60/200 ml; Tk.
Biovit (Biopharma), Paed drops, Tk. 15.06/15 90.34/100 ml
ml Multivit Plus (Square), Tab., Tk. 1.80/Tab.
Micovit (Amico ),Paed drops, Tk. 15/15 ml Natal (Opsonin), Tab., Tk. 2.26/Tab.
Multisina (Ibn Sina), Paed Drops, Tk. 20/15ml Newage (Orion ), Tab., Tk. 5.02/Tab.
Nutrivit-MV(ACI), Paed Drops, Tk.16.01/15 ml Nipro Gold (Nipro JMI), Tab., Tk. 6.00/Tab.
Restovit M (Zenith) Paed drops, Tk. 15/15 ml Norad Plus (Pacific), Cap., Tk.3.76/Tab.
Tynisol (Beximco), Drops, Tk. 24/15 ml Nox (Alco ), Tab. , Tk. 2.53/Tab.
Vita M (Opsonin), Paed drops, Tk. 16.54/15 ml Nutrum 50+ (Acme), Tab., Tk. 6.02/Tab.
V-Plex (Acme), Paed Drops, Tk. 22/15 ml Nutrum Bone (Acme), Tab., Tk. 4.01/Tab.
Nutrum Gold (Acme), Tab., Tk. 6.02/Tab.
Nutrum Junior(Acme),Syrup,Tk. 85.32/100 ml
MULTIVITAMIN + MULTIMINERALS Nutrum Super (Acme), Tab., Tk. 4.01/Tab.
Opsovit Mm (Opsonin), Tab., Tk. 1.14/Tab.
Proprietary Preparations Orioplex-M(Orion), Tab. , Tk. 1.51/Tab.
Activit Gold (Delta), Tab., Tk. 6.00/Tab. Ostium-Gold (APC ), Tab., Tk. 6.00/Tab.
Activit Silver (Delta), Tab. , Tk. 6.00/Tab. Oxidex (Albion), Tab., Tk. 2.53/ Tab.
Apevit- M (APC ), Tab., Tk. 1.00/Tab. Polyvit Plus A to Z Gold (Albion), Syrup, Tk.
Aristocal M (Beximco), Tab., Tk. 5.50/Tab 85.00/100 ml ; Tab., Tk. 6.00/Tab.
Aristo Gold (Aristo), Tab. , Tk. 7.00/Tab. Restovit M (Zenith), Tab., Tk. 1.43/Tab
Aristo Kid (Aristo), Syrup, Tk. 86.00/100 ml; Restovit M (Zenith), Tab., Tk. 1.43/Tab.
Tk. 152.00/200 ml Revigor (ACI), Tab., Tk. 5.02/Tab.
Aristo Kid (Aristo), Syrup, Tk. 86.00/50ml, Tk. Revital 30 (ACI), Tab., Tk. 6.02/Tab.
52.00/100ml,200ml Revital32 (ACI), Tab., Tk. 6.02/Tab.
Aristo Mom (Aristo), Tab., Tk. 3.00/Tab. S-32 Gold (Sharif), Tab., Tk. 6.00/Tab.
Aristogold (Aristo), Tab., Tk. 7.00/Tab. Santox (Healthcare), Tab., Tk. 4.00/Tab.
Aristovit M (Beximco), Tab., Tk. 2.00/Tab. Silvage (Orion), Tab., Tk. 6.02/Tab.
Aristovit X (Beximco), Tab., Tk. 4.00/Tab. Sina Gold (Ibn Sina), Tab., Tk. 6.50/Tab.
Asitrum Gold (Asiatic), Tab., Tk. 6.00/Tab. Solvit-M (Eskayef), Tab, Tk. 1.80/Tab.
Asitrum Silver (Asiatic), Tab., Tk. 6.00/Tab. Supravit (Drug Intl), Soft Cap., Tk. 2.00/Cap.
Atoz Premium (Radiant), Tab., Tk. 12.00/Tab. Supravit-M (Drug Int.), Soft Cap.,Tk.
Atoz Senior (Radiant), Tab., Tk. 12.00/Tab. 3.50/Cap.
532
16. NUTRITION
Synergy (Amico), Tab., Tk. 4.00/Tab. Nine Seas (Aristo), Syrup, Tk. 80/100 ml;
Vitace M (Aristo), Tab., Tk. 4.00/Tab. Tk.150/200 ml
Vitachild (Popular), Tab., Tk. 75.28/100 ml; Pediavit (UniMed), Syrup, Tk. 80/100 ml
Tk.140.53/200 ml Polyvit Kids (Albion), Syrup,Tk. 80/100 ml
Vitaforce S (Biopharma),Tab., Tk. 4.02/Tab. Revam (Navana), Syrup, Tk. 45.17/50 ml; Tk.
Vitagrow (Incepta), Syrup, Tk. 80/100 ml 80.30/100 ml
Vitalgin (Ibn Sina), Syrup, Tk. 175/200ml; Seasvita (Organic), Syrup, Tk. 80/100 ml; Tk.
Tk.85/100 ml 145/200 ml
Vitrum Gold (Eskayef), Tab, Tk. 6.00/Tab. Simcod (Pharmasia), Syrup, Tk. 80/100 ml;
Vitrum Silver(Eskayef), Tab, Tk. 6.00/Tab. Tk. 145/200 ml
VM Gold (Organic), Tab., Tk. 6.00/Tab. Supracod (Drug Int.),Syrup,Tk.80.00/100 ml
V-Plex Plus (Acme), Tab., Tk. 0.44/Tab. Vitalex Cod (Supreme), Syrup, Tk.80/100 ml
Zovia Teen B (Opsonin), Tab., Tk. 4.51/Tab. Vitcod (Alco), Syrup, Tk. 75.00/100 ml; Tk.
Zovia Teen G (Opsonin), Tab., Tk. 4.51/Tab 140.00/200 ml
Zovia Kids (Opsonin), Syrup, Tk. 60.38/100
MULTIVITAMIN WITH COD-LIVER OIL ml; Tk. 109.43/200
A special preparation of multivitamin PRENATAL MULTIVITAMIN AND

comprising vitamin A, D, B2, B6, C, E, MULTIMINERAL
nicotinamide and codliver oil.
Indications:Improving the nutritional
Aquavit (Somatec), Syrup, Tk. 80.30/100 ml;
status of throughout the pregnancy and
Tk. 150.00/200 ml in postnatal period for both lactating and
Asitrum Cod (Asiatic), Syrup, Tk. 80/100 ml non-lactating mother; increase the
CNV (Delta), Syrup, Tk. 80.00/100 ml nutritional status of women prior to
Cod Liver (Drug Intl), Cap. Tk. 2.05/Cap. conception
Cod Plus (Apex), Syrup, Tk. 80/100 ml; Side-effects: Allergic sensitization has
Tk.145/200 ml been reported following oral
Codcap (Incepta), Cap. , Tk. 2.00/Cap. administration of folic acid
Codliv (Pacific), Cap. , Tk. 2.00/Cap. Cautions: Folic acid in doses above
Codlivit (Silva), Syrup, Tk. 80.30/100ml 0.1mg daily may obscure pernicious
Codomix (Jayson), Syrup, Tk. 80.00/100 ml anemia in that hematological remission
Codvit (Opsonin), Cap. , Tk. 2.00/Cap. can occur while neurological
Codvita (Amico), Syrup, Tk. 80.00/100 ml
manifestation remain progressive.
Dorakid (Beacon), Syrup, Tk. 100.00/Syrup
Accidental over dose of iron containing
Filwel (Square), Syrup, Tk. 80.55/100ml
Filwel Kids (Square), Syrup, Tk.145.54/200
products is a leading cause of fatal
ml ; Tk. 80.30/100 ml poisoning in children under
Gold Kid (Orion), Syrup, Tk. 80.30/100 ml Dose: one daily.
Hepta seas (ACI), Syrup, Tk. 150.00/200ml; Tk.
Junivit (Ibn Sina), Syrup, Tk. 90.00/100 ml Biovit PN (Biopharma), Tab., Tk. 5.02/Tab
Kiddi (Renata,), Syrup, Tk. 40.15/50 ml; Tk. Nutrum PN (Acme), Tab. Tk.5/Tab
140.53/200ml; Tk. 80.31/100 ml Nutrum PN (Acme), Tab., Tk. 5.01/Tab.
Kidicare (Virgo), Syrup, Tk. 145.00/200ml; Tk. Placent-M (Navana), Tab., Tk. 1.51/Tab.
Precare (Incepta), Tab. Tk.5/Tab
80.00/100ml Supravit-PN (Drug Intl), Soft Cap., Tk.5/Tcap
Kidivit (Monico), Syrup, Tk. 145.00/200ml; Tk. Supravit-PN (Drug Intl), Soft Cap.,Tk. 5/Cap.
80.00/100ml
16.2.3.8 ANTIOXIDANT VITAMIN
Kidsgro (Biopharma), Syrup, Tk. 80.00/100ml
PREPARATIONS
Kvit seas (Kemiko), Syrup, Tk. 145.00/200 ml;
Tk. 80.00/100 ml
Mixavit (Eskayef), Syrup, Tk. 80.00/100 ml - CAROTENE + VITAMIN C +
Multi Seas (General), Syrup, Tk. 80.30/100 VITAMIN E:
ml; Tk. 145.54/200 ml
Multicod (Pacific), Syrup, Tk. 75.19/100 ml
Multiseas (General), Cap. , Tk. 3.01/Cap. Beta-carotene, vitamin C & vitamin E are
Newseas (Sharif), Syrup, Tk. 80/100 ml antioxidant vitamins. It is found that their
533
16. NUTRITION
presence in foods help fight & protect the Vitamin C+Vitamin E + Zinc + Copper
cell against harmful cell damage. Lutein,
Indications: As antioxidant vitamins to Alvital (Silva), Tab. , Tk. 4.00/Tab.
Azecol (Incepta), Cap. , Tk. 10.00/Cap.,
combat degenerative process of ageing; Ecotin (Globe), Cap., Tk. 10.00/Cap
prevent old age diseases, inflammatory Eye-gel(Nipa), Cap. , Tk. 10.00/Cap.
rheumatic diseases, inflammatory Eyevi (Square), Cap. , Tk. 10.00/Cap.
rheumatic diseases, malignancy & pre- I-Gold (Aristo), Cap., Tk. 10.00/Cap.
cancerous conditions, lung functional I-Vita (Opsonin), Cap. , Tk. 10.00/Cap.
problems & immunological problems. Kvit I (Kemiko), Cap. , Tk. 10.03/Cap.
Prophylactic use of vitamin E and LutinPlus (General), Cap. , Tk. 10.03/Cap.
Nutrum Eye (Acme), Cap. , Tk. 8.03/Cap.
vitamin C may prevent certain Ocuvit (Asiatic), Cap., Tk. 10.00/Cap.
degenerative diseases Optagold (Ibn Sina), Cap. , Tk. 10.00/Cap.
Contra-indications; Side-effects & Optavit (Popular), Cap. , Tk. 10.00/Cap.
Cautions: See under respective Santox (Healthcare), Tab., Tk. 4.00/Tab.
vitamins individually Tanox
Dose: 1 tablet or capsule daily, or as -Plus (Drug Intl), Tab.Tk. 4 /Tab
prescribed by the physician Tioxil (ACI), Cap., Tk. 10.00/Cap
Vivis (Beximco), Cap., Tk. 10.00/Cap
Beta-carotene 6 mg + Vitamin C 200 mg

+ VitaminE 50 mg.
Active Plus (White Horse), Tab.,Tk.2.50/Tab.
Antox (Acme), Tab., Tk. 2.54/Tab
Bec (Opsonin), Tab., Tk. 1.7/Tab.
Carocet (Beximco), Tab.Tk. 2.54 /Tab
Ceb (Rephco), Tab., Tk. 4.00/Tab.
Cebeta (Amulet), Tab., Tk. 2.53/Tab
Norad (Pacific), Tab., Tk. 3.01/Tab; Cap.,
Tk.3.01/Cap.
Oxet (Amico), Tab., Tk. 2.50/Tab.
Perex (Central),Tab., Tk. 2.50/Tab
Race (Ibn Sina), Tab., Tk. 2.50/Tab.
Rex (Square), Tab., Tk. 2.54/Tab.
Rexovit (Maks), Tab., Tk. 2.50/Tab
Tanox (Drug Intl), Tab.Tk.3.00 /Tab
Tasti (ACI), Tab., Tk. 2.50/Tab.
Vitace (Aristo), Tab., Tk. 3.00/Tab.
Vitaforce (Biopharma), Tab., Tk. 2.54/Tab
534
17. CONTRAST MEDIA
Chapter 17
CONTRAST MEDIA
17 Contrast media p. 535
17.1 Drugs used in contrast media p. 540
17 CONTRAST MEDIA • Sialography.

Non ionic, low-osmolar iodinated
X-Ray image is produced by the contrast media is preferable and suitable
differential attenuation of x-ray photons for all the above indications.
by tissues of different densities in the
body; giving radiographic contrast in the BARIUM SULPHATE IS USED AS
image. CONTRAST MEDIUM IN THE
A number of organs and anatomic FOLLOWING EXAMINATIONS:
regions do not have sufficient inherent • Barium swallow-oesophagus
contrast for the plain radiography e.g. • Barium meal examination plain and
kidneys, gastrointestinal tract, double contrast
gallbladder, brain etc. To visualize these • Hypotonic duodenography
organs in the body, it is necessary to • Barium follow-through
introduce into the patients a contrast
• Small bowel enema or enteroclysis
medium that is deposited in the organs
• Barium enema examination
and that absorbs X-ray either more or
less than the surrounding tissue.
Barium sulfate of different suspension at
Contrast media in common uses are: air,
different weight by volume strength is
barium sulphate in the gastrointestinal
required for different examinations.
tract and iodinated compound in the
gallbladder, kidneys, vascular system, Biliary contrast is used for visualization
and brain. of the gallbladder and common bile duct.
For operative or post-operative
IODINATED CONTRAST MEDIA ARE choledochography and for visualization
USED IN THE FOLLOWING of the biliary tree and pancreatic duct in
RADIOLOGICAL PROCEDURES: Percutaneous Transhepatic Cholengio-
graphy (P.T.C) and in Endoscopic
• Contrast enhancement in the CT Retrograde Cholecysto Pancreatography
scan of brain and in different parts (E.R.C.P) the iodinated conventional
of body. water soluble contrast media is used.
• Cardio angiography. Intravascular radiological contrast
• Cerebral aortography. agent: Iodine (Atomic weight -53).
• Thoracic aortography. Iodine is the only element that has
• Abdominal aortography. proved to be safe for an intravascular
• Peripheral aortography. radiological contrast agent.
• Phlebography. In the contrast media iodine molecule
• Urography. gives the radio-opacity, whereas the
• Myelography. other elements in the media provide no
• Hysterosalpingography. radio-opacity but acts as a carrier of the
• Arthrography. iodine, increasing the solubility and
• Fistulography. reducing the toxicity of iodine molecule.
• Dacryocystography. To perform a 2 vessel or 3 vessel
• Galactography. angiogram of brain or heart, 70-
535
17. CONTRAST MEDIA
80 gm of iodine is required, delivered iv. Radiologist or Radiographer

into arterial tree for about one hour. should remain by the side of the
Probably this is the largest quantity of patients for first 15 minutes
any drug,used intravascularly in clinical following injections and an
practices. emergency trolley with all facilities
Thus, highest quality of precaution and should be immediately available.
care is required for iodinated Both conventional high osmolar ionic
compounds, which is to be injected into contrast and the newer more expensive
the circulation. low osmolar contrast media are very
All conventional ionic water soluble safe drugs, but like all other drugs care
contrast media are hypertonic with high should be taken in high risk patients.
osmolalities of 1200 to 2000 mosmol/kg Intravenous Urography (IVU) probably
of water. does not justify the use of the more
The very high osmolality is due to the expensive low osmolar contrast media
non-radio opaque carrier ion i.e. cation except in special cases. The total dose
(sodium or meglumine), which exert just of contrast medium in healthy persons
as great as osmolar load, like that of should not exceed 75 gm of iodine at
iodinated anions. The cation serves no any one procedure or in a single day.
radiographic function, so a contrast High price of the low osmolar contrast is
medium with fewer cation or no cation restricting their use, though they are
would sound better. safer and more comfortable.
ADVERSE REACTIONS:
Factors predisposing to adverse This can be described as -
reactions:
Unknown aetiology : Acute anaphylaxis
1. Previous significant adverse - occurring in a previously sensitized
reaction increases the risk of individual within minutes of administering
second serious reactions by 10 a contrast medium. Manifestations are -
times. bronchospasm, glottic oedema,
2. History of allergy: cardiac disease, circulatory collapse, abdominal cramps.
sickle cell anemia. The patient may die unless immediate
3. Phaeochromocytoma. resuscitation is taken.
4. Myelomatosis. Anaphylactoid reactions: Similar but
occurs in a non-sensitized individual.
5. Diabetes mellitus.
Chemotoxic effects: Conventional high
6. Neonates, infants, and elderly osmolar contrast media e.g. diatrizoate
patients. and iothalamate dissociate into ions.
Cautions: The anions are probably not a major
i. Most complications of contrast cause of contrast medium reactions but
agents are unpredictable. the cations are clinically toxic. Sodium
cations are more toxic than meglumine
ii. The smallest dose, the lowest to brain (increased incidence of
concentration, and the smallest unconsciousness in patients with an
number of injection, which will give altered blood-brain barrier) and
reliable and comprehensive myocardium (increased incidence of
diagnostic results, should be arrhythmias).
used.
Hyperosmolar effects: Osmolality of
iii. A negative test dose or previous
contrast agents is 5-8 times higher than
uneventful contrast examination
plasma (300 mosmol/kg of water)
do not ensure the safety of the
osmolality.
present examination.
Haemodynamic and systemic effects:
Injection of a conventional contrast
536
17. CONTRAST MEDIA
medium produces a significant, followed by a more prolonged decrease);

transient decrease in systemic arterial increased rigidity of red blood cells; pre-
pressure, a decrease in peripheral dehydration; osmotic diuresis.
vascular resistance, peripheral Glomerular injury and tubular injury: Due
vasodilatation, tachycardia and an to Impaired perfusion; hyperosmolar
increase in pulmonary arterial pressure. effects; chemotoxic effects.
This is accompanied by clinical Obstructive nephropathy: Cytoplasmic
perception of heat and with intra-arterial vacuolation in tubules. Precipitation of
injections there is often pain. Low Tamm-Horsfall protein; precipitation of
osmolar contrast media produce Bence Ioned protein in multiple
significantly less fluid shifts, change in myeloma.
measurable para-meters, heat and pain.
Gadolinium-based contrast medium can
Cardiac effects: There is a decrease in cause a condition known as nephrogenic
peak left ventricular systolic pressure, an systemic fibrosis (NSF) in patients with
increase in left ventricular end diastolic severely reduced kidney
pressure, a biphasic decrease then function. Severely reduced function is
increase in coronary blood flow, and usually determined by a blood test called
bradycardia. Low osmolar contrast estimated glomerular filtration rate
media have less effect on these (eGFR). If patient’s eGFR is 30 mL/min
parameters. or below and kidney function is actively
Red cell effects: Increasing concen- deteriorating then the patient may have
trations of contrast media have an a small increased risk of experiencing
increasing sickling effect on red cells in NSF with certain gadolinium contrast
sickle-cell anemia. Low osmolar contrast agents.
media have a lesser effect. Iodine-containing contrast medium has
Vascular endothelial damage: the potential to cause a condition known
Contrast medium nduced as contrast-induced nephropathy. This
thrombophlebitis is a particular condition can result in temporary and
complication of lower limb venography sometimes permanent reduction in
but its incidence is reduced fourfold kidney function to those with an already
when low-osmolar contrast media are existing kidney problem.
used. Contrast media are regarded as
Central nervous system effects: generally very safe for patients who do
Patients with cerebral tumours show an not have severe kidney disease. If a
increased incidence of convulsions patient has severe kidney disease, the
following enhancement for CT scans. radiologist in discussion with doctor
might still decide that he/she should
Pulmonary effects: Most patients suffer
have contrast, because the benefit of the
bronchospasm following administration
test or procedure outweighs the risk.
of a contrast medium although this is not
clinically apparent in the majority. It
occurs more frequently in asthmatic and COMPLICATIONS:
atopic individuals. The aetiology is
MINOR REACTIONS: Flushing, nausea,
uncertain but possible mechanisms
arm pain, pruritus, vomiting, headache,
include: direct histamine release from
mild urticaria. These are usually mild, of
mast cells and platelets; cholinesterase
short duration, self limiting and require
inhibition; vagal overtone; complement
no treatment. Reassurance and
activation; direct effect of contrast media
restoration of patient’s confidence is
on bronchi.
enough. Incidence of minor reaction is
Renal effects: Impaired renal perfusion 5% to 30% only.
due to cardiotoxic effects; increased
INTERMEDIATE REACTIONS: More
peripheral vasodilatation; renal vascular
serious degree of above symptoms, with
bed changes (increased blood flow
537
17. CONTRAST MEDIA
moderate degree of hypotension, bron- at 20 min. interval provides the rapid and
chospasm. They respond to appropriate reliable relief for bronchospasm,
therapy-reassurance, chlorpheniramine angioneurotic oedema and other
for urticaria, 5 mg diazepam for anxiety, anaphylactoid symptoms.
hydrocortisone 100 mg IV, salbutamol Adrenaline - If given IV may precipitate
inhalation for bronchospasm. Incidence ventricular fibrillation; but in very severe
of moderate reaction is 0.5 to 2% but anaphylactoid reactions, even this route
with non-ionic low osmolar contrast, it is should be considered - 1:10,000 solution
still lesser. in 2 to 5 ml quantity IV very slowly
SEVERE LIFE THREATENING preferably under ECG control.
REACTIONS: Severe manifestations of Incidence of these life-threatening
the above mentioned minor and reactions is 0.1% in conventional
moderate symptoms and in addition the contrast media and 0.02% in non-ionic
following-convulsions, unconsciousness, contrast media.
laryngeal oedema, severe
bronchospasm, cardiac arrhythmia, Deaths: Above mentioned reactions may
arrest, circulatory collapse. not respond to treatment and patient
may die. Death may however be
MANAGEMENT OF COMPLICATIONS: immediate also. Death rate is 1 in
The airway to be secured. Oxygen, 40,000 in conventional ionic contrast
artificial respiration, cardiac massage, reactions and 1 in 100,000 in low
electrical DC defibrillators are to be osmolar contrast media.
administered as required. IV fluid
infusion and drug therapy should be Indications for the use of low-osmolar
given. contrast media:
IV furosemide for pulmonary oedema, IV Those at high risk from the
diazepam for convulsions, adrenaline, hyperosmolar effects : Infants and small
hydrocortisone, aminophylline IV for children, those with renal and/or cardiac
anaphylactic symptoms can be used. failure;poorly hydrated patients, patients
Vasopressors - Noradrenaline or with diabetes, myelomatosis or sickle-
dopamine infusion for hypotension. cell anaemia, patients who have had a
Sodium-bi-carbonate for correction of previous severe anaphylactoid or allergic
acidosis. reaction to a conventional contrast
Adrenaline 0.5 ml, 1/1000 solution by medium or those with strong allergic
deep subcutaneous injection, repeated history.
Dose of non-ionic low osmolar contrast medium - Iopamidol in common

radiological examination :
Indications Route of Iodine in Volume in ml

administration mg/ml
Myelography Subarachnoid 200-300 5-15
Cerebral arteriography Intra-arterial 300 Variable
Coronary arteriography intracoronary 370 Variable
Thoracic and abdominal Intra-arterial 370 1.2 ml/kg
aortography
Peripheral arteriography Intra-arterial 300-370 40-50
Selective abdominal Intra-arterial 300-370 Variable
arteriography
Venography Intravenous 200-300 30-50
Urography Intravenous –Adults 370 30-50
Children < 8 kg 300 2-4 ml/kg
Children > 8 kg 300 1.5-2 ml/kg
Arthrography Intra-articular 300-370 Variable
CT scanning Intravenous 300-370 0.5-2 ml/kg
538
17. CONTRAST MEDIA
BILIARY CONTRAST MEDIA Complications: Pulmonary oedema if

aspirated; hypovolaemia due to
Like conventional urographic contrast hypertonicity of the contrast medium;
media, biliary contrast media are also allergic reactions due to absorbed
triiodobenzoic acid derivative. Iopanoic contrast may occur.
acid (Telepaque) was introduced in
1951. BARIUM
Oral cholecystography: Now a
days,this examination is not done as Barium suspension is made up from
other modalities like ultrasonography & pure barium sulphate. Barium carbonate
CT scan are preferred for biliary tree is poisonous. The particles of barium
evaluation.Previously,it was routinely must be small (0.1 to 3 micron) since
done to demonstrate suspected this makes them more stable in
pathology in the gallbladder. The suspension.
examination would not be successful,if There are many varieties of barium
serum bilirubin is greater than 34 suspension in use. In most situations the
micromol/litre. preparation may be diluted with water to
Dose: Iopanoic acid (Telepaque) 500 give a lower density.
mg, six tablets or sodium ipodate Examination of different parts of the
(Biloptin) 500 mg six capsules is the gastrointestinal tract require barium
usual dose preparations with different properties :
Timing:Six tables are to be taken about 1. Barium swallow - require about 100
14 hours before the X-ray examination ml of barium of density 150% w/v.
and no food or drink is to be allowed 2. Barium meal - require about 135
during this 14 hours. After the first film ml of barium of density 250% w/v.
when gallbladder is opacified, a fatty
meal is given and X-ray taken after 45 A high density, low-viscosity barium
minutes to see its contraction. is required for a double contrast
barium meal to give a good thin
Occasional adverse effects: Mild coating that is still sufficiently
gastro intestinal distrubance in 50% dense to give satisfactory shadow.
cases. Skin reactions: urticaria, pruritus.
3. Barium follow through require about
Impairment of renal function may
300 ml of barium of density 100%
happen, if there is co-existent liver
w/v.
impariment, dehydration and repeat
dose or double dose of contrast medium 4. Small bowel enema - require about
is used. 1000 ml. of diluted barium of
density 100% w/v.
For doing choledochography - 25%
hypaque or equivalent is used by diluting Barium enema - require about 500 ml of
the contrast media. barium of density 125% w/v.
Contrast media used in radiography Complications :
of the Gastro intestinal tract : Perforation : The escape of barium into
Water soluble contrast media: the peritoneal cavity is extremely serious
gastrografin, gastroconray; Barium and will cause peritonitis. Mortality rate
sulphate. is about 50%. Of those who survive 30%
will develop peritoneal adhesions and
Indications of water soluble contrast
granulomata. So, water-soluble contrast
media:Suspected perforation; media should be used in suspected
meconium ileus. To distinguish bowel perforation or in any investigation if there
from other structures on a computerized is any risk of perforation.
tomography scan
Aspiration : Barium if aspirated, is
relatively harmless. Only
539
17. CONTRAST MEDIA
treatment required is physiotherapy. after the administration of Magnevist. In

Contrast agents used in CT scan : very rare case anaphylactoid reactions,
convulsions have been observed.
Already mentioned Iodinated contrast Transient headache, vasodilatation,
media both ionic and low osmolar non- dizziness, chills and syncope have
ionic are used according to the clinical occasionally been reported.
situation. However non-ionic low osmolar Nephrogenic systemic fibrosis (NSF) is a
Iodinated contrast media are safer and relatively uncommon condition in which
preferable. Different amount of iodinated fibrous plaques develop in the dermis
contrast is used in different CT and, often, in deeper connective tissues.
examinations.Non ionic low osmolar Reported cases have occurred almost
iodinated contrast is preferred & can be exclusively in patients with severe renal
safely used.Dose should not exceed 1to disease, and almost all have
2ml/kg body wt.of contrast having beenassociated with prior use of
concentration of 300 to 370mg iodine/ml. gadolinium-containing MRI contrast
Contrast agents used in Magnetic agents. The disease is often disabling,
Resonance Imaging (MRI) : no proven treatments exist, and it may
The following agents can be used for contribute to patient demise
enhancement MR scanning (a)
Gatopentotic (b) Gadodiamide 17.1 DRUGS USED IN
loversal is an iodinated non-ionic CONTRAST MEDIA
monomeric contrast medium that is used
by injection in angiography and
BARIUM SULPHATE[ED]
urography.
Indications: Cranial and spinal Proprietary Preparations
Magnetic Resonance Imaging (MRI) in Visugut(Sonear), Powder, Tk. 102.51/150 gm
particular for the demonstration of Viewgut(Popular), Powder,Tk.200.75/150 gm
tumors and for further differential
diagnostic clarification in suspected GADODIAMIDE
meningioma, invasive tumors and
metastases; for the demonstration of One ml contains Gadodiamide 287mg
small and or isointense tumors; in (0.5mMol/ml)
suspected recurrence after surgery or
radiotherapy; for the differentiated Proprietary Preparations
Diascan(Techno), Inj., 28.7 gm/100 ml , Tk. ;
demonstration of rare neoplasms such
Tk. 590.00/10 ml;
as haemangioblastomas, ependymomas Gadoscan(Popular), Inj.,28.7 gm/100 ml, Tk.
and small pituitary adenomas; for 995.00/10 ml;
improved determination of the spread of Omniscan(I)(GE Healthcare),Inj.,28.7 gm/100
tumors not of cerebral origin. ml, Tk. 2225.29/10ml
Additionally in spinal MR: Differentiation
of intra and extramedullary tumours : GADOBUTROL
demonstration of solid tumor areas in Gadavist Injection (Bayer)
known syrinx; determination of The recommended dose of Gadavist for adult
intramedullary tumor spread and pediatric patients (including term neonates)
is 0.1 mL/kg body weight (0.1 mmol/kg)
Dose: patient is to fast of for two hours
before the examination. In general the Gadavist is indicated for use with magnetic
administration of 0.2 ml Magnevist/kg resonance imaging (MRI) in adult and pediatric
body weight is sufficient for good patients to detect and visualize areas with
shadow and to answer the clinical disrupted blood brain barrier and/or abnormal
question. vascularity of the central nervous system also
to assess the presence and extent of malignant
Side effects: nausea and vomiting and breast disease and to evaluate known or
also allergy-type dermal and mucosal suspected supra-aortic or renal artery disease.
reactions were occasionally observed
540
17. CONTRAST MEDIA
Not Available Imiro(Popular), Inj., 350mgI/ml, Tk.

1900.00/100ml, Tk. 1000.00/50ml
GADOXEDATE DOSODIUM Omniclear(Incepta), Inj., 350mgI/ml, Tk.
Eovist Injection (Bayer) 1000.00/50ml
The recommended dose of EOVIST is 0.1 Omnipaque(I)(GE health care) Inj., 350 mgi/ml,
mL/kg body weight (0.025 mmol/kg body Tk. 1043.81/50 ml, Tk. 2072.50/100ml
weight).
IOPAMIDOL
EOVIST is indicated for intravenous use in
magnetic resonance imaging (MRI) of the liver One 100mL bottle contains: active component
to detect and characterize lesions in patients Iopamidol 75.53 gm corresponding to 370mg of
with known or suspected focal liver disease. iodine/mL. inactive component trometamol 100
mg; calcium disodium edentate (dehydrate) 41
Not Available mg; hydrochloric acid q.s. to pH 6.9-7.1; water
for injection q.s. to 100ml
IODIXANOL
One mL contains IODIXANOL 652 mg Amidol(Incepta), Inj., 300 mg/ml, Tk.
equivalent to 320 mg iodine/mL; trometamol 1,203.00/50ml; 370 mg/ml, Tk. 1,318.00/50 ml;
1.2 mg; sodium calcium edetate 0.1 mg; Tk. 2,636.00/100 ml
calcium chloride 0.04 mg; sodium chloride 1.11 Diapamiro(Techno), Inj., 300 mg/ml, Tk.
mg; hydrochloric acid q.s.; water for injection 1,450.00/100 ml; Tk. 750.00/50 ml; 370 mg/ml,
q.s. to 1mL Tk. 1,650.00/100 ml; Tk. 850.00/50 ml
Lopidam(Beximco), Inj., 370 mg/ml , Tk.
Proprietary Preparation 1,318.50/50 ml ;300 mg/ml, Tk. 2,636/100 ml
Visipaque 320(I)(GE Healthcare), Lopamiro(Popular), Inj. 370mg/ml, Tk.
Inj.,320mgI/ml Tk.2874.26/50ml bottle 752.83/50ml, Tk. 1454.00/100ml,;75.52gm, Tk.
853.00/50ml, Tk. 1656.00/100ml
IOHEXOL
IOTHALAMIC ACID + MEGLUMINE
Each mL contains Iohexol 755 mg
corresponding to 350 mg of iodine/mL; GenericPreparations
trometamol 1.2 mg; sodium calcium edetate Inj. iothalamic acid 45.6% + meglumine 8.4%;
0.1 mg water for injection q.s. to 1mL. Inj. iothalamic acid 67.59% + meglumine
8.4%;Oral Sol 57.94%.
Diapack(Techno), Inj., 300mgI/ml, Tk.
300/10ml; Tk. 500/20ml; Tk. 650/30 ml; Tk. IOPANOIC ACID
850/50ml; Tk. 1,530/100ml; , Tk. 360/10ml; Tk.
600/20ml; Tk. 970/50ml; Tk. 1,880/100ml Proprietary Preparation
Visugall(Sonear),Tab,500 mg,Tk. 0.89/Tab.
541
APPENDIX 1 : TREATMENT GUIDELINES
APPENDIX-1
TREATMENT GUIDELINES
Treatment Guidelines followed in the National Disease Control Programmes of the

Directorate General of Health Services, Government of the People’s Republic of
Bangladesh :
Appendix-1a : Treatment Guidelines for Acute Watery Diarrhoea. p.584

Appendix-1b : Treatment Guidelines for Tuberculosis. p. 589
Appendix-1c : Treatment Guidelines for Leprosy. p. 592
Appendix-1d : Treatment Guidelines for Dengue Infection. p. 594
Appendix-1e : Treatment Guidelines for Acute Respiratory Tract Infection. p. 598
Appendix-1f : Treatment Guidelines for Drug Addicts. p. 598
Appendix-1g : Treatment Guidelines for Burn Injury. p. 602
Appendix-1h : Treatment Guidelines For Malaria p. 606
Appendix-1i : Treatment Guidelines for Kala-azar p.607
Appendix-1j : Treatment Guidelines for Chikungunya
Appendix-1a
Treatment Guidelines for Acute Watery Diarrhoea
PLAN A: TREAT DIARRHEA AT HOME

Counsel the mother on the 4 Rules of Home treatment
1. Give extra fluid
2. Give zinc supplements (age 6 months up to 5 years)
3. Continue Feeding
4. When to return
1. GIVE EXTRA FLUID (as much as the child will take)

➢ Tell the mother
• Breastfeed frequently and for longer at each feed
• If the child is exclusively breastfeed, give ORS or clean water in
addition to breast milk
• If the child is not exclusively breastfeed, give one or more of the
following ORS: ORS solution, food-based fluid (such as rice water,
chira apni, yogurt drink) or clean water
It is especially important to give ORS at home when:
- The child has been treated with Plan B or Plan C during the visit
- The child cannot return to a clinic if the diarrhea get worse
➢ TEACH THE MOTHER HOW TO MIX AND GIVE ORS. GIVE THE
MOTHER 2 PACKETS OF ORS TO USE AT HOME
➢ SHOW THE MOTHER HOW MUCH FLUID TO GIVE IN ADDITION TO THE

USUAL FLUID INTAKE
Up to 2 years 50 to 100ml after each loose stool

2 years or more 100 to 200ml after each loose stool
➢ Tell the mother to

- Give frequent small sips from a cup
- If the child vomits, wait 10 minutes. Then continue, but more slowly
542
- Continue giving extra fluid until the diarrhea stops
2. GIVE ZINC
➢ For acute diarrhea, persisting diarrhea and dysentery, give Zinc supplements for
10 days
AGE ZINC TABLET (20mg)
2 months up to 6 months (Persistent diarrhea) ½
6 months up to 5 years 1
TELL THE MOTHER HOW MUCH ZINC TO GIVE

SHOW THE MOTHER HOW TO GIVE ZINC SUPPLEMENTS
• Infants –dissolve tablet in a small amount of expressed breast milk or ORS
3. CONTINUE FEEDING
4. WHEN TO RETURN
PLAN B: TREAT SOME DEHYDRATION WITH NEW ORS
In clinic, recommended amount of ORS over 4-hour period
➢ DETERMINE AMOUNT OF ORS TO GIVE DURING FIRST 4 HOURS
AGE* Up to 4 4 months up 12 2 years up

months to months to
up to
WEIGHT <6kg 6-<10kg 10-<12 kg 12-<20kg
Amount of Fluid
200-450 450-800 800-960 960-1600
(ml) over 4 hours
*Use the child’s age only when you do not know the weight. The approximate
amount of ORS required (in ml) can also be calculated by multiplying the child’s
weight (in kg) times 75.
• If the child wants more ORS than shown, give more

➢ SHOW THE MOTHER HOW TO GIVE ORS SOLUTION
• Give frequent small sips from a cup
• If the child vomits, wait 10 minutes. Then continue, but more slowly
• Continue breastfeeding whenever the child wants.
➢ AFTER 4 HOURS
• Release the child and classify the child for dehydration
• Select the appropriate plan to continue the treatment
• Begin feeding the child in clinic.
➢ IF THE MOTHER MUST LEAVE BEFORE COMPLETING TREATMENT:
• Show her how to prepare ORS solution at home.
• Show her how much ORS to give to finish 4 hours treatment at home
• Give her instruction how to prepare salt and sugar/gur solution at home
(If ORS not available).
• Explain the 4 Rules of Home Treatment:
1. GIVE EXTRA FLUID
2. GIVE ZINC (age 6 months up to 5 years)
3. CONTINUE FEEDING (exclusively breastfeeding if age less than 6
months)
4. WHEN TO RETURN
543
Plan C: Treat Severe Dehydration Quickly
FOLLOW THE ARROWS, IF ANSWER IS “YES”, GO ACROSS, IF “NO” GO

DOWN
• Start IV fluid immediately
Can you give • If the child can drink, give ORS by mouth
Intravenous (IV) while the drip is set up.
Fluid Yes • Give 100ml/kg of cholera saline of Ringer’s
Immediately? Lactate solution
(or, If not available, normal saline), divide as
follows
AGE First Then
Give given
Infants (under 12 months) 1 hour 5 hours
Children (12 months up to 30 2 ½ hours
5 years) minutes*
• Reassess the child every ½ hours. If hydration status
is not improving, repeat the same for another hour.
• Also give ORS (about 5ml/kg/hour) as soon as child can
drink.
Usually after 3-4 hours (infants) or 1-2 hours (children)
• Reassess an infant after 6 hours and a child after 3
hours. Classify dehydration. Then choose the
Is IV treatment appropriate plan (A, B, or C) to continue treatment
available
nearby (within Yes
30 minutes)? • Refer URGENTLY to hospital for IV treatment
• If the child can drink, provide the mother with ORS
solution and show her how to give frequent sips during
NO the trip pr give ORS by naso-gastric tube.
• Start rehydration by tube(or mouth) with ORS

Are you trained solution: give 20ml/kg/hour for 6 hours (total 120ml/kg)
to use a naso- • Reassess the child every 1-2 hours, while waiting
gastric (NG) for transfer. :
tube for -If there is repeated vomiting or increasing abdominal
rehydration? distension, give the fluid more slowly.
-If hydration status is not improving after 3 hours, send
the child for IV therapy.
Yes • After 6 hours, reassess the child. Classify dehydration.
NO
Then choose the appropriate plan (A,B, or C) to
continue treatment.
Can the child

drink?
NO
Note:
Refer URGENTLY to • If the child is not referred to hospital, observe the child at least 6
hospital for IV or NG hours after rehydration to be sure the mother can maintain
treatment. hydration giving the child ORS solution by mouth.
544
For dysentery: Give Ciprofloxacin for 3 days 15mg/kg/day-2 times a day for 3 days
Age or weight Ciprofloxacin

Give two times daily for 3 days
2 months up to 12 months 1/4
4 - <6kg
4 months up to 3years 1/2
6 - <14kg
3years up to 5years 1
14 - <20kg
For CHOLERA: Give Tetracycline for 3 days
Age or weight TETRACYCLIN ERYTHROMYCIN

Give 4 times Give 4 times daily
daily for 3 days for 3 days
CAPSULE TABLET
250mg 250mg
2years up to 5years 10 - 19kg 1 1
See also EPI Programme, DGHS, Ministry of Health & Family Welfare, Govt. of
Bangladesh
545
Appendix-1b
Treatment Guidelines for Tuberculosis
See also in section 1.1.9

Case Definition by previous treatment history
Case Classification Definition

New - A patient who has never received anti-TB drugs or
- A patient who received anti-TB drugs for less than one
month
Relapse Relapse patients have previously been treated for TB, were
declared cured or treatment completed at the end of their
most recent course of treatment, and are now diagnosed
with a recurrent episode of TB (either a true relapse or a
new episode of TB cause by reinfection)
Treatment after failure Treatment after failure patients are those who have
previously been treated for TB and whose treatment failed
at the end of their most recent course of treatment
Treatment after loss to Treatment after loss to follow up patients have previously
follow up/default been treated for TB and were declared to follow-up at the
end of their most recent course of treatment. (These were
previously known as treatment after default patients.)
Transfer in A patient already registered for treatment in a DOTS centre
and who is subsequently transferred to another register unit
Others(s) Other previously treated patients are those who have
previously been treated for TB but whose outcome after
their most recent course of treatment is unknown or
undocumented.
Standardized treatment regimen for each diagnostic category (Adults)
Treatment regimen
TB diagnostic Continuatio
Types of Patient Intensive Phase
Category n Phase
Daily)
(Daily)
New smear-positive
bacteriologically positive
PTB patient
4(HR)
New smear-negative PTB 2(HRZE)
4=Next
Cat. I patient 2=First 2 months
4months
New extra pulmonary TB (HRZE)=4-FDC
(HR)=2-FDC
patient
New concomitant
/associated HIV/AIDS
Sputum smear-positive PTB
with history of treatment of 2(HRZE)S/1(HR
one month or more ZE) 5(HRE)
2=First 2 5=Last 5
Relapse
Cat. II months, 1=Next months
Treatment failure after Cat. I
1 month (HRE)=3-
treatment
(HRZE)=4-FDC FDC
After loss to follow up
S=Streptomycin
Others
546
Dosage of FDC Tablets
FDC Tablets are composed as follows:
4FDC: rifampicin 150mg + isoniazid 75mg + pyrazinamide 400mg + ethambutol

275mg
2FDC: rifampicin 150mg + isoniazid 75mg
3FDC: rifampicin 150mg + isoniazid 75mg + ethambutol 275mg
The Dosage of FDC Tablets for adults are as follows:
Category I Category II
Pre- Intensiv Continuati Pre- Intensive Phase Continuatio

treatme e Phase on Phase treatme n Phase
nt nt
Weight Weight
(Kg) (Kg)
Daily Daily Daily Daily Daily
First 2 Next 4 First 3 First 2 Next 5
Months Months Months Months Months
Number Number Number Injection Number of
of 4FDC of 2FDC of 4FDC Steptomy 3FDC
tablets tablets tablets cin tablets
30-37 2 2 30-37 2 500mg 2
38-54 3 3 38-54 3 750mg 3
55-70 4 4 55-70 4 1gm 4
>70 5 5 >70 5 1gm 5
Definition of Drug Resistance:
There are four different categories of drug resistance, namely:
Mono-resistance: resistance to one anti TB drug

Poly-resistance: resistance to more than one anti TB drug; other than isoniazid and
rifampicin
Multidrug-resistance MDR: resistance to at least isoniazid and rifampicin; two most
potent anti-TB agents
Extensive drug-resistance XDR: MDR-TB, plus resistance to at least one of the
fluroquinolones, and al least one of three injectable second-line drugs capreomycin,
kanamycin and amikacin
The standard MDR-TB regimen:
The recommended standard MDR-TB regimen is as follows:
8km-Z-LfxOfx-Eto-CS/12LfxOfx-Eto-CS-Z
547
Length of the treatment for the standard MDR-TB Regimen:
Date of first sustained Length of the injectable Length of total

conversion agents treatment for the
standard MDR-TB
Regimen
Between month 0 and 4 8 months 20-22 months
Between months 5 and 8 Add 4 months from Add 18 months from
conversion date conversion date
* Date of first negative smear and culture by two consecutive months
Adult dosage for second line antituberculosis drugs
Drug <33kg 33-50kg 51-70kg >70kgnax

mg/kg/day mg/kg/day mg/kg/day mg/kg/day
PyrazinamideZ 30-40mg 1000-1750mg 1750- 2000-
500mg 2000mg 2500mg
Kanamycin Km 15-20mg 500-750mg 1000mg 1000mg
1gm Vial
Levofloxacin Lfx 7.5mg-10mg 750mg 750mg 750-1000mg
250mg, 500mg
Ethionamide 15-20mg 500mg 750mg 750-1000mg
Eto 250mg
Cycloserine CS 15-20mg 500mg 750mg 750-1000mg
250mg
See also section 1.1.9 and for more details NATIONAL GUIDELINES AND
OPERATIONAL MANUAL FOR TUBERCULOSIS CONTROL (fifth edition), Published
by National Tuberculosis Control Programme, DGHS, Ministry of Health & Family
welfare, Govt. of Bangladesh
548
Appendix-1c
Treatment Guidelines for Leprosy
Leprosy (Hansen’s disease) is a chronic disease caused by Mycobactrium leprae; it

affects peripheral nervous system, skin and some other tissues, It is transmitted from
person to person when bacilli shed from the nose and skin lesions of infected patients,
but most individuals are naturally immune. Clinical leprosy manifests as a result of
deficient cell mediated immunity in susceptible individuals. In Bangladesh,
approximately 3 per 10,000 people are affected, with highest prevalence in the
northern districts of Nilphamari, Dinajpur, Thakurgaon and Lalmonirhat.
For the purpose of grouping patients for chemotherapy, leprosy may be classified as
multibacillary or paucibacillary.
Multibacillary leprosy occurs when cellular immunity is largely deficient and includes
the subgroups lepromatous (LL), borderline lepromatous (BL) and other types giving
positive skin smear for acid-fast bacilli, generally the lepromin test is negative.
Paucibacillay leprosy, results when cellular immunity is only partially deficient and
includes subgroups like borderline tuberculoid (TB), tuberculoid (TT) and
indeterminate (I) when skin smear is negative, generally lepromin test is positive.
Reactive episodes may be seen in leprosy patients undergoing treatment - the lepra
reactions. Most reactions belong to one of two main types. Type 1 lepra reactions are
delayed hypersensitivity reactions (type IV hypersensitivity) and respond to analgesics
and corticosteriods.
Type 2 lepra reactions (also known erythema nodosum leprosum, ENL) represent a
humoral antibody reaction (type III hypersensitivity) to dead bacteria, usually occurring
in lepromatous type and respond to increasing dose of clofazamine, corticosteroid and
analgesics.
Multidrugs treatment (MDT) for leprosy, as promoted by National TB and Leprosy

Control Service of the Directorate General of Health Services, Government of the
People’s Republic of Bangladesh is shown in the Table I below.
Leprosy is a slowly progressive chronic infectious granulomatous disease caused by

Mycobacterium leprae affecting mostly the skin and peripheral nerves resulting in
anaesthetic hypopigmented patches in skin, and sometimes trophic changes
producing deformities in certain other tissues notably oral/nasal mucosa, the eye,
muscle and bone.
Leprosy can affect all ages and sexes. It is directly transmitted via droplets from nose
and mouth, and by prolonged and/or close frequent contacts for many years. Rarely it
may spread through fomites.
549
Table 1 : The following table is showing the classification of leprosy, age of

patients, mode of administration and the doses of different drugs used
in MDT
Monthly Supervised Dose Self-Administered

Dose
Adults Rifampi Clofazi Dapso Clofazim Dapson
MB cin mine ne ine e
Cases (15 yrs.+) 600mg 300mg 100mg 50mg 100mg
daily daily
Children (10-15 450mg 150mg 50mg 50mg 50mg
yrs) alternate daily
days
Children (6- 300mg 100mg 25mg 50mg 25mg
9yrs) twice a daily
week
Adults (15 600mg - 100mg - 100mg
PB yrs.+) daily
Cases Children (10-15 450mg - 50mg - 50mg
yrs) daily
Children (6- 300mg - 25mg - 25mg
9yrs) daily
For more details NATIONAL GUIDELINES AND TECHNICAL MANUAL FOR

LEPROSY (4th edition), Published by National leprosy Control Programme, DGHS,
Ministry of Health & Family Welfare, Govt. of Bangladesh
550
Appendix-1d
Treatment Guidelines for Dengue Infections
Dengue is the most important emerging tropical viral disease of humans in the world
today. Over the last 10-15 years, dengue fever (DF) and dengue haemorrhagic fever
(DHF) has become a leading cause of hospitalization and death among children in
South-East Asian region, following diarrhoeal diseases and acute respiratory
infections.
Manifestation of Dengue Infection

Asymptomatic Dengue Fever : Undifferentiated fever.
Without haemorrhage.
Symptomatic Dengue fever : With usual haemorrhage.

Dengue haemorrahagic fever (DHF).
Dengue haemorrhagic shock (DHS).
Chart-1: Clinical manifestation & Management of DHS Grades I and II

(The Manifestations & Management of DF & DHF during the febrile phase are the
same)
Phase Manifestations Management
Febrile • Temp 39-40°C (102- • At home

Duration: 2-7 104°F) • Bed rest
days • Headache • Keep the body temp. below
• Retro-orbital pain 30°C
• Muscle pain • Paracetamol
• Joint bone pain • No aspirin/NSAIDs
• Flushed face • Oral fluids (fresh fruit
• Rush juices) electrolyte
• Skin hemorrhage, therapy(ORS)
bleeding from nose, • Follow-up for any change
gums of platelet/Hct
• Positive tourniquet test
• Liver often enlarged
• Leucopenia
• Platelet/Hct normal
Afebrile • Same as during febrile • Bed rest
(critical) phase • Check platelets /Hct
Duration: 2-7 • Improvement can be • Fluids & electrolyte therapy
days achieved with fluid (oral & intravenous)
after febrile therapy • The fluids if given
stage • Platelet /Hct reduced intravenously should be
• Appetite regained slowly started
1.5ml/kg/hr(18drops/min)fo
r6
hours,then3ml/kg/hrs(36
drops/min) for 6 hours,
then
5ml/kg/hrs(60drop/min) for
6 hrs, then
7ml/kg/hrs(90drop/min) for
551
6 hrs. ( the increment of

fluid is important if patient
is not responding with
starting low dose)
• After 24 hrs, the rate of IV
fluid should be gradually
reduced from 7 to 5, 5 to 3,
3 to 1.5 ml/kg/hr within
next 24 hours.
Convalescence • Further improvement in • No special advise

During 7-10 general condition & • No restriction
days after return of appetite • Normal diet
critical stages • Bradycardia
• Confluent petechial rash
with white center/itching
• weakness for 1or 2
weeks
1. Patients & household members should be informed by the doctor that severe
abdomen pain, passing of black stool, bleeding from other sites, no urine output
in last 6 hrs, sweating & cold skin are warning signs & if any of these signs is
noticed the patients should be taken to hospital immediately.
2. Paracetamol should be administered not more than 4 times in a 24-hr period.
Paracetamol (250mg):<1 year-1/4 tablet,1-4 years tablet,5yrs& above-one
tablet. If syrup 50mg/kg/dose
3. 18drops/min (1.5ml/kg/hr) can be given in children as 72 micro drops/min
through microburret set. Rest will be accordingly [ 1drop=4 micro drops in
microburret set]
552
Chart-1: DHS Grades III and IV
Phase Manifestations Management

Afebrile In addition to the -Check Hct and total platelet count
(critical) manifestations of DGF (TPL)
Grade II: -Initial IV therapy (0.9%NS)
Duration 2-3 -Circulatory failure evident 10ml/kg/hr (125 drop/min)
days after by rapid and weak pulse, -Check vital signs , Hct, timed urine
febrile phase narrowing the pulse output
pressure (<20) or - If improves, IV fluids should be
hypotension with the reduced every hour from 10 (125
presence of cold clammy drop/min)
skin To 7 (90 drop/min) and then from 7
to 5 (60 drop/min) and then 5 to 3 (36
-CTR more than 2 seconds. drop/min) and lastly from 3 to
1.5ml/kg/hour(18 drop/min) that
should be maintained up to 48 hours
- If patient has already received 1
Profound shock with hour treatment of 10ml/kg/hour
unstable pulse and blood of IV fluids and vital signs are
pressure not stable check Hct again and
- If Hct is increasing changed IV
fluid to colloidal solution
preferably Dextran or Plasma at
10ml/kg/hour
- If Hct is decreasing from initial
value give fresh hole blood
transfusion 10ml/kg/hour and
continue fluid therapy at
10ml/kg/hour and reducing it
stepwise to 1.5ml/kg/hour and
maintain it up to 48 hours
- Initiate IV therapy (5%DNS)
10ml/kg/hour
(125drops/minutes) as a bolus 1
or 2 times
- Oxygen therapy
- If continued shock colloid fluids
(Dextran/Plasma) at 10-
20ml/kg/hour to instituted
- Persisting shock with declining
Hct fresh whole blood 10ml/kg
as bolus
- Vital signs monitoring half hourly
- If severe bleeding fresh whole
blood bolus 20ml/kg
- If TPL <500-1000mm3 Platelet
rich plasma transfusion
- After blood transfusion continue
fluid therapy at 10ml/kg/hour and
step wise reduce it to
1.5ml/kg/hour to be maintained
up to 24-48 hours
553
Convalescence - 6-12 hours after - Rest for 1-2 days

Duration: 2-3 critical/shock stage, - Normal diet or no medication
days after some symptoms of - Continued observation
recovery from respiratory distress
critical stage (Pleural effusion,
ascites)
- 2-3 days after critical
stage , strong pulse
and normal blood
pressure
- Improved general
condition with return
of appetite
- Good urine output
- Stable Hct
- TPL >50000 mm3
- Bradycardia/
arrhythmia
- Eligible for discharge
from hospital
- Asthenia and
depression continue
for few weeks in
adult.
See also for more details NATIONAL GUIDELINES AND FOR CLINICAL
MANAGEMENT 0F DENGUE SYNDROME (3rd edition; 2013), Published by Disease
Control Division, DGHS, Ministry of Health & Family Welfare, Govt. of Bangladesh
554
Appendix-1e
Treatment Guidelines for Acute Respiratory Tract Infections (ARI)
FOR PNEUMONIA, ACUTE EAR INFECTION, VERY SEVER DISEASE OR SEVERE

MALNUTRITION, IF INJECTABLE Drugs are not available
Oral Amoxicillin can be given, in very severe disease; it is not possible to administer
injectable Ampicillin, Gentamycin
Amoxicillin COTRIMOXAZOLE
Give two times  Trimethoprim + Sulphamethoxazole
daily for 5 days Give two times daily for 5 days
Age or Table Syrup Adult tablet Pediatric Syrup
weight t 125mg/5 80mg tablet 40mg
250m ml Trimethopr 20mg Trimethoprim +
g im + 400mg Trimethopri 200mg
Sulphamet m + 100mg Sulphamethoxaz
hoxazole Sulphameth ole/5ml
oxazole
2months
up to 12
months 3/4 7.5ml 1/2 2 5.0ml
4-
<10kg
12mont
hs up to
5years 1.5ml 15ml 1 3 7.5ml
10-
<19kg
See also EPI PROGRAMME, DGHS, Ministry of Health & Family Welfare, Govt. of
Bangladesh
Appendix-1f
Treatment Guidelines for Drug Addicts
Psychoactive Substance: A psychoactive substance is a substance that affects the

body’s central nervous system (CNS) and changes how people behave or perceive
what is happening around them. Psychoactive substances include illicit/illegal drugs
and some medications.
Psychoactive drugs are of the following types:

Stimulants Opioids Depressant Hallucinations Others (Some
(Narcotics) s drugs do not fit
neatly into a
category)
Cocaine Heroin Alcohol LSD Cannabinoids

(marijuana,
hashish)
555
Amphetamin Morphine Barbiturates Mescaline Khat/Miraa

e Peyote
Methamphet Opium Benzodiaze Ecstasy Dissociative
amine pines anesthetics
(phencyclidine
[PCP],
ketamine)
Nicotine, Demerol Gamma- Mushrooms Inhalants
Caffeine Hydroxybut solvents, gases,
yrate nitrites
(GHB);
Rohypnol
Nicotine, caffeine, and alcohol (in some countries), all of which are legal, are included
in the chart of psychoactive substances. Just because a substance is legal does not
mean it is safer than an illegal substance. The legality of a substance is generally
more the result of traditions, culture, or political or religious factors than whether a
substance is more or less harmful than another.
Substance Dependence: Also known as Drug Dependence. A maladaptive pattern of
substance use, leading to clinically significant impairment or distress, as manifested
by three (or more) of the following, occurring at any time in the same 12-month
period:
(1) tolerance,
(2) Withdrawal,
(3) the substance is often taken in larger amounts or over a longer period
than was intended
(4) there is a persistent desire or unsuccessful efforts to cut down or control
substance use
(5) a great deal of time is spent in activities necessary to obtain the substance
(e.g., visiting multiple doctors or driving long distances), use the substance
(e.g., chain-smoking), or recover from its effects
(6) important social, occupational, or recreational activities are given up or
reduced because of substance use
(7) the substance use is continued despite knowledge of having a persistent
or recurrent physical or psychological problem that is likely to have been
caused or exacerbated by the substance (e.g., current cocaine use despite
recognition of cocaine-induced depression, or continued drinking despite
recognition that an ulcer was made worse by alcohol consumption) (DSM-IV
TR)
Addiction: Addiction is a chronic, relapsing brain disease that is characterized by
compulsive substance seeking and use, despite harmful consequences.
Recovery: Recovery from alcohol and drug problems is a process of change through
which an individual achieves abstinence and improved health, wellness, and quality of
life. Recovery is defined as a process of continuous growth and improved functioning.
It is not a goal that one achieves. It is instead a process of recovery management over
a person’s lifetime.
Relapse: A relapse is a complete return to using substances in the same way the
person did before he or she quit.
Motivation
Treatment and recovery are ultimately about change. As we all know, change is not
always easy for people. It is important to understand the concept of motivation
because motivation for change is closely related to the level of probability that a
556
person with a substance use disorder (or SUD) will enter treatment, continue in
treatment and adhere to a specific change strategy.
Motivation has been found to actually be dynamic rather than static and is: Purposeful,
Intentional, Positive and Changeable.
Tolerance Tolerance, as defined by either of the following:
1. A need for markedly increased amounts of the substance to achieve
intoxication or desired effect or
2. Markedly diminished effect with continued use of the same amount of the
substance
Withdrawal: The unpleasant physical reaction that accompanies the process of
ceasing to take an addictive drug:
• Withdrawal is the constellation of symptoms and a sign that a person
experiences when, after a period of regular use, the quantity of available
substance in the brain is reduced.
• Symptoms and signs of withdrawal are opposite to the main effect of the
drug. For example:
o Sedative withdrawal creates autonomic hyperactivity with
dangerous medical complications.
o Opioids withdrawal is accompanied by anxiety, powerful cravings
and flu-like symptoms.
o Stimulant withdrawal consists of depression, insomnia and
cravings.
MANAGEMENT AND TREATMENT
Treatment of substance dependence patient refers to the whole range of services a
client can receive directly from a treatment program or coordinated by the treatment
program, the recovery oriented systems of care. These services or components,
roughly in the order in which a client typically participates in them are as follows:
Components of Treatment
❖ Pre-treatment components
❖ Primary treatment
❖ Case management
❖ Continuing care, including ongoing recovery management
Pretreatment Components
 Outreach - SUD program outreach includes organized efforts to identify and

screen individuals who might have a problem with substance use, rather
than wait for them to be
referred to treatment programs or to decide to enroll in a program
themselves
 Screening and brief intervention-
▪ Screening is the process of identifying individuals with possible
SUDs. Screening provides an opportunity to initiate discussions with
individuals about their substance use.
▪ Brief intervention focuses on increasing a person’s insight into and
awareness of substance use and behavioral changes.
 Assessment and treatment planning
▪ Assessment begins with engaging the client, obtaining the client’s
history, collecting data on the client, and observing the client during
the first visit. It’s important to remember that although it begins at the
first visit, assessment is an ongoing process as the client’s needs
change over time.
▪ The treatment plan needs to be:
557
• Individualized; Flexible; Realistic with behavioral objectives

that are achievable, observable, and measurable;
• Simple so that clients being served, their families, and staff
members can understand them;
• Focused on solutions and strengths and not on negative
factors;
• Clear in identifying the type and frequency of interventions;
and Responsive to changes and progress.
 Detoxification- Detoxification is the process of
• Stopping substance use;
• Clearing the substance from the body; and
• Managing the withdrawal syndrome.
Primary Treatment:
Primary treatments help patients engage in the treatment process, modify their
attitudes and behaviors related to drug abuse, and increase healthy life skills. These
treatments can also enhance the effectiveness of medications and help people stay in
treatment longer. Treatment for drug abuse and addiction can be delivered in many
different settings using a variety of behavioral approaches. It includes-
• Group Counseling
• Individual Counseling
• Other Components of primary treatment
1. Testing for drug use
2. Pharmacotherapy
3. Orientation to mutual-help groups
4. Medical treatment-symptomatic treatment during withdrawal
period and any other physical illness
5. Treatment for mental disorders
6. General schooling for adolescents or young adults
7. Employment skills training
Case Management: An integral part of treatment begins with screening and

assessment and continues throughout a person’s treatment and into ongoing
recovery. It is the coordination of professional, social, and medical services to assist
people with complex needs, often for long-term care and protection. Case
management functions include: assessment, service planning, linkage and referral,
monitoring and advocacy.
Continuing care, including ongoing recovery management
The continuing care process begins with discharge planning. Discharge planning
leads to development of a continuing care plan. The plan contains written, treatment-
related, and measurable objectives for the client to, for example: Sustain abstinence,
Develop continuing recovery supports and Gain community living.
558
Appendix-1g
Treatment Guidelines for Burn Injury
Admission Criteria to NIBPS:
1. Burns greater than 10% of TBSA in paediatric <12ears and geriatric

group>60years
2. >15% TBSA in adults partial thickness
3. Full thickness burns >5% of TBSA
4. burns of special areas-face, hands, feet, genitalia, perineum and major
joints
5. Electrical burns, also lighting injury
6. Chemical burns
7. Burns with associated inhalation injury
8. Circumferential burns of the limbs or chest, neck
9. Burns in the very young or very old
10. Burns in people with pre existing medical or psychological disorders that
could complicate management, prolong recovery or increase mortality
11. Burns with associated trauma
12. Burns with pregnancy
13. Burns in patients who will require special social, emotional, rehabilitative
intervention.
Criteria’s for Burn Patient to be called “Critical”
1. 15% in a child
>30% in a adult partial thickness burns/full thickness burns
2. All Inhalation Burn
3. All Chemical Burn
4. Patients presenting late with inadequate resuscitation and or in a state of
sepsis
5. All Electric Burn in First 24 hours
TRIAGE
On admission segregate the patients into groups and attach code to the file
A. Outpatient:
<15% in adult<10% in children
B. Inpatient for routine care:
15-30% in adult-10-25% in children
C. Critical but salvageable:
>30%-50% in adult, >25%-50% in child
Need HDU or ICU care in course of time
D. Critical but unpredictable outcome
>50-70% HDU
E. Unsalvageable:
>70%, comfort care
559
Out Patient Burn Management:
1. Take Clinical Picture

2. Wound lavage with normal saline, wash with mild soap
Bister: if ruptured-debride if cause functional impairments-debride
3. Cover with moisture retaining no-adherent dressing/hydrocolloid
dressing/Collagen/sufratulle/silver sulfadiazine
4. If contaminated wound, devitalized skin-topical antibiotic, silver sulhadiazine,
Instruct-Change dressing daily. 24-48 hours after first dressing, check infection,
give antibiotic, See at 2-3days interval, Heals within 2-3 weeks if partial
thickness. Report on admission day of same unit.
5. Face open-bacitracin ointment/collagen
6. Analgesic
7. Elevation of affected extremity
8. Injection T.T.  TIG
9. Discharged patient will Come for weekly fixed follow up days for one month or till
all the wounds have healed and advice pressure garments if there is tendency to
develop hypertrophy
10. Refer patients to physiotherapy department and do the exercise explained
11. Follow up till 2 Years and may come at any time when they have difficulties. If the
outpatients require surgery they are either admitted or grafted as outpatient in
outdoor/Emergency OT.
Monitoring in first 24 hours
Clinical-
(Value in bracket, be alert, look for signs of shock or heart failure)
1. Pulse -4hourly(<60->100/min)
2. BP -4 hourly (<100mm of Hg systolic)
3. Urine output - hourly
0.5ml/kg/hr adult
1ml/kg/hour child
2ml/kg/hour electric burn
Maintain I/O Chart
4. Respiratory rate -4 hourly
5. Pulse oximetry - hourly in patients with suspected inhalation, shock,
ventilated patient (<90% saturation)
6. Temp->1050 (Mild fever expected secondary to hypermetobolic state)
7. Pain-
VAS- utilize and document

A) If severe pain- IV morphin 0.1-0.2mg/kg/dose children/2.5-10mg in
adults/Oral/rectal. (titrate using patient response and respiratory rate) +
diclofenac
Or, ibuprofen+ paracetamol (in combination)
A narcotic infusion can be commenced once the initial treatments have
stabilized the patient.
B) Moderate pain – codeine 1mg/Kg + diclofenac 1mg/Kg/dose
Or, Ibuprofen + Paracetamol
C) Mild Pain-Ibuprofen 10mg/Kg + paracetamol oral 20mg/Kg/dose, per-
rectal 30mg/kg/dose
560
(Narcotic IM Inj. should not be administered as if >10% TBSA burn in

adult, >15% in child as there is peripheral shutdown is present, so no
absorption occurs. When circulation improves then overdose occurs.)
Monitoring after 24 hours

A daily progress note will include:
1. All vital sign (Pulse, BP, Temp, RR)
2. Level of consciousness
3. Systemic Exam-Chest, abdomen, lower limb for DVT, pressure areas
4. Intake output
5. Pain scoring
6. Notes on dressing change, wound condition/Color/Discharge/ odor
7. Nutritional adequacy
8. Physiotherapy-required or not
9. Psychological aspects
10. To communicate with family if parameter deterioriates
11. Patency of all channels
Lab Parameters:
1. Weight –on admission then quickly
2. Wound culture/biopsy on admission and weekly
3. CBC, sugar, urea, creatinine, Electrolyte daily if critical or until stable then
weekly
4. FDP, D-Dimer, on admission & weekly
5. LFT, Albumin, CRP-weekly
6. CXR on admission and as required
7. PT/PTT (on admission and as required)
8. Ca, Mg, Phos (on admission and as required)
9. S.HBs. Ag/HIV/Urine Drug screening (on adm)
10. Beta-HCG (If female of reproductive age)
Drugs
1. Analgesic- adjust according to pain score
2. Antiemetic-Metachlorpromide/ondansetron
3. Antiulcer
4. Antihistamine
5. DVT Prophylaxis-Heparin 5000 IU s/c bd or Clexane 0.5mg/kg s/c
6. Nystatin (200,000I.U.) -3 times daily PO/NGT
7. Folate 1mg PO/NGT once daily
8. If %50% burn MgSO4 500ml once a week
9. Codeine 30mg PO 6 hours (for diarrhea)
10. Antibiotics
See also for more details CLINICAL PRACTICE GUIDELINES FOR BURN PATIENT
MANAGEMENT, Published by National Institute of Burn & Plastic Surgery, Dhaka
Medical College
561
Appendix-1h
Treatment Guidelines for Malaria
Uncomplicated Malaria (Falciparum): Fever or history of fever with high suspicion of

malaria and positive BDT or Blood Slide Examination.
Treatment: Tablet artemether-lumefantrine, 20mg/120mg (6 doses over 3days) with
single dose Tablet Primaqdine (0.75mg/kg) on day 0.
Virax Malaria: Fever or history of fever with high suspicion of malaria and positive
BDT or Blood Slide Examination.
Treatment: Tablet Chloroquine over 3 days (1500mg for adult) and Tablet Primaquine
0.25mg/kg daily for 14 days.
Severe Malaria: Fever or history of fever with high suspicion of malaria and positive
BDT or Blood Slide Examination with unconsciousness and/or confused and/or
convulsion and/or prostration and/or jaundice and/or severe anemia and/or Acidosis
and or ABDS.
Treatment: Injection artesunate (2.4mg/kg body weight). 1st dose instantly and then
second dose at 12hrs. Subsequent dose once daily (Total depends on the condition of
the patient’s improvement). Injection artesunate will be follwed artemether-
lumefantrine when patient can take orally (with single dose Primaquine)
Procedure for dilution of Injection artesunate:
- Inj. Artesunate 60mg/Vial should be mixed with 1ml 5% sodium

bicarbonate solution and shaken for 2-3 min for better dissolution.
- For I/V: 5ml of 5% glucose or normal saline be added to make the
concentration 10mg/ml for slow intravenous infusion.
- For I/M : 2ml 5% glucose or normal saline be added to make the
concentration of Artesunate 20mg/ml for intramuscular injection.
- The total dose of intravenous infusion should be given within 3-4
minutes.
See also section 1.4.1 and for more details DIAGNOSIS AND MANAGEMENT OF
SEVERE MALARIA, EARLY DIAGNOSIS AND PROMPT TREATMENT (EDPT),
Learner’s Guide, 2014; published by National Malaria Control Programme, Disease
Control Division, DGHS, Ministry of Health & Family Welfare, Govt. of Bangladesh
562
Appendix-1i
Treatment Guidelines for Kala-azar
The objective of treatment for Kala-azar is to cure the patient, prevent the
complications of the disease and minimize side effects of medicines, restrain drug
resistance and reduce the risk of spread of disease. Complications and concomitant
disease(if any)should also be diagnosed and treated accordingly.
Drug treatment of Primary Kala-azar (PKA):
1st line treatment:
Following drugs are recommended as 1st line treatment for KA in Bangladesh:
Drug of Choice -
Liposomal Amphotericin B(10mg/kg single dose)
Alternative 1st line choices-(Depending on availability in our country)
• Miltefosine
• Paromomycin
• Combination treatment:
Combination of Miltefosine & Paromomycin will be 1st choice
Other alternative combinations will be
Liposomal Amphotericin B*
+
Miltefosine
Or
Liposomal Amphotericin B*
+
Paromomycin.
*LAmB5mg/kg body weight on alternate days for 3 doses
2nd line treatment:

The following drug is recommended as 2nd line treatment for PKA patients (if the 1st
line drugs are not available or not tolerated):
1. Amphotericin B deoxycholate
2. Sodium Stibogluconate(SSG)
Indications of 2nd line drugs:
3. When the first line drugs are not available or not tolerated.
Description of 1st line drugs for KPA

Liposomal Amphotericin B (LAmB):
563
Figure-1: Treatment Chart for Kala-azar
Treatment Chart Primary Kala-azar (PKA)
st nd
1 line treatment for PKA 2 line treatment for PKA
Amphoterician -B deoxycholate
Drug of Choice Dose: 1mg/kg body wt IV daily or alternative day
1. LiposomalAmphoterician (in 5% Dextrose solution 500ml)Duration: 15doses
B Sodium stibogluconate(SSG)
(10mg/kg single dose) Dose: 20mg/kg body wt IM daily.
st
Duration: 30 Days
Alternative 1 line choice – (
Weight(kg) SAG (ml)
Depending on availability in
our country) up to 3 0.6
• Miltefosine 4-5 0.8-1
• Paromomycin 6-8 1.2-1.6
• Combination
Treatment : Combination of 9-10 1.8-2
Miltefosine & Paromomycin 11-13 2.2-2.6
st
will be 1 choice 14-15 2.8-3.0
16-18 3.2-3.6
Other alternative 19-20 3.8-4.0
combination will be 21-23 4.2-4.6
Liposomal
24-25 4.8-5.0
Amphoterician B*
+ 26-28 5.2-5.6
Milterfosine 29-30 5.8-6.0
Or, 31-35 6.2-7.0
Liposomal Amphoterician
36-40 7.2-8.0
B*
41-45 8.2-9.0
+
Paromomycin 46-50 9.2-10
51-55 10.2-11
*LamB 5mg/kg body weight 56-60 11.2-12
on alternative days for 3
doses
564
Treatment Chart of PKTF, PKDL and RKA
Treatment Chart KATF, PKDL & RKA
When LAmB is not available or Rx for RKA

crontraindicatedor in KATF 1. Combination 1st line drugs cap.
1st line drugs : Miltefosine ( For adult dose:100mg
1. Miltefosine 28 days daily in two divided doses for
a. Age more than 12 years & weighing? Children:2.5mg/kg body weight in
25kg: 100mg. two divided doses for10days) plus
(cap. 50mg in morning & 50mg in inj. Paromomycin at a dose
evening with meal) 15mg/kg/day for 10 days.2.If fail
b. Age more than 12 years but weighing then choose alternate combination-
< 25kg: 50mg. (Cap 50mg in the morning Inj.Liposomal Amphotericin B
with meal) 5mg/kg body weight IV single dose
c. 2-12 years: 2.5mg/kg body weight in on day 1
two divided does with meal, not +
exceeding 50mg/day) Cap. Miltefosine following the above
2.Paromomycin: Dose: 15mg/kg/day mention dose from day 2 to day 8
Paromomycin for 21 days IM Or,
3.Combination of 1st choice 2nd line drugs Inj. Liposomal Amphotericin B 5mg/kg
a. Amphtericin-B deoxycholate ( 1mg/kg body weight IV single dose on day 1
daily or alternate day in IV for 15 doses) +
b. Sodium stibogluconate (SSG should Inj. Paromomycin following the above
be given at 20mg/kg daily IM for 30 days) mention dose from day 2 to day 11
Rx for PKDL
1st line-
Miltefosine;
ADULT dose: 100mg daily in two divided doses for 12 wks.
Children: 2.5mg/kg/day in two divided doses, not exceeding 50mg/day for 12 weeks
2nd line
a. Inj. Amphoterisin b Deoxycholate
Dose: 1 mg/kg body wt daily or alternate days IV for 15 doses per cycle with 6
cycle followed by 10days gap.
b. Inj. Sodium stibogluconate (SSG)
Dose: 20mg/kg body wt daily for 20days per cycle IM
Duration : Six cycles with 10days interval between cycles
PKTF : Primary Kala-azar Treatment failure

PKDL : Post Kala-azar Dermal leishmaniasis
RKA : Relapse Kala-azar
KATF : Kala-azar Treatment failure
See also for more detail in NATIONAL GUIDELINE FOR KALA-AZAR CASE
MANAGEMENT, MAY, 2013; published by Kala-azar Elimination program, Directorate
General of Health Services, Ministry of Health & Family Welfare, Govt. of Bangladesh
565
Appendix-1j
Treatment Guidelines for Chikungunya
Chikungunya fever is an emerging viral disease transmitted to humans by mosquitoes.

The disease may evolve in three phases; acute or febrile phase (lasting up to 21
days), sub-acute phase (21-90 days) and chronic phase (lasting more than 90 days).
Outbreaks are most likely to occur in post-monsoon period.
Flow Chart 1 : Treatment of arthralgia in the acute phase of Chikungunya in

Adult and Children
Flowchart for management of Chikungunya
Suspected Chikungunya (Clinical and

Epidemiological Criteria)
Adult: Paracetamol-500 to 750mg 6

hourly, Orally (max dose is 4gm)In
Children: 10-15mg /kg/dose 6 hourly [1]
Neuropathic Pain:
To be evaluated by
Do not use NSAIDs Reassess after 7
burning, Numbness,
(non-steroidal anti- days
parasthesia, Pin prick and
inflammatory) or acetyl
hypo or hyperesthesia. If
salicylic acid in the acute Pain Persist Neuropathic pain is
phase due to the risk of
present then:
complications associated
For adult:
with severe forms of Y N Amitriptyline : 25mg once
Chikungunya e o a day or gabapentin
(hemorrhage and renal
s
Reassess Stop 300mg every 12h. In
failure). Corticosteroid use
NSAID gel Medication elderly people do not use
in the acute phase
and seek amitriptyline due to
associated with risks and
specialist sedation risk. Also avoid it
complication
opinion in arrhythmia.
In Children
> 6 years: Add
amitriptyline (10mg) or
gabapentin
[1] Analgesics: take in fixed, regular doses and never use when necessary. 10-
20mg/kg/day
566
Flow Chart 2 : Treatment of arthralgia in the Subacute phase of Chikungunya in

Adult and Children
Suspected Chikungunya > 3week

and less than 3 months (Subacute)
Start Paracetamol as acute stage and if necessary add non-steroidal

anti-flammatories (NSAID) Ibuprofen 600mg every 8h, orally or
Naproxen 250mg every 8
Continue until resolution of the

symptoms, maximum 7-10days
Pain Persist
No Yes
Stop medication Higher potent NSAID (Indomethacin Doclofenac can be

switched)
Add Prednisolon: 0.5mg/kg/day, orally (maximum dose:
40mg) Continue until resolution of symptoms, maximum
For Children: Start with 3 weeks
Paracetamol 15mg/kg/dose 6h
for 7days. Assess after 7 days, if
pain persists, Naproxen,
Ibuprofen and Indomethacin for After resolution of the symptoms, maintain dose for 3-
7 days. Reassess after 7 days of 5days and begin weaning by 5mg/day every 7 days
treatment. If pain persist
Prednisolone – 0.5mg/kg/day for
2-4 weeks followed by weaning
(20% dose withdrawn every 5 If relapse occurs, during weaning, take the previous
days) dose until the symptoms resolve, maintaining that dose
Naproxen: 10 to 20 mg/kg/day for no longer than 3 weeks.
every 12h (maximum dose: After improvement, continue for 3-5 days and begin
2400mg/day or Indomethacin: 1 weaning by 2.5mg/day every 7 days
to 3mg/kg/day in 3 to 4 divided
doses (maximum dose:
200mg/day, orally
If relapse occurs, refer to specialist
Neuropathic Pain: To be evaluated by burning, Numbness, parasthesia, Pin prick and hypo or
hyperesthesia. If Neuropathic pain is present then: For adult: Amitriptyline: 25mg once a day or
gabapentin 300mg every 12h. In elderly people do not use amitriptyline due to sedation risk. Also
avoid it in arrhythmia.
In Children > 6 years: Add amitriptyline (10mg) or gabapentin 10-20mg/kg/day
567
NSAIDs: Only tobe used after the acute phase (>10-14 days). Be attentive to side
effects. Renal function must be assessed in elderly people and in those with
comorbidities, prior to starting treatment. Be alert for the higher risk for chronic
degenerative diseases in patients such as the elderly, those with diabetes, peptic ulcer
disease, nephropathy, liver disease, and cadiomyopathy, among others. Until the
onset of corticosteroid action, prescribe analgesics according to protocol
Steroids: Anti-inflamatory dose of corticosteroid is – 0.5mg/kg/day

Exclusion criter4ia for the use of corticosteroids:
• Patients with diabetes.
• Difficult to control hypertension.
• History of fracture due to documented Osteoporosis.
• Bipolar Mood disorder.
• Chronic renal failure on dialysis.
• Cushing’s syndrome.
• Obesity grade III.
• Arrhythmias, and coronary artery disease.
There is no risk of inducing adrenal insufficiency if used for 21 days, Corticosteroids
maybe prescribed for patients in the chronic phase if not yet used.
568
APPENDIX 2: DRUG INTERACTIONS
Appendix-2
DRUG INTERACTIONS
One of the factors that can alter the response to drugs is the concurrent administration
of other drugs. Two or more drugs given at the same time may exert their effects
independently or may interact. The interaction may be either potentiation, synergism
or additive effect or may be antagonism of one drug by another, or occasionally some
other effects. There are several mechanisms by which drugs may interact, but most
can be categorized as pharmacodynamic, pharmacokinetic (absorption, distribution,
metabolism, excretion) or combined toxicity.
Pharmacodynamic interactions occur between drugs which have similar or
antagonistic pharmacological effects or side-effects. The two drugs may or may not
interact on the same recptor to produce additive or synergistic effects. Conversely,
drugs with opposing pharmacologic effects may reduce the response to one or both
drugs. Pharmacodynamic interactions are usually predicatable from knowledge on
pharmacology of the interacting drugs. They occur in a greater or lesser extent in most
patients who receive the interacting drugs.
On the other hand, pharmacokinetic interactions occur when one drug alters the
ADME (absorption, distribution, metabolism or excretion) of another, thus increasing
or reducing the amount of drug available to produce its pharmacological effects.
Reduction in the total amount of drug absorbed may result in infective therapy.
Induction of the hepatic microsomal enzymes system by one drug can gradually
increase the rate of metabolism of another, resulting in lower plasma concentrations
and a reduced effect. Conversely, inhibition of metabolism of one drug results in
higher plasma concentrations and an increased effect with potential risk of toxicity.
Drugs which share active transport mechanisms for elimination can delay excretion,
resulting in toxicity of some drugs.
The combined use of two or more drugs, each of which has toxic effects on the same
organ, can greatly increase the likelihood of organ damage.
Drug interactions are studied extensively in Clinical Pharmacy. Clinical Pharmacists of
the developed countries deal with the case of drug interactions. But in Bangladesh,
the importance of drug interaction is not yet fully appreciated. Although most drug
interactions are harmless, many of those, which are potentially harmful, occur in a
small proportion of patients. Moreover, the severity of an interaction varies from one
patient to another. Patients at increased risk from drug interactions include the elderly
and those with impaired renal or liver function.
Drugs with a small therapeutic ratio (e.g. digoxin) and those which require careful
control of dosage (e.g. anticoagulants, antihypertensives and antidiabetics) are most
often involved in the drug interactions. Most of the potentially hazardous drug
interactions are listed in the following chart. The combined administration of the drug
listed in the chart should be avoided or only undertaken with caution and appropriate
monitoring and under supervision by clinicians as well as pharmacists.
List of drug interactions:

The following is an alphabetical list of drugs and their interactions. To avoid excessive
cross-referencing each drug or group is listed twice: in the alphabetical list and also
against the drug or group with which it interacts. It is to be mentioned that in this
compilation, an asterisk mark (*) has been placed against interactions that are
569
potentially hazardous and where combined administration of the drugs involved should
be avoided (or undertaken with caution and appropriate monitoring).
Abacavir
Use of alcohol with abacavir may result in decreased elimination of abacavir and
consequent increases in exposure. Abacavir increases the systemic clearance of oral
methadone and patients should be monitored for signs of withdrawal symptoms. The
dose of methadone may need to be increased in some patients.
Acarbose see under Antidiabetics.
ACE inhibitors and Angiotensin-II antagonists
Alcohol: enhanced hypotensive effect.
Allopurinol: increased risk of toxicity with Captopril, especially in renal
impairment.
* Anesthetics: enhanced hypotensive effect.
* Analgesics: antagonism of hypotensive effect and increased risk of renal
impairment with NSAIDs; hyperkalaemia with Ketorolac and possibly other
NSAIDs.
Antacids: absorption of Captopril, Enalapril, Fosinopril and possibly other ACE
inhibitors reduced.
Anti-arrhythmics: Procainamide increases risk of toxicity with Captopril, especially
in renal impairment.
Anticoagulant: increased risk of hyperkalaemia with Heparin.
Antidepressants: possibly enhanced hypotensive effect.
Antidiabetics: hypoglycemic effect possibly enhanced.
Other Antihypertensives: enhanced hypotensive effect.
Antipsychotics: enhanced hypotension effect.
Anxiolytics and Hypnotics: enhanced hypotensive effect.
Beta-blockers: enhanced hypotensive effect.
Calcium-channel blockers: enhanced hypotensive effect.
* Cardiac Glycosides: plasma concentration of Digoxin possibly increased by
Captopril.
* Ciclosporin: increased risk of hyperkalaemia.
Corticosteroids: antagonism of hypotensive effect.
Cytotoxics: Azathioprine increases risk of leucopoenia with Captopril.
* Diuretics: enhanced hypotensive effect (can be extreme); risk of severe
hyperkalaemia with Potassium-sparing diuretics.
Dopaminergics: Levodopa enhances hypotensive effect.
Epoetin beta: antagonism of hypotensive effect: increased risk of hyperkalaemia.
* Lithium: ACE inhibitors and possibly Angiotensin-II antagonists reduce excretion
of Lithium (increased plasma-lithium concentration).
Muscle Relaxants: Tizanidine enhance hypotensive effect.
Nitrates: enhance hypotensive effect.
Oestrogens and Progestogens: Oestrogens and combined oral contraceptives
antagonize hypotensive effect.
* Potassium Salts: increased risk of hyperkalaemia.
Uricosurics: Probenecid reduces excretion of Captopril.
Acebutolol see Beta-blockers.

Aceclofenac see NSAIDs
Acetazolamide see Diuretics (Carbonic Anhydrase inhibitor).
Aciclovir
Note: Interactions do not apply to topical preparations.
570
Mycophenolate Mofetil: higher plasma concentrations of Aciclovir and of

Mycophenolate Mofetil on concomitant administration.
Uricosurics: Probenecid reduces Aciclovir execration (increased plasma
concentrations).
Acitretin see Retinoids.
Acrivastine see Antihistamines.
Adenosine Possibility of interaction with drugs tending to impair myocardial
conduction:
• Anaesthetics, Local: increased myocardial depression when anti-
arrhythmics given with bupivacaine, levobupivacaine, prilocaine or
ropivacaine.
• Anti-arrhythmics: increased myocardial depression when anti-arrhythmics
given with other antiarrhythmics.
• Antipsychotics: increased risk of ventricular arrhythmias when anti-
arrhythmics that prolong the QT interval given with antipsychotics that
prolong the QT interval.
• Beta-blockers: increased myocardial depression when anti-arrhythmics
given with beta-blockers.
• Dipyridamole: effect of adenosine enhanced and extended by dipyridamole
(important risk of toxicity).
• Nicotine: effects of adenosine possibly enhanced by nicotine.
• Theophylline: anti-arrhythmic effect of adenosine antagonised by
theophylline.
Adrenaline see Sympathomimetics.

Aliskiren
• ACE Inhibitors: avoid concomitant use of aliskiren with ACE inhibitors.
• Analgesics: hypotensive effect of aliskiren possibly antagonised by NSAIDs.
• Angiotensin-II Receptor Antagonists: avoid concomitant use of aliskiren with
angiotensin-II receptor antagonists; plasma concentration of aliskiren
possibly reduced by irbesartan.
• Antibacterials: plasma concentration of Aliskiren reduced by rifampicin.
• Anticoagulants: increased risk of hyperkalaemia when aliskiren given with
heparins.
• Antifungals: plasma concentration of Aliskiren increased by itraconazole-
avoid concomitant use.
• Calcium-channel Blockers: plasma concentration of aliskiren increased by
verapamil.
• Ciclosporin: plasma concentration of Aliskiren increased by ciclosporin.
• Diuretics: aliskiren reduces plasma concentration of furosemide; increased
risk of hyperkalaemia when aliskiren given with potassium-sparing diuretics
and aldosterone antagonists.
• Potassium Salts: increased risk of Hyperkalaemia when aliskiren given with
potassium salts.
Alcohol
ACE Inhibitors and Angiotensin-II Antagonists: enhanced hypotensive effect.
Analgesics: sedative and hypotensive effect of opioid analgesics enhanced.
* Antibacterials: Disulfiram-like reaction with Metronidazole, and possibly
Tinidazole.
* Anticoagulants: see Warfarin.
571
* Antidepressants: sedative effect of Tricyclics (and related) enhanced; Tyramine

(contained in some alcoholic and dealcoholised beverages) interacts with MAOIs
(hypertensive crisis) - but if no Tyramine, enhanced hypotensive effect; effects of
alcohol possibly enhanced by SSRIs.
Antidiabetics: enhanced hypoglycemic effect; flushing with chlorpropamide (in
susceptible subjects); increased risk of lactic acidosis with Metformin.
Antiepileptics: CNS side-effects of Carbamazepine possibly enhanced.
Antihistamines: enhanced sedative effect.
Antihypertensives: enhanced hypotensive effect.
Antimuscarinics: sedative effect of Hyoscine enhanced.
Antipsychotics: enhanced sedative effect.
Anxiolytics and Hypnotics: enhanced sedative effect.
Barbiturates: enhanced sedative effect.
Calcium-channel Blockers: enhanced hypotensive effect; plasma-alcohol
concentration possibly increased by Verapamil.
Cytotoxics: disulfiram-like reaction with procarbazine.
Muscle Relaxants: Tizanidine enhanced sedative effect.
Nitrates: enhanced hypotensive effect.
Retinoids: Etretinate formed form Acitretin in presence of alcohol.
Albendazole
*Anthelmintics: The plasma concentration of albendazole sulfoxide has been
increased by praziquantel.
*Antiepileptics: Phenytoin, carbamazepine, andphenobarbital appear to induce the
oxidative metabolism ofalbendazole via the cytochrome P450 isoenzyme CYP3A by
roughly the same extent, resulting in significantly reduced concentrations of
albendazolesulfoxide.
*Corticosteroids: lasma concentrations of the active metabolite of albendazole
(albendazole sulfoxide) were reported to be raised by about 50% in a study in 8
patients receivingdexamethasone.
*Gastrointestinal drugs: Concentrations of albendazole sulfoxide have been found
to be raised in bile and hydatid cyst fluid when albendazole was given
withcimetidine, which may increase efficacy in the treatment of echinococcosis.
Alendronate Sodium see Bisphosphonates.
Allopurinol
ACE Inhibitors and Angiotensin-II Antagonists: increased risk of toxicity with
Captopril, especially in renal impairment.
Antibacterials: increased risk of rash with concomitant ampicillin and amoxicillin.
Anticoagulants: effects of Warfarin possibly enhanced.
Ciclosporin: plasma-ciclosporin concentration possibly increased (risk of
nephrotoxicity).
• Cytotoxics: effects of Azathioprine and Mercaptopurine enhanced with increased
toxicity (reduce dose when given with Allopurinol).
Theophylline: plasma-theophylline concentration possibly increased
Alpha-Blockers
ACE Inhibitors and Angiotensin-II Antagonists: enhanced hypotensive effect.
* Anaesthetics: enhanced hypotensive effect.
Analgesics: NSAIDs antagonize hypotensive effect.
* Antidepressants: enhanced hypotensive effect.
Other Antihypertensives: additive hypotensive effect.
Antipsychotics: enhanced hypotensive effect.
Anxiolytics and Hypnotics: enhanced hypotensive and sedative effect.
572
* Beta-blockers: enhanced hypotensive effect; increased risk of first-dose

hypotensive effect of past-synaptic alpha-blockers such as Prazosin.
* Calcium-channel Blockers: enhanced hypotensive effect; increased risk of first-
dose hypotensive effect of post-synaptic alpha-blockers such as Prazosin.
Corticosteroids; antagonism of hypotensive effect of post-synaptic alpha-blockers
such as Prazosin.
* Diuretics: enhanced hypotensive effect; increased risk of first-dose hypotensive
effect of post-synaptic alpha-blockers such as Prazosin.
Dopaminergics: Levodopa enhances hypotensive effect.
Muscle Relaxants: Tizanidine enhance hypotensive effect.
Oestrogens and Progestogens: Oestrogens and combined oral contraceptive
Alprazolam see Anxiolytics and Hypnotics.

Aluminium Hydroxide see Antacids.
Ambrisentan
• Antibacterials: plasma concentration of ambrisentan possibly increased by
rifampicin
• Ciclosporin: plasma concentration of ambrisentan increased by closporin
Amikacin see Aminoglycosides.
Amiloride see Diuretics (potassium-sparing).
Aminoglycosides
Analgesics: Indomethacin possibly increases plasma concentration of Gentamicin
and Amikacin in neonates.
Other Antibacterials: increased risk of ototoxicity and nephrotoxicity with
Vancomycin; Neomycin reduces absorption of Phenoxymethyl Penicillin.
* Anticoagulants: see Phenindione and Warfarin.
Antidiabeti7cs: Neomycin possibly enhances hypoglycemic effect of Acarbose
and increases severity of gastro-intestinal effects.
Antifungals: increased risk of nephrotoxicity with Amphotericin.
* Botulinum Toxin: neuromuscular block enhanced (risk of toxicity).
* Ciclosporin: increased risk of nephrotoxicity.
Cardiac Glycosides: Neomycin reduces absorption of Digoxin.
* Cytotoxics: increased risk of nephrotoxicity and possibly of ototoxicity with
Cisplatin.
* Diuretics: increased risk of ototoxicity with loop diuretics.
* Muscle Relaxants: effect of non-depolarizing muscle relaxants enhanced.
* Parasympathomimetics: antagonism of effect of Neostigmine and Pyridostigmine.
Aminophylline see Theophylline.
Amiodarone
Note: Amiodarone has a long half-life; there is a potential for drug interactions to occur
for several weeks (or even months) after treatment with it has been stopped.
* Other Anti-arrhythmics: additive effect with Disopyramide, Flecainide,
Procainamide, and Quinidine (increased risk of ventricular arrhythmias - avoid
concomitant use); increased plasma concentration of Flecainide, Procainamide
and Quinidine; increased myocardial depression with any anti-arrhythmic.
* Antibacterials: increased risk of ventricular arrhythmias with Erythromycin
(parenteral) Co-trimoxazole and moxifloxacin (avoid concomitant use).
* Anticoagulants: metabolism of Warfarin inhibited (enhanced anticoagulant effect).
573
* Antidepressants: increased risk of ventricular arrhythmias with Tricyclics (avoid

concomitant use).
* Antiepileptics: metabolism of Phenytoin inhibited (increased plasma
concentration).
* Antimalarials: increased risk of ventricular arrhythmias with Chloroquine,
Hydroxychloroquine, Mefloquine and Quinine (avoid concomitant use);
manufacturer of artemether with lumefantrine advises avoid concomitant use (risk
of ventricular arrhythmias)
* Antipsychotics: increased risk of ventricular arrhythmias with Phenothiazines and
Haloperiodol (avoid concomitant use).
* Beta-blockers: increased risk of bradycardia, AV block, and myocardial
depression (avoid concomitant use).
* Calcium-channel Blockers: Diltiazem and Verapamil increase risk of bradycardia,
AV block, and myocardial depression.
* Cardiac Glycosides: increased plasma concentration of Digoxin (halve Digoxin
maintenance dose).
Ciclosporin: plasma concentration of Ciclosporin possibly increased.
Diuretics: cardiac toxicity increased if hypokalaemia occurs with Acetazolamide,
loop diuretics, and Thiazides.
Lithium: increased risk of hypothyroidism.
Ulcer-healing Drugs: Cimetidine increases plasma concentrations of Amiodarone.
Amitriptyline see Tricyclic Antidepressants.

Amlodipine see Calcium-Channel Blockers.
Amlodipine + Telmisartan see Calcium Channel Blockers and Angiotensin-II
antagonist
Amoxycillin see Penicillins.

Ampicillin see Penicillins.
Anabolic Steroids
* Anticoagulants: anticoagulant effect of Warfarin enhanced.
Antidiabetics: hypoglycaemic effect possibly enhanced.
Anaesthetics, General
* ACE Inhibitors and Angiotensin-II antagonist: enhanced hypotensive effect.
Antibacterials: possible potentiation of Isoniazid hepatotoxicity; effect of
Thiopental enhanced by Sulphonamides; hypersensitivity-like reactions can occur
with concomitant intravenous Vancomycin.
Antidepressants: risk of arrhythmias and hypotension increased with Tricyclics:
MAOIs.
* Antihypertensives: enhanced hypotensive effect.
* Antipsychotics: enhanced hypotensive effect.
* Beta-blockers: enhanced hypotensive effect.
* Calcium-channel Blockers: enhanced hypotensive effect and AV delay with
Verapamil; hypotensive effect of Dihydropyridines enhanced by Isoflurane.
* Dopaminergics: risk of arrhythmias if volatile liquid anaesthetics such as
Halothane given with Levodopa.
Oxytocin: oxytocic effect possibly reduced by volatile anaesthetics (also
enhanced hypotensive effect and risk of arrhythmias).
* Sympathomimetics: risk of arrhythmias if adrenaline or Isoprenaline given with
volatile liquid anaesthetics such as Halothane.
Theophylline: increased risk of arrhythmias with halothane.
574
Anaesthetics, Local see Bupivacaine, Lignocaine.

Analgesics see Aspirin, NSAIDs, Opioid Analgesics, and Paracetamol.
Antacids
ACE Inhibitors: reduced absorption of captopril, enalapril, fosinopril and possibly
other ACE inhibitors.
Analgesics: excretion Aspirin increased in alkaline urine.
Anti-arrhythmics: excretion of Quinidine reduced in alkaline urine (may
occasionally increase plasma concentration).
Antibacterials: reduced absorption of Azithromycin, Cefaclor, Cefpodoxime,
Ciprofloxacin, Isoniazid, Levofloxacin, Moxifloxacin, Nitrofurantoin, Norfloxacin,
Ofloxacin, Rifampicin and most Tetracyclines.
Antiepileptics: reduced absorption of Gabapentin and Phenytoin.
Antifungals: reduced absorption of Itraconazole and Ketoconazole.
Antihistamines: reduced absorption of Fexofenadine
Antiplatelet Drugs: Dipyridamole patient information leaflet advises avoidance of
antacids.
Antimalarials: reduce absorption of Chloroquine and Hydroxychloroquine;
Magnesium trisilicate reduces absorption of Proguanil.
Antipsychotics: reduced absorption of Phenothiazines and of Sulpiride
Antivirals: reduced absorption of Zalcitabine.
Bisphosphonates: reduced absorption.
Cardiac Glycosides: possibly reduced absorption of Digoxin.
Iron: Magnesium trisilicate reduces absorption of oral iron.
Lithium: sodium bicarbonate increases excretion (reduced plasma-lithium
concentration).
Penicillamine: reduced absorption.
Ulcer-healing Drugs: possibly reduced absorption of Lansoprazole.
Antazoline see Antihistamines.

Anthranol see dithranol
• Minoxidil: Absorption of minoxidil may be increased by the concurrent use of
topical dithranol.
Anti-arrhythmics see Adenosine; Amiodarone; Disopyramide; Lignocaine;
Procainamide; Quinidine.
Anticholinergics see Antimuscarinics.
Anticholinesterases see Parasympathomimetics.
Anticoagulants see Heparin, and Warfarin.
Antidepressants, SSRIs
Alcohol: effects possibly enhanced.
* Analgesics: risk of CNS toxicity increased with Tramadol; increased risk of
bleeding with aspirin and NSAIDs.
* Anticoagulants: effect of Warfarin possibly enhanced.
* Other Antidepressant: CNS effects of SSRIs increased by MAOIs (risk of serious
toxicity), plasma concentration of some Tricyclics increased; agitation and
nausea with Tryptophan; Fluoxetine increases plasma concentration of
Nefazodone.
* Antiepileptics: antagonism (convulsive threshold lowered); plasma concentration
of Carbamazepine lowered by Fluoxetine; plasma concentration of Phenytoin
increased by Fluoxetine; Phenytoin and possibly other antiepileptics reduce
plasma concentration of Paroxetine.
575
* Antimalarials: manufacturer of Artemether with Lumefantrine advises avoid

concomitant use.
* Antipsychotics: plasma concentration of Clozapine increased by Fluoxetine,
Paroxetine and Sertraline; plasma concentration of Haloperidol increased by
Fluoxetine; plasma concentration of Thioridazine increased by Paroxetine (risk of
ventricular arrhythmias – avoid concomitant use); plasma concentration of
Risperidone increased by Fluoxetine.
* Antivirals: plasma concentration possibly increased by Ritonavir.
* Dopaminergics: hypertension and CNS excitation with Fluoxetine, Paroxetine or
Sertraline and Selegiline (Selegiline should not be started until 5 weeks after
discontinuation of Fluoxetine for 2 weeks after stopping Selegiline).
* Lithium: increased risk of CNS effects (lithium toxicity reported).
Opioid Analgesics: Tramadol possibly increases risk of convulsions.
* Theophylline: plasma-theophylline concentration increased (concomitant use
should usually be avoided, but where not possible halve Theophylline dose and
monitor plasma-theophylline concentration).
Antidepressants, Tricyclic
* Alcohol: enhanced sedative effect.
* Anaesthetics: risk of arrhythmias and hypotension increased.
* Analgesics: risk of CNS toxicity increased with Tramadol; possibly increased
sedation with opioid analgesics.
* Anti-arrhythmics: increased risk of ventricular arrhythmias with drugs that prolong
QT interval, including Amiodarone (avoid concomitant use), Disopyramide,
Procainamide and Quinidine.
Antibacterials: increased risk of ventricular arrhythmias with moxifloxacin (avoid
concomitant use); plasma concentrations of some tricyclics reduced by
Rifampicin (reduced antidepressant effect).
* other Antidepressants: CNS excitation and hypertension with MAOIs; Tricyclic or
related antidepressant should not be started until 2 weeks after stopping MAOI;
conversely, MAOI should not be started until at least 1 week after Tricyclic or
related antidepressant has been stopped; plasma concentrations of some
Tricyclics increased by SSRIs.
* Antiepileptics: antagonism (convulsive threshold lowered); plasma concentration
of some Tricyclics reduced (reduced antidepressant effect).
* Antihypertensives: in general, hypotensive effect enhanced, but antagonism of
effect of adrenergic neurone blockers and of Clonidine (and increased risk of
hypertension on Clonidine withdrawal).
Antimuscarinics: increased antimuscarinic side-effects.
* Antipsychotics: increased risks of ventricular arrhythmias- avoid concomitant use
with Pimozide; increased plasma concentrations of Tricyclic antidepressants and
increased antimuscarinic side-effects with Phenothiazines.
* Barbiturates: see under Antiepileptics, above.
Calcium-channel Blockers: Diltiazem and Verapamil increase plasma
concentration Imipramine and possibly other Tricyclics.
Diuretics: increased risk of postural hypotension.
* Dopaminergics: CNS toxicity reported with Selegiline.
Muscle Relaxant: enhanced muscle relaxant effect.
Nitrates: reduced effect of sublingual nitrates (owing to dry mouth).
Oestrogens and Progestogens: oral contraceptives antagonize antidepressant
effect (but side-effects may be increased due to increased plasma concentrations
of Tricyclics).
576
* Sympathomimetics: hypertension and arrhythmias with adrenaline (but local

anaesthetics with adrenaline appear to be safe); hypertension with
Noradrenaline.
Ulcer-healing Drugs: plasma concentrations of Amitriptyline, and probably other
Tricyclics increased by Cimetidine (inhibition of metabolism).
Antidiabetics
Note: Includes Acarbose; Insulin; Metformin; Nateglinide; Repaglinide,
Sulphonylureas.
ACE Inhibitors: possibly enhance hypoglycemic effect.
Alcohol: enhanced hypoglycemic effect; flushing with Chlorpropamide (in
susceptible subjects); risk of lactic acidosis with Metformin.
Anabolic Steroids: possibly enhance hypoglycemic effect.
* Analgesics: possibly NSAIDs enhance effect of Sulphonylureas.
* Antibacterials: Chloramphenicol, Co-trimoxazole, and Sulphonamides enhance
effect of Sulphonylureas; Ciprofloxacin possibly enhances effect of
Glibenclamide; Neomycin possibly enhances hypoglycemic effect of Acarbose
and increases severity of gastrointestinal effects; Clarithromycin enchances effect
of repaglinide; Rifampicin reduces effect of Chlorpropamide, Tolbutamide and
possibly other Sulphonylureas (accelerate metabolism); Rifampicin reduces
plasma concentration of Repaglinide.
Anticoagulants: possibly enhanced hypoglycemic effects of Sulphonylureas and
changes to anticoagulant effects of Warfarin and other Coumarins.
Antidepressants: MAOIs enhance hypoglycemic effect of Insulin, Metformin,
Sulphonylureas and possibly other antidiabetics.
Antifungals: Fluconazole and Miconazole increase plasma concentrations of
Sulphonylureas- avoid concomitant use Miconazole with Gliclazide or Glipizide.
Antihistamines: depressed thrombocyte count with concomitant use of
Biguanides and Ketotifen.
Antihypertensives: hypoglycemic effect antagonized by Diazoxide.
Antipsychotics: Phenothiazines possibly antagonize hypoglycemic effect of
Sulphonylureas.
Beta-blockers: enhanced hypoglycemic effect and masking of warning signs of
hypoglycemia such as tremor.
Calcium-channel Blockers: Nifedipine may occasionally impair glucose tolerance
Corticosteroids: antagonism of hypoglycemic effect.
Diuretics: hypoglycemic effect antagonized by loop and Thaizide diuretics;
Chlorpropamide increases risk of hyponatraemia with Thiazides in combination
with potassium-sparing diuretics.
Hormone Antagonists: manufacturer advises metabolism of oral Antidiabetics
possibly accelerated by Aminoglutethimide.
Lipid-regulating drugs: Fibrates may improve glucose tolerance and have an
additive effect; increased risk of severe hypoglycaemia with Repaglinide and
Gemfibrozil (avoid concomitant use)
Lithium: may occasionally impair glucose tolerance.
Oestrogens and Progestogens: oral contraceptives antagonize hypoglycemic
effect.
Orlistat: manufacturer advises avoid concomitant use with Acarbose or
Metformin.
Pancreatin: hypoglycemic effect of Acarbose reduced by Pancreatin.
Testosterone: hypoglycemic effect possibly enhanced.
Ulcer-healing Drugs: Cimetidine inhibits renal excretions of Metformin (increased
plasma Metformin concentration); Cimetidine enhances hypoglycemic effect of
Sulphonylureas.
577
Antiepileptics see Carbamazepine; Clonazepam; Ethosuximide; Gabapentin;

Lamotrigine; Phenytoin; Valproate.
Antifungals see Amphotericin; Imidazole, Triazole, Griseofulvin, Terbinafine.
Antifungals, Imidazole and Triazole

Note: Imidazole antifungals include Clotrimazole, Ketoconazole and Miconazole;
Triazoles include Fluconazole and Itraconazole. In general, interactions relate to
multiple-dose treatment.
Analgesics: metabolism of Alfentanil inhibited by Ketoconazole (risk of prolonged
or delayed respiratory depression); plasma concentration of Celecoxib increased
by Fluconazole (halve Celecoxib dose).
Antacids: Antacids reduce absorption of Itraconazole and Ketoconazole.
* Antibacterials: Rifampicin accelerates metabolism of Fluconazole, Itraconazole
and Ketoconazole (reduced plasma concentrations); plasma concentration of
Rifampicin may be reduced by Ketoconazole; plasma concentration of Rifabutin
increased by Fluconazole and possibly other Triazoles (risk of uveitis-reduce
Rifabutin dose); plasma concentration of Ketoconazole may be reduced by
Isoniazid.
* Anticoagulants: effect of Warfarin enhanced by Fluconazole, Itraconazole,
Ketoconazole, and Miconazole (note: oral gel and vaginal formulations
absorbed).
* Antidiabetics: plasma concentrations of Sulphonylureas increased by
Fluconazole and Miconazole; Fluconazole, Itraconazole, and Ketoconazole
possibly increase plasma concentration Repaglinide (manufacturer advises avoid
concomitant use); avoid concomitant use of Miconazole with Glipizide.
* Antiepileptics: effect of Phenytoin enhanced by Fluconazole and Miconazole;
plasma concentrations of Itraconazole and Ketoconazole reduced by Phenytoin.
Other Antifungals: Imidazoles and Triazoles possibly antagonize effect of
Amphotericin.
* Antihistamines: manufacturer advises possibility of increased plasma-loratadine
concentration with Ketoconazole; metabolism of Mizolastine inhibited by
Ketoconazole and possibly other Imidazoles (avoid concomitant use).
Antimuscarinics: reduced absorption of Ketoconazole.
* Antipsychotics: risk of ventricular arrhythmias if Imidazoles or Traizoles given with
Pimozide (avoid concomitant use).
* Anxiolytics and Hypnotics: plasma concentration of Midazolam increase by
Itraconazole, Ketoconazole, and possibly Fluconazole ( prolonged sedative
effect).
* Calcium-channel Blockers: Itraconazole inhibits metabolism of dihydropyridines
(increased plasma concentration).
* Cardiac Glycosides: plasma concentration of Digoxin increased by Itraconazole.
* Ciclosporin: metabolism inhibited by Itraconazole, Ketoconazole and possibly
Fluconazole and Miconazole (increased plasma-Ciclosporin concentration).
Corticosteroids: Ketoconazole inhibits metabolism of Methylprednisolone and
possibly other Corticosteroids; Itraconazole possibly inhibits metabolism of
Methylprednisolone.
Cytotoxics: Itraconazole may inhibit metabolism of Vincristine (increased risk of
neurotoxicity); in vitro studies suggest possible interaction between Ketoconazole
Diuretics: plasma concentration of Fluconazole increased by Hydrochlorothiazide
* Lipid-regulating Drugs: Itraconazole, Ketoconazole, and possibly other
Imidazoles and Triazoles increase risk of myopathy with Simvastatin - avoid
concomitant use of Itraconazole, Ketoconazole with Simvastatin, Itraconazole
578
and possibly other Imidazole and Triazoles may increase risk of myopathy with
Atorvastatin; Itraconazole increases plasma concentration of Cervistatin.
Oestrogens and Progestogens: anecdotal reports of contraceptive failure with
Fluconazole, Itraconazole, Ketoconazole and possibly others.
* Theophylline: plasma-theophylline concentration possibly increased by
Fluconazole and possibly Ketoconazole.
Ulcer-healing Drugs: histamine H2- antagonists reduce absorption of Itraconazole
and Ketoconazole; proton-pump inhibitors reduce absorption of Ketoconazole
and possibly Itraconazole; Sucralfate reduces absorption of Ketoconazole.
Antihistamines
Note: Sedative interactions apply to a lesser extent to the non-sedating
antihistamines, and they do not appear to potentiate the effects of alcohol. Interactions
do not generally apply to antihistamines used for topical action (including inhalation).
Alcohol: enhanced sedative effect.
* Anti-arrhythmics: increased risk of ventricular arrhythmias with Mizolastine (avoid
concomitant use with Amiodarone, Disopyramide, Procainamide and Quinidine).
* Antibacterials: manufacturer advises possibility of increased plasma-loratadine
concentration with Erythromycin.
Antidepressants: MAOIs and Tricyclics increase antimuscarinic and sedative
effects.
* Antidiabetics: depressed thrombocyte count with concomitant use of Biguanides
and Ketotifen.
* Antifungals: manufacturer advises possibility of increased plasma-loratadine
concentration with Ketoconazole (avoid concomitant use).
Antimuscarinics: increased antimuscarinic side-effects.
Antivirals: plasma concentration of non-sedating antihistamines possibly
increased by Ritonavir.
* Beta-blockers: Sotalol increases risk of ventricular arrhythmias with Mizolastine.
Betahistine: antagonism (theoretical).
Ulcer-healing Drugs: manufacturer advises possibility of increased plasma-
loratadine concentration with Cimetidine.
Antihypertensives see individual drugs or groups.

Antimalarials see individual drugs.
Antimuscarinics
Note: Many drugs have antimuscarinic effects; concomitant use of two or more such
drugs can increase side effects such as dry mouth, urine retention, and constipation;
concomitant use can also lead to confusion in the elderly; interactions do not generally
apply to antimuscarinics used by inhalation.
Alcohol: sedative effect of Hyoscine enhanced.
Analgesics: increased antimuscarinic effects.
Anti-arrhythmics: increased antimuscarinic effects with Disopyramide; Atropine
delays absorption of Mexiletine.
Antidepressants: increased antimuscarinic side-effects with Tricyclics and
MAOIs.
Antidepressants: increased antimuscarinic side-effects with Tricyclics and
MAOIs.
Antifungals: reduced absorption of Ketoconazole.
Antihistamines: increased antimuscarinic side-effects of Phenothiazines (but
reduced plasma concentrations).
579
Antipsychotics: increased antimuscarinic side-effects of Phenothiazines (but

reduced plasma concentrations); increased side effects of Clozapine.
Dopaminergics: increased antimuscarinic side-effects with Amantadine;
absorption of Levodopa possibly reduced.
Metoclopramide and Domperidone: antimuscarinics antagonize gastro-intestinal
effects.
Nitrates: reduced effect of sublingual nitrates (failure to dissolve under tongue
owing to dry mouth).
Parasympathomimetics: antagonism of effect.
Antiplatelet Drugs see Aspirin, Clopidogrel, Dipyridamole and Ticlopidine.
Antipsychotics
Note: Increased risk of toxicity with myelosuppressive drugs- Clozapine in particular
should not be used concurrently with drugs associated with a substantial potential for
causing agranulocytosis, such as Carbamazepine, Co-trimoxazole, Chloramphenicol,
Sulphonamides, Pyrazolone analgesics such as Azapropazone, Penicillamine or
Cytotoxics also avoid Clozapine with long-acting depot antipsychotics (have
myelosuppressive potential).
ACE Inhibitors and Angiotensin-II antagonist: severe postural hypotension with
Chlorpromazine and possibly other Phenothiazines.
* Analgesics: enhanced sedative and hypotensive effect with opioid analgesics;
severe drowsiness possible if Indomethacin given with Haloperidol; risk of
ventricular arrhythmias if Levacetylmethadol given with Chlorpromazine,
Haloperidol, Pimozide or Thioridazine (avoid concomitant use).
Antacids and Adsorbents: reduced absorption of Phenothiazines with antacids
and possibly with Kaolin.
QT interval – avoid concomitant use of Pimozide or Thioridazine with
Amiodarone, Disopyramide, Procainamide or Quinidine (also avoid Haloperidol
with Amiodarone).
* Antibacterials: risk of arrhythmias if Clarithromycin and possibly Erythromycin
given with Pimozide (avoid concomitant use); Erythromycin possibly increases
plasma concentration Clozapine (possible increased risk of convulsions);
Rifampicin accelerates metabolism of Haloperidol (reduced plasma-Haloperidol
concentration).
* Antidepressants: increased risk of arrhythmias with Tricyclic antidepressants-
avoid concomitant use of Pimozide with Tricyclics; increased plasma
concentrations and increased antimuscarinic effects notably on administration of
Tricyclics with Phenothiazines; Fluoxetine possibly increase plasma
concentration of Clozapine; Fluoxetine increases plasma concentration of
Haloperidol; Clozapine possibly enhances central effects of MAOIs.
Antidiabetics: hypoglycemic effect of Sulphonylureas possibly antagonized by
Phenothiazines.
* Antiepileptics: antagonism (convulsive threshold lowered); Carbamazepine
accelerates metabolism of Clozapine and Haloperidol (reduced plasma
concentrations); Phenytoin accelerates metabolism of Clozapine
* Antifungals: risk of ventricular arrhythmias if Imidazoles or Triazoles given with
Antihypertensives: enhanced hypotensive effect; increased risk of extrapyramidal
effects on administration Methyldopa.
* Antimalarials: avoid concomitant use of Pimozide with Mefloquine and Quinine.
580
Antimuscarinics: antimuscarinic side-effects of Phenothiazines increased (but

reduced plasma concentrations).
* Antivirals: Protease inhibitors possibly increase plasma concentration of
Pimozide (risk of ventricular arrhythmias- avoid concomitant use); Ritonavir
increases plasma concentration of Clozapine (risk of toxicity – avoid concomitant
use); Ritonavir possibly increases plasma concentration of other antipsychotics.
* Anxiolytics and Hypnotics: enhanced sedative effect; Diazepam increases
plasma concentration of Zotepine; Buspirone increases plasma concentration of
Haloperidol.
* Beta-blockers: Phenothiazines increase risk of ventricular arrhythmias with
Sotalol; concomitant administration of Propranolol and Chlorpromazine may
increase plasma concentration of both drugs.
Calcium-channel Blockers: enhanced hypotensive effect.
* Desferrioxamine: manufacturer advises avoid Prochlorperazine (also
Levomepromazine on theoretical grounds).
* Diuretics: hypokalaemia increased risk of ventricular arrhythmias with Pimozide
(avoid concomitant use).
Dopaminergics: antagonism of hypoprolactinaemic and ant antiparkinsonian
effects of Bromocriptine; antagonism of effect of Apomorphine, Levodopa and
Pergolide.
Lithium: increased risk of extrapyramidal effects and possibility of neurotoxicity
with Clozapine, Haloperidol and Phenothiazines.
Metoclopramide and Domperidone: increased risk of extrapyramidal effects with
Metoclopramide.
Sympathomimetics: antagonize pressor action.
Ulcer-healing Drugs: Cimetidine may enhance effects of Chlorpromazine,
Clozapine, and possibly other antipsychotics.
Antivirals see Aciclovir; Saquinavir; Zalcitabine; Zidovudine.

Anxiolytics and Hypnotics
Anaesthetics: enhanced sedative effect.
Analgesics: opioid analgesics enhance sedative effect.
* Antibacterials: erythromycin inhibits metabolism of Midazolam (increased plasma-
Midazolam concentration, with profound sedation) and Zopiclone; Isoniazid
inhibits metabolism of Diazepam; Rifampicin increased metabolism of diazepam
and possibly other Benzodiazepines.
Anticoagulants: Chloral Hydrate may transiently enhance anticoagulant effect of
Warfarin.
Antidepressants: enhanced sedative effect; manufacturer contra-indicates
Buspirone with MAOIs.
Antiepileptics: metabolism of Clonazepam accelerated (reduced effect); plasma-
Phenytoin concentrations increased or decreased by Diazepam and possibly
other Benzodiazepines.
* Antifungals: Itraconazole, Ketoconazole, and possibly Fluconazole increase
plasma concentration of Midazolam (prolonged sedative effect)
Antihistamines: enhanced sedative effect.
Antihypertensives: enhanced hypotensive effect; enhanced sedative effect with
alpha-blockers.
Antipsychotics: enhanced sedative effects; Diazepam increases plasma
concentration of Zotepine.
Calcium-channel Blockers: Diltiazem and Verapamil inhibit metabolism of

Midazolam (increased plasma-midazolam concentration, with increased sedation)
581
Disulfiram: metabolism of Benzodiazepines inhibited, with enhanced sedative

effect.
Dopaminergics: Benzodiazepines occasionally antagonize effect of Levodopa.
Muscle Relaxants: Tizanidine enhance sedative effect.
Ulcer-healing Drugs: Cimetidine inhibits metabolism of Benzodiazepines and
Chlormethiazole and Zaleplon (increased plasma concentrations); Omeprazole
inhibits metabolism of Diazepam (increased plasma concentration).
Apremilast:
• YP3A4 Inducers (Moderate): May decrease the serum concentration of
CYP3A4 Substrates (High risk with Inducers). Monitor therapy
• CYP3A4 Inducers (Strong): May decrease the serum concentration of
Apremilast. Avoid combination
• Dabrafenib: May decrease the serum concentration of CYP3A4 Substrates
(High risk with Inducers). Management: Seek alternatives to the CYP3A4
substrate when possible. If concomitant therapy cannot be avoided, monitor
clinical effects of the substrate closely (particularly therapeutic effects).
Consider therapy modification
• Deferasirox: May decrease the serum concentration of CYP3A4 Substrates
(High risk with Inducers). Monitor therapy
• Pitolisant: May decrease the serum concentration of CYP3A4 Substrates (High
• risk with Inducers). Management: Combined use of pitolisant with a CYP3A4
substrate that has a narrow therapeutic index should be avoided. Other
CYP3A4 substrates should be monitored more closely when used with
pitolisant. Consider therapy modification
• Riociguat: Apremilast may enhance the hypotensive effect of Riociguat.
Management: Riociguat is contraindicated with nonselective
phosphodiesterase (PDE) inhibitors and PDE type 5 inhibitors. Other types of
PDE inhibitors are not contraindicated, but caution is advised and patients
should be monitored for hypotension. Monitor therapy
• Sarilumab: May decrease the serum concentration of CYP3A4 Substrates
• Siltuximab: May decrease the serum concentration of CYP3A4 Substrates
• Tocilizumab: May decrease the serum concentration of CYP3A4 Substrates
Aripiprazole
• May reduce plasma levels w/ CYP3A4 inducers (e.g. carbamazepine).
• May increase plasma levels w/ CYP3A4 inhibitors (e.g. clarithromycin,
ketoconazole) or CYP2D6 inhibitors (e.g. fluoxetine, quinidine).
• Concurrent admin w/ anticholinergic agents may disrupt body temp regulation.
Additive effects w/ hypotensive agents.
• Increased sedative and orthostatic hypotensive effects w/ lorazepam and other
benzodiazepines.
• Overlapping adverse reactions (e.g. sedation) w/ CNS agents.
Armodafinil
• Reduced plasma levels w/ potent CYP inducers (e.g. carbamazepine,
phenobarbital).
• May reduce the effectiveness of steroidal contraceptives. May reduce
ciclosporin blood levels.
• May decrease clearance of phenytoin, warfarin, diazepam, propranolol,
omeprazole
Artemether with Lumefantrine
582
Note: Grapefruit juice possibly inhibits metabolism Artemether and Lumefantrine

(manufacturer advises avoid)
• Antiarrhythmics: manufacturer of Artemether with Lumefantrine advises avoid
concomitant use with Amiodarone, Disopyramide, Procainamide and Quinidine
(risk of ventricular arrhythmias)
• Antibacterials: manufacturer of Artemether with Lumefantrine advises avoid
concomitant use with Macrolides and Quinolones.
• Antidepressants: manufacturer of Artemether with Lumefantrine advises avoid
concomitant use.
• Antifungals: manufacturer of Artemether with Lumefantrine advises avoid
concomitant use with imidazoles and triazoles
• Other Antimalarials: manufacturer of Artemether with Lumefantrine advises avoid
concomitant use.
• Antipsychotics: manufacturer of Artemether with Lumefantrine advises avoid
concomitant use.
• Beta-blockers: manufacturer of Artemether with Lumefantrine advises avoid
concomitant use with metoprolol.
Artesunate as of artemisinin
Use of artemisinin derivatives with drugs that prolong the QT interval should be
avoided if possible; caution is advised when artemisinin derivatives are given with
other antimalarials that have this propensity.Artemisinin has been reported to be a
potent inhibitor of the cytochrome P450 isoenzyme CYP1A2, and might interact with
drugs metabolised via this enzyme (such as theophylline). In contrast it is said to be
an inducer of CYP2A6, although the clinical implications of this are unclear.
Aspirin
* Other Analgesics: avoid concomitant administration of other NSAIDs (increased
side-effects).
Antacids and Adsorbents: excretion of aspirin increased in alkaline urine; Kaolin
possibly reduces absorption.
* Anticoagulants: increased risk of bleeding due to Antiplatelet effect.
Antiepileptics: enhancement of effect of Phenytoin and Valproate.
Corticosteroids: increased risk of gastro-intestinal bleeding and ulceration;
Corticosteroids reduce plasma-salicylate concentration.
* Cytotoxics: reduced excretion of Methotrexate (increased toxicity).
Diuretics: antagonism of diuretic effect of Spironolactone; reduced excretion of
Acetazolamide (risk of toxicity).
Leukotriene Antagonists: Aspirin increases plasma concentration Zafirlukast.
Metoclopramide and Domperidone: Metoclopramide enhances effect of Aspirin
(increased rate of absorption).
Uricosurics: effect of Probenecid and Sulphinpyrazone reduced.
Atenolol see Beta-blockers.

Atorvastatin see Statins.
Atracurium see Muscle Relaxants (non-depolarizing).
Atropine see Antimuscarinics.
Azathioprine
* Allopurinol: enhancement of effect with increased toxicity (reduce dose of
Azathioprine when given with Allopurinol).
* Antibacterials: manufacturer reports interaction with Rifampicin (transplants
possibly rejected).
Azithromycin see Erythromycin and other Macrolides.

Aztreonam
583
Caution is recommended in patients receiving aztreonam and oral anticoagulants

because of the possibility of increased prothrombin time.
Barbiturates
Anti-arrhythmics: metabolism of Disopyramide and Quinidine increased (reduced
plasma concentrations).
Antibacterials: metabolism of Chloramphenicol, Doxycycline, and Metronidazole
accelerated (reduced effect); Sulphonamides enhance effect of Thiopental
* Anticoagulants: metabolism of Warfarin accelerated (reduced anticoagulant
effect).
* Antidepressants: antagonism of anticonvulsant effect (convulsive threshold
lowered); metabolism of Mianserin and some Tricyclics accelerated (reduced
* Antiepileptics: concomitant administration Phenobarbital with other antiepileptics
may enhance toxicity without a corresponding increase in antiepileptics effect;
moreover interactions can complicate monitoring of treatment; interactions
include enhanced effects, increased sedation, and reductions in plasma
concentrations.
Antifungals: Phenobarbital reduces absorption of Griseofulvin (reduced effect).
* Antipsychotics: antagonism of anticonvulsant effect (convulsive threshold
lowered); Phenobarbital accelerates metabolism of Haloperidol (reduced plasma
concentration).
* Antivirals: plasma concentration of Saquinavir possibly reduced.
* Calcium-channel Blockers: effect of Felodipine and probably Nifedipine and other
Dihydropyridines, Diltiazem, and Verapamil reduced.
Cardiac Glycosides: metabolism of Digitoxin only accelerated (reduced effect).
* Ciclosporin: metabolism of Ciclosporin accelerated (reduced effect).
* Corticosteroids: metabolism of Corticosteroids accelerated (reduced effect).
* Folic Acid and Folinic Acid: plasma concentration of Phenobarbital possibly
reduced by Folic acid and Folinic acid.
Leukotriene Antagonists: plasma concentration of Montelukast reduced by
Phenobarbital.
* Oestrogens and Progestogens: metabolism of oral contraceptives accelerated
(reduced contraceptive effect).
Theophylline: metabolism of Theophylline accelerated (reduced effect).
Thyroxine: metabolism of Thyroxine accelerated (may increase Thyroxine
requirements in hypothyroidism).
Vitamins: vitamin D requirements possibly increased.
Beclomethasone see Corticosteroids.

Bendrofluazide see Diuretics (thiazide).
Benzodiazepines see Anxiolytics and Hypnotics.
Benzoic acid There are no interaction messages
Benzoylperoxide There are no interaction messages
Benzylpenicillin see Penicillins.
Beta-Blockers
Note: Since systemic absorption may follow topical application of beta-blockers to the
eye the possibility of interactions, in particular, with drugs such as Verapamil should
be borne in mind.
ACE Inhibitors: enhanced hypotensive effect.
* Anaesthetics: enhanced hypotensive effect; increased risk of Bupivacaine toxicity
with Propranolol.
584
* Anti-arrhythmics: increased risk of myocardial depression and bradycardia; with

Amiodarone increased risk of bradycardia and AV block; increased risk of
Lignocaine toxicity with Propranolol; Propafenone increases plasma
concentration of Metoprolol and Propranolol; risk of ventricular arrhythmias
associated with Sotalol increased by Amiodarone, Disopyramide, Procainamide,
and Quinidine (avoid concomitant use).
* Antibacterials: increased risk of arrhythmias with Sotalol and Fluroquinolones
(avoid concomitant use); Rifampicin accelerates metabolism of Propranolol
(significantly reduced plasma concentration).
* Antidepressants: risk of ventricular arrhythmias associated with Sotalol increased
by Tricyclics.
Antidiabetics: enhanced hypoglycemic effect and masking of warning signs of
hypoglycemia such as tremor.
* Antihypertensives: enhanced hypotensive effect; increased risk of withdrawal
hypertension with Clonidine (withdraw beta-blocker several days before slowly
withdrawing Clonidine); increased risk of first-dose hypotensive effect with post-
synaptic alpha-blockers such as Prazosin.
* Antimalarials: risk of ventricular arrhythmias associated with Sotalol increased by
Phenothiazines; concomitant administration of Propranolol and Chlorpromazine
may increase plasma concentration of both drugs.
* Calcium-channel Blockers: increased risk of bradycardia and AV block with
Diltiazem; severe hypotension and heart failure occasionally with Nifedipine and
possibly other Dihydropyridines; asystole, severe hypotension, and heart failure
with Verapamil.
Cardiac Glycosides: increased AV block and bradycardia.
Diuretics: enhanced hypotensive effect; risk of ventricular arrhythmias associated
with Sotalol increased by hypocalcaemia.
Ergotamine: increased peripheral vasoconstriction.
Muscle Relaxants: Propranolol enhances effect; possible enhanced hypotensive
effect and bradycardia with Tizanidine.
Oestrogens and Progestogens: oestrogens and combined oral contraceptives
Parasympathomimetics: risk of arrhythmias possibly increased by Pilocarpine;
Propranolol antagonizes effect of Neostigmine and Pyridostigmine.
* Sympathomimetics: severe hypertension with Adrenaline and Noradrenaline and
possibly with Dobutamine (especially with non-selective beta-blockers).
Theophylline: beta-blockers should be avoided on pharmacological grounds
(bronchospasm).
Thyroxine: metabolism of Propranolol accelerated (reduced effect).
Ulcer-healing Drugs: plasma concentrations of Labetalol, Metoprolol and
Propranolol increased by Cimetidine; hypotensive effect antagonized by
Carbenoxolone.
Betahistine
Antihistamines: antagonism (theoretical).
Betamethasone see Corticosteroids.

Betaxolol see Beta-blockers
Bile Acids
Antacids: may reduce absorption of bile acids.
* Clofibrate group: Clofibrate increases elimination of cholesterol in bile.
585
* Oestrogens and Progestogens: oestrogens increase elimination of cholesterol in

bile.
Bismuth Chelate see Tripotassium Dicitratobismuthate.

Bisoprolol see beta blockers
Bisphosphonates
Analgesics: bioavailability of Tiludronic acid increased by Indomethacin.
Antacids: reduced absorption.
Antibacterials: increased risk of hypocalcaemia with Aminoglycosides.
Calcium salts: reduced absorption.
Iron: reduced absorption.
Bivalirudin May increase risk of bleeding when used with thrombolytics, oral
anticoagulants or drugs that affect platelet function.
Bortezomib Bortezomib is a substrate of cytochrome P450 enzyme 3A4, 2C19 and
1A2.
CYP3A4 Inhibitors: Co-administration of ketoconazole, a strong CYP3A4 inhibitor,
increased the exposure of bortezomib by 35% in 12 patients. Monitor patients for
signs of bortezomib toxicity and consider a bortezomib dose reduction if bortezomib
must be given in combination with strong CYP3A4 inhibitors (e.g. ketoconazole,
ritonavir).
CYP2C19 Inhibitors: Co-administration of omeprazole, a strong inhibitor of CYP2C19,
had no effect on the exposure of bortezomib in 17 patients.
CYP3A4 Inducers: Co-administration of rifampin, a strong CYP3A4 inducer, is
expected to decrease the exposure of bortezomib by at least 45%. Because the drug
interaction study (n=6) was not designed to exert the maximum effect of rifampin on
bortezomib PK, decreases greater than 45% may occur.
Efficacy may be reduced when bortezomib is used in combination with strong CYP3A4
inducers; therefore, concomitant use of strong CYP3A4 inducers is not recommended
in patients receiving bortezomib.
St. John’s Wort (Hypericum perforatum) may decrease bortezomib exposure
unpredictably and should be avoided.
Dexamethasone: Co-administration of dexamethasone, a weak CYP3A4 inducer, had
no effect on the exposure of bortezomib in 7 patients.
Melphalan-Prednisone: Co-administration of melphalan-prednisone increased the
exposure of bortezomib by 17% in 21 patients. However, this increase is unlikely to be
clinically relevant.
Bosentan
• Antibacterials: plasma concentration of bosentan reduced by rifampicin
• Antidiabetics: increased risk of hepatotoxicity when bosentan given with
glibenclamide
• Antifungals: plasma concentration of bosentan possibly increased by fluconazole;
plasma concentration of bosentan possibly increased by itraconazole
• Antivirals: bosentan possibly reduces plasma concentration of indinavir; plasma
concentration of bosentan increased by lopinavir ritonavir (consider reducing of
bosentan); bosentan possibly reduces plasma concentration of telaprevir, also
concentration of bosentan possibly increased; avoidance of bosentan advised by
manufacturer of tipranavir
• Ciclosporin: plasma concentration of bosentan increased by ciclosporin (also
plasma concentration of iclosporin reduced
• Cytotoxics: bosentan possibly reduces plasma concentration of bosutinib
• Lipid-regulating Drugs: bosentan reduces plasma concentration of simvastatin
586
• Oestrogens: bosentan possibly causes contraceptive failure of hormonal

contraceptives containing oestrogens (alternative contraception recommended)
• Progestogens: bosentan possibly causes Contraceptive failure of hormonal
contraceptives containing progestogens (alternative contraception
recommended)
• Sildenafil: bosentan reduces plasma concentration of sildenafil
• Tadalafil: bosentan reduces plasma concentration of tadalafil
Brinzolamide see diuretics (Carbonic anhydrase inhibitor)

Bromazepam see Anxiolytics and Hypnotics.
Bromfenac
Abciximab: Bromfenac may increase the anticoagulant activities of Abciximab.
Acebutolol: Bromfenac may decrease the antihypertensive activities of
Acebutolol.
Aceclofenac: The risk or severity of adverse effects can be increased when
Bromfenac is combined with Aceclofenac.
Acemetacin: The risk or severity of adverse effects can be increased when
Bromfenac is combined with Acemetacin.
Acenocoumarol: Bromfenac may increase the anticoagulant activities of
Acenocoumarol.
Acetylsalicylic acid: The risk or severity of adverse effects can be increased when
Bromfenac is combined with Acetylsalicylic acid.
Bromocriptine
Alcohol: reduced tolerance to Bromocriptine.
Antibacterials: Erythromycin and possibly other Macrolides increase plasma
concentration (increased risk of toxicity).
Antipsychotics: antagonism of hypoprolactinaemic and antiparkinsonian effects.
Metoclopramide and Domperidone: antagonize hypoprolactinaemic effect.
* Sympathomimetics: increased risk of toxicity with Bromocriptine and
Phenylproponolamine.
Budesonide see Corticosteroids.

Bumetanide see Diuretics
Bupivacaine
Anti-arrhythmics: increased myocardial depression.
Beta-blockers: increased risk of Bupivacaine toxicity with Propranolol.
Butenafine there are no interaction messages
Butobarbitone see Barbiturates and Primidone.
Calcipotriol see vitamin D derivative
Calcium Salts
Antibacterials: reduced absorption of Ciprofloxacin and Tetracyclines.
Cardiac Glycosides: large intravenous doses of calcium can precipitate
arrhythmias.
Diuretics: increased risk of hypocalcaemia with Thiazides.
Calcium-Channel Blockers
Note: Grapefruit juice increases plasma concentration of dihydropyridine calcium-
channel blockers (except Amlodipine) and Verapamil; Dihydropyridine calcium-
channel blockers include Amlodipine, Felodipine, Lacidipine, Nifedipine and
Nimodipine.
* Anaesthetics: Verapamil increases hypotensive effect of general anaesthetics
and risk of AV delay; Isoflurane enhances hypotensive effect of Dihydropyridines
587
* Anti-arrhythmics: Amiodarone-induced risk of bradycardia, AV block, and

myocardial depression increased by Diltiazem and Verapamil; plasma-
concentration of Quinidine reduced by Nifedipine; increased risk of myocardial
depression and asystole if Verapamil given with Disopyramide; with Verapamil
raised plasma concentration Quinidine (extreme hypotension may occur).
* Antibacterials: Erythromycin possibly inhibits metabolism of Felodipine (increased
plasma concentration); Rifampicin increases metabolism of Diltiazem, Nifedipine,
Verapamil and possibly Nisoldipine (plasma concentrations significantly reduced).
Antidepressants: Diltiazem and Verapamil increase plasma concentration of
Imipramine and possibly other Tricyclics.
Antidiabetics: Nifedipine may occasionally impair glucose tolerance.
* Antiepileptics: effect of Carbamazepine enhanced by Diltiazem and Verapamil;
Diltiazem and Nifedipine increase plasma concentration of Phenytoin; effect of
Felodipine and probably Nifedipine and other Dihydropyridines reduced by
Carbamazepine, Phenobarbitone, Phenytoin; effect of Diltiazem and Verapamil
reduced by Phenobarbital and Phenytoin.
* Antifungals: Itraconazole inhibits metabolism of Felodipine (increased plasma
concentration).
* Antihypertensives: enhanced hypotensive effect, increased risk of first-dose
hypotensive effect of post-synaptic alpha-blockers such as Prazosin
Antimalarials: possible increased risk of bradycardia with some calcium-channel
blockers and Mefloquine.
Anxiolytics and Hypnotics: Diltiazem and Verapamil inhibit metabolism of
Midazolam (increased plasma-midazolam concentration, with increased sedation)
* Beta-blockers: increased risk of bradycardia and AV block with Diltiazem;
occasionally severe hypotension and heart failure with Nifedipine and possibly
other dihydropyridines; asystole, severe hypotension, and heart failure with
Verapamil.
* Other Calcium-channel Blockers: clearance of Nifedipine reduced by Diltiazem
(increased plasma Nifedipine concentration).
* Cardiac Glycosides: plasma concentration of Digoxin increased by Diltiazem,
Verapamil and possibly Nifedipine; increased AV block and bradycardia with
Verapamil.
* Ciclosporin: plasma-ciclosporin concentrations increased by Diltiazem and
Verapamil; possibly increases plasma concentration of Nifedipine.
Diuretics: enhanced hypotensive effect.
Lithium: neurotoxicity may occur without increased plasma-lithium concentrations
in patients given Diltiazem and Verapamil.
Muscle Relaxants: Nifedipine and Verapamil enhance effect of non-depolarizing
muscle relaxants, hypotension, myocardial depression, and hyperkalaemia with
Verapamil and intravenous Dantrolene; risk of arrhythmias with Diltiazem and
intravenous Dantrolene; enhanced hypotensive effect with Tizanidine.
* Theophylline: Diltiazem, Verapamil and possibly other calcium-channel blockers
enhance effect (increased plasma-theophylline concentration).
Ulcer-healing Drugs: Cimetidine inhibits metabolism of some calcium-channel
blockers (increased plasma concentration).
Candesartan see ACE Inhibitors and Angiotensin-II Antagonists.

Capecitabine see Fluorouracil (prodrug of fluorouracil)
Capreomycin care should be taken when capreomycin is used with other drugs that
have neuromuscular blocking activity. It should not be given with other drugs that
are ototoxic or nephrotoxic.
588
Captopril see ACE Inhibitors.
Carbamazepine
Alcohol: CNS side-effects of Carbamazepine possibly enhanced.
* Analgesics: Dextropropoxyphene enhances effect of Carbamazepine; effect of
Methadone and Tramadol decreased by Carbamazepine.
* Antibacterials: metabolism of Doxycycline accelerated (reduced effect); plasma-
Carbamazepine concentration increased by Clarithromycin, Erythromycin and
Isoniazid (also Isoniazid hepatotoxicity possibly increased).
* Anticoagulants: metabolism of Warfarin accelerated (reduced anticoagulant
effect).
lowered); plasma concentration of Carbamazepine increased by Fluoxetine;
metabolism of Mianserin and Tricyclics accelerated (reduced plasma
concentrations); manufacturer advises avoid with MAOIs or within 2 weeks of
MAOIs.
* Other Antiepileptics: concomitant administration of two or more antiepileptics may
enhance toxicity without a corresponding increase in antiepileptic effect;
moreover interactions between individual antiepileptics can complicate monitoring
of treatment; interactions include enhanced effects, increased sedation, and
reductions in plasma concentrations.
* Antimalarials: Chloroquine and Mefloquine antagonize anticonvulsant effect
lowered); metabolism of Clozapine, Haloperidol and Olanzapine accelerated
(reduced plasma concentrations).
* Antivirals: plasma concentration of Saquinavir possibly reduced.
* Calcium-channel Blockers: Diltiazem and Verapamil enhance effect of
Carbamazepine; effect of Felodipine and probably Nifedipine and other
Dihydropyridines reduced.
* Corticosteroids: metabolism accelerated (reduced plasma-ciclosporin
concentration).
* Diuretics: increased risk of hyponatraemia; Acetazolamide increases plasma-
Carbamazepine concentration.
* Hormone Antagonists: Danazol inhibits metabolism of Carbamazepine (enhanced
effect).
Lithium: neurotoxicity may occur without increased plasma-lithium concentration.
Muscle Relaxants: effect of non-depolarizing muscle relaxants antagonized
(recovery from neuromuscular blockade accelerated).
Oestrogens and Progestogens: Carbamazepine accelerates metabolism of oral
contraceptives (reduced contraceptive effect).
Retinoids: plasma concentration possibly reduced by Isotretinoin.
Theophylline: metabolism of theophylline accelerated (reduced effect).
Thyroxine: metabolism accelerated (may increase Thyroxine requirements in
hypothyroidism).
* Ulcer-healing Drugs: metabolism inhibited by Cimetidine (increased plasma-
Carbamazepine concentration).
Vitamins: Carbamazepine possibly increases vitamin D requirements.
Carbonic Anhydrase Inhibitors see Diuretics.
Cardiac Glycosides
ACE Inhibitors: Captopril possibly increases plasma concentration Digoxin.
Analgesics: NSAIDs may exacerbate heart failure reduce GFR and increase
plasma-cardiac glycoside concentrations.
589
Antacids and Adsorbents: Antacids and Kaolin possibly reduce absorption of

Digoxin.
* Anti-arrhythmics: plasma concentration of Digoxin increased by Amiodarone,
Propafenone, and Quinidine (halve maintenance dose of Digoxin).
Antibacterials: Erythromycin and possibly other Macrolides enhance effect of
Digoxin.
* Antifungals: plasma concentration Digoxin increased by Itraconazole.
* Antimalarials: quinine (includes use of quinine for cramp), hydroxychloroquine
and possibly Chloroquine raise plasma concentration of Digoxin; possible
increased risk of bradycardia with Mefloquine.
Barbiturate: see under Antiepileptics, above.
Beta-blockers: increased AV block and bradycardia.
* Calcium Salts: large intravenous doses of calcium can precipitate arrhythmias.
* Calcium-channel Blockers: plasma concentration Digoxin increased by Diltiazem,
Verapamil and possibly Nifedipine; increased AV block and bradycardia with
Verapamil.
Corticosteroids: increased risk of hypokalaemia.
* Diuretics: increased toxicity if hypokalaemia occurs with Acetazolamide, loop
diuretics, and Thiazides; effects of Digoxin enhanced by Canrenoate and
Spironolactone.
* Lipid-regulating Drugs: plasma concentration of Digoxin possibly increased by
Atorvastatin.
* Muscle Relaxants: arrhythmias with Suxamethonium.
* Sulphasalazine: absorption of Digoxin possibly reduced.
* Ulcer-healing Drugs: plasma concentration of Digoxin possibly increased by
proton pump inhibitors; absorption possibly reduced by Sucralfate.
Carteolol see Beta-blockers
Carvedilol see Beta-blockers.
Cefaclor see Cephalosporins.
Cefazoline see Cephalosporins.
Cefdinir see Cephalosporins.
Absorption of cefdinir is decreased by antacids or iron supplements and doses
should be separated by an interval of at least 2 hours. Probenecid reduces the
renal excretion of cefdinir.
Cefditoren see Cephalosporins.
Absorption of cefditoren after oral doses is decreased by antacids or histamine
H2-receptor antagonists. Probenecid reduces the renal excretion of cefditoren.
see Cephalosporins.
Cefetamet see Cephalosporins.
Cefixime see Cephalosporins.
Cefoperazone see Cephalosporins.
Unlike many other cephalosporins, the renal clearance of cefoperazone is not
affected by probenecid.
Cefotaxime see Cephalosporins.
cefpirome Cephalosporins.
Probenecid reduces the renal clearance of cefpirome.
Cefpodoxime see Cephalosporins.
Ceftazidime see Cephalosporins.
Ceftibuten see Cephalosporins.
Ceftriaxone see Cephalosporins.
Cefuroxime see Cephalosporins.
Celecoxib see NSAIDs.
Cephalosporins
590
* Anticoagulants: anticoagulant effect of Warfarin enhanced by Cephamandole

and possibly others.
Diuretics: Loop diuretics may increase nephrotoxicity of Cephalosporines.
Uricosurics: excretion of Cephalosporins reduced by Probenecid (increased
Cephalexin see Cephalosporins.

Cephradine see Cephalosporins.
Cetirizine see Antihistamines.
Chloramphenicol
Other Antibacterials: Rifampicin accelerates metabolism (reduced
Chloramphenicol-plasma concentration).
* Anticoagulants: anticoagulant effect of Warfarin enhanced.
* Antidiabetics: effect of Sulphonylureas enhanced.
* Antiepileptics: metabolism accelerated by Phenobarbital (reduced
Chloramphenicol-plasma concentration); increased plasma concentration of
Phenytoin (risk of toxicity).
Chloroquine and Hydroxychloroquine

* Analgesics: Chloroquine and Hydroxychloroquine increase risk of ventricular
arrhythmia with Levacetylmethadol (avoid concomitant use).
Antacids and Adsorbents: antacids reduce absorption of Chloroquine and
Hydroxychloroquine; Kaolin educes absorption of Chloroquine.
* Antiarrhythmics: Chloroquine and Hydroxychloroquine increase risk of ventricular
arrhythmias with Amiodarone (avoid concomitant use).
* Antiepileptics: antagonism of anticonvulsant effect of other Antimalarials;
increased risk of convulsions with Mefloquine; increased risk of arrhythmias with
Halofantrine.
* Cardiac Glycosides: Hydroxychloroquine and possibly Chloroquine increase
plasma concentration of Digoxin.
* Ciclosporin: Chloroquine increases plasma-Ciclosporin concentration (increased
risk of toxicity).
Parasympathomimetics: Chloroquine and Hydroxychloroquine have potential to
increase symptoms of myasthenia gravis and thus diminish effect of Neostigmine
and Pyridostigmine.
Ulcer-healing Drugs: Cimetidine inhibits metabolism of Chloroquine (increased
plasma concentration).
Chlorpheniramine see Antihistamines.

Chlorpromazine see Antipsychotics.
Chlorpropamide see Antidiabetics (Sulphonylureas).
Cilazapril see ACE Inhibitors.
Cilostazol
Cilostazol is extensively metabolised to active and inactive metabolites by cytochrome
P450 isoenzymes, mainly CYP3A4 and to a lesser extent CYP2C19. Therefore use
with other drugs that inhibit or are metabolised by these hepatic enzymes may result
in changes in plasma concentrations of either drug and, possibly, adverse
effects.Cilostazol should therefore be used with caution in patients taking drugs
metabolised by these enzymes; in patients taking enzyme inhibitors it should be
avoided or a reduced dose should be considered.
591
The risk of bleeding is increased if cilostazol is given with clopidogrel and aspirin; its
use, therefore, is contra-indicated in patients receiving two or more other antiplatelet
or anticoagulant drugs.
Cimetidine see Histamine H2-antagonists.
Cinnarizine see Antihistamines.
Ciprofloxacin see Quinolones.
Cisatracurium see Muscle Relaxants (non-depolarizing).
Cisplatin
* Antibacterials: Aminoglycosides increased risk of nephrotoxicity and possibly of
ototoxicity.
Diuretics: increased risk of nephrotoxicity and ototoxicity.
Citalopram see Antidepressants, SSRI
Clarithromycin see Erythromycin and other Macrolides.
Clindamycin
Muscle Relaxants: enhancement of effect of non-depolarizing muscle relaxants.
Parasympathomimetics: antagonism of effect of Neostigmine and Pyridostigmine.
Clobazam see Anxiolytics and Hypnotics.

Clofazimine
Some preliminary data have suggested that the anti-inflammatory action of clofazimine
in Type 2 lepra reactions may be reduced by dapsone, although US licensed product
information (Lamprene; Novartis, USA) states that these findings have not been
confirmed; the antimycobacterial effect was not affected.
Elevated plasma and urine concentrations of clofazimine have been detected in
patients receiving high doses of clofazimine with isoniazid, although skin
concentrations were found to be lower.
For a report of the effect of clofazimine on rifampicin absorption.
Clomipramine see Antidepressants, Tricycles.

Clonidine
• ACE Inhibitors: enhanced hypotensive effect when clonidine given with ACE
inhibitors;
• Adrenergic Neurone Blockers: enhanced hypotensive
• Alcohol: enhanced hypotensive effect
• Aldesleukin: enhanced hypotensive effect
• Alpha-blockers: enhanced hypotensive effect
• Anaesthetics, General: enhanced hypotensive effect
• Analgesics: hypotensive effect
• Angiotensin-II Receptor Antagonists: enhanced hypotensive effect
• Antidepressants: enhanced hypotensive effect when clonidine given with MAOIs;
hypotensive effect of clonidine possibly antagonised by mirtazapine, tricyclics,
also increased risk of hypertension on clonidine withdrawal
• Antipsychotics: enhanced hypotensive effect when clonidine given with
phenothiazines
• Anxiolytics and Hypnotics: enhanced hypotensive effect when clonidine given
with anxiolytics and hypnotics
• Beta-blockers: increased risk withdrawal hypertension when clonidine given with
beta-blockers
• Calcium-channel Blockers: enhanced hypotensive effect
• Corticosteroids: hypotensive effect of clonidine antagonized by corticosteroids
592
• Cytotoxics: possible increased risk of bradycardia when clonidine given with

crizotinib
• Diazoxide: enhanced hypotensive effect when clonidine given with diazoxide
• Diuretics: enhanced hypotensive effect when clonidine given with diuretics
• Dopaminergics: enhanced hypotensive effect when clonidine given with levodopa
• Histamine: avoidance of clonidine advised by manufacturer of histamine
• Methyldopa: enhanced hypotensive effect when clonidine given with methyldopa
• Moxisylyte: enhanced hypotensive effect when clonidine given with moxisylyte
• Moxonidine: enhanced hypotensive effect when clonidine given with moxonidine
• Muscle Relaxants: enhanced hypotensive effect when clonidine given with
baclofen or tizanidine
• Nitrates: enhanced hypotensive effect when clonidine given with nitrates
• Oestrogens: hypotensive effect of clonidine antagonized by oestrogens
• Prostaglandins: enhanced hypotensive effect when clonidine given with
alprostadil.
• Sympathomimetics: possible risk of hypertension when clonidine given with
adrenaline (epinephrine) or noradrenaline (norepinephrine); serious adverse
events reported with concomitant use of clonidine and methylphenidate
(causality not established)
• Vasodilator Antihypertensives: enhanced hypotensive effect when clonidine
given with hydralazine, minoxidil or sodium nitroprusside
Clonazepam (general sedative interactions as for Anxiolytics and Hypnotics).

Clopidogrel
Analgesics: increased risk of bleeding with NSAIDs (including aspirin)
• Anticoagulants: enhanced effect due to antiplatelet action of Clopidogrel;
manufacturer advises avoid concomitant use of Warfarin.
• Other Antiplatelet drugs: increased risk of bleeding.
Clotrimazole see Antifungals, Imidazole and Triazole.

Clozapine see Antipsychotics.
Co-amoxiclav see Penicillins.
Codeine see Opioid Analgesics.
Cold and Cough Remedies see Antihistamines and Sympathomimetics.
Colestipol as for Colestyramine
Contraceptives, Oral
Note: Also covers Oestrogens taken alone; interactions unlikely with low dose
hormone replacement therapy.
ACE Inhibitors: Oestrogens and combined oral contraceptives antagonize
hypotensive effect.
* Antibacterials: Rifampicin accelerate metabolism of both combined and
Progestogen-only oral contraceptives (reduced contraceptive effect); when
broad-spectrum antibiotics such as Ampicillin and Tetracycline given with
combined oral contraceptives possibility have reduced contraceptive effect (risk
probably small).
* Anticoagulants: antagonism of anticoagulant effect of Nicoumalone, Phenindione,
and Warfarin.
Antidepressants: antagonism of antidepressant effect has been reported, but
side-effects of Tricyclics may be increased due to higher plasma concentration.
Antidiabetics: antagonism of hypoglycemic effect.
* Antiepileptics: Carbamazepine, Phenobarbital and Phenytoin accelerate
metabolism (reduce effect of both combined and Progestogen-only
contraceptives).
593
* Antifungals: Griseofulvin accelerates metabolism (reduced contraceptive effect)

anecdotal reports of contraceptive failure with Fluconazole, Itraconazole,
Ketoconazole and possibly others.
Antihypertensives: combined oral contraceptives antagonize hypotensive effect
Beta-blockers: Oestrogens and combined oral contraceptives antagonize
hypotensive effect.
* Bile Acids: Oestrogens increase elimination of cholesterol in bile.
* Ciclosporin: increased plasma Ciclosporin concentration.
Corticosteroids: oral contraceptives increase plasma concentration of
Corticosteroids.
Diuretics: combined oral contraceptives antagonize diuretic effect.
* Retinoids: oral Tretinoin reduces efficacy of Progestogen-only and possibly
combined oral contraceptives.
Tacrolimus: efficacy of oral contraceptives possibly decreased.
Theophylline: combined oral contraceptives delay excretion (increased plasma-
theophylline concentration).
Ulcer-healing drugs: manufacturer advises Lansoprazole possibly accelerates
metabolism.
Corticosteroids
Note: Do not generally apply to Corticosteroids used for topical action (including
inhalalation).
Analgesics: increased risk of gastro-intestinal bleeding and ulceration with aspirin
and NSAIDs. Corticosteroids reduce plasma-salicylate concentration.
* Antibacterials: Rifampicin accelerate metabolism of Corticosteroids (reduced
effect); Erythromycin inhibits metabolism of Methylprednisolone and possibly
other Corticosteroids.
Antihypertensives: antagonism of hypoglycemic effect.
Antivirals: plasma concentration of Saquinavir possibly reduced by
Dexamethasone.
* Cardiac Glycosides: increased toxicity if hypokalaemia occurs with
Corticosteroids.
* Ciclosporin: plasma-Ciclosporin concentration increased by high-dose of
Methylprednisolone (risk of convulsions); Ciclosporin increases plasma
concentration of Prednisolone.
Diuretics: antagonism of diuretic effect; Acetazolamide, loop diuretics, and
Thiazides increase risk of hypokalaemia.
Hormone Antagonists: Aminoglutethimide accelerates metabolism of
Corticosteroids (reduced effect).
Oestrogens and Progestogens: oral contraceptives increase plasma
concentration Corticosteroids.
Somatropin: growth promoting effect may be inhibited.
Sympathomimetics: increased risk of hypokalaemia if high does of
Corticosteroids given with high doses of Ritodrine, Salbutamol, Salmeterol and
Terbutaline; Ephedrine accelerates metabolism of Dexamethasone.
Ulcer-healing Drugs: Carbenoxolone increases risk of hypocalcaemia.
Co-Trimoxazole and Sulphonamides

Note: For interactions with co-trimoxazole see also under Trimethoprim.
Anesthetics: effect of Thiopental enhanced.
* Anti-arrhythmics: Co-trimoxazole increases risk of ventricular arrhythmias with
Amiodarone (avoid concomitant use).
594
* Anticoagulants: effect of Warfarin enhanced.

* Antidiabetics: effect of Sulphonylureas enhanced.
* Antiepileptics: antifolate effect and plasma concentration of Phenytoin increased
by Co-trimoxazole and possibly other Sulphonamides.
* Antimalarials: increased risk of antifolate effect with Pyrimethamine (includes
Fansidar and Maloprim).
* Ciclosporin: increased risk of nephrotoxicity; plasma Ciclosporin concentration
possibly reduced by Sulphadiazine.
* Cytotoxics: antifolate effect of Methotrexate increased by Co-trimoxazole; risk of
Methotrexate toxicity increased by Sulphonamides.
Cyclophosphamide
* Anticoagulants: possibly enhances effect of Warfarin.
* Muscle Relaxants: Cyclophosphamide enhances effect of Suxamethonium.
Cycloserine
Patients receiving cycloserine and taking alcohol are at increased risk of
convulsions; for reference to increased blood-alcohol concentrations in patients
receiving cycloserine. Neurotoxic effects may be potentiated by use of
cycloserine with ethionamide, and concurrent use ofcycloserine and isoniazid
may result in increased CNS toxicity, such as dizziness and drowsiness.
Cyclosporin
Note: Grapefruit juice increases plasma-Ciclosporin concentration (risk of toxicity).
* ACE Inhibitors: increased risk of hyperkalaemia.
Allopurinol: possibly increases plasma-ciclosporin concentration (risk of toxicity).
* Analgesics: increased risk of nephrotoxicity with NSAIDs; Ciclosporin increases
plasma concentration of Diclofenac (halve diclofenac dose).
* Anti-arrhythmics: Amiodarone and Propafenon possibly increase plasma-
Ciclosporin concentration.
* Antibacterials: Aminoglycosides, Co-trimoxazole (and Trimethoprim alone), and
Quinolones increase risk of nephrotoxicity; Doxycycline possibly increases
plasma-Ciclosporin concentration; Erythromycin, Clarithromycin and possibly
other Macrolides increase plasma-Ciclosporin concentration; Erythromycin;
Clarithromycin and possibly other Macrolides increase plasma-Ciclosporin
concentration; Rifampicin, intravenous Trimethoprim (and possibly
Sulphadiazine) reduce plasma-ciclosporin concentration.
* Antiepileptics: Carbamazepine, Phenobarbitone, Phenytoin, and Primidone
accelerate metabolism (reduced plasma-Ciclosporin concentration).
* Antifungals: Griseofulvin possibly reduces plasma-Ciclosporin concentration;
Itraconazole, Ketoconazole, and possibly Fluconazole and Miconazole inhibit
metabolism (increased plasma-Ciclosporin concentration).
* Antimalarials: Chloroquine increases plasma-Ciclosporin concentration (risk of
toxicity).
Barbiturates: see under Antiepileptics, above.
* Calcium-channel Blockers: Diltiazem and Verapamil increase plasma-Ciclosporin
concentration; Ciclosporin possibly increases plasma concentration of Nifedipine.
* Corticosteroids: high-dose Methylprednisolone increases plasma-Ciclosporin
concentration (risk of convulsions); Ciclosporin increases plasma concentration
Prednisolone.
* Cytotoxics: increased risk of neurotoxicity with Doxorubicin, increased toxicity
with Methotrexate; in vitro studies suggest possible interaction with Docetaxel-
consult product literature.
* Diuretics: potassium-sparing diuretics increase risk of hyperkalaemia.
* Hormone Antagonists: Danazol inhibits metabolism (increased plasma-
Ciclosporin concentration).
595
* Lipid-regulating Drugs: increased risk of myopathy with statins.

* Oestrogens and Progestogens: Progestogens inhibit metabolism (increased
plasma-Ciclosporin concentration).
* Potassium Salts: increased risk of hyperkalaemia.
* Tacrolimus: plasma-Ciclosporin half-life prolonged (increased risk of toxicity).
* Ulcer-healing Drugs: Cimetidine possible increased plasma-Ciclosporin
concentration.
Cytarabine
Flucytosine: plasma-flucytosine concentration possibly reduced.
Cytotoxics see under individual drugs.
Daclatasvir
May cause severe bradycardia and heart block when concomitantly used with
amiodarone (in conjunction with sofosbuvir). Decreased plasma concentration and
therapeutic effect with moderate CYP3A4 enzyme inducers. Increased plasma
concentration with strong CYP3A4 enzyme inhibitors (e.g. clarithromycin, itraconazole,
ketoconazole, ritonavir, etc.). May increase systemic exposure to drugs that are
substrates of P-gp transporter (e.g. digoxin), OATP 1B1/1B3, and BCRP.
Potentially Fatal: Decreased plasma concentration and therapeutic effect with strong
CYP3A4 enzyme inducers (e.g. carbamazepine, phenytoin, rifampicin, etc.).
Dalteparin see Heparin.
Danazol
* Anticoagulants: effect of Warfarin enhanced (inhibits metabolism).
* Antiepileptics: inhibits metabolism of Carbamazepine (increased plasma-
Carbamazepine concentration).
* Ciclosporin: inhibits metabolism (increased plasma-ciclosporin concentration).
Dantrolene see Calcium-Channel Blockers and Muscle Relaxants.

Dapagliflozin
• Increased risk of dehydration and hypotension when used w/ diuretics.
• Additive hypoglycaemic effect if concomitantly used w/ insulin and insulin
secretagogues (e.g. sulfonylureas).
Dapsone
Antibacterials: plasma concentration reduced by Rifampicin.
Probenecid: Dapsone excretion reduced (increased risk of side-effects).
Darbepoetin alfa Antagonism of hypotensive effect and increased risk of
hyperkalemia with ACE inhibitors and angiotensin II receptor antagonists. Ethanol.
Dasatinib
Concomitant use w/ drugs that have narrow therapeutic index (e.g. alfentanil,
cisapride, ciclosporin, fentanyl, pimozide, quinidine, simvastatin, sirolimus, tacrolimus,
ergot alkaloids) as it may increase the serum levels of these drugs. Increased risk of
bleeding and thrombocytopenia w/ antiplatelet drugs, anticoagulants, and NSAIDs.
Potentially Fatal: May reduce plasma levels w/ antacids, administer antacid 2 hr
apart from the admin of dasatinib. May increase plasma levels w/ CYP3A4 inhibitors
(e.g. atazanavir, clarithromycin, erythromycin, indinavir, itraconazole, ketoconazole,
nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin or voriconazole). May
reduce plasma levels w/ CYP3A4 inducers (e.g. carbamazepine, dexamethasone,
phenytoin, phenobarbital or rifampicin).
Deflazacort
596
Desferrioxamine
Antipsychotics: manufacturer advises avoid Prochlorperazine (also
Methotrimeprazine of theoretical grounds).
Desloratadine see Antihistamines
Desmopressin
Analgesics: effect of Desmopressin potentiated by Indomethacin.
Desogestrel see Progestogens.

Dexamethasone see Corticosteroids.
Dexamethasone + Moxifloxacin see Dexamethasone and Moxifloxacin
Dextromethorphan Hydrobromide + Phenylephrine Hydrochloride + Triprolidine
Hydrochloride see de
• Additive CNS effect when used w/ antihistamines, psychotropics and other
CNS depressants.
• Increased toxic effect when used w/ potent CYP2D6 enzyme inhibitors (e.g.
fluoxetine, paroxetine, quinidine, terbinafine).
• Potentially Fatal: Increased risk of serotonin syndrome (e.g. hyperpyrexia,
hallucinations, gross excitation or coma) when concomitantly used w/
MAOIs or SSRIs.
Diazepam see Anxiolytics and Hypnotics.
Diclofenac see NSAIDs.
Diclofenac Diethylamine see NSAIDS.
Diethylcarbamazine
* Ammonium chloride: Making the urine acidic with ammonium chloride appears to
markedly increase the excretion of diethylcarbamazine.
* Sodium bicarbonate: Making the urine alkaline with sodium bicarbonate appears
to markedly increase the retention of diethylcarbamazine.
Digoxin see Cardiac Glycosides.
Diltiazem see Calcium-channel Blockers.
Dimenhydrinate see Antihistamines.
Diosmin Metabolism of metronidazole may be reduced by concurrent admin of
diosmin.
Diphenydramine see Antihistamines.

Dipivefrine see Sympathomimetics (as for adrenaline).
Dipyridamole
Antacids: patient information leaflet advises avoidance of antacids.
* Anti-arrhythmics: effect of adenosine enhanced and extended (important risk of
toxicity).
* Anticoagulants: enhanced effect due to antiplatelet action of Dipyridamole.
Cytotoxics: efficacy of Fludarabine possibly reduced.
Disopyramide
* Other Anti-arrhythmics: Amiodarone increases risk of ventricular arrhythmias
(avoid concomitant use); increased myocardial depression with any
antiarrhythmic.
* Antibacterials: plasma concentration of Disopyramide reduced by Rifampicin but
increased by erythromycin and possibly Clarithromycin (risk of toxicity).
* Antidepressants: increased risk of ventricular arrhythmics with Tricyclics.
Antiepileptics: plasma concentration of Disopyramide reduced by Phenobarbital,
Phenytoin.
Antihistamines: increased risk of ventricular arrhythmias with Mizolastine (avoid
concomitant use).
597
* Antimuscarinics: increased antimuscarinic side-effects.

* Antipsychotics: increased risk of ventricular arrhythmias –avoid concomitant use
with Pimozide or Thioridazine.
* Beta-blockers: increased myocardial depression; increased risk of ventricular
arrhythmias associated with Sotalol (avoid concomitant use).
* Calcium-channel blockers: increased myocardial depression with Verapamil.
* Diuretics: cardiac toxicity of Disopyramide increased if hypokalaemia occurs with
Acetazolamide, Loop diuretics, and Thiazides.
* Nitrates: reduced effect of sublingual nitrates (failure to dissolve under tongue
owing to dry mouth).
Diuretics
* ACE Inhibitors: enhanced hypotensive effect (can be extreme) risk of severe
hyperkalaemia with potassium-risk of severe hyperkalaemia with potassium-
sparing diuretics.
* Analgesics: diuretics increase risk of nephrotoxicity of NSAIDs; NSAIDs notably
Indomethacin and Ketorolac antagonize diuretic effect; Indomethacin and
possibly other NSAIDs increase risk of hyperkalaemia with potassium-sparing
diuretics; occasional reports of decreased renal function when Indomethacin
given with Triamterene; diuretic effect of Spironolactone antagonized by Aspirin;
Aspirin reduces excretion of Acetazolamide (risk of toxicity).
* Anti-arrhythmics: cardiac toxicity of Amiodarone, Disopyramide and Quinidine
increased if hypokalaemia occurs; action of Lignocaine and Mexiletine
antagonized by hypokalaemia; Acetazolamide reduces excretion of Quinidine
* Antibacterials: loop diuretics increase ototoxicity of Aminoglycosides and
Vancomycin.
* Antidepressants: increased risk of postural hypotension with Tricyclics.
Antidiabetics: hypoglycemic effect antagonized by Loop and Thiazide diuretics;
Chlorpropamide increases risk of hyponatraemia associated with Thiazides in
combination with potassium-sparing diuretics.
* Antiepileptics: increased risk of hyponatraemia with Carbamazepine;
Acetazolamide increases plasma concentration of Carbamazepine; carbonic
anhydrase inhibitors possibly increase risk of osteomalacia with antiepileptics
such as Phenytoin.
Antifungals: Hydrochlorothiazide increases plasma concentration Fluconazole.
* Antihypertensives: enhance hypotensive effect; increased risk of first-dose
hypotensive effect of post-synaptic alpha-blockers such as Prazosin.
* Antimalarials: electrolyte disturbances increase risk of ventricular arrhythmias
with Halofantrine.
* Antipsychotics: in hypokalaemia increased risk of ventricular arrhythmias with
Beta-blockers: enhanced hypotensive effect: in hypokalaemia increased risk of
ventricular arrhythmias with Sotalol.
Calcium Salts: increased risk of hypercalcaemia with Thiazides.
* Cardiac Glycosides: increased toxicity if hypokalaemia occurs with
Acetazolamide, Loop diuretics, and Thiazides; effect enhanced by Canrenoate
and Spironolactone.
Corticosteroids: increased risk of hypokalaemia with Acetazolamide, Loop
diuretics, and Thiazides, antagonism of diuretic effect.
* Ciclosporin: increased risk of hyperkalaemia with potassium-sparing diuretics.
Cytotoxics: increased risk of nephrotoxicity and ototoxicity with Cisplatin.
598
Other Diuretics: increased risk of hypokalaemia if Acetazolamide, Loop diuretics

or Thiazides given together; profound diuresis possible if Metolazone given with
Frusemide.
Hormone Antagonists: increased risk of hyponatraemia with Aminoglutethimide.
* Lithium: Lithium excretion reduced by Loop diuretics, potassium-sparing diuretics
and Thiazides (increased plasma-lithium concentration and risk of toxicity-loop
diuretics safer than Thiazides); lithium excretion increased by Acetazolamide.
* Oestrogens and Progestogens: Oestrogens and combined oral contraceptive
antagonize diuretic effect.
* Potassium Salts: hyperkalaemia with potassium-sparing diuretics.
Sympathomimetics: increased risk of hypokalaemia if Acetazolamide, Loop
diuretics, and Thiazides given with high does of Ritodrine, Salbutamol,
Salmeterol and Terbutaline.
Ulcer-healing Drugs: increased risk of hypokalaemia if Acetazolamide, Loop
diuretics, and Thiazides given with Carbenoxolone; Carbenoxolone antagonizes
diuretic effect; Amiloride and Spironolactone antagonize ulcer-healing effect of
Carbenoxolone.
Vitamins: increased risk of hypercalcaemia if Thiazides given with vitamin D.
Dobutamine see Sympathomimetics.
Docetaxel Trihydrate
Antibacterials: in-vitro studies suggest possible interaction with erythromycin-consult
product literature.
Antifungals: in-vitro studies suggest possible interaction with Ketoconazole-consult
product literature.
Ciclosporin: in-vitro studies suggest possible interaction with Ciclosporin.
Dofetilide
Increased plasma concentration when used w/ drugs secreted by renal tubular
cationic transport (e.g. amiloride, metformin, triamterene). Increased risk of toxicity
when used w/ QT prolonging agents (e.g. class I/III antiarrhythmics, bepridil, cisapride,
phenothiazines, TCAs, certain fluoroquinolones and oral macrolides).
Potentially Fatal: Increased risk of torsade de pointes when used w/
hydrochlorothiazide (w/ or w/o triamterene), verapamil, and renal cation transport
inhibitors (e.g. cimetidine, dolutegravir, trimethoprim, ketoconazole, prochlorperazine,
megestrol).
Domperidone
Analgesics: opioid analgesics antagonize effect on gastro-intestinal activity; absorption
of Paracetamol accelerated (enhanced effect).
Antimuscarinics: antagonism of effect on gastrointestinal activity.
Dopaminergics: possible antagonism of hypoprolactinaemic effect of Bromocriptine.
Dopamine see sympathomimetics
Dopaminergics see Bromocriptine and Levodopa.
Doxazosin see Alpha blockers (post-synaptic).

Doxepin
Increased plasma concentration when concurrently used w/ CYP2D6 inhibitors
(e.g.quinidine, SSRIs), methylphenidate, and anxiolytics. Cimetidine may fluctuate
steady-serum concentration of doxepin. Increased risk of arrhythmias, hypotension, or
HTN if given w/ anaesthetics. Increased rate of metabolism w/ barbiturates. May
decrease antihypertensive effects of clonidine, guanethidine, debrisoquine, and
bethanidine. May reduce effect of sublingual nitrates owing to dry mouth.
Potentially Fatal: May cause serious adverse effects w/ MAOIs.
599
Doxofylline This drug should not be administered together with other xanthine
derivatives, including beverages and foods containing caffeine. Toxic synergism
with ephedrine has been documented for xanthines. Concomitant therapy with
erythromycin, troleandomycin, lincomycin, clindamycin, allopurinol, cimetidine,
propranolol and anti-flu vaccine may decrease the hepatic clearance of xanthines
causing an increase in blood levels.
Doxorubicin
Note: Antivirals may inhibit effect of Stavudine.
* Ciclosporin: increased risk of neurotoxicity.
Doxycycline see Tetracycline.

Doxylamine Succinate + Pyridoxine Hydrochloride
Drospirenone + Estradiol see oral contraceptives.
Econazole
Econazole is a known inhibitor of CYP3A4/2C9. Due to the limited systemic availability
clinically relevant interactions are unlikely to occur but have been reported with oral
anticoagulants. In patients taking oral anticoagulants, such as warfarin or
acenocoumarol, caution should be exercised and the anticoagulant effect should be
monitored more frequently.
Adjustment of the oral anticoagulant dosage may be necessary during and after the
treatment with econazole.
Ecothiophate see Parasympathomimetics.
Efavirenz
Efavirenz is metabolised mainly by cytochrome P450 isoenzymes including CYP3A4.
Consequently, it may compete with other drugs metabolised by this system, potentially
resulting in mutually increased plasma concentrations and toxicity. Enzyme inducers
may decrease plasma concentrations of efavirenz; efavirenz itself acts as an enzyme
inducer and can reduce plasma concentrations of other drugs. Inhibition of some P450
isoenzymes has also been found in vitro.
Efavirenz is contra-indicated with drugs that are highly dependent on CYP3A4 for
clearance and for which elevated plasma concentrations are associated with serious
or life-threatening events. These drugs include antihistamines (astemizole and
terfenadine), calcium-channel blockers (bepridil), ergot derivatives
(dihydroergotamine, ergometrine, ergotamine, methylergometrine), gastrointestinal
prokinetics (cisapride), antipsychotics (pimozide), and sedatives and hypnotics
(midazolam and triazolam). St John's wort decreases the concentration of efavirenz;
use with the antiretroviral is not recommended due to the possible loss of its activity
and development of resistance.
Empagliflozin Additive hypoglycaemic effect if concomitantly used w/ insulin and
insulin secretagogues (e.g. sulfonylureas). Increased risk of dehydration and
hypotension when used w/ diuretics (e.g. thiazides, loop diuretics).
Eltrombopag
• Antacids decrease the absorption of eltrombopag
• Oral calcium salts decrease the absorption of eltrombopag.
• Dairy products are predicted to decreases the absorption of eltrombopag.
• Iron (oral) is predicted to decrease the absorption of eltrombopag.
• Selenium is predicted to decrease the absorption of eltrombopag
• Eltrombopag is predicted to increase the exposure to statins. Monitor and
adjust dose.
• Zinc is predicted to decrease the absorption of eltrombopag.
Eluxadoline
600
• Alcohol (Ethyl): May enhance the adverse/toxic effect of Eluxadoline.

Specifically, alcohol use may increase the risk of pancreatitis. Avoid
combination
• Alosetron: May enhance the constipating effect of Eluxadoline.
• Anticholinergic Agents: May enhance the constipating effect of Eluxadoline.
Avoid combination
• Atazanavir: May increase the serum concentration of Eluxadoline.
Management: Decrease the eluxadoline dose to 75 mg twice daily if combined
with atazanavir and monitor patients for increased eluxadoline
effects/toxicities. Consider therapy modification
• Cyclosporine (Systemic): May increase the serum concentration of
Eluxadoline. Management: Decrease the eluxadoline dose to 75 mg twice
daily if combined with cyclosporine and monitor patients for increased
eluxadoline effects/toxicities. Consider therapy modification
• Loperamide-Loperamide Oxide: May enhance the constipating effect of
Eluxadoline. Monitor therapy
• Lopinavir: May increase the serum concentration of Eluxadoline. Management:
Decrease the eluxadoline dose to 75 mg twice daily if combined with lopinavir
and monitor patients for increased eluxadoline effects/toxicities.
• Opioid Analgesics: May enhance the constipating effect of Eluxadoline. Avoid
combination
• RifAMPin: May increase the serum concentration of Eluxadoline.
Management: Decrease the eluxadoline dose to 75 mg twice daily if combined
with rifampin and monitor patients for increased eluxadoline effects/toxicities.
Consider therapy modification
• Ritonavir: May increase the serum concentration of Eluxadoline. Management:
Decrease the eluxadoline dose to 75 mg twice daily if combined with ritonavir
and monitor patients for increased eluxadoline effects/toxicities. Consider
therapy modification
• Rosuvastatin: Eluxadoline may increase the serum concentration of
Rosuvastatin. Management: Use the lowest effective dose of rosuvastatin if
combined with eluxadoline. Consider therapy modification
• Saquinavir: May increase the serum concentration of Eluxadoline.
• Teriflunomide: May increase the serum concentration of OAT3 Substrates.
Monitor therapy
Enalapril see ACE Inhibitors.

Fnfuvirtide no clinical data is available
Enoxaparin see Heparin.
Entacapone
Antidepressants: manufacturer advises avoid concomitant use of MAOIs, Tricyclics or
Maprotiline.
Antihypertensives: effect of Methyldopa possibly enhanced.
Iron: absorption of Entacapone reduced.
Sympathomimetics: effect of Adrenaline, Dobutamine, Dopamine, Isoprenaline and
Noradrenaline possibly enhanced.
Entecavir
Ephedrine see Sympathomimetics.

Caution should be exercised when entecavir is given with other drugs eliminated
by active tubular secretion as competition for the elimination pathway may
increase the serum concentrations of either drug.
Eplerenone see Diuretics
Epoetin Beta
601
ACE Inhibitors and Angiotensin-II Antagonists: antagonism of hypotensive effect;

increased risk of hyperkalaemia.
Eptifibatide
*Warfarin and dipyridamole: Eptifibatide did not appear to increase the risk of major
and minor bleeding associated with concomitant use of warfarin and dipyridamole.
Eptifibatide -treated patients who had a prothrombin time (PT) > 14.5 seconds and
received warfarin concomitantly did not appear to be at an increased risk of bleeding.
*Eptifibatide and thrombolytic agents: Data are limited on the use of eptifibatide in
patients receiving thrombolytic agents. There was no consistent evidence that
eptifibatide increased the risk of major or minor bleeding associated with tissue
plasminogen activator in either a PCI or an acute myocardial infarction study;
Eptifibatide appeared to increase the risk of bleeding when administered with
streptokinase in an acute myocardial infarction study. The combination of reduced
dose tenecteplase and eptifibatide compared to placebo and eptifibatide significantly
increased the risk of both major and minor bleeding when administered concomitantly
in an acute ST-elevation myocardial infarction study.
In an acute myocardial infarction study involving 181 patients, eptifibatide (in regimens
up to a bolus injection of 180 microgram/kg, followed by an infusion up to 2
microgram/kg/min for up to 72 hours) was administered concomitantly with
streptokinase (1.5 million units over 60 minutes). At the highest infusion rates (1.3
microgram/kg/min and 2.0 microgram/kg/min) studied, eptifibatide was associated with
an increased incidence of bleeding and transfusions compared to the incidence seen
when streptokinase was given alone.
Ergometrine see Ergotamine and Ergometrine

Ergotamine and Ergometrine
* Anaesthetics: Halothane reduces effect of ergometrine on the parturient uterus
* Antibacterials: increased risk of ergotism with Azithromycin, Clarithromycin and
Erythromycin – avoid concomitant use; increased risk of ergotism with
Tetracyclines.
* Antivirals: risk of ergotism with Nelfinavir and Ritonavir-avoid concomitant use
Beta-blockers: increased peripheral vasoconstriction.
Ertapenem
Probenecid inhibits the renal excretion of ertapenemthereby increasing its plasma
concentrations and prolonging its elimination half-life.
Erythromycin and Other Macrolides
Note: Interactions do not apply to small amounts used topically.
Antacids: antacids reduce absorption of Azithromycin.
* Anti-arrhythmics: plasma concentration of Disopyramide increased by
erythromycin and possibly Clarithromycin (risk of toxicity);erythromycin
(parenteral) increases risk of ventricular arrhythmias with Amiodarone (avoid
concomitant use).
* Other Antibacterials: Clarithromycin and possibly other Macrolides increase
plasma concentration of Rifabutin (risk of uveitis-reduce Rifabutin dose).
* Anticoagulants: effect of Warfarin enhanced by Erythromycin and possibly
enhanced by Clarithromycin and some other Macrolides.
Antidiabetics: Erythromycin possibly increase plasma concentration of
Repaglinide (manufacturer advises avoid concomitant use).
* Antihistamines: manufacturer advises possibility of increased plasma-loratadine
concentration with erythromycin and possibly other Macrolides (avoid
concomitant use).
* Antipsychotics: risk of arrhythmias if Clarithromycin and possibly erythromycin
given with Pimozide (avoid concomitant use); Erythromycin possibly increases
plasma concentration Clozapine (possible increased risk of convulsions).
602
* Antivirals: Clarithromycin tablets reduce absorption of Zidovudine; Ritonavir

possibly increases plasma concentration Macrolides.
* Anxiolytics and Hypnotics: Erythromycin inhibits metabolism of Midazolam
(increased plasma-Midazolam concentration, with profound sedation) and
Zopiclone.
Calcium-channel Blockers: erythromycin possibly inhibits metabolism of
Felodipine (increased plasma concentration).
Cardiac Glycosides: effect of Digoxin enhanced by Erythromycin and possibly
enhanced by other Macrolides.
Corticosteroids: Erythromycin inhibits metabolism of Methylprednisolone and
possibly other Corticosteroids.
* Ciclosporin: Erythromycin, Clarithromycin and possibly other Macrolides inhibit
metabolism (increased plasma-ciclosporin concentration).
Cytotoxics: in-vitro studies suggest possible interaction between Erythromycin
and Docetaxel- consult product literature.
Dopaminergics: plasma concentration of Bromocriptine increased by
Erythromycin and possibly other Macrolides.
* Ergotamine: ergotism reported.
Leukotriene Antagonists: erythromycin reduces plasma concentration of
Zafirlukast.
Lipid-regulating Drugs: Clarithromycin and erythromycin increase risk of
myopathy with Simvastatin.
* Tacrolimus: Clarithromycin and Erythromycin increase plasma-tacrolimus
concentration.
* Theophylline: Clarithromycin and Erythromycin inhibit metabolism (increased
plasma-Theophylline concentration (if Erythromycin given by mouth also
decreased plasma-erythromycin concentration).
Ulcer-healing Drugs: Cimetidine increases plasma-erythromycin concentration
(increased risk of toxicity, including deafness).
Erythropoietin see Epoetin.

Escitalopram see Antidepressants, SSRI.
Esomeprazole see Proton pump Inhibitors.
Estradiol see Contraceptives, Oral
Ethacrynic Acid see Diuretics (loop).
Ethinyloestradiol see Contraceptives, Oral.
Ethambutol none
Ethionamide
The adverse effects of other antimycobacterials may be increased when
ethionamide is used see Effects on the Liver, and under Cycloserine,
Interactions.
Etidronate Disodium see Bisphosphonates.
Ezetimibe
• Anticoagulants: ezetimibe possibly enhances Anticoagulant effect of
coumarins
• Ciclosporin: plasma concentration of both drugs may increase when
ezetimibe given with ciclosporin
• Lipid-regulating Drugs: increased risk of cholelithiasis and gallbladder
disease when ezetimibe given with fibrates - discontinue if suspected
Famotidine see Histamine H2-antagonists.

Felodipine see Calcium-channel Blockers.
Fenofibrate see Fibrates.
Fentanyl see Opioid Analgesics.
603
Ferric Carboxymaltose see Iron (injectables).

Ferrous Salts see Iron.
Fexofenadine See Antihistamines
Fibrates
* Anticoagulants: enhancement of effect of Nicoumalone, Phenindione, and
Warfarin.
Antidiabetics: may improve glucose tolerance and have additive effect; increased
risk of severe hypoglycaemia with gemfibrozil (avoid concomitant use)
* Cyclosporin: possible increased risk of renal impairment with fenofibrate.
* Other Lipid-regulating Drugs: increased risk of myopathy with statins (preferably
avoid concomitant use of gemfibrozil with statins)
Filgrastim
Note: Use not recommended in period form 24 hours before to 24 hours after
chemotherapy - for further details consult product literature.
Cytotoxics: possible exacerbation of neutropenia with Fluorouracil.
Finasteride
Note: No clinically important interactions reported.
Flucloxacillin see Penicillins.
Fluconazole see Antifungals, Imidazole and Triazole.
Flucytosine
Flucytosine is commonly used with amphotericin B. Amphotericin B can cause a
deterioration in renal function, which can result in raised flucytosine blood
concentrations and increased toxicity. However, the two drugs are generally
regarded as having synergistic antifungal activity. Cytarabine has been claimed
to reduce blood concentrations of flucytosine and to antagonise its antifungal
activity, although the evidence is limited.
Fluorouracil
Antibacterials: Metronidazole inhibits metabolism (increased toxicity
Filgrastim: possible exacerbation of neutropenia.
Ulcer-healing Drugs: Cimetidine inhibits metabolism (increased plasma-fluorouracil
concentration).
Fluoxetine see Antidepressants, SSRI.
Flupenthixol see Antipsychotics.
Fluphenazine see Antipsychotics.
Flurazepam see Anxiolytics and Hypnotics.
Flutamide
* Anticoagulants: effect of Warfarin enhanced.
Fluticasone see Corticosteroids.
Fluticasone Propionate + Formoterol Fumarate Dihydrate
• Fluticasone: Increased plasma concentration w/ CYP3A4 inhibitors (e.g.
ketoconazole, HIV protease inhibitors, clarithromycin, ketoconazole).
• Formoterol: May induce hypokalaemia w/ xanthine derivatives, steroids and
diuretics. Increased risk of ventricular arrhythmias w/ digitalis glycoside,
halogenated hydrocarbon anaesthetics. May prolong QTc-interval w/ TCAs,
MAOIs, antipsyschotics, quinidine, disopyramide, procainamide, and
antihistamines. Reduced therapeutic effect w/ β-blockers. May impair
cardiac tolerance w/ L-dopa, L-thyroxine, oxytocin.
Fluvastatin see Statins.
Folic Acid and Folinic Acid
* Antiepileptics: plasma concentrations of Phenobarbital and Phenytoin possibly
reduced.
Formoterol See Sympathomimetics, Beta2
604
Fosfomycin
Additive or synergistic effect w/ β-lactam antibiotics (e.g. penicillin, ampicillin,
cefazolin, carbapenems) and anti-staphylococcal agents (e.g. linezolid,
quinupristin/dalfopristin, moxifloxacin). Reduced serum levels w/ drugs which increase
GI motility (e.g. metoclopramide).
Fosinopril see ACE inhibitors.
Frusemide see Diuretics, Loop.
Gabapentin
• Antacids: reduced Gabapentin absorption.
• Antidepressants: antagonism of anticonvulsive effect (convulsive threshold
lowered)
Other Antiepileptics: none demonstrated with Carbamazepine, Phenobarbital,
Phenytoin, or Valproate.
Antimalarials: Mefloquine antagonises anticonvulsant effect; Chloroquine
occasionally reduces convulsive threshold.
Gallamine see Muscle Relaxant (non-depolarizing).
Gemfibrozil see Fibrates.
Gemifloxacin as for Ciprofloxacin
Gentamicin see Aminoglycosides.
Gestrinone
Antibacterials: Rifampicin accelerates metabolism (reduced plasma
concentration)
Antiepieptics: Carbamazepine, Phenobarbital, and Phenytoin accelarate
metabolism (reduced plasma concentration)
Glibenclamide see Antidiabetics (Sulphonylureas).
Gliclazide see Antidiabetics (sulphonylurea).
Glimepride see Antidiabetics (sulphonylurea).
Glimepiride + Metformin Hydrochlorid see Glimepiride and Metformin.
Glipizide see Antidiabetics (sulphonylurea).
Glyceryl Trinitrate
Note: General hypotensive interactions as for Hydralazine.
Anti-arrhythmics: Disopyramide may reduce effect of sublingual nitrates (owning
to dry mouth).
* Anticoagulants: excretion of heparin increase by Glyceryl Trinitrate infusion
(reduced anticoagulant effect).
Antidepressants: Tricyclics may reduce effect of sublingual nitrates (owing to dry
mouth).
Antimuscarinics: Antimuscarinics such as Atropine and Propantheline may
reduce effect of sublingual nitrates (owing to dry mouth).
Griseofulvin
* Anticoagulants: metabolism of Nicoumalone and Warfarin accelerated (reduced
anticoagulant effect).
Antiepileptics: absorption reduced by Phenobarbital (reduced effect).
Barbiturates: see under Antiepileptics above.
Ciclosporin: plasma-ciclosporin concentration possibly reduced.
* Oestrogens and Progestogens: metabolism of oral contraceptives accelerated
(reduced contraceptive effect.
Halofantrine
605

QT interval (including Amiodarone, Disopyramide, Flecainide, Procainamide and
Quinidine).
* Antidepressants: increased risk of ventricular arrhythmias with Tricycles.
* Other Antimalarials: increased risk of arrhythmias with Chloroquine, Mefloquine
and Quinine (important: see also advice under Halofantrine).
* Antipsychotics: increased risk of ventricular arrhythmias with Phenothiazines.
* Beta-blockers: increased risk of ventricular arrhythmias with Sotalol.
* Diuretics: increased risk of ventricular arrhythmias if electrolyte disturbances
occur.
Haloperidol see Antipsychotics.

Halothane see Anaesthetics, General (volatile liquid).
Heparin
ACE Inhibitors and Angiotensin–II Antagonists: Increased risk of hyperkalaemia
* Analgesics: aspirin enhances anticoagulant effect; increased risk of hemorrhage
with parenteral Diclofenac and Ketorolac (avoid concomitant use, including low-
dose Heparin).
Antiplatelet Drugs: Aspirin, Dipyridamole and possibly Clopidogrel enhance
anticoagulant effect.
* Nitrates: Glyceryl Trinitrate infusion increases excretion (reduced anticoagulant
effect).
Histamine H1-Antagonists see Antihistamines.
Histamine H2-Antagonists
Analgesics: Cimetidine inhibits metabolism of opioid analgesics notably Pethidine
(increased plasma concentrations) Cimetidine possibly increases plasma
concentration of Azapropozone.
Anthelmintics: Cimetidine possibly inhibits metabolism of Mebendazole
* Anti-arrhythmics: Cimetidine increases plasma concentrations of Amiodarone,
Flecainide, Lignocaine, Procainamide, Propafenone, Quinidine, and possibly
Moracizine.
Antibacterials: Cimetidine increases plasma-erythromycin concentration
(increased risk of toxicity, including deafness); Rifampicin accelerates
metabolism of Cimetidine (reduced plasma-cimetidine concentration); Cimetidine
inhibits metabolism of Metronidazole (increased plasma-metronidazole
concentration).
Anticoagulants: Cimetidine enhances anticoagulant effect.
Antidepressants: Cimetidine inhibits metabolism of Amitriptyline, Doxepin,
Imipramine, Moclobemide, Nortriptyline and Sertraline (increased plasma
concentration).
Antidiabetics: Cimetidine inhibits real excretion of Metformin (increased plasma
concentration; Cimetidine enhances hypoglycemic effect of Sulphonylureas.
Antiepileptics: Cimetidine inhibits metabolism of Carbamazepine, Phenytoin, and
Valproate (increased plasma concentration).
Antifungals: absorption of Itraconazole and Ketoconazole reduced; plasma
concentration of Terbinafine increased by Cimetidine.
Antihistamines: manufacturer advises possibility of increased plasma-loratadine
concentration with Cimetidine.
Antimalarials: Cimetidine inhibits metabolism of Chloroquine and Quinine
606
Antipsychotics: Cimetidine possibly enhance effect of chlorpromazine, Clozapine,

and possibly other antipsychotics.
Antivirals: plasma concentration of Zalcitabine possibly increased by Cimetidine.
Anxiolytics and Hypnotics: Cimetidine inhibits metabolism of Benzodiazepines
and Chlormethiazole and Zaleplon (increased plasma concentration).
Beta-blockers: Cimetidine inhibits metabolism of beta-blockers such as Labetalol,
Metoprolol and Propranolol (increased plasma concentrations).
Calcium-channel Blockers: Cimetidine inhibits metabolism of some calcium-
channel blockers (increased plasma concentration).
* Ciclosporin: Cimetidine possibly increases plasma-ciclosporin concentration.
Cytotoxics: Cimetidine increases plasma concentration of Fluorouracil.
Hormone Antagonists: Octreotide possibly delays absorption of Cimetidine.
5HT1- Agonists: Cimetidine inhibits metabolism of Zolmitriptan (reduce dose of
Zolmitriptan).
* Theophylline: Cimetidine inhibits metabolism (increased plasma-theophylline
concentration).
Homatropine see Antimuscarinics.

Hormone Antagonists see Aminoglutethimide; Bicalutamide; Danazol; Finasteride;
Flutamide; Gestfrinone; Octeotide; Tamoxifen; Toremifene; Trilostane.
5HT1 -Agonists
Note: There are currently no recognized drug interaction with Naratriptan.
Antibacterials: Quinolones possibly inhibit metabolism of Zolmitriptan (reduce
dose of Zolmitriptan).
* Antidepressants: risk of CNS toxicity with MAOIs including Lobemide (avoid
Rizatriptan or Sumatriptan for 2 weeks after MAOI, reduce dose of Zolmitriptan
when given with Moclobemide); Sumatriptan increases risk of CNS toxicity with
SSRIs (avoid concomitant use); Fluvoxamine possibly inhibits metabolism of
Zolmitriptan (reduce dose of Zolmitriptan).
Beta-blockers: Propranolol may increase plasma concentration of Rizatriptan
(reduce Rizatriptan dose).
* Ergotamine: increased risk of vasospasm (avoid Ergotamine for 6 hours after
Rizatriptan, Sumatriptan or Zolmitriptan, avoid Rizatriptan or Sumatriptan for 24
hours and Zolmitriptan for 6 hours after Ergotamine).
* Lithium: Sumatriptan increases risk of CNS toxicity (avoid concomitant use)
Ulcer-healing Drugs: Cimetidine inhibits metabolism of Zolmitriptan (reduce dose
of Zolmitriptan (reduce dose of Zolmitriptan).
Hydralazine
Antidepressants: enhanced hypotensive effect.
Other Antihypertensives: additive hypotensive effect.
Dopaminergics: Levodopa enhanced hypotensive effect.
Muscle Relaxant: Baclofen and Tizanidine enhances hypotensive effect.
607

Thymoxamine: enhanced hypotensive effect.
Hydrochlorathiazide see Diuretics (Thiazide).

Hydrocortisone see Corticosteroids.
Hydroxyprogesterone Caproate see Cortocosteroids
Hydroxychloroquine see Chloroquine and Hydroxychloroquine.
Hydroxyprogesterone see Progestogens.
Hyoscine see Antimuscarinics (for general sedative interactions see also
Antihistamines).
Hypnotics see Anxiolytics and Hypnotics.
Ibuprofen see NSAIDs.
Ifosfamide see Cyclophosphamide.
Imatinib
• Analgesics: manufacturer of imatinib advises restriction or avoidance of
concomitant regular paracetamol.
Anticoagulants: manufacturer of imatinib advises replacement of Warfarin with a
Heparin (possibility of enhanced Warfarin effect)
Antiepileptics: plasma concentration of Imatinib reduced by Phenytoin.
Antifungals: plasma concentration of Imatinib increased by Ketoconazole.
Lipid-regulating Drugs: plasma concentration of Simvastatin increased by
Imatinib.
Imidapril see ACE Inhibitors and Angiotensin-II Antagonists.
Imipramine see Antidepressants, Tricyclic.
IMMUNOGLOBULINS
Note: for advice on Immunoglobulins and live virus vaccines, see under Normal
Immunoglobulin section.
Indapamide see Diuretics (thiazide-related).
Indinavir
Indinavir is metabolised mainly by the cytochrome P450 isoenzyme CYP3A4. It may
compete for the same metabolic pathways with many drugs that are metabolised
similarly, often resulting in mutually increased plasma concentrations. A drug that is a
significant inducer of microsomal enzymes, particularly CYP3A4, may reduce plasma
concentrations of indinavir. HIV-protease inhibitors may themselves induce
metabolism and may reduce plasma concentrations of other drugs.
Although specific guidance varies between licensing authorities, licensed product
information generally contra-indicates the use of HIV-protease inhibitors,
includingindinavir with drugs that are highly dependent on CYP3A4 for clearance and
for which elevated plasma concentrations are associated with serious or life-
threatening events. These include
-the alpha1-adrenoceptor antagonist alfuzosin
-antiarrhythmics (amiodarone)
-antihistamines (astemizole and terfenadine)
-antipsychotics (pimozide)
-ergot derivatives (dihydroergotamine, ergometrine, ergotamine, and
methylergometrine)
-gastrointestinal prokinetics (cisapride)
-sedatives and hypnotics (alprazolam, oral midazolam, and triazolam)
-statins (lovastatin and simvastatin)
When indinavir is boosted with ritonavir, use with bepridil, clozapine,
dextropropoxyphene, fusidic acid, diazepam, estazolam, flurazepam, quinidine,
pethidine, and piroxicam should also be avoided. Similarly, ritonavir-boosted indinavir
608
should not be used with drugs having narrow therapeutic windows that are highly
dependent on CYP2D6 for clearance, such as the antiarrhythmics encainide,
flecainide, and propafenone. Owing to the potential for increased serum
concentrations of sildenafil,indinavir should be avoided with sildenafil when given at
the doses needed for the treatment of pulmonary hypertension. Similarly, indinavir
may increase serum concentrations of inhaled salmeterol and the combination is not
recommended. Use of indinavir with rosuvastatin should also be avoided. Rifampicin
and St John's wort decrease the concentration ofindinavir; use with the antiretroviral is
contra-indicated due to the possible loss of its activity and development of resistance.
Use of indinavir with atazanavir is contra-indicated as both drugs have been
associated with indirect hyperbilirubinaemia.
Indomethacin see NSAIDs.
Inositol no interaction of clinical significance is available.
Insulin see Antidiabetics
Interferons
Note: Consult product literature for interactions of interferon beta and gamma.
Theophylline: interferon alpha inhibits metabolism of Theophylline (enhanced
effect).
Ipratropium see Antimuscarinics.

Irbesartan see ACE Inhibitors and Angiotensin-II Antagonists.
Iron
Antacids: Magnesium Trisilicate reduces absorption of oral iron.
Antibacterials: Tetracyclines reduce absorption of oral iron (and vice versa);
absorption of Ciprofloxacin, Norfloxacin, and Ofloxacin reduced by oral iron
Bisphosphonates: reduced absorption.
Dopaminergics: absorption of Entacapone and Levodopa may be reduced.
Penicillamine: reduced absorption of Penicillamine.
Trientine: reduced absorption of oral iron.
Zinc: reduced absorption of oral iron (and vice versa).
Isoflurane see Anaesthetics, General (volatile liquid).
Isoniazid
Anaesthetics: hepatotoxicity possibly potentiated by Isoflurane.
Antacids and Adsorbents: antacids reduce absorption.
Other Antibacterials: increased CNS toxicity with Cycloserine.
* Antiepileptics: metabolism of Carbamazepine, Ethosuximide, and Phenytoin
inhibited (enhanced effect); also, with Carbamazepine, Isoniazid hepatotoxicity
possibly increased.
Antifungals: plasma concentration of Ketoconazole may be reduced.
Anxiolytics and hypnotics: metabolism of diazepam inhibited.
Theophylline: Isoniazid possibly increases plasma-theophylline concentration.
Isoprenaline see Sympathomimetics.

Isosorbide Dinitrate see Glyceryl Trinitrate.
Isosorbide Mononitrate see Glyceryl Trinitrate.
Isotretinoin see Retinoids.
Isradipine see Calcium-Channel Blockers.
Itraconazole see Antifungals, Imidazole and Triazole.
Ivabradine
• Anti-arrhythmics: increased risk of ventricular arrhythmias when ivabradine
given with amiodarone or disopyramide
609
• Antibacterials: plasma concentration of Ivabradine possibly increased by

clarithromycin and telithromycin — avoid concomitant use; increased risk of
ventricular arrhythmias when ivabradine given with erythromycin—avoid
concomitant use
• Antidepressants: plasma concentration of Ivabradine reduced by St John’s
wort
• Antifungals: plasma concentration of ivabradine increased by
fluconazole—reduce initial dose of vabradine; plasma concentration of
ivabradine possibly increased by itraconazole
• Antimalarials: increased risk of ventricular arrhythmias when ivabradine
given with mefloquine
• Antipsychotics: increased risk of ventricular arrhythmias when ivabradine
given with pimozide
• Antivirals: plasma concentration of ivabradine possibly increased by
ritonavir
• Beta-blockers: increased risk of ventricular arrhythmias when ivabradine
given with sotalol
• Calcium-channel Blockers: plasma concentration of ivabradine increased by
diltiazem and verapamil
• Grapefruit Juice: plasma concentration of ivabradine increased by grapefruit
juice
• Pentamidine Isetionate: increased risk of ventricular arrhythmias when
ivabradine given with pentamidine isetionate
Ivermectin
* Levamisole: Levamisole appears to increase the exposure to ivermectin. Ivermectin
does not alter the pharmacokinetics of levamisole.
* Acenocoumarol: A patient showed a marked increase in his response to
acenocoumarol when exposed to insecticides containing ivermectin and methidathion.
* Warfarin: The US manufacturer notes that cases of raised INRs have been rarely
reported with ivermectin and warfarin.
* Alcohol: Alcohol may increase the bioavailability of ivermectin, which could increase
adverse effects such as postural hypotension.
Kanamycin as for Gentamicin Sulfate
Kaolin
Analgesics: absorption of aspirin possibly reduced.
Anti-arrhythmics: absorption of Quinidine possibly reduced (possibly reduced plasma
concentration).
Antibacterials: absorption of Tetracyclines possibly reduced.
Antimalarials: absorption of Chloroquine reduced.
Antipsychotics: absorption of Phenothiazines possibly reduced.
Cardiac Glycosides: absorption of Digoxin possibly reduced.
Ketamine see Anaesthetics, General.

Ketoconazole see Antifungals, Imidazole and Triazole.
Ketoprofen see NSAIDs.
Ketorolac see NSAIDs.
ketorolac Tromethamine see ketorolac
Ketotifen see Antihistamines.
Lacidipine see Calcium-channel Blocker.
Lactic Acid + Salicylic Acid see salicylic acid
Labetalol see Beta-blockers
Lamivudine
610
Antibacterials: Trimethoprim increases plasma concentration.- avoid concomitant use

of high-dose co-trimoxazole.
Lamotrigine
* Other Antiepileptics: concomitant administration of two or more Antiepileptics
may enhance toxicity without a corresponding increase in antiepileptic effect;
moreover interactions between individual antiepileptics can complicate monitoring
of treatment; interactions include enhanced effects, increased sedation, and
reductions in plasma concentrations.
Lansoprazole see Proton Pump Inhibitors.

Leflunomide
Note: Increased risk of toxicity with other haematotoxic and hepatotoxic drugs.
Lenograstim
Note: Use not recommended from 24 hours before until 24 hours after chemotherapy;
for further details consult product literature.
Lercarnidipine see Calcium channel Blockers
Leukotriene Antagonists
Analgesics: aspirin increases plasma concentration of Zafirlukast.
Antibacterials: Erythromycin reduces plasma concentration of Zafirlukast.
Anticoagulants: anticoagulant effect of Warfarin enhanced by Zafirlukast.
Barbiturates: plasma concentration of Montelukast reduced by Phenobarbital.
Theophylline: Zafirlukast possibly increases plasma-theophylline concentration;
plasma-Zafirlukast concentration reduced.
Levamisole
*Alcohol: US licensed product information states that levamisole can produce a
disulfiram-like reaction withalcohol.
*Anticoagulants: Increase in the activity of warfarin when given with levamisole and
fluorouracil.
*Antiepileptics: Increased phenytoin concentrations when given with levamisole and
fluorouracil.
Levocetirizine see Antihistamines

Levodopa
* Antidepressants: hypertensive crisis with MAOIs (including Moclobemide)- avoid
for at least 2 weeks after stopping MAOI.
* Antihypertensives: enhanced hypotensive effect.
* Antipsychotics: antagonism of effect.
Anxiolytics and Hypnotics: occasional antagonism of effect by Chlordiazepoxide,
Diazepam, Lorazepam and possibly other Benzodiazepines.
Iron: absorption of Levodopa may be reduced.
Metoclopramide and Domperidone: Levodopa-plasma concentrations increased
by Metoclopramide.
Vitamins: effect of Levodopa antagonized by pyridoxine unless a dopa-
decarboxylase inhibitor also given.
Levofloxacin see Quinolones
Levonorgestrel see Progestogens.
Lignocaine
Other Anti-arrhythmics: increased myocardial depression.
Beta-blockers: increased risk of myocardial depression; increased risk of
Lignocaine toxicity with Propranolol.
611
Diuretics: effect of Lignocaine antagonized by hypokalaemia with Acetazolamide,

loop diuretics, and Thiazides.
Muscle Relaxants: action of Suxamethonium prolonged.
Ulcer-healing Drugs: Cimetidine inhibits metabolism of Lignocaine (increased risk
of toxicity).
Linagliptin + Metformin Hydrochloride
• Concomitant cationic drugs that interfere w/ renal tubular transport systems
(e.g. ranolazine, vandetanib, dolutegravir, cimetidine) may increase
metformin levels.
• Thiazides and other diuretics, corticosteroids, phenothiazines, thyroid
products, OCs, sympathomimetics, phenytoin, niacin, Ca channel blockers
and isoniazid may produce hyperglycaemia which may lead to loss of
glycaemic control.
• Increased risk of lactic acidosis w/ topiramate or other carbonic anhydrase
inhibitors (e.g. zonisamide, acetazolamide, dichlorphenamide).
• Plasma concentration of linagliptin may be decreased by strong inducers of
P-glycoprotein (e.g. rifampicin) and may be increased by strong P-
glycoprotein inhibitors (e.g. ritonavir).
• Linagliptin may increase risk of hypoglycaemia when used in combination w/
sulfonylureas or insulin.
Linezolid see MAOIs

Note: Linezolid is a reversible, non-selective MAO inhibitor.
Lipid-regulating Drugs see Cholestyramine and Colestipol; Clofibrate Group;
Nicotinic Acid; Statins.
Lisinopril see ACE Inhibitors.
Lithium
* ACE Inhibitors: lithium excretion reduced (increased plasma-lithium
concentration).
* Analgesics: excretion of lithium reduced by Azapropazone, Diclofenac, Ibuprofen
Indomethacin, Ketorolac (avoid concomitant use), Mefenamic acid, Naproxen,
Piroxicam and probably other NSAIDs (risk of toxicity).
* Antacids: Sodium bicarbonate increases excretion of Lithium (reduced plasma-
lithium concentrations).
* Anti-arrhythmics: increased risk of hypothyroidism with Amiodarone.
* Antibacterials: lithium toxicity reported with Metronidazole and Spectinomycin.
* Antidepressants: SSRIs increase risk of CNS effects (lithium toxicity reported).
Antidiabetics: Lithium may occasionally impair glucose tolerance.
Antiepileptics: neurotoxicity may occur with Carbamazepine and Phenytoin
without increased plasma-lithium concentration.
* Antihypertensives: neurotoxicity may occur with Methyldopa without increased
plasma-lithium concentration.
Antipsychotics: increased risk of extrapyramidal effects and possibility of
neurotoxicity (notably with Haloperidol).
Calcium-channel Blockers: neurotoxicity may occur with Diltiazem and Verapamil
without increased plasma-lithium concentration.
* Diuretics: Lithium excretion reduced by loop diuretics, potassium-sparing
diuretics, and Thiazides (increased plasma-lithium concentration and risk of
toxicity- loop diuretics safer than Thiazides); lithium excretion increased by
Acetazolamide.
* 5HT1 -Agonists: Sumatriptan increases risk of CNS toxicity.
612
Metoclopramide and Domperidone: increased risk of extrapyramidal effects and

possibility of neurotoxicity with Metoclopramide.
Muscle Relaxants: muscle relaxant effect enhanced, Baclofen possibly
aggravates hyperkinesis.
Parasympathomimetics: Lithium antagonizes effect of Neostigmine and
Pyridostigmine.
Theophylline: lithium excretion increased (reduced plasma-lithium concentration).
Loratadine see Antihistamines.

Lorazepam see Anxiolytics and Hypnotics.
Losartan as for ACE Inhibitors.
Loteprednol May increase the risk of intraocular pressure with cycloplegics and other
ocular hypotensive agents.
Lumefantrine see Artemether with Lumefantrine.
Lurasidone HCl
Strong CYP3A4 Inhibitors: increased exposure to lurasidone, should not be used
concomitantly with such drugs (e.g. clarithromycin, ketoconazole, mibefradil,
ritonavir, voriconazole, etc.).
Moderate CYP3A4 Inhibitors: increased exposure to lurasidone when used
concomitantly with such drugs (e.g. atazanavir, diltiazem, erythromycin,
fluconazole, verapamil, etc.). Lurasidone HCl dose should be reduced to half of
the original level when used concomitantly.
Strong CYP3A4 Inducers: decreased exposure to lurasidone when used with
strong CYP3A4 inducers, viz. avasimibe, carbamazepine, phenytoin, rifampin, St.
John’s wort, etc. So, strictly avoid concomitant use with these drugs.
Moderate CYP3A4 Inducers: decrease the exposure of lurasidone, drugs that
should not be used concomitantly include bosentan, efavirenz,
etravirine, modafinil, nafcillin, etc. Dose of Lurasidone HCl should be increased
when used concomitantly with such moderate inducers of CYP3A4.
Macrogol 3350 (a component of bowel cleansing preparations). Other oral drugs

should not be taken 1 hour before, or after, administration of bowel cleansing
preparations because absorption may be impaired. Consider withholding ACE
inhibitors, angiotensin-II receptor antagonists, and NSAIDs on the day that bowel
cleansing preparations are given and for up to 72 hours after the procedure. Also
consider withholding diuretics on the day that bowel cleansing preparations are given.
Macrolides see Erythromycin and other Macrolides.

Magnesium Salt (see also Antacids and Adsorbents)
Muscle Relaxants: effect of non-depolarizing muscle relaxants enhanced by parenteral
magnesium salts.
Magnesium Trisilicate see Antacids.
MAOIs
Note: For interactions of reversible MAO-A inhibitors (RIMAS), see Moclobemide, and
for interactions of MAO-B inhibitors see Selegiline.
* Alcohol: some alcoholic and dealcoholised beverages contain Tyramine which
interacts which interacts with MAOIs (hypertensive crisis)-but if no Tyramine,
enhanced hypotensive effect; foods, see section.
* Alpha2–adrenoceptor Stimulants: manufacturers of Apraclonidine and
Brimonidine advise to avoid concomitant use.
* Altretamine: risk of severe postural hypotension.
613
* Analgesics: CNS excitation or depression(hypertension or hypotension) with

Pethidine and possibly other opioid analgesics- avoid concomitant use and for
two weeks after MAOI discontinued; manufacturer advises avoid Nefopam
* Anorectics: see Sympathomimetics, below.
* Other Antidepressants: enhancement of CNS effects and toxicity with other
MAOIs (avoid for at least a week after stopping previous MAOIs then start with
reduced dose); increased risk of toxicity with Nefazodone (important: if MAOIs
discontinued shortly before, initiate Nefazodone cautiously with gradual dose
increase); CNS effects of SSRIs increased by MAOI should not be started until at
least I week after Citalopram or Fluvoxamine have been stopped, at least 5
weeks for Fluoxetine, at least 2 weeks for Paroxetine and Sertraline; CNS
excitation and hypertension with most Tricyclics and related antidepressants
(avoid for at least 2 weeks after stopping MAOI, and avoid MAOI for at least I
week 1 week after stopping Tricyclic); CNS excitation and confusion with
Tryptophan (reduce Tryptophan dose); enhancement of CNS effects and toxicity
possible with Reboxetine and Venlafaxine (avoid for at least 2 weeks after
stopping MAOI, and avoid MAOI for at least 1 week after stopping Reboxetne or
Venlafaxine).
Antidiabetics: effect of Insulin, Metformin, and Sulphonylureas enhanced
* Antiepileptics: antagonism of anticonvulsant effect (convulsive threshold
lowered); manufacturer advises avoid Carbamazepine with or within 2 weeks of
MAOIs.
* Antihypertensives: hypotensive effect enhanced; manufacturer advises
avoidance of Indoramin; manufacturer advises avoid concomitant use with
Methyldopa.
Antihistamines: increased antimuscarinic and sedative effects.
Antimuscarinics: increased side-effects.
* Antipsychotics: CNS excitation and hypertension with Oxypertine; Clozapine
possibly enhances central effects.
Anxiolytics and Hypnotics: manufacturer advises avoidance of Buspirone
* Dopaminergics: hypertensive crisis with Levodopa (avoid for at least 2 weeks
after stopping MAOI); hypotension with Selegiline; manufacturer advises avoid
concomitant use with Entacapone.
* 5HT1Angonists: risk of CNS toxicity (avoid Rizatriptan or Sumatriptan for 2 weeks
after MAOI).
* Sympathomimetics: hypertensive crisis with sympathomimetics such as
Dopamine, Dopexamine, Ephedrine, Isometheptene, Methylphenidate,
Phentermine, Phenylephrine, Phenylpropanolamine, and Pseudoephedrine
* Tetrabenazine: CNS excitation and hypertension.
Maprotiline see Antidepressants, Tricyclic.
Maraviroc
Maraviroc is a substrate for the cytochrome P450 isoenzyme CYP3A4 and for P-
glycoprotein, and may therefore have several clinically significant interactions.
Inhibitors of CYP3A4, such as HIV-protease inhibitors (other than tipranavir), increase
the serum concentration of maraviroc. Inducers of CYP3A4 such as efavirenz may
decrease serum maraviroc concentrations. No clinically significant interaction is
expected between maraviroc and NRTIs, nevirapine, or boosted fosamprenavir or
tipranavir.
Non-antiretroviral medications that significantly alter maravirocmetabolism include the
CYP3A4 inhibitors ketoconazole, itraconazole, clarithromycin, and nefazodone and
the CYP3A4 inducers rifampicin and St John's wort. Maraviroc does not appear to
cause clinically significant changes in concentrations of other medications.
Mebendazole
614
Ulcer-healing Drugs: metabolism possibly inhibited by Cimetidine (increased plasma-

mebendazole concentration).
Medroxyprogesterone see Progestogens.

Mefenamic Acid see NSAIDs.
Mefloquine
* Anti-arrhythmics: increased risk of ventricular arrhythmias with Amiodarone
(avoid concomitant use) and Quinidine.
* Antiepileptics: antagonism of anticonvulsant effect.
* Other Antimalarials: increased risk of convulsions with Chloroquine and Quinine,
but should not prevent use of intravenous quinine in severe cases; increased risk
of ventricular arrhythmias with Halofantrine (important: see also advice under
Halofantrine).
* Antipsychotics: increased risk of ventricular arrhythmias-avoid concomitant use
with Pimozide.
Beta-blockers: possible increased risk of bradycardia with some calcium-channel
blockers.
Cardiac Glycosides: possible increased risk of bradycardia with Digoxin.
Megestrol see Progestogens.

Megestrol Acetate
• Indinavir: Due to the significant decrease in the exposure of indinavir by
Megestrol acetate, administration of a higher dose of indinavir should be
considered when coadministering with Megestrol acetate
• Zidovudine and Rifabutin: No dosage adjustment for zidovudine and
rifabutin is needed when Megestrol acetate is coadministered with these
drugs
Meloxicam see NSAIDs
Melphalan
Antibacterials: increased toxicity with Nalidixic acid.
Mercaptopurine
* Allopurinol: enhancement of effect (increased toxicity-reduce dose of
Mercaptopurine).
Meropenem
Antiepileptics: plasma concentration of Valproate reduced.
Uricosurics: excretion reduced by Probenecid (concomitant use not
recommended by manufacturer)
Mestranol see Contraceptives, Oral.
Metformin see Antidiabetics.
Methotrexate
* Analgesics: excretion reduced by aspirin, Azapropazone (avoid concomitant use),
Diclofenac, Ibuprofen, Indomethacin, Ketoprofen, Meloxicam, Naproxen and
probably other NSAIDs (increased risk of toxicity).
Antibacterials: antifolate effect increased by Co-trimoxazole and Trimethoprim;
risk of Methotrexate toxicity in creased by Sulphonamides; excretion reduced by
Penicillins (increased risk of toxicity).
Antiepileptics: Phenytoin increases antifolate effect.
Antimalarials: antifolate effect increased by Pyrimethamine (ingredient of
Fansidar ®).
615
* Ciclosporin: increased toxicity.

* Retinoids: plasma concentration of Methotrexate increased by Acitretin (also
increased risk of hepatotoxicity).
Methyldopa
Antidepressants: enhanced hypotensive effect.
Other Antihypertensives: enhanced hypotensive effect.
Antipsychotics: increased risk of extrapyramidal effects; enhanced hypotensive
effect.
Beta-Blockers: enhanced hypotensive effect.
Dopaminergics: antagonism of antiparkinsonian effect; Levodopa enhances
hypotensive effect; effect of Methyldopa possible enhanced by Entacapone
Lithium: neurotoxicity may occur without increased plasma-lithium concentration
Muscle Relaxants: enhanced hypotensive effect with Baclofen and Tizanidine
Nitrates: enhance hypotensive effect.
Sympathomimetics: see Sympathomimetics (main list).
Ulcer-healing Drugs: Carbenoxolone antagonizes hypotensive effect.
Methylphenidate see Clonidine, MAOIs and Sympathomimetics. Methylphenidate is

predicted to increase the risk of elevated blood pressure when given with linezolid and
increase the risk of a hypertensive crisis when given with moclobemide and
monoamine-oxidase A and B inhibitors. Methylphenidate is predicted to decrease the
effects of apraclonidine.
Methylprednisolone see Corticosteroids.
Metolazone see Diuretics.
Metoclopramide
Analgesics: increased absorption of aspirin and Paracetamol (enhanced effect);
opioid analgesics antagonize effect on gastro-intestinal activity.
Antipsychotics: increased risk of extrapyramidal effects.
Atovaquone: plasma concentration reduced by Metoclopramide.
Dopaminergics: antagonism of hypoprolactinaemic effect of Bromocriptine;
increased plasma concentration of Levodopa; antagonism of antiparkinsonian
effects of Pergolide.
Lithium: increased risk of extrapyramidal effects and possibility of neurotoxicity.
Tetrabenazine: increased risk of extrapyramidal effects.
Metolazone see Diuretics.
Metoprolol see Beta-Blockers.
Metronidazole
Alcohol: Disulfiram-like reaction.
* Anticoagulants: effect of Nicoumalone and Warfarin enhanced.
* Antiepileptics: Metronidazole inhibits metabolism of Phenytoin (increased
plasma-Phenytoin concentration); Phenobarbital accelerates metabolism of
Metronidazole (reduced plasma-metronidazole concentration).
Cytotoxics: Metronidazole inhibits metabolism of Fluorouracil (increased toxicity)
616
Disulfiram: psychotic reactions reported.

Lithium: increased toxicity reported.
Ulcer-healing Drugs: Cimetidine inhibits metabolism (increased plasma-
metronidazole concentration).
Mianserin
Alcohol: enhanced effect.
Alpha2-Adrenoceptor Stimulants: manufactures of Apraclonidine and Brimonidine
advise to avoid concomitant use.
Other Antidepressants: as for Antidepressants, Tricyclic.
* Antiepileptics: antagonism (convulsive threshold lowered); metabolism
accelerated by Carbamazepine, Phenobarbital, and Phenytoin (reduced plasma-
mianserin concentration).
Anxiolytics and Hypnotics: enhanced effect.
Miconazole see Antifungals, Imidazole and Triazole.

Midazolam see Anxiolytics and Hypnotics.
Mirabegron
Increased exposure w/ strong CYP3A inhibitors (e.g. ketoconazole). May increase
exposure to CYP2D6 substrates (e.g. desipramine, metoprolol), digoxin, and warfarin.
Increased risk of urinary retention w/ antimuscarinic agents (e.g. solifenacin,
darifenacin) due to additive pharmacologic effect.
Mirtazapine
Anticoagulants: Mirtazapine enhances anticoagulant effect of Warfarin.
Other Antidepressants: as for Antidepressants, tricyclic.
Antiepileptics: Carbamazepine and Phenytoin reduce plasma concentration of
Mirtazapine.
Antifungals: Ketoconazole increases plasma concentration of Mirtazapine.
Antimalarials: manufacturer of Artemether with Lumefentrine advises avoid
concomitant use.
Ulcer-healing Drugs: Cimetidine increases plasma concentration of Mirtazapine.
Misoprostol
Analgesics: increased risk of CNS toxicity with Phenylbutazone.
Monoamine-oxidase Inhibitors see MAOIs, Moclobemide, and Selegiline.

Montelukast see Leukotriene Antagonists.
Morphine see Opioid Analgesics.
Moxifloxacin see Quinolones
Moxonidine
The hypotensive effect of moxonidine may be enhanced by other antihypertensives
and drugs that cause hypotension. The effect of sedatives and hypnotics, including
benzodiazepines, may be enhanced bymoxonidine.
Muscle Relaxants
ACE Inhibitors and Angiotensin-II Antagonists: enhanced hypotensive effect with
Baclofen and Tizanidine.
Alcohol: enhanced sedative effect with Baclofen and Tizanidine.
Analgesics: ibuprofen and possible other NSAIDs reduce excretion of Baclofen
(increased risk of toxicity).
* Anti-arrhythmics: Procainamide and Quinidine enhance muscle relaxant effect;
Lignocaine prolongs action of Suxamethonium.
617
* Antibacterials: effect of non-depolarizing muscle relaxants enhanced by

Aminoglycosides, Azlocillin, Clindamycin, Colistin and Piperacillin.
Antidepressants: Tricyclics enhance muscle relaxant effect of Baclofen.
Antiepileptics: effect of non-depolarizing muscle relaxants antagonized by
Carbamazepine and Phenytoin (recovery form neuromuscular blockade
accelerated).
Antihypertensives: enhanced hypotensive effect with Baclofen and Tizanidine.
Anxiolytics and Hypnotics: enhanced sedative effect with Baclofen and
Tizanidine.
Beta-blockers: Propranolol enhances muscle relaxant effect; possible enhanced
hypotensive effect and bradycardia with Tizanidine.
* Botulinum Toxin: neuromuscular block enhance by non-depolarizing muscle
relaxants (risk of toxicity).
Calcium-channel Blockers: Nifedipine and Verapamil enhance effect of non-
depolarizing muscle relaxants; hypotension, myocardial depression, and
hyperkalaemia reported with intravenous Dantrolene and Verapamil; risk of
arrhythmias with Diltiazem and intravenous Dantrolene.
Cardiac Glycosides: arrhythmias if Suxamethonium given with Digoxin; possible
bradycardia if Tizanidine given with Digoxin.
Cytotoxics: Cyclophosphamide and Thiotepa enhance effect of Suxamethonium
Diuretics: enhanced hypotensive effect with Baclofen and Tizanidine.
Lithium: lithium enhances muscle relaxant effect; Baclofen possibly aggravates
hyperkinesis.
Magnesium Salts: parenteral magnesium enhances effect of non-depolarizing
muscle relaxants.
Parasympathomimetics: Ecothiophate eye-drops, Edrophonium, Neostigmine,
Pyridostigmine, Rivastigmine and possibly Donepezil enhance effect of
Suxamethonium but antagonize effect of non-depolarizing muscle relaxants.
Sympathomimetics: Bambuterol enhances effect of Suxamethonium.
Mycophenolate Mofetil
Anion-exchange Resins: Cholestyramine reduces absorption.
Antacids: reduced absorption of Mycophenolate Mofetil.
Antivirals: higher plasma concentrations of Mycophenolate Mofetil and of
Aciclovir on concomitant administration.
Nalidixic Acid see Quinolones.

Nandrolone see Anabolic Steroids.
Naproxen see NSAIDs.
Nateglinide see Antidiabetics.
Nebivolol see Beta-blockers
Nelfinavir
Nelfinavir is reported to be metabolised in part by cytochrome P450 isoenzymes
CYP3A4 and CYP2C19. Drugs that induce these isoenzymes may reduce the plasma
concentration of nelfinavir. Conversely, whennelfinavir is given with drugs that inhibit
CYP3A4 plasma concentrations, nelfinavir concentrations may be increased. It may
also alter the pharmacokinetics of drugs metabolised by this isoenzyme system and
possibly cause serious adverse effects.
Although specific guidance varies between licensing authorities, licensed product
information generally contra-indicates the use ofnelfinavir with drugs that are highly
dependent on CYP3A4 for clearance and for which elevated plasma concentrations
are associated with serious or life-threatening events. These drugs include
• the alpha1-adrenoceptor antagonist alfuzosin
• antiarrhythmics (amiodarone and quinidine)
618
• antihistamines (astemizole and terfenadine)

• antipsychotics (pimozide)
• ergot derivatives (dihydroergotamine, ergometrine, ergotamine, and
methylergometrine)
• gastrointestinal motility agents (cisapride)
• sedatives and hypnotics (triazolam and oral midazolam)
• statins (simvastatin and lovastatin)
Owing to the potential for increased serum concentrations of sildenafil, nelfinavir
should be avoided with sildenafil when given at the doses needed for the treatment of
pulmonary hypertension. Similarly, nelfinavir may increase serum concentrations of
inhaled salmeterol and the combination is not recommended. Omeprazole, rifampicin,
and St John's wort decrease the concentration ofnelfinavir; use with the antiretroviral
is not recommended due to the possible loss of its activity and development of
resistance.
Neomycin see Aminoglycosides.
Neostigmine see Parasympathomimetics.
Nevirapine
Nevirapine is metabolised mainly by the cytochrome P450 isoenzymes CYP3A4 and
CYP2B6. Consequently it may compete with other drugs metabolised by this system,
possibly resulting in mutually increased plasma concentrations and toxicity.
Alternatively, enzyme inducers may decrease plasma concentrations ofnevirapine;
nevirapine itself acts as a mild to moderate enzyme inducer and may thus reduce
plasma concentrations of other drugs.
Rifampicin and St John's wort decrease the concentration ofnevirapine; use with the
antiretroviral is not recommended due to the possible loss of its activity and
development of resistance.
Netilmicin see Aminoglycosides.
Nicorandil
Nicorandil should not be used with phosphodiesterase type-5 inhibitors such as
sildenafil as the hypotensive effect of nicorandil may be significantly enhanced.
Nicotinic Acid
Note: Interactions apply to lipid-regulating doses of nicotinic acid.
Other Lipid-regulating Drugs: increased risk of myopathy with Statins.
Nifedipine see Calcium-channel Blockers.

Nimodipine see Calcium-channel Blockers.
Nitazoxanide see antiprotozoal
Nitrofurantoin
Antacids and Adsorbents: Magnesium Trisilicate reduces excretion of Nitrofurantoin
(risk of toxicity).
Nitrous Oxide see Anaesthetics, General.

Nizatidine see Histamine H2 – antagonists.
Noradrenaline see Sympathomimetics.
Norethisterone see Progestogens.
Norgestrel see Progestogens.
Nortriptyline see Antidepressants, Tricyclic.
NSAIDs (see also Aspirin).

Note: Interaction do not generally apply to topical NSAIDs.
* ACE Inhibitors: antagonism of hypotensive effect; increased risk of renal
impairment and increased risk of hyperkalaemia on administration with Ketorolac
and possibly other NSAIDs.
619
* Other Analgesics: avoid concomitant administration of two or more NSAIDs,

including Aspirin (increased side effects).
Antacids: absorption of Diflunisal reduced.
* Antibacterials: NSAIDs possibly increase risk of convulsions with Quinolones;
Indomethacin possibly increases plasma concentration of Gentamicin and
Amikacin in neonates.
* Anticoagulants: anticoagulant effect of Nicoumalone, Warfarin (and possibly
Phenindione) seriously enhanced by Azapropazone (avoid concomitant use) and
possibly enhanced by Diclofenac, Diflunisal, Flurbiprofen, Ibuprofen, Mefenamic
acid, Meloxicam, Piroxicam, Sulindac, and other NSAIDs; increased risk of
hemorrhage with parenteral Diclofenac and Ketorolac and all anticoagulants,
including low-dose heparin (avoid concomitant use).
Antidepressants: Moclobemide enhances effect of Ibuprofen and possibly other
NSAIDs.
* Antidiabetics: effect of Sulphonylureas enhances effect of ibuprofen and possibly
other NSAIDs.
* Antiepileptics: effect of Phenytoin enhanced by Azapropazone (avoid
concomitant use) and possibly other NSAIDs.
Antihypertensives: antagonism of hypotensive effect.
Antiplatelet Drugs: possibly increased risk of gastrointestinal bleeding with
Clopidogrel.
Antipsychotics: severe drowsiness possible if Indomethacin given with
Haloperidol.
* Antivirals: plasma concentration of Piroxicam increased by Ritonavir (risk of
toxicity-avoid concomitant use); plasma concentration of other NSAIDs possibly
increased by Ritonavir.
Beta-blockers: antagonism of hypotensive effect.
Bisphosphonates: bioavailability of Tiludronic acid increased by Indomethacin;
Alendronic acid possibly increases gastro-intestinal side-effects of NSAIDs.
Cardiac Glycosides: NSAIDs may exacerbate heart failure, reduce GFR, and
increase plasma-cardiac glycoside concentration.
Corticosteroids: increased risk of gastro-intestinal bleeding and ulceration.
* Ciclosporin: increased risk of nephrotoxicity; Ciclosporin increases plasma
concentration of Diclofenac (halve Diclofenac dose).
Cytotoxics: excretion of Methotrexate reduced by Aspirin, Azaproazone (avoid
concomitant use), Diclofenac, Ibuprofen, Indomethacin, Ketoprofen, Meloxicam,
Naproxen and probably other NSAIDs (increased risk of toxicity).
Desmopressin: effect potentiated by Indomethacin.
Diuretics: risk of nephrotoxicity of NSAID increased; NSAIDs notably
Indomethacin and Ketorolac antagonize diuretic effect; Indomethacin and
possibly other NSAIDs increase risk of hyperkalaemia with potassium-sparing
diuretics; occasional reports of decreased renal function when Indomethacin
given with Triamterene.
* Lithium: excretion of Lithium reduced by Azapropazone, Diclofenac, Ibuprofen,
Indomethacin, Ketorolac (avoid concomitant use), Mefenamic acid, Naproxen,
Piroxicam, and probably other NSAIDs (risk of toxicity).
Muscle Relaxants: Ibuprofen and possibly other NSAIDs reduce excretion of
Baclofen (increased risk of toxicity).
* Tacrolimus: Ibuprofen increases risk of nephrotoxicity.
Ulcer-healing drugs: plasma concentration of Azapropazone possibly increased
by Cimetidine.
* Uricosurics: Probenecid delays excretion of Indomethacin, Ketoprofen, Ketorolac
(avoid concomitant use), and Naproxen and increases plasma – NSAID
concentration.
620
* Vasodilators: risk of Ketorolac-associated bleeding increased by Oxpentifylline

Oestrogens see Contraceptives, Oral.

Ofloxacin see Quinolones.
Olanzapine see Antipsychotics.
Olmesartan see Angiotensin-II Receptor Antagonists
Omeprazole see Proton Pump Inhibitors.
Opioid Analgesics
Alcohol: enhanced sedative and hypotensive effect.
Antiarrhythmics: delayed absorption of Mexiletine.
Antibacterials: Rifampicin accelerates metabolism of methadone (reduced effect);
Erythromycin increases plasma concentration of Alfentanil; manufacturer of
Ciprofloxacin advises avoid premedication with opioid analgesics (reduced
plasma-Ciprofloxacin concentration).
* Anticoagulants: Dextropropoxyphene may enhance effect of Nicomumalone and
Warfarin.
* Antidepressants: CNS excitation or depression (hypertension or hypotension) if
Pethidine and possibly other opioid analgesics given to patients receiving MAOIs
(including Moclobemide)-avoid concomitant use and for 2 weeks after MAOI
discontinued; Tramadol possibly increases risk of convulsions with SSRIs and
Tricyclics.
* Antiepileptics: Dextropropoxyphene enhances effect of Carbamazepine; effect of
Methadone and Tramadol decreased by Carbamazepine; Phenytoin accelerates
Methadone metabolism (reduced effect and risk of withdrawal effects)
Antifungals: metabolism of Alfentanil inhibited by Ketoconazole (risk of prolonged
or delayed respiratory depression).
Antipsychotics: enhanced sedative and hypotensive effect.
* Antivirals: Methadone possibly increases plasma concentration of Zidovudine;
plasma concentration of Dextroproposyphene and Pethidine increased by
Ritonavir (risk of toxicity — avoid concomitant use); plasma concentration of
other opioid analgesics possibly in increased by Ritonavir.
* Dopaminergics: hyperpyrexia and CNS toxicity reported if Pethidine given to
patients receiving Selegiline (avoid concomitant use).
Metoclopramide and Domperidone: antagonism of gastro-intestinal effects.
Ulcer-healing Drug: Cimetidine inhibits metabolism of opioid analgesics notably
Pethidine (increased plasma concentration).
Orciprenaline see Sympathomimetics.

Ornidazole
* Alcohol: A disulfiram-like reaction has been reported in a patient taking ornidazole
after drinking alcohol.
*Rifampicin: Rifampicin slightly decreases ornidazole exposure.
Orlistat
Antidiabetics: manufacturer advises avoid concomitant use with Acarbose or
Metformin.
Lipid-regulating Drugs: manufacturer advises avoid concomitant use with
Clofibrate group; Orlistat increases plasma concentration of Pravastatin
(increased risk of toxicity-reduce dose of Pravastatin).
Sympathomimetics: manufacturer advises avoid concomitant use with
Phentermine.
Oseltamivir
621
Pharmacokinetic properties of oseltamivir, such as low protein binding and

metabolism independent of the CYP450 and glucuronidase systems, suggest that
clinically significant drug interactions via these mechanisms are unlikely.
Oxazepam see Anxiolytics and Hypnotics.
Oxcarbazepine
• Antibacterials: see Linezolid
• Antidepressants: antagonism of anticonvulsant effect (convulsive threshold
lowered); manufacturer advises avoid concomitant use with MAOIs.
• Other Antiepileptics: interactions include enhanced effects, increased sedation,
and reductions in plasma concentrations.
• Antimalarials: Mefloquine antagonises anticonvulsant effect; Chloroquine and
hydroxychloroquine occasionally reduce seizure threshold.
• Oestrogens and Progestogens: Oxcarbazepine accelerates metabolism of oral
Contraceptives (reduced contraceptive effect)
Oxprenolol see Beta-blockers.
Oxybutynin see Antimuscarinics
Oxymetazoline see Sympathomimetics.
Oxytetracycline see Tetracyclines.
Oxytocin
Anaesthetics: inhalational anaesthetics possibly reduce oxytocic effect (also
enhanced hypotensive effect and risk of arrhythmias).
Prostaglandins: uterotonic effect potentiated.
Sympathomimetics: enhancement of vasopressor effect of vasoconstrictor
sympathomimetics.
Paclitaxel
Antifungals: Ketoconazole possibly inhibits metabolism of Paclitaxel.
Paliperidone Increased risk of QT prolongation with class IA (e.g. quinidine,
disopyramide) and class III (e.g. amiodarone, sotalol) antiarrhythmics. Additive
effects with drugs that cause orthostatic hypotension (e.g. other antipsychotics,
tricyclics). May antagonise actions of levodopa and other dopaminergics. Additive
effect with drugs known to lower seizure threshold (e.g. phenothiazines or
butyrophenones, clozapine, tricyclics or SSRIs, tramadol, mefloquine). May
reduce plasma levels with carbamazepine. Enhanced central effects with other
CNS depressants. May increase plasma levels with valproate. May affect the
absorption with metoclopramide.
Pancreatin
Antidiabetics: hypoglycemic effect of Acarbose reduced.
Pancuronium see Music Relaxants (non-depolarizing).

Pantoprazole see Proton Pump Inhibitors.
PARA-Aminosalicylic acid same as Aminosalicylic acid
The adverse effects of aminosalicylates and salicylates may be additive.
Probenecid may also increase toxicity by delaying renal excretion and enhancing
plasma concentrations of aminosalicylate. The activity of aminosalicylic acid may
be antagonised by ester-type local anaesthetics such as procaine.
Paracetamol
Anion-exchange Resins: Cholestyramine reduces absorption of Paracetamol.
Anticoagulants: prolonged regular use of Paracetamol possibly enhances
Warfarin.
Metoclopramide and Domperidone: Metoclopramide and Domperidone
accelerate absorption of Paracetamol (enhanced effect).
622
Parasympathomimetics
Anti-arrhythmics: Procainamide, Quinidine and possibly Propafenone antagonize
effect of Neostigmine and Pyridostigmine.
Antibacterials: Aminoglycoside, Clindamycin and Colistin antagonize effect of
Neostigmine and Pyridostigmine.
Antimalarials: Chloroquine and Hydroxychloroquine have potential to increase
symptoms of myasthenia gravis and thus diminish effect of Neostigmine and
Pyridostigmine.
Antimuscarinics: antagonism of effect.
Beta-blockers: Propranolol antagonizes effect of Neostigmine and
Pyridostigmine.
Lithium: antagonism of effect of Neostigmine and Pyridostigmine.
Muscle Relaxants: Ecothiophate eye-drops, Edrophonium, Neostigmine,
Pyridostigmine, Rivastigmine and possibly Donepezil enhance effect of
Suxamethonium, but antagonize effect of non-depolarizing muscle relaxants.
Paroxetine see Antidepressants, SSRIs

Pefloxacin see fluoroquinolone
Penicillamine
Antacids: reduced absorption of Penicillamine.
Iron: reduced absorption of Penicillamine.
Zinc: reduced absorption of Penicillamine.
Penicillins
Antacids: reduced absorption of Pivampicillin.
Anticoagulants: see Phenindione and Warfarin.
Cytotoxics: reduced excretion of Methotrexate (increased risk of toxicity).
Muscle relaxants: enhanced by Azlocillin and Piperacillin.
Oestrogens and Progestogens: see Contraceptives, Oral.
Uricosurics: excretion of Penicillins reduced by Probenecid.
Pentazocine see Opioid Analgesics.
Perindopril see ACE Inhibitors and Angiotensin-II Antagonists.
Perphenazine see Antipsychotics.
Pethidine see Opioid Analgesics.
Pheniramine see Antihistamines.
Phenobarbital see Barbiturates.
Phenothiazines see Antipsychotics.
Phenoxymethyl Penicillin see Penicillins.
Phenylephrine see Sympathomimetics.
Phenytoin
* Analgesics: plasma-phenytoin concentration increased by Aspirin, Azapropazone
(avoid concomitant use) and possibly other NSAIDs; metabolism of Methadone
accelerated (reduced effect and risk of withdrawal effects).
Antacids: reduced Phenytoin absorption.
* Anti-arrhythmics: Amiodarone increases plasma-phenytoin concentration;
phenytoin reduces plasma concentrations of Disopyramide, Mexiletine, and
Quinidine.
* Antibacterials: plasma-phenytoin concentration increased by Chloramphenicol,
Cycloserine, Isoniazid, and Metronidazole; plasma-phenytoin concentration and
antifolate effect increased by Co-trimoxazole and Trimethoprim and possibly by
other Sulphonamides; plasma-phenytoin concentration reduced by Rifampicin;
623
plasma concentration of Doxycycline reduced by Phenytoin; plasma-phenytoin

concentration possibly altered by Ciprofloxacin.
* Anticoagulants: metabolism of Nicoumalone and Warfarin accelerated (possibility
of reduced anticoagulant effect, but enhancement also reported).
lowered); Fluoxetine, Fluvoxamine, and Viloxazine increase plasma-phenytoin
concentration; Phenytoin reduces plasma-concentrations of Mianserin,
Paroxetine, and Tricyclics.
Antidiabetics: plasma-phenytoin concentration transiently increased by
Tolbutamide possibility of toxicity); Phenytoin possibly reduces plasma
concentration of Repaglinide (manufacturer advises avoid concomitant use).
* Other Antiepileptics: concomitant administration of tow or more antiepileptics may
enhance toxicity without a corresponding increase in Antiepileptic effect;
moreover interactions between individual Antiepileptics can complicate
monitoring of treatment; interactions include enhanced effects, increased
sedation, and reductions in plasma concentrations.
* Antifungals: plasma-phenytoin concentration increased by Fluconazole and
Miconazole; plasma concentration of Itraconazole and Ketoconazole reduced
* Antimalarials: antagonism of anticonvulsant effect; increased risk of antifolate
effect with Pyrimethamine (includes Fansidar ® and Maloprim ®).
* Antiplatelet Drugs: plasma-phenytoin concentration increased by aspirin.
lowered); Phenytoin accelerates metabolism of Clozapine and Quetiapine
(reduced plasma concentrations).
* Antivirals: plasma concentration of Indinavir, Nelfinavir and Saquinavir possibly
reduced; plasma-phenytoin concentrations increased or decreased by
Zidovudine.
* Anxiolytics and Hypnotics: Diazepam and possibly other Benzodiazepines
increase plasma-phenytoin concentration.
* Calcium-channel Blockers: Diltiazem and Nifedipine increase plasma
concentration of Phenytoin; effect of Felodipine, Isradipine and probably
Nicardipine, Nifedipine and other Dihydropyridines, Diltiazem, and Verapamil
reduced.
Cardiac Glycosides: metabolism of digitoxin only accelerated (reduced effect).
* Ciclosporin: metabolism of Ciclosporin accelerated (reduced plasma
concentration).
Cytotoxics: reduced absorption of Phenytoin; increased antifolate effect with
Methotrexate.
* Disulfiram: Plasma-phenytoin concentration increased.
* Diuretics: increased risk of osteomalacia with Carbonic Anhydrase inhibitors.
* Folic Acid and Folinic Acid: plasma-phenytoin concentration possibly reduced by
Folic acid and Folinic acid.
* Hormone Antagonists: metabolism of Toremifene possibly accelerated.
* Lithium: neurotoxicity may occur without increased plasma-lithium concentration.
* Muscle Relaxants: effect of non-depolarizing muscle relaxants antagonized
(recovery from neuromuscular blockade accelerated).
* Oestrogens and Progestogens: metabolism of Gestrinone, Tibolone, and oral
contraceptives accelerated (reduced contraceptive effect).
* Sympathomimetics: plasma-phenytoin concentration increased by
Metheylphenidate.
* Theophylline: metabolism of Theophylline accelerated (reduced plasma-
624
* Thyroxine: metabolism of Thyroxine accelerated (may increase Thyroxine

* Ulcer-healing Drugs: Cimetidine inhibits metabolism (increased plasma-phenytoin
concentration); Sucralfate reduces absorption; Omeprazole enhances effect of
Phenytoin (interaction with Lansoprazole possibly differs).
* Uricosurics: Plasma-phenytoin concentration increased by Sulphinpyrazone.
* Vaccines: effect enhanced by influenza vaccine vitamins D requirements possibly
increased.
Phytomenadione see Vitamins (Vitamins K).

Pilocarpine see Parasympathomimetics.
Pimecrolimus
Alcohol intolerance, described as flushing, rash, burning, itching, or swelling, has
occurred rarely after the consumption of alcohol by patients using topical
pimecrolimus.
Pindolol see Beta-blockers.
Pioglitazone see Antidiabetics
Piroxicam see NSAIDs.
Pitavastatin
The interactions of statins with other drugs are described under simvastatin.
Pitavastatin is only marginally metabolised by the cytochrome P450 isoenzyme
CYP2C9 and may not have the same interactions with CYP3A4 inhibitors as
simvastatin. However, ciclosporin significantly increases pitavastatin exposure and the
combination should be avoided. On theoretical grounds, use with ritonavir-boosted
lopinavir is also contra-indicated. Rifampicin and erythromycin also increase
pitavastatin exposure; if such combinations must be used, lower doses of pitavastatin
should be used.
Pizotifen
Antihypertensives: hypotensive effect of adrenergic neurone blockers
antagonized.
Polymyxins see Colisten.
Potassiam Salts (including salt substitutes)

* ACE Inhibitors: increased risk of hyperkalaemia.
* Ciclosporin: increased risk of hyperkalaemia.
* Diuretics: hyperkalaemia with potassium-sparing diuretics.
Prasugrel
• Analgesics: possible increased risk of bleeding when prasugrel given with
NSAIDs
• Anticoagulants: possible increased risk of bleeding when prasugrel given with
coumarins or phenindione
• Clopidogrel: possible increased risk of bleeding when prasugrel given with
clopidogrel
Prazosin see Alpha-blockers (post synaptic).
Prednisolone see Corticosteroids.
Primaquine
Mepacrine: increased plasma concentration of Primaquine (risk of toxicity).
Primidone see Barbiturates and Primidone.
625
Probenecid
* ACE Inhibitors: reduced excretion of Captopril.
* Analgesics: Aspirin antagonizes effect; excretion of Indomethacin, Ketoprofen,
Ketorolac (avoid concomitant use), and Naproxen delayed and increased
plasma-NSAID concentrations.
* Antibacterials: reduced exertion of Cephalosporins, Cinoxacin, Ciprofloxacin, and
Penicillins (increased plasma-concentrations); antagonism by Pyrazinamide.
* Antivirals: reduced excretion of Aciclovir, Vanciclovir, Zidovudine, and possibly
Famciclovir and Zalcitabine (increased plasma concentrations).
* Cytotoxics: reduced excretion of Methotrexate (increased risk of toxicity).
Procainamide
ACE Inhibitors: increased risk of toxicity with captopril, especially in renal
impairment.
* Other Anti-arrhythmics: Amiodarone increases Procainamide-plasma
concentrations (increased risk of ventricular arrhythmias-avoid concomitant use);
increased myocardial depression with any anti-arrhythmic.
* Antibacterials: increased risk of arrhythmias with Grepafloxacin (avoid
concomitant use); Trimethoprim increases plasma concentration of
Procainamide.
* Antidepressants: increased risk of ventricular arrhythmias with Tricyclics.
* Antihistamines: increased risk of ventricular arrhythmias with Mizolastine (avoid
concomitant use).
* Antimalarials: increased risk of ventricular arrhythmias with Halofantrine.
* Antipsychotics: increased risk of ventricular arrhythmias –.avoid concomitant use
with Pimozide, Sertindole or Thioridazine.
* Beta-blockers: increased risk of ventricular arrhythmias associated with Sotalol
* Muscle Relaxants: muscle relaxant effect enhanced.
* Ulcer-healing Drugs: Cimetidine inhibits excretion increased plasma-
procainamide concentration).
Procarbazine
Alcohol: Disulfiram-like reaction.
Prochlorperazine see Antipsychotics.

Procyclidine see Antimuscarinics.
Progestogens (see also Contraceptives, Oral).

Antibacterials: metabolism accelerate by Rifampicin (reduced effect).
* Antivirals: Nevirapine accelerates metabolism of hormonal contraceptives
(reduced contraceptive effect).
* Ciclosporin: increased plasma-ciclosporin concentration (inhibition of
metabolism).
Hormone Antagonists: Aminoglutethimide reduces plasma concentration of
Medroxyprogesterone.
Promethazine see Antihistamines.

Propafenone
Propafenone is extensively metabolised by the cytochrome P450 enzyme system,
mainly by the isoenzyme CYP2D6, although CYP1A2 and CYP3A4 are also involved.
Interactions may therefore occur with other drugs that are metabolised by these
626
enzymes. Plasma-propafenone concentrations may be reduced by enzyme inducers

such as rifampicin; enzyme inhibitors, such as cimetidine, fluoxetine, quinidine, and
HIV-protease inhibitors, may increase plasma-
propafenoneconcentrations.Propafenone itself may alter the plasma concentrations of
other drugs, including beta blockers, ciclosporin, desipramine, digoxin, theophylline,
venlafaxine, and warfarin. The absorption of propafenone may be reduced by orlistat.
There may be an increased risk of arrhythmias if propafenone is given with other
antiarrhythmics or arrhythmogenic drugs.
Propantheline see Antimuscarinics.
Propofol see Anaesthetics, General.
Propranolol see Beta-blockers.
Prostaglandins
Oxytocin: uterotonic effect enhanced.
Proton Pump Inhibitors

Analgesics: plasma concentration of Omeprazole increased by Valdecoxib.
Antacids: possibly reduced absorption of Lansoprazole.
* Anticoagulants: effect of Warfarin enhanced by Omeprazole; interaction with
Lansoprazole possibly differs.
* Antiepileptics: effects of Phenytoin enhanced by Esomeprazole and Omeprazole;
interaction with Lansoprazole possibly differs.
Antifungals: absorption of Ketoconazole and possibly Itraconazole reduced.
Anxiolytics and Hypnotics: metabolism of diazepam possibly inhibited by
Omeprazole and Esomeprazole (increased effect possible).
Cardiac Glycosides: plasma concentration of Digoxin possibly increased.
Oestrogens and Progestogens: manufacturer advises that Lansoprazole possibly
accelerates metabolism of oral contraceptives.
Tacrolimus: Omeprazole possibly increases plasma-tacrolimus concentration.
Ulcer-healing Drugs: Sucralfate reduces absorption of Lansoprazole.
Protriptyline see Antidepressants, Tricyclic.

Pseudoephedrine see Sympathomimetics.
Pyrantel
* Piperazine: Piperazine opposes the anthelmintic actions of pyrantel.
*Aminophylline: A single case report describes rapidly increased theophylline levels in
a child given pyrantel.
Pyrazinamide
Uricosurics: antagonism of effect of Probenecid and Sulphinpyrazone.
Pyridoxine see Vitamins.
Pyrimethamine
* Antibacterials: increased antifolate effect with Co-trimoxazole and Trimethoprim.
Antiepileptics: increased antifolate effect with Phenytoin.
Cytotoxics: increased antifolate effect with Methotrexate.
Quinidine
Antacids and Adsorbents: reduced excretion in alkaline urine (plasma-quinidine
concentration occasionally increased); absorption possibly reduced by Kaolin
(possibly reduced plasma concentration).
* Other Anti-arrhythmics: Amiodarone increases plasma-quinidine. Concentrations
(and increases risk of concentration of Propafenone increased; increased
myocardial depression with any anti-arrhythmic.
627
* Antibacterials: Rifampicin accelerates metabolism and leads to reduced plasma-

quinidine concentration.
Antidepressants: increased risk of ventricular arrhythmias with Tricyclic
antidepressants.
Antiepileptics: Phenobarbitone, Phenytoin, and Primidone accelerate metabolism
(reduced plasma-quinidine concentration).
* Antihistamines: increased risk of ventricular arrhythmias with Mizolastine (avoid
concomitant use).
* Antimalarials: increased risk of ventricular arrhythmias with Halofantrine and
Mefloquine.
* Antipsychotics: increased risk of ventricular arrhythmias- avoid concomitant use
with Pimozide, Sertindole or Thioridazine.
* Antivirals: increased risk of ventricular arrhythmias with Nelfinavir and Ritonavir
Barbiturates: see under Antiepileptics.
* Beta-blockers: increased risk of ventricular arrhythmias associated with Sotalol
* Calcium-channel Blockers: Nifedipine reduces plasma-quinidine concentration;
Verapamil increases plasma-quinidine concentration (possibility of extreme
hypotension).
* Cardiac Glycosides: plasma concentration of Digoxin increased (halve Digoxin
maintenance dose).
* Diuretics: Acetazolamide reduces excretion (plasma-quinidine concentration
occasionally increased); Quinidine toxicity increased if hypokalaemia occurs with
Acetazolamide, loop diuretics, and Thiazides.
* Muscle Relaxants: muscle relaxant effect enhanced.
* Ulcer-healing Drugs: Cimetidine inhibits metabolism (increased plasma-quinidine
concentration).
Quinine
* Anti-arrhythmics: plasma concentration of Flecainide increased; increased risk of
ventricular arrhythmias with Amiodarone (avoid concomitant use).
* Antipsychotics: increased risk of ventricular arrhythmias-avoid concomitant use
with Pimozide.
* Other Antimalarials: see Halofantrine, Mefloquine.
* Cardiac Glycosides: plasma concentration of Digoxin increased (halve Digoxin
maintenance of Digoxin increased use of quinine for cramps.
* Ulcer-healing Drugs: Cimetidine inhibits metabolism (increased plasma-quinine
concentration).
Quinolones
* Analgesics: possible increased risk of convulsions with NSAIDs; manufacturer of
Ciprofloxacin advises to avoid premedication with opioid analgesics (reduced
plasma-Ciprofloxacin concentration).
Antacids and adsorbents: Antacids reduce absorption of Ciprofloxacin,
Levofloxacin, Moxifloxacin, Norfloxacin and Ofloxacin.
* Anti-arrhythmics: increased risk of arrhythmias with drugs that prolong QT
interval (avoid concomitant use with Moxifloxacin, Amiodarone, Disopyramide,
Procainamide and Quinidine).
Other Antibacterials: increased risk of ventricular arrhythmias with Moxifloxacin
and parenteral Erythromycin (avoid concomitant use)
Anticoagulants: anticoagulant effect of Warfarin enhanced by Ciprofloxacin,
Nalidixic acid, Norfloxacin and Ofloxacin.
628
Antidepressants: increased risk of ventricular arrhythmias with Moxifloxacin and

tricyclic antidepressants (avoid concomitant use)
Antidiabetics: effect of Glibenclamide possibly enhanced by Ciprofloxacin.

Antiepileptics: Ciprofloxacin possibly alters plasma concentration of Phenytoin.
Antimalarials: manufacturer of Artemether with Lumefantrine advises avoid
concomitant use; increased ventricular arrhythmias with Moxifloxacin and
Chloroquine, Mefloquine or Quinine (avoid concomitant use)
Antipsychotics: increased risk of ventricular arrhythmias with Moxifloxacin and
Haloperidol, Phenothiazines (avoid concomitant use).
* Beta-blockers: increased risk of ventricular arrhythmias with Moxifloxacin and
Sotalol, avoid concomitant use.
Calcium Salts: reduced absorption of Ciprofloxacin.
Cytotoxics: toxicity of Melphalan increased by Nalidixic acid.
* 5HT1-Agonists: Quinolones possibly inhibit metabolism of Zolmitriptan (reduce
dose of Zolmitriptan).
Iron: absorption of Ciprofloxacin, Levofloxacin, Moxifloxacin, Norfloxacin, and
Ofloxacin reduced by oral iron.
* Theophylline: possible increased risk of convulsions; Ciprofloxacin and
Norfloxacin increase plasma-theophylline concentration.
Ulcer-healing Drugs: Sucralfate reduces absorption of Ciprofloxacin,
Levofloxacin, Moxifloxacin, Norfloxacin, and Ofloxacin.
Uricosurics: Probenecid reduces excretion of Ciprofloxacin, Nalidixic acid and
Norfloxacin.
Zinc Salts: Zinc reduces absorption of Ciprofloxacin, Moxifloxacin and
Norfloxacin.
Rabeprazole see Proton Pump Inhibitors

Racecadotril No interactions with other medicinal products have been described in
humans til to date. In humans, joint treatment with racecadotril and loperamide,
or nifuroxazide does not modify the kinetics of racecadotril.
Raloxifen
Anticoagulants: antagonism of anticoagulant effect of Warfarin.
Raltegravir
Raltegravir is not a substrate for cytochrome P450 isoenzymes, and does not appear
to interact with drugs metabolised by this mechanism. However, rifampicin induces the
glucuronidase responsible for raltegravirmetabolism (UGT1A1) and reduces plasma
concentrations ofraltegravir; if use with rifampicin cannot be avoided, increasing the
dose of raltegravir may be considered.
• Antivirals: Plasma concentrations of raltegravir were modestly increased by
atazanavir and ritonavir-boosted atazanavir in healthy subjects; this increase is
not considered to be clinically significant.
In a pharmacokinetic study, use of raltegravir andmaraviroc together resulted in
decreased plasma concentrations of both drugs, although these changes were
also not thought to be clinically significant.
• Gastrointestinal drugs: The solubility of raltegravir is pH-dependent, and use
ofomeprazole has been noted to increase plasma concentrations of raltegravir
in healthy subjects. However, some HIV-infected patients (and particularly those
with AIDS) have increased gastric pH relating to their illness, and data from
HIV-infected patients suggests acceptable safety and only modest
pharmacokinetic interaction when gastric-acid reducing drugs are used
withraltegravir. US licensed product information forraltegravir therefore suggests
that no dose adjustment is needed whenraltegravir is used with gastric-acid
629
reducing drugs, although UK licensed information has advised that such

combinations should be avoided unless considered essential.
Ramipril see ACE Inhibitors.

Ranitidine see Histamine H2-antagonists.
Ranolazine
• Anti-arrhythmics: manufacturer of ranolazine advises avoid concomitant use
with disopyramide.
• Antibacterials: plasma concentration of ranolazine possibly increased by
clarithromycin and telithromycin; plasma concentration of ranolazine reduced by
rifampicin.
• Antidepressants: plasma concentration of ranolazine increased by paroxetine.
• Antifungals: plasma concentration of ranolazine possibly increased by
itraconazole, posaconazole and voriconazole.
• Antivirals: plasma concentration of ranolazine possibly increased by atazanavir,
darunavir, fosamprenavir, indinavir, lopinavir, ritonavir, saquinavir and
tipranavir.
• Beta-blockers: manufacturer of ranolazine advises avoid concomitant use with
sotalol.
• Calcium-channel Blockers: plasma concentration of ranolazine increased by
diltiazem and verapamil (consider reducing dose of ranolazine).
• Cardiac Glycosides: ranolazine increases plasma concentration of digoxin.
• Ciclosporin: plasma concentration of both drugs may increase when ranolazine
given with ciclosporin.
• Grapefruit Juice: plasma concentration of ranolazine possibly increased by
grapefruit juice - manufacturer of ranolazine advises avoid concomitant use.
• Lipid-regulating Drugs: ranolazine increases plasma concentration of
simvastatin.
• Tacrolimus: ranolazine increases plasma concentration of tacrolimus.
Remifentanil see Opioid Analgesics.

Repaglinide see Antidiabetics.
Retinoids
Alcohol: Etretinate formed from Acitretin in presence of alcohol.
Antibacterials: possible increased risk of benign intracranial hypertension with
Tetracyclines and Acitretin, Isotretinoin and Tretinoin.
* Anticoagulants: Acitretin possibly reduces anticoagulant effect of Warfarin.
* Antiepileptics: plasma concentration of Carbamazepine possibly reduced by
Isotretinoin.
* Cytotoxics: Acitretin increases plasma concentration of Methotrexate (also
increased risk of hepatotoxicity).
* Oestrogens and Progestogens: Tretinoin reduces efficacy of Progestogen only
and possibly combined oral contraceptives.
Vitamins: risk of hypervitaminosis A with vitamin A and Acitretin, Isotretinoin and
Tretinoin.
Ribavirin May exacerbate immunosuppression w/ azathioprine. Increased risk of
mitochondrial toxicity and lactic acidosis in HIV-positive patients taking
nucleoside reverse transcriptase inhibitor (e.g. didanosine, stavudine). Increased
risk of anaemia w/ zidovudine. Decreased bioavailability w/ antacids containing
Mg, Al and simethicone. Increased risk of lactic acidosis w/ other nucleoside
analogues.
Rifabutin as for Rifampicin.
630
Rifampicin
Analgesics: metabolism of methadone accelerated (reduced effect).
Antacids: reduced absorption of Rifampicin.
* Anti-arrhythmics: metabolism accelerated-reduced plasma concentrations of
Disopyramide, Mexiletine, Propafenone, and Quinidine.
* Other Antibacterials: metabolism of Chloramphenicol accelerated by Rifampicin
(reduced plasma concentration); plasma concentration of Dapsone reduced;
plasma concentration of Rifabutin increased by Clarithromycin and possibly other
Macrolides (risk of uveitis-reduce Rifabutin dose).
* Anticoagulants: metabolism of Nicoumalone and Warfarin accelerated (reduced
anticoagulant effect).
* Antidepressants: metabolism of some Tricyclics accelerated by Rifampicin
(reduced plasma concentration).
* Antidiabetics: metabolism of Chlorpropamide, Tolbutamide and possibly other
Sulphonylureas accelerated (reduced effect); Rifampicin possibly reduces plasma
concentration of Repaglinide (manufacturer advises avoid concomitant use).
* Antiepileptics: metabolism of Carbamazepine and Phenytoin accelerated
* Antifungals: metabolism of Fluconazole, Itraconazole and Ketoconazole
accelerated by Rifampicin (reduced plasma concentrations); plasma
concentration of Rifampicin may be reduced by Ketoconazole; plasma
concentration of Terbinafine reduced plasma concentration of Terbinafine
reduced by Rifampicin; plasma concentration of Rifabutin increased by
Fluconazole and possibly other Triazoles (risk of uveitis - reduce Rifabutin dose).
* Antipsychotics: metabolism of Haloperidol accelerated by Rifampicin (reduced
plasma concentration).
* Antivirals: concomitant administration of Indinavir and Rifabutin increases
plasma-Rifabutin concentration and decreases plasma-indinavir concentration
(reduce dose of Rifabutin and increase dose of Indinavir); metabolism of Indinavir
enhanced by Rifampicin (plasma-indinavir concentration significantly reduced -
avoid concomitant use); plasma concentration of Nelfinavir significantly reduced
by Rifampicin (avoid concomitant use); plasma concentration of Rifabutin
increased by Nelfinavir (halve Rifabutin dose); plasma concentration of Rifabutin
increased by Ritonavir (risk of uveitis-avoid concomitant use); plasma
concentration of Saquinavir reduced (avoid concomitant use).
* Anxiolytics and Hypnotics: metabolism of Diazepam and possibly other
Benzodiazepines accelerated (reduced plasma concentration).
* Atovaquone: plasma concentration reduced by Rifampicin (possible therapeutic
failure of Atovaquone).
* Beta-blockers: metabolism of Bisoprolol and Propranolol accelerated by
Rifampicin (plasma concentrations significantly reduced).
* Calcium-channel Blockers: metabolism of Diltiazem, Nifedipine, and Verapamil
and possibly Isradipine, Nicardipine (plasma concentrations significantly
reduced).
* Cardiac Glycosides: metabolism of Digitoxin only accelerated (reduced effect).
* Ciclosporin: metabolism accelerated (reduced plasma-ciclosporin concentration).
* Cytotoxics: manufacturer reports interaction with Azathioprine (transplants
possibly rejected).
* Lipid-regulating Drugs: metabolism of Fluvastatin accelerated (reduced effect).
* Oestrogens and Progestogens: metabolism accelerated (contraceptive effect of
both combined and Progestogen-only oral contraceptives reduced).
* Tacrolimus: Rifampicin decreases plasma-tacrolimus concentration.
631
Theophylline: metabolism accelerated by Rifampicin (reduced plasma-

Thyroxine: metabolism of Thyroxine accelerated by Rifampicin (may increase
Ulcer-healing Drugs: metabolism of Cimetidine accelerated by Rifampicin
Rifaximin
There is no experience regarding administration of rifaximin to subjects who are
taking another rifamycin antibacterial agent to treat a systemic bacterial infection.
In vitro data show that rifaximin did not inhibit the major cytochrome P-450 (CYP)
drug metabolizing enzymes (CYPs1A2, 2A6, 2B6, 2C8, 2C9, 2C19, 2D6, 2E1,
and 3A4). In in vitro induction studies, rifaximin did not induce CYP1A2 and CYP
2B6 but was a weak inducer of CYP3A4.
In healthy subjects, clinical drug interaction studies demonstrated that rifaximin
did not significantly affect the pharmacokinetics of CYP3A4 substrates, however,
in hepatic impaired patients it cannot be excluded that rifaximin may decrease the
exposure of concomitant CYP3A4 substrates administered (e.g. warfarin,
antiepileptics, antiarrhythmics), due to the higher systemic exposure with respect
to healthy subjects.
An in vitro study suggested that rifaximin is a moderate substrate of P-
glycoprotein (P-gp) and metabolized by CYP3A4. It is unknown whether
concomitant drugs which inhibit P-gp and/or CYP3A4 can increase the systemic
exposure of rifaximin.
The potential for drug-drug interactions to occur at the level of transporter
systems has been evaluated in vitro and these studies suggest that a clinical
interaction between rifaximin and other compounds that undergo efflux via P-gp
and other transport proteins is unlikely (MDR1, MRP2, MRP4, BCRP and BSEP).
Riluzole
Caffeine, theophylline, amitriptyline, quinolones may decrease the rate of
riluzole elimination. Cigarette smoke, rifampin, omeprazole may increase
the rate of riluzole elimination.
Risedronate sodium see Bisphosphonates

Risperidone see Antipsychotics
Ritodrine see Sympathomimetics, Beta2 Sympathomimetics.
Ritonavir
* Analgesics: plasma concentration of Dextropropoxyphene, Pethidine and
Piroxicam increased (risk of toxicity - avoid concomitant use); plasma
concentrations of other opioid analgesics and other NSAIDs possibly increased.
* Anti-arrhythmics: increased plasma concentration of Amiodarone, Flecainide,
Propafenone and Quinidine 9 increased risk of ventricular arrhythmia-avoid
concomitant use).
* Antibacterials: plasma concentration of Rifabutin increased by Ritonavir (risk of
uveitis - avoid concomitant use); plasma concentration of Macrolides possibly
increased.
* Anticoagulants: plasma concentration of Warfarin and other anticoagulants
possibly increased.
* Antidepressants: plasma concentration of SSRIs and Tricyclics possibly
increased.
Antidiabetics: plasma concentration of Tolbutamide possibly increased.
632
* Antiepileptics: plasma concentration of Carbamazepine possibly increased.

* Antifungals: plasma concentration of Imidazoles and Triazoles possibly
increased.
* Antihistamines: plasma concentration of non-sedating antihistamines possibly
increased.
* Antipsychotics: increased plasma concentration of Pimozide (risk of ventricular
arrhythmias - avoid concomitant use); increased plasma concentration of
Clozapine (risk of toxicity - avoid concomitant use); possibly increased plasma
concentration of other antipsychotics.
* Other Antivirals: combination with Nelfinavir may lead to increased plasma
concentration of either drug; Ritonavir increases plasma concentration of
Saquinavir.
* Anxiolytics and Hypnotics: plasma concentration of Alprazolam, Clorazepate,
Diazepam, Flurazepam, Midazolam and Zolpidem increased (risk of extreme
sedation and respiratory depression – avoid concomitant use); plasma
concentration of other anxiolytics and hypnotics possibly increased.
* Calcium-channel Blockers: plasma concentration of calcium-channel blocker
possibly increased.
Corticosteroids: plasma concentration of Dexamethasone and Prednisolone (and
possibly other Corticosteroids) possibly increased.
* Ciclosporin: plasma-ciclosporin concentration possibly increased.
* Ergotamine: risk of ergotism - avoid concomitant use.
* Oestrogens and Progestogens: metabolism accelerated by Ritonavir
(contraceptive effect of combined oral contraceptives reduced).
* Tacrolimus: plasma-tacrolimus concentration possibly increased.
* Theophylline: metabolism accelerated by Ritonavir (reduced plasma-theophylline
concentration).
Rivaroxaban
Rivaroxaban is metabolised by the cytochrome P450 isoenzyme CYP3A4 and is also
a substrate for P-glycoprotein. It should not be given with potent inhibitors of both
CYP3A4 and P-glycoprotein, such as ketoconazole, itraconazole, posaconazole,
voriconazole, or HIV-protease inhibitors, although it may be used cautiously with
fluconazole. Drugs that inhibit only one of these pathways or are less potent inhibitors,
such as clarithromycin and erythromycin, do not appear to have clinically relevant
effects. Potent inducers of CYP3A4, such as rifampicin, may reduce the effect of
rivaroxaban.
Caution is needed if rivaroxaban is given with other anticoagulants or with drugs that
affect bleeding, including NSAIDs and antiplatelet drugs.
Rivstigmine see Parasympathomimetics.
Rizatriptan see 5HT1 Agonists.
Rocuronium see Muscle Relaxants (non-depolarizing).
Rofecoxib see NSAIDs.
Rosiglitazone see Antidiabetics.
Roxithromycin see drug interactions of macrolide antibacterials, or see Erythromycin
Salbutamol see Beta2 Sympathomimetics.
Sacubitril + Valsartan
• Additive hypotensive effect with sildenafil and other PDE5 inhibitors. Increased
risk of acute renal failure with NSAID(s).
• Increased serum concentration with rifampicin, ciclosporin, ritonavir.
• May reduce serum concentration of metformin.
• Sacubitril: May increase serum concentration of OATP1B1, OATP1B3
substrates (e.g. atorvastatin). Increased concentration of statins.
• Valsartan: May increase serum lithium concentration and toxicity.
633
• Increased risk of hyperkalaemia with potassium-sparing diuretics (e.g.

triamterene), mineralocorticoid antagonists (e.g. spironolactone), K
supplements, or other K-containing salt substitutes (e.g. heparin).
• Potentially Fatal: Increased risk of angioedema with ACE inhibitors/ARBs.
Increased risk of hypotension, hyperkalaemia, and acute renal failure with
aliskiren in patients with diabetes mellitus.
Salicylic acid there are no interaction messages.
Salmeterol see Beta2 Sympathomimetics.
Saquinavir
Note: Limited clinical data available, but possibly of interactions with number of drugs
consult product literature for details.
* Antibacterials: metabolism accelerated by Rifampicin (reduced plasma
concentration - avoid concomitant use).
* Antiepileptics: plasma concentration possibly reduced by Carbamazepine,
Phenobarbitone and Phenytoin.
* Other Antivirals: Nevirapine reduces plasma concentration of Saquinavir (avoid
concomitant use); combination with Nelfinavir may lead to increased plasma
concentration of Saquinavir.
Barbiturates: see under Antiepileptics above.
* Corticosteroids: plasma concentration possibly reduced by Dexamethasone.
Selegiline
Note: Selegiline is an MAO-B inhibitor.
* Analgesics: hyperpyrexia and CNS toxicity with Pethidine (avoid concomitant
use).
* Antidepressants: hypertension and CNS excitation with Fluoxetine, Paroxetine
and Sertraline (Selegiline should not be started until 5 weeks after discontinuation
of Fluoxetine, avoid Fluoxetine for 2 weeks after stopping Selegiline);
hypotension with MAOIs; CNS toxicity reported with Tricyclic antidepressants.
Sertraline see Antidepressants, SSRIs.

Sildenafil
• Alpha-blockers: enhanced hypotensive effect when sildenafil given with
alpha-blockers (avoid alphablockers for 4 hours after sildenafil)
• Anti-arrhythmics: avoidance of sildenafil advised by manufacturer of
disopyramide (risk of Ventricular arrhythmias)
• Antibacterials: plasma concentration of sildenafil increased by
clarithromycin, erythromycin and telithromycin—reduce initial dose of
sildenafil
• Antifungals: plasma concentration of sildenafil increased by itraconazole
• Antivirals: side-effects of sildenafil possibly increased by atazanavir; plasma
concentration of sildenafil reduced by etravirine; plasma concentration of
sildenafil possibly increased by fosamprenavir; plasma concentration of
sildenafil increased by indinavir—reduce initial dose of sildenafil; plasma
concentration of sildenafil significantly increased by ritonavir— avoid
concomitant use; increased risk of ventricular arrhythmias when sildenafil
given with saquinavir— avoid concomitant use; avoidance of sildenafil
advised by manufacturer of telaprevir Bosentan: plasma concentration of
sildenafil reduced by bosentan
• Calcium-channel Blockers: enhanced hypotensive effect when sildenafil
given with amlodipine
• Cobicistat: plasma concentration of sildenafil possibly increased by
cobicistat manufacturer of cobicistat advises avoid concomitant use of
634
sildenafil for pulmonary arterial hypertension or reduce dose of sildenafil for

erectile dysfunction
• Dapoxetine: avoidance of sildenafil advised by manufacturer of dapoxetine
• Grapefruit Juice: plasma concentration of sildenafil possibly increased by
grapefruit juice
• Nicorandil: sildenafil significantly enhances hypotensive effect of nicorandil
(avoid concomitant use)
• Nitrates: sildenafil significantly enhances hypotensive effect of nitrates
(avoid concomitant use)
• Ulcer-healing Drugs: plasma concentration of sildenafil increased by
cimetidine (consider reducing dose of sildenafil)
Simvastatin see Statins.

Sodium Aurothiomalate
Note: Increased risk of toxicity with other nephrotoxic and meylosuppressive drugs.
Sodium Bicarbonate see Antacids.

Sodium Fusidate
Although the exact metabolic pathways of fusidic acid are not known, an
interaction has been suspected with drugs metabolised by the hepatic
cytochrome P450 isoenzyme CYP3A4, and UK licensed product information
suggests avoiding their use with fusidic acid.
Sodium Valproate see Valproate.
Somatropin
Corticosteroids: may inhibit growth promoting effect of Somatropin.
Sotalol see Beta-blockers.
Sparfloxacin see Ciprofloxacin
Spectinomycin
* Botulinum Toxin: neuromuscular block enhanced (risk of toxicity).
* Lithium: increased toxicity reported.
Spiramycin see drug interactions of macrolide antibacterials, or see Erythromycin

Spironolactone see Diuretics (potassium-sparing).
Statins
Note: Grapefruit juice increases plasma concentration of Simvastatin.
* Antibacterials: metabolism of Fluvastatin accelerated by Rifampicin(reduced
effect); Clarithromycin and Erythromycin increase risk of myopathy with
Simvastatin (avoid concomitant use); Erythromycin possibly increases risk of
myopathy with Atorvastatin; Clarithromycin increases plasma concentration of
Atorvastatin.
* Anticoagulants: effect of Nicoumalone and Warfarin enhanced by Simvastatin.
• Antifungals: Itraconazole, Ketoconazole and possibly other Imidazoles and
Triazoles increase risk of myopathy with Simvastatin – avoid concomitant use of
Itraconazole, Ketoconazole or Miconazole with Simvastatin; Itraconazole and
possibly other Imidazoles and Triazoles increase risk of myopathy with
Atorvastatin – avoid concomitant use of Itraconazole with Atorvastatin.
Cardiac Glycosides: plasma-digoxin concentration possibly increased by
Atorvastatin.
* Ciclosporin: increased risk of myopathy.
Cytotoxics: plasma concentration of Simvastatin increased by Imatinib.
* Other Lipid-regulating Drugs: increased risk of myopathy with Fibrates and
Nicotinic acid.
635
Streptomycin see Aminoglycosides.
Sucralfate
Antibacterials: reduced absorption of Ciprofloxacin, Grepafloxacin, Levofloxacin,
Norfloxacin, Ofloxacin, and Tetracycline.
* Anticoagulants: absorption of Warfarin possibly.
* Antiepileptics: reduced absorption of Phenytoin.
Antifungals: reduced absorption of Ketoconazole.
Cardiac Glycosides: absorption of Cardiac Glycosides possibly reduced
Thyroxine: reduced absorption of Thyroxine.
Other Ulcer-healing Drugs: reduced absorption of Lansoprazole.
Sulfadoxine see Co-trimoxazole and Sulphonamides.

Sulindac see NSAIDs.
Sulphadiazine see Co-trimoxazole and Sulphonamides.
Sulphadimidine see Co-trimoxazole and Sulphonamides.
Sulphasalazine
Cardiac Glycosides: absorption of Digoxin possibly reduced.
Sulphonamides see Co-trimoxazole and Sulphonamides.

Sulphonylureas see Antidiabetics.
Sulpiride see Antipsychotic.
Sumatriptan see 5HT1 Agonists.
Suvorexant Suvorexant is primarily metabolized by CYP3A. Therefore, decreased
systemic exposure of suvorexant may occur during concurrent use with CYP3A
inducers. Thus, suvorexant exposure can be substantially decreased when co-
administered with strong CYP3A inducers (e.g., rifampin, carbamazepine and
phenytoin). On the otherhand, concomitant use of Suvorexant with strong
inhibitors of CYP3A (e.g., ketoconazole, itraconazole, posaconazole,
clarithromycin, nefazodone, ritonavir, saquinavir, nelfinavir, indinavir, boceprevir,
telaprevir, telithromycin and conivaptan) is not recommended.
Suxamethonium see Muscle Relaxants.
Sympathomimetics (see below for Beta2- Sympathomimetics).

Alpha2-adrenoceptor Stimulants: possible risk of hypertension with Adrenaline
and Noradrenaline.
* Anaesthetics: risk of arrhythmias if adrenaline and Isoprenaline given with volatile
liquid anaesthetics such as halothane.
* Antidepressants: with Tricyclics administration of adrenaline and Noradrenaline
may cause hypertension and arrhythmias (but local anaesthetics with adrenaline
appear to be safe); methylphenidate may inhibit metabolism of Tricyclics; with
MAOIs administration of inotropics such as Dopamine and Dopexamine may
cause hypertensive crisis; also with MAOIs administration of dexamphetamine
and other Amphetamines, Ephedrine, Isometheptene, Methylphenidate,
Phentermine, Phenylephrine, Phenylpropanolamine, and Pseudoephedrine may
cause hypertensive crisis(these drugs are contained in anorectics or cold and
cough remedies).
Antiepileptics: methylphenidate increases plasma concentration of Phenytoin and
possibly of Phenobarbitone and Primidone.
* Antihypertensives: Sympathomimetics in anorectics and cold and cough
remedies (see above) and methylphenidate antagonize hypotensive effect of
adrenergic neurone blockers.
636
* Beta-blockers: severe hypertension with Adrenaline and Noradrenaline and

possibly with Dobutamine (especially with non-selective beta-blockers).
Corticosteroids: ephedrine accelerates metabolism of Dexamethasone.
* Dopaminergics: increased risk of toxicity when Isometheptene or
Phenylpropanolamine given with Bromocriptine; effect of Adrenaline,
Dobutamine, Dopamine, Isoprenaline and Noradrenaline possibly enhanced by
Entacapone.
Orlistat: manufacturer advises avoid concomitant use with Phentermine.
Doxapram: risk of hypertension.
Oxytocin: hypertension with vasoconstrictor Sympathomimetics.
* Other Sympathomimetics: Dopexamine possibly potentiates effect of Adrenaline
and Noradrenaline.
Sympathomimetics, Beta2
Corticosteroids: increased risk of hypokalaemia if high doses of Corticosteroids
given with high doses of Bambuterol, Eformoterol, Fenoterol, Reprotrol, Ritodrine,
Salbutamol, Salmeterol, Terbutaline and Tulobuterol.
Diuretics: increased risk of hypokalaemia if with high doses of Bambuterol,
Eformoterol, Fenoterol, Reproterol, Ritodrine, Salbutamol, Salmeterol,
Terbutaline, and Tulobuterol.
Muscle Relaxants: effect of Suxamethonium enhanced by Bambuterol.
Theophylline: increased risk of hypokalaemia if given with high doses of
Bambuterol, Eformoterol, Fenoterol, Reproterol, Ritodrine, Salbutamol,
Salmeterol, Terbutaline, and Tulobuterol.
Tamoxifen
* Anticoagulants: anticoagulant effect of Nicoumalone and Warfarin enhanced.
Other Hormone Antagonists: Aminoglutethimide reduces plasma-tamoxifen
concentration.
Tedizolid
* Tedizolid is predicted to increase the exposure to imatinib, lapatinib,
methotrexate, sulfasalazine, statins, topotecan.
* Monoamine-oxidase A and B inhibitors, moclobemide are predicted to increase
the risk of side-effects when given with tedizolid.
Tenofovir
Decreased plasma concentrations of atazanavir and increased plasma
concentration of tenofovir when given concomitantly. Increased plasma
concentration w/ ritonavir-boosted lopinavir. Tenofovir increases the plasma
concentrations of didanosine. Increased risk of nephrotoxicity w/ drugs that
reduce renal function (e.g. cidofovir, aciclovir, valaciclovir, aminoglycosides, high-
dose or multiple NSAIDs). Decreased therapeutic effect of adefovir.
Terazosin see Alpha-blockers (post-synaptic).
Terbinafine
Antibacterials: plasma concentration reduced by Rifampicin.
Ulcer-healing Drugs: plasma concentration increased by Cimetidine.
Terbutaline see Sympathomimetics, Beta2.
Testosterone
* Anticoagulants: anticoagulant effect of Warfarin, Nicoumalone and Phenindione
enhanced.
Antidiabetics: hypoglycemic effect possibly enhanced.
637
Tetrabenazine see MAOIs and Metoclopramide
Tetracyclines
ACE Inhibitors: Quinapril reduces absorption (tablets contain Magnesium
Carbonate excipient).
Antacids and Adsorbents: reduced absorption with antacids and possibly with
Kaolin.
Anticoagulant: see Phenindione and Warfarin.
Antiepileptics: Carbamazepine, Phenobarbitone and Phenytoin increase
metabolism of Doxycycline (reduced plasma concentration).
Atovaquone: plasma-atovaquone concentration reduced by tetracycline.
Calcium Salts: reduced absorption of Tetracyclines.
* Ciclosporin: Doxycycline possibly increases plasma-ciclosporin concentration.
Dairy products: reduced absorption (except Doxycycline and Minocycline).
Iron: absorption of oral iron reduced by Tetracyclines and vice versa.
Oestrogens and Progestogens: see Contraceptives, Oral (main list).
Retinoids: possible increased risk of benign intracranial hypertension with
Tetracyclines and Acitretin, Isotretinoin and Tretinoin.
Ulcer-healing Drugs: Tripotassium Dicitrato-bismuthate and Sucralfate reduce
absorption.
Zinc Salts: reduced absorption (and vice versa).
Theophylline
Anaesthetics: increased risk of arrhythmias with halothane.
Anthelmintics: Thiabendazole may increase plasma-theophylline concentration.
Anti-arrhythmics: antagonism of anti-arrhythmic effect of adenosine; plasma-
theophylline concentration increased by Mexiletine and Propafenone; plasma-
theophylline concentration reduced by Moracizine.
* Antibacterials: possible increased risk of convulsions with Quinolones; plasma-
theophylline concentration increased by Ciprofloxacin, Clarithromycin,
Erythromycin (if erythromycin given by mouth, also decreased plasma-
erythromycin concentration), and Norfloxacin and possibly increased by
Isoniazid; plasma-theophylline concentration reduced by Rifampicin.
* Antidepressants: plasma-theophylline concentration increased by Fluvoxamine
(concomitant use should usually be avoided, but where not possible halve
theophylline dose and monitor plasma-theophylline concentration) and
Viloxazine.
Antiepileptics: plasma-theophylline concentration reduced by Carbamazepine,
Phenobarbital and Phenytoin.
* Antifungals: plasma-theophylline concentration possibly increased by
Fluconazole and Ketoconazole.
* Antivirals: plasma-theophylline concentration reduced by Ritonavir.
Beta-blockers: should be avoided on pharmacological grounds (bronchospasm).
* Calcium-channel Blockers: plasma-theophylline concentration increased by
Diltiazem, Verapamil, and possibly other calcium-channel blockers.
Disulfiram: increased plasma-theophylline concentration.
Doxapram: increases CNS stimulation.
Hormone Antagonists: plasma-theophylline concentration reduced by
Aminoglutethimide.
Interferons: plasma-theophylline concentration increased by interferon alfa.
Leukotriene Antagonists: Zafirlukast possibly increases plasma-theophylline
concentration; plasma-zafirlukast concentration reduced.
638
Lithium: Lithium excretion accelerated (reduced plasma-lithium concentration).

Nicotine and Tobacco: plasma-theophylline concentration reduced by tobacco
smoking.
Oestrogens and Progestogens: plasma-theophylline concentration increased by
combined oral contraceptives.
Sympathomimetics: increased risk of hypokalaemia if theophylline given with high
doses of Bambuterol, Eformoterol, Fenoterol, Reproterol, Ritodrine, Salbutamol,
Salmeterol, Terbutaline and Tulobuterol.
* Ulcer-healing Drugs: plasma-theophylline concentration increased by cimetidine.
Uricosurics: plasma-theophylline concentration increased by Cimetidine.
Vaccines: plasma-theophylline concentration occasionally increased by influenza
vaccine.
Thiabendazole
Theophylline: plasma concentration may be increased.
Thioacetazone may enhance the ototoxicity of streptomycin
Tioconazole there are no interaction messages
Thiopentone see Anaesthetics, General.
Thioridazine see Antipsychotics.
Thyroxine
Anion-exchange Resins: Cholestyramine reduces absorption of Thyroxine.
Antibacterials: Rifampicin accelerates metabolism of Thyroxine (may increase
* Anticoagulants: effect of Nicoumalone, Phenindione and Warfarin enhanced.
Antidepressants: manufacturer of Lofepramine advises avoid Thyroxine.
Antiepileptics: Carbamazepine, Phenobarbital and Phenytoin accelerate.
metabolism of Thyroxine ( may increase requirements in hypothyroidism).
Beta-blockers: metabolism of Propranolol accelerated (reduced effect).
Ulcer-healing Drugs: Sucralfate reduces absorption of Thyroxine.
Timolol see Beta-blockers.
Tinidazole
Alcohol: possibly Disulfiram-like reaction.
Trihexyphenidyl Hydrochloride see Anticholinergics.
Tizanidine see Muscle Relaxants.

Tobramycin see Aminoglycosides.
Tofacitinib Potent CYP3A4 inhibitors (e.g., ketoconazole) & inducers (e.g., rifampin),
moderate CYP3A4 & potent CYP2C19 inhibitors & immunosuppressive drugs
(e.g., azathioprine, tacrolimus, cyclosporine).
Tolbutamide see Antidiabetics (sulphonylurea).
Torasemide see Diuretics (loop)
Tramadol see Opioid Analgesics.
Tranexamic Drugs with actions on haemostasis should be given with caution to
patients on antifibrinolytic therapy. The risk of thrombosis may be increased if
tranexamic acid is given with factor IX complex concentrates or factor VIII inhibitor
bypassing fraction, and such combinations are not recommended. Antifibrinolytics and
thrombolytics have antagonistic effects, and concomitant use may reduce the efficacy
of both. The potential for thrombus formation may be increased by oestrogens.
639
*Retinoids: Antifibrinolytics should be used with caution in patients receiving oral

tretinoin as thrombotic events have been reported in patients being treated with
tranexamic acid and tretinoin.
Tretinoin see Retinoids.

Triamcinolone see Corticosteroids.
Trifluoperazine see Antipsychotics
Trimetaphan
Trimetaphan should be used with caution in patients being treated with other
antihypertensives, drugs that depress cardiac function, or muscle relaxants, and in
those taking NSAIDs or corticosteroids. The hypotensive effect is enhanced by
general and spinal anaesthetics. Adrenaline should not be infiltrated locally at the
site of incision when trimetaphan is being given since this may antagonise the effect
of trimetaphan.
Trimetazidine no clinically significant drug interaction is reported.
Trimethoprim
Anti-arrhythmics: plasma concentration of Procainamide increased.
Anticoagulants: effect of Nicoumlone and antifolate effect of Phenytoin increased.
* Antimalarials: increased risk of antifolate effect with Pyrimethamine (in Fansidar®
and Maloprim).
Antivirals: plasma concentration of Lamivudine and possibly Zalcitabine
increased - avoid high-dose Co-trimoxazole with Lamivudine.
* Ciclosporin: increased risk of nephrotoxicity; plasma-ciclosporin concentration
possibly reduced by intravenous Trimethoprim.
Cytotoxics: antifolate effect of Methotrexate increased.
Trimipramine see Antidepressants, Tricyclic.

Tropicamide see Antimuscarinics.
Tulobuterol see Sympathomimetics, Beta2.
Ulcer-healing Drugs see individual drugs.
Uricosurics see individual drugs.
Vaccines
For a general warning on live vaccines and Immunoglobulins, see under Normal
Immunoglobulin.
Valdecoxib see NSAIDs

Valproate
Analgesics: aspirin enhances effect.
Anion- exchange Resins: Cholestyramine possibly reduces absorption.
Antibacterials: erythromycin possibly inhibits metabolism (increased plasma-
valproate concentration).
Anticoagulants: anticoagulant effect of Nicoumalone and Warfarin possibly
increased.
lowered).
* Other Antiepileptics: concomitant administration of two or more antiepileptics may
enhance toxicity without a corresponding increase in antiepileptics effect;
Moreover, interactions between individual antiepileptics can complicate
monitoring of treatment; interactions include enhanced effects, increased
sedation, and reductions in plasma concentrations.
* Antimalarials: Chloroquine and Mefloquine antagonize anticonvulsant effect.
lowered).
640
Antivirals: plasma concentration of Zidovudine possibly increased (risk of

toxicity).
Ulcer-healing Drugs: Cimetidine inhibits metabolism (increased plasma-valproate
concentration).
Valsartan see ACE Inhibitors and Angiotensin-II Antagonists.
Vancomycin
Anaesthetics: hypersensitivity-like reactions can occur with concomitant
Vancomycin infusion.
Anion-exchange Resins: Aminoglycosides and Capreomycin.
Diuretics: increased risk of ototoxicity with Loop diuretics.
Vecuronium see Muscle Relaxants (non-depolarizing).

Verapamil see Calcium-channel Blockers.
Vincristine
Antifungals: Itraconazole may inhibit metabolism (increased risk of neurotoxicity).
Vitamins
* Anticoagulants: anticoagulant effect of Nicoumalone, Phenindione, and Warfarin
antagonized by vitamin K (present in some enteral feeds).
Antiepileptics: Vitamin D requirements possibly increased by Carbamazepine,
Phenobarbital and Phenytoin.
Barbiturates: see Antiepileptics.
Diuretics: increased risk of hypercalcaemia if Thiazides given with vitamin D.
Dopaminergics: effect of Levodopa antagonized by pyridoxine (unless a dopa
decarboxylase inhibitor also given).
Retinoids: risk of hypervitaminosis A with Vitamin A and Acitretin, Isotretinoin and
Tretinoin.
Voglibose
May enhance effects of other antidiabetics including insulin.
Warfarin and Other Coumarins

Note: Change in patient’s clinical condition particularly associated with liver disease,
intercurrent illness, or drug administration, necessitates more frequent testing. Major
changes in diet (especially involving salads and vegetables) and in alcohol
consumption may also affect Warfarin control.
* Alcohol: enhanced anticoagulant effect with large amounts (see also above).
* Allopurinol: anticoagulant effect possibly enhanced.
* Anabolic Steroids: Oxymetholone, Stanozolol and others enhance anticoagulant
effect.
* Analgesics: Aspirin increases risk of bleeding due to antiplatelet effect ;
anticoagulant effect seriously enhanced by Azapropazone (avoid concomitant
use ) and possibly enhanced by Diclofenac, Diflunisal, Flurbiprofen, Ibuprofen,
Mefenamic acid, Meloxicam, Piroxicam, Sulindac, and other NSAIDs;
anticoagulant effect possibly also enhanced by Dextropropoxyphene and by
prolonged regular use of Paracetamol; increased risk of hemorrhage with
parenteral Diclofenac and Ketorolac(avoid concomitant use).
* Anion-exchange Resins: Cholestyramine may enhance or reduce anticoagulant
effect.
* Anti-arrhythmics: Amiodarone and Propafenone enhance anticoagulant effect;
Quinidine may enhance anticoagulant effect.
641
* Antibacterials: anticoagulant effect reduced by Rifampicin; anticoagulant effect

enhanced by Cephamandole, Chloramphenicol, Ciprofloxacin, Co-trimoxazole,
Erythromycin, Metronidazole, Ofloxacin, and Sulphonamides; anticoagulant effect
possibly also enhanced by Aztreonam, Clarithromycin and some other
Macrolides, Nalidixic acid, Neomycin, Norfloxacin. Tetracyclines, and
Trimethoprim; although studies have failed to demonstrate interaction, common
experience in anticoagulant clinics is that INR can be altered following course of
oral broad-spectrum antibiotic, such as Ampicilli (may also apply to antibiotics
given for local action on gut such as Neomycin).
* Antidepressants: SSRIs and Viloxazine possibly enhance anticoagulant effect
Antidiabetics: possibly enhanced hypoglycemic effects of Sulphonylureas and
changes to anticoagulant effect.
* Antiepileptics: reduced anticoagulant effect with Carbamazepine and
Phenobarbital; anticoagulant effect possibly increased by Valproate; both
reduced and enhanced effects reported with Phenytoin.
* Antifungals: anticoagulant effect reduced by Griseofulvin; anticoagulant effect
enhanced by Fluconazole, Itraconazole, Ketoconazole, and Miconazole (note:
oral gel absorbed).
* Antimalarials: anticoagulant effect possibly enhanced by Proguanil.
* Antiplatelet Drugs: Aspirin, Clopidogrel and Dipyridamole increase risk of
bleeding due to antiplatelet effect.
* Antivirals: Ritonavir possibly increases plasma concentration.
Anxiolytics and Hypnotics: Chloral may transiently enhance anticoagulant effect
Barbiturates: Anticoagulant effect reduced.
* Corticosteroids: anticoagulant effect possibly altered.
* Cytotoxics: anticoagulant effect possibly enhanced by Ifosfamide.
* Disulfiram: enhanced anticoagulant effect.
* Hormone Antagonists: Aminoglutethimide reduces anticoagulant effect; Danazol,
Flutamide, Tamoxifen and possibly Bicalutamide and Toremifene enhance
anticoagulant effect.
Leukotriene Antagonists: Zafirlukast enhances anticoagulant effect of Warfarin.
* Lipid-regulating Drugs: Fibrate group and Simvastatin enhance anticoagulant
effect.
Raloxifene: antagonism of anticoagulant effect.
* Retinoids: Acitretin possibly reduces anticoagulant effect.
Rowachol: possibly reduced anticoagulant effect.
* Testosterone: anticoagulant effect of Warfarin and Nicoumalone enhanced.
* Thyroxine: enhanced anticoagulant effect.
* Ulcer-healing Drugs: Sucralfate possibly reduces anticoagulant effect (reduced
absorption); Cimetidine and Omeprazole enhance anticoagulant effect.
* Uricosurics: Sulphinpyrazone enhances anticoagulant effect.
Vaccines: Influenza vaccine occasionally enhances anticoagulant effect.
Vitamins: Vitamin K reduces anticoagulant effect; major changes in diet.
(especially involving vegetables) may affect control; vitamin K also present in
some enteral feeds.
Xamoterol
Beta-blockers: antagonism of effect of Xamoterol and reduction in beta-blockade.
Xylometatzoline see Sympathomimetics.

Zafirlukast see Leukotriene Antagonists.
Zalcitabine
Note: Clinical data limited. Avoid use with other drugs that have potential to cause
642
peripheral neuropathy or pancreatitis-for further details consult product literature.

Antacids: possibly reduce absorption.
Antibacterials: Trimethoprim possibly increases plasma concentration of
Zalcitabine.
Uricosurics: Probenecid possibly increases plasma concentration of Zalcitabine.
Zidovudine
Note: Increased risk of toxicity with nephrotoxic and myelosuppressive drugs; for
further details, consult product literature.
Analgesics: increased risk of haematological toxicity with NSAIDs; methadone
possibly increases plasma-zidovudine concentration.
Antibacterials: Clarithromycin tablets reduce absorption of Zidovudine.
Antiepileptics: plasma-phenytoin concentrations increased or decreased; plasma-
Zidovudine concentration possibly increased by Valproate (risk of toxicity).
Antifungals: plasma concentration of Zidovudine increased by Fluconazole
(increased risk of toxicity).
* Other Antivirals: profound myelosuppression with Ganciclovir (if possible avoid
concomitant administration, particularly during initial Ganciclovir therapy).
Uricosurics: Probenecid increases plasma-zidovudine concentration and risk of
toxicity.
Zinc
Antibacterials: reduced absorption of Ciprofloxacin, Moxifloxacin and Norfloxacin,
Tetracyclines reduce absorption of zinc (and vice versa).
Iron: reduced absorption of oral Iron (and vice versa).
Penicillamine: reduced absorption of Penicillamine.
Zinc Orotate see Zinc above.
Zoledronic Acid see Bisphosphonates.

Zonisamide Reduced plasma concentration with phenytoin, phenobarbital, and
carbamazepine. Increased risk of metabolic acidosis with carbonic anhydrase
inhibitors (e.g. acetazolamide).
Zopiclone see Anxiolytics and hypnotics.
Zuclopenthixol see Antipsychotics.
643
APPENDIX 3 : LIVER DISEASES
Appendix- 3
LIVER DISEASES
Drug induced hepatotoxicity has been associated with over 600 drugs. Drugs can
cause direct cellular injury to the liver or otherwise interfere with its function. Acute
liver injury can be cytitoxic or cholestatic. Cytotoxic injury involves direct injury to the
hepatocytes with necrosis that can be localized or diffuse throughout the liver.
Prominent signs and symptoms include fatigue, anorexia, nausea and
jaundice.Cholestatic injury results in a characteristic decrease in bile flow. Hepatic
injury of this type leads to jaundice and pruritus. Chronic liver damage consists of a
group of disorders including chronic hepatitis, steatosis. Pseudo-alcoholic liver
diseases, granulomatous disease and cirrosis. Chronic lesions can result from
continued or repeated exposure to hepatotoxic agents.
Liver injury occurs as the dose of some drugs is increased causing centrizonal
necrosis with paracetamol in overdose and also carbon tetrachloride., Isoniazid,
Methyl dopa and Phenytoin have been associated with direct cytotoxic reactions that
led to mortality rates over 10% or hogher. Hepatocellular necrosis with salicylates,
particularly in patients with collagen diseases, when more than 2gm/day are taken.
Fatty change in liver cells and Hepatic failure occur with tetracyclines with high doses.
Acute Hepatocellular necrosis can be induced by several drugs including general
anaesthetics (halothane), antiepileptics (carbamazepine, phenytoin, sodium
valporate, phenobarbitone), antidepressants (MAO inhibitors), anti-inflammatory drugs
(indomethacin, ibuprofen), antimicrobials (isoniazid, sulphonamides, nitrofurantoin)
and cardiovascular drugs (methyldopa, hydralazine). Chronic active hepatitis may
develop with prolonged use of methyldopa, isoniazid, dantrolene. Hepatic fibrosis or
cirrhosis may be caused by prolonged intake of excess of alcohol and therapeutic use
of methotrexate (for psoriasis). Benign liver tumours may develop when synthetic
androgen, e.g. anabolic steroids usually in high doses and oral contraceptives are
used for more than five years; there is also increased risk of hepatocellular carcinoma,
although the absolute risk of either complication is very low.
It is especially important that drugs should be prescribed for patients with liver disease
only if there is a real need. Patients at greatest risk are those with ascites, jaundice or
evidence of encephalopathy. Pharmacokinetic and pharmacodynamic changes are
caused by liver diseases which may affect adversely to other cells and organs.
Central Nervous System. The brain receives concentrations of toxic substances

(ammonia, amines) to which it is normally not exposed, as a result of failure of liver
cells to metabolise naturally occuring substances and also of shunting of blood from
the portal to the systemic circulation.
Opioids should be avoided as comma may occur, but if an opioid is essential,
pethidine is probably less dangerous than morphine. Lorazepam and oxazepam are
preferred as anxiolytics and temazepam as a hypnotic. Antiepileptic drugs should be
monitored with particular care. Phenobarbitone may induce comma. A tricyclic
antidepressant may be used when anti-depressant therapy is deemed necessary but
MAO inhibitors are hazardous.
Cardiovascular System. Beta-adrenoceptor blockers (e.g. propranolol, labetalol etc)

that are metabolized by liver should be given in reduced initial oral dose, as should
calcium channel antagonists, e.g. nicardipine, nifedipine, or verapamil.
644
Gastrointestinal System. Antacids that contain much sodium may cause fluid
retention and those containing aluminium and calcium may constipate, which
predisposes to encephalopathy as there is greater opportunity for absoption of toxic
substances from the gut.
Infections. Avoid or use in reduced doses of drugs that have known risk of
hepatotoxicity, e.g. isoniazid, erythromycin, rifampicin, tetracyclines.
Endocrine System. Avoid C-17-substituted androgens and anabolic steroids which

are hepatoxic. It is better to avoid combined oral contraceptives especially in
cholestatic liver disease. Metformin is normally inactivated by the liver and should be
avoided as it may cause lactic acidosis.
Ascites. Abrupt diuresis, e.g. with large doses of a loop diuretic, may precipitate
electrolyte imbalance, renal dysfunction and hepatic encephalopathy. In patients who
fail to respond or who develop adverse effects of diuretic therapy, up to 4-6 litres of
ascitic fluid may be removed per day by paracentesis, with simultaneous IV infusion
of albumin (6-8 gm per litre of ascitic fluid) to prevent hypovolaemia.
Portal hypertension and variceal bleeding. Bleeding from rupture of varices is

serious, the mortality from an initial event being up to 50%, and 30% for subsequent
bleeds. If endoscopic expertise is available, bleeding from oesophageal varices can
be stopped by injection of a sclerosing substance or by band ligation.
Viral hepatitis. Chronic hepatitis caused by hepatitis B, C or D may lead to cirrhosis,

hepatocellular failure or hepatocellular carcinoma. Collectively, hepatitis is probably
the commonest of serious viral diseases in general, and constitutes a major health
problem.
The list of drugs to be avoided or used with caution in liver disease is given below
based on current information concerning the use of these drugs in therapeutic dosage:
Drugs Comment
Acamprosate Avoid.
Acarbose Avoid.
ACE inhibitors Most of the ACE inhibitors are associated with liver injury on
chronic use. Use cilazapril, enalapril, fosinopril, imidapril,
moexipril, perindopril, quinapril, ramipril, trandolapril and
monitoring is required for the patients with impaired liver
functions.
Acitretin Avoid, further impairment of liver function may occur.
Alprazolam See Anxiolytics and Hypnotics.
Altretamine Rare reports of hepatotoxicity.
Aminophylline See Theophylline.
Amitriptyline See Antidepressants, Tricyclics.
Amlodipine Half-life prolonged, may need dose reduction.
Anabolic Steroids Preferably avoid, dose related toxicity.
Androgens Avoid, dose related toxicity with some, and produce fluid
retention.
Antacids In patients with fluid retention, avoid those containing large
amounts of sodium e.g. magnesium trisilicate mixture.
Anticoagulants, Oral Avoid in severe liver disease, especially if prothrombin time
already prolonged.
645
Antidepressants, SSRI Reduce dose or avoid in severe liver disease.

Antidepressants, Tricyclics preferable to MAOIs but sedative effects are
tricyclic (and increased (avoid in severe liver disease.)
related)
Antipsycotics All can precipitate coma; phenothiazines are hepatotoxic.
Anxiolytics All can precipitate coma; small dose of oxazepam or
and hypnotics temazepam is probably the safest; reduce oral dose of
clomethiazole or zopiclone or avoid in liver injury ).
Aspirin Avoid, increased risk of gastro-intestinal bleeding.
Atorvastatin See Statins.
Azathioprine May need dose reduction.
Azithromycin Avoid; jaundice is reported.
Bendrofluazid See Thiazides.
Bromazipam See Anxiolytic and Hypnotics.
Budesonide Plasma concentration of Budesonide may increase on oral
administration.
Bupivacaine See Lidocaine.
Buprenorphine See Opioid Analgesics.
Carbamazepine Metabolism is impaired in advanced liver disease.
Carvedilol Avoid.
Ceftriaxone Reduce dose and monitor plasma concentration in both
hepatic and severe renal impairment.
Celecoxib See NSAIDs.
Chloramphenicol Avoid. Increased risk of bone-marrow depression.
Chlorpheniramine Sedation inappropriate in severe liver disease, avoid.
Chlorpromazine See Antipsychotics.
Chlorpropamide See Sulphonylureas.
Cilazapril See ACE Inhibitors.
Cimetidine Increased risk of confusion; reduce dose.
Cinnarizine Sedation inappropriate in severe liver disease;-avoid.
Ciprofloxacin See Quinolones.
Clarithromycin Hepatic dysfunctions including jaundice are reported.
Clobazam See Anxiolytics and Hypnotics.
Clomipramine See Antidepressants, Tricyclic.
Clozapine Initial dose of 12.5mg daily can be increased slowly with
regular monitoring of liver function; avoid in symptomatic or
progressive liver disease or liver failure.
Cyclophosphamide Reduce dose.
Cyclosporin May need dose adjustment.
Cytarabine Reduce dose.
Dalteparin See Heparin.
Daunorubicin Reduce dose.
Dextromethorphan See Opioid Analgesics.
Diazepam See Anoxiolytics and Hypnotics.
Diclofenac See NSAIDs.
Diltiazem Reduce dose.
Diphenhydramine Caution in mild to moderate liver disease; avoid in severe
liver disease if sedation is inappropriate.
Disopyramide Half-life is prolonged; may need dose reduction.
Docetaxel Monitor liver function; reduce dose according to liver
enzymes; avoid in severe hepatic impairment.
Doxazosin No information, manufacturer advises caution.
Doxycycline See Tetracycline.
Droperidol See Antipsychotics.
646
Enalapril See ACE Inhibitors.

Enoxaparin See Heparin.
Entacapone Avoid.
Epoetin Manufacturers advise caution in chronic liver failure.
Ergometrine Avoid in severe liver disease.
Ergotamine Avoid in severe liver disease; risk of toxicity is increased.
Erythromycin May cause idiosyncratic hepatotoxicity.
Estradiol See Oestrogens.
Estriol See Oestrogens.
Felodipine Reduce dose.
Fentanyl See Opioid Analgesics.
Flucloxacillin May cause cholesttic jaundice.
Fluconazole Toxicity with related drugs.
Fluoxetine See Antidepressants, SSRI.
Flupentixol See Antipsychotics.
Fluphenazine See Antipsychotics.
Flurazepam See Anxiolytics and Hypnotics.
Flutamide Use with caution (hepatotoxic).
Fluvastatin See Statins.
Fosfestrol See Oestrogens.
Frusemide See Loop Diuretics.
Fusidic Acid Impaired biliary excretion; may increase risk of
hepatotoxicity; avoid or reduce dose.
Gemfibrozil Avoid in liver disease.
Glibenclamide See Sulphonylureas.
Glimepiride Manufacturer advises avoid in severe liver impairment.
Glipizide See Sulphonylureas.
Gold (auranofin, Avoid in severe liver diseases.
aurothiomalate)
Griseofulvin Avoid in severe liver diseases.
Haloperidol See Antipsychotics.
Halothane Avoid in the history of unexplained pyrexia or jaundice .
Heparin Reduce dose in severe liver disease.
Hydralazine Reduce dose.
Hydrochlorothiazide See Thiazides.
Hydroxyprogesterone See Progesteron.
caproate
Hydroxyzine Sedation inappropriate in severe liver disease; avoid.
Ibuprofen See NSAIDs.
Ifosfamid Avoid.
Imidapril See ACE Inhibitors.
Imipramine See Antidepressants, Tricyclic.
Indapamide See Thiazides.
Indometacin See NSAIDs.
Interferon alfa Close monitoring in mild to moderate liver impairment; avoid
in severe liver disease.
Interferon beta Avoid in decompensated liver disease.
Irinotecan Monitor closely for neutropenia if plasma-bilirubin
concentration increases up to 1.5 times upper limit of normal
range; avoid if plasma-bilirubin concentration is greater than
1.5 times upper limit of normal range.
Isoniazid Avoid if possible; idiosyncratic hepatotoxicity is common.
Isotretinoin Avoid; further impairment of liver function may occur.
Isradipine Reduce dose.
647
Itraconazole Half-life is prolonged; dose reduction may be necessary.

Ketoconazole Avoid.
Ketoprofen See NSAIDs.
Ketorolac See NSAIDs.
Ketotifen Sedation inappropriate in severe liver disease; avoid.
Lacidipine Antihypertensive effect is possibly increased.
Lamotrigine Try to avoid.
Lansoprazole In severe liver disease dose should not exceed 30mg daily.
Levonorgestrel See Progesterones.
Lidocaine Avoid (or reduce dose) in severe liver disease.
Lignocaine See Lidocaine.
Loop Diuretics Hypokalaemia may precipitate coma (use potassium-spring
diuretic to prevent this); increased risk of hypomagnesaemia
in alcoholic cirrhosis.
Maprotiline See Antidepressants, Tricyclic (and related).
Mefenamic Acid See NSAIDs.
Mefloquine Avoid for prophylaxis in severe liver disease.
Meloxicam See NSAIDs.
Meropenem Monitor transaminase and bilirubin concentrations.
Mesterolone See Androgens.
Metformin Avoid; increased risk of lactic acidosis.
Methyldopa Manufacturer advises caution in history of liver disease;
avoid in active liver disease.
Metoclopramide Reduce dose.
Metronidazole In severe liver disease reduce total daily dose to one-third,
and give once daily.
Mainserin See Antidepressants, Tricyclic (and related).
Miconazole Avoid.
Morphine See Opioid Analgesics.
Nalidixic Acid See Quinolones.
Nandrolone See Anabolic Steroids.
Naproxen See NSAIDs.
Neomycin Increased risk of ototoxicity.
Nefedipine Reduce dose.
Nimodipine Elimination is reduced in cirrhoss; monitor blood pressure
Nitrazepam See Anxiolytics and Hypnotics.
Nitrofurantoin Cholestatic jaundice and chronic active hepatitis are
reported
Nitroprusside Avoid in severe liver disease.
Norethisterone See Progesterone.
Norfloxacin See Quinolones.
Norgestrel See Progesterone.
Nortriptyline See Antidepressants, Tricyclic.
NSAIDs Increased risk of gastro-intestinal bleeding and can cause
fluid retention; avoid in severe liver disease; aceclofenac:,
use initially 100 mg daily; rofecoxib max 12.5 mg daily in
mild impairment.
Oestrogens Avoid; See also Contraceptives (Oral).
Ofloxacin See Quinolones.
Olanzapine Consider initial dose of 5mg daily.
Omeprazole Not more than 20 mg daily should be used.
Ondasetron Reduce dose; use not more than 8 mg daily in severe liver
disease.
Opioid Analgesics Avoid or reduce dose, may precipitate coma.
648
Oxazepam See Anxiolytics and Hypnotics.

Oxcarbazepine No dosage adjustment required in mild to moderate
impairment; no information in severe impairment
Oxprenolol Reduce dose.
Oxytetraycline See Tetracyclines.
Paclitaxel Avoid in severe liver disease.
Pancuronium Possibly slower onset, higher dose requirement and
prolonged recovery time.
Paracetamol Dose-related toxicity; avoid large doses.
Pentazocine See Opioid Analgesics.
Pethidine See Opioids Anlagesics.
Pheniramine Sedation inappropriate in severe liver disease, avoid.
Phenobarbital May precipitate coma.
Phenytoin Reduce dose to avoid toxicity.
Pholcodine See Opioids Analgesics.
Pilocarpine Reduce initial oral dose in moderate or severe cirrhosis.
Piracetam Avoid.
Piroxicam See NSAIDs.
Prazosin Initial 500 microgram daily dose can be increased with
caution.
Prednisolone Side-effects are more common.
Prochlorperazine See Antipsychotics.
Progesterone Avoid.
Promethazine Avoid; may precipitate coma in severe liver disease;
hepatotoxic.
Propranolol Reduce dose.
Propylthiouracil May cause chronic active hepatitis

Pyrazinamide Avoid; idiosyncreatic hepatotoxicity is more common.
Quinolones Hepatitis with necrosis is reported with ciprofloxacin;
hepatitis is also reported for norfloxacin; nalidixic acid is
partially conjugated in liver; reduce dose of ofloxacin in
severe liver disease.
Ranitidine Increased risk of confusion; reduce dose.
Rifampicin Impaired elimination; may increase risk of hepatotoxicity;
avoid or do not exceed 8 mg/kg daily.
Risperidone Manufacturer advices initial dose of 500 micrograms twice
daily; stepwise increase of dose to 1-2 mg twice daily is
possible.
Rivastigmine No information available;-manufacturer advises avoid in
sever liver disease.
Rofecoxib See NSAIDs.
Saquinavir Plasma concentration is possibly increased; manufacturer
advises caution with fortovase (Saquinavir) in moderate
impairment; avoid fortovase in severe impairment.
Sertraline See Antidepressants, SSRI.
Simbastatin See Statins.
Sodium
aurothiomalate See Gold.
Sodium Fusidate See Fusidic Acid.
Sodium Nitroprusside See Nitroprusside.
Sodium Valproate See Valproate.
Statins Avoid in active liver disease or unexplained persistent
elavations in serum transaminases.
649
Sulindac See NSAIDs.

Sulpiride See Antipsychotics.
Sulfonamides Increased risk of chronic hepatitis; AIDS patients are more
sensitive
Sulphonylureas Increased risk of hypoglycemia in severe liver disease; avoid
or use small dose; can produce jaundice.
Suxamethonium Prolongd apnoea may occur in severe liver disease due to
reduced hepatic synthesis of pseudocholinesterase.
Tenoxicam See NSAIDs.
Terbinafine Reduce dose.
Testosterone See Androgens.
Tetracyclines Avoid (or use with caution).
Theophylline Reduce dose.
Thiazides Avoid in severe liver disease; hypokalaemia may precipitate
coma (potassium sparing diuretic can prevent); increased
risk of hypomagnesaemia in alcoholic cirrhosis.
Thiopental Reduce dose for induction in severe liver disease.
Thioridazine See Antipsychotics.
Ticlopidine Manufacturer advises caution; discontinue if hepatitis or
jaundice develop.
Tramadol See Opioid Analgesics.
Tretinoin (Oral) Reduce dose.
Trifluoperazine See Antipsychotics.
Trimipramine See Antidepressants, Tricyclic.
Valproate Avoid if possible, hepatotoxicity and liver failure may
occasionally occur.
Valsartan Halve dose in mild to moderate hepatic impairment; avoid if
severe.
Verapamil Reduce oral dose.
Vinblastine Dose reduction may be necessary.
Vincristine Dose reduction may be necessary.
Warfarin See Anticoagulants, oral.
Zafirlukast Manufacturer advises avoid in liver diseases.
Zalcitabine Further impairment of liver function may occur.
Zaleplon See Anxiolytics and Hypnotics.
Zidovudine Accumulation may occur.
Zopiclone See Anxiolytics and Hypnotics.
Zuclopenthixol See Antipsychotis.
650
APPENDIX 4 : RENAL IMPAIRMENT
Appendix- 4
RENAL IMPAIRMENT
Kidney is an important organ in regulating body fluid levels, electrolyte balance and
removal of metabolic waste products and drugs (intact and/or metabolites) from the
body.
Renal impairment or renal failure (chronic and acute) is a reduced functional activity of
kidney. Some common causes or renal impairment are pyelonephritis, hypertension,
diabetes mellitus, nephrotoxic drugs/metals, hypovolemia or hypoperfusion and
nephroallergens.
Problems faced by renal impaired patient on drugs :

As most of the drugs and their metabolites have to encounter kidney prior to excretion
from the body, the rate and extent of their excretion from the body largely depend on
the functional activity of the kidney. Therefore a patient with reduced renal function
(renal insufficiency) develops primarily accumulation of drugs and or metabolites
(inactive or active) or both in his/her body and eventually gets exposed to the following
problems:
• Accumulation of drugs and / or its metabolites may produce toxicity.
• Sensitivity to some drugs may be increased.
• Poor tolerance to many common and new side-effects.
• Reduction in efficacy of some drugs.
However many of the before mentioned problems can be avoided by simply adjusting
(reducing) the dose or using an alternative drug which is therapeutic equivalent.
Diagnosis and assessment of renal failure:

Renal function is indicated by Glomerular Filtration Rate (GFR), which is in turn
clinically measured by the creatinine clearance or blood urea nitrogen (BUN) levels.
The serum creatinine concentration provides only a rough guide for the assessment of
renal impairment unless corrected for age, weight and sex. For prescribing purpose,
renal impairment is divided into five stages of chronic kindey disease and GRF
including :
Stages Grade GFR Serum Creatinine level

Normal No protein in the 90-130 mL/min/ 1.73m2 Men: 0.6–1.2 (mg/100mL)
urine Women: 0.5–1.1 mg/100mL
Child: 0.3–0.7 mg/100mL
Stage 1 Protein in the urine > 90 mL/min/ 1.73m2 1.2-1.5 (mg/100mL), men
Stage 2 Mild CKD 60-89 mL/min/ 1.73m2 1.6-2.8 (mg/100mL), men
Stage 3A Moderate CKD 45-59 mL/min/ 1.73m2 2.9 -3.9 (mg/100mL), men
Stage 3B Moderate CKD 30-44 mL/min/ 1.73m2 4.0-5. 0 (mg/100mL), men
Stage 4 Severe CKD 15-29 mL/min/ 1.73m2 5.1-7.5 (mg/100mL), men
Stage 5 End Stage Renal <15 mL/min/ 1.73m2 7.6 (mg/100mL) and above,
Disease (ESRD) men
651
Principles of dose adjustment in renal impairment :

Alteration in renal clearance of drugs in renal impairment is by far the most important
parameter to consider while making dosage calculation. In clinical practice the
estimation of the appropriate drug dosage regimen in renally impaired patient is
primarily focused on the remaining renal function of the patient and a prediction of the
total body clearance (ClT). The loading dose of a drug is based on apparent volume of
distribution (VD) of the patient. Generally, drugs in patients with uremia or kidney
impairment have prolonged elimination half-lives and a change in the apparent volume
of distribution. But practically the apparent volume of distribution of drug in renally
impaired patient is assumed to be same as that of normal patients. Consequently, the
methods for dose adjustment in renally impaired patients are based on an accurate
estimation of the drug clearance in these patients.
The maintenance dose is based on the clearance of the drug in the patient and hence
it has to be individualized for such patients. Generally two pharmacokinetic
approaches for dosage adjustment in clinical situation have been used monitoring
kidney function which includes:-
a) dosage adjustment method based on drug clearance-
To maintain the same desired Cav, the dose must change to Duo or the dosage
interval must change to u, as shown in the following equation.
Cav = DN0 / ClNT. N = DR0 / ClRT. R….(i)

(normal) (renally impaired)
ClRT . R
DR0 = DN0 ×-----------
ClNT . N
Where,
Cav = average plasma concentration
DR0 = dose for renally impaired patient
DN0 = dose for normal patient
ClRT = Clearance for renally impaired paitent
ClNT = Clearance for normal patient
R = Dosing interval for renal impaired patient
N = Dosing interval for normal patient
If dosing interval () is kept unchanged (R = N), the adjusted dose of renally impaired
patients (DR0) will be equal to a fraction (ClRT / ClNT) of the normal dose, as shown in
the equation-
ClRT
DR0 = DN0 ×-------- …..… (ii)
ClNT
b) dosage adjustment method based on changes in drug elimination rate constant-

The overall elimination rate constant for many drugs is reduced in the renally impaired
patients. A dosage regimen may be designed for such renally impaired patients either
1. by reducing the normal dose of the drug and keeping the frequency of
dosing or dosage interval () constant or
2. by decreasing the frequency of dosing (prolong the dosage interval) and
keeping the dose constant.
652
According to above equations, keeping dosing interval () unchanged (R = N), the
usual approach to estimate a multiple-dosage regimen in the renally impaired patients
the maintenance dose will be-
ClRT
DR0 = DN0 ×-------- …..… (ii)
ClNT
Putting the ClT = K.VD in both normal and renally impaired patients the equation is -
KR.VDR
R N
D 0 = D 0 ×--------
KN.VDN
Where,
KN = elimination rate constant of normal patient
KR = elimination rate constant of renally impaired patient
VDN = volume of distribution of normal patient
VDN = volume of distribution of renally impaired patient
Assuming VD is same in both normal and uremic patients, the uremic dose Du0 is a
fraction (kR/kN) of the normal dose-
KR
DR0 = DN0 ×-------- …..… (iv)
KN
N.B.: Drugs with known nephrotoxicity should be, if possible, avoided in patients with
renal failure or disease.
Drugs Degree of Impairment Comment
Acarbose Moderate to severe Avoid; no information available.

Acebutolol Mild to moderate See Beta-blockers.
Acetazolamide Mild Avoid; metabolic acidosis.
Aciclovir Moderate to severe Reduce intravenous dose.
Acrivastine Moderate Moderate Avoid; excreted by kidney.
ACE inhibitor Mild to moderate Use with caution and monitor
response. Hyperkalamia and other
side-effects more common.
Captopril :12.5 mg b.i.d.
Cilazapril: 500 microgm once daily.
Enalapril: 2.5 mg once daily.
Imidapril: 2.5 mg once daily.
Moexipril: 3.75 mg once daily.
Perindopril: 2 mg once daily.
Quinapril: 2.5 mg once daily.
Ramipril: 1.25 mg once daily.
Trandorapril: 500 micrograms daily.
Alprazolam Severe See Anxiolytics and Hypnotics.
Amikacin Mild See Aminoglycosides.
Aminoglycosides Mild Reduce dose and monitor plasma
concentrations.
Amoxicillin Severe Reduce dose; rashes more
common.
Ampicillin Severe Reduce dose; rashes more
common.
653
Anxiolytics and Severe Start with small dose; increased

hypnotics cerebral sensitivity.
Anti psychotics Severe Start with small doses; increased
cerebral sensitivity.
Aspirin Severe Avoid; sodium and water retention;
deterioration in renal function;
increased risk of gastro-intestinal
bleeding.
Atenolol Mild, Moderate See Beta Blockers.
Azithromycin Moderate No information available
Balsalazide Moderate Avoid.
Beta-Blockers Mild, Start with 2.5 mg of nebivolol.
moderate Start with small dose; acebutolol
reduce dose of atenolol, nadolol,
pindolol, sotalol.
All excreted unchanged.
Severe Start with small dose; higher
plasma concentrations after oral
administration; may reduce renal
blood flow and adversely affect
renal function in severe
impairment.
Bendrofluazide See Thiazide.
Betaxolol See Beta Blockers.
Bleomycin Moderate Reduce dose.
Bromazepam See Anxiolytics and Hypnotics.
Captopril See ACE Inhibitors.
Carbamazepine Take caution.
Cefalexin Severe Max. 500 mg daily.
Cefazolin Mild Reduce dose.
Cefotaxime Severe Use half dose.
Ceftazidime Mild Reduce dose.
Ceftriaxone Severe Reduce dose; also monitor plasma
concentration if both severe renal
renal and hepatic impairment.
Cefuroxime Moderate to Reduce parenteral dose.
Severe
Celecoxib See NSAIDs.
Cetirizine Moderate Use half dose.
Chloramphenicol Severe Avoid unless no alternative; dose-
related depression of
haematopoiesis.
Chloroquine Mild to Moderate Reduce dose.
Severe Avoid (but for malaria prophylaxis
adjust dose).
Chlorpromazine See Antipsychotics.
Chlorpropamide Avoid.
Chlortetracycline See Tetracyclines.
Cilazapril See ACE Inhibitors.
Climetidine Mild to Moderate 600-800 mg daily;
occasional risk of confusion
Severe 400 mg daily.
Ciprofloxacin Moderate Use half dose.
Cisplatin Mild Avoid if possible; nephrotoxic and
neurotoxic.
Clarithromycin Moderate Use half dose.
654
to Severe neurotoxic.
Clavulanic Acid See Coamoxiclav.
Clobazam See Anxiolytics and Hypnotics.
Clozapine Mild to Initial dose 12.5 mg daily.
Moderate
Cotrimoxazole Moderate Reduce dose; rashes and blood
disorder may cause further
deterioration in renal function.
Cycophosphamide Reduce dose.
Cyclosporin See Ciclosporin.
Dalteparin See Heparin.
Dextromethorphan See Opioid Analgesics.
Diazepam See Anxiolytics and Hypnotics.
Diclofenac See NSAIDs.
Digoxin Mild Reduce dose; toxicity increased by
electrolyte disturbances.
Disopyramide Mild 100 mg every 8 hours or 150 mg
every 12 hours.
Moderate 100 mg every 12 hours.
Severe 150 mg every 24 hours.
Doxycycline See Tetracyclines.
Droperidol See Antipsychotics.
Enalapril See ACE Inhibitors.
Ergometrine Severe Avoid.
Ergotamine Moderate Avoid; nausea and vomiting; risk of
renal vasoconstriction.
Erythromycin Severe Max. 1.5 gm daily (ototoxicity).
Ethambutol Mild Reduce dose; if creatinine
clearance less than 30 ml/minute;
monitor plasma ethambutol
concentration; optic nerve damage.
Famotidine Severe Reduce dose.
Fenoprofen See NSAIDs.
Flucloxacillin Severe Reduce dose.
Fluconazole Mild to Usual initial dose then halve the
Moderate subsequent doses.
Fluoxetine Mild to Reduce dose (give on
Moderate alternate days).
Severe Avoid.
Flupenthixol See Antipsychotics.
Fluphenazine See Antipsychotics.
Flurazepam See Anxiolytics and Hypnotics.
Fluvastatin Severe Avoid.
Fosinopril See ACE Inhibitors.
Floxacin Mild Usual initial dose, then use half
dose.
Moderate Usual initial dose, then 100 mg
every 24 hours.
Frusemide See Furosemide.
Gallamide Moderate Avoid; prolonged paralysis.
Gemfibrozil Severe Start with 900 mg daily.
Gentamicin See Aminoglycosides.
Glimepiride Severe Avoid.
Glipizide Mild to moderate Increased risk of hypoglycaemia;
avoid if hepatic impairment also
present.
655
Severe Avoid.
Haloperidol See Antipsychortics.
Heparin Severe Risk of bleeding increased.
Hydrochlorothiazide See Thiazides.
Ibuprofen See NSAIDs.
Ifosfamide Mild Avoid if serum creatinine
concentration greater than
120 µmol/litre.
Imidapril See ACE Inhibitors.
Indapamide See Thiazides.
Indometacin See NSAIDs.
Insulin Severe May need dose reduction; insulin
requirements fall; compensatory
response to hypoglycaemia is
impaired.
Interferon alfa Mild to Close monitoring.
Moderate required.
Severe Avoid.
Interferon beta No information available-monitoring
advised.
Irinotecan No information available.
Isoniazid Severe Max. 200 mg daily; peripheral
neuropathy.
Isotretinoin Mild Avoid; Increased risk of toxicity
Itraconazole Bioavailability possibly reduced.
Kanamycin See Aminoglycosides.
Ketoprofen See NSAIDs.
Ketorolac See NSAIDs.
Lamotrigine Moderate to Metabolite may.
Severe accumulate.
Lamivudine Mild Reduce dose; consult product
literature.
Lisinopril See ACE Inhibitors.
Lithium Mild Avoid if possible or reduce dose
and monitor plasma concentration
carefully.
Lorazepam See Anxiolytics and Hypnotics.
Losartan Moderate to Start with 25 mg once .
Severe daily.
Mefenamic Acid See NSAIDs.
Meloxicam See NSAIDs.
Melphalan Reduce dose initially; avoid high
doses in moderate to severe
impairment.
Mercaptopurine Moderate Reduce dose.
Meropenem Mild Increase dose interval to every
12 hours.
Metformin Mild Avoid; increased risk if lactic
acidosis.
Methyldopa Moderate Start with small dose; increased
sensitivity to hypotensive and
sedative effect.
Metoclopramide Severe Avoid or use small dose;
increased risk of extrapyramidal
reactions.
Metoprolol See Beta Blockers.
656
Midazolam See Anxiolytics and Hypnotics.

Morphine See Opioid Analgesics.
Naproxen See NSAIDs.
Neomycin Mild Avoid; ototoxic; nephrotoxic.
Neostigmine Moderate May need dose reduction.
Netilmicin See Aminoglycosides.
Nicotine Severe May affect clearence of nicotine or
its metabolities.
Nitrazepam See Anxiolytics and Hypnotics.
Nitrofurantoin Mild Avoid; peripheral neuropathy;
ineffective because of inadequate
urine concentrations
Norfloxacin Mild to Halve dose if creatinine clearance
Moderate less than 30 ml/minute.
NSAIDs Mild Use lowest effective dose and
monitor renal function; sodium and
water retention ; deterioration in
renal function possibly leading to
renal failure; deterioration also
reported after topical use.
Moderate to Severe Avoid if possible.
Olanzapine Consider initial dose of 5 mg daily.
Oxazepam See Anxiolytics and Hypnotics.
Oxytetracycline See Tetracyclines.
Pancuronium Severe Prolonged duration of block.
Penicillamine Mild Avoid if possible or reduce dose;
naphrotoxic.
Pentazocine See Opioid Analgesics.
Pentoxifylline
(oxpentifylline) Mild Reduce dose by 30-50% if
creatinine clearance less than
30 ml/minute.
Pethidine See Opioid Analgesics.
Pholcodine See Opioid Analgesics.
Pilocarpine Caution with tablets.
Pindolol See Beta blockers.
Pipotiazine See Antipsychotics.
Piroxicam See NSAIDs.
Povidone Iodine Severe Avoid regular application to
inflamed or broken mucosa.
Prazosin Moderate to Initially 500 microgram
Severe daily; increase with caution.
Procarbazine Moderate Reduce dose.
Prochlorperazine See Antipsychotics.
Promazine See Antipsychotics.
Propranolol See Beta Blockers.
Pseudoephedrine Severe Avoid; increased CNS
toxicity.
Quinine Reduce parenteral maintenance
dose for malaria treatment.
Ramipril See ACE Inhibitors.
Ranitidine Severe Use half normal dose;
occasional risk of confusion.
Risperidone Initial dose of 500 micrograms
twice daily increased in steps of
500 micrograms twice daily to 1-2
657
mg twice daily.
Rofecoxib See NSAIDs.
Simvastatin Moderate to Doses above 10 mg
Severe daily should be used with caution.
Sodium Bicarbonate Severe Avoid; specialised role
in some forms of renal disease.
Sodium Clodronate See Clodronate Sodium.
Sodium Nitroprusside See Nitroprusside.
Sodium Salts Severe Avoid.
Sodium valproate See Valproate.
Spironolactone See Diuretics, potassium-sparing.
Sucralfate Severe Avoid; aluminium is absorbed and
may accumulate.
Sulfadiazine Severe Avoid; high risk of crystalluria.
Sulfasalazine Moderate Risk of toxicity including .
crystalluria-ensure high fluid intake
Severe Avoid.
Sulpiride Moderate Avoid if possible, or reduce dose.
Tenoxicam See NSAIDs.
Terbinafine Mild Use half normal dose.
Tetracycline Avoid, use doxycycline or
(except doxycycline minocycline if necessary;
and minocycline mild) anti-anabolic effect, increased
plasma urea, further deterioration
in renal function.
Thiazides and Moderate Avoid; ineffective (metolazone
related diureties remains effective but risk of
excessive diuresis).
Timolol See Beta blockers.
Tobramycin See Aminoglycosides.
Tramadol See Opioid Analgesics.
Triamterene See Diuretics, potassium-sparing.
Trimethoprim Moderate Reduce dose.
Valsartan Moderate to Start with 40 mg once
Severe daily.
Warfarin See Anticoagulants, Oral.
Zafirlukast Moderate to Caution to be taken.
Severe
Zalcitabine Mild to 750 micrograms every.
Moderate 12 hours.
Severe 750 micrograms daily.
Zidovudine Severe Reduce dose; manufacturer
advises oral dose of 300-400 mg
daily.
Zopiclone See Anxiolytics and Hypnotics.
Zuclopenthixol See Antipsychotics.
Fluids/Solutions used in Haemodialysis
Acetic Acid 0.469 % + Calcium Chloride 1.008 % + Magnesium Chloride 0.754 %

+ Potassium Chloride 0.554 % + Sodium Chloride 21.968 %
Not Available in the market
658
Dextrose Anhydrous 7 % + Sodium Chloride 0.561 %
Not available in the market
Calcium Chloride 9 mg + Dextrose Anhydrous 70 mg + Magnesium Chloride

1.189 mg + Potassium Chloride 594.57 mg + Sodium Acetate 0.03 mg + Sodium
Chloride 5.94 mg in 100 mL
Calcium Chloride 22 mg + Dextrose Anhydrous 1.5 gm + Magnesium Chloride 15

mg + Potassium Chloride 22 mg + Sodium Acetate 476 mg + Sodium Chloride
556 mg in 100 mL
Calcium Chloride 257 mg + Dextrose Anhydrous 3.86 gm + Magnesium Chloride

15.2 mg + Sodium Acetate 369 mg + Sodium Chloride 561 mg in 100 mL
Not available in the market.
Calcium Chloride 9.74 gm + Glacial Acetic Acid 8.84 gm + Magnesium Chloride

3.74 gm + Potassium Chloride 5.50 gm + Sodium Chloride161.43 gm in 1000 mL
Dialyte-A 10L; Maximum retail price: Tk. 450.87/=; Popular Pharmaceuticals Ltd
Renal Care –A 10L, MRP: Tk. 409.93/=; Greenland Pharmaceuticals Ltd
Calcium Chloride Dihydrate 5.14 gm + Magnesium Chloride 3.56 gm +

Potassium Chloride 5.2 gm + Sodium Acetate 181.01+ Sodium Chloride 198.4gm
in 1000 mL
Dialyte-AC 10L; Maximum retail price: Tk. 490.29/=; Popular Pharmaceuticals Ltd
Renal Care-AC 10L; MRP: Tk. 462.26/=; Greenland Pharmaceuticals Ltd
Sodium Bicarbonate 66 gm + Sodium Chloride 30.5 gm in 1000 mL
Renal Care-B; Retail price: Tk. 358.93/= for 10L solution, Popular Pharmaceuticals Ltd
Renal Care-B 10L; MRP: Tk. 327.07/= Greenland Pharmaceuticals Ltd
659
APPENDIX 5 : PREGNANCY
Appendix- 5
PREGNANCY
When prescribing it should be kept in mind that drugs can have harmful effects on the
embryo or fetus at any time during pregnancy, so the expected benefit to the mother
must be greater than the risk to the fetus. Drugs that have been extensively used in
pregnancy and appear to be usually safe should be prescribed in preference to new or
untried drugs. Lists of drugs are mentioned below that should be avoided or used with
caution in pregnancy. Absence of a drug from the list does not imply safety.
The US FDA has divided all the drugs in 6 categories depending upon the studies
undertaken on human and animal, which are much good implication of safety and
easier to understand, so FDA pregnancy drug category is included here for quick
access. Whereas category ‘A’ stands for the safest drug category ‘X’ stands for
potentially harmful drugs which must be avoided. Category ‘B’ and ‘C’ drugs have
shown toxicity in animals but category ‘B’ has failed to prove toxicity in humans.
Category ‘D’ drugs are dangerous.
Drugs FDA Comments (Trimester risks 1,2,3)

pregnancy
drug
category
Abacavir C All treatment options need careful
assessment.
Acamprosate C Avoid
calcium
Acarbose B Avoid; insulin is substituted 1, 2, 3
Aceclofenac D Avoid the use of NSAIDs during pregnancy

or avoid them unless the potential benefit
outweighs the risk. It should be avoided
during the third trimester because use is
associated with a risk of closure of fetal
ductus arteriosus in utero and possibly
persistent pulmonary hypertension of the
newborn.3
Acemetacin D Avoid the use of NSAIDs during pregnancy
or avoid them unless the potential benefit
outweighs the risk. It should be avoided
during the third trimester because use is
associated with a risk of closure of fetal
ductus arteriosus in utero and possibly
newborn.
Acetazolamide C Toxicity in animal studies; avoid, especially
in first trimester.
Acetylcysteine B Acetylcysteine is only recommended for use
during pregnancy when benefit outweighs
risk.
660
Acetylsalicylic D Delayed onset and increased duration of

acid or Aspirin labour with increased blood loss; avoid in
last few weeks at analgesic doses; low
doses probably not harmful; high doses
cause closure of fetal ductus arteriosus in
utero and persistent newborn.3
Acitretin X Avoid—teratogenic; effective contraception
must be used
Acrivastine B No evidence of teratogenicity except for
hydroxyzine where toxicity has been
reported with high doses in animal studies.
The use of sedating antihistamines in the
latter part of the third trimester may cause
adverse effects in neonates such as
irritability, paradoxical excitability and
tremor.
Acyclovir B Use only when potential benefit outweighs
the risks; limited absorption from topical
preparations.
Adefovir dipivoxil C Toxicity in animal studies , use only if
potential benefit outweighs risk; effective
contraception needed during treatment
Adenosine C Large doses may produce fetal toxicity; use
only if potential benefit outweighs risk.
Adrenaline C May reduce placental perfusion and can
delay 2nd stage of labour; use only if
benefit outweighs risk
Agomelatine Avoid
Albendazole C Should not be used in pregnant women

except in clinical circumstances where no
alternative management is appropriate.
Alcohol Regular intake is teratogenic (fetal alcohol
syndrome) and may cause growth
retardation. Withdrawal syndrome may
occur in babies of alcoholic mother. 1, 2, 3
Alendronate C Avoid.
sodium
Alendronic acid C Avoid.
Alfuzosin B Alfuzosin should only be given during

pregnancy when need has been clearly
established.
Aliskiren D Avoid, no information available; other drugs
acting on the renin-angiotensin system have
been associated with fetal malformations
and neonatal death.
Allopurinol C Avoid; use only when there is no alternative
and disease carries risk for mother or child.
3
661
Allystrenol C Use only when potential benefit outweighs

the risks;
Almotriptan C Limited experience of using 5HT1-receptor
agonists during pregnancy; they should be
avoided unless the potential benefit
outweighs the risk.
Alprazolam D Avoid (during late pregnancy or labour, high
doses may cause neonatal hypothermia,
hypotonia and respiratory depression). 1,2,3
Alverine citrate Use with caution.
Amantadine C Avoid; toxicity in animal studies.
Ambrisentan X Avoid (teratogenic in animal studies);

exclude pregnancy before treatment and
ensure effective contraception during
treatment; monthly pregnancy tests advised.
Amikacin D Chance of damage of 8th cranial nerve; if
prescribed then monitor plasma
concentration. 2,3
Amiloride B Avoid. 1,2,3
Aminocaproic C Aminocaproic acid is only recommended for

acid use during pregnancy when benefit
outweighs risk.
Aminophylline C Asthma should be well controlled during
pregnancy.
Amiodarone D Possible risk of neonatal goitre; use only if
no alternative is available.
Amitriptyline C Use only if potential benefit outweighs risk
Amlexanox B Should be used during pregnancy only if

clearly needed.
Amlodipine C Avoid, but risk to fetus should be balanced
against risk of uncontrolled maternal
hypertension.
Amoxicillin B Not known to be harmful
Amphotericin B Avoid unless potential benefit outweighs

risk.
Anastrozol D Avoid.
Aprepitant B Avoid unless potential benefit outweighs

risk.
Aripiprazole C Use only if potential benefit outweighs risk.
Artemether with C Toxicity in animal studies with artemether;

lumefantrine use only if potential benefit outweighs risk.
662
Artesunate Use only if potential benefit outweighs risk.
Asenapine C Use only if potential benefit outweighs risk,

toxicity in animal studies.
Atenolol & D Cause intrauterine growth retardation,
acebutolol neonatal hypoglycemia and bradycardia.3
Atomoxetine C Avoid unless potential benefit outweighs
risk.
Atorvastatin X Should be avoided in pregnancy as
congenital anomalies have been reported
and the decreased synthesis of cholesterol
possibly affects fetal development.
Adequate contraception is required during
treatment and for 1 month afterwards.
Atracurium C Avoid unless benefit outweighs risk. There
may be fetal distress (slower to start
breathing)1,2
Atropine C Prescribe with caution.
Azathioprine C Treatment should not generally be initiated

during pregnancy. Transplant patients
immuno-suppressed with this drug should
not be discontinued if not becoming
pregnant; intra-uterine growth retardation;
there is on evidence that this drug is
teratogenic. (see cytotoxic drugs)1,2,3
Azelaic Acid B Should only be used during pregnancy

when need has been clearly established.
Azilsartan C Should be avoided in pregnancy unless
medoxomil essential. They may adversely affect fetal
and neonatal blood pressure control and
renal function; skull defects and
oligohydramnios have also been reported.
Azithromycin B No adverse fetal outcomes were reported.
Aztreonam B Avoid unless essential.
Bacitracin C Potential benefits may warrant use of the

drug in pregnant women despite potential
risks.
Baclofen C Potential benefits may warrant use of the
risks.
Bambuterol C Asthma should be well controlled during
pregnancy.
Beclometasone C Asthma should be well controlled during
dipropionate pregnancy.
663
Benzalkonium N Prescribe with caution.

Chloride
Benzocaine C Benzocaine topical is only recommended for
use during pregnancy when benefit
outweighs risk.
Betahistine B Manufacturers advise to avoid.
hydrochloride
Betaine C Avoid; manufacturer advises effective
contraception during and for at least 1
month after treatment in men or women.
Betamethasone C Transient effect on fetal movements and
heart rate.
Betaxolol C Use when benefit outweighs risk.
Bevacizumab C Avoid, toxicity in animal studies; effective

contraception required during and for at
least 6months after treatment in women.
Bimatoprost C Use only if potential benefit outweighs risk.
Bisacodyl B Animal studies have failed to reveal

evidence of teratogenicity or fetotoxicity.
Bismuth X Avoid.
subcitrate/subsali
cylate
Bisoprolol C Beta-blockers may cause intra-uterine
fumarate growth restriction, neonatal hypoglycaemia,
and bradycardia; the risk is greater in
severe hypertension. If beta-blockers are
used close to delivery, infants should be
monitored for signs of beta-blockade.(and
alpha-blockade with labetalol or carvedilol).
Bosentan X Avoid (teratogenic in animal studies);
effective contraception required during
administration (hormonal contraception not
considered effective); monthly pregnancy
tests are advised.
Bromazepam D Prescribe with caution; discourage regular
use; high
doses during late pregnancy or labour may
cause neonatal hypothermia, hypotonia and
respiratory depression.
Brimonidine B Use only if benefit outweighs risk.

tartrate
Brinzolamide C Avoid; toxicity in animal studies.
Bromfenac C Should be avoided during late pregnancy.
Bromocriptine B Exclude pregnancy before starting and

664

months), discontinue if pregnancy occurs
during treatment (specialist advice needed).
Budesonide B,C Transient effect on fetal movements and
heart rate.
Bumetanide C Avoid, should not be used to treat
gestational hypertension because of the
maternal hypovolemia associated with this
condition.
Bupivacaine C Large doses during delivery can cause
neonatal respiratory depression, hypotonia,
and bradycardia after epidural block; use
lower doses for intrathecal use during late
pregnancy.
Buprenorphine C Acute withdrawal of opioids should be
avoided in pregnancy because it can cause
fetal death. Opioid substitution therapy is
recommended during pregnancy because it
carries a lower risk to the fetus than
continued use of illicit drugs.
Bupropion C Manufacturer advises avoid.
hydrochloride
Buspirone B Manufacturer advises avoid.
hydrochloride
Busulphan D Avoid; toxicity in animal studies; effective
contraceptive measure must be taken
during administration in women.
Butenafine B Use only if benefit outweighs risk.
Cabergoline D Exclude pregnancy before starting and

months), discontinue if pregnancy occurs
during treatment (specialist advice needed).
Calcipotriol C Avoid if possible.
Calcitonin C Avoid unless benefit outweighs risk; toxicity

in animal studies.
Candesartan D Should be avoided in pregnancy unless
cilexetil essential. They may adversely affect fetal
Capecitabine D Women of childbearing potential be advised
to avoid becoming pregnant while receiving
treatment with it.
Capsaicin B Should be used during pregnancy only
when benefit outweighs risk.
Captopril D Avoid; may adversely affect fetal and
neonatal blood pressure control and renal
function; skull defects and oligohydramnios;
665
toxicity in animal studies. 1, 2, 3
Carbamazepine D Teratogenic; increased risk of neural tube

defects if used in first trimester; neonatal
bleeding if used in third trimester.
1, 3
Carbimazole Neonatal goitre and hypothyroidism if used
in second or third trimester 2,3
Carbocysteine Avoid. 1
Carboplatin D Avoid.
Carvedilol C Beta-blockers may cause intra-uterine

growth restriction, neonatal hypoglycaemia,
severe hypertension. Information on the
safety of carvedilol during pregnancy is
lacking. If beta-blockers are used close to
delivery, infants should be monitored for
signs of beta-blockade (and alpha-blockade
with labetalol or carvedilol).
Cefaclor B Not known to be harmful.
Cefadroxil B Not known to be harmful.
Cefdinir B Should be given during pregnancy only if

need is clearly established.
Cefditoren B Recommended for use during pregnancy
Cefepime B Should only be given in pregnancy when the
need has been clearly established.
Cefotaxime B Should be given during pregnancy only if
Cefoxitin B Should be given during pregnancy only if
Cefpodoxime B Should only be given in pregnancy when the
Cefprozil B Recommended for use during pregnancy
Ceftazidime B Should only be given in pregnancy when the
Ceftriaxone B Should only be given in pregnancy when the
Cefuroxime B Manufacturers advise to avoid.
Celecoxib D Avoid (teratogenic in animal studies).
666
Celiprolol C Should not be used to treat gestational

hydrochloride hypertension. They may cause neonatal
thrombocytopenia, bone marrow
suppression, jaundice, electrolyte
disturbances, and hypoglycaemia; placental
perfusion may also be reduced. Stimulation
of labour, uterine inertia, and meconium
staining have also been reported.
Cephalexin B Should only be given in pregnancy when the
Cephradine B Should only be given in pregnancy when the
Cetirizine B No evidence of teratogenicity except for
hydrochloride hydroxyzine where toxicity has been
tremor.
Cetrimide B Not known to do any harm.
Chloramphenicol C Avoid; Grey baby syndrome may occur. 3
Chlorhexidine B Should only be given in pregnancy when the

gluconate need has been clearly established.
Chloroquine N Prescribe with caution; potential teratogenic
phosphate effect; for
malaria if benefit outweighs risk.1,3
Chloroxylenol C Use during pregnancy when benefit
outweighs
risk.
Chlorpheniramine B No evidence of teratogenicity except for
maleate hydroxyzine where toxicity has been
tremor.
Chlorpromazine C Prescribe with caution; possibility of lethargy
an extrapyramidal effect due to slow
elimination. 3
Chlorpromazine C Extrapyramidal effects and withdrawal
hydrochloride syndrome have been reported occasionally
in the neonate when antipsychotic drugs are
taken during the third trimester of
pregnancy. Following maternal use of
antipsychotic drugs in the third trimester,
neonates should be monitored for
symptoms including agitation, hypertonia,
hypotonia, tremor, drowsiness, feeding
667
problems, and respiratory distress.
Chlorambucil D Avoid; effective contraceptive measure must

be taken
during administration.
Chlortetracycline B Should be used only if benefit outweighs

risk.
Chlorthalidone B Should not be used, may cause neonatal
thrombocytopenia, bone marrow
suppression, jaundice, electrolyte
disturbances and hypoglycaemia.
Ciclesonide C Only recommended for use during
pregnancy when there are no alternatives.
Cilastatin C Should be used only if benefit outweighs
risk.
Cilostazol C An increase in the incidence of stillbirth and
of cardiovascular, renal, and skeletal
defects has been reported in animal. Should
be used only if benefit outweighs risk.
Cimetidine B Avoid unless benefit outweighs risk.
Cinacalcet C Patient taking the drug should be under

observation.
Cinnarizine C Most manufacturers of antihistamines
advise avoiding their use during pregnancy;
however there is no evidence of
teratogenicity. The use of sedating
antihistamines in the latter part of the third
trimester may cause adverse effects in
neonates such as irritability , paradoxical
excitability , and tremor.
Ciprofloxacin C Prescribe with caution; 1, 2, 3
Cisatracurium B Non-depolarising neuromuscular blocking

drugs are highly ionised at physiological pH
and are therefore unlikely to cross the
placenta in significant amounts. Contact
with physician before use.
Cisplatin D Avoid; toxicity in animal studies.
Citalopram C SSRIs should not be used during pregnancy

unless the potential benefit outweighs the
risk. There is small increased risk of
congenital heart defects when SSRIs are
taken during early pregnancy. If SSRIs are
of neonatal withdrawal symptoms , and
persistent pulmonary hypertension in the
newborn has been reported.
668
Citicoline D Avoid.
Clarithromycin C Avoid unless potential benefit outweighs

risk.
Clindamycin B Use when benefit outweighs risk.
Clioquinol C Potential benefits may warrant use of the

risks.
Clobazam C Use during pregnancy when benefit
outweighs risk. Avoid in late pregnancy.
Clobetasol C Use when there are no alternatives.
propionate
Clomifene citrate X Exclude pregnancy before treatment;
possible effects on fetal development.
Clomipramine C Neonatal withdrawal symptoms reported if
used during third trimester.
Clonazepam D Risk of neonatal withdrawal symptoms
when benzodiazepines are used during
pregnancy. Avoid regular use and use only
if a clear indication such as seizure
control. High doses administered during late
pregnancy or labour may cause neonatal
hypothermia, hypotonia and respiratory
depression.
Clonidine C Use when benefit outweighs risk.
hydrochloride
Clopidogrel B Use when the need is clearly established.
Cloprostenol Use with caution.
Clotrimazole B Use when established need is clearly. No

proven risk in human.
Cloxacillin B Use when established need is clearly. No
proven risk in human.
Clozapine B Potential benefit should outweigh the
potential risk.
Colestipol N Should be used with caution as although the
hydrochloride drugs are not absorbed, they may cause fat-
soluble vitamin deficiency on prolonged use.
Colistin sulphate C Use only if benefit outweighs risk.
Crotamiton C Avoid especially during the first trimester. 1
Cyanocobalamin C Administer as recommended dose.
669
Cyclizine B Use only if benefit outweighs risk.However

there is no evidence of teratogenicity.
Cyclobenzaprine B Use of drug is not recommended unless
clearly needed.
Cyclopentolate C Discuss with physician before use.
Cyclophosphami D Avoid; evidence of embryotoxicity and

de fetotoxicity.
Cyclosporine C Evidence of toxicity in animals. Use with
caution.
Cypermethrin C Evidence of toxicity in animals. Use with
caution.
Cytarabine D Most of the manufacturers advises to avoid.
Danazol X Avoid; has weak androgenic effects and

virilisation of female fetus reported.
Dactinomycin X Avoid; teratogenic in animal studies.
Dapsone C Neonatal haemolysis and

methaemoglobinaemia; adequate Folate
supplements should be given to mother.
Darifenacin C Only recommended for use during
pregnancy when benefit outweighs risk.
Daunorubicin D Avoid; teratogenic and carcinogenic in
animal studies.
Deferasirox B Use only when the need is established.
Deferiprone D Women of reproductive potential should be

advised to avoid pregnancy when taking
deferiprone.
Demeclocycline D Only recommended for use during
pregnancy when there are no alternatives
and benefit outweighs risk.
Desferrioxamine C Toxicity in animal studies.
Desloratadine C No evidence of teratogenicity except for

hydroxyzine where toxicity has been
tremor.
Desmopressin C Small oxytocic effect if used in third
trimester.
670
Desogestrel X Avoid.
Desonide C Should only be used during pregnancy

Dexamethasone C The benefit of treatment with corticosteroids
during pregnancy and breast-feeding
outweighs the risk; pregnant women with
fluid retention should be monitored closely.
Dexibuprofen C Should be avoided during the third trimester
because use is associated with a risk of
closure of fetal ductus arteriosus in utero
and possibly persistent pulmonary
hypertension of the newborn.
Dexketoprofen C Should be avoided during the third trimester
Dexlansoprazole B No evidence of human toxicity, use with
caution.
Dexpanthanol C Discuss with physician before use.
Dextran 70 C Avoid , reports of anaphylaxis in mother.
Dextromethorpha C Prescribe with caution.

n
Dextromethorpha C Use when benefit outweighs risk.

n
Diacerein N Contraindicated in pregnancy.
Diazepam N Prescribe with caution; neonatal withdrawal

symptoms or floppy instant syndrome may
develop if used in third trimester.
Dibromopropami N Avoid; no information available.
dine isethionate
Diclofenac D Avoid unless benefit outweighs risk.
Dicloxacillin B Use when the need is clearly established.
Dicycloverine C Use when no alternative is available.

hydrochloride
Diethylstilbestrol C In first trimester, high doses associated with
vaginal carcinoma, urogenital abnormalities
and reduced fertility in female offspring;
increased risk of hypospadias in male
offspring.
Diflorasone C Consult with physician before use.
diacetate
671
Digoxin C Dosage adjustment is required.
Dihydroergotamin Oxytocic effects on pregnant uterus. 1, 2, 3

e
Diloxanide C Avoid.
fuorate
Diltiazem C Avoid; teratogenic in animal studies.
hydrochloride
Dimethothiazine C Avoid.
mesylate
Dinoprostone C Use during pregnancy when benefit
outweighs risk.
Diosmin B No evidence of toxicity. Use with caution.
Diphenhydramine B Use only if potential benefit outweighs risk.
Dipyridamole B Use only if potential benefit outweighs risk.
Disopyramide C Avoid; may induce labor due to uterine

contraction if used in third trimester.
Dobutamine B Use only if potential benefit outweighs risk.
Docetaxel D Avoid; toxicity in animal studies.
Docosanol N Consult with physician before use.
Domperidone N Avoid.
Donepezil C Use only if potential benefit outweighs risk.

hydrochloride
Dopamine C Use only if potential benefit outweighs risk.
hydrochloride
Dorzolamide C Use only if potential benefit outweighs risk.
Doxepin C Use with caution.
Doxorubicin D Avoid; teratogenic in animal studies.

hydrochloride
Doxycycline D When travel to malarious areas is

unavoidable during pregnancy, doxycycline
can be used for malaria prophylaxis if other
regimens are unsuitable and if the entire
672
course of doxycycline can be completed

before 15 weeks gestation.
Dronedarone X Avoid, toxicity in animal studies.
Drospirenone X Avoid.
Drotaverine C Use only if potential benefit outweighs risk.

hydrochloride
Duloxetine C Toxicity in animal studies, use only if
potential benefit outweighs risk; risk of
neonatal withdrawal symptoms.
Dutasteride X Avoid.
Dydrogesterone B Use with caution.
Ebastine B Use with caution.
Econazole nitrate C Use only if potential benefit outweighs risk.
Efavirenz D Avoid (effective contraception required

during treatment and for 12 weeks after
treatment); use efavirenz only if no
alternative available.
Enalapril maleate D Should be avoided in pregnancy unless
essential. They may adversely affect fetal
Enoxaparin B Manufacturer advises avoid.
Enrofloxacin C Use only if benefit outweighs risk.
Entacapone C Avoid.
Entecavir C Toxicity in animal studies, use only if

potential benefit outweighs risk effective
contraception required during treatment.
Ephedrine C Use only if benefit outweighs risk.
hydrochloride
Epinastine C Use only if benefit outweighs risk.
hydrochloride
Epirubicin D Use of epirubicin is not recommended
hydrochloride unless there are no alternatives and benefit
outweighs risk.
Eplerenone B Use only if needed clearly.
673
Epoetin X Avoid.
Eprosartan D Should be avoided in pregnancy unless

Eptifibatide B Use only if potential benefit outweighs risk.
Ergometrine X Avoid.
maleate
Ergotamine Oxytocic effects on pregnant uterus. 1, 2, 3
Erlotinib D Avoid; harmful for fetus.
Ertapenem B Avoid; unless potential benefit outweighs

risk.
Erythromycin B Avoid; unless potential benefit outweighs
risk.
Escitalopram C Should not be used during pregnancy
risk. A small increased risk of congenital
heart defects when SSRIs are taken during
early pregnancy. If SSRIs are used during
the third trimester a risk of neonatal
withdrawal symptoms and persistent
pulmonary hypertension in the newborn has
been reported.
Eslicarbazepine C Women of child-bearing potential should
acetate discuss with a specialist the impact of both
epilepsy and its treatment, on the outcome
of pregnancy. An increased risk of
teratogenicity associated with the use of
antiepileptic drugs (especially if used during
the first trimester and particularly if the
patient takes two or more antiepileptic
drugs).
Esomeprazole C Use with caution.
Eszopiclone C Use only if potential benefit outweighs risk.
Ethambutol C Use only if potential benefit outweighs risk.
Ethosuximide N Women of child-bearing potential should

discuss with a specialist the impact of both
epilepsy and its treatment on the outcome
of pregnancy.
Etodolac C Avoid during pregnancy or avoid unless the
potential benefit outweighs the risk, should
be avoided during the third trimester
674

Etomidate C May depress neonatal respiration if used
during delivery.
Etoposide D Avoid, teratogenic in animal studies.
Etoricoxib X Avoid.
Etravirine B Treatment of HIV infection in pregnancy

aims to reduce the risk of toxicity to the
fetus (although the teratogenic potential of
most antiretroviral drugs is unknown) to
minimize the viral load and disease
progression in the mother and to prevent
transmission of infection to the neonate.
Everolimus D Avoid.
Ezetimibe C Use only if potential benefit outweighs risk.
Famotidine B Avoid unless benefit outweighs risk.
Febuxostat C Avoid unless benefit outweighs risk.
Felodipine C Avoid.
Fenofibrate C Avoid , embryo toxicity in animal studies.
Fentanyl C Depress neonatal respiration; withdrawal

effects in neonates of dependent mothers;
gastric stasis and risk of inhalation
pneumonia in mother during labour. 3
Use only if potential benefit outweighs risk.
Fenticonazole C
nitrate
Filgrastim C There have been reports of toxicity in
animal studies and not to use granulocyte-
colony stimulating factors during pregnancy
risk.
Finasteride X Unprotected intercourse may cause
feminisation of male fetus 1, 2, 3
Flavoxate B Use during pregnancy when there are no
hydrochloride alternatives and benefit outweighs risk.
Flucloxacillin B Use during pregnancy when there are no
alternatives and benefit outweighs risk.
675
Fluconazole C,D Avoid; teratogenic, craniofacial and limb

abnormality with long term high doses.
Fludrocortisone C The benefit of treatment with corticosteroids
acetate during pregnancy and breast-feeding
outweighs the risk; Pregnant women with
Fluocinolone C Avoid.
acetonide
Fluorescein C Use during pregnancy when there are no
sodium alternatives and benefit outweighs risk.
Fluorometholone C Only recommended for use during
Fluorouracil X Avoid.
Fluoxetine C Should not be used during pregnancy

risk. a small increased risk of congenital
withdrawal symptoms, and persistent
been reported.
Flupenthixol C Only recommended for use during
Fluphenazine C Prescribe with caution. 3
hydrochloride
Flurazepam N Prescribe with caution; discourage regular
use.
Flurbiprofen C Avoid during pregnancy or avoid unless the
potential benefit outweighs the risk, should
be avoided during the third trimester
Flutamide D Should only be given during pregnancy
when there are no alternatives and benefit
outweighs risk.
Fluticasone C Prescribe with caution.
furoate
Fluvastatin X Avoid, teratogenic
676
Fluvoxamine C Should not be used during pregnancy

maleate unless the potential benefit outweighs the
risk, a small increased risk of congenital
withdrawal symptoms and persistent
been reported.
Folinic acid C Should only be given during pregnancy
outweighs risk.
Follitropin alfa & X Avoid.
beta
Formoterol C It is particularly important that asthma
fumarate should be well controlled during pregnancy.
Frusemide C Should not be used to treat gestational
hypertension because of the maternal
hypovolemia associated with this condition.
Fusidic Acid C Use with caution.
Gabapentin C Women of child-bearing potential should

discuss with a specialist the impact of both
epilepsy and its treatment on the
outcome of pregnancy, an increased risk of
teratogenicity associated with the use of
antiepileptic drugs (especially if used during
the first trimester and particularly if the
patient takes two or more antiepileptic
drugs).
Gadodiamide C Use with caution.
Gadoversetamide C Should only be given during pregnancy

outweighs risk.
Galantamine C Use with caution.
Ganciclovir C Avoid; women of childbearing potential

should use effective contraception during
ganciclovir therapy.
Gatifloxacin C Should only be given during pregnancy
outweighs risk.
Gemcitabine D Avoid.
677
Gemefloxacin C Use with caution.
Gemfibrozil C Avoid; theoretical possibility of interference

with embryonic growth and development
due to anti-cholesterol effect.
Gentamicin C, D Avoid unless benefit outweighs risk;
probably very small auditory or vestibular
nerve damage. 1, 2, 3
Glibenclamide Insulin is substituted. 3
Gliclazide C Insulin is substituted. 3
Glimepiride C Avoid; toxicity in animal studies. 3
Glipizide C Insulin is substituted.
Glycerin C Use with caution.
Glycopyrrolate B Use only when benefit outweighs risk.
Gonadorelin B Consult with physician.
Granisetron B Use during pregnancy when there are no

Griseofulvin C Avoid; teratogenic. 1, 2, 3
Guaiphenesin C Potential benefits may warrant use of the

risks.
Halcinonide C Potential benefits may warrant use of the

risks.
Halobetasol C Potential benefits may warrant use of the

propionate drug in pregnant women despite potential
risks.
Haloperidol C Prescribe with caution; extra pyramid effects

reported in neonates if administered in third
trimester. 3
Halothane Depress neonatal respiration if administered
in third trimester.
Heparin sodium C Safer than warfarin for fetus; mother may
develop haemorrhage, thrombocytopenia;
osteoporosis may develop after prolonged
use. does not cross the placenta; maternal
osteoporosis reported after prolonged use;
678
multi dose vials may contain benzyl alcohol

, some avoid.1, 2, 3
Hexachlorophene C Use when benefit outweighs risk.
Homatropine C Use when benefit outweighs risk.

hydrobromide
Hydrochlorothiazi B Not recommended to treat hypertension;
de causes neonatal thrombocytopenia if used
in third trimester. 3
Hydrocortisone C The benefit of treatment with corticosteroids
during pregnancy and breast-feeding
outweighs the risk; pregnant women with
Hydroquinone C Consult with physician before use.
Hydroxocobalami C Use when benefit outweighs risk.

n
Hydroxyurea D Avoid.
Hydroxychloroqui N It is not necessary to withdraw an

ne antimalarial drug during pregnancy if the
rheumatic disease is well controlled;
however, the manufacturer of
hydroxychloroquine advises avoiding use.
Hydroxyzine C Avoid; may associate with fetal abnormality.
hydrochloride
Hyoscine butyl C Avoid unless benefit outweighs.
bromide
Hyoscine C Use only if potential benefit outweighs risk,
hydrobromide injection may depress neonatal respiration.
Hypromellose X Avoid.
Ibandronic Acid C Avoid unless benefit outweighs risk.
Ibuprofen C,D Avoid unless benefit outweighs risk. 3
Idoxuridine C Toxicity in animal studies.
Ifosfamide D Avoid.
Imatinib D Avoid, potential benefits may warrant use of

the drug in pregnant women despite
potential risks.
Imipramine N Tachycardia, irritability and muscle spasm in

hydrochloride neonate.
1, 2, 3
679
Indapamide B Prescribe with caution.1, 3
Indomethacin C Most avoiding the use of NSAIDs during

pregnancy or avoiding them unless the
potential benefit outweighs the risk. NSAIDs
should be avoided during the third trimester
Inositol C Avoid unless potential benefit outweighs
risk.
Insulin B Dose should be adjusted frequently 1, 2, 3
Interferons C Avoid unless compelling reasons.
Iodixanol B Use with caution.
Iohexol B Use with caution.
Iopamidol B Use with caution.
Ipratropium B It is particularly important that asthma

bromide should be well controlled during pregnancy.
Irbesartan D Should be avoided in pregnancy unless
Isoflurane C May depress neonatal respiration if used
during delivery.
Isoniazid C There are no controlled data in human
pregnancies. Embryocidal effects were
noted in both rats and rabbits after
administration of isoniazid orally during
pregnancy. While cases of suspected
isoniazid induced anomalies have been
reported, causality is unknown and
retrospective analyses have failed to
document significant teratogenic risk. It
should only be given during pregnancy
Isosorbide C May cross placenta, avoid unless potential
dinitrate benefit outweighs risk.
Isosorbide C Avoid unless potential benefit outweighs
mononitrate risk.
Isotretinoin X Topical retinoids are contra-indicated in
pregnancy; women of child-bearing age
must use effective contraception (oral
680
progestogen-only contraceptives not

considered effective).
Itraconazole C Use only in life threatening situations
(toxicity at high doses in animal studies);
ensure effective contraception during
treatment and until the next menstrual
period following end of treatment.
Ivabradine D Avoid, toxicity in animal studies.
Ivermectin C Consult physician before use.
Ketamine C Depress neonatal respiration if used during

delivery.
Ketoconazole C Teratogenicity in animal studies; packs
carry a warning to avoid in pregnancy.
Ketoprofen C Toxicity in animal studies.
Ketorolac tromethamine C Avoid; manufacturer advises use only if

potential
benefit outweighs risk.
Ketotifen C Prescribe with caution.
Levothyroxine sodium A Monitor maternal serum-thyrotropin

concentration, levothyroxine may cross the
placenta and excessive maternal
concentration can be detrimental to fetus.
Labetalol C Use only if potential benefit outweighs risk.
hydrochloride
Lacidipine Avoid; may inhibit labour.
Lacosamide C Increased risk of teratogenicity,associated

with the highest risk of major and minor
congenital malformations.
Lactulose B Use only when need has been clearly
established.
Lamivudine C Avoid during first trimester.
Lamotrigine C Prescribe with caution; increased risk when

used more than one antiepileptic drug.
Lansoprazole B Avoid.
Latanoprost C Use only if potential benefit outweighs risk.
Leflunomide X Avoid.
Letrozole D Avoid (isolated cases of birth defects

reported).
681
Levamisole C Use only if potential benefit outweighs risk.
Levetiracetam C Use when the potential benefits justify the

potential risk to the fetus.
Levobunolol C Use only if potential benefit outweighs risk.
hydrochloride
Levobupivacaine Large doses during delivery can cause
hydrochloride neonatal respiratory depression, hypotonia
and bradycardia after epidural block; avoid if
possible in the first trimester, toxicity in
animal studies.
Levocarnitine B Use only if potential benefit outweighs risk.
Levocetirizine B Use only if potential benefit outweighs risk.

hydrochloride
Levofloxacin C Avoid-shown to cause arthropathy in animal
studies.
Lidocaine B Use only if potential benefit outweighs risk.
Linagliptin B Linagliptin is only recommended for use

during pregnancy when there are no
Linezolid C Use only if potential benefit outweighs risk.
Lisinopril D Animal studies show still birth, renal failure

and oligohydramnios.1,2,3
Lithium carbonate D Avoid in possible if first trimester, risk of
teratogenicity including cardiac
abnormalities; dose requirement is
increased if necessary as because of the
risk of toxicity in neonate. 1,2, 3
Lomefloxacin C Use only if potential benefit outweighs risk.
Lomustine D Use only when there are no alternatives and

Loperamide C Avoid.
Loratidine C Avoid.
Lorazepam D Risk of neonatal withdrawal symptoms high

doses administered during late pregnancy
or labour may cause neonatal hypothermia,
hypotonia and respiratory depression.
Losartan potassium D Use only if potential benefit outweighs risk.
Loteprednol etabonate C Use only if potential benefit outweighs risk.
682
Lovastatin X Use only if potential benefit outweighs risk.
Lubiprostone C Use only if clearly needed and benefit

outweighs potential risk.
Magaldrate
Magnesium hydroxide
Not known to be harmful for short-term intravenous
Magnesium sulphate administration in eclampsia but excessive doses in
third trimester cause neonatal respiratory depression.
Mannitol C Use only if clearly needed and benefit outweighs
potential risk.
Maprotiline B Use only when need has been clearly
hydrochloride established.
Mebendazole C Manufacturer advises to avoid, toxicity in
animal Studies.
Mebeverine Prescribe with caution.
hydrochloride
Meclizine hydrochloride B Use only if potential benefit outweighs risk.
Medroxyprogesterone X Avoid , genital malformations and cardiac

acetate defects reported.
Mefenamic acid C See Acetylsalicylic acid. 3
Mefloquine B Adequate contraception during prophylaxis

and for 3 months after stopping
(teratogenicity in animal studies).
Melatonin N Avoid.
Meloxicam C Avoid; use only if potential benefit

outweighs risk.
Memantine B Use only if potential benefit outweighs risk.
hydrochloride
Mercaptopurine D Avoid (teratogenic).
Meropenem B Use only if potential benefit outweighs risk.
Mesalazine Negligible quantities cross placenta.
Mesna disulfide B Use only if potential benefit outweighs risk.
Metaraminol C May reduce placental perfusion,

manufacturer advises use only if potential
683
Metformin B Avoid; insulin is substituted. 1, 2, 3
Methionine C Use only when need has been clearly

established.
Methotrexate X Avoid; teratogenic; fertility may be reduced
during therapy which may be reversible.
Methyl prednisolone C Use when there are no alternatives and
Methyldopa C Use only if potential benefit outweighs risk.
Methylphenidate C Use only if potential benefit outweighs risk.

hydrochloride
Metoclopramide B Use only when compelling reasons.
hydrochloride
Metoprolol tartarate C Prescribe with caution.
Metronidazole B Avoid high doses; increased risk of

teratogenicity if used during first trimester.
Miconazole C Avoid unless essential.
Miconazole nitrate Absorbed from skin in small amounts;

manufacturer advises caution.
Midazolam D Increased risk of teratogenicity ,
associated with the highest risk of major
and minor congenital malformations
Mifepristone X Avoid.
Miglitol B Use only when need has been clearly

established.
Milnacipran C Use only if potential benefit outweighs risk.
hydrochloride
Minoxidil C Avoid , possible toxicity including reduced
placental perfusion; neonatal hirsutism
reported.
Mirtazapine C use with caution—limited experience.
Misoprostol X Avoid; teratogenic; potent stimulant of

uterus.1, 2, 3
Mitomycin Avoid (teratogenic in animal studies).
Mizolastine Avoid.
Mometasone furoate C Use when there are no alternatives and

Montelukast B Avoid unless essential.
684
Morphine sulphate C Use only if potential benefit outweighs risk.
Moxifloxacin C Cause arthropathy in animal studies.
Moxonidine Avoid—no information available.
Mupirocin B Use only when need has been clearly

established.
Mycophenolate mofetil D Avoid; toxicity in animal studies; effective
contraceptive measures must be taken
during and for 6 weeks of treatment.
Nalbuphine B Use only if potential benefit outweighs risk.
hydrochloride
Nalidixic acid C Shown to cause arthropathy in animal
studies.
Naloxone C Use only if potential benefit outweighs risk.
Naltrexone C Use only if potential benefit outweighs risk.
Nandrolone X Avoid,masculinization of female fetus.1, 2, 3
Naphazoline nitrate C Prescribe with caution.
Naproxen C Prescribe with caution. 3
Natamycin C Prescribe with caution.
Nateglinide C Avoid, toxicity in animal studies.
Nebivolol C Use only if potential benefit outweighs risk.
Nefopam hydrochloride Avoid unless no safer treatment.
Nelfinavir B Use only if potential benefit outweighs risk.
Neomycin D Prescribe with caution. 2, 3
Neostigmine C Neonatal myasthenia with large doses.3
Nepafenac C Use only if potential benefit outweighs risk.
Nevirapine B Use only when need has been clearly

established.
Niacin C Use when there are no alternatives and
685
Nicorandil Use only if potential benefit outweighs risk.
Nicotine D Use only if potential benefit outweighs risk.
Nifedipine C Prescribe with caution.
Nimodipine C Use only if potential benefit outweighs risk.
Nitazoxanide B Use only if potential benefit outweighs risk.
Nitrazepam Prescribe with caution.
Nitrofurantoin B Avoid at term, may produce neonatal

Hemolysis.
Nitroglycerin C Use only if potential benefit outweighs risk.
Nitrous oxide May depress neonatal respiration if used

during delivery.
Nizatidine B Avoid unless essential.
Noradrenaline/ C Avoid, may reduce placental perfusion.

norepinephrine
Norethisterone Masculinization of female fetuses and other
defects reported.
Norgestrel X Use only if potential benefit outweighs risk.
Nortriptyline Prescribe with caution. 3
Ofloxacin
C Should be avoided in pregnancy because
they have been shown to cause arthropathy
in animal studies; safer alternatives are
available; however , a single dose of
ciprofloxacin may be used for the prevention
of a secondary case of meningococcal
meningitis.
Olanzapine C Use only if potential benefit outweighs
risk;neonatal lethargy, tremor, and
hypertonia reported when used in third
trimester.
Olmesartan medoxomil D Avoid unless essential. They may adversely
affect fetal and neonatal blood pressure
control and renal function; skull defects and
Olopatadine C Only recommended when there are no
686
Omega-3 acid ethyl C use only if potential benefit outweighs risk—

esters no information available.
Omeprazole C Not known to be harmful.
Ondansetron B avoid unless potential benefit outweighs

risk.
Orlistat X Use with caution.
Oseltamivir C use only if potential benefit outweighs risk.
Oxaliplatin D Avoid, toxicity in animal studies; effective

contraception required during and for 4
months after treatment in women and 6
months after treatment in men.
Oxaprozin C Avoid; only recommended when benefit
outweighs risk.
Oxazepam N Risk of neonatal withdrawal symptoms
when benzodiazepines are used during
pregnancy. Avoid regular use and use only
if a clear indication such as seizure
control. High doses administered during late
pregnancy or labour may cause neonatal
hypothermia,hypotonia , and respiratory
depression.
Oxybutynin B Avoid unless essential, toxicity in animal
hydrochloride studies.
Oxcarbazipine C Teratogenic, if used in first trimester;

neonatal bleeding occur if used in third
trimester.
Oxiconazole B No controlled data in human pregnancy.
Oxiconazole topical should only be used
Oxymetazoline C Use when benefit outweighs risk.
hydrochloride
Oxytetracycline Should not be given to pregnant women.

Effects on skeletal development when
tetracyclines have been used in the first
trimester in animal studies. Administration
during the second or third trimester may
cause discoloration of the child’s teeth and
maternal hepatotoxicity. However, when
travel to malarious areas is unavoidable
during pregnancy.
Oxytocin XAvoid.
Paclitaxel DAvoid (toxicity in animal studies); ensure

effective contraception during and for at least 6
687
months after treatment in men or women.
Palonosetron B Avoid , no information available.
Pancreatin Not known to be harmful.
Pancuronium bromide C Non-depolarising neuromuscular blocking

drugs are highly ionised at physiological pH
and are therefore unlikely to cross the
placenta in significant amounts.
Pantoprazole B Avoid unless potential benefit outweighs risk
, fetotoxic in animals.
Paracetamol C not known to be harmful.
Paricalcitol C Avoid unless potential benefit outweighs

risk.
Paroxetine D Increased risk of congenital malformations ,
especially if used in the first trimester.
Pegfilgrastim C There have been reports of toxicity in
animal studies and not to use granulocyte-
colony stimulating factors during pregnancy
risk.
Peginterferon alfa-2a C,X Use when potential benefit outweighs risk.
Pemirolast potassium C Only recommended for use during

Pentazocine C Use when need has been clearly
hydrochloride established.
Pentoxifylline C Use when benefit outweighs risk.
Peppermint oil Not known to be harmful.
Perindopril erbumine C, D Avoid unless essential. They may adversely

affect fetal and neonatal blood pressure
control and renal function; skull defects and
Permethrin B Only use when benefit outweighs risk.
Pethidine Respiratory depression and withdrawal

symptoms can occur in the neonate if opioid
analgesics are used during delivery; also
gastric stasis and inhalation pneumonia has
been reported in the mother if opioid
analgesics are used during labour.
Pheniramine maleate B Unlikely to harm an unborn baby.
688
Phenobarbitone C Congenital abnormality occurs if used in first

trimester; neonatal bleeding occurs if used
in third trimester. 1, 2, 3
Phenoxymethyl penicillin B Only be given when need has been clearly
established.
Phenytoin hydrochloride D Changes in plasma-protein binding make
interpretation of plasma-phenytoin
concentrations difficult, monitor unbound
fraction.
Pholcodine Avoid unless potential benefit outweighs
risk.
Phytomenadione Use if potential benefit outweighs risk.
Pilocarpine hydrochloride C Avoid; stimulation of smooth muscle; toxicity

in animal studies.
Pioglitazone C Avoid.
Pindolol D See Atenolol.
Piracetam Avoid.
Piroxicam C Avoid
Pitavastatin X Avoid
Pivmecillinam Avoid; not known to be harmful.
Pizotifen Avoid unless potential benefit outweighs

risk.
Podophyllotoxin Avoid.
Poly ethylene C Use when benefit outweighs risk.

glycol 3350
Potassium chloride C Use only when benefit outweighs risk.
Potassium citrate C Use only when benefit outweighs risk.
Potassium guaiacol C Use only when benefit outweighs risk.

sulphonate
Potassium iodide D Avoid.
Povidone Use only when benefit outweighs risk.
Povidone iodine Sufficient iodine may be absorbed to affect

the fetal thyroid in the second and third
689
trimester.
Pralidoxime chloride C Use only when benefit outweighs risk.
Prazosin C No evidence of teratogenicity; use only if

potential benefit outweighs risk.
Prednisolone C Use only when benefit outweighs risk
Pregabalin C Increased risk of teratogenicity, associated

with the highest risk of major and minor
congenital malformations.
Primaquine Risk of neonatal haemolysis and
methaemoglobinaemia in third trimester.
Procarbazine
Avoid; teratogenicXin animal studies.
Prochlorperazine Use only when benefit outweighs risk.

maleate
Prochlorperazine Extrapyramidal effects and withdrawal

mesilate syndrome have been reported occasionally
in the neonate when antipsychotic drugs are
taken during the third trimester of
pregnancy. Following maternal use of
antipsychotic drugs in the third trimester,
neonates should be monitored for
symptoms including agitation, hypertonia,
hypotonia, tremor, drowsiness, feeding
problems, and respiratory distress.
Procyclidine Use only if potential benefit outweighs risk.
hydrochloride
Progesterone Not known to be harmful.
Promethazine C Avoid.
hydrochloride
Promethazine theoclate C Avoid.
Propafenone C use only if potential benefit outweighs risk.

hydrochloride
Propantheline bromide C Avoid.
Propofol B May depress neonatal respiration if used

during delivery; max. dose for maintenance
of anaesthesia 6 mg/kg/hour.
Propranolol C May cause intra-uterine growth restriction,
hydrochloride neonatal hypoglycaemia and bradycardia;
the risk is greater in severe hypertension.If
beta-blockers are used close to delivery,
690
infants should be monitored for signs of

beta-blockade.
Protamin sulphate C Use only when need has been clearly
established.
Pseudoephedrine defective closure of the abdominal wall
hydrochloride (gastroschisis) reported very rarely in
newborns after first trimester exposure.
Pyrazinamide C Use only if potential benefit outweighs risk.
Pyridostigmine C Use only if potential benefit outweighs risk.
Pyridoxine A,C Use only if potential benefit outweighs risk.

hydrochloride
Pyrimethamine C Theoretical teratogenic risk in first trimester

(folate antagonist); adequate folate
supplements should be given to mother.
Quetiapine C Use only if potential benefit outweighs risk.
Extrapyramidal effects and withdrawal
syndrome have been reported.
Quinine dihydrochloride C High doses are teratogenic in first trimester;
but in malaria benefit of treatment
outweighs risk.
Quinine sulphate C High doses are teratogenic in first trimester;
but in malaria benefit of treatment
outweighs risk.
Rabeprazole sodium BAvoid—no information available.
Raloxifene hydrochloride XAvoid.
Ramipril DShould be avoided in pregnancy unless essential. They may

adversely affect fetal and neonatal blood pressure control and
renal function; skull defects and oligohydramnios have also
been reported.
Ranitidine B Avoid unless essential, but not known to be
harmful.
Ranolazine C Avoid unless essential— no information
available.
Repaglinide C Avoid; insulin is substituted.
Retapamulin B Use only if potential benefit outweighs risk.
Ribavirin X Avoid; teratogenicity in animal studies.
Riboflavin A,C Use with caution.
Rifampicin Teratogenic in animal studies in first

trimester; risk of neonatal bleeding may be
increased in third trimester.
691
Rifaximin C Avoid, toxicity in animal studies.
Rimexolone C Use only if potential benefit outweighs risk.
Risedronate sodium C Use only if potential benefit outweighs risk.
Risperidone C Use only if potential benefit outweighs risk.
Ritodrine hydrochloride B Not for use in first or third trimester.
Rituximab C Use only if potential benefit outweighs risk.
Rivaroxaban C Avoid.
Rivastigmine B Use only if potential benefit outweighs risk.
Rizatriptan C Avoid unless the potential benefit

outweighs the risk.
Rofecoxib C Prescribe with caution.
Rocuronium bromide C Use only if potential benefit outweighs risk.
Roflumilast C Avoid.
Ropinirole C Avoid unless potential benefit outweighs

risk.
Rosiglitazone C use only if potential benefit outweighs risk.
Rosuvastatin X Avoid.
Rupatadine Take caution—limited information available.
Salmeterol C Use only if potential benefit outweighs risk.
Salmon calcitonin C Avoid unless potential benefit outweighs

risk.
Salsalate C Use only if potential benefit outweighs risk.
Saxagliptin B Avoid unless essential , toxicity in animal

studies.
Sennosides C Use only if potential benefit outweighs risk.
Sertraline C Avoid unless potential benefit outweighs

risk.
692
Sevelamer C Use only if potential benefit outweighs risk.

hydrochloride
Sibutramine C Use only if potential benefit outweighs risk.

hydrochloride
Sildenafil B Use only if potential benefit outweighs risk.
Silver B Use only if potential benefit outweighs risk.

sulphadiazine
simethicone Use only if potential benefit outweighs risk.
Simvastatin X Avoid.
Sitagliptin B Avoid.
Sodium C Use only if potential benefit outweighs risk.

bicarbonate
Sodium fusidate Not known to be harmful; use only if

potential benefit outweighs risk.
Sodium Use only if potential benefit outweighs risk.
hyaluronate
Sodium Use only if potential benefit outweighs risk.

stibogluconate
Sodium C Use only if potential benefit outweighs risk.

thiosulfate
Sodium valproate D, X Avoid, increased risk of teratogenicity,

and minor congenital malformations.
Somatropin Discontinue if pregnancy occurs.
Solifenacin C Caution—no information available.

succinate
Sorafenib D Avoid unless essential.
Sotalol B Beta-blockers may cause intra-uterine

hydrochloride growth restriction, neonatal hypoglycaemia,
severe hypertension.For the treatment of
hypertension in pregnancy.
Sparfloxacin C Use only if potential benefit outweighs risk.
693
Spectinomycin B Take caution.
Spironolactone C Use only if potential benefit outweighs risk.
Streptokinase C Thrombolytic drugs can possibly lead to

premature separation of the placenta in the
first 18 weeks of pregnancy, risk of maternal
haemorrhage throughout pregnancy and
post-partum, and also a theoretical risk of
fetal haemorrhage throughout pregnancy.
Streptomycin D Avoid unless essential; greatest risk of
auditory or vestibular nerve damage in the
infant.
Sulfasalazine B Theoretical risk of neonatal haemolysis in
third trimester; adequate folate supplements
should be given to mother.
Sulfinpyrazone Caution—no information available.
Sulindac C Avoid unless the potential benefit outweighs

the risk.
Sulphanilamide C Use only if potential benefit outweighs risk.
Sumatriptan C Use only if potential benefit outweighs risk.
Sunitinib D Avoid unless the potential benefit outweighs

the risk.
Suxamethonium chloride Mildly prolonged maternal neuromuscular
blockade may occur.
Tacrolimus C Exclude before treatment; avoid unless
potential benefit outweighs risk, risk of
premature delivery, intra-uterine growth
restriction, and hyperkalaemia.
Tadalafil B Avoid
Tamoxifen D Avoid , possible effects on fetal

development; effective contraception must
be used during treatment and for 2 months
after stopping.
Tamsulosin hydrochloride B Consult physician.
Tapentadol C Respiratory depression and withdrawal

symptoms can occur in the neonate if opioid
analgesics are used during delivery; also
gastric stasis and inhalation pneumonia has
been reported in the mother if opioid
analgesics are used during labour.
Tazarotene X Avoid.
694
Tegaserod B Use only if potential benefit outweighs risk.
Teicoplanin Use only if potential benefit outweighs risk.
Telmisartan D Should be avoided in pregnancy unless

Temazepam X There is a risk of neonatal withdrawal
symptoms when benzodiazepines are used
during pregnancy. Avoid regular use and
use only if a clear indication such as
seizure control. High doses administered
during late pregnancy or labour may cause
neonatal hypothermia , hypotonia , and
Temozolomide D Avoid (teratogenic and embryotoxic in
animal studies); manufacturer advises
adequate contraception during treatment;
men should avoid fathering a child during
and for at least 6 months after treatment.
Tenofovir disoproxil B Use only if potential benefit outweighs risk.
fumarate
Tenoxicam Avoid unless the potential benefit outweighs

the risk.
Terazosin C No evidence of teratogenicity; use only
when potential benefit outweighs risk.
Terbinafine Avoid.
Terbutaline sulphate B Use only if potential benefit outweighs risk.
Testosterone Avoid; causes masculinisation of female

fetus.
Tetanus vaccines Live vaccines should not be administered
routinely to pregnant women because of the
theoretical risk of fetal infection.
Tetracosactide Avoid.
Tetracycline Avoid; effects on skeletal development in

animal studies; dental discoloration if used
in second and third trimester. 1, 2, 3
Theophylline C Prescribe with caution; neonatal irritability
and apnoea. 3
Thioridazine Prescribe with caution.
Thiamine hydrochloride A Use only if potential benefit outweighs risk.
695
Thiopentone sodium May depress neonatal respiration when

used during delivery.
Tibolone Avoid , toxicity in animal studies.
Ticlopidine Avoid unless essential.

hydrochloride
Tigecycline D Should not be given to pregnant women.

Effects on skeletal development have been
documented when tetracyclines have been
used in the first trimester in animal studies.
Administration during the second or third
trimester may cause discoloration of the
child’s teeth, and maternal hepatotoxicity
has been reported with large parenteral
doses.
Timolol maleate C Beta-blockers may cause intra-uterine
growth restriction, neonatal hypoglycaemia
severe hypertension.If beta-blockers are
used close to delivery, infants should be
monitored for signs of beta-blockade.
Tinidazole Avoid in first trimester.
Tioconazole C Manufacturer advises avoid.
Tiotropium C Manufacturer advises use only if potential

Tizanidine C Avoid.
Tobramycin Prescribe with caution.
Tolfenamic acid Avoid the use of NSAIDs during pregnancy

or avoiding them unless the potential benefit
outweighs the risk. NSAIDs should be
avoided during the third trimester because
use is associated with a risk of closure of
fetal ductus arteriosus in utero and possibly
newborn. In addition , the onset of labour
may be delayed and its duration may be
increased.
Tolmetin C Avoid; use only if potential benefit
outweighs risk.
Tolnaftate Use only if potential benefit outweighs risk.
Tolterodine tartrate C Avoid.
696
Topiramate D Use only if potential benefit outweighs risk

;increased risk of cleft palate if taken in the
first trimester of pregnancy.
Torasemide B Manufacturer advises avoid , toxicity in
Animal studies.
Tramadol hydrochloride C Embryotoxic in animal studies, avoid.
Tranexamic acid Use only if potential benefit outweighs risk.
Trastuzumab D Manufacturer advises avoid,

oligohydramnios reported; effective
contraception must be used during
treatment and for 6 months after stopping.
Travoprost C Avoid.
Tretinoin Teratogenic, effective concentration must

be used for at least 1 month before oral
treatment, during treatment and at 1 month
after stopping also avoid topical treatment.
1, 2, 3
Triamcinolone acetonide C use only if potential benefit outweighs risk.
Trifluoperazine Prescribe with caution.
Trihexyphenidyl Use only if potential benefit outweighs risk.

hydrochloride
Trimethoprim C Avoid;teratogenic risk in first trimester

(folate antagonist).
Trimipramine C Use only if potential benefit outweighs risk.
Tropicamide C Use only if potential benefit outweighs risk.
Ulipristal acetate X Manufacturer advises avoid , no

information available.
Urokinase B Thrombolytic drugs can possibly lead to
premature separation of the placenta in the
first 18 weeks of pregnancy. There is also a
risk of maternal haemorrhage throughout
pregnancy and post-partum, and also a
theoretical risk of fetal haemorrhage
throughout pregnancy.
Ursodeoxycholic acid No evidence of harm but manufacturer
Advises avoid.
Valacyclovir B Use only if potential benefit outweighs risk.
Valsartan Avoid.
697
Sodium valproate D, X Avoid, increased risk of teratogenicity,

and minor congenital malformations.
Vancomycin B Use only if potential benefit outweighs risk.
Vasopressin Oxytocic effect in third trimester.
Varenicline C Avoid, toxicity in animal studies.
Vecuronium bromide C Highly ionised at physiological pH and are

therefore unlikely to cross the placenta in
significant amounts.
Venlafaxine C Avoid unless potential benefit outweighs
risk, toxicity in animal studies; risk of
withdrawal effects in neonate.
Verapamil hydrochloride C May reduce uterine blood flow with fetal
Hypoxia; manufacturer advises avoid in first
trimester Unless absolutely necessary; may
inhibit labour.
Vildagliptin Avoid , toxicity in animal studies.
Vinblastine D Avoid (teratogenicity and fetal loss in animal

studies).
Vincristine D Avoid (teratogenicity and fetal loss in animal
studies).
Vinorelbine D Avoid unless essential (teratogenicity, and
fetal loss in animal studies); manufacturer
advises effective contraception during and
for 3 months after treatment; men must
avoid fathering a child during and for at
least 3 months after treatment.
Vinpocetine Avoid.
Vitamin A X Excessive doses may be teratogenic.
Vitamin C A use only if potential benefit outweighs risk.
Vitamin E A Use only if potential benefit outweighs risk.
Voriconazole D Toxicity in animal studies. Manufacturer

advises avoid unless potential benefit
outweighs risk; effective contraception
required during treatment.
Warfarin sodium X Teratogenic.
Xylometazoline Manufacturer advises to avoid.
698
Zalcitabine C Use only if potential benefit outweighs risk.
Zafirlukast B Avoid.
Zaleplon Avoid in first trimester; neonatal withdrawal.

symptoms if used in third trimester.
Zidovudine C Use only if potential benefit outweighs risk.
Zinc oxide Use only if potential benefit outweighs risk.
Zinc sulfate C Crosses placenta; risk theoretically minimal,

but no information available.
Zinc sulphate monohydrateC Use only if potential benefit outweighs risk.
Ziprasidone C Use only if potential benefit outweighs risk.
Zoledronic acid D Avoid , toxicity in animal studies.
Zolmitriptan D Limited experience of using 5HT1-receptor

agonists during pregnancy; that they
should be avoided unless the potential
benefit outweighs the risk.
Zolpidem tartrate C Avoid regular use (risk of neonatal
withdrawal symptoms); high doses during
late pregnancy or labour may cause
neonatal hypothermia, hypotonia, and
Zopiclone Avoid regular use (risk of neonatal
withdrawal symptoms); high doses during
late pregnancy or labour may cause
neonatal hypothermia, hypotonia, and
699
APPENDIX 6 : BREAST-FEEDING
Appendix- 6
BREAST-FEEDING
When nursing mothers take some categorical drugs that affect the newborn, most of
the drugs are found in breast milk. Some in too small quantity to be harmful for the
neonate but some are found pharmacologically toxic to the infants. Some drugs also
inhibit the infant’s sucking reflex (e.g. phenobarbitone). Concentration of some drugs
in milk may exceed those in (like iodides) the maternal plasma so that therapeutic
doses in the mother may cause toxicity to the infant.
For some drugs information available is so insufficient that providing guidance is
difficult. It is better to use only essential drugs by a breast-feeding mother.
The following table of information about drugs can be used as a guideline; absence of
drugs from the table does not imply safety.
Chemotherapeutics, though harmful to infant, must be administered to the affected

mother in certain cases like HIV, cancer etc. In such cases, breast-feeding of children
must be suspended.
Drugs present in breast milk :
Drug Comment
Abacavir breast feeding recommended first six months if no safe
alternative to breast milk.
Acarbose Avoid.
ACE inhibitors. Avoid.
Aceclofenac Avoid; no information available.
Atenolol & Acebutolol Grater amount found in the milk, avoid.
Acetazolamide Can be used, very small amount found in the milk.
Acetylsalicylic acid Avoid, because regular intake has a
or Aspirin possible risk of Raye’s syndrome; regular use of high
doses could impair platelet function and produce
hypoprothrombinaemia in infant if neonatal vitamin K
stores low.
Acitretin Avoid.
Aciclovir Significant amount is found in milk after systemic
administration.
Alendronate sodium Avoid.
Allopurinol Present in milk.
Alprazolam Present in milk; avoid.
Alcohol Large amount may affect infant and reduce milk
consumption.
Amantadine Should not be used
Amiodarone Should not be used
Androgens Avoid; may cause masculinisation in the female infant or
precocious development in the male infant; high dose
suppresses lactation.
Amiloride Avoid, no information available
Antidepressants Amount of tricyclic antidepressants (including related
drugs such as mianserin and trazodone) too small to be
harmful; avoid.
700
.
Atracurium Avoid, no information available.
Atropine Use with caution, very small amount available in milk.
Azithromycin Prescribe with caution; no harmful effect is known; use
only if adequate alternatives not available.
Bendrofluazide Amount too small to be harmful; large doses may
suppress lactation.
Beta-blokers Monitor infants; possible toxicity due to beta-blockade but
amount of most beta-blockers excreted in milk too small to
affect infant; acebutolol. Atenolol, nadolol and solatol are
present in higher amounts than other beta-blockers;
manufacturers advice to avoid celiprolol and nebivolol.
Bismuth
Subcitrate/Subsalicylate Avoid.
Benzoiazepines Present in milk; avoid if possible.
Benzylpenicillin trace amount present in milk; safe in usual dosage;
monitor infant.
Betamethasone Systemic effect in infant unlikely with maternal dose of
less than equivalent of Prednisolone 40mg daily; monitor
Infants adrenal function with higher dosage.
Bromazepam See benzoiazepines.
Bupivacaine Amount too small to be harmful.
Busulphan Discontinue breast-feeding.
Calcipotriol Avoid if possible; no information available.
Carbamazepine Amount too small to be harmful; but 1-2 cases of reported
skin rashes in infants.
Carbimazole Amounts in milk may be sufficient to affect neonatal
thyroid function, therefore lowest effective dose should be
used.
Carbocisteine Avoid.
Ceftriaxone Excreted in low concentration; safe in usual dosage;
monitor infant in higher dosage.
Clindamycin Should avoid.
Clomiphene May inhibit lactation; Avoid.
Clonidine May decrease milk supply; Avoid.
Clozapine Should not be used.
Carboplatin Discontinue breast-feeding.

Chloramphenicol Use replacement, may cause bone-marrow toxicity in
infants; concentration in milk usually insufficient to cause
Grey syndrome.
Chlorthalidone May inhibit lactation; Avoid.
Chlorambucil Discontinue breast-feeding.
Chloroquine Amount too small to be harmful; inadequate for reliable
protection against malaria.
Chlorpromazine Drowsiness in infants reported.
Chlorpropamide Caution; theoretical possibility of hypoglycemia in infants.
Cilazapril Avoid; excreted in milk.
Cimetidine Significant amount present in milk; till not known to be
harmful; but better to avoid.
Citalopram Can cause infant drowsiness; should avoid.
Ciprofloxacin High concentrations in breast milk; avoid.
Cisatracurium No information available.
Cisplatin Discontinue breast-feeding.
701
Contraceptives (oral) Combined OCP inhibit lactation; Should avoid.

Co-trimoxazole Small risk of kernicterus in jaundiced infants and
of haemolysis in G6PD-deficient infants.
Clarithromycin Avoid; excreted in milk.
Dactinomycin Discontinue breast-feeding.
Dalteparin No information available.
Dapsone Haemolytic anaemia; although significant amount in milk
risk to infant very small.
Daunorubicin Discontinue breast-feeding.
Diazepam Present in milk, avoid if possible.
Diclofenac Amount too small to be harmful.
Digoxin Amount too small to be harmful.
Dihydroergotamine Avoid, ergotism may occur in infants; repeated doses may
inhibit lactation.
Diloxanide Avoid.
Diltiazem Avoid; significant amount present in milk.
Disopyramide Present in milk; use only if essential and monitor infant for
antimuscarinic effects.
Docetaxel Discontinue breast-feeding.
Domperidone Amount probably too small to be harmful.
Doxepin Should avoid.
Doxorubicin Discontinue breast-feeding.
Doxycycline Avoid, or if necessary, discontinue breast-feeding.
Droperidol Although amount excreted in milk probably too small to be
harmful, animal studies indicate possible adverse effects
of these drugs on developing nervous system, therefore
avoid unless absolutely necessary.
Enoxaparin Avoid, no information available.
Epoetin Avoid, no information available.
Ergotamine Avoid, ergotism may occur in infant; repeated doses may
inhibit lactation.
Erythromycin only a small amount is present in breast milk; safe in usual
dosage; monitor infant.
Ethosuximide Should avoid.
Etoposide Discontinue breast-feeding.

Famotidine Present in milk, not known to be harmful; avoid.
Felodipine Appears in milk; avoid.
Fentanyl Avoid.
Filgrastim Avoid, no information available.
Fluconazole Avoid; present in milk.
Fluorouracil Discontinue breast-feeding.
Fluoxetine Should Avoid.
Fluphenazine Amount excreted in milk too small to be harmful. Animal
studies showed harmful effect.
Flurazepam See benzodiazepine.
Fluvastatin Manufacturer advises to avoid.
Fosinopril Present in milk; avoid.
Frusemide Too small to be harmful.
Gemcetabine Discontinue breast-feeding.
Gemfibrozil Avoid; no information available.
Gentamicin Avoid.
Glibenclamide See sulphonylureas.
Gliclazide See sulphonylureas.
702
Glimepiride See sulphonylureas.

Glipizide See sulphonylureas.
Haloperidol Excreted in milk, but too small to be harmful.
Halothane Excreted in milk.
Heparin Avoid, risk of haemorrhage in infants.
Hydralazine Present in milk but not known to be harmful. Monitor
infants.
Hydrocortisone Systemic effect in infant unlikely with maternal dose of
less than equivalent of Prednisolone 40mg daily; monitor
Infants adrenal function with higher dosage.
Hydrochlorothiazide Amount too small to be harmful, large doses may
suppress lactation.
Hydroxyzine Avoid; significant amount found in milk.
Hyoscine butylbromide Amount too small to be harmful.
Ibuprofen Too small to be harmful, but better if avoided.
Idoxuridine May possibly make taste of milk unpleasant.
Imipramine May cause respiratory depression; avoid.
Indapamide Avoid; no information available.
Indomethacin Avoid; too small amount found in milk; convulsion reported
in some infants.
Insulin Amount too small to be harmful.
Interferons Avoid; no information available.
Iodine Stop breast-feeding; danger of neonatal hypothyroidism or
goitre; appears to be concentrated in milk.
Irinotecan Discontinue breast-feeding.
Isoniazide Monitor infants for possible toxicities; theoretical risk of
convulsion and neuropathy; prophylactic Pyridoxine is
advisable for mother and infant.
Isotretinoin Avoid.
Ivermectin Avoid until infant is 1 week old.
Itraconazole Small amount found in milk, not harmful.
Ketorolac Avoid.
Ketotifen Significant amount present in milk, not harmful but
drowsiness in infants reported.
Lacidipine Avoid; no information available.
Lamivudine Breast-feeding not advised in HIV infection.
Lamotrigine Small amount found in milk, not harmful.
Lignocaine Amount too small to be harmful.
Lipid lowering agents Should not be used.
Lisinopril Caution to be taken; no information available.
Lithium Present in milk, and risk of toxicity in infant.
Loperamide Amount found in milk not harmful for infant.
Mebendazole No information available.
Mebeverine Amount in milk too small to be harmful.
Mefloquine Present in breast milk but risk to infant is minimal.
Melphalan Discontinue breast-feeding.
Mercaptopurine Discontinue breast-feeding.
Meropenem Avoid.
Methadone Withdrawal symptoms in infant; breast-feeding permissible
during maintenance but dose should be as low as
possible and infant monitored to avoid sedation.
Methotrexate Discontinue breast-feeding.
Metoclopramide Although amount in milk is small, avoid unless essential.
Metronidazole Significant amount in milk; do not take single large doses.
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Mianserin Risk of respiratory depression in infants.

Miconazole Take caution; no information available.
Misoprostol Avoid; no information available.
Mitomycin Discontinue breast-feeding.
Morphine Therapeutic doses unlikely to affect infants; withdrawal
symptoms in infants of dependent mothers.
Mycophenolate Avoid; no information available.
Nadolol Should avoid.
Naloxone Avoid; no information available.
Naproxen Amount too small to be harmful.
Neostigmine Amount too small to be harmful. Monitor infant.
Nifedipine Amount too small to be harmful.
Nitrazepam See benzodiazepam.
Nitrofurantoin Only small amounts in milk but could be enough to
produce G6PD-deficient infant.
Nortryptyline Risk of respiratory depression in infants.
Ofloxacin Avoid.
Olanzapine Avoid; adverse reactions occur.
Omeprazole Avoid; no information available.
Orlistat Avoid; no information available.
Oxcarbazipine See benzodiazepine.
Oxytetracycline Avoid; teeth deformity in infants.
Paclitaxel Discontinue breast-feeding.
Penicillamine Trace amount in milk, use with caution.
Pethidine Avoid.
Phenobarbital Avoid.
Phenytoin Small amount present in milk, avoid.
Piroxicam should avoid.
Pilocarpine Avoid; no information available.
Pindolol Too small amount found in milk to be harmful; monitor
infants.
Praziquantel Avoid breast feeding during and 72 hours after treatment.
Prazosin Amount probably too small to be harmful.
Primaquine Avoid; risk of haemolysis in G-6PD deficit infant.
Procarbazine Discontinue breast-feeding.
Propafenone Avoid. No information available.
Propranolol Monitor infant; possible toxicity due to beta-blockade but
amount of most beta-blockers excreted in milk too small to
affect infants.
Pyrazinamide Amount too small to be harmful.
Pyrimethamine Significant amount, avoid administration of other folate
antagonists to infants.
Quinidine Significant amount, but not known to be harmful.
Ranitidine Significant amount present in breast milk but not known to
be harmful.
Repaglinide Avoid.
Reserpine Should avoid.
Retinol Theoretical risk of toxicities in infants of mother taking
larger dose.
Rifampicin Amount too small to be harmful.
Ritonavir Breast-feeding not advised in HIV infections.
Recuronium Avoid.
Rofecoxib Avoid. Present in milk in animal studies.
Simvastatin Avoid.
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Sodium autothiomalate Avoid.

Sodium valproate Amount too small to be harmful.
Somatropin Avoid, no information available.
Sotalol Should avoid.
Sulphonylureas Caution, theoretical possibility of hypoglycaemia in infants.
Sulphasalazine Small amounts in milk. Theoretical risk of neonatal
haemolysis especially in G6PD- deficient infants.
Sulpride Significant amount in milk; avoid.
Tamoxifen Avoid; no information available.
Terbinafne Present in milk; avoid.
Tetracycline Avoid; deformity and dental decolourisation in infants.
Theophylline Irritability in infant reported; modified release preparations
probably safe.
Thioridazine Avoid.
Ticlopidine Avoid.
Timotol Avoid.
Tinidazole Avoid.
Trimethoprime Present in milk; short-term use not harmful.
Tretinoin Avoid.
Trifluoperazine Avoid.
Valsartan Avoid.
Valproic acid Amount too small to be harmful.
Vancomycin Avoid; present in milk.
Verapamil Amount probably too small to be harmful.
Venlaflaxine Should avoid.
Vinblastine Discontinue breast-feeding.
Vincristine Discontinue breast-feeding.
Warfarin See anticoagulant.
Zafirlukast Avoid; present in milk.
Zalcitabine Breast-feeding not advised in HIV infections.
Zaleplon Avoid.
Zidovudine Breast-feeding not advised in HIV infections.
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APPENDIX-7 : POISONING
Appendix-7
POISONING
A BRIEF OVERVIEW
Poisoning occurs when any substance interferes with normal body functions after it is
swallowed, inhaled, injected, or absorbed. In 80% of the cases, the victim is a child
under the age of five. Curiosity, inability to read warning labels, a desire to imitate
adults, and inadequate supervision lead to childhood poisonings. The elderly are the
second most likely group to be poisoned. Mental confusion, poor eyesight, and the
use of multiple drugs are the leading reasons why this group has a high rate of
accidental poisoning. A substantial number of poisonings also occur as homicide,
suicide attempts or drug overdoses.
There are basically two major types of poisons. One group consists of products that
are never meant to be ingested or inhaled, such as shampoo, paint thinner, pesticides,
toxic planteaves, and carbon monoxide. The other group contains products that can
be ingested in small quantities, but which are harmful if taken in large amounts, such
as pharmaceuticals, medicinal herbs, or alcohol. Other types of poisons include the
bacterial toxins that cause food poisoning, such as Escherichia coli; heavy metals,
such as the lead found in the paint on older houses; and the venom found in the bites
and stings of some animals and insects.
On the basis of severity, the types of poisoning are 1) Acute poisoning – excessive
single dose, or several smaller doses of a poison taken over a short interval of time; 2)
Chronic poisoning – smaller doses over a period of time, resulting in gradual
worsening; 3) Sub-acute poisoning – the poisoning lies between acute and chronic
poisoning, resulting in gradual worsening and 4) Fulminate poisoning – a very high
or massive dose of poison at a time results death with or without any sign and
symptom and patient become collapse suddenly. There have some nature of
poisoning which are- a) Homicidal – killing of a human being by another human being
by administering poisonous substance deliberately without other one’s notice. b)
Suicidal – when poisoning is created by himself/ herself to end his/ her life; c)
Accidental – any poisonous substance taken/administered unknowingly by the
person or children. Eg. Household poisons- nail polish remover, acetone etc; and d)
Occupational – poisoning occurs as professional workers. Eg. insecticides, noxious
fumes.
The effects of poisons are as varied as the poisons themselves; however, the exact
mechanisms of only a few are understood. Some poisons interfere with the
metabolism. Others destroy the liver or kidneys, such as heavy metals and some pain
relief medications, including acetaminophen and nonsteroidal anti-inflammatory drugs.
A poison may severely depress the central nervous system, leading to coma and
eventual respiratory and circulatory failure. Potential poisons in this category include
anesthetics (e.g. ether and chloroform), opiates (e.g., morphine and codeine), and
barbiturates. Some poisons directly affect the respiratory and circulatory system.
Carbon monoxide causes death by binding with hemoglobin that would normally
transport oxygen throughout the body. Certain corrosive vapors trigger the body to
flood the lungs with fluids, effectively drowning the person. Cyanide interferes with
respiration at the cellular level. Another group of poisons interferes with the
electrochemical impulses that travel between neurons in the nervous system. Yet
another group, including cocaine, ergot, strychnine, and some snake venoms, causes
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potentially fatal seizures. Severity of symptoms can range from headache and nausea
to convulsions and death. The type of poison, the amount and time of exposure, and
the age, size, and health of the victim are all factors which determine the severity of
symptoms and the chances for recovery
Some general principles for diagnosing and treating poisoning are discussed first.
Highlights of symptoms and treatment for individual chemicals and drugs, or groups of
substances follow alphabetically. Poisoning from snakebites and other life-forms are
discussed.
GENERAL PRINCIPLES OF TREATMENT:
DIAGNOSIS
Poisoning should be considered in the differential diagnosis of any unexplained
symptoms or signs, especially in children < 5 yr. Similarly, in the young adult, any
disparity between expected history and clinical findings should suggest poisoning.
Often the type and speed of onset of the total clinical picture will conform or refute a
suspicion of poisoning. Occasionally, the absence of a specific finding will be as
important as its presence. Any pertinent history should be secured and the person and
premises inspected for traces of drugs, i.e. imprint identifications on solid medication
forms, alcohol, etc., particularly for the unconscious patient.
IMMEDIATE CARE/ FIRST AID MEASURES
1. Remove patient from further exposure to pain.
2. Determine adequacy of cardiac and respiratory function and begin
resuscitation if needed.
3. Determine quickly what has happened. Identify the substance ingested, its
route of entry into the body, and its toxicity potential. Save any containers
and appropriate specimens of the product or of emetic returns.
4. Determine the need for medical care, recognizing that many substances
eed no further treatment. At all times, it should be recalled that over
treatment per se may be a hazard. Unless contraindicated, immediately
dilute and remove the toxic substance from the body. A person who has
ingested a toxic substance may also have spilled it on the skin and may be
inhaling fumes as well.
5. Maintain body temperature and blood pressure.
6. Fluid balance should be maintained.
Ingested poison: Emesis will usually remove more of the toxic substance than will
gastric lavage. Immediately induce vomiting with ipecac syrup 15 to 30 mL (1 to 2
tbsp for children and adults taken with water or soft drinks (orally: 15 mL/kg for infants:
1 qt [1 L] for adults); and keep the patient actively moving if possible. The dose of
ipecac may be repeated in 15 min if necessary. If ipecac is not available, give soapy
water, anionic or non-anionic detergent (hand-washing liquid detergent) plus water
and induce vomiting by inserting a finger or blunt instrument into the patient’s throat.
Avoid being bitten. Place a child in the head-down position. Save a portion of the
vomitus for analysis. (CAUTION : Do not induce vomiting if the patient is comatose, is
having convulsions [or is likely to], or has ingested petroleum distillates or corrosive
substances. Emesis of petroleum distillates is hardly ever indicated unless some other
compound has been dissolved in the distillates that requires evacuation [eg.
parathion]).
When gastric lavage is carried out (do not use lavage if the patient is convulsing or if
the ingested substance is corrosive), use the largest tube appropriate for the patient.
For comatose or sedated patients > 2 yr of age, use a cuffed endotracheal tube to
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prevent aspiration. For those < 2, no cuff is needed on the endotracheal tube because
of the snug fit. Have the patient in a head-low position. For adults, physiologic (0.9%)
sodium chloride solution or tap water may be used; for children, 0.45% sodium
chloride solution is recommended. Introduce lavage fluids in 20 to 30 mL aliquots and
remove the stomach contents by siphon or syringe after each installation. Continue
the rinsing procedure until washings return free of toxin. After the return is clear, instill
a specific antidote if one is available; otherwise instill a slurry of activated charcoal
(see below).
The use of cathartics remains controversial; some evidence suggests that they may
actually enhance absorption rather than promote excretion. If a cathartic is used, it is
best limited to sodium sulfate 30gm dissolved in 250 mL water, with proportionally
reduced amounts for children.
When taken internally, activated charcoal with its molecular configuration and large
surface area adsorbs significant amounts of many poisons, precluding their absorption
from the gut. The earlier the charcoal is used, the more effective it is. From 5 to 10
times the amount of charcoal as that of poison suspected of being ingested should
be used. For children < 5 yr the usual dose is 25 gm; for older children and adults, 50
to 100 gm.
Specific antidotes: While not numerous, specific antidotes are remarkably effective
eg., naloxone in opioid overdoses, atropine and pralidoxime in organo-phosphate
encounters, methylene blue for methemoglobinemia, N- acetylcysteine for
acetaminophen, protamine sulphate for heparine, flumazenil for benzodiazepine.
Inhaled poison: The patient should be removed from the contaminated environment,
his/her respiration supported and other personnel protected from contamination.
Skin and eye contamination: Contaminated clothing (including shoes and socks)
should be removed. The skin should be thoroughly washed and the eyes flushed with
water. Helpers should also be taken care of being protected from contamination.
CNS stimulation by the poison may require sedation. Usually, diazepam or a
barbiturate is used. In pure amphetamine poisoning, chlorpromazine is the drug of
choice. To terminate convulsions, diazepam (5 to 10 mg for adults; 0.1 to 0.2 mg/kg
for children) is given slowly IV. Phenobarbital (100 to 200 mg for adults and 4 to 7
mg/kg for children) may be used IV or IM to either terminate or prevent the recurrence
of a convulsion.
CONTINUING CARE
Symptomatic and supportive treatment depends on symptoms and signs and on
anticipation of the clinical course, based upon identification of the poison. Continuation
of the appropriate measures already begun and attempts to enhance excretion of
poison already absorbed are basic considerations. Stimulants are unlikely to be
effective and are generally contraindicated. Severe CNS depression requires support
of the circulation and ventilation. Endotracheal intubation and rarely tracheostomy may
be necessary. In suspected or known narcotic poisoning, naloxone-an potent opiod
antagonist should be used.
Cerebral edema is common in poisoning due to sedatives, carbon monoxide, lead,
and other CNS depressants. A 20% mannitol solution (5 to 10 mL/kg) is given slowly
IV over a 30- to 60 min period. Corticosteroids are also used (dexamethansone 1
mg/sq m of BSA q 6 h by IV drip). The use of intracranial monitoring with
hyperventilation to alter the degree of cerebral edema enjoys widespread favor. The
use of “barbiturate coma” in cerebral edema associated with hypoxic episodes has
been advocated but the practice must be considered experimentally.
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Renal failure may occur in poisoning, and dialysis may be required. Elimination of
poisons sometimes can be hastened either by augmenting normal excretory pathways
or by using artificial means such as dialysis, depending upon the nature of the
poisoning, the availability of the faculties and the condition of the patient. Flushing out
the poison by simply increasing urine volume is rarely helpful. Alkalinization or
acidification of the urine can occasionally be helpful (eg. in acute salicylate ingestions,
giving 2 to 3 mEq/kg of sodium bicarbonate IV will augment excretion significantly). In
general, weak acids are captured in alkalinized urine and weak bases in acidified
urine.
Over the past decade, hemo- and peritoneal dialysis have been augmented by the
development of “lipid dialysis” aimed at removal of lipid-soluble substances from the
blood and hemoperfusion, to provide an even more rapid and efficient clearance of
toxic substances from the blood. However, these techniques are useless if the
involved substance has a large “apparent volume of distribution” – i.e. if it is stored in
fatty tissue or extensively bound to tissue protein. In select circumstances these
techniques may be effective, but in many instances their yield is negligible. Thus while
digoxin is rapidly cleared from the blood via hemoperfusion, such a small amount (3 to
5%) of the total body digoxin is present in the blood that hemoperfusion is ineffective.
TREATMENT OF COMMON POISONING:

ACETAMINOPHEN or PARACETAMOL
SYMPTOMS
Early: Often asymptomatic; mild nausea, vomiting, diaphoresis, pallor, beginning signs
of hepatotoxicity; oliguria; Later (at 24-48h): Nausea & protracted vomiting, right upper
quadrant pain, jaundice, coagulation defects, hypoglycemia, encepthalopathy, hepatic
failure; renal failure, myocardiopathy may occur.
TREATMENTS
Emesis: gastric lavage. Monitor plasma drug levels for prognosis;
If > 160-200 µg/ mL at 4 h. hepatic necrosis may occur; if plasma level > 300 µg/ mL
at 4 h. hepatic damage is almost certain. If given before 18 h. oral N-acetylcysteine
(Mucomyst®) 140 mg/ kg to start and 70 mg/ kg q 4 h for 4 to 18 doses have been
effective in preventing significant hepatotoxicity.
ASPIRIN AND SALICYLATES

SYMPTOMS
Nausea, vomitting, dizziness, tinnitus, headache, confusion, hyperventellation,
tachycardia, fever. In severe case: delirium, hallucination, convulsion, coma and
respiratory crisis may occur.
TREATMENTS
Supportive treatment: Fluid/ electrolyte management: Rehydrate with 0.9 % saline at
the rate of 10-20 cc / hr over 1-2 hrs until urine flow is 3-6 cc/kg/ hr. For preventing
absorption: Ipecac, Gastric lavage, charcoal and cathertic administration. For
enhancing elimination, perform forced alkaline diuresis, hemodialysis, hemoperfusion
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BARBITURATES
Amobarbital, Pentobarbital, Phenobarbital, Secobarbital
SYMPTOMS
Headache, confusion, ptosis, excitement, delirium, loss of corneal reflex, respiratory
failure, coma
TREATMENT
Empty stomach up to 24 h after ingestion. If immediately after, use ipeace emetic; if
sedated, use lavage with cuffed endotracheal tube. Consider saline cathartic (sodium
sulphate 15-30gm); good nursing care; support respirations, give O 2; correct any
dehydration. Rarely hemodialysis or peritoneal lavage, especially for long-acting
barbiturates.
NAPHTHALENE
SYMPTOMS
On contact, dermatitis and corneal ulceration occur. Inhalation results in headache,
confusion, vomiting, dyspnea. On ingestion, abdominal cramps, nausea, vomiting,
headache, confusion; dysuria; intravascular hemolysis; convulsions occurs. Hemolytic
anemia results in persons with G6PD deficiency
TREATMENT
For poisoning due to contact, remove clothing if formerly stored with naphthalene,
flush skin and eyes. If ingested, perform Ipecac emesis, gastric lavage; blood
transfusion for severe hemolysis; alkalize urine for hemoglobinuria; for severe
hermolysis, blood transfusions is necessary; control convulsions
NARCOTICS
Alpharodine, codeine, heroin, meperidine, methadone, morphine, opium,
propoxyphene.
SYMPTOMS
Pinpoint pupils, drowsiness, shallow respirations, spasticity and respiratory failure.
TREATMENT
Do not give emetics. Gastric lavage, respiratory support. Naloxone 5 g/ kg IV to
awaken & improve respiration; if patient does not respond, give 2-20 mg naloxone
(dosage must be repeated as many as 10- 20 times); fluids IV to support circulation.
PESTICIDES
PARAQUAT preparations are available to farmers and horticulturists. It has local and
systemic effects. Splashes in the eyes irritate and ulcerate the cornea and conjunctiva.
Washing of the eye and installiation of antibacterial eye drops, should promote
healing. Skin irritation, blistering and ulceration can occur from prolonged contact.
Nausea, vomitting and diarrhoea follow ingestion of concentrated paraquat solutions.
Painful ulceration of the mucous membranes may appear within 36-48 hours.
The single most useful measure of immediate treatment is the oral administration of
activated charcoal. The first dose of 100 gm is given with magnesium sulfate followed
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by activated charcoal 50 gm every 4 hours. Fluid and eletrolyte balance to be

maintained. Oxygen therapy in early stages may make paraquat more toxic.
ORGANOPHOSPOROUS INSECTICIDES
These are usually supplied as powders or as dissolved in organic solvents. All are
absorbed through the bronchi and intact skin as well as through the gut and inhibit
cholinesterase activity, thereby prolonging and intensifying the effects of acetylcholine.
TREATMENT
The patient should be removed from source of poisoning and the contaminated
clothing should be removed immediately. Emptying the stomach with gastric lavage
should prevent further absorption, contaminated skin should be washed. In severe
poisoning the airway is to be established. Artificial respiration is to be started with air
or oxygen if necessary. The excess bronchial secretions are to be removed. Atropine
injection IV or IM 2 mg is to be given. It should be repeated every 20-30 minutes until
signs of atropinisation (hot dry skin, dry mouth, widely dilated pupils and flat pulse). Up
to 12 mg of atropine can be given safely during the first 2 hours of treatment.
Pralidoxime mesilate, a cholinesterase reactivator is indicated, as an adjunct to
atropine, in moderate or severe poisoning but is only effective if given within 24 hours.
A dose of 30 mg/ kg diluted with 10-15 ml water for injections by slow intravenous
injections should produce improvement in muscle power within 30 minutes.
Pralidoxime mesilate avilable as: Protopam (Ayerst), Tab. 500mg ; Inj. 1 gm/ vial.
PARAFFIN, PETROL AND OTHER PETROLIUM PRODUCTS

(Including pain thinners, organic solvents etc.)
Gastric lavage should be performed, using activated charcoal. Before lavage is carried
out a cuffed endotracheal tube should be inserted to prevent pulmonary aspiration.
ETHANOL
Unabsorbed ethanol to be removed by gastric lavage. Activated charcoal is to be
given to reduce absorption of any remaining ethanol. Adequate airway should be
maintained. If patient is in coma, naloxone IV 0.01 mg/ kg to be given. Normal body
temperature to be maintained.
In acute alcoholic mania, Inj. diazepam 10 mg IV slowly to be given, followed by 5 mg
slow IV every 5-10 minutes until mania is controlled. The blood glucose should be
measured and injection glucose IV to be given if indicated.
CARBON MONOXIDE
The patient should be removed from further exposure. 100 % oxygen is given by mask
for several hours. Blood pressure and body temperature is to be maintained. Mannitol
20% IV is given to reduce cerebral oedema and prednisolone is to be given by slow IV.
To control convulsions, IV diazepam should be given slowly.
VENOMOUS BITES AND STINGS POISONOUS SNAKES
A good number of snake varieties are poisonous. Among the poisonous snakes,
members of Crotalidae, Elapidae and a few species of Colubridae families are
important. Small scale studies indicate that, about 25% snakebite is poisonous and
the highest bite rates are in the hilly areas of the country. Severity of any venomous
snakebites depends on the size and variety of the snake, the amount and toxicity of
the venom injected and underlying medical conditions of the victim, among other
factors.
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CHEMISTRY, PHARMACOLOGY, AND PATHOLOGY

Snake venoms are complex mixtures, chiefly proteins, many having enzymatic activity.
Although the enzymes contribute to the deleterious effect of the venom, some of the
more important toxic components are smaller polypeptides, which are more toxic than
the crude venom. Most venom components appear to have specific chemical and
physiologic receptor sites.
Envenomation may be further complicated by the release of autopharmacologic
substances (eg. histamine, serotonin) that can make diagnosis and treatment difficult,
Arbitrary grouping of snake venoms into categories such as “ neurotoxins,”
“hemotoxins,” “cardiotoxins” is pharmacologically superficial and can lead to grave
errors in clinical judgment. A so-called neurotoxic venom can produce marked
cardiovascular changes or direct hematologic effects. The so-called hemotoxin
venoms can also produce changes in the nervous system, or in vascular dynamics. A
patient with snake venom poisoning must be considered as a victim of a complex
poisoning .
SYMPTOMS, SIGNS AND DIAGNOSIS
Venomous snake bites are medical emergencies, requiring immediate attention and
considerable judgment. Before any treatment is begun, it must be determined whether
the snake was venomous and whether envenomation occurred, since a venomous
snake may bite and not inject venom. When no envenomation occurs, or the bite
inflicted by a nonvenomous snake, it should be treated as a puncture wound.
Symptoms and signs very considerably, depending on the species of snake, the
amount of venom injected and other factors. If there is evidence of poisoning soon
after a bite, the possible consequences must not be underestimated.
Contrary to popular opinion, severe pain is not a constant finding; it may be mild or
absent.
Untreated the edema progresses rapidly and may involve the entire extremity within
hours. There may be lymphangitis and enlarged, tender, regional lymph nodes, Skin
temperature over the injured part and body temperature are usually elevated.
Although the patient may complain of chills. Weakness, a rapid and weak pulse,
syncope, sweating, nausea and vomiting may be present. BP often drops and shock
may develop early. Respiratory distress may occur.
There may be hemorrhage from the gums, hematemesis, melena, and hematuria.
Bleeding and clotting times are prolonged and platelet counts may fall sharply in
moderate or severe envenomations.
Laboratory Tests
In all but trivial cases, a CBC (including platelets), coagulation profile (PT, PTT,
fibrinogen), blood typing, and urinanalysis are essential. Other tests, such as ESR,
serum electrolytes, BUN, creatinine, and RBC fragility tests, may be useful. An ECG is
indicated in all severe cases.
TREATMENT
When bitten by poisonous snakes and if the patient is within 30 to 40 min of a medical
facility, he/she should be put at rest, reassured, kept warm, and transported there as
quickly as possible. The injured part should be loosely immobilized in a functional
position just below heart level, and all rings, watches and constrictive clothing
removed. If the patient is > 40 min from medical care, single incision can be made
through the fang marks (no longer than ¼ inch and no deeper than ¹/8 inch) within the
first 5 min. Suction, using Sawyer’s “extractor”, applied directly over the incisions or
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even over the fang punctures is of value only during the first 30 to 60 min following the
bite. The wound should be cleansed and covered with a sterile dressing.
If antivenin is needed, a skin test for horse serum sensitivity should be performed as
described in the antivenin brochure. If the patient is mildly sensitive to horse serum
and the poisoning is serious, diphenhydramine IV may be indicated before given the
antivenin. When a patient is 3+ or 4+ sensitive and life or limb are at stake, the patient
should be placed in a critical or intensive care unit, carefully monitored, and antivenin
given in the presence of a physician. A tourniquet, O2, epinephrine, and other drugs
and equipment for treating for treating anaphylaxis should be available during
antivenin therapy.
BEES, WASPS, HORNETS, ANTS
The venoms of these insects (order Hymenoptera) contain, among other components
peptides and nonenzymatic proteins (eg, apamin and melittin and/or kinins), enzymes
(eg, phospholipase A and B and hyaluronidase), and amines (eg, histamine and 5-
hudroxytryptamine).
While it may take over 100 bees to inflict a lethal does of venom in most adults, one
sting can cause a fatal anaphylactic reaction in a hypersensitive person.
TREATMENT
The stings of many hymenoptera may remain in the skin and should be removed by
teasing or scraping rather than pulling. An ice cube placed over the sting will reduce
pain; an antihistamine – analgesic – corticosteroid balm is often useful. Persons with
known hypersensitivity to such stings should carry a kit containing an antihistamine
and epinephrine when in endemic areas. Desensitization can be carried out using
insect whole-body antigens or preferably, whole-venom antigens.
OTHER BITING ARTHROPODS
Among the more common biting and sometimes blood sucking arthropods the ticks
and mites, mosquitoes; fleas; lice; bedbugs are most prominent. The composition of
the saliva of these arthropods varies considerably, and the lesions produced by the
bites of these animals vary from a small papule to a large ulcer with swelling and
acute pain. Dermatitis may also occur. Most serious bites are complicated by
sensitivity reaction or infection. In hypersensitive persons, bites can be fatal.
TREATMENT
The offending arthropod should be quickly removed. For ticks and some of the bugs,
this is best accomplished by direct application of a petroleum products or other irritant
to the animal or by slowly withdrawing the arthropod while twisting it slowly with
forceps. Care should be taken not to leave the capitulum in the wound, as it may
induce chronic inflammation or migrate into deeper tissues and give rise to a
granuloma. The bite should be cleansed and a corticosteroid lotion applied.
TICKS AND MITES
Ticks are vectors of many diseases. In addition to the reactions noted above under
BITING ARTHROPODS, ticks are also involved in poisonings. In North America, some
species of Dermacentor and Amblyomma cause tick paralysis, Symptoms and signs
include anorexia, lethargy, muscle weakness, incoordination, nystagmus, and
ascending flaccid paralysis. Bulbar or respiratory paralysis may develop.
Mite infestations are quite common and are responsible for “chiggers” (intensely
pruritic dermatitis caused by the mite larva, or chigger) , various forms of scabies,
demodicidosis and a number of other diseases. The bites produce varying degrees of
local tissue reaction with or without sensitization.
713
TREATMENT SCHEDULE FOR BITE BY TICKS AND MITES

Treatment of tick paralysis is symptomatic. O2 and respiratory assistance may be
needed. An antitoxin is presently under study. Pajaroello tick lesions should be
cleansed, soaked in 1:20 Burow’s solution, debrided, and painted with the aqueous
triple dye as used for viper bites. Corticosteroids are of value in severe reactions.
Infections are common during the ulcer stage but rarely require more than local
antiseptic measure.
CENTIPEDES AND MILLIPEDES
Some of the large centipedes of the genus Scolopendra can inflict bite with some
localized swelling and erythema .Lymphangitis and lymphadenitis are common.
Necrosis is rare and infection almost unknown. Symptoms and signs seldom persist
for 48 h. Millipedes do not bite but when handled may secrete a toxin that can cause
local skin irritation and in severe cases, tissue changes.
TREATMENT
An ice cube will control the pain of most centipede bites. Toxic secretions of millipedes
should be washed from the skin with copious amounts of soap and water; alcohol
should not be used. A topical corticosteroid should be applied if a skin reaction
develops. Eye injuries require immediate irrigation and the application of a
corticosteroid – analgesic ointment.
SCORPIONS
Most of the scorpions except Centruroides exilicauda ( sculpturatus ) are relatively
harmless , their stings usually causing no more than some localized pain with minimal
swelling , some lymphangitis with regional lymph gland swelling and increased skin
temperature and tenderness around the wound. Children become tense, restless, and
abnormal and random head, neck, and eye movements. In adults, tachycardia,
hypertension, increased respirations, weakness and motor disturbances may
predomainate. Respiratory difficulties may occur in both children and adults often
complicated by excessive salivation.
TREATMENT
An ice cube over the wound area reduces pain. Hypertension can be controlled with
diazoxide in doses of 5 mg/kg by slow IV push. For convulsions, diazepam is given IV
0.1 to 0.2 mg/kg up to 10 mg in adults and repeated q 15 min prn ; in children the total
dose is 10 mg. Muscle spasms usually respond to calcium gluconate, methocarbamol,
or diazepam. Complete bed rest is indicated and no food for the first 8 to 12 h.
Antivenin should be use in all severe cases.
714
Appendix-8
IMMUNIZATION SCHEDULE
Appendix- 8a :
IMMUNIZATION SCHEDULE FOR CHILDREN UNDER ONE YEAR WITH
DOSAGE AND MODE OF ADMINISTRATION OF VACCINE
Interval
between doses Route of
Quantity for Number Age of Age of Site of
Disease Vaccine adminis-
each dose of dose starting completion Vaccination
Mini- Maxi- tration
mum mum
Tuberculosis BCG 0.05 ml 1 - - After birth Within one Upper part of Intradermal
year left arm
Diphtheria, DPT 0.5 ml 3 4 weeks None 6 weeks Do Anterolateral Intra-
Pertussis & part of mid- muscular
Tetanus thigh (IM)
Poliomyelitis OPV 2-3 drops* 4** 4 weeks None 6 weeks Do Mouth Oral route
(by
dropper)
Measles Measles 1 - - Just after Do Anterolateral Sub-
vaccine 0.5 ml completion part of mid- cutaneous
of 9 thigh
months***
* According to manufacturer’s instruction. *** Currently available vaccine is not given before the age of 9 months because
** (4th dose is to be given with Measles vaccine). it interferes with the maternal antibodies passively transferred to the child.
Source: EPI Head Quarter, Mohakhali, Dhaka.
715
APPENDIX 8 : IMMUNIZATION SCHEDULE
Appendix- 8b :
IMMUNIZATION SCHEDULE FOR PREGNANT WOMEN & OTHER WOMEN
OF CHILDBEARING AGE (15-49 years) WITH
DOSAGE AND MODE OF ADMINISTRATION OF VACCINE
Route
Quantity
Number Age of Age of Site of of
Disease Vaccine for each Interval between doses
of dose starting completion Vaccination admini
dose
stration
minimum Maxi-mum
Neonatal TT-1 Total - - 15 years Upper part of IM
tetanus 5 doses /As early as arm (Deltoid
0.5 ml. possible in muscle)
pregnancy As early as
TT-2 4 weeks after TT-1 none 4 weeks possible
after TT-1
TT-3 6 months after TT-2 none 6 months
after TT-2
TT-4 1 year after TT-3 none 1 year after
TT-3
TT-5 1 year after TT-4 none 1 year after
TT-4
Source: EPI Head Quarter, Mohakhali, Dhaka
716
Appendix-8c :
VACCINATION SCHEDULE FOR TRAVELLERS
Meningo-coccal
Recommended
Yellow Ffever
Country
Encephalitis
prophylaxis
Hepatitis A
Meningitis
Japanese
Typhoid
regimen
Malaria
Afghanistan * * *,I C+P
Albania * * •
Algeria * * • -
American Samoa * * •
Angola * * • * Mef
Antigua & Barbuda * * •
Argentina * * - - - Chl
Armenia * * - - -
Australia (6)
Austria - - - -
Azerbaijan * * - - - Chl
Bahamas  •
Bahrain * *
Bangladesh * * *, I, E • * C+P/Mef
Barbados  •
Belarus - - - -
Belgium - - - -
Belize * * *I Chl
Benin * * • * Mef
Bermuda - - - -
Bhutan * * *, I, E C+P
Bolivia * * *, I, E Chl/Mef
Bosnia & * - - -
Herzegovina
Botswana * * - - - C+P
Brazil * * >9 * Mef
British Virgin Islands - - - -
Brunei Darussalam * * (6)
Bulgaria * * - - -
Burkino Faso * * • * Mef
Burundi * * • * Mef
Cambodia * * *I * Mef/Dox
Cameroon * * • * Mef
Canada - * *, I, E - -
Cape Verde Islands * * *, I, E -
717
Meningo-coccal
Recommended
Yellow Fever
Country
Encephalitis
prophylaxis
Hepatitis A
Meningitis
Japanese
Typhoid
regimen
Malaria
Cayman Islands * * - - -
C. African Republic * * • * Mef
Chad * * • * Mef
Chile * * - * -
China * * * * Chl/Mef
Christmas Island (6)
Colombia * *  C+P
Congo * * • * Mef
Costa Rica * * - - - Chl
Cuba * - - -
Cyprus * * - - -
Czech Republic * * - - -
DPR Korea * - - - -
Denmark - - - -
Djibouti * * • Mef
Domonica * •
Domonican Republic * - - - Chl
Ecuador * • C+P
Egypt * * • Chl
El Salvador * * >6 Chl
Equatorial Guinea * * *, I Mef
Eritrea * * *, I Mef
Estonia - - - -
Ethiopia * * • * Mef
Fiji * * •
Finland - - - -
France - - - -
French Guyana * * • Mef
French Polynesia * * •
Gabon * * • * Mef
Gambia * * • E * Mef
Georgia * * - - -
Germany - - - -
Ghana * * * * Mef
Gibraltar - - - -
Greece * * >6
Greenland - - - -
Grenada * •
718
Meningo-coccal
Recommended
Yellow Ffever
Country
Encephalitis
prophylaxis
Hepatitis A
Meningitis
Japanese
Typhoid
regimen
Malaria
Guatemala * * • Chl
Guinea * * • * Mef
Guinea Bissau * * • E * Mef
Guyana * * *, I, E Mef
Haiti (including Ports) * * *, I Chl
Honduras * * *, I Chl
Hong Kong  - -
Hungary - - - -
Iceland - - - -
India * * >6 E * * C+P
Indonesia * * *, I, E * C+P/Mef
Iran * * - - - Chl/C+P
Iraq * * *, I Chl
Ireland - - - -
Israel * * - - -
Italy - - - -
Jamaica * •
Japan  - - - -
Jordan * * •
Kazakhstan * * *, I
Kenya * * • * Mef
Kirbati * * •
Kuwait * * - - -
Kyrgyzstan * * - - -
Laos * * *, I * Mef
Latvia - - - -
Lebanon * * *, I
Lesotho * *, I
Liberia * * • Mef
Libyan Arab Jamahiriya * * •
Lithuania - - - -
Luxembourg - - - -
Macao * - - - -
Madagascar * *, I, E Mef
Malawi * * *, I * Mef
Malaysia * * • E * C+P/Mef
Maldives * * *, I
Mali * * • * Mef
719
Meningo-coccal
Recommended
Yellow Ffever
Country
Encephalitis
prophylaxis
Hepatitis A
Meningitis
Japanese
Typhoid
regimen
Malaria
Malta * >9
Marshal Islands * * - - -
Martinique •
Mauritania * • * C+P
Mexico * >6 Chl
Mongolia * - * -
Morocco * * - - - -
Mozambique * * • Mef
Myanmar * * *, I * Mef
Namibia * * *, I, E C+P
Nepal * * *, I * * C+P
Netherlands - - - -
New Zealand - - - -
Nicaragua * * • Chl
Niger * * • Mef
Nigeria * * • * Mef
Norway - - - -
Oman * * *, I C+P
Pakistan * * >6, E C+P
Panama * *  Chl
Papua New * * • Mef
Guinea
Paraguay * * *, E Chl
Peru * * >6, E * C+P/Mef
Philippines * * (6) C+P
Poland  - - -
Portugal * •
Polynesia, French * * • - -
Puerto Rico * - -
Qatar * * - -
Romania * - -
Rwanda * * • - - Mef
Samoa * * • - -
San Marino - -
Saudi Arabia * * *, I * C+P
Senegal * * *, E Mef
Singapore * * (6) - -
Slovakia - - - -
Slovenia - -
720
Malaria prophylaxis
Meningo-coccal
Recommended
Yellow Ffever
Country
Encephalitis
Hepatitis A
Meningitis
Japanese
Typhoid
regimen
Solomon Islands * * *, I * Mef
Somalia * * *, I * Mef
South Africa * * • E - - C+P
Spain * - *
Sri Lanka * * • * C+P
Sudan * * • E Mef
Surinam * * *, I Mef
Sweden - - - -
Switzerland - -
Taiwan * * - -
Tajikistan * * - * Chl
Thailand * * • E Mef/Dox
Togo * * • Mef
Tonga * * •
Trinidad and Tobago * * •
Tunisia * * •
Turkey * * - - - Chl
Turkmenistan * * *, I - -
Uganda * - • E * Mef
Ukraine * - - -
United Arab Emirates * - - - - C+P
United Kingdom - - -
United Republic of * - • E - Mef
Tanzania
United States of * - - -
America
Uruguay * - - - -
Uzbekistan * * - - -
Venezuela * * - - * Chl/C+P
Vietnam * - • * Mef
Virgin Islands * - - - -
Yemen * * • C+P
Yugoslavia * * - - -
Zaire * * • * Mef
Zambia * * - * Mef
Zimbabwe * *, I * Mef
721
POSITIVE RESULTS OF AFP CASES

(1996 - November 2000)
Year 1996 1997 1998 1999 2000*
No. of AFP Cases 71 267 505 824 1135

+ve Polio P1 16 13 12 41 -
Cases P2 0 3 7 17 -
P3 0 4 6 11 -
Mix 0 3 3 14 -
Non type 0 0 0 2 -
Total 16 23 28 85 68
+ve Single 10 20 38 121 -
NPEV cases
Mix 0 2 0 8 -
Total 10 22 38 129 98**-
Wild Polio P1 14 8 6 27 1***
Virus P2 0 0 0 0 0
P3 0 0 3 2 0
Total 14 8 9 29 1
* Up to November 2000 except **

** Up to June 2000
*** Detected in August 2000
Source: National Polio Lab, IPH, Mohakhali, Dhaka (Personal Communication)
LEGEND :
* Vaccination recommended for all travelers to that country.

I Coming from infected areas.
E Coming from Endemic areas.
• Vaccination required from travelers over 1 year of age coming from infected areas.
 Vaccination required to certain areas of the country.
>6 Vaccination required from travelers over 6 months of age coming from infected areas.
>9 Vaccination required from travelers over 9 months of age coming from infected areas.
- No Vaccination (or chemoprophylaxis in case of malaria) required for any international
travelers.
(6) Vaccination required from travelers over 1 year of age entering the country within 6
days of having stayed overnight or longer in an infected country.
Chl Chloroquine.
C+P Chloroquine plus Proguanil
Mef Mefloquine
Dox Doxycycline
722
APPENDIX 9 : ESSENTIAL DRUG LIST
Appendix–9
ESSENTIAL DRUG LIST

LIST OF 285 ESSENTIAL DRUGS
Sl.
1. ANAESTHETICS
#
1.1 General anaesthetics and oxygen
1.1.1 Inhalational medicines
1 Halothane
2 Nitrous Oxide-Oxygen for Anaesthesia
3 Oxygen Inhalation
1.1.2 Injectable medicines
4 Thiopental Sodium Injection
5 Ketamine Injection
1.2 Local anaesthetics
6 Lignocaine with or without Adrenaline Injection 1% and 2%
Injection (Various
7 Procaine Hydrochloride
Strengths)
8 Bupivacaine Hydrochloride Injection
1.3 Preoperative medication and sedation for short-term procedures
9 Atropine Sulphate Injection
10 Morphine Sulphate Injection
2. ANALGESICS, ANTIPYRETICS, NON-STEROIDAL ANTI-INFLAMMATORY MEDICINES
(NSAIMs), MEDICINES USED
TO TREAT GOUT AND DISEASE MODIFYING AGENTS IN RHEUMATOID DISORDERS
(DMARDs)
2.1 Non-opioids and non-steroidal anti-inflammatory medicines (NSAIMs)
Tablet 75-100
11 Aspirin
mg
Tablet/Syrup/Su
12 Paracetamol spension/
Suppository
13 Pethidine Hydrochloride Injection
Capsule/Supposi
14 Indomethacin tory/Sustained
Release Tablet
15 Ibuprofen Tablet
16 Naproxen Tablet
2.2 Opioid analgesics
SL No - 10
2.3 Medicines used to treat gout
17 Allopurinol Tablet
18 Colchicine Tablet
2.4 Disease modifying agents used in rheumatoid disorders (DMARDs)
19 Penicillamine Tablet
20 Sulphasalazine Tablet
21 Sodium Aurothiomalate Injection
723
22 Methotrexate Tablet/Injection
23 Chloroquine Oral liquid/Tablet
3. ANTIALLERGICS AND MEDICINES USED IN ANAPHYLAXIS
Tablet/Syrup/Inje
24 Chlorpheniramine Maleate
ction
25 Prednisolone Tablet
Tablet/Cream/Inj
26 Dexamethasone
ection
Injection/Cream/
27 Hydrocortisone
Ointment
28 Promethazine Hydrochloride Tablet/Injection
4. ANTIDOTES AND OTHER SUBSTANCES USED IN POISONINGS
4.1 Non-specific
29 Activated Charcoal Tablet
4.2 Specific
30 Naloxone Hydrochloride Injection
31 Pralidoxime Mesylate Injection
Injection/Eye
SL No - 09
drop/ointment
5. ANTICONVULSANTS/ANTIEPILEPTICS
32 Phenobarbitone Tablet/Injection
Tablet/Capsule/
33 Phenytoin
Elixir
34 Ethosuximide Capsule
35 Magnesium Sulphate 50% Injection
6. ANTI-INFECTIVE MEDICINES
6.1 Anthelminthics
6.1.1 Intestinal anthelminthics
36 Mebendazole Tablet
37 Albendazole Chewable Tablet
38 Levamisole Tablet/Syrup
39 Niclosamide Tablet
6.1.2 Antifilarials
Tablet/Suspensi
40 Diethylcarbamazine
on
SL No - 37
6.2 Antibacterials
6.2.1 Beta Lactam medicines
Capsule/Dry Syrup
41 Amoxycillin
/Injection
Capsule/Dry Syrup
42 Ampicillin
/Injection
43 Phenoxymethyl Penicillin Tablet/Syrup
44 Benzathine Penicillin Injection
45 Flucloxacillin Capsule/Syrup/Injection
46 Procaine Penicillin Injection
47 Cephradine Capsule/Syrup/Injection
48 Cephalexin Capsule/Tablet/Syrup
49 Benzyl Penicillin Injection
50 Cloxacillin Capsule/Syrup/Injection
51 Amoxiclav Tablet/Capsules/ Dry
724
Syrup/Injection
6.2.2 Other antibacterials
Tablet/Oral Suspension
52 Erythromycin
/Injection
53 Chloramphenicol Eye/Ear Drops/Ointment
54 Doxycycline Capsule
55 Co-Trimoxazole Tablet/Suspension
Tablet/Oral
56 Metronidazole
Liquid/Injection
57 Tetracycline/Oxytetracycline Hydrochloride Capsule/Injection
58 Nalidixic Acid Tablet/Syrup
Tablet/Suspension/Injec
59 Trimethoprim
tion
6.2.3 Antileprosy medicines
60 Clofazimine Capsule
61 Dapsone Tablet
6.2.4 Antituberculosis medicines
62 Ethambutol Tablet
63 Isoniazid with or without Ethambutol Tablet
64 Pyrazinamide Tablet
65 Rifampicin with or without Isoniazid Tablet
66 Streptomycin Sulphate Injection
67 Rifampicin + Isoniazid + Pyrazinamide with or without Ethambutol combination tablet
68 Rifampicin + Isoniazid + Ethambutol Tablet
6.3 Antifungal medicines
69 Griseofulvin Tablet
Cream/Pessaries/Soluti
70 Clotrimazole
on/Dusting Powder
Tablet/Suspension/Crea
71 Nystatin
m/Gel
Preparations of Imidazole or Nystatin for Vaginal and Vulval
72
Candidiasis
6.4 Antiviral medicines
Tablet/Cream /Eye
73 Acyclovir ointment/
Intravenous Infusion
74 Nelfinavir (NVP) Oral powder/tablet
6.4.1 Antiherpes medicines
75 Idoxruridine Eye Drops
6.4.2 Antiretrovirals
6.4.2.1 Nucleoside/Nucleotide reverse transcriptase inhibitors
76 Abacavir (ABC) Oral Liquid/ Tablet
77 Lamivudine (3TC) Oral liquid,/Tablet
78 Tenofovir disoproxil fumarate (TDF) Tablet
Capsul/ Oral liquid/ IV
79 Zidovudine (ZDV or AZT) infusion/
injection/Tablet
6.4.2.2 Non-nucleoside reverse transcriptase inhibitors
Capsule/ Oral Liquid/
80 Efavirenz
Tablet
81 Nevirapine (NVP) Oral Liquid/ Tablet
725
6.4.3 Other antivirals

82 Oseltamivir Tablet
6.5 Antiprotozoal medicines
6.5.1 Antiamoebic and antigiardiasis medicines
83 Diloxanide Tablet
6.5.2 Antileishmaniasis medicines
84 Sodium Stibogluconate Injection
6.5.3 Antimalarial medicines
6.5.3.1 For curative treatment
85 Artemether with Lumefantrine Tablet
86 Primaquine Tablet
87 Sulfadoxin with Pyrimethamine Tablet
88 Artesunate Injection,/ Tablet
89 Mefloquine Tablet
90 Quinine Injection,/Tablet
6.5.4 Antipneumocystosis and antitoxoplasmosis medicines
91 Pyrimethamine Tablet
7. ANTIMIGRAINE MEDICINES
7.1 For treatment of acute attack
Tablet/Injection/
92 Sumatriptan Succinate
Nasal Spray
Suppository/Tabl
93 Acetylsalicylic acid
et
SL No - 11
SL No - 12
7.2 For prophylaxis
94 Propranolol Tablet
8. ANTINEOPLASTIC, IMMUNOSUPPRESSIVES AND MEDICINES USED IN PALLIATIVE
CARE
8.1 Immunosuppressive medicines
95 Azathioprine Tablet/Injection
Capsule/Oral
96 Cyclosporin Solution/IV
Infusion
8.2 Cytotoxic and adjuvant medicines
97 Actinomycin D/Dactinomycin Injection
98 Bleomycin Injection
99 Calcium Folinate/Calcium Leucovorin Tablet/Injection
100 Cyclophosphamide Tablet
101 Busulphan Tablet
102 Cisplatin Injection
103 Chlorambucil Tablet
104 Crisantaspase/L-asparaginase Injection
105 Thioguanine Tablet
106 Vinblastine Sulphate Injection
107 Vincristine Sulphate Injection
108 Doxorubicin Injection
109 Mercaptopurine Tablet
110 Lomustine Capsule
111 Melphalan Tablet/Injection
112 Mitomycin Injection
726
113 Mustine Hydrochloride Injection

8.3 Hormones and antihormones
114 Tamoxifen Tablet/Capsule
115 Vasopressin Injection
116 Liothyronine Sodium Tablet/Injection
117 Stilboestrol/Diethylstilboestrol Tablet
SL No - 26 Injection
8.4 Medicines used in palliative care
118 Hyoscine Butylbromide Tablet/Injection
119 Amitryptyline Tablet
120 Propanththeline Bromide Tablet
121 Lactulose Powder/Solution
SL No - 26 Tablet/ Injection
9. ANTIPARKINSONISM MEDICINES
122 Levodopa with Carbidopa Tablet
10. MEDICINES AFFECTING THE BLOOD
10.1 Antianaemia medicines
123 Ferrous Sulphate/Fumarate, with or without Folic Acid Tablet/Syrup
124 Folic Acid Tablet
10.2 Medicines affecting coagulation
125 Heparin Injection
Tablet/Oral
126 Dipyridamole Suspension/Injec
tion
127 Protamine sulfate Injection
11. BLOOD PRODUCTS AND PLASMA SUBSTITUTES
11.1 Plasma substitutes
128 ACD Blood Pack/Double Bag/Triple Bag
129 Plasma Substitutes/Dextran-40/ Succinylated Gelatin Intravenous Infusions
130 Dextran 70 Injection
11.2 Plasma fractions for specific use
Solution for IV
131 Plasma Fractions/Human Albumin
infusion
12. CARDIOVASCULAR MEDICINES
12.1 Antianginal medicines
132 Metoprolol Tartrate Tablet
133 Glyceryl Trinitrate Tablet /Spray
134 Isosorbide dinitrate Tablet /Injection
135 Isosorbide Mononitrate Tablet
12.2 Antiarrhythmic medicines
Injection/Capsul
136 Procainamide
e
137 Digoxin Tablet/Injection
138 Disopyramide Tablet/Capsule
12.3 Antihypertensive medicines
139 Atenolol Tablet
SL No 94 Tablet /Injection
140 Methyldopa
141 Captopril Tablet
142 Diazoxide Injection
727
143 Sodium Nitroprusside Injection

144 Prazocin Hydrochloride Tablet
145 Enalapril Tablet
146 Spironolactone Tablet
147 Hydrochlorothiazide Tablet
12.4 Medicines used in heart failure
148 Dopamine Injection
SL No - 137
SL No - 144
12.5 Antithrombotic medicines
149 Clopidogrel Tablet
12.6 Lipid-lowering agents
150 Simvastatin Tablet
12.7 Anti- Hypotensive medicine
151 Metarminol Injection
13. DERMATOLOGICAL MEDICINES (topical)
13.1 Antifungal medicines
Cream/ Dusting
152 Miconazole Powder/Spray/O
ral Gel
153 Sodium thiosulfate Solution
13.2 Anti-infective medicines
Crystal/Solution
154 Potassium Permanganate
(0.1%)
Sl No 57 Ointment
155 Silver sulfadiazine Cream
13.3 Anti-inflammatory and antipruritic medicines
156 Calamine Lotion
157 Betamethasone Ointment, Cream
158 Betamethasone with Neomycin Ointment
Ointment/Powde
159 Neomycin sulfate with Bacitracin
r
SL No - 26 Cream
SL No - 27 Cream/ Ointment
13.4 Medicines affecting skin differentiation and proliferation
160 Salicylic Acid + Benzoic Acid Ointment, Cream
Capsule/Injectio
161 Fluorouracil
n/Cream
162 Salicylic acid Solution
13.5 Scabicides and pediculicides
163 Benzyl Benzoate Lotion
164 Permethrin Cream/ Lotion
14. DIAGNOSTIC AGENTS
14.1 Ophthalmic medicines
165 Flurescein Eye drops
166 Tropicamide Eye drops
14.2 Radiocontrast media
167 Barium Sulphate (X-Ray Grade)
168 Iodipamide Injection
169 Iothalamic Acid with Meglumine Oral Solution
15. DISINFECTANTS AND ANTISEPTICS
728
15.1 Antiseptics
170 Chlorhexidine with or without Cetrimide Solution/Cream
Alcoholic
171 Povidone-Iodine 10%
Solution
172 Bismuth, Iodoform and Paraffin Paste (BIPP) For Nasal Pack
15.2 Disinfectants
173 Chloroxylenol Solution/Cream
16. DIURETICS
174 Frusemide Tablet/Injection
175 Bendrofluazide Tablet
SL No - 146 Tablet/Capsule
176 Mannitol Infusion Solution 10% and 20%
SL No - 147
17. GASTROINTESTINAL MEDICINES
17.1 Antiulcer medicines
Tablet/
177 Aluminium Hydroxide Gel with or without Magnesium Trisilicate
Suspension
178 Ranitidine Tablet /Injection
Capsule/Tablet
179 Omeprazole
/Injection
17.2 Antiemetic medicines
180 Cinnarizine Tablet
Tablet/Oral
181 Metoclopramide Hydrochloride
Solution/Injection
182 Prochlorperazine Tablet/Injection
SL No - 28
17.3 Anti-inflammatory medicines
SL No-20 Suppository
17.4 Laxatives
Suppositoryfor
183 Glycerin/Glycerol
adult/child/infant
184 Senna/Sennosides Tablet
17.5 Medicines used in diarrhoea
17.5.1 Oral rehydration
185 Potassium Chloride Tablet/Syrup
Intravenous
186 Sodium Chloride 0.9%, without or with Dextrose
Infusion
Infusion (Various
187 Sodium Bicarbonate
Strengths)
17.5.2 Medicines for diarrhoea in children
188 Zinc sulfate Oral liquid/Tablet
18. HORMONES, OTHER ENDOCRINE MEDICINES AND CONTRACEPTIVES
18.1 Adrenal hormones and synthetic substitutes
189 ACTH Injection
18.2 Androgens
190 Danazol Capsule
18.3 Contraceptives
18.3.1 Oral hormonal contraceptives
Tablet : 30
191 Ethinylestradiol + Levonorgestrel
micrograms +
729
150 micrograms
Tablet
192 Ethinylestradiol + Lynestrenol 0.0375mg+0.75
mg
Tablet:0.15mg+0
193 Desogesterol + Ethinylestradiol
.03mg
Tablet
194 Levonorgestrel
750microgram
18.3.2 Injectable hormonal contraceptives
195 Depot Medroxyprogesterone Injection
18.3.3 Intrauterine devices
196 Copper-T containing device
18.3.4 Barrier methods
197 Condoms
18.3.5 Implantable contraceptives
198 Levonorgestrel‐releasing implant
18.4 Estrogens
199 Oestrogens with or without Progestogens for HRT
18.5 Insulins and other medicines used for diabetes
200 Glibenclamide Tablet
Various
201 Insulin
preparations
202 Chlorpropamide Tablet
203 Metformin Hydrochloride Tablet
18.6 Ovulation inducers
204 Clomiphene Citrate Tablet
18.7 Progestogens
205 Medroxyprogesterone acetate Tablet: 5 mg.
18.8 Thyroid hormones and antithyroid medicines
206 Carbimazole Tablet
Oral Solution
207 Aqueous Iodine (Lugol’s
Solution)
208 Thyroxine Sodium Tablet
209 Levothyroxine Tablet
19. IMMUNOLOGICALS
19.1 Diagnostic agents
210 Sodium Diatrozoate with Meglumine Sodium Injection
211 Tuberculin, purified protein derivative Injection
19.2 Sera and immunoglobulins
212 Diphtheria Antitoxin
213 Polyvalent Antivenoms
Injection
214 Tetanus Antitoxin (Minimum
10,000 IU Dose)
215 Human Normal Immunoglobulin Injection
19.3 Vaccines
216 BCG Vaccine
217 DPT Vaccine
218 Pentavalent vaccine(DPT,HepatitiesB ,Hib)
219 Pneumococcal Vaccine(PCV)
730
220 Poliomyelitis Vaccine(OPV &IPV))

221 MR Vaccine (Mesales &Rubella)
222 Measles vaccine Injection
223 Hepatitis- B Vaccine Injection
20. MUSCLE RELAXANTS (PERIPHERALLY-ACTING) AND CHOLINESTERASE
INHIBITORS
224 Neostigmine Tablet/Injection
225 Suxamethonium Chloride Injection
226 Pancurium Bromide Injection
227 Gallamine Trithiodide Injection
21. OPHTHALMOLOGICAL PREPARATIONS
21.1 Anti-infective agents
Eye
228 Framycetin Sulphate Drops/Ointmen
t
Injection/Eye
229 Gentamycin Drops/Ointmen
t
230 Tetracaine/Amethocaine Eye Drops
Eye Drops/
SL No - 53
Ointment
21.2 Anti-inflammatory agents
Eye
231 Corticosteroid
drops/Ointment
SL No - 158 Eye Drops
21.3 Local anaesthetics
SL No - 230
21.4 Miotics and antiglaucoma medicines
Eye Drops
232 Pilocarpine (Various
Strengths)
233 Acetazolamide Tablet
Tablet/Eye
234 Carbachol
Drops
SL No - 151
21.5 Mydriatics
235 Phenylephrine Hydrochloride Eye drops
236 Homatropine Eye drops
Injection/eye
SL No - 09
drop/ointment
22. OXYTOCICS AND ANTIOXYTOCICS
22.1 Oxytocics
237 Trifluperazine Tablet/Oral
731
Solution
238 Oxytocin Injection

239 Ergometrine Injection
22.2 Antioxytocics (tocolytics)
240 Nifedipine Capsule
23. PERITONEAL DIALYSIS SOLUTION
Parenteral
241 Intraperitoneal dialysis solution (of appropriate composition)
solution.
24. MEDICINES FOR MENTAL AND BEHAVIOURAL DISORDERS
24.1 Medicines used in psychotic disorders
Tablet/Syrup/In
242 Chlorpromazine Hydrochloride
jection
Tablet/Capsule
243 Haloperidol
/Oral Liquid
24.2 Medicines used in mood disorders

24.2.1 Medicines used in depressive disorders
244 Imipramine Hydrochloride Tablet/Syrup
245 Nortriptyline Tablet
246 Flupenthixol Dihydrochloride/Decanoate Tablet/Injection
SL No - 119
24.2.2 Medicines used in bipolar disorders
Tablet/Oral
247 Carbamazepine Liquid/Supposi
tory
Tablet/Oral
248 Lithium Carbonate/Citrate
liquid
24.3 Medicines for anxiety disorders
249 Diazepam Tablet/Injection
250 Clobazam Tablet
24.4 Medicines used for obsessive compulsive disorders
Tablet/Syrup/C
251 Clomipramine Hydrochloride apsule/Injectio
n
24.5 Medicines for disorders due to psychoactive substance use
252 Methadone Hydrochloride Tablet/Injection
25. MEDICINES ACTING ON THE RESPIRATORY TRACT
25.1 Antiasthmatic and medicines for chronic obstructive pulmonary disease
732
253 Salbutamol Tablet/Elixir

254 Adrenaline/Epinephrine Injection
255 Aminophylline Tablet/Injection
26. SOLUTIONS CORRECTING WATER, ELECTROLYTE & ACID-BASE DISTURBANCES
26.1 Oral
Sachet for 500
256 Oral Rehydration Salts (ORS)
ml
Intravenous
257 Cholera Fluid
Infusion
258 Sodium hydrogen carbonate Injection
26.2 Parenteral
Intravenous
259 Dextrose in Water Infusion, 5%,
25% and 50%
For adding to
260 Supplemental Parenteral Nutrients
Infusion
Injectable
261 Glucose
solution
Injectable
262 Glucose with sodium chloride
solution
Injectable
263 Sodium chloride
solution
264 Sodium chloride 3% I/V fluid
265 Sodium chloride quartat strength (0.225%) + Dextrose 5% I/V fluid
Injectable
SL No 259
solution
26.3 Miscellaneous
266 Water for Injection (sterile/pyrogen free)
267 Dialysis Fluid
27. VITAMINS AND MINERALS
268 Ascorbic Acid/Vitamin C Tablet
Capsule
50,000-
2,00,000 IU
269 Vitamin A
(Injection
100,000 IU for
SL and above)
Tablet
270 Vitamin B1
/Injection
Tablet
271 Vitamin K
/Injection
272 Vitamin E Tablet
273 Vitamin B-Complex Tablet/Drops
733
274 Calcium Gluconate Tablet/Injection

275 Iodized Oil Injection
276 Vitamin B12 Injection
277 Nicotinamide Tablet
278 Pyridoxine Tablet
Capsule/
Tablet/ Oral
oily
279 Retinol
solution/Water-
miscible
injection
280 Riboflavin Tablet
281 Thiamine Tablet
SL No - 124
28. EAR, NOSE AND THROAT CONDITIONS IN CHILDREN [c]
Eye drops for
282 Ciprofloxacin
SL and above
283 Gentamicin + Hydrocortisone Ear Drops
284 Xylometazoline Nasal drops
Ear Drops/
SL No - 53
Ointment
29. SPECIFIC MEDICINES FOR NEONATAL CARE [c]
30. MUCOLYTICS, EXPECTORANTS AND COUGH SUPRESSANTS
285 Dextromethorphan Syrup
734
Appendix–10
LIST OF OVER-THE-COUNTER (OTC) DRUGS
(ALLOPATHIC)
1. Albendazole Chewable Tablet
2. Antacid Chewable Tablet/ Suspension
3. Ascorbic Acid Chewable Tablet/ Syrup
4. Benzyl Benzoate Lotion
5. Calcium Tablet
6. Chloramphenicol Eye/Ear Ointment/Drops
7. Chlorhexidine Lotion/ Cream
8. Chloroxylenol Lotion/ Cream
9. Chlorpheniramine Maleate Tablet/ Syrup
10. Condoms
11. Diclofenac Gel
12. Dextromethorphen Syrup
13. Ferrous (Sulphate, Gluconate & Fumarate) Tablet/ Capsule/ Syrup
14. Gentian Violet
15. Glycerin Suppository
16. Low Dose Contraceptive Pills
17. Mebendazole Tablet
18. Metronidazole Tablet/ Suspension
19. Methyl Salicylate Gel
20. Milk of Magnesia Suspension
21. Mouthwash Preparations
22. Multivitamin Tablet/ Capsule/ Drops
23. Neomycin/ Gentamycin/ Bacitracin or combination Ointment/ Cream/ Dusting Powder
24. Omeprazole capsule
25. Oral Rehydration Salt (ORS) (with or without glucose or flavours) Sachets
26. Paracetamol/Acetaminophen Tablet/ Syrup/ Suspension/Suppository
27. Permethrin Ointment/ Cream
28. Potassium Permenganate Granules for Gargle
29. Povidone Iodine
30. Promethazine Theoclate Tablet
31. Ranitidin Tablet
32. Riboflavine tablet
33. Salbutamol Tablet
34. Salicylic Acid + Benzoic Acid Ointment
35. Silver Sulphadiazine Ointment
36. Sunscreen Preparations
37. Vitamin A Capsule
38. Vitamin B Complex (individual or combinations) Tablet/ Syrup/ Drops
39. Xylometazoline 0.1% Nasal Drops
735
Appendix 10
Appendix-11
LIST OF CONTROLLED DRUGS
Controlled drugs are classified in this list according to the First Schedule of the
Narcotics Control Act, 1990. Note that the said Schedule contains also the names of
other narcotic and psychotropic substances that are not used either in their crude
forms or otherwise in the preparation of pharmaceutical or medicinal products. The
penalties applicable for offences involving the different classes of the listed drugs are
graded broadly according to the degree of harmfulness attributable to a drug when it is
misused. For details of such offences, see the Narcotics Control Act, 1990.
1. A-Class Controlled Drugs

Alfentanil; buprenorphine; cocaine and its salts; codeine phosphate;
dextromoramide; dihydrocodeine tartrate; diphenoxylate; ethylmorphine;
fentanyl; heroin (diamorphine) hydrochloride; hydromorphone hydrochloride;
meptazinol; methadone hydrochloride; morphine and its salts; pentazocine;
pethidine hydrochloride; phenazocine hydrobromide; pholcodeine;
tetrahydro cannabinol or cannabis resin in any form; and remifentanil.
2. B-Class Controlled Drugs

(a) Amphetamine/ methylamphetamine and related other drugs
(these drugs are prohibited in Bangladesh for medicinal
purposes); barbiturates (e.g. amylobarbitone, butobarbitone,
methyl phenobarbitone, phenobarbitone, phenobarbitone sodium,
quinalbarbitone/ secobarbital, etc.)
(b) Ethyl alcohol and all kinds of wine, spirit, liquor and beer; rectified
spirit; any medicine or liquid containing more than 5% of ethyl
alcohol.
(c) Herbal cannabis in any form; LSD or any other drug containing
LSD.
3. C-Class Controlled Drugs

Benzodiazepines (e.g. alprazolam. bromazepam, chlorazepate,
chlordiazepoxide, diazepam, flurazepam, loprazolam, lorazepam,
lormetazepam, nitrazepam, oxazepam etc.); denatured spirit or methylated
spirit; meprobamate; other tranquilizer or hypnotic drugs not included in B-
Class.
736
APPENDIX-12: Pharmacovigilance
Appendix-12
PHARMACOVIGILLANCE System
and ADR Monitoring in BANGLADESH
Pharmacovigilance (PV) is defined by the World Health Organization (WHO) as -
“The science and activities relating to the detection, assessment, understanding,
and prevention of adverse effects or any other drug-related problem”.
Major aims of Pharmacovigilance are-

• Early detection of unknown safety problems
• Identification and quantification of risk factors
• Preventing patients from being affected unnecessarily
• Collection of more information about safety of drugs
• To ensure Rational use of Medicines and Patient Safety
Some Drug Reactions Defined by WHO
Adverse Event (AE): any untoward medical occurrence that may be present during
treatment with a pharmaceutical product but which does not necessarily have a casual
relationship with this treatment.
Adverse Drug Reaction (ADR): “any response to a medicinal product that is noxious
and unintended and which occurs at doses normally used for the prophylaxis, diagnosis
or modification of physiological function.”
Side Effect: any unintended effect of a pharmaceutical product occurring at doses

normally used by a patient which is related to the pharmacological properties of the
product.
An ADR may therefore include any of the following:

(a) a harmful drug response,
(b) an unwanted effect on an organ system different from that being treated,
(c) an allergic or hypersensitivity reaction,
(d) an idiosyncratic reaction, or
(e) a drug interaction that causes either an increased or diminished response.
A side effect and a drug allergy are both types of ADRs. A side effect is an example of
a dose-related, predictable reaction to a drug. It is typically accepted that a side effect
of a drug is known to occur in a given percentage of the population and has been
observed with regular frequency. A drug allergy is an example of a non-dose-related,
unpredictable adverse effect to a drug.
Any reaction to a new drug (e.g., a drug on the market 3 years or less), whether or not
included in the product labeling and regardless of its severity, should be reported.
Reporting for biologic agents (e.g., vaccines) as well as devices, and any reactions for
these agents or products should be reported as well. Table-1 below shows the
reportable adverse drug reactions.
Importance of Pharmacovigilance
• Adverse Drug Reactions are among the top ten causes of mortality
737
• The percentage of hospital admissions due to drug related events is about or

more than 10%. More than 50% of ADRs are preventable.
• Drug classes frequently involved in Adverse Drug Reactions (ADRs) related
admissions include drugs of abuse, anticonvulsants, antibiotics, respiratory
drugs, and pain medications. ADRs can also occur in hospitalized patients
and require an increase in length of stay and treatment with medical and
pharmacologic interventions.
Table 1: Reportable Adverse Drug Reactions.

• For “new” drugs – report all suspected reactions, including minor ones.
• For established or well-known drugs – report all serious or unexpected
(unusual) suspected ADRs;
• Report if an increased frequency of a given reaction is observed;
• Report all suspected ADRs associated with drug-drug, drug-food or drug-food
supplements (including herbal and complementary products) interactions;
• Report ADRs in special fields of interest such as drug abuse and drug use in
pregnancy and during lactation;
• Report when suspected ADRs are associated with drug withdrawals;
• Report ADRs occurring from overdose or medication error;
• Report when there is a lack of efficacy or when suspected pharmaceutical
defects are observed.
An event is serious and should be reported when it:
1. resulted in death.
2. was life-threatening.
3. required prolonged hospitalization
4. directly resulted in disability.
5. resulted in congenital anomaly.
How to recognize ADRs

Since ADRs may act through the same physiological and pathological pathways as
different diseases, they are difficult and sometimes impossible to distinguish. However,
the following step-wise approach may be helpful in assessing possible drug-related
ADRs:
1. Ensure that the medicine received as per prescription and actually taken by the
patient at the dose advised;
2. Verify that the onset of the suspected ADR was after the drug was taken, not
before and discuss carefully the observation made by the patient;
3. Do a thorough physical examination with appropriate laboratory investigations,
when possible;
4. A full drug and medical history should be done, when possible;
5. Determine the time interval between the beginning of drug treatment and the onset
of the event;
6. Evaluate the suspected ADR after discontinuing the drugs or reducing the dose
and monitor the patient’s status. If appropriate, restart the drug treatment and
monitor recurrence of any adverse events.
7. Analyze the alternative causes (other than the drug) that could on their own have
caused the reaction;
8. Use relevant up-to-date literature and personal experience as a health
professional on drugs and their ADRs and verify if there are previous conclusive
reports on this reaction.
738
9. Report any suspected ADR to the person nominated (if any) for ADR reporting in
the hospital or directly to the ADRM Cell, Directorate General of Drugs
Administration, Aushadh Bhabon, Mohakhali, Dhaka-1
10. Collected reports are primarily assessed by ADRM cell, then Technical sub-
committee. Finally these are reviewed by ADR Advisory Committee (ADRAC) and
pass comment. The ADRAC also make regulatory recommendation if needed to
the DGDA. Thus ADRs are identified. All safety information are being
disseminated to the relevant stakeholders through different means.
11. The reports are uploaded to Uppsala Monitoring Centre VigiBase (Global
database) for further analysis in broader aspect. As a member country
Bangladesh gets WHO-UMC collaboration in Pharmacovigilance activities.
Drug Induced Diseases
Disease management, collective management of all aspects of a patient’s disease,

rather than isolated drug treatment of a disease is rapidly becoming the accepted
practice in health care. Adverse drug monitoring and management should be thought of
in a similar fashion. It is impossible to consider the desired outcomes of drug therapy
without taking into consideration all adverse, as well as beneficial, consequences of
treatment. The remaining sections of this chapter will focus on major organ systems
most commonly associated with adverse pharmacologic reactions. Throughout the
remainder of this chapter, the reader may be referred to other chapters in this book that
describe in detail the mechanism of specific drug-induced diseases.
Hypersensitivity Reactions: True hypersensitivity reactions are immunologically

mediated through a series of reproducible steps. Hypersensitivity reactions are most
frequently associated with -lactam antibiotics, which include penicillin and
cephalosporin. While allergic reactions to penicillin have been reported to occur in 0.7
to 8% of the general population, anaphylaxis only occurs in 0.01% of identified
treatment courses.
Hypersensitivity reactions may manifest as acute urticaria, rhinitis, bronchial asthma,

and angioedema. Depending on the severity of the reaction, there may also be
peripheral circulatory collapse; therefore, immediate medical care should be sought.
The offending agent should be removed. Epinephrine should be administered 0.1—0.2
mg IV over 2 to 3 minutes. This dose may be repeated every 15 to 20 minutes as
needed up to 3 doses. Oxygen should be administered if available. Since the patient
may be experiencing vascular collapse, fluid therapy should be initiated as needed to
maintain blood pressure. If the patient is unresponsive to fluid replacement, a dopamine
infusion may be necessary at a rate of 2 to 15 mg/kg. -Agonists, diphenhydramine,
and hydrocortisone should also be administered after the emergent situation is
controlled.
Hepatotoxicity: Drug-induced hepatotoxicity has been associated with over 600 drugs.
Hepatotoxicity can be difficult to diagnose because the literature consists primarily of
case reports and because injury can present acutely or after prolonged drug
administration. Table-2 illustrates some of the risk factors associated with developing
hepatotoxic reactions. Table-3 lists a number of drugs that have been implicated in
causing chronic active hepatitis. Acute liver injury can be cytotoxic or cholestatic.
Cytotoxic injury involves direct injury to the hepatocytes with necrosis that can be
localized or diffuse throughout the liver. Aminotransferase levels can be elevated to up
to 500 times the normal levels. Prominent signs and symptoms include fatigue,
anorexia, nausea, and jaundice. Drug-induced cytotoxic injury can progress to fulminant
hepatic failure. Isoniazid, methyldopa, and phenytoin have been associated with direct
739
cytotoxic reactions that have led to mortality rates of 10% or higher. Cholestatic injury
results in a characteristic decrease in bile flow. Hepatic injury of this type leads to
jaundice and pruritus, and aminotransferase levels are only moderately elevated.
Cholestatic hepatic injury has a much better prognosis as compared to cytotoxic injury
with a mortality rate of less than 1%.
Table 2 : Risk Factors Associated with Developing Hepatotoxic Reactions

Factor Example
Age Adult > Children Isoniazid, halothane
Elderly> others NSAIDs
Children > Adults Valproic acid, aspirin
Sex Female > Male Methyldopa, Drug-induced chronic active hepatitis
Drugs Alcohol & Phenobarbital Can induce Cytochrome p 450 system and
enhance the toxicity of agents converted to active
metabolites
Pathological State AIDS Increased susceptibility to hepatotoxic effects of
Sulfamethoxazole-Trimethoprim
Diabetes Enhances toxicity of carbon tetrachloride
Hyperthyroidism Enhances toxicity of carbon tetrachloride
Adapted from Zimmerman HJ. Hepatotoxicity. Disease-a-Month 39:675 787. 1993.
Table 3 . Drugs Implicated in Causing Chronic Active Hepatitis

Acetaminophen Isoniazid Papaverine
Dantrolene Nitrofurantoin Propylthiouracil
Diclofenac Methyldopa Sulfonamides
Adapted from Zimmerman HJ. Hepatotoxicity. Disease-a-Month 39:675 787. 1993.
Pancreatitis: Pancreatitis can also be characterized as being either acute or chronic. A

large number of medications can cause acute pancreatitis. Clinical symptoms of
pancreatitis include acute abdominal pain and increased blood and urine pancreatic
enzyme concentrations. Morphologic changes in the pancreas itself are minor or
absent. Table-4 given below.
Table 4: Examples of Drugs Suspected in Drug-Induced Pancreatitis

Asparginase Furosemide Sulindac
Azathioprine Mercaptopurine Tetracyclines
Didanosine Pentamidine Thiazides
Estrogens Sulfonamides Valporic Acid
Nephrotoxicity: Drug-induced nephrotoxicity depends on the concentration of drug

presented to the kidney and the biochemical or physiologic effect of the drug on the
affected tissue. Factors that influence the concentration of given drugs in the kidney
include mechanisms for the transport of drugs across the tubular epithelium, the rate of
water versus drug reabsorption, plasma protein binding, and rate of urine flow. A list of
drugs and chemicals associated with each of these lesions is provided in Table-5.
740
Table 5: Drugs Associated with Nephrotoxicity

Acute tubular Antibiotics Acute Penicillins
necrosis Aminoglycosides tubulointerstitial Amoxicillin
disease
Amphotericin B Carbenicillin
Bacitracin Methicillin
Cephalosporins Nafcillin
Polymixins Oxacillin
Sulfonamides Penicillin
Metals Other antibiotics
Antimony Cephalosporins
Bismuth Cotrimoxazole
Mercurials Erythromycin
Platinum p-Aminosalicylate
Chelates Polymixins
Dimercaprol Rifampin
EDTA Sulfonamides
Contrast media NSAIDs
Miscellaneous Fenoprofen
Acetaminophen Ibuprofen
Aminocaproic acid Indomethacin
Carbamazepine Mefenamic acid
Cisplatin Phenylbutazone Tolmetin
Cyclosporine Miscellaneous
Methotrexate Allopurinol
Methoxyflurane Azathioprine
Phenazopyridine Captopril
Streptozocin Cimetidine
Glomerulo- Allopurinol Cloflbrate
nephritis
Captopril Furosemide
Cyclophosphamide Phenytoin
Daunorubicin Thiazides
Fenoprofen
Hydralazine Chronic Acetaminophen
tubulointerstitial
Rifampin Aspirin
disease
Sulfonamides Lithium
Thiazides Methyl-CCNU
Trimethadone Phenacetin
Gastrointestinal Diseases: Nausea and vomiting are among the most frequent drug-
induced symptoms and they occur more often in women. Almost any orally
administered drug can produce these symptoms by a direct irritant effect on the gastric
or small-bowel mucosa, or by central stimulation of the chemoreceptor zones and
vomiting center in the medulla. The most common drugs causing these reactions
included potassium chloride, heparin, docusate and aluminum and magnesium
hydroxide suspension. The most clinically significant ADRs affecting the upper
741
gastrointestinal tract result from the use of nonsteroidal anti-inflammatory drugs

(NSAIDs), partly because of their widespread use in this country. There are two types
of gastrointestinal toxicity associated with NSAIDs: dyspepsia and ulceration of the
gastric mucosa. Ulcerogenic properties of NSAIDs have received intensive study both
in the laboratory and epidemiologically. The anti-inflammatory activity of these agents is
derived from their ability to inhibit cyclooxygenases (prostaglandin synthetases), which,
unfortunately, results in an impairment of the gastrointestinal mucosa to resist acid
attack.
Hematologic Disorders: Drug-induced hematologic disorders encompass a wide

variety of disorders, only some of which are mechanistically understood. Hematologic
disorders such as, aplastic anemia, agranulocytosis, hemolytic anemia, megoblastic
anemia, and thrombocytopenia have been associated with drug-induced etiologies.
Aplastic anemia is the most serious drug-induced blood disorder, and it has been
estimated that drugs are responsible for nearly one-half of all cases of aplastic anemia.
The first clinical manifestations of aplastic anemia usually are related to hemorrhage.
Pancytopenia is observed in a majority of the patients on initial examination, and a
hypocellular bone-marrow biopsy may be obtained at some time in the course of the
illness. Many drugs can cause suppression of bone-marrow activity or aplasia in a
dose-dependent manner, as is the case with cytotoxic drugs. For many other drugs,
aplastic anemia can occur suddenly in the form of an idiosyncratic reaction, unrelated to
the dose. Cytostatic drugs are used in the treatment of neoplastic disorders because of
their action on dividing cells. All of these agents, which include alkylating agents,
antibiotics, antimetabolites and vinca alkaloids, in large doses, can produce bone-
marrow aplasia.
In agranulocytosis resulting from allergic mechanisms, signs and symptoms appear in a

few days to weeks following administration. There is an abrupt onset of high fever,
rigors and occasional episodes of localized infections. Drugs associated with this type
of reaction include sulfonamides, sulfonylureas, phenothiazines, antithyroid agents,
phenylbutazone and semisynthetic penicillins. Drugs that can produce a lupus-like
syndrome and result in agranulocytosis are procainamide, hydralazine, isoniazid,
rifampicin and propylthiouracil.
Cardiovascular Effects: Adverse drug reactions involving the cardiovascular system

are not specifically limited to those agents used to treat cardiovascular disease. For
example, bronchodilator therapy and sympathomimetic effects of various cough and
cold remedies often negatively affect cardiac rate and rhythm regulation. Many
antiarrhythmic agents may also be proarrhythmic. Tricyclic antidepressants in an
overdose situation cause ECG changes that can be life-threatening. In addition to
certain cardiac medications, bradycardia can also be induced by agents such as
carbamazepine, methyldopa, and H2 antagonists. Some agents used in chemotherapy
regimens, such as the anthracyclines, have a dose limiting side effect of causing
congestive cardiomyopathy. Additionally, some diuretics and -blockers may adversely
affect lipid risk profiles.
Pulmonary Effects: Pulmonary injury secondary to pharmacologic treatment has been

shown to occur with the administration of over 150 medications. Table-6 lists agents
known to cause pulmonary disease.
742
Table 6: Agents Known to Cause Pulmonary Disease

Cardiovascular Anti-inflammatory Chemotherapeutic Agents
Amiodarone Aspirin Azathioprine
ACE inhibitors Ifosfamide Bleomycin
Anti-coagulants Methotrexate Busulphan
-Blockers NSAIDs Chlorambucil
Dipyridamole Penicillamine Cyclophosphamide
Tocainide Miscellaneous Etoposide
Antibiotics Bromocriptine Melphalan
Amphotericin B Dantrolene Mitomycin
Nitrofurantoin Oral Contraceptives Nitrosoureas
Sulfasalazine Hydrochlorothiazide Procarbazine
Pentamidine Tricyclic Antidepressants Vinblastine
Adapted from Rosenow ECIII. Drug-induced pulmonary disease. Disease-a-Month. 5:258—310, 1994.
Ototoxicity: Ototoxicity from drug therapy may be manifested in two ways, depending
on the portion of the inner ear affected. Vestibular toxicity can result in dizziness or
vertigo, while cochlear toxicity usually results in hearing loss. Manifestations of
ototoxicity may range from mild tinnitus or dizziness to total bilateral irreversible hearing
loss and/or permanent disabling vertigo. Aminoglycosides such as neomycin,
streptomycin, gentamicin, amikacin and netilmicin are considered to be the most
ototoxic, in terms of permanent damage. These drugs destroy the outer hair cells in the
cochlea in such a way that high-frequency hearing loss occurs first; lower and midrange
frequencies or conversational tones are affected later. Topically administered
aminoglycoside antibiotics can be absorbed sufficiently to result in ototoxicity. Oral or
peritoneal administration or topical use of neomycin for wound irrigation has also
resulted in ototoxicity. Similarly ototoxicity has followed the application of a 0.1%
gentamicin cream to the skin. Loop diuretics, ethacrynic acid, furosemide and bumetan-
ide all possess the potential to produce ototoxicity. There have been numerous case
reports of transient effects of ethacrynic acid on auditory function and reports of
permanent deafness, even after oral administration. High intravenous doses of
furosemide may cause vertigo and transient hearing loss, particularly in patients with
renal impairment. Even in the absence of renal failure, oral doses of furosemide have
been reported to result in permanent hearing impairment.
Ocular Toxicity: The list of drugs that are toxic to the eye is extensive. Nearly every
structure of the eye has been affected adversely by drugs. Decreased tear production
has been shown to have damaging effects on the eye. Tear secretion can be
diminished by anticholinergic and by ganglionic blocking drugs. A decrease in tear
production occasionally has been noted in patients receiving phenothiazines. Patients
using chloroquine, or related aminoquinolines, for diseases such as systemic lupus
erythematous and rheumatoid arthritis take high doses for prolonged periods and are at
risk of developing ocular toxicity. Ocular damage normally does not occur with lower
dosages used in the suppression and treatment of malaria. Both chloroquine and
hydroxychloroquine produce numerous forms of ocular toxicity, which include whitening
of the lashes, extraocular muscle palsy, corneal deposits, decreased corneal sensitivity
and retinal damage. Elevated intraocular pressure is a well-documented side effect of
both local and systemic corticosteroid therapy. The increased intraocular pressure
occurs a few weeks after topical application and a few months after systemic therapy.
Severe increases in intraocular pressure, similar to those seen in acute glaucoma, have
resulted in cupping of the optic discs and visual field defects similar to those seen in
743
open-angle glaucoma. Corticosteroid-induced glaucoma develops more commonly in

patients with a family history of glaucoma.
Sexual Dysfunction:
Normal sexual function is mediated by various physiologic mechanisms including
neurogenic, psychogenic, vascular, and hormonal factors. It is expected, then, that
medications that interfere with any of these systems may also interfere with sexual
Function. Sexual dysfunction is often associated with antihypertensive and
antipsychotic medications.
Thiazide diuretics, peripheral and central sympatholytics, and -blockers have all have
been associated with a decline in sexual function. The adverse events range from loss
of libido to impotence, ejaculatory failure, and anorgasmia, with impotence being the
most frequently reported. Calcium channel blockers and ACE inhibitors appear to have
a relatively decreased potential for causing sexual dysfunction. Antipsychotic or
antidepressant medications are also associated with a variety of effects on sexual
function (e.g., impotence, priapism, anorgasmia, and diminished libido); however,
ejaculatory failure is the most frequently reported.
Additional medications that have been associated with sexual dysfunction, although
less frequently than the aforementioned agents, are the H2 antagonists,
metoclopramide, anticonvulsants (e.g., carbamazepine, phenytoin, phenobarbital, and
primidone), and opioids when used chronically.
HISTORY OF ADVERSE DRUG REACTIONS MONITORING (ADRM)
Background
• In 1962, in the wake of the thalidomide disaster, World Health Assembly

requested WHO to establish an international system of monitoring adverse
reactions to drugs using information derived from national centres.
• The Sixteenth World Health Assembly in 1963 adopted a resolution (WHA
16.36)
• WHO Pilot Research Project started for International Drug Monitoring in 1968
• In 1978 International Drug Monitoring Centre (Uppsala Monitoring Centre,
Sweden) has been established
• More than 147 countries are member of the WHO-UMC.
• Bangladesh is the 120th member of WHO-UMC.
Before an effective international system could become operative, a common reporting

form had to be developed, agreed guidelines for entering information had to be
formulated, common terminologies and classifications had to be prepared and
compatible systems for transmitting, storing, retrieving and disseminating data had to
be created. Upon the successful completion of these tasks the operational activities sub
serving the international data base were relocated in 1978 to a WHO collaborating
centre situated in Uppsala, Sweden.
ADRM and Pharmacovigilance in Bangladesh
Under the guidance of WHO, an Adverse Drug Reaction Monitoring (ADRM) Cell was
established in the Directorate of Drug Administration, now known as Directorate
General of Drug Administration (DGDA) in 1996. Initially the Cell circulated posters
bearing awareness slogans of drug use throughout the country, organized awareness
meetings among the chemists of different area and also published awareness
instructions in the daily newspapers and broadcasted these awareness slogans on
744
Radio Bangladesh. The Cell has been trying since its inception to introduce a
systematic mechanism for ADR monitoring in Bangladesh and for collection, analysis
and compilation of ADRs, spontaneously reported by the medical and pharmaceutical
professional of all health services outlets of the country. With this end in view, DGDA
has been organizing ADR Monitoring Workshops/meetings in the Medical Colleges and
Hospitals of the country and distributing printed ADR reporting forms to the doctors for
spontaneous reporting of ADR cases since 2000. On 6 July 1997, the Ministry of Health
& Family Welfare (MOHFW) formed a 10-Member ADR Advisory Committee (ADRAC)
to evaluate, analyze and make recommendations for solving problems of medicinal
hazards due to ADRs.
Present Position of PV
• It is functioning well after re-starting in 2013 with technical support of USAID

funded MSH/SIAPS program.
• Adverse Drug Reaction Monitoring (ADRM) Cell of DGDA has been declared
as the National Drug Monitoring Centre (National PV Centre) for
Bangladesh
• Bangladesh has been awarded 120th Membership of the WHO-UMC in 2014.
• Standard Suspected AE Reporting form is available in the DGDA website and
hard copies are also available in the Health facilities and in the
Pharmaceutical Companies.
• WHO-UMC is providing support for using their tools VigiFlow, VigiBase etc
• PV newsletter, posters, pamphlets for risk communication and awareness
building among stakeholders.
• Technical sub-committee and ADR Advisory Committee work for technical
evaluation of Suspected AE reports and provide regulatory recommendation.
• ADRM cell first started PV activities with primarily selected 20 Pharma
Industry and 20 Hospitals
• Then the number has been increased in 30 and 32 respectively. Now the
area has been extended to all the Pharmaceutical Industries, all Govt.
Medical College Hospitals & General Hospitals.
• Public Health Programs (specially Kala-azar Porgram) are also collaborating
in this regard. They are providing reports regular basis.
• ADRM Cell is regularly meeting with stakeholders, visiting hospitals and
companies for exchanging views to improve the PV awareness.
What to Report
The National Drug Monitoring Centre shall encourage reporting of all suspected
adverse drug related events, whether it is seemingly insignificant or common adverse
reactions, as it may highlight widespread prescribing problem. The reporter should
made aware not to wait until he feels certain that a causal link can be considered
proven or disproven. In any case of doubt it is better to report than not to report.
A case report in pharmacovigilance can be defined as: A notification relating to a

patient with an adverse medical event (or laboratory test abnormality) suspected to be
induced by a medicine. It should also be a comprehensive and complete medical
description of the case.
An updated and standardized suspected adverse event reporting form has been
developed and adopted by Bangladesh to report all cases of ADRs. The ADR form is
available at DGDA and on the website in a fillable pdf format. ADR case report should
(as a minimum to aim at) contain information on the following elements:
745
1. The patient : name or initials, age, sex, contact information, and brief medical
history
2. Suspected Adverse event: type of event, description (nature, localization,
severity, characteristics), results of investigations and tests, start/end date, course
and outcome.
3. Suspected drug(s) :name (brand or generic name, manufacturer) dose, dosage
form, frequency, Batch number, start/stop date, indication for use, seriousness of
event, outcomes attributed, other relevant history.
4. All concomitant drugs information (including self medication): names, doses,
routes, indication, frequency, start/stop dates.
5. Relevant history of the patient (e.g., impaired renal faction, previous exposure to
suspected drug, previous allergies)
6. Name and address of the reporter (to be considered confidential and to be used
only for date verification, completion and case follow-up)
NB: The mandatory fields of the Suspected AE Reporting form have been marked
`star’.
Who Should Report
12. Government/Private Hospitals/Clinics/Pharmaceutical Companies: Every

hospitals and clinics must decide for itself how the reporting system should be
operated and by whom. The arrangements will depend on the hospital’s / clinic’s
own organization and traditions. Conversely, during the launch of Bangladesh as a
National Pharmacovigilance Program on September 2, 2013, DGDA identified
Focal Point persons at 20 public & private hospitals and 20 Pharmaceutical
Companies, which has subsequently be increased to 30 in 2014 that would be
responsible for collecting ADRs and submitting to DGDA. Recently this number
has been increased to 50, although all the Pharmaceutical Companies have been
served administrative order from DGDA to form functional PV team with focal
(responsible) person for performing Pharmacovigilance of their own products. All
The Medical College Hospitals and General Hospitals have been requested to
form PV team also to perform PV activities at their own facilities. All
pharmaceutical companies and hospitals/clinics are encouraged to do the same.
Generally the Healthcare Providers (Doctors, Pharmacists, Nurses) themselves
act as reporters, completing the reporting form, keeping a record and sending
them to the Focal Person at the hospital, who will forward the report to: ADRM
Cell, Directorate General of Drug Administration, Aushadh Bhabon, Mohakhali,
Dhaka-1212, Bangladesh.
The hospital pharmacist may act as a reporter, completing the forms in consultation
with the reporting physician. Patients/Consumers may also act as reporters and contact
the pharmaceutical companies regarding any suspect adverse event or ADRM Cell
directly.
A reporter should report
(a) Apparent ADRs previously unknown to the reporter

(b) Serious ADRs
(c) All suspected ADRs to new drugs
(d) Medication Errors
(e) Suspected events due to product quality issues.
746
Suspected AE reporting forms: are available as printed hard copy. It is also available
in the DGDA website: www.dgda.gov.bd.com. It can be downloaded easily, then after
filling up to be sent to the e-mail ids: adrmcell.dgda@gmail.com or
dgda.gov@gmail.com
NB : A Light green- coloured card for reporting Adverse Drug Reactions is

available from the above address and also included in this book (inside back
cover).
Conclusion
Pharmacovigilance is an important task for patient safety. It is very much crucial and
important to ensure the safety of marketed drug products. It can save us from any
unwanted disaster for unidentified risks of drugs. So, we need to perform
Pharmacovigilance intensely throughout the country.
747
APPENDIX-13 : PHARMACEUTICAL ABBREVIATIONS
Appendix-13
PHARMACEUTICAL ABBREVIATIONS
Communication of dosage instructions to patients
Physicians and Pharmacists have to devote considerable time and effort to the
development and utilization of safe and cost-effective drug therapy. In order to
gain maximum benefit from the use of drugs while minimizing their side effects,
prescribers and pharmacists must maintain effective communications not only
among themselves, but with their patients as well. The directions for drug use and
other information which prescribers indicate on prescription orders must be
transferred on the labels and explained by the pharmacists to the patients for safe
and effective drug therapy. In order to assure that this information is conveyed
clearly and effectively to the patients, the following guidelines have to be followed
by the professionals.
Notes for prescribers

1. Whenever possible, specific times of the day for drug administration should
be indicated (for example, Take one capsule at 8:00 am, 2:00 pm, and 8:00
pm is more preferable as compared Take one capsule three times daily).
2. The use of potentially confusing abbreviations, ie, qid, tid, bd, etc, is
discouraged.
3. Vague instructions such as “take as necessary” or “take as directed” which
are confusing to the patient’s should be avoided.
4. If dosing at specific intervals around-the-clock is therapeutically important,
this should specifically be stated on the prescription by indicating appropriate
times for drug administration.
5. The symptom, indication, or the intended effect for which the drug is being
used should be included in the instructions whenever possible (for example,
Take one tablet at 6:00 am and 6.00 pm for high blood pressure, or Take one
tablet at 7:00 am, 11:00 am, 4:00 pm, and 8.00 pm for cough).
6. The Metric System of weights and measures should be used.
7. The prescription order should indicate whether or not the prescription should
be refilled and, if so, the number of refill(s) and the period of time for such
renewal is recommended.
8. The prescriber should print his/her name, telephone number and registration
number on the prescription blank.
Notes for Pharmacists

1. Instructions to the patient regarding directions for use of medication should
be concise and precise, but readily understandable to the patient. The
pharmacist should give verbal reinforcement and clarification of instructions
to the patient when appropriate.
2. For those dosage forms where confusion may develop as to how the
medication is to be administered, the pharmacist should clearly indicate the
intended route of administration on the prescription label.
3. Where special storage conditions are required, the pharmacist should

indicate appropriate instructions for storage on the prescription label and
explain to the patient.
748
TABLE: Common Abbreviations of Prescriptions, Medical and

Pharmaceutical orders.
ABBREVIATION MEANING
a.d. Right ear
a.s left ear
Aa of each
abd abdomen
ac before meals
ad lib At pleasure, freely
ad To, up to
amp Ampoule of medication
aq Water
as directed
ATC Around the clock
au each ear
BCP birth control pill
bid Twice a day
BM Bowel movement.
BP Blood pressure
BPH benign prostatic hypertrophy
BS Blood sugar
BSA Body surface area
CAD coronary artery disease
caps Capsule
cc cubic centimeter [milliliter]
CHF congestive heart failure
COPD chronic obstructive pulmonary
CP chest pain
DC discontinue medication
dil dilute
disp dispense
div divide
DJD degenerative joint disease
DM diabetes mellitus
dtd Let such doses be given
DW distilled water
DX diagnosis
elix elixir
Ft Make,
GI Gastrointestinal
grGrain Sx symptom
gtt A drop
GU Genitourinary
HA headache
749
HBP High blood pressure

HR heart rate
HRT hormone replacement therapy
hs at bedtime
HTN Hypertension
ID Intradermal injection
IM intramuscular injection
inj An injection
IU international units
IV Intravenous injection
JRA juvenile rheumatoid arthritis
kg kilogram
L liter ud
let it be made
m or min Minimum
wk week
m Mix
mcg microgram
mEq milliecluivalent
mg milligram
mL milliliter
mOsmol milliosmole
N&V Nausea and vomiting
noct At night
non rep/NR Do not repeat
OA osteoarthritis
od Right eye
os Left eye
ou Each eye
p pulse
pc After eating
PEFR peak expiratory flow rate
po by mouth
postop after surgery
pr rectally
prn when necessary
pulv A powder
PVD peripheral vascular disease
q every
qd every day
qh every hour
qid four times daily
qod every other day
qs ad a sufficient quantity to
qs as much as is sufficient disease (prepared)
750
RA rheumatoid arthritis
Rect Use rectally
s without
Sig write on label
SL sublingual
SOB shortness of breath
Sol Solution
ss One-half
stat immediately
supp Suppository
Susp Suspension
Syr Syrup
TB tuberculosis
tbsp tablespoon
TED thromboembolic disease
TIA transient ischernic attack
tid three times a day
tiw three times a week
top (Use) topically
tsp teaspoon
Tx treatment
U unit
UC ulcerative colitis
Oint. ointment
URI upper respiratory infection
ut dict as directed
UTI urinary tract infection
WA while awake
P.F prefilled syringe
751
APPENDIX-14 : MEDICINAL GASES
Appendix-14
MEDICINAL GASES
The following is a brief descriptions of the medical gases in common use, together
with some details of their administration, health hazard information, contraindication,
and color coding of cylinders.
1. OXYGEN (O2)
Uses : Oxygen is used extensively in medical practice to increase oxygenation in

patients with acute and chronic lung disease and cardiac disorders, for resuscitation,
and for the treatment of victims of poisoning. It is always administered during
anaesthesia. Oxygen therapy is also used in several applications: to supplement the
breathing of patients whose respiratory system has become comprised from ailments
such as bronchitis, or emphysema; to treat patients who are suffering from
hemorrhage, shock, convulsions or other trauma; to administer atomized, liquid
medication into the lungs; or as a treatment itself, due to pure oxygen's
vasoconstrictive properties.
Administration: Oxygen is administered by mask, tent, endotracheal tube, nasal

catheter and by special equipment for prolong treatment. Masks are used for
controlled flows which may give concentrations over 60% by volume. Tents are used
when the concentration need not to exceed 50% by volume. Respiratory facemasks
are used to provide oxygen concentrations of approximately 30% of inhaled air.
Humidification of the gas may be needed when nasal catheters are used with a flow
rate of over 3 liters/minute. Dependent on whether masks, tents or nasal catheters
are used the flow rate is determined by the clinician. The dosage is adapted to the
patient on the basis of the clinical course of the illness and generally ranges from 1 to
10 litres of gas per minute. In circumstances where oxygen is being mixed with other
gases ( anesthetics and analgesics) it is essential that the proportion of oxygen in the
inspired mixture never falls below the concentration in air.
Health Hazard Information: At normal atmospheric pressures, oxygen is non-toxic up

to about 20 hours exposure. At increasing pressures, oxygen becomes toxic to the
lungs and central nervous system. Oxygen toxicity may result from the long-term
exposure to partially reduced oxygen products which alter the metabolic function and
structure of lung cells.
Contraindications: Newly born and premature infants should be given oxygen only if
absolutely necessary because of the risk of the development of retinal damage.
Patients who have chronic respiratory disease with carbon dioxide retention may
develop apnoea if given oxygen, due to the reduction in stimulation of the respiratory
system by carbon dioxide. Careful monitoring of these patients for hypoventilation is
required during oxygen therapy.
Color code of cylinders : Black body, white shoulder.
752
2. CARBON DIOXIDE (CO2)
Uses: Carbon dioxide stimulates the respiratory centre directly and if its concentration
is raised from the normal concentration in air, the rate and depth of respiration are
increased. At 3 percent concentration the depth is doubled while at 5 percent it is
trebled with a great increase in respiration rate. Its use is not without danger and,
therefore, it is reserved mainly for emergencies; for example, to induce and improve
respiration rate in new-born infants, drowning persons, and cases of poisoning by
carbon monoxide, morphine, hypnotics and other depressants. Generally,
concentrations of 5 to 7 percent mixed with oxygen are used. Solid carbon dioxide is
used in tissue freezing techniques. Carbon dioxide is also used: to increase the depth
of anaesthesia rapidly, when volatile agents are being administered, it increases depth
of respiration and helps to overcome breathholding and bronchial spasm, to increase
cerebral blood flow in arteriosclerotic patients undergoing surgery, in gynaecological
investigation for insufflation into fallopian tubes and abdominal cavities.
Administration: Carbon dioxide should only be administered by medical personnel

trained in the appropriate techniques. Cylinders should only be used in conjunction
with medical carbon dioxide gas pressure regulators. Special medical equipment will
be used if it is being used to inflate parts of the body during keyhole surgery or
gynaecological procedures.
Health Hazard Information: Carbon dioxide regulates the rate of breathing. The
occupational exposure limit is 5000 ppm. As the concentration of carbon dioxide rises
it affects the rate of breathing, at 2% the rate is noticeably above normal, at 10%
breathing is very rapid and headache, vomiting and death may occur in an unfit
person, 15% will cause unconsciousness in a few minutes, 25% leads to rapid
circulatory insufficiency and death.
Pregnancy and breast feeding: The use of Medical Carbon Dioxide is not
recommended during pregnancy but is unlikely to influence lactation.
Contraindications: Carbon dioxide is contraindicated:

-In acidosis
-In respiratory obstruction, the administration of carbon dioxide may be dangerous
since any further increase in respiratory effort increases negative intra-thoracic
pressure
-During resuscitation, where it can be dangerous and should be avoided.
Color code of cylinders: Grey body, grey shoulder.
3. NITROUS OXIDE (N2O)
Uses: Nitrous oxide is a non irritating anaesthetic gas, used as a carrier for the volatile
anaesthetics, it may be used to insufflate body cavities and in cryosurgery as a
refrigerant. It can also be used as an analgesic and in dental work to provide short-
term analgesia for tooth extraction and other brief procedures, administered with 50%
oxygen.
Administration: Nitrous oxide should only be administered by medical personnel

trained in the appropriate techniques. Cylinders should only be used in conjunction
with medical nitrous oxide gas pressure regulators. Nitrous oxide should not be used
for more than a total of 24 hours, or more frequently than every 4 days, without close
clinical supervision and haematological monitoring.
753
Health Hazard Information: Nitrous oxide does not support life and when used for
anaesthesia an adequate oxygen concentration must be ensured. Because it is much
more soluble than nitrogen, nitrous oxide will diffuse into air filled body cavities much
faster than nitrogen will diffuse out, increasing the pressure within them.
Administration of nitrous oxide will, if continued for some hours, result in some
inactivation of vitamin B12, which is a co-factor of methionine synthase. Folate
metabolism is consequently interfered with and DNA synthesis is impaired following
prolonged administration of nitrous oxide. If administration is frequent, say every 2
days, this can result in megaloblastic changes in bone marrow, myeloneuropathy and
sub acute combined degeneration of the spinal cord. Addiction can also occur. After a
substantial period of time signs similar to those of sub acute combined degeneration
of the spinal chord may develop. The suggested limits for continuous exposure range
between 25-400 ppm. Nitrous oxide should never be given with less than 21% oxygen,
but a maximum of 30% oxygen should be used during anaesthesia (except when used
in combination with a volatile anaesthetic agent) and more at altitude and in the
presence of disorders affecting oxygenation.
Absolute Contraindications:
• High and low atmospheric pressures.
• Unconsciousness.
• The first sixteen weeks of pregnancy.
• Artificial, traumatic or spontaneous pneumothorax.
• Gross abdominal distension
• During myringoplasty
• Air embolism
Care is required in the following conditions:

• Sedated patients.
• The very young and old due to mask fitting difficulties.
• Bowel obstruction.
• Having Vitamin B12 deficiency.
Color code of cylinders: Blue body, blue shoulder
754
4. HELIUM (He)
Uses: Helium is used in physiological investigations. The low density of helium

compared to nitrogen enables it to provide a substitute for air when mixed with oxygen
which is easier to breath in obstructive or dystrophic chest disease. It is indicated to
assist flow of oxygen into the alveoli and to reduce the work of breathing in patients
with severe airway obstruction. It is also used in some cryogenic applications.
Administration: By mask or endotracheal tube; cylinders should only be used in

conjunction with medical oxygen gas pressure regulators. It may also be administered
via nasal prongs if sufficiently high flow rate is employed to prevent air entrainment. It
can be administered to spontaneously breathing patients or in combination with
various forms of invasive and non-invasive ventilatory modes.
Health Hazard Information: Helium is an inert gas and will not support life. An
adequate concentration of oxygen must be ensured when helium is administered. The
risk for cooling should be taken into account, especially in smaller children. When
using devices not designed for helium-oxygen mixtures, set ventilator tidal volumes
and measured flow rates may not be accurate due to the physical properties of helium.
Contraindications: Not reported.
Color code of cylinders: Brown body, brown shoulder.
5. CYCLOPROPANE (C3H6)
Uses: Cyclopropane is a potent anaesthetic producing good muscular relaxation. It is

non-irritating and induction and recovery are rapid. Mixtures of 4, 8 and 20 to 25
percent with oxygen produce analgesia, light analgesia and surgical analgesia
respectively.
Administration: Cyclopropane should only be administered by anesthetists trained in

the use of Cyclopropane. Because of the flammability and expense of cyclopropane, it
is usually used in a closed (rebreathing) system, in which an absorbent chemical, such
as soda lime, removes exhaled carbon dioxide, and theanesthetic is recirculated.
Health Hazard Information: Cardiac irregularities are possible if atropine or
catechelomines are used with cyclopropane, nausea, vomiting and a degree of
hypotension are common post-operative symptoms.
Color code of cylinders: Orange body, orange shoulder.
6. OXYGEN + CARBON DIOXIDE
Uses: Oxygen/carbon dioxide mixtures are used as a stimulant to the respiratory

centre.
Administration: Usually by mask or endotracheal tube. Cylinders should only be
used in conjunction with medical oxygen gas pressure regulators.
Health Hazard Information: Oxygen/carbon dioxide mixtures have similar toxicity to
oxygen, but at normal atmospheric pressures the mixtures will induce a marked
increase in breathing rate. The mixture should not be used at pressures above normal
atmospheric pressure.
Contraindications: Newly born and premature infants should be given oxygen only if
absolutely necessary because of the risk of the development of retinal damage.
Color code of cylinders: Black body, white and green shoulder.
755
7. HELIUM + OXYGEN
Uses: The low density of helium compared to nitrogen enables it to provide a

substitute for air when mixed with oxygen which is easier to breath in obstructive or
dystrophic chest diseases.
Administration: By mask or endotracheal tube; cylinders should only be used in
conjunction with medical oxygen gas pressure regulators.
Health Hazard Information: Not reported.
Color code of cylinders: Brown and green.
8. Nitric Oxide (NO)

Uses: Nitric oxide is a powerful vasodilator, essential signaling molecule, and also a
free radical. Since it dilates blood vessels, it is commonly prescribed to patients who
suffer from circulation or heart ailments; however, it is prescribed as nitroglycerin and
amyl nitrate pills which are metabolized into NO. In fact, the only instance for a NO
gas prescription, which needs to be implemented in equal parts with oxygen, is for
neonatal patients who suffer from pulmonary hypertension or post-meconium
aspiration.
Administration: Nitric oxide is a gas available in concentrations of only 100 ppm and
800 ppm. The nitric oxide administration apparatus is to be used in conjunction with a
ventilator or other breathing gas administration system. The concentration of nitric
oxide is maintained approximately constant during the inspiratory flow regardless of
the variation in flow rate within the inspiratory portion of the respiratory cycle. The
concentration of inspired nitric oxide can be set, typically in the range of 0 to 80 parts
per million (ppm). The administration apparatus includes a pressure regulator and
connectors with fittings which are specific for nitric oxide gas cylinders, typically
containing 400 or 800 ppm nitric oxide in nitrogen
Health Hazard Information: Overdosage with inhaled nitric oxide will be seen by
elevations in methemoglobin and pulmonary toxicities associated with inspired nitric
oxide. Elevated NO may cause acute lung injury.
Contraindications: Inhaled nitric oxide is contraindicated in the treatment of neonates

known to be dependent on right-to-left shunting of blood.
Color code of cylinders: Nitric oxide lines and cylinders are frequently labeled with
teal and black labels.
9. Medical air
Medical air cylinders are supplied to the following speciﬁcation:
- oxygen content 20.9% Oxygen ± 0.5%
- nitrogen balance.
Uses: Medical air is used: as a replacement for atmospheric air when the atmosphere
is contaminated by noxious fumes, vapours or gases, in anaesthesia as a carrier gas
for volatile anaesthetic agents, as a power source for pneumatic equipment in
ventilators and incubators to provide uncontaminated and controlled air ﬂows.
Administration: For breathing purposes medical air is administered by various means,

commonly by self contained or compressed air line breathing apparatus.In
anaesthesia, medical air is administered via a cylinder and valve assembly through a
face mask or endotracheal tube.
756
Health Hazard Information: Medical air should never be administered to a patient if,
when it is mixed with other gases, the oxygen content is less than 21%. Care is
needed in the handling and use of medical air cylinders.
Contraindications: Medical air is contraindicated where oxygen or other gaseous

combinations would be indicated (airways obstruction, pneumonia, and a myriad of
cardio-respiratory conditions).
Color code of cylinders: Yellow
757
APPENDIX-15: NUCLEAR MEDICINE AND RADIOPHARMACEUTICALS
Appendix-15
NUCLEAR MEDICINE AND

RADIOPHARMACEUTICALS
Introduction:
Nuclear Medicine is a medical specialty devoted to diagnostic, therapeutic and

research applications of radionuclides utilizing nuclear gamma and positron emission
and sometimes beta-ray which are used specially in therapy.
Radiopharmaceuticals have been defined as radioactive drugs that, when used for the
purpose of diagnosis or therapy, typically elicit no physiological response from the
patient.
The design of these compounds is based solely upon physiological function of the
target organ. Unlike radiographic procedures, which depend almost entirely upon
tissue density differences, external imaging of radiopharmaceuticals is essentially
independent of the density of the target organ. The mechanism of localization of a
radiopharmaceutical in a particular target organ can be as simple as the physical
trapping of particles or as sophisticated as an antigen-antibody reaction or
chemisorption of an inorganic phosphate on the hydroxyapatite crystals deposited in
an acute myocardial infarction.
Properties of the ideal diagnostic radiopharmaceuticals

1. Pure gamma emitter.
2. 100 < gamma energy < 250 keV.
3. Effective half-life = 1.5 X test duration.
4. High target to non target ratio.
5. Minimal radiation dose to patient and Nuclear Medicine personnel
6. Patient safety.
7. Chemical reactivity.
8. Inexpensive, readily available radiopharmaceutical.
9. Simple preparation and quality control if manufactured in house.
Diagnostic approaches of Nuclear Medicine include both in vivo and in vitro

procedures:
In vivo technique is the most common type of procedure, where

radiopharmaceuticals/ radionuclides/ radiotracers are administered to the patients.
Then patients are imaged from outside using the instruments- planar Gamma Camera
and SPECT (Single Photon Emission Computed Tomography) by mapping radiotracer
distribution in different target organs of the body. Characteristics of commonly used
radiopharmaceuticals are shown in Table-I.
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APPENDIX-15 : NUCLEAR MEDICINE AND RADIOPHARMACEUTICALS
PET (Positron Emission Tomography) images offer potentially more functional

demonstration (cellular activity at molecular level) rather than simply anatomical
information. A PET scan allows the physician to distinguish between living and dead
tissue or between benign and malignant disease.
18 fludeoxyglucose (FDG) is mostly used radiotracer in PET studies. 18 Fl is produced
by cyclotron and half life is 110 min. The uptake of 18 F -FDG by tissues reflects the
tissue uptake of glucose which correlates with certain type of tissue metabolism.
PET/CT:
PET/CT are both state of art imaging tools that allow physicians to pinpoint the
location of cancer within the body before making treatment recommendations. The
highly sensitive PET scan images the biology of disorders at the molecular level, while
CT scan provides a detailed picture of the body’s internal anatomy. The PET/CT scan
combines the strengths of these two well-established imaging modalities into a single
scan. A PET/CT scan can also help physicians monitor the treatment of disease and
identify recurrence of disease. This PET/CT has become the fastest growing imaging
modality since its introduction to clinical medicine in 2001.
SPECT/CT:
Hybrid SPECT/CT demonstrate added value to single imaging modality. With

SPECT/CT scanners, lesions visualized by functional imaging can be correlated with
anatomic structures. The addition of anatomic information increases the sensitivity as
well as the specificity of scintigraphic findings.
In vitro procedure includes Radioimmunoassay (RIA) and Immuno-radiometric assay

(IRMA), which are used to measure different hormone levels in serum such as free
triiodothyronine (FT3), free tetraiodothyronine (FT4), Thyroid stimulating hormone
(TSH), follicularstimulating hormone (FSH), Luteinizing hormone (LH), calcitonin and
prolactin and antibodies. Sometimes radionuclides are introduced to the patients and
samples of breath, urine and faeces are taken from the patient. Measurements of
radioactivity in samples are made by gamma- or beta-sample counting techniques.
Therapeutic aspects of nuclear medicine mostly deal with radioiodine (131I)

treatment of primary hyperthyroidism and carcinoma of thyroid. Low-energy beta-
emitting radionuclides (153samarium-ethylenediaminetetrameth-ylenephosphonate
(EDTMP) and 89strontium (89Sr) are used to relieve metastatic bone pain. 90 Sr are for
the treatment pterygium. Furthermore, radionuclides are being used for cardiac
stenting, synovectomy, liver cancer, ovarian and prostatic cancer.
Radioimmunotherapy is the promising aspect of therapeutic Nuclear Medicine. In non-
Hodgkins lymphoma radioimmunotherapy (Zevalin) has been approved by the FDA of
USA since 2002.
759
Table I- Characteristics of commonly used radionuclides.

Radionuclide Mode of Type of Principles of Half-life
production decay photon emissions
(kev)
99m
Tc Generator IT 140 6h
131
I Reactor Gamma, 360, 640 8 day
Beta
123
I Cyclotron Ec 160 13 h
125
I Reactor Gamma 35 60 day
67
Ga Cyclotron EC 92, 182, 300, 390 78 day
201
Tl Cyclotron EC 68-80b 73.5 h
111
In Cyclotron EC 173, 247 2.8 day
133
Xe Reactor Beta 81 5.3 day
81m
Kr Generator IT 191 13 s
18
F Cyclotron Positron 635 110 min
EC- Electron capture, IT- isomeric transition, b- Characteristic X-rays
Organ specific imaging procedures:
Some Nuclear Medicine imaging for different organs are described very shortly below
which will provide introductory knowledge about Nuclear Medicine. Organ specific
radiopharmaceuticals are given in Table-II and Table-III.
Thyroid gland
The oldest but most frequently performed nuclear medicine procedure is thyroid scan
by 99m Tc (Technetium), 131 I (Iodine) or 123 I. Thyroid scan gives information about
radiotracer uptake by thyroid gland and details about nodular goiter. Previously
radioiodine uptake was used to evaluate thyroiditis, hypothyroidism and calculation of
therapy dose for hyperthyroidism. But radioiodine uptake is no more use in most of the
nuclear medicine departments. Commonly 37 or 74 MBq of 99m Tc is injected
intravenously and scan is taken after 20 minutes.
Most of the therapeutic nuclear medicine in our country deals with radioiodine
treatment in primary hyperthyroid patients by giving 370 MBq-555 MBq 131 I as outdoor
patient.. About 1110 MBq -7400 MBq dose of 131 I are usually given to differentiated
thyroid carcinoma patient after total thyroidectomy at National Institute of Nuclear
Medicine and Allied Sciences (NINMAS) and other Institutes of Nuclear Medicine
under Bangladesh Atomic Energy Commission. These patients are followed up life
long at the concerned institutes.
Skeletal System
Whole body bone scan represents main bulk of study in most of the nuclear medicine
departments. This is a highly sensitive test to survey the entire skeletal system with
less radiation in comparison to X-ray imaging. 99m/Tc phosphonate
radiopharmaceuticals are highly sensitive to bone turnover and therefore are useful in
the early detection of bone and joint abnormalities. About 740 MBq of 99m Tc
phosphonate is introduced intravenously to the patients and different spot views are
taken after 2-3 hours.
760
Renal System
Morphology and functional status of renal system can be well evaluated by 99m Tc
DMSA (Dimercaptosuccinate acid) scan and renogram by 99m Tc DTPA (Diethylene
triamine pentaacetic acid). These techniques are useful in diagnosing renal scar,
obstructive uropathy and parenchymal disease of kidneys.
Cardiovascular System
Several nuclear medicinal techniques are available for the diagnosis and management
of cardiovascular diseases. Myocardial perfusion study using Thallium-201 (201Tl),
99m
Tc sestamibi, 99m Tc teboroxime, 99m Tc tetrofosmin are used to diagnose coronary
artery disease. Radionuclide ventriculography by 99m Tc labeled RBCs is used to
evaluate by global and regional ventricular function before and after intervention.
Brain
In the late 1960s & early 1970s conventional brain scintigraphy by blood brain barrier
agent, 99m Tc DTPA was the method of choice. Now a days CT (Computed
tomography) and MRI (Magnetic Resonance Imaging) have been playing important
role in anatomical imaging. Rather, the role of nuclear medicine imaging for central
nervous system has been redefined as functional brain imaging. 99mTc HMPAO
(Hexamethyl propylene amine oxime) is currently the best agent to estimate regional
cerebral blood flow (rCBF). SPECT imaging of 99m Tc HMPAO is useful in
cerebrovascular disease and psychiatric disorders. PET using both blood flow and
metabolic agents 18F FDG produces images of physiologic and biochemical processes
in the brain that has both important research and clinical impacts. Radionuclide
cisternography is a simple method to investigate differentiation of communicating and
non-communicating hydrocephalous, CSF (cerebrospinal fluid) leaks and
demonstration of CSF shunt patency.
Liver and Biliary Scan
Colloid liver scan is used to examine the liver, spleen and bone marrow. Now a days
liver scan is rarely performed. Readily available ultrasound scan has replaced this
procedure to see the liver focal lesions. Hepatobiliary imaging using several amino-
diacetic acid compounds labeled with 99m Tc has been used to investigate biliary
excretion and the pathway from liver to small intestine. Indications of this scintigraphy
are- cholecystitis, biliary atresia in newborn to assess the hepatic uptake, bile duct
patency, cystic duct patency, and sphincter of Oddi dysfunction.
Lungs
Pulmonary imaging comprises ventilation scan & perfusion scan. Ventilation scan is
usually performed by 81m Kr (Krypton) gas / 133 Xe (Xenon) gas or Technegas (99m Tc
–labelled carbon particles). Perfusion imaging is done by 99m Tc labeled 99m Tc MAA
(macroaggregate albumin). Combined ventilation/ perfusion (V/Q) study is mostly
applied to diagnose the medical emergency condition pulmonary embolism.
Conditions associated with V/Q mismatch are acute and chronic pulmonary embolism,
bronchogenic carcinoma, mediastinal and hilar adenopathy, hypoplasia of pulmonary
artery and vasculitis. V/Q matched abnormalities are seen in chronic obstructive
pulmonary disease, bronchitis, blebs, congestive heart failure, pulmonary oedema,
pleural effusion, asthma, pulmonary trauma and bronchogenic carcinoma.
761
Gastrointestinal tract
Gastric emptying studies by 99m Tc DTPA combined with meal are most often
performed on patients who have an unsatisfactory result from peptic ulcer surgery and
in studying the physiology of the stomach. The milk scan using 99m Tc –sulphur colloid
in 100 ml milk or orange juiceis applied orally to diagnose gastro-oesophageal reflux in
children. Meckels’ diverticulum, the commonest congenital anomaly of gastrointestinal
tract could be evaluated by simple imaging technique by 99m Tc-pertechnetate.
Tumour Imaging
Tumour imaging is the growing area of Nuclear Medicine application. Many

radionuclide studies are performed for the detection of primary and metastatic
tumours. These studies are divided into tumour specific imaging and tumour-non-
specific imaging. Tumour specific imaging include 131I whole body scan, 131I MIBG
(metaiodobenzylguanidine) radiolabeled monoclonal antibodies and peptides.
Radionuclides those are not tumour specific are gallium –67 (67 Ga), thallium-201
(201Tl) and 99m Tc sestamibi. 18 F FDG PET imaging also heps in diagnosis of primary
tumour and to assess metastases and prognosis of treatment.
Lymphoscintigraphy and sentinel lymphnodes
Lymphoscintigraphy is performed by injecting a small quantity of 99m Tc labeled

nanocolloid subcutaneously usually unilateral lymphoedema and lymphnodes
metastases are diagnosed by this imaging procedure. ‘Sentinel’ node detection has
become popular in recent years and routinely used in some Nuclear Medicine
Departments to diagnose early stage of breast carcinoma and melanoma. This
procedure is useful to surgeons to take decision about extent of operation.
Infection
There has been considerable improvement in the scintigraphic imaging of

inflammation and infection over the last few years. Radiolabelled white blood cells
have been used as an important diagnostic modality in the diagnosis of infection. The
radionuclides available for leucocyte labeling for localization of infection are 111 In, 99m
Tc and 67 Ga.
Radiation safety issue:

As was the case with diagnostic radiopharmaceuticals, the goal is a minimal radiation
dose absorbed by both the patient, who is probably having a one-time therapeutic
procedure, and the Physician or Nuclear Medicine Technologist, who is routinely
exposed to radioactive patients on a daily basis. The usual rules of the TDS concept
apply: one should minimize TIME, maximize DISTANCE, and use the appropriate
amount of SHIELDING. There should be specific rules governing the release of
patients from the hospital after administration of a therapeutic radiopharmaceutical.
762
Precautions for radiopharmaceuticals handling:
There are many precautions one must take during the preparation and use of
radiopharmaceuticals, in general, and Tc-99m radiopharmaceuticals, in particular.
Since most radiopharmaceuticals are intended to be administered intravenously, it is
imperative to use aseptic technique in order to maintain sterility of the product. The
vial septum must be wiped with 70% isopropanol prior to puncturing the septum with a
needle. This is really a cleansing step rather than a true sterilization step since the
alcohol doesn't remain on the septum long enough to kill all pathogens that might be
present.
Air must NEVER be injected into any radiopharmaceutical vial, especially one
containing a Tc-99m product. The oxygen contained in only 0.1 ml of air is enough to
completely destroy the stannous ion used in many commercially available cold kits as
a reducing agent. In addition, room air is not sterile so it is possible to introduce
pathogens into the vial by using a preliminary injection of air to increase internal
pressure in the vial and ease the removal of the contents.
Prior to reconstituting a cold kit with Tc-99m pertechnetate, oxidant-free pertechnetate
must be diluted to the required final volume with 0.9% NaCl solution. Ideally, oxidant-
free saline (Low Dissolved Oxygen Saline) should be used for the dilution step.
Reconstitution of a cold kit with a small volume of pertechnetate followed a few
minutes later by dilution with saline solution can cause dissociation of certain weak
chelates, resulting in the formation of significant amounts of Free Tc. This is not a
problem with sulfur colloid or other insoluble Tc-99m compounds.
Patient safety
Patient safety is also critical. Ideally, the therapeutic radiopharmaceutical should
exhibit no toxicity to the patient. While most commonly used compounds are inherently
safe and provide wide margins of safety, we routinely inject drugs that are potentially
toxic. Thallous ion (Tl1+), for example, is known to be a potent cardiotoxin and yet we
routinely inject Tl-201 thallous chloride intravenously into our patients. This is an
acceptable practice since the specific activity (activity per unit mass) of carrier-free Tl-
201 is very high and the amount of Tl-201 contained in the typical 3 mCi dose (only 42
ng) is very small.
One of the concerns regarding treating a patient with I-131 NaI therapy solution is
whether the patient is allergic to iodine. A calculation will show that 10 mCi of carrier-
free I-131 contains only 80 ng of elemental iodine, far too small an amount to have a
physiological effect on the patient.
763
Table II Commonly used radiopharmeceuticals for different organs.

Target organ Radiopharmaceuticals Indications Dose (MBq)
99m
Skeletal System Tc HDP Metastatic lesions, size 350-750
(disodium oxidronate) and extent of primary bone
99m
Tc MDP tumour, osteomyelitis and
(Methylene diphosphonate) fractures.
99m
Kidneys Tc DTPA Parenchymal function, 200-750
(diethylenetriamine evaluation of obstruction.
pentacetic acid)
99m
Tc MAG Congenital anomaly,
(mercaptylacetyltriglycerine) Tumour, Cortical scarring.
99m
Tc DMSA
(dimercaptosuccinic acid) 40-80
99m
Thyroid Tc pertechnetate Thyroid scan to see size of 40-80
gland and uptake in
nodule.
131
Thyroid I Therapy for ~ 555
hyperthyroidism.
~1700-5550
Carcinoma of thyroid.
99m
Cardiovascular Tc sestamibi Evaluation of ischaemia, 370-1100
99m
system Tc Tetrofosmin infarction wall motion.
99m
Tc teboroxime 74-111
201
TL Cardiac output.
99m
Tc RBC
99m
Lungs Tc Technegas Pulmonary embolism 40-74
Tumour 370
133
Xe
81m
Kr
99m
Brain Tc DTPA Primary or secondary ~740
99m
Tc HMPAO tumour, psychiatric
(hexamethylpropylele problems 555
oxime)
99m
Liver scan Tc Tin colloid Tumour. 40-80
99m
Biliary system Tc hepatic iminodiacetic Biliary atersia, Acute 40-80
acid cholecystitis.
67
Tumour Ga (Gallium citrate) Tumour 100
111
Infection In White blood cell Infection 12
99m
Lymphoscintigrap Tc nanocolloid Lymphoedema, 40
hy Metastases & ‘sentinel
node’detection
Clinical Utility
Radiopharmaceuticals have been used clinically for a wide variety of studies which
generally fall into three categories. (Table III).
1. Static studies.
2. Dynamic studies.
3. In vivo non-imaging studies.
764
Table III. Clinical use of Radiopharmaceuticals

Study Type Tracer Region Pathology
Static Studies
With
Radiotracers
Bone Scan Tc-MDP, Tc- Whole Body Bone tumors, fractures,
HDP Paget's disease, spread of
metastatic disease
Liver/Spleen Tc-SC, Tc- Abdomen Tumors, cysts,
Scan MIAA hepatocellular disease
Brain Scan Tc-HMPAO Brain Tumors, trauma, dementia
Tumor Scan Ga-67 citrate Whole Body Malignant Tumors
Dynamic
Studies With
Radiotracers
Study Type Tracer Region Pathology
Cardioangiograp Tc-RBC, Tc- Chest Aneurysms, congenital
hy HSA heart defects; myocardial
dyskinesia; cardiomegaly
Cerebral Blood TcO4 Head/neck Cerebral death, AVM
Flow
Cholecystograph Tc-DISIDA Abdomen Obstructive disease
y
Cisternogram In-111 DTPA Head/neck Blockage/slowed CSF flow
Dynamic kidney Tc-DTPA Back Obstructive disease
Gastric emptying Tc-ovalbumin Abdomen Abnormal GE Rates In-
DTPA regurgitation
Pulmonary vent Xe-133 gas Upper back obstructed airways
Renogram I-131 hippuran Back renal dysfunction
Venogram Tc-MAA Legs thrombosis
Voiding Tc-sulfur Abdomen reflux of urine incomplete
cystogram colloid bladder emptying
In Vivo Non-
Imaging Tracer
Kinetic Studies
CO2 breath test C-14 CO2 breath glucose intolerance
Iron turnover Fe-59 chloride whole body abnormal ferrokinetics
Ocular P-32 P-32 Na3PO4 eyes ocular melanoma
uptake
Platelet survival In-111 blood abnormal platelet loss
platelets
765
Radioactive *I-NaI thyroid abnormal uptake test,

iodine (RAIU) hyperthyroidism
RBC Survival Cr-51 RBC's blood hemolytic anemias
Schilling Test Co-57 B12 urine pernicious anemia, Vitamin
B12 malabsorption
syndromes
Splenic Cr-51 RBC's spleen hypersplenism
Sequestration
Categories of Radiopharmaceuticals
Radiopharmaceuticals fall into several different categories:
• ready-to-use radiopharmaceuticals
• instant kits for preparation of Tc99m products
• kits requiring heating
• products requiring significant manipulation.
Examples of each of these categories are listed in the Table IV.
Table IV. Categories of Radiopharmaceuticals

Prepared Products Tc-99m Kits requiring heating
I-123 capsules MAG3
I-131 hippuran sestamibi
Ga-67 citrate sulfur colloid
Tl-201 chloride teboroxime
Xe-133 gas Products requiring significant manipulation
Tc-99m pertechnetate Cr-RBC's
Instant Tc-99m kits Tc-99m RBC's
Disofenin Tc-99m WBC's
DTPA In-111 WBC's,
GH In-111 Platelets
HDP Xe-133 in saline
MDP I-123 mIBG
mebrofenin
MIAA
MAA
PYP
766
APPENDIX-16 : PARENTERAL DOSES OF DRUGS FOR MEDICAL EMERGENCIES
Appendix-16
PARENTERAL DOSES (FOR ADULTS AND

CHILDREN) OF DRUGS FOR MEDICAL
EMERGENCIES
Drugs which are required immediate administration within minutes post or during a
medical emergency. Medicines which have the potential to sustain life and/or prevent
further complications.
DRUG USE DOSAGE
Adrenaline Anaphylaxis or acute Give intramuscularly (not intravenously):
(1 mg/ml, i.e. 1:1,000) angioedema adults and 12-18 years olds: 500
microgram (0.25 ml)
6 months- 6 years: 120 microgram (0.12
ml) under 6 months: 50 microgram (0.05
ml)
Aminophylline Reversible airways Given Intravenously : Adults: 300
obstruction, severe micrograms/kg/hour; CHILD under 12
acute asthma years :1mg/kg/hour, adjusted according
to plasma-theophylline
concentration
Amiodarone Arrhythmia (ventricular Given Intravenously : initially
tachycardia) 5 mg/kg over 20–120 minutes with ECG
monitoring; subsequent infusion given if
necessary according to response up to
max. 1.2 g in 24 hours
Atropine Bradycardia (arrhythmia) adults: 0.3-1 mg intravenously; the dose
(600 microgram/ml) plus hypotension in may be repeated every 3-5 times if the
myocardial infarction first dose is not effective
Benzylpenicillin Suspected bacterial Give intravenously (or intramuscularly if
(600 mg vial for meningitis or venous access is not available) as a
reconstitution with meningococcal single dose:
sodium chloride or septicemia adults and children 10 years and over:
water for injection) 1.2 g
1-9 years: 600 mg
under 1 year: 300 mg
Calcium Gluconate In severe acute An initial slow intravenous injection of 10–
hypocalcaemia or 20mL of calcium gluconate injection 10%
hypocalcaemic tetany, (providing approximately 2.25–4.5 mmol of
calcium) in adult with plasma Ca and ECG
monitoring.
Cefotaxime Suspected bacterial Give intravenously or IM as a single
(1 g vial for meningitis or dose: adults and children 12 years and
reconstitution with water meningococcal over: 1 g children up to 12 years: 50
for injection) septicemia, in patients mg/kg
allergic to penicillin (on
history of anaphylaxis)
Chloramphenicol Suspected bacterial adults and children: 12.5-25 mg/kg
(1 g vial for meningitis or intravenously
reconstitution with water meningococcal
for injection) septicemia, if there is a
history of anaphylaxis
due to penicillin
Chlorphenamine As an adjunct after Give by slow intravenous injection over 1
(10 mg/ml) adrenaline in the min:
treatment of anaphylaxis adults and children over 12 years: 10-20
767
or acute angioedema mg
6-12 years: 5-10 mg
1-6 years: 2.5-5 mg
1 month-1 year: 250 microgram/kg (max
2.5 mg)
Cyclizine Vomiting due to adults: 50 mg IM or intravenously children
(50 mg/ml) vestibular disorders or over 1 month: 0.5-1 mg/kg intravenously
with diamorphine (max single dose: 6-18 years, 50 mg:
(except in myocardial 1 month 6 years, 25 mg)
infarction)
Diamorphine Severe pain (e.g. Give by slow (1 mg/min) intravenous
(5 mg or 10 mg powder myocardial infarction) injection (particularly with shock or
for reconstitution with and acute left ventricular peripheral vasoconstriction):
water for injection) failure adults : 1.25-5 mg
12-18 years: 2.5-5 mg
1-12 years: 75-100 microgram/kg
6-12 months: 75 microgram/kg
Or, IM (not in myocardial infarction) or
subcutaneously (but not if tissue
perfusion is impaired or if there is edema)
in a dose of 5-10 mg in adults, or 5 mg in
children aged 12-18 years
Diazepam Severe acute anxiety, Given by intramuscular injection or slow
(5mg/ml Injection) control of acute panic intravenous injection: for severe acute
attacks, and acute anxiety, control of acute panic attacks, and
alcohol withdrawal, acute acute alcohol withdrawal, 10 mg,
drug induced dystonic repeated if necessary after not less than
reactions, 4 hours
Given by slow intravenous injection: for
acute drug induced dystonic reactions, 5–
10mg repeated as necessary after at
least 10 minutes; CHILD: 1 month–12
Years: 100 micrograms/kg repeated as
necessary after at least 10 minutes
Diclofenac Analgesia (e.g. ureteric adults: 75 mg IM deep into the gluteal

(25 mg/ml) colic, bone pain, acute muscle
back pain)
Dobutamine inotropic support in Given by intravenous infusion, 2.5–10
infarction, cardiac micrograms/kg/minute, adjusted
surgery, according to response
cardiomyopathies, septic
shock, and cardiogenic
shock; cardiac stress
testing
Dopamine cardiogenic shock Given by intravenous infusion, 2–5

micrograms/kg/minute
initially
Flumazenil To reverse respiratory adults: 200 microgram intravenously over

(100 microgram/ml) depression caused by 15 seconds, then 100 microgram at 1 min
benzodiazepines intervals, if needed (max. 1 mg)
Furosemide To relieve pulmonary adults: 20-50 mg by slow intravenous
(100 mg/ml) edema associated with injection
acute left ventricular
failure
Glucagons Hypoglycaemia-first-line Give subcutaneously, IM or
768
(1 mg/ml) use, except in those who intravenously:

have been adult: 1 mg
hypoglycaemic for some children 2-18 years: 0.5-1 mg (i.e. weight
time and may have <25 kg, 0.5 mg: >25 kg/1 mg)
exhausted their supplies 1 month- 2 years: 500 microgram
of liver glycogen under 1 month: 20 microgram/kg
Glucose Hypoglycaemia-second Give intravenously into a large vein over
(10% and 20% solution) line use in unconscious 3 min:
patients adults: up to 50 ml to 20% infusion
children:2-5 ml/kg of 10% infusion
Haloperidol Very agitated or violent adults: 2-10 mg IM
(5 mg/ml) patients with psychiatric
illness
Hydrocortisone Acute severe asthma Give intravenously over at least 1 min:
(100 mg powder as adults: 100 mg
sodium succinate) children: 4 mg/kg (max 100 mg)
Severe or recurrent Give by slow intravenous injection:
anaphylaxis adults: 100-300 mg
children: 1 month-18 years: 4-8 mg/kg
(max 200 mg)
Hypoadrenalism Give by slow intravenous or IM injection:
adults and children 12 years: 100 mg
children: 1 month-12 years: 2-4 mg/kg
Lorazepam Very agitated or violent adults: 1-2 mg IM or 4 mg by slow
(4 mg/ml) patients with psychiatric intravenous injection into a large vein
illness and convulsion
Lidocaine 2% Injection for the treatment of in patients without gross circulatory impairment,
ventricular tachycardia in 100 mg as a bolus over a few
haemodynamically stable minutes (50mg in lighter patients or those
patients, and ventricular whose circulation is severely impaired), followed
fibrillation and pulseless immediately -
ventricular tachycardia in by infusion of 4 mg/minute for 30 minutes,
cardiac arrest refractory to 2 mg/minute for 2 hours, then 1 mg/minute;
defibrillation.
Metoclopramide Nausea and vomiting, adults: 10 mg IM or intravenously over 1-
(5 mg/ml) can be given with 2 min
diamorphine in patients
with myocardial infection
Midazolam status epilepticus; febrile Given by continuous subcutaneous
5mg/5ml and convulsions infusion, it is given initially in a dose of
15mg/5ml Injection 20-40 mg/24 hrs.
Morphine Severe pain Adults: 10 mg (15 mg for heavier well-
(100 mg/ml) muscled patients) subcutaneously (but
not if patient is edematous) or IM, or 2.5-
7.5 mg by slow (2 mg/min) intravenous
injection
Children, subcutaneously or
intramuscularly:
12-18 years: 10 mg
5-12 years: 5-10 mg
1-5 years: 2.5-5 mg
children, intravenously (over at least 5
min):
12-18 years: 2.5-10 mg
1 month-12 years: 100-200 microgram/kg
Naloxone Opioid overdose Give intravenously (subcutaneously or IM
(400 microgram/ml) and if intravenous route not feasible):
Adults and children 12-18 years: 0.4-2
mg
Dose can be repeated every 2-3 min up
769
to a maximum of 10 mg
Children 1 month- 12 years: 1
microgram/kg with a subsequent dose of
100 microgram/kg if there is no response
Phenobarbitone Sodium status epilepticus Dilute injection 10 mg/kg at a rate of not more
(200mg/ml Injection) than 100 mg/minute; max. 1 g
Phenytoin acute symptomatic seizures By slow intravenous injection or infusion (with

(50mg/ml Injection) associated with head trauma blood pressure and ECG monitoring), ADULT: 20
or neurosurgery, status mg/kg (max. 2 g) at a rate not exceeding 1
epilepticus mg/kg/minute (max. 50mg
per minute),
CHILD: 1 month–12 years, 20 mg/kg at a rate not
exceeding 1 mg/kg/minute (max. 50mg per
minute) as a loading dose; maintenance
dose of 5–10 mg/kg daily (max. 300 mg daily) in
2 divided doses;
NEONATE 20 mg/kg at a rate not exceeding 1
mg/kg/minute, as a loading dose; maintenance
dose of 5–10 mg/kg daily in 2 divided doses
Potassium Chloride Severe hypokalaemia Ready-mixed infusion solutions should be used

15% Injection containing 1.5 g (K+ 20 mmol) in 10 mL, is
thoroughly mixed with 500mL of sodium
chloride 0.9% intravenous infusion and given
slowly over 2 to 3 hours
Pralidoxime chloride (2- In Organophosphorus By intravenous infusion, ADULT and CHILD initially
PAM) 25mg/ml Injection poisoning as cholinesterase 30 mg/kg over 20 minutes, followed by 8
inhibitor mg/kg/hour; usual max. 12 g in 24 hours.
Prochlorperazine Nausea and vomiting Give by deep IM injection:
(12.5 mg/ml) Adults and children 12-18 years: 12.5 mg
5-12 years: 5-6.25 mg
2-5 years: 1.25-2.5 mg
Procyclidine Oculogyric crisis or acute Give IM or intravenously:
(5 mg/ml) dystonia adults and children 10-18 years: 5-10 mg
(occasionally more than 10 mg is
needed)
2-10 years: 2-5 mg
under 2 years: 0.5-2 mg
Salbutamol sulphate severe or life-threatening acute High-flow oxygen plus salbutamol 5mg via
Inhalation asthma oxygen-driven nebuliser for ADULT;
CHILD under 5 years 2.5 mg,
5–12 years 2.5–5 with prednisolone and inhaled
ipratropium bromide.
Sodium bicarbonate Severe metabolic acidosis sodium bicarbonate (1.26%) should be infused
8.4% Injection (pH<7.1) over 3–4 hours with plasma-pH and electrolyte
monitoring
Streptokinase Injection acute myocardial infarction MI (initiated within 12 hours of symptom onset),
by intravenous infusion, 1.5 million
units over 60 minutes
Table of ideal weight for age (kg)

newborn 1month 3months 6months 1 years 3 years 5 years 7 years 12 years adult female adult male
3.5 4.2 5.6 7,7 10 15 18 23 39 56 68
Compiled from: British National Formulary (BNF) and BNF for Children
770
Appendix-17
DRUG AND FOOD INTERACTION
Drugs that interact with grapefruit
Examples of some of the most common grapefruit or grapefruit juice drug interactions
include:
• Alprazolam
• Amiodarone
• Atorvastatin
• Carbamazepine
• Cilostazol
• Clarithromycin
• Colchicine
• Dronedarone
• Erythromycin
• Felodipine
• Fentanyl
• Fentanyl Transdermal System
• Fexofenadine
• Indinavir
• Loratadine
• Losartan
• Lovastatin
• Nilotinib
• Pazopanib
• Pimozide
• Ranolazine
• Saquinavir
• Sildenafil
• Simvastatin
• Tadalafil
• Vardenafil
• Verapamil
Drugs that interact with Apple and Orange Juice
• Amphetamines
• Fexofenadine
• Second-generation antihistamines, such as cetirizine and loratadine
Drugs that interact with cranberry juice
• Warfarin.
Drugs that interact with Caffeine
• Fluoroquinolones,
771
APPENDIX-17 : DRUG AND FOOD INTERACTION
• H2 antagonist (e.g., ranitidine, famotidine),

• Oral contraceptives and prednisone,
• Theophylline.
Drugs that interact with Dairy Products/Calcium
• Calcium. Bisphosphonates (alendronate, risedronate, and ibandronate)

• Cefuroxime
• Fluoroquinolones (e.g., ciprofloxacin, levofloxacin)
• Methotrexate, tetracyclines
Drugs that interact with Protein-Rich Foods
• beta-Blocker's
• Carbidopa/levodopa and theophylline
Drugs that interact with High-Fat Meals
• Griseofulvin
Drugs that interact with Fiber
• Digoxin
• Levothyroxine
• Metformin and
• Penicillin
Drugs that interact with Tyramine-Containing Foods (cheese and red wine)
• Monoamine oxidase inhibitors (MAOIs)

• Oxazolidinone antibiotic Linezolid
Drugs that interact with Alcohol
• Acetaminophen
• Anticonvulsants.
• Antidepressants,
• Antihistamines,
• Antipsychotics,
• Barbiturates,
• Benzodiazepines
• Isoniazid,
• Metronidazole,
• Muscle Relaxants,
• Opiates or
Sulfonylureas.
772
Appendix-18
SIDE EFFECT OF SOME COMMON DRUGS
Analgesics & Antipyreties Side effects
Non-opioid Analgesics-
Aspirin Nausea, dyspepsia, gastrointestinal ulceration &
bronchospasm, Prolong bleeding time, urticaria.
Ibuprofen Epigastria pain, Edema, Heart Burn, Nausea,
Constipation.
Paracetamol Thrombocytopenia, leukopenia, and neutropenia.
Tolfenamic Acid Tremor, constipation, confusion, dysuria specially in
male.
Opioid Analgesics-
Morphine sulphate Urinary Retention, constipation, vomiting, purities,
headache, depression, dyspnea, insomnia.
Tramadol Hydrochloride Sweating, dizziness, constipation, GI bleeding,
vomiting, nausea, dry mouth and fatigue.
Anti-bacterials
Aminoglycosides Nephrotoxicity, Ototoxicity, Neurotoxictiy
Carbapenems Constipation
Cephalosporins Nephrotoxicity, Stevens j. syndrome, Toxic
epidermal dermatitis, A.A. diarrhea
Clindamycin Thrombocytopenia, Renal dysfunction
Colistimethate sodium Nephrotoxicity, Neurotoxicity
Isoniazide Elevated liver func. Tests, Loss of apetite,
Weakness, Lethargy, Thrombocytopenia, peripheral
neuropathy (dose related).
Linezolid, Tedizolid Thrombocytopenia, Elevated blood pressure,
Serotonin syndrome, Diarrhea in children,
Headache, Nausea.
Nitrofurantoin Urine discoloration, Anemia
Penicillins Thrombocytopenia, Abdominal discomfort,
Nephrotoxicity, Hypersensitivity reaction- fever, joint
pain, rash.
Polymyxin B Nephrotoxicity, Neurotoxicity
Rifampicin Ataxia, Elevated liver func. Tests, Flu like
syndrome.
Teicoplanin Nephrotoxicity, Thrombocytopenia
Tigecycline Systemic acidosis, Vit. K deficiency, Hepatotoxicity
Vancomycin Nephrotoxicity, Ototoxicity, Thrombocytopenia
Macrolides Diarrhea, nausea, abdominal pain, loose stool in
(Azithromycin/Clarithromycin/ high single dose therapy, Taste disturbance,
Erythromycin) Paresthesia, Pruritis, Cramping, Flatulence.
Fluoroquinolones Nausea, Headache, Diarrhea, Dizziness,
(Ciprofloxacin/Levofloxacin/ Dyspepsia, Photo sensitivity.
Gatifloxacin)
Tetracycline Children may develop permanent brown
discoloration of teeth (>10%), Diarrhea, nausea,
Antibiotic associated pseudomembranous colitis (1-
2%)
773
APPENDIX-18 : SIDE EFFECT OF SOME COMMON DRUGS
Chloramphenicol Leucopenia, Thrombocytopenia, Suppression of red

cell production, Aplastic Anemia, Peripheral
neuritis, Grey baby syndrome.
Anti-coagulants
Enoxaparin Anemia, Blood thin, hemorrhage, Fever.
Rivaroxaban Abdominal pain, Back pain, Headache, Dizziness,
Fatigue, peripheral edema.
Warfarin Taste perversion, Rash, Diarrhea, Jaundice, and
Fever, Hemorrhage.
Anti-fungals
Azoles Q-T prolongation, Hypokalemia, Increased
ALT/AST, Thrombocytopenia, SJS, TEN,
Spontaneous hypoglycemia
Echinocandins (Anidulafungin, Hepatotoxicity (Caspof.)

Caspofungin)
Anti-hypertensive
Acetazolamide Thirst, Confusion, Malaise, Polyuria, Anorexia.
Alfuzosin Abdominal pain, Headache, constipation
Amlodipine Edema, Headache, palpitation, abdominal pain,
Atenolol Tiredness, Depression, Leg pain, Hypotension,
Bradycardia, Cold extremities.
Bisoprolol Dizziness. Upper Respiratory infection,
Bradyarrythmia.
Captopril Hyperkalemia, Skin Rash
Carvedilol Hypotension, Diarrhea, Vomiting, Weight gain,
Dizziness, Fatigue, Hyperglycemia.
Eplerenone Hypercalamia, Abdominal pain, Cough
Frusemide Hypokalemia, Hyperuricemia
Hydrochlorothiazide Weakness, vertigo, gastric irritation, Electrolyte
disturbance, Hypotension.
Irbesartan Dizziness, Diarrhea, Fatigue, Hyperkalemia.
Labetalol Dizziness, Fatigue, Nausea
Losartan Potassium Hypoglycemia, Weakness, Chest pain
Nifedipine Heart Burn, Peripheral edema, Headache
Olmesartan Midoxomil Back pain, Headache, Dizziness, Diarrhea, Fatigue
Prazosin Palpitation, Weakness, Headache, Dizziness.
Ramipril Cough, Hypotension, Headache
Telmisartan Headache, Dizziness, Diarrhea, Fatigue
Terazosin Dizziness, Hypotension, Impotence, edema
Valsartan Vertigo, Dizziness, Upper abdominal pain
Verapamil HCl Headache, Constipation, Sleep disturbance
Anti-virals
Acyclovir Elevated transaminase level, Abdomina pain,
Anemia, Fatigue, Oral malaise
Oseltamivir Nephrotoxicity, Arrhythmia, Delirium, Abnorla liver
func. Tests, Abnormal pain.
774
Drugs for Cancer Therapy

Bevacizumab Dry mouth, cough, voice changes, and loss of
appetite, diarrhea, nausea, vomiting, constipation,
mouth sores, and headache, Weakness.
Bleomycin Skin reaction, Pulmonary toxicity, Hypersensitivity
reaction, Myelosuppression.
Carboplatin Nausea& vomiting, Anemia, Elevation of ALT, AST,
Blood urea & bilirubin level, Cardiac failure etc.
Cisplatin Nausea &vomiting, Hair loss, Diarrhea, loss of
appetite, Hiccup etc.
Cyclophosphamide Anorexia, Nausea & vomiting, Anemia, Alopecia,
Skin & nail pigmentation.
Dacarbazine Myelosuppression, nausea and vomiting, Flu -like
syndrome, CNS Toxicity, photosensitivity.
Docetaxel Myelosuppression, Hypersensitivity reaction, Fluid
retention, Alopecia, Mucositis, Peripheral
neuropathy.
Doxorubicin GI toxicity, Blurred vision, Headache, Seizure, Skin
pigmentation, Myelosuppression, Cardiac toxicity.
Epirubicin Alopecia, Diarrhea, Nausea & vomiting, Cardio
toxicity, Skin rash, Leukopenia or Neutropenia.
Etoposide Nausea &vomiting, Anorexia, Diarrhea, Stomatitis,
CNS effects, Peripheral neuropathy,
Thrombocytopenia, Leukopenia.
Folinic Acid(Leucovorin) GI disturbances, Hypersensitivity reactions,
Bronchospasm.
5-Flurouracil Myelosuppression, Hand-foot syndrome, Neurologic
toxicity, Dry skin, Metallic taste.
Gemcitabine Leukopenia, Thrombocytopenia, Anemia, Mild GI
effects, Rashes, Renal impairment, Pulmonary
toxicity & edema, Proteinuria, Hematuria etc.
Irinotican Nausea & vomiting, skin reactions, Diarrhea,
Cardiovascular toxicity, Neutropenia, Anemia,
Abdominal Cramps etc.
Ifosphophamide Nausea & vomiting, Depression, Hallucinations,
Wound healing impairment, Nephrotoxicity, Cardiac
toxicity etc.
Methotrexate Myelosuppression, Mucositis, Uric acid
nephropathy, Acute cerebral dysfunction, Skin rash,
Arachnoiditis with intrathecal administration.
Oxaliplatin Myelosuppression, Neurotoxicity, Nausea and
vomiting, Diarrhea, Allergic reaction, Hepatotoxicity
Paclitaxel Neutropenia, Anemia, Chest Pain, Neurotoxicity,
Skin Discoloration, Alopecia.
Pemetrexed Myelosuppression, Skin rash, Mucositis, Fatigue.
Rituximab Headache, fever, chills, stomach pain, nausea,
diarrhea, heartburn, flushing, night sweats,
weakness, muscle or joint pain, back pain,
dizziness.
Topotecan Myelosuppression, Nausea, Vomiting, Headache,
Fever, Myalgias, Alopecia.
Trastuzumab Fever, Chills, Muscle aches, Nausea.
775
Vinblastin Neurotoxicity, Constipation, Alopecia,

Myelosuppression, Hypertension, Mucositis.
Vincristine Neurotoxicity, Constipation, Alopecia,
Myelosuppression, Azoospermia, Mucositis.
Drugs for Depression

Amitriptyline HCL Dry mouth, weight, vision problem, Sweating,
Postural hypotension, Tachycardia.
Escitalopram Somnolence, Insomnia, Headache, Nausea,
Menstrual Disorder.
Flupenthixol Melitracen Insomnia, Restlessness.
Mirtazepine Weight gain, appetite, somnolence.
Nortiptyline Anxiety, Palpation, Arrhythmias, panic.
Drugs for Epilepsy

Carbamazepine Dry mouth, Ataxia, Nausea, Vomiting.
Clonazepam Somnolence, Depression, memory impairment,
impotence, urinary frequency.
Diazepam Diarrhea, Euphoria, Rash, Incoordination.
Gabapentin Ataxia, Fatigue, Drowsiness, Somnolence.
Phenobarbitone Drowsiness, Excitement, Vomiting, confusion.
Phenytoin GI disturbance, Lack of appetite, Dizziness, tremor.
Piracetam Depression, Sleep Disturbance, weight gain,
Hyperkinesia, Nervousness.
Pregabalin Ataxia, Fatigue, Drowsiness, Somnolence,
Peripheral edema, weight gain, Tremor.
Drugs for Heart Failure

(Inotropic-Sympathomimetic)
Dopamine HCL Angina pain, atrial fibrillation, ventricular arrhythmia,
Ectopic beats, Tachycardia.
Dobutamine HCl Angina, dyspnea, fever, nausea, Tachyarrhythmia.
Digoxin Dizziness, Mental disturbance, Diarrhea,
Headache, Nausea.
Drugs for Lipid Regulation

Atorvastatin Diarrhea, Nasopharyngitis, Arthralgia.
Fenofibrate Abdominal Pain, Back Pain, Headache,
constipation.
Omega -3 fatty Acid Taste perversion, Rash, Infection, pain.
Rosuvastatin Myalgia, Headache, pharyngitis.
Simvastatin Myalgia, Headache, pharyngitis, abdominal pain,
constipation.
Drugs for Psychosis

Haloperidol Parkinsonism, Dystonia, Erectile dysfunction,
Sedation, Weight gain, Erectile dysfunction.
Trifluperazin Dry mouth, sedation, blurred vision.
Drugs for Respiratory System

Aminophylline Convulsion, vomiting, insomnia, Abdominal pain.
Glycopyronium Bromide Dry mouth, dehydration, immune system disorder.
776
Ipratropium Bromide Dry mouth, Headache, Urinary retention, Buccal

ulceration.
Ipratropium bromide + Salbutamol Bronchitis, chest pain, nausea, URTI, Headache.
Rofumilast Diarrhea, Weight loss, Back pain.
Salbutamol +Theophylline Bronchitis, chest pain, nausea.
Drugs Used in the Alimentary

Disease/Disorder
Antacids & other Anti-Dyspeptics Diarrhea, Stomach cramps, milk-alkali syndrome,
drugs Chalky taste, Vomiting.
Domperidone Dry mouth, nervousness, drowsiness, skin rash and
itching.
Diosmin + Hesperidin Routine gastric disorders and neurovegetative
disorders (feeling of discomfort).
H2 -Receptor antagonists Nausea, headache, dizziness and diarrhea, skin
rashes.
Hydrocortisone + Aesculin + Local atrophic changes in the skin.
Cinchocaine + Framycetin/
Neomycin
Proton pump inhibitors Diarrhea, headache (both may be severe); also
nausea, constipation, flatulence, dizziness,
somnolence, malaise, Abdominal pain.
Drug Used in Respiratory

Diseases
Adrenaline Anxiety, tremor, tachycardia, cardiac arrhythmias,
Dizziness, Dyspnea, Flushing.
Aminophylline Gastric irritation, nausea, vomiting, epigastric pain
and tremor.
Ephedrine Tremor, tachycardia, insomnia, urinary retention,
dry mouth, Palpitation, Restlessness.
Ipratropium Bromide Dryness of the mouth, nausea, dizziness, blurred
vision.
Ketotifen Dry mouth, sedation, Weight gain, Rash.
Montelukast Dizziness, headache, diarrhea, restlessness,
abdominal pain.
Pizotifen Weight gain, Dry mouth, muscle pain, Hepatic
injury.
Salbutamol Tremor, Palpitations, muscle cramps, and
tachycardia.
777
APPENDIX-19 : CLINICAL PATHOLOGY AND OTHER BIOMEDICAL TABLE
Appendix-19
CLINICAL PATHOLOGY AND OTHER

BIOMEDICAL TABLE
Part A: Laboratory Reference Values for Adults:

* Blood (B), Plasma (P), Serum (S)
Test Conventional units SI units
Aminotransferase
Alanine (ALT) SGPT 10-40 U/L (37°C) 0.22–0.68 mckat/L (37°C)
Aspartate (AST) 0.17–1.00 -2 to +3 kat/L
SGOT 10-59 U/L (37°C)
-1 antitrypsin (P) 78–200 mg/dL 0.78–2.00 g/L
Albumin (P) 3.5–5.2 g/dL 35–52 g/L
Aldolase (S) 1.0–7.5 U/L (30°C) 0.02–0.13 mckat/L (30°C)
Alkaline phosphatase
(P) 38–126 U/L (37°C) 0.65–2.14 mckat/L
Amylase (P) 27–131 U/L 0.46–2.23 mckat/L
Ammonia (B) 9–33 mcmol/L 9–33 mcmol/L
Angiotensin converting
enzyme (ACE) (S) 12-35 u/L
Acetone and
acetoacetate(S) 0.3–2.0 mg/dL 0.05–0.34 mmol/L
Acid phosphatase (S) <3.0 ng/mL <3.0 mcg/L
Ascorbic acid (P) 0.4–1.5 mg/dL 23-85 micromol/L
Bicarbonate (S) 22–29 mEq/L 22–29 mmol/L
Bilirubin (S) Total 0.2-1.2 mg/dL 2-20 micromol/L
Direct (conjugated) 0.1-0.4 mg/dL <7 micromol/L
Indirect
(unconjugated) 0.2-0.7 mg/dL <12 micromol/L
Blood volume 8.5-9% of body weight
(kg) 80-85 ml/kg
Blood urea nitrogen
(BUN) (S or P) 8-25 mg/dl 2.9-8.9 mmol/L
Calcium (S) Total 8.5-10.3 mg/dL 2.1-2.6 mmol/L
Ionized 4.25-5.25 mg/dL 1.05-1.3 mmol/L
Carcinoembryonic
antigen
(CEA)(S) 0-2.5 ng/ml 0-2.5microgram/l
CO2 content (S) 24-30 mEq/L 24-30 mmol/L
CO (B) 0.5–1.5% total Hb 0.005–0.015 HbCO fraction
Carotenoids (S) 50-300 microgram/dL 0.9-5.58 micromol/L
Ceruloplasmin (S) 27-37 mg/dL 1.8-2.5 pmol/L
Chloride (S) 96-106 mEq/L 96-106 mmol/L
Cholesterol (S) 120-220 mg/dL 3.1-5.68 mmol/L
Creatine kinase (S)
female 10-80 u/L 0.17–1.36 mckat/L (30°C)
male 15-105 u/L 0.26–1.79 mckat/L (30°C)
778

Creatine kinase (MB)
(S) 0–7 ng/mL 0–7 mcg/L
Copper (S) 70-155 pg/dL 11-24 micromol/L
Complement C3 (S) 64-166 mg/dl 640-1660 mg/L
Complement C4 (S) 15-45 mg/dl 150-450 mg/L
Cryoglobulins (S) <0.12 mg/dl
Creatinine (S) <1.5 mg/dL <133 micromol /L
Cyanocobalamin (S) 200pgm/mL 148 pmol/L
Digoxin (S)
Therapeutic 0.8-2 ng/ml 1.0-2.6 nmol/L
Toxic >2.5 ng/ml >3.2 nmol/L
Erythropoietin (EPO)
(S) 5-20 mU/ml 5-20 u/L
Ethanol Not normally
detectable
65-87 mmol/L (marked
intoxication) >21.7 mmol/L (Depression
87-109 mmol/L of CNS)
(stupor) >86.8 mmol/L (Fatalities
>109 mmol/L Coma reported)
-fetoprotein (AFP)
(S) 0-15 ng/ml 0-15 microgram/L
Ferritin (S)
Female 4-161 ng/ml 4-161 microgram/L
Male 16-300 ngm/ml 16-300 microgram/L
Children to 15 years 7-140 ngm/ml
Folic acid (S) 2-20 ngm/ml 4.5-45 nmol/L
Folic acid (RBC) (B) 165-760 ng/ml 370-1720 nmol/L
Glucose, fasting (S or
P) 65-110 mg/dl 3.6-6.1 mmol/L
Gamma glutamyl 2-30 u/l male 0.03–0.51 mckat/L (37°C)
transferase (GGT) (P) 1-24 u/l female 0.02–0.41 mckat/L (37°C)
Glycated haemoglobin
(HbA1) (P) 4.2% – 5.9% 0.042–0.059
Haptoglobin (S) 46-316 mg/dl 0.5-3.2 g/L
Haemoglobin HbA->95% >0.95 Hb fraction
electrophoresis (B) HbA2 1.5-3.5% 0.015–0.035 Hb fraction
Haemoglobin, fetal Adult <2% (varies with
(HbF) (B) age) <0.02 Hb fraction
-hydroxybutyrate (S) 0.5-3 mg/dl 0.05-0.3 mmol/L
Insulin,
immunoreactive (S) 6-35 microunit/ml 42-243 pmol/L
Insulin-like growth
factor-1(P) 123-463 ng/ml 123-463 microgram/L
Iron (S) 50-150 mcg/dl 9-27 micromol/L
Iron binding capacity
(S) 250-410 mcg/dl
45-73 micromol/L
Iron Percent saturation 20-55% 0.2-0.55
779

Immunoglobulin A (P) 70–400 mg/dL 0.7-4 g/L
Immunoglobulin G (P) 700–1600 mg/dL 7–16 g/L
Immunoglobulin M (P)
Male 30-220 mg/dL 0.3-2.2g/L
Female 40-250 mg/dL 0.4-2.5g/L
Lactic acid (lactate)
(B)
Venous 4.5-20 mg/dl 0.5–2.2 mmol/L
Arterial 4.5-14.4 mg/dl 0.5–1.6 mmol/L
Lactate
dehydrogenase (LDH)
(total)(S) 100-190U/L 1.7–3.2 mckat/L
Lead (B) 0-50 pg/dl 0-2.4 pmol/l
Lipase (S) 23–300 U/L (37°C) 0.39–5.1 mckat/L (37°C)
Lithium (S)
Therapeutic 0.5-1.4 mEq/L 0.5-1.4 mmol/L
Toxic 2.0 mEq/L >2.0 mmol/L
Lipid fractions (S or P) HDL- Cholesterol >50
mg/dl, LDL-
Cholesterol-
<130mg/dl, VLDL- **(to convert into mmol/l,
Cholesterol <40 mg/dl multiply by 0.026)
Magnesium (S) 1.8-3 mg/dl 0.7-1.1 mmol/L
5’-Nucleotidase (S) 2-17 u/L 0.034–0.29 mckat/L
Osmolality (S) 280-296 mosm/kg
water 280-296 mmol/kg water
Oxygen saturation (B) 96-100% of capacity
Arterial PO2 (PaO2) 80-100 mmHg 10-13.3 kPa
PCO2 35-45 mmHg 4.7-6 kPa
pH (Arterial, B) 7.35-7.45 7.35-7.45
Phosphorous
(Inorganic) (S) 3-4.5 mg/dl 1-1.5 mmol/L
Potassium (S or P) 3.5-5 mEq/L 3.5-5 mmol/L
Protein (S)
Total (S) 6-8 gm/dl 60-80 g/L
Albumin (S) 3.5-5.5 gm/dl 35-55 g/L
Globulin (S) 2.2-4.2 gm/dl 22-42 g/L
A/G Ratio 1.1-2.4 11-24 g/L
Fibrinogen (P) 0.2-0.6 gm/dl 2-6 g/L
Prostate-specific
antigen (PSA) (S) 0-4 ng/ml 0-4 microgram/L
Protein S (P) (antigen) 76-178%
Pyruvate (B) 0.6-1 mg/dl 70-114 micromol/L
Sodium (S or P) 136-145 mEq/L 136-145 mmol/L
Specific gravity (B) 1.056
Specific gravity (S) 1.0254-1.0288 same
Sulphate (S) 2.9-3.5 mg/dl 0.3-0.36 micromol/L
Transferrin (S) 200-400 mg/dl 23-45 micromol/L
Triglycerides (S) <165 mg/dl 1.9 mmol/L
780

Troponin-I <1.5 ng/ml
Thyroglobulin (S) 3-42 ng/ml 3-42 microgram/L
Thrombin time (P) 24-35 seconds
Urea (P) 2.5-6.6 mmol/L
Uric acid (S or P) Male 3-9 mg/dl 0.18-0.54 mmol/L
Female 2.5-7.5 mg/dl 0.15-0.45 mmol/L
Electrophoresis
Globulin
1 0.1-0.4 gm/dl 1-4 gm/L
2 0.4-1.1 gm/dl 4-11 gm/L
 0.5-1.6 gm/dl 5-16 gm/L
 0.5-1.4 gm/dl 5-14 gm/L
Vitamin A (S) 20-60 pg/dl 0.7-2.1 micromol/L
Vitamin B 12 (S) 140-820 pg/ml 100-600 pmol/L
Vitamin D derivatives
(S)
1,25-dihydroxy 20-45 pg/ml 48-108 pmol/L
25- hydroxy 25-40 ng/ml 62.5-100 nmol/L
Zinc (S) 50-150 microgram/dl 7.65-22.95 micromol/L
A.2. Reference value for hormones in serum or plasma

Adrenal
Aldosterone (P)
Supine 2-9 ng/dl 56-250 pmol/L
Cortisol (S) 8.00AM 5-20 microgram/dl 0.14-0.55 micromol/L
8.00 PM <10 microgram/dl 0.28 micromol/L
Deoxycortisol (S) After metyrapone >7
microgram/dl >0.2 micromol/L
Dopamine(P) <135pg/ml
Epinephrine (P) <0.1 ng/ml <0.55nmol/L
Norepinephrine (P)
supine <500 pg/ml <3 nmol/L
Follicle-stimulating 1.4–15.4 IU/L (male)
hormone (FSH) Male 1.5-9 u/L 1–10 IU/L (female-
Female: 3-15 u/L (early follicular phase), 6–17
follicular), Upto 17 mIU/mL IU/L (Mid cycle), 19–
(mid-cycle), 19–100 mIU/mL 100 IU/L
(postmenopausal) (postmanopausal)
Gastrin <100 pg/mL <100 ng/L
Growth Hormone (GH) Male, <5 mcg/L,
Male <5 ng/mL Female<10 mcg/L
Female <10 ng/mL
Gonad:
Testosterone, free Male 10-30 ng/dl
(S) Female 0.3-2 ng/dl
781

Testosterone, Total Prepubertal <100ng/dl 0.52–38.17 nmol/L
(S) Adult male 280–1100 ng/dL (adult male), 0.52–
Adult female 20-80 ng/dl 2.43 nmol/L (adult
Luteal phase upto 120 ng/dl female)
Estradiol (E2)(S) Male 12-50 pg/ml
Female menstrual cycle 1-10
days 24-68 pg/ml,
11-20 days 50-300pg/ml, Male: 37-184 pmol/L
21-30 days 73-149 pg/ml (By Female: Varies with
RIA) menstrual cycle
Progesterone (S) Male : 13–97 ng/dL Male: 0.4–3.1 nmol/L
Female: Follicular phase 15– Female:
70 ng/dL Follicular Phase: 0.5–
Luteal phase 200–2500 2.2 nmol/L
ng/dL Luteal Phase: 6.4–
Pregnancy Varies with 79.5 nmol/L
gestational week Pregnancy: Same
Islets:
Insulin (S) 4-25 microunit/ml 29-181 pmol/L
C-peptide (S) 0.78–1.89 ng/mL 0.26–0.62 nmol/L
Glucagon(S) fasting 20-100 pg/ml
Parathyroid hormone
(PTH) 10-55 ng/L
Lutenising hormone Female: Female:
Follicular phase 1.68–15.0 Follicular phase: 1.68–
mIU/mL 1.68–15.0 IU/L 15.0 IU/L
Mid-cycle peak 21.9–56.6 Mid-cycle peak : 21.9–
mIU/mL 21.9–56.6 IU/L 56.6 IU/L
Luteal phase 0.61–16.3 Luteal phase: 0.61–
mIU/mL 0.61–16.3 IU/L 16.3 IU/L
Postmenopausal 14.2–52.5 Postmenopausal:
mIU/mL 14.2–52.3 IU/L 14.2–52.3 IU/L
Male: 1.24–7.8 mIU/mL Male: 1.24–7.8 IU/L
Prolactin (S) 1-25 ng/ml 0.4-10 nmol/L
Somatomedin C (P) 0.4-2 U/ml
ADH (P) Serum osmolality 285:
mosm/kg 0-2pg/ml,
Serum osmolality>290/kg: 2-
12+pg/mL
Placenta Male and nonpregnant
Estriol (E3) (S) female <0.2 microgram/dl <7nmol/L (by RIA)
Placenta Chorionic Beta subunit male <9
gonadotropin mIU/ml, female pregnant
after implantation >10
mIU/ml.
Thyroid
Thyroxine, free (FT4)
(S) 0.8-2.4 ng/dl 10-30 pmol /L
Thyroxine, Total 65-156 nmol/L (by
(TT4) (S) 5-12 microgram/dl RIA)
782

Triidothyronine (T3)
(S) 80-220 ng/dl 1.2-3.3 nmol/L
Reverse
Triidothyronine (rT3) 30-80 ng/dl 0.45-1.2 nmol/L
Throid stimulating
hormone(TSH) (S) <10 microU/ml <10 mU/L
Calcitonin (S) <100 pg/ml <29.2pmol/L
A.3. Reference value for urine

Acetone plus
acetoacetate negative
Amylase 1-17 u/h 1-17 u/h
Calcium 100-300 mg/day 2.5-7.5 mmol/d
Copper 0-50 pg/d 0-0.8 pmol/d
Cortisol 9-50 micromol/mol
creatinine
Creatinine 10-20 mmol/24 hour
Hemosiderin Negative
Hemoglobin and
myoglobin Negative
Lead <120 pg/d <0.39 pmol/L
Osmolality Random: 100-900 mosm/kg Random: 100-900
H2O mmol/kg H2O
Oxalate 80-490 (M) mmol/24 hour
40-320 (F) mmol/24 hour
Phosphate 15-50 mmol/d
Porphyrins
Delta-aminolevulinic
acid 1.5-7.5 mg/24 hour 11-57 micromol/d
Porphobilinogen <2 mg/24 hour <8.8 micromol/d
Protein <150 mg/day <150mg/day
Potassium 25-100mmol/24 hour
Sodium 100-200 mmol/24 hour
Urobilinogen 0-2.5 mg/24 hour 70-470 micromol/d
Urate 1.2-3 mmol/24 hour
Urea 170-600 mmol/24 hour
Vanilylmandelic acid
(VMA) 1-9 mg/d 5-45 micromol/d
783
A.4. Reference values for Cerebrospinal fluid

Cells 0–10 lymphocytes/mm3 0–10lymphocytes/mm3
0 RBC/mm3 0 RBC/mm3
Chloride 118–132 mmol/L (20 mmol/L
higher than serum) Same
Glucose 40–70 mg/dL 2.2–3.9 mmol/L
Total protein 8–32 mg/dL 80–320 mg/L
Glutamine 6-16 mg/dL 60-160 mg/L
Part B. Conditions in which normal chemistry values may increase or

decrease
Analyte Increase Decrease

Alanine It is an enzyme found
aminotransferase primarily in the liver but also
(ALT or SGPT) found in heart and other
tissue. The value increases Decreased ALT in
in hepatitis, cirrhosis of liver, combination with
obstructive jaundice, increased cholesterol
alcoholism, chemical levels is seen in cases
pollutants, myocardial of a congested liver.
infarction. Vitamin B6 deficiency.
Aspartate It is an enzyme found
aminotransferase primarily in liver, heart,
(AST or SGOT) kidney, pancreas and
muscle. It increases in
myocardial infarction, heart
failure, myocarditis,
pericarditis, myositis,
muscular dystrophy, trauma,
hepatic disease, pancreatitis,
renal infarct, cerebral Vitamin B deficiency,
damage, seizure. pregnancy.
Alkaline phosphatase Produced in the cells of the
bone and liver with some
activity in the kidney,
intestine, and placenta.
Growing children have
higher levels of this enzyme Low levels are
also. It increases in bone sometime found in
growth, bone metastases, protein deficiency,
Paget’s disease, ricket, malnutrition,
healing fracture, bone injury, pernicious anaemia
pregnancy, hepatic disease, and a number of
obstructive jaundice. vitamin deficiencies.
784

decrease

Lactic dehydrogenase It is an intracellular enzyme
(LDH) found particularly in kidney,
heart, skeletal muscle, brain,
liver, and lungs. It can be
useful in confirming
myocardial or pulmonary
infarction only in relation to
other tests. It is raised in
haemolytic anaemia,
leukemia, lymphoma, hepatic Malnutrition,
disease, renal infarction, hypoglycaemia,
trauma, seizures, cerebral adrenal exhaustion
damage etc.
Bilirubin, Total A byproduct of the
breakdown of haemoglobin
in the liver. It is excreted into
bile; it gives the bile its
pigmentation. It is raised in
liver disease, obstructive
jaundice, haemolytic Inefficient liver,
anaemia, pulmonary infarct, excessive fat
neonatal jaundice. digestion.
Albumin It is the major constituent of
serum protein (usually over
50%). It is manufactured by
liver from amino acids taken
from diet. It helps in osmotic Low levels are found
pressure regulation, nutrient in poor diets, diarrhea,
transport and waste removal. fever, infections, liver
High values are rarely found disease, burn, edema.
and are primarily due to hypocalcaemia,
dehydration. multiple myeloma.
Globulin A larger protein than albumin
is important for its
immunologic responses,
particularly its gamma
component. It has many
diverse functions like carrier
of some hormones, lipids, Lower levels may be
metals, and antibodies. T is found in immune
elevated in chronic compromised patients,
infections, liver disease, poor diet,
rheumatoid arthritis, malabsorption, liver
myeloma. and kidney disease.
785

decrease

Calcium The most abundant mineral
in the body and is involved in
bone metabolism, protein
absorption, muscular
contraction, transmission of
nerve impulse, blood clotting It decreases in
and cardiac function. It hypoparathyroidism,
increases in renal failure,
hyperparathyroidism, bone malabsorption,
metastases, myeloma, pancreatitis, vitamin D
sarcoidosis, deficiency,
hypervitaminosis D. overhydration.
Phosphorous Abundant element found in
most tissue and cells in the
body and is involved in
calcium transport, buffering
action and osmotic pressure.
It is closely related to
calcium with an inverse Hyperparathyroidism,
relationship. It is increased in osteomalacia,
renal failure cirrhosis,
hypoparathyroidism, diabetic hypokalemia. Excess
acidosis, acromegaly. IV glucose.
Potassium It is the major intracellular
cation in the blood. It along
with the help of sodium
maintains osmotic balance
and also involved in acid- Cirrhosis, malnutrition,
base balance. It helps in vomiting, metabolic
nerve and muscle action. It is alkalosis, diarrhea,
increased in hyperkalemic diuretics,
acidosis, cardiac arrhythmia, hyperadrenalism,
diabetic acidosis, familial periodic
hypoadrenalism. paralysis.
Sodium Most abundant cation in
blood and its chief base. It is
required to maintain osmotic
pressure, acid-base impulse,
and transmission of nerve Excess ADH,
impulse. It is increased in nephrosis, myxedema,
dehydration, diabetes congestive heart
insipidus, excessive salt failure, diarrhea,
ingestion. vomiting, diuretics.
Chloride Maintain cellular integrity
through its influence on
osmotic pressure. It also
helps in acid-base balance
and water balance. It is
increased in acidosis.
786

decrease

Cholesterol It is a fat that is a structural
component of cell membrane
and plasma lipoproteins and
is required for synthesis of
steroid hormones,
glucocorticoids and bile
acids. Mostly synthesized in
liver, some is absorbed Low levels are found
through diet. HDL is desired in
as opposed to the LDL. hyperthyroidism,
Elevated levels are found in depression,
atherosclerosis, diabetes, malnutrition, anaemia,
obstructive jaundice, infections, heart
hypothyroidism, pregnancy. failure, malignancies.
Tryglycerides It is stored in adipose tissue
as glycerol, fatty acids and
monoglycerides are
reconverted as tryglycerides
by liver.90% of dietary intake
and 95% of fat stored in
tissue are tryglycerides.
Elevated levels are found in
atherosclerosis, Low levels are found
hypothyroidism, liver in chronic obstructive
disease, pancreatitis, pulmonary disease,
myocardial infarction, brain infarction,
metabolic disorder, hyperthyroidism,
toxaemia, nephrotic malnutrition and
syndrome, hereditary. malabsorption.
Creatinine It is the waste product of
muscle catabolism. Elevated Low levels are found
levels are found in kidney in kidney damage,
disease, muscle protein starvation, liver
degeneration, drugs. disease, pregnancy.
Blood urea nitrogen The nitrogen component of
urea, is the end product of
protein catabolism. Elevated
levels are found in excessive Lower levels may be
protein intake, kidney found in poor diet,
damage, low fluid intake, malabsorption, liver
intestinal bleeding, exercise, damage, low nitrogen
heart failure. intake.
Uric acid It is the end product of purine
metabolism. Elevated levels
are found in gout, infections, Lower levels may be
kidney disease, alcoholism, found in diet low in
high protein diet, diuretics, purine, liver damage,
leukemia, lymphoma, uricosuric drugs,
polycythemia, psoriasis, allopurinol, large
toxaemia of pregnancy. doses of vitamin C.
787

decrease

Glucose (fasting) Primary source of energy is Lower levels may be
elevated in diabetes, obesity, found in excess
pancreatitis, steroid, stress, insulin, insulinoma,
IV glucose, thiazides, liver disease,
Cushing syndrome, hypothyroidism,
acromegaly, alcoholism,
hyperthyroidism. malabsorption.
Part: C. Clinical chemistry for paediatric range
Test Reference range Age

C1. Blood chemistry
Albumin g/dl 2.6-4.1(M) 2.7-4.3 (F) 1-30 days
2.8-4.6 2.9-4.2 31-days-6 months
2.8-4.8 3.3-4.8 6 months-1 year
3.2-4.7 2.9-4.2 1-18 years
Alkaline phosphatase 0-6 years
(S) u/L 72-307 6-9
133-340 9-15 (male)
103-429 15-18 (male)
49-210 9-13 (F)
99-453 13-15(F)
53-186 15-18(F)
38-110 18 years and older
38-110
Alanine transaminase,
u/L 13-45 Newborn
AST (Aspartate 20-60 0-6 years
transaminase, U/L 20-40 6-10
14-40 10-18
5-40 18 years and older
Amylase (S) U/L 5-65 Newborn
27-131 Adult
Ammonia micromol/L 20-100 <1 month
20-60 >1month
Bicarbonate (arterial) 17-24 mmol/L Newborn
19-24 Infant
16-24 2 months-2 year
22-26 Adult
Bilirubin (total) (S) 24-149 micromol/L 0-1 day
58-197 micromol/L 1-2 days
26-205 micromol/L 3-5 days
Bilirubin Direct (S) 1-25 micromol/L <2 weeks
<10 micromol/L >2 weeks
Carbon dioxide mEq/L 15-20 Cord blood
18-27 Child
Calcium (ionized)
mg/dL 4.2-5.9 Neonatal
788

Calcium (S) (Total) 8.5-10.6 (M) 8.4-10.6 (F) Birth – 30 days
(mg/dl) 8.7-10.5 8.9-10.5 31 days- 1 year
8.8-10.6 8.5-10.5 1-6 years
8.7-10.3 8.5-10.3 7-12 years
8.5-10.2 8.4-10.0 13-15 years
8.4-10.3 8.6-9.8 16-18 years
Cholesterol Total (S or 1.3-2.6 <1 month
P) mmol/L 1.8-3.2 1 month-2 years
2.6-4.5 2-10 years
2.6-5.5 >10 years
Creatinine 0.5-1.2(M) 0.5-0.9 (F) Birth-30 days
(mg/dl) 0.4-0.7 0.4-0.7 31days-3 years
0.5-0.8 0.5-0.8 4-6
0.6-1.0 0.6-1.0 7-12
0.6-1.2 0.7-1.1 13-15
0.8-1.4 0.8-1.2 16-18
CK (creatine 10-200 Newborn
kinase)(S) U/L 15-105 Adult M
10-80 Adult F
20-110 >60 years M
16-18 >60 years F
Total protein g/dl 4.6-7 Newborn
4.4-7.6 1 week
5.1-7.3 7 month-1 year
5.6-7.5 1-2 year
6-8 >3years
Glucose (S) fasting 1.1-3.3 Premature
mmol/L 1.7-3.3 Neonate
2.2-3.3 Newborn- 1day
2.8-4.5 Newborn>1day
3.3-5.6 Child
4.1-5.9 Adult
GGT (Gamma 8-154 U/L 0-1 wk
glutamyl 7-103 1-2
transpeptidase) 9-76 2-4
6-52 4-6
5-40 6-7
5-24 7wk-16 years
<45 >16 years
Lactate
mmol/L 0.7-2.0 All ages
Magnesium
mmol/L 0.71-0.96 All ages
Osmolality
mmol/kg 265-295 All ages
Sodium (S or P) 130-140 Premature
mmol/L 133-146 Newborn
139-146 Infant
138-145 Child
136-145 Thereafter
789

Potassium (S) ) 3.7-5.9 Newborn
mmol/L 4.1-5.3 Infant
3.4-4.7 Child
3.5-5.1 Thereafter
Chloride (S or P) 98-113 Newborn (0-30 days)
mmol/L 98-107 Thereafter
Urea 1-6 mmol/L All ages
Uric acid mg/dL 2-7 0-2 years
2-6.5 2-12 years
2-7 12-14 years
Phosphorous mg/dL 4.2-9 Newborn
3.8-6.2 1 year
3.5-6.8 2-5 years
Triglyceride (fasting) 0.5-1.4 mmol/L <5 years
0.6-1.7 > 5 years
C.2. Reference values for cerebrospinal fluid in paediatric age ranges
Glucose >3.0 mmol/L
Protein <1.20 g/L Full term newborn
0.20-0.80 <1 month
0.15-0.4 >1 month
C.3. Thyroid function test in paediatric age ranges
TSH (S) Micro IU/mL Male Female

0.52-16.0 0.72-13.1 0-30 days
0.55-7.10 0.46-8.10 1month-5 years
0.37-6.0 0.36-5.80 5-18 years
0.40-5.00 18 years and older.
Total T4 Male Female
(microgram/dL) 3.0-14.3 3.0-13.3 0-30 days
5.2-16.3 4.6-13.3 1-12 months
5.5-11.4 6.3-12.8 1-5 years
5.3-10.5 5.3-10.8 5-10 years
4.5-10.3 4.9-10.0 10-15 years
4.9-8.8 5.1-10 15-18 years
Free T4 (ng/dL) Male Female
0.8-2.8 0.9-1.9 0-2 days
0.5-2.3 0.6-1.9 3-30 days
0.8-2.0 0.9-1.9 1-12 months
0.9-1.6 1.0-1.7 1-5 years
0.8-1.7 0.9-1.6 5-10 years
0.9-1.6 0.8-1.5 10-15 years
0.9-1.6 0.9-1.5 15-18 years
790
C.4. Pediatric haematology
Value At Day-3 1 2-6 2-6 6-12

birth month months years years
Red blood cell 6.0±1.0 5.3± 4.2±1.2 3.8±0.8 4.6±0.7 4.6±0.
count (1012/l 1.3 6
Haemoglobin 165±30 185±40 140±30 115±20 125±15 135±2
(g/L) 0
Packed cell 0.54±0. 0.56±0. 0.43±0. 0.35±0.07 0.37±0. 0.40±
volume 10 11 12 03 0.05
Mean cell 110±10 108±13 104±19 91±17 81±6 86±8
volume (MCV)
(fl)
Mean cell 34±3 34±3 34±6 30±5 27±3 29±4
haemoglobin
(MCH) (pg)
Mean cell 330±30 330±40 330±40 330±30 340±30 340±3
haemoglobin 0
con. (MCHC)
(g/l)
Reticulocytes 2-5 1-4.5 0.3-1 0.4-1 0.2-2 0.2-2
(%)
WBC (×109/l) 18±8 15±8 12±7 12±6 10±5 9±4
Neutrophils 5-13 3-5 3-9 1.5-9 1.5-8 2-8
(×109/l)
Lymphocytes 3-10 2-8 3-16 4-10 6-9 1-5
(×109/l)
Monocytes 0.7-1.5 0.5-1 0.3-1 0.1-1 0.1-1 0.1-1
(×109/l)
Eosinophils 0.2-1 0.1-2.5 0.2-1 0.2-1 0.2-1 0.1-1
(×109/l)
C.5. Miscellaneous haematological tests

Tests Normal range
Prothrombin time (P) 11-15 seconds for children >6 months
International normalized ratio (INR) 1.0-1.3 for children >6 months
Activated partial thromboplastin 27-39 seconds for children >6 months
time (P) (APTT)
Fibrinogen (P) Above 1.5 g/L for children >6 months
D-Dimer (P) <0.2 mg/L for children >6 months
Ferritin (S) 10-150 microgram/L for children >6
months
Iron 110-270 ug/dl Birth- 4 months
30-70 ug/dl 4 months-1 year
20-124 ug/dl 2-3 years
53-119 ug/dl 3-10 years
Iron binding capacity 59-175 ug/dl birth-4 months
250-400 ug/dl 4 months-10 years
Percent saturation 65% Newborn
25% 4-10 months
30% 3-10 years
791
APPENDIX-20 : List of thermo labile product with recommended storage condition
Appendix-20
List of thermo labile product with recommended storage condition
SL. Name of the Generic Name with Dosage form Storage Condition
No. product Strength
1 Eposis Erythropoietin Pre-filled Store in a refrigerator
Injection Concentrated Solution Syringe (2°C to 8°C), Do not
(Erythropoietin Alfa) BP freeze or shake.
2,000 IU/ 0.50 ml
2 Eposis 3000 Erythropoietin Pre-filled Store in a refrigerator
3,000 IU/ 0.75 ml
4,000 IU/ 0.40 ml
5,000 IU/ 0.5 ml
5 Filgrast Filgrastim INN 300 mcg/ Pre-filled Store in a refrigerator
Injection 0.5 ml Syringe (2°C to 8°C), Do not
freeze or shake.
6 Interon Interferon Alfa-2a BP 4.5 Pre-filled Store in a refrigerator
Injection MIU/ 0.5 ml Syringe (2°C to 8°C), Do not
freeze or shake.
7 Pegfilgrast Pegfilgrastim INN 6 mg/ 0.6 Pre-filled Store in a refrigerator
Injection ml Syringe (2°C to 8°C), Do not
freeze or shake.
8 Pegin Peginterferon Alfa-2a INN Pre-filled Store in a refrigerator
Injection 180 mcg/ 0.5 ml Syringe (2°C to 8°C), Do not
freeze or shake.
9 Pegin 135 Peginterferon Alfa-2a INN Pre-filled Store in a refrigerator
Injection 135 mcg/ 0.5 ml Syringe (2°C to 8°C), Do not
freeze or shake.
10 Darbesis 25 Darbepoetin Alfa INN 25 Pre-filled Store in a refrigerator
mcg Injection mcg/ 0.42 ml Injection Syringe (2°C to 8°C), Do not
freeze or shake.
freeze or shake.
freeze or shake.
13 Methoxy PEG Methoxy PEG Pre-filled Store in a refrigerator
Erythropoietin Erythropoietin Beta INN 50 Syringe (2°C to 8°C), Do not
Beta 50 mcg/ 0.3 ml Injection freeze or shake.
Injection
Erythropoietin Erythropoietin Beta INN 75 Syringe (2°C to 8°C), Do not
Beta 75 mcg/ 0.3 ml Injection freeze or shake.
Injection
Erythropoietin Erythropoietin Beta INN Syringe (2°C to 8°C), Do not
Beta 100 100 mcg/ 0.3 ml Injection freeze or shake.
792
Injection
16 Erythropoietin Erythropoietin Beta 2000 IU Pre-filled Store in a refrigerator
Beta 2000 IU Injection/ 0.3 ml Injection Syringe (2°C to 8°C), Do not
Injection freeze or shake.
19 Sarilumab Sarilumab 100 mg/1.14 ml Pre-filled Store in a refrigerator
100 Injection Injection Syringe (2°C to 8°C), Do not
freeze or shake.
20 Sarilumab Sarilumab 150 mg/1.14 ml Pre-filled Store in a refrigerator
150 Injection Injection Syringe (2°C to 8°C), Do not
freeze or shake.
21 Dupilumab Dupilumab 300 Injection/ 2 Pre-filled Store in a refrigerator
300 Injection ml Injection Syringe (2°C to 8°C), Do not
freeze or shake.
22 Brodalumab Brodalumab 210 mg/ 1.15 Pre-filled Store in a refrigerator
210 Injection ml Injection Syringe (2°C to 8°C), Do not
freeze or shake.
23 Rituximab Rituximab 100 mg/10 mL Injection Store in a refrigerator
100 Injection Injection (2°C to 8°C), Do not
freeze or shake.
24 Rituximab Rituximab 500 mg/50 mL Injection Store in a refrigerator
500 Injection Injection (2°C to 8°C), Do not
freeze or shake.
25 Bevastim Bevacizumab 100 mg/4 Injection Store in a refrigerator
Injection mL (2°C to 8°C), Do not
freeze or shake.
26 Bevastim 400 Bevacizumab 400 mg/16 Injection Store in a refrigerator
Injection mL (2°C to 8°C), Do not
freeze or shake.
27 Nab-Xelpac Nanoparticle Albumin- Lyophilized Store the vials
Injection Bound Paclitaxel USP 100 Powder for paclitaxel powder for
(Lyophilized mg/ vial Injection Injectable suspension
Powder) (nanoparticle, albumin-
bound [nab®]
paclitaxel) in original
cartons between 20°C
and 25°C. Retain in the
original package to
protect from bright light
28 Heparon Heparin Sodium BP 25000 Injection HEPARIN INJECTION
Injection IU/ 5 ml BP 5,000 UNITS/ ML
should be stored at a
temperature below 25
°C.
After first opening the
preparation can be
stored for four weeks at
room temperature.
29 Cetuxim Cetuximab INN 100 mg/ 20 Injection Store in a refrigerator
Injection ml (2°C to 8°C), Do not
freeze or shake.
30 Cetuximab INN 200 mg/ Injection Store in a refrigerator
100 ml (2°C to 8°C), Do not
freeze or shake.
793
31 Trastunix 150 Trastuzumab INN 150 mg Lyophilized Store in a refrigerator
Injection Powder for (2°C – 8°C).
(Lyophilized Injection
Powder)
32 Trastunix Trastuzumab INN 440 mg Lyophilized Store in a refrigerator
Injection Powder for (2°C – 8°C).
(Lyophilized Injection
Powder)
33 Nivolumab Nivolumab 40 mg/4 mL Injection Store in a refrigerator
Injection (2°C to 8°C), Do not
freeze or shake. Protect
from light
794
Appendix-21
WHO Model List of Essential Medicines
(20th list, March 2017)
ACCESS, WATCH and RESERVE groups of Antibiotics
ANTIBIOTICS:
To assist in the development of tools for antibiotic stewardship at local, national and
global levels and to reduce antimicrobial resistance, three different categories were
developed– ACCESS, WATCH and RESERVE groups.
Group 1 - KEY ACCESS ANTIBIOTICS:

To improve both access and clinical outcomes antibiotics that were first or second
choice antibiotics in at least one of the reviewed syndromes are designated as key
ACCESS antibiotics, emphasizing their role as the antibiotics that should be widely
available, affordable and quality- assured.
ACCESS antibiotics are listed below.
Selected ACCESS antibiotics may also be included in the WATCH group.
Beta-lactam medicines Other antibacterials

Amoxicillin Cefotaxime* Amikacin Gentamicin
Amoxicillin + Ceftriaxone* Azithromycin* metronidazole
clavulanic acid
Ampicillin Cloxacillin chloramphenicol nitrofurantoin
Benzathine Phenoxymethylpenicillin ciprofloxacin* spectinomycin
benzylpenicillin (EML only)
Benzylpenicillin Piperacillin + clarithromycin* clarithromycin*
tazobactam*
Cefalexin Procaine benzyl clindamycin vancomycin
penicillin (oral)*
Cefazolin Meropenem* doxycycline vancomycin
(parenteral)*
Cefixime*
Italics = complementary list
*Watch group antibiotics included in the EML/EMLc only for specific, limited
indications
The 2017 Expert Committee identified the following antibiotics or antibiotic classes
that should be the subject of a specific stewardship focus. Antibiotics or antibiotic
classes in these groups are designated accordingly in the EML/EMLc. The “WATCH”
and “RESERVE” stewardship groups could assist in activities such as local, national
and global monitoring of use; development of guidelines and educational activities.
Group 2 - WATCH GROUP ANTIBIOTICS

This group includes antibiotic classes that have higher resistance potential and so are
recommended as first or second choice treatments only for a specific, limited number
of indications. These medicines should be prioritized as key targets of stewardship
programs and monitoring.
795
APPENDIX-21 : ACCESS, WATCH and RESERVE groups of Antibiotics
This group includes most of the highest priority agents among the Critically Important
Antimicrobials for Human Medicine1 and/or antibiotics that are at relatively high risk of
selection of bacterial resistance.
Watch group antibiotics

Quinolones and fluoroquinolones
e.g. ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin
3rd-generation cephalosporins (with or without beta-lactamase inhibitor)
e.g. cefixime, ceftriaxone, cefotaxime, ceftazidime
Macrolides
e.g. azithromycin, clarithromycin, erythromycin
Glycopeptides
e.g. teicoplanin, vancomycin
Antipseudomonal penicillins + beta-lactamase inhibitor
e.g. piperacillin-tazobactam
Carbapenems
e.g. meropenem, imipenem + cilastatin
Penems
e.g. faropenem
1 http://apps.who.int/iris/bitstream/10665/251715/1/9789241511469-eng.pdf?ua=1
Group 3 - RESERVE GROUP ANTIBIOTICS
This group includes antibiotics that should be treated as “last resort” options that
should be accessible, but whose use should be tailored to highly specific patients and
settings, when all alternatives have failed (e.g., serious, life-threatening infections due
to multi-drug resistant bacteria). These medicines could be protected and prioritized
as key targets of national and international stewardship programs involving monitoring
and utilization reporting, to preserve their effectiveness.
Reserve group antibiotics

Aztreonam Fosfomycin (IV)
4th generation cephalosporins Oxazolidinones
e.g. cefepime e.g. linezolid
5th generation cephalosporins Tigecycline
e.g. ceftaroline
Polymyxins Daptomycin
e.g. polymyxin B, colistin
796
[c] symbol is placed next to the complementary list it signifies that the
medicine(s) require(s) specialist diagnostic or monitoring facilities, and/or
specialist medical care, and/or specialist training for their use in children.
Complementary List [c]

ceftazidime Powder for injection: 250 mg or 1 g (as pentahydrate) in
WATCH GROUP vial.
meropenem* Powder for injection: 500 mg (as trihydrate); 1 g (as
WATCH GROUP trihydrate) in vial >3 months.
*imipenem + cilastatin is an alternative except for acute
bacterial meningitis where meropenem is preferred.
FIRST CHOICE SECOND CHOICE
- acute bacterial meningitis in neonates
[c]
- complicated intraabdominal infections
(severe)
- high-risk febrile neutropenia
vancomycin Powder for injection: 250 mg (as hydrochloride) in vial.
WATCH GROUP
FIRST CHOICE SECOND CHOICE
-high-risk febrile neutropenia
Complementary List – RESERVE GROUP

aztreonam Powder for injection: 1 g; 2 g in vial
fifth generation cephalosporins Powder for injection: 400 mg; 600 mg

(with or without beta-lactamase (as fosamil) in vial
inhibitor) e.g, ceftaroline
fourth generation cephalosporins Powder for injection: 500 mg; 1g; 2g (as
(with or without beta-lactamase hydrochloride) in vial
inhibitor) e.g., cefepime
daptomycin Powder for injection: 350 mg; 500 mg in
vial
fosfomycin Powder for injection: 2 g; 4 g (as
sodium) in vial
797
Complementary List – RESERVE GROUP

oxazolindinones Injection for intravenous administration:
e.g., linezolid 2 mg/ mL in 300 mL bag.
Powder for oral liquid: 100 mg/5 mL.
Tablet: 400 mg; 600 mg.
polymyxins Powder for injection: 1 million I.U. (as
e.g., colistin colistemethate sodium) in vial
tigecycline Powder for injection: 50 mg in vial

Complementary List – RESERVE GROUP (Anti TB Medicine
Reserve second-line drugs for the treatment of multidrug-resistant tuberculosis
(MDR-TB) should be used in specialized centres adhering to WHO standards for
TB control.
amikacin Powder for injection: 100 mg; 500 mg; 1 g (as sulfate) in
vial.
bedaquiline Tablet: 100 mg.
capreomycin Powder for injection: 1 g (as sulfate) in vial.
clofazimine Capsule: 50 mg; 100 mg.
cycloserine* Solid oral dosage form: 250 mg.
*Terizidone may be an alternative
delamanid Tablet: 50 mg. >6 years
ethionamide* Tablet: 125 mg; 250 mg.
*Protionamide may be an alternative.
kanamycin Powder for injection: 1 g (as sulfate) in vial.
levofloxacin Tablet: 250mg; 500 mg; 750 mg.
linezolid Injection for intravenous administration: 2 mg/ mL in 300
mL bag.
Powder for oral liquid: 100 mg/5 mL.
Tablet: 400 mg; 600 mg.
moxifloxacin Tablet: 400 mg.
p-aminosalicylic Granules: 4 g in sachet.
acid Tablet: 500 mg.
streptomycin [c] Powder for injection: 1 g (as sulfate) in vial.
798
DENTAL PRACTITIONERS FORMULARY
DENTAL PRACTITIONERS’ FORMULARY

Dentistry as a profession continues to undergo changes including improvements in
clinical treatment. Although the major part of the dentist’s work is still of a restorative
nature, the increasing improvements in prevention, diagnosis, and treatment of oral
diseases and the oral manifestation of many systemic disease is becoming well
recognized internationally. Recent views reflect the systemic implicationsof oral
diseases is of great concern. Periodontal disease is being considered as a risk factor
for developing ischemic heart disease, myocardial infarction, stroke, kidney disease,,
pre matured child birth, malformed babies etc. So, oral rehabilitations including dental
implants surgery has become a part of general dentistry.
The dentist’s role has therefore been broadened to include the management of
patients with soft tissue diseases such as oral cancer, and AIDS, facial pain, Tempero
Mandibular Joint (TMJ) disorders and salivary dysfunction etc. In addition, dental
caries and its sequel and periodontal disease still prevalent in Bangladesh.
The profession seems to feel that dentistry is currently in something of a state of
transition. Dental caries once the main area of dental work has declined strikingly in
the most developed nations, as the profession has come under the eagle eye of the
Health and safety Executive. But the theme virtually does not reflect the present
situation of dentistry in Bangladesh, due to lack of knowledge, integration, cooperation
between the dental professionals and health executives. It can be regrettably said that
unfortunately, oral health is still neglected in Bangladesh and not included in the
primary health care system of the Government. Should oral health be the ninth
component of primary health care system of Bangladesh! As without oral health we
cannot think of a sound human being. Mouth is the gateway of health containing more
than 740 species of microorganisms!
In this way dental and oral health is increasingly being seen as part of general health.
In such circumstances the need for the dentists to have more of an oral physician’s
approach and to be more concerned with the patients’ previous history, drug history
and life style is obvious. Dentists must know much more about medical conditions that
can affect the management of their patients.
Medically compromised patients who are attending for dental treatment require special
needs. Other requires only routine dentistry, but their medical conditions may require it
to be modified to varying degrees.
Therefore, it is essential that general dental practitioners keep up to date and this
dental practitioners formulary is primarily intended to help them to do so in their daily
clinical practice.
COMMON DENTAL DISEASES IN BANGLADESH
1. Dental caries 12. Cavernous sinus thrombosis

2. Gingivitis 13. Cysts of the jaw
3. Periodontitis 14. Odontogenic tumors of the jaw
4. Pericoronitis 15. Non-odontogenic tumors of the
5. Pulpitis jaw
6. Osteomyelitis of the jaw 16. Rickets
7. Alveolar ostitis (Dry Socket ) 17. Scurvy
8. Cervico facial cellulitis 18. Tempero mandibular joint
9. Cancrum oris disorders
10. Actinomycosis 19. Primary herpetic stomatitis
11. Infective endocarditis 20. Oral ulceration
799
21. Oral candidiasis 31. Pyogenic granuloma and

22. Recurrent aphthae (Aphthous pregnancy epulis
stomatitis) 32. Medically compromised patients
23. Lichen plannus 33. Oral Manifestations of many
24. Mucous membrane pemphigoid systemic diseases
25. Pemphigus vulgaris 34. Trigeminal neuralgia
26. Ulceration of the tongue 35. Glossopharyngeal neuralgia
27. White oral mucosal lesions 36. Bell’s palsy
28. Oral pre-malignant lesions 37. Emergencies in dental practice
29. Oral cancer such as Faints, strokes, sudden
30. Diseases of the salivary glands, loss of consciousness etc.
salivary gland tumours.
LIST OF DRUGS USED IN DENTISTRY
1. Acetylsalicylic Acid (Aspirin) 34. Griseofulvin

2. Acyclovir 35. Hydrocortisone
3. Adrenaline 36. Ibuprofen
4. Aluminum Hydroxide 37. Indomethacin
Magnesium Hydroxide + 38. Ketoconazole
Simethicone 39. Ketoprofen
5. Ampicillin 40. Lignocaine
6. Amoxicllin 41. Lignocaine + Adrenaline
7. Azithromycin 42. Mefenamic Acid
8. Erythromycin 43. Metronidazole
9. Clindamycin 44. Miconazole + Hydrocortisone
10. Betacarotine + Vitamin C + 45. Multivitamine + Minerals
Vitamin E 46. Naproxen
11. Betamethasone + Neomycin 47. Neomycin + Bacitracin +
12. Bupivacaine Polymyxin-B
13. Calcium gluconate 48. Nimesulide
14. Carbamazepine 49. Nystatin
15. Cefazoline 50. Omeprazole
16. Ceftriaxone 51. Oxytetracycline
17. Celecoxib 52. Paracetamol
18. Cephradine 53. Phenoxymethyl penicillin
19. Chlorhexidine 54. Phenytoin
20. Ciprofloxacin 55. Piroxicam
21. Clarithromycin 56. Povidone Iodine
22. Clobazam 57. Prednisolone
23. Cloxacillin 58. Ranitidine
24. Co- trimoxazole 59. Rofecoxib
25. Dexamethasone 60. Sodium Chloride Solution
26. Diazepam 61. Tetracycline
27. Diclofenac 62. Tetanus Antitoxin (10,000 IU)
28. Diclofenac + Lignocaine 63. Tetanus Toxoid
29. Dicloxacilline 64. Tinidazole
30. Doxycycline 65. Tramadol
31. Ferrous Sulphate + Folic Acid + 66. Tranexamic Acid
Zinc sulfate 67. Triamicinolone
32. Fluconazole 68. Vitamin B-Complex
33. Folic Acid + Zinc Sulfate
800
LIST OF DENTAL PHARMACOLOGICAL AGENTS AND THERAPEUTICS
1.
Antiplaque Agents- Chlorohexidine • Salts of zinc
gluconate- • Salts of iron, potassium
a) 0.2% mouth ringe • Tranexamic acid
b) 0.2% mouth irrigator • Bone wax
c) 1% gels • Salts of nitrate
d) 4% antiseptic in surgical • Calcium alginate
scrub. b) Systemic haemostatic
agents-
2. Anticaries Agents: Fluoride
• Fresh frozen plasma
a) Community water
• Anti haemophilic globulin
fluoridation
b) Fluoride supplements • Vitamin-K
• Tablets • Amino caproic acid
• Drops • Adrenaline
dentifriges • Nor-adrenaline
• Lozens
6. Local Anaesthetics:
• Table salt
a) Natural- Cocaine
• Milk
b) Synthetic- Nitrogenous-
• Mixed with vitamins Lidocaine
c) Topical fluoridation- Non-nitrogenous-
• Mouth washes ethylalcohol
• gels c) Short acting- procain,
• Dentrifriges pyrrocaine
d) Medium acting- Lidocain,
3. Mouth washes prilocaine
a) 0.2% chlorohexidine e) Long acting- Tetracaine,
gluconate Mepivacaine
b) Sodium chloride and f) Surface anaesthetic-
sodibicarbonate Lignocaine, Lidocaine
c) Milk of magnesia g) Infiltration Anaesthetic-
d) Potassium permenganate. Lignocaine 5%, 10%, 15%
e) 1% Povidone iodine solution etc.
f) Mixed solution of menthol, h) Block anaesthetic- 2%,
Thymol, eucalyptol etc. Lignocaine, 2% mepivacaine
4. Obtundents- 7. Mummifying agents

a) Essential oils- Eugenol, a) Formal dehyde
clove oil b) Para formal dehyde
b) Chlorobutanol- (Dentanol) c) Iodoform
c) Zinc chlorite- d) Phenol
d) Zinc nitrate- as desensitizing e) Para-chlonophenol
agents f) Cresol
g) Cresote
5. Haemostatic agents: h) Formocresol
a) Local haemostatic agents- i) Resorsinol
• Oxidized cellulose j) Camphorated Mono-chloro-
• Gel foam phenol (CMCP)
• Fibrin foam k) Pulp devitalizing agents
• Tannic acid (costinerve forte)
801
r) Frizzed dries hydroxypeptide

8. Root canal medicaments crystals
a) 5% sodium hypochlorite
b) Eugenol, Cresol 9. Agents affecting salivary
c) 15% EDTA (Etheline di- secretion
amine Tetra acetic acid) a) Sialogogue ( Salivary
d) 0.9% Nacl secretion)
e) Phenol, parachlorophenol • Prilocarpine
f) 30% urea solution • Volatile oils
g) 6% Hydrogen peroxide • Alcohol
h) 50% citric acid • Nicotine
i) 0.25% Metronidazole • Carbacol
solution
b) Anti-sialogogue ( Salivary
j) 0.25% Tinidazole solution
secretion)
k) Calcium hydroxide solution
• Astringents
l) MTA (Mineral trioxide
aggregate)/MTD • Hyocine
m) 3 Drug mix (Ciprofloxacin + • Beladona
metronidazole + Minocycline • Atropine
+ Polyethylene glycol) • Opium
n) Gutta percha, chloropercha • Morphine
points • Hexamithonium
o) Silver points, titanium points 10. Acidulated Caffeine
p) Resorbable paste- iodoform, phosphoprotein (ACPP) -
KRI-1 paste Anti caries agents
q) BMP (Bone Morphogenetic
Protein) • Mixed with baby food
Products
•
802
DRUGS USED FOR PERIODONTITIS AND PERICORONITIS
1. Doxycycline
2. Tetracycline
3. Metronidazole
4. Tinidazole
5. Cephalaxin
6. Cephradine
7. Amoxycillin
8. Phenoxymethyl penicillin
9. Erythromycin
10. Ibuprofen
11. Diclofenac Sodium
12. Ketoprofen
13. Povidone Iodine
14. Aspirin
15. Zinc-oxide engenol
16. Resorcinol
ANTIMICROBIALS USED FOR PERIODONTITIS AND PERICORONITIS
DOXYCYCLINE
This drug has a broad range of anti-microbial activity like tetracycline and
administered orally and better absorbed in the gut. They are bacteriostatic.
Indications: Chronic periodontitis with deep periodontal pockets,
Lyme disease of the T.M joint; see also section 1.1.6
Cautions: This drug should not be used with antacids and iron preparations as they
reduce absorption.
Contraindications: Children below 12 years, pregnant and lactating mothers.
Side-effects: Gastrointestinal disturbances, staining of developing teeth.
Dose: By oral route, in adult, 100 to 200 mg once daily
TETRACYCLINE
It is the drug having broadest spectrum of activity of all microbial drugs. It is

bacteriostatic.
Indications: Chronic periodontitis with deep periodontal pockets; topical applications
in mouth rinse for the treatment of apthous ulcer; see also section 1.1.6
Cautions & Contraindications: Same as for doxycycline.
Side-effects: Gastrointestinal disturbances like nausea, vomiting, diarrhoea, super
infection, renal and metabolic complications, staining of developing teeth.
Dose: Orally, 250-500 mg capsules 6 hourly for 5-7 days.
803
METRONIDAZOLE & TINIDAZOLE: See section 1.1.9
CEPHALEXIN and CEPHRADINE
The pharmacology of the cephalosporins in terms of absorption, action and excretion

is similar to that of penicillin. They are acid stable and can be given orally. They are
bactericidal drugs.
Indications: Mixed infections of oral cavity due to alveolar abscess, fascial cellulitis,
septicemia, maxillofacial injury with soft tissue trauma; see section 1.1.2.1
Cautions: Should not be used in case of penicillin sensitivity, as the drug will produce
10% hypersensitivity reactions in penicillin sensitive patients.
Contraindications: In case of known hypersensitivity to penicillin.
Side-effects: See section 1.1.2.1
Dose: Adult dose, by oral route, 250-500 mg capsules 8 hourly for 5-7 days.
ERYTHROMYCIN
Erythromycin has a generally similar spectrum of action to penicillin and can be used
as an alternative in patients allergic to penicillin. It is bacteriostatic.
Indications: As an alternative to patients allergic to penicillin; see also section 1.1.5
Cautions, Contraindications & Side-effects: See section 1.1.5
Dose: Adult dose, by oral route, 250 mg 6 hourly for 5-7 days.
IBUPROFEN: See section 9.1.1
This drug is a propionic acid derivative of NSAIDs, usually the drug of choice and are
likely to be the most effective in most dental pain. It is well absorbed after an oral dose
and is inactivated by metabolism.
Indications: Most painful condition of teeth, gingiva, oral mucosa and alveolar bone,
inflammatory condition of pulp and periodontium like pulpits, gingivitis, periodontitis,
alveolitis, abscess etc., injury due to maxillofacial trauma.
Cautions: Should be used under coverage of gastric irritation with antacids or H2
receptor blockers (e.g. Ranitidine).
Contraindications: Known peptic ulcer patients.
Side-effects: Epigastric discomfort, activation of peptic ulcer, bleeding, headache,
dizziness, rashes etc.
Dose: Adult dose is 400-600 mg 3 times daily.
804
ANALGESICS USED FOR PERIODONTITIS AND PERICORONITIS
KETOPROFEN
This drug is similar in action to Ibuprofen and mostly used in painful conditions like
rheumatoid disease, musculoskeletal disorders, toothache, and TMJ disorders.
Indications: Like Ibuprofen.
Caution, Contraindications & Side-effects: Like Ibuprofen.
Dose: Orally, 50-100 mg 3 times daily.
NOTE : Ibuprofen, Ketoprofen, Fenoprofen and Naproxen have almost same anti-
inflammatory action but are to be used in different doses.
DICLOEENAC: See 9.1.1
Among the NSAIDs, this drug is one of the potent anti inflammatory and analgesic
drug that is widely used in acute painful situation in dentistry.
Indications: Acute pulpitis, acute periopical periodontitis, acute painful conditions in
the oral cavity including tooth ache .
Caution: Like other NSAIDs.
Contraindications: In case of known peptic ulcer diseases.
Side-effects: Like other NSAIDs.
Dose: Adult 25-100 mg 3 times daily.
DRUG USED FOR DENTAL CARIES
FLUORIDES have a caries-prevention action. They are as yet the only effective drugs
for the purpose. The optimum effect is achieved when drinking water containing about
1 part per million (PPM) of fluoride ingested through out the period of dental
development.
Indications: For prevention of dental caries, to prevent bacterial metabolism in dental
plaque, for remineralization of tooth substance.
Cautions: Should be used cautiously by measuring the level of fluoride in community
water.
Contraindications: Known hypersensitivity, tetany.
Side-effects: Dental fluorosis mottled enamel, skeletal fluorosis, osteoclerosis,
acute fluoride poisoning.
Route of administration: Ingestion by oral route
(a) In drinking water, other fluids or foods.
(b) Fluoride tablets.
Local application :
(a) Tooth pastes containing fluoride.
(b) Fluoride Mouth rinse.
(c) Topical application.
805
Dose: If flouride-content less than 0.3 ppm in water :

Up to 6 months – None.
6 months to 2 years - 0.5 mg NaF/day.
2-4 years - 1.1 mg NaF/day.
Over 4 years - 2.2 mg NaF/day.
If flouride-content is 0.3 to 0.7 ppm in water :
Up to 2 years – None.
2-4 years - 0.5 mg NaF/day.
DRUGS USED FOR GINGIVITIS
1. Ampicillin; see section 1.1.1.2.1

2. Amoxicillin; see section 1.1.1.2.1
3. Tinidazole; see section 1.1.9
4. Metronidazole; see section 1.1.9
5. Acetamenophen (Paracetamol); see section 7.5.2.1 & 9.1.1
6. Chlorhexidine;
AMPICILLIN: See section 1.1.1.2.1
It is a broad-spectrum bactericidal drug that inhibit the cell wall synthesis of

susceptible bacteria. It is acid stable and is moderately well absorbed when
swallowed. It is highly effective in the infections caused by Gram-positive and Gram-
negative organisms.
Indications: Orofacial infections like abscess, periodontal infections,
osteomyelitis etc.; see also section 1.1.1.2.1
Cautions: Not to be given to those subjects hypersensitive to penicillin; see also
section 1.1.1.2.1
Contraindications: In case of known penicillin hypersensitivity.
Side-effects: Diarrhoea, skin rash, urticaria; see also section 1.1.1.2.1
Dose: The usual adult dose by all routes is 250-500 mg 6 hourly for 5-7 days.
CHLORHEXIDINE has proven to be a useful effective and safe antiseptic with many
applications. Aqueous chlorhexidine of 0.1% or 0.2% inhibit dental bacterial plaque
formation. It is commercially available as a gel (1%) and as a 0.2% mouthwash.
Indications: Acute ulcerative gingivitis, chronic gingivitis and periodontitis, for the
prevention of bacterial plaque, any infection of the oral tissues that is related to
bacterial dental plaque, for prevention of oral sepsis.
Cautions: Before a course of chlorhexidine is started, all dental plaque and calculus
should be removed to allow the drug a fair start.
Contraindications: It is not used in case of deep periodontal pocket, as it does not
penetrate into subgingival pockets or stagnation area.
Side-effects: Prolonged use of chlorhexidine mouth washes produce tooth staining
both natural and artificial teeth, restoration of composite, hypersensitivity reaction to
some individuals, unpleasant taste in the month due to disturbance of taste buds.
Dose: Only topical application as gel or mouth rinse, external use as surgical scrub
0.2% chlorhexidine 2 spoon full mixed with water used 3 times daily for 5-7 days. 1%
gel applied on gingival area for 5 mints twice daily in case denture stomatitis 4%
chlorhexidine used as a surgical scrub.
806
ACETAMINOPHEN (PARACETAMOL): see also section 7.5.2.1 & 9.1.1
This is a popular domestic analgesic and antipyretic for adults and children. It inhibits
prostaglandin synthesis in the brain but hardly in the periphery. It is the analgesic
recommended for children under 12 years old.
Indications: As analgesic for headache, toothache, arthralgia, amyalgia; as
antipyretic in fever; see also section 9.1.1
Cautions: It should not be used in liver disease and kidney diseases. See also
section 9.1.1
Contraindications: Severe liver diseases and kidney diseases.
Side-effects: Nausea, vomiting, anorexia, abdominal pain; hepatic necrosis, liver cell
damage, renal tubular necrosis, hypoglycemic coma, pancytopenia, skin rash,
urticaria; see also section 9.1.1
Dose: For adult, 500 mg 4 hourly; see also section 9.1.1
AMOXYCILLIN: See also section 1.1.1.2.1

This is semi-synthetic penicillin with a broad spectrum of antibacterial activity similar to
that of ampicillin. It is better absorbed following oral administration and absorption is
not influenced by food.
Indications: See also section 1.1.1.2.1 Skin and soft tissue infections as mentioned in
Ampicillin, infections caused by Gram-positive and Gram-negative cocci. For
prophylaxis of bacterial endocarditis.
Cautions: Like ampicillin.
Contraindications: Like ampicillin.
Side-effects: Like ampicillin.
Dose: Normal adult dose, 250-500 mg 8 hourly for 5-7 days.
METRONIDAZOLE: See also section 1.1.9 & 1.3.2

It is active against a wide range of anaerobic bacteria and protozoa. It binds with DNA
and prevents nucleic acid formation. It is bacteriostatic. It is well absorbed after oral
and rectal administration.
Indications: Acute ulcerative gingivitis, dental infections like pericoronitis,
osteomyelitis of the jaw, abscess; see also section 1.1.9 & 1.3.2
Cautions: Patients given metronidazole should be warned against taking alcohol
during and for a week after completion of treatment; see also section 1.1.9 & 1.3.2
Contraindications: In case of known hypersensitivity to the drug, in case of chronic
alcoholic patients; see also section 1.1.9 & 1.3.2
Side-effects: Metallic taste due to excretion of drug in saliva, nausea, vomiting,
diarrhoea, headache, furred tongue, angioedema, peripheral neuropathy, flushing,
sweating, palpitation due to interaction with alcohol.
Dose: In adult, ulcerative gingivitis, 200 mg 8 hourly for 3 days.
TINIDAZOLE: see also section 1.1.9 & 1.3.2
807
It is similar to metronidazole but has a longer half-life (13 hour). It is excreted mainly
through urine unchanged. Due to its longer action it is considered better than
metronidazole in giardiasis, trichomoniasis and acute ulcerative gingivitis.
Indications: Any inflammatory conditions and pain in orofacial structures such as
gingivitis, periodontitis, pulpitis, oral ulceration etc. like metronidazole.
Cautions : Like metronidazole.
Contraindications : Like metronidazole.
POVIDONE IODINE
This drug is widely used in dentistry as an antiseptic mouthwash prior to different

orodental procedures such as extraction of tooth, scaling, minor surgical procedures to
prevent post-operative infections. 1% povidone iodine is used as mouthwash to
prevent bacteremia and bacterial endocarditis.
DRUG USED FOR PERICORONITIS

2. Amoxycillin; see section 1.1.1.2.1
3. Cephalexin; see section 1.1.2.1
4. Cephradin; see section 1.1.2.1
5. Metronidazole; see section 1.1.9 & 1.3.2 and notes above
6. Tetracycline (Topical use); see section 1.1.6 & notes above
7. Diclofenac and other NSAIDS; see section 9.1.1 & notes above
8. Povidone Iodine or Chlorhexidine mouthwash; see notes above
DRUGS USED FOR PULPITIS
1. Penicillin & its derivatives ; see section 1.1.1.1.2.1

3. Cephradine; see section 1.1.2.1
4. Anti-inflammatory drugs such as Diclofenac, Ibuprofen; see section 9.1.1 & notes
above
5. Diazepam; see section 7.1
6. Eugenol (clove oil) as local sedative dressing into the pulp.
7. Pulp devitalizing agents
8. Intracanal medicanals
9. Root canal scolars
DRUGS USED FOR ALVEOLAR OSTITIS (DRY SOCKET)
1. Antibiotics such as Amoxycillin, Cephalexin, Cephradin; see section 1.1.1.2 &

1.1.2.1
2. NSAIDS; see section 9.1.1
3. Zinc oxide engal dressing
DRUGS USED FOR OSTEOMYELITIS OF THE JAW
1. Benzyl Penicillin; see section 1.1.1.1.1

2. Long-term Tetracycline; see section 1.1.6
3. Metronidazole; see section 1.1.9 & 1.3.2
4. Anti-inflammatory drugs; see section 9.1.1
808
5. Cloxacillin; see section 1.1.1.1.1

6. Co-trimoxazole; see section 1.1.8
DRUGS USED FOR CERVICOFACIAL CELLULITIS
1. Penicillin & its derivatives; see section 1.1.1.1 & 1.1.1.2

2. Cephradine & Cephalexin; see section 1.1.2.1
3. Metronidazole; see section 1.1.9 & 1.3.2 and notes above
4. Ciprofloxacin; see section 1.1.7
5. Azithromycin ;see section 1.1.5
6. Erythromycin; see section 1.1.5
7. Analgesics and anti-inflammatory drugs; see section 7.5.2.1, 7.5.2.2 & 9.1.1
8. Ceftriaxone; see section 1.1.2.3
DRUGS USED FOR ACTINOMYCOSIS
1. Long term antibiotics such as

(a) Penicillin; see section 1.1.1.1
(b) Tetracycline; see section 1.1 .6 & notes above
(c) Erythromycin; see section 1.1.5
2. Analgesics and anti-inflammatory drugs; see section 9.1.1
DRUGS USED FOR CANCRUM ORIS
1. A combination of penicillins; see section 1.1.1.1

2. Metronidazole ; see section 1.1.9 & 1.3.2 and notes above
3. Analgesics; see section 7.5.2.1, 7.5.2.2 & 9.1.1
4. Povidone Iodine mouthwash; see notes above;
5. Multivitamins
DRUGS USED FOR CAVERNOUS SINUS THROMBOSIS
1. Anticoagulants drugs; see section 3.8

2. Antibiotics such as penicillin; see section 1.1.1.1
3. Analgesics such as aspirin; see section 7.5.2.1
DRUGS USED FOR PREVENTION OF BACTERIAL ENDOCARDITIS

2. Amoxycillin; see section 1.1.1.2.1
4. Cephradin; see section 1.1.2.1
5. Azithromycin; see section 1.1.5
6. Clindamycin; see section 1.1.12
7. Cefazoloin; see section 1.1.2
8. Povidone Iodine mouthwash reduce 50% chance of bacteremia; see notes above
DRUGS USED FOR RICKET
1. Vitamin D; see section 16.2.3.4
809
DRUGS USED FOR SCURVY
1. Vitamin C; see section 16.2.3.3
DRUGS USED FOR T.M. JOINT DISORDERS
1. Analgesics such as Mefenamic acids; see section 9.1.1

2. Anti-inflammatory drugs; see section 7.5.2.1, 7.5.2.2 & 9.1.1
3. Muscle relaxants such as diazepam; see section 7.1
DRUGS USED FOR PRIMARY HERPETIC STOMATITIS
1. Antiviral drugs such as acyclovir; see section 1.4.1

2. Antibiotics to prevent secondary infection; see section 1.1
3. Analgesics; see section 7.5.2.1, 7.5.2.2 & 9.1.1
4. Chlorhexidine mouthwash; see notes above;
DRUGS USED FOR ORAL CANDIDIASIS
1. Nystatin HCl tablet or suspension; see section 1.2.3

2. Amphotericin lozenges
3. Chlorhexidine mouth wash; see notes above;
DRUGS USED FOR APHTOHUS ULCER
1. Topical salicylate preparations (e.g. lotio pyral vex)

2. Vitamin B12; see section 16.2.3.1
3. Folic Acid & Iron preparations; see section 15.1.1.2
4. Tetracycline mouthwash ; see section 11.3.2
5. Hydrocortisone lozenges.
6. Analgesics and Anti-inflammatory drugs; see section 7.5.2.1, 7.5.2.2 & 9.1.1
DRUGS USED FOR ORAL ULCERATIONS
1. Antibiotics; see section 11.3.1 & 11.3.2

2. Analgesics; see section 9.1.1
3. Povidone Iodine mouthwash; see notes above;
4. Topical steroids.
5. Triamicnalone Acetonide; see section 5.3.2
6. Vitamin B-12; see section 16.2.3.2
7. Vitamin B2; see section 16.2.3.2
8. Zinc Supplements; see section 16.2.2.7
9. Tetracycline mouthwash.
DRUGS USED FOR TRIGEMINAL NURALGIA
1. Carbamazepine; see section 7.5.3

2. Phenytoin; see section 7.6.1
810
DRUGS USED FOR BELL’S PALSY
1. Prednisolone tablet 20 mg 4 times a day is given for 5 days and the tailed off
over the following 4 days; see section 5.3.2.
MEDICAL EMERGENCIES IN DENTAL PRACTICE
This section provides guidelines on the management of the more common medical
emergencies which may arise in dental practice. Dental surgeons and their staffs
should be familiar with standard resuscitation procedures, but in all circumstances it is
advisable to summon medical assistance as soon as possible.
SYNCOPE
Insufficient blood supply to the brain results in loss of consciousness. The commonest
cause in a vasovagal attack or simple faint (syncope) due to emotional stress.
Treatment
Lay the patient flat and raise the legs to improve cerebral circulation. loosen any tight
clothing around the neck. Once consciousness is regained, give sugar in water or a
cup of sweet tea.
The drugs referred to in this section are:

Adrenaline injection, adrenaline I in 1000, (adrenaline 1gm/ml as acid tartrate), 1-ml
amps.
Chlorpheniramine Injection, chlorpheniramine maleate 10mg/ml. 1-ml amps.
Diazepam Injection, diazepam 5mg/ml. 2-ml amps
Glucagon Injection, glucagon (as hydrochloride), 1-unit and 10-unit vials (with solvent)
Glucose-50g for one drink
Glucose injection, glucose 50% (500gm/mL), 50-mL amps
Hydrocortisone Injection, hydrocortisone 100mg (preferable as sodium succinate vials
with 2-mL solvent)
Oxygen
Salbutamol Injection, salbutamol (as sulphate) 500 micrograms/mL, 1-mL amps
ANAPHYLAXIS
A severe allergic reaction may follow oral or parenteral administration of a drug.
Allergic reaction in dentistry most commonly follow injections of penicillin but other
drug may be implicated, including local anaesthetics. In general, the more rapid the
onset of the reaction the more profound it tends of the reaction the more profound it
tends to be. Symptoms may develop within minutes and rapid treatment is essential.
Treatment
First-line treatment includes restoration of blood pressure, laying patient flat, raising
feet, and administration of adrenaline1 injection. This is usually given intramuscularly
in a dose of 0.50-1mg (0.5-1mL adrenaline injection 1 in 1000), repeated every 10
minutes, according to blood pressure and pulse, until improvement occurs.
Antihistamines given by slow intravenous injection are a useful adjunctive treatment
(e.g. chlorpheniramine 10 to 20 mg diluted in syringe with 5 to 10 mL of blood and
given over 1 minute).
Intravenous corticosteroids are of secondary value in anaphylactic shock as their
onset of action is delayed for several hours but they should be used to prevent further
deterioration in several affected patients. Usually hydrocortisone (preferable as
sodium succinate) is given by intravenous injection in a dose of 100 to 300 mg.
811
CARDIAC EMERGENCIES
ANGINA, If there is a history of angina the patient will probably carry glycery 1 trinitrate
tables or spray (or isosorbide dinitrate tables) and should be allowed to use them.
MYOCARDIAL INFARCTION. The pain of myocardial infarction is similar to that of
angina but generally more severe and more prolonged.
Treatment
Call for medical assistance or an ambulance immediately. Allow patient to rest in the
position that feels most comfortable; in presence of breathlessness this is likely to be
sitting position, whereas syncopal patient will want to lie flat; often an intermediate
position (dictated by patient) will be most appropriate.
Intramuscular injection of drugs does not provide useful relief of pain because
absorption is too slow (particularly when cardiac output is reduced) but a mixture of
nitrous oxide 50% and oxygen 50% can be effective if given continuously; it is safe in
this situation.
Reassure patient as much as possible to relieve further anxiety. If patient collapses
and loses consciousness attempt standard resuscitation measures. For an algorithm
of the procedure for cardiopulmonary resuscitation, see section p. 3.
Hypoglycaemia
Diabetic patients occasionally administer their standard dose of insulin before dental
treatment but omit the usual meal (although they should not). This can lead to the
blood glucose falling to an abnormally low level (hypoglycaemia). Patients can often
recognise the symptoms themselves and this state responds to sugar in water or a
few lumps of sugar. Children may not have such prominent changes by may appear
unduly lethargic.
Treatment
In early stages, 4-6 teaspoons of sugar in water. If patient unconscious, up to 50 mL of
50% glucose intravenous injection, or glucagon 1 mg (1 unit) injected by any route
(subcutaneous, intramuscular, or intravenous) (useful when intravenous injection of
glucose difficult or impossible to administer).
EPILEPTIC SEIZURE
Patients with epilepsy must continue with their normal dosage of anticonvulsant drugs
when attending for dental treatment. It is not uncommon for epileptic patients not to
volunteer the information but there should be little difficulty in recognizing a tonic-
clonic (grand mal) seizure.
Symptoms and signs
Treatment
During a convulsion try to ensure that patient is not at risk from form injury but make
on attempt to put anything in month or between teeth (in mistaken belief that this will
protect tongue).
Do not attempt to restrain convulsive movements. After convulsive movements have
subsided place patient in coma position and check airway.
After convulsion patient may be confused (postictal confusion) and may need
reassurance and sympathy. Patient should not be sent home until fully recovered but it
is not necessary to seek medical attention or transfer to hospital unless convulsion
was atypical, prolonged (or repeated), or in injury occurred.
Medication should only be given if convulsive seizures are prolonged (convulsive
movements lasing 15 minutes or longer) or repeated rapidly. intravenous
812
administration of diazepam 10 to 20 mg is often effective but should be used with

caution because of risk of respiratory depression.
Partial seizures similarly need very little active management (in an automatism only
minimum amount of restraint should be applied to prevent injury). Again patient should
be observed until post-ictal confusion has completely resolved.
CARDIOVASCULAR DISEASE
Arrhythmias
Patients, especially those who have suffered a myocardial infarction, may have
unstable cardiac rhythm or a degree of heart failure. Current medication should be
carefully checked. Premedication (e.g. with temazepam) may be useful in some
instances for very anxious patients.
See below for reference to vasoconstrictors and unstable cardiac rhythm.
Hypertension
Patients with hypertension may be under treatment with antihypertensive drugs. Their
blood pressure may fall to dangerously low levels when they are given general
anaesthesia and should only be administered in hospital when appropriate
precautions can be taken.
See also under Vasoconstrictors (below).
Thrombo-embolic disease
Patients receiving heparin or oral anticoagulants such as warfarin, nicoumalone, or
phenindione may be liable to excessive bleeding after extraction of teeth. Often dental
surgery can be delayed until the anticoagulant therapy is discontinued.
Occasionally, an extraction during anticoagulant treatment may be unavoidable. The
patient’s physician should be consulted and the anticoagulant level adjusted (with
laboratory control) so that the prothrombin time is not more then twice the control
figure. If possible, a single simple extraction should be done first. If this goes well
further teeth may be extracted, two or three at a time. Some dental surgeons suture
the gum lightly over the socket to hold in place a haemostatic ash as oxidized
cellulose.
Aspirin is contra-indicated in patients on anticoagulant therapy, and in those with any
disorder of haemostasis.
Vasoconstrictors in local anaesthetic solutions
Lignocaine 2 per cent with adrenaline 1 in 80000 is probably the most used local
anaesthetic agent. For the vast majority of patients, experience over many years
indicates that it is a safe and effective preparation.
There is on indication for the use of noradrenaline as a vasoconstrictor for local
anaesthetics since it presents on advantages. Administration of local anaesthetics
containing noradrenaline 1 in 25000 has been followed by a small number of severe
hypertensive episodes. These few episodes emphasise the possible danger of using
local anaesthetics containing noradrenaline, especially in high concentrations.
In patients with sever hypertension or unstable cardiac rhythm, the use of adrenaline
in a local anaesthetic may be hazardous if inadvertently give intravenously. For these
patients prilocaine with or without felypressin can be used but there is no clinical
evidence that it is any safer.
There is no clinical evidence of dangerous interactions between adrenaline containing
local anaesthetics and monoamine-oxidase inhibitors (MAOLs) or tricyclic anti-
depressants.
813
INFECTIVE ENDOCARDITIS
Patients with cardiac defects (congenital, rheumatic, etc) or who have had a prosthetic
replacement of a damaged valve are at risk from infective endocarditis following dental
procedures. The risk is not related to the severity of the heart defect, as the onset of
endocarditis in occasionally the first overt manifestation of a defects.
Those who have had one or more episodes of infective endocarditis in the past appear
to be particularly susceptible.
There is no evidence that patients with prosthetic heart valves are nay more
susceptible to infective endocarditis after dental operations than those with damaged
natural valves, but if it develops treatment may be more difficult.
Although almost any dental procedure is capable of causing bacteraemia, infective
endocarditis is a rare and unpredictable complication even in susceptible patients. It is
virtually impossible therefore to assess the relative effectiveness of different
prophylactic regimens; nevertheless there is now some consensus among
cardiologists and microbiologists.
Although there are theoretical advantages in giving antibiotics by injection (to ensure
rapid absorption and high plasma concentrations), this present difficulties in general
dental practice. It is agreed therefore that wherever possible it is more practical to give
antibiotics by mouth for prophylaxis in dental out-patients.
IDENTIFICATION OF PATIENTS AT RISK. All patients must be questioned about a
history of rheumatic fever or heart defects and especially whether they have
previously had infective endocarditis. The value of such a history is limited in that the
patient may be unaware of a vulnerable heart lesion, but this is the best that can be
done. Heart murmurs in children are often of no significance but whenever there is any
doubt a cardiologist should be consulted.
The peak incidence of infective endocarditis is now in the sixth and seventh decades,
so that the elderly are at greater risk than young persons.
PROCEDURES THAT NEED COVER. The main source of bacteria causing dentally
related infective endocarditis is the bacteria of the gingival margins and periodontal
pockets. Infective endocarditis can follow virtually any dental procedure but there
appears to be a significant risk only after dental extractions, scaling, periodontal
surgery, or the raising of mucogingival flaps for any other purpose.
REDUCTION OF ORAL SEPSIS. A history of a dental procedure preceding an attack
of infective endocarditis is obtained in only a minority of patients but oral bacteria enter
the blood stream on may other occasions. The frequency and severity of bacteraemia
is also related to the severity of bacteraemia is also related to the severity of the
gingival sepsis. Maintenance of the highest possible standards of oral hygiene in
patients at risk reduces:
need for dental extractions or other surgery;

chances of severe bacteraemia if dental surgery has to be carried out;
chance or frequency of ‘spontaneous’ bacteraemia.
Application of an antiseptic such as 0.2% chlorhexidine gluconate solution to the

gingival margins before dental treatment reduces the severity of any resulting
bacteraemia and may be used to supplement antibiotic prophylaxis in those at risk.
POSTOPERATIVE CARE. It is imperative to warn every patients at risk to report to

the doctor or dentist if any minor illness develops after dental treatment, whether or
814
nor antibiotics have been given, as infective endocarditis has an insidious onset and
many failures of treatment develops it is likely to be within a month of dental treatment.
RECOMMENDATIONS
Under local or no anaesthesia (taken in presence of dentist or dental nurse):

Patients not allergic to penicillin and who have not received a penicillin more than
once in the pervious month including those with a prosthetic heart valve (but not those
who have had endocarditis)
ADULT single dose of amoxycillin1 3 g by mouth 1 hour before procedure
CHILD under 5 years, quarter adult dose; 5-10 years, half adult dose
Patients allergic to penicillin or who have received a penicillin more than once in the
previous month ADULT erythromycin (as sterate) 1.5 g by mouth2 1-2 hours before
procedure, then 500 mg 6 hours later
CHILD under 5 years, quarter adult dose; 5-10 years, half adult dose
or
ADULT single dose of clindamycin 600 mg by mouth 1 hour before procedure
CHILD under 10 years, 6 mg/kg as single dose by mouth 1 hour before procedure
Under general anaesthesia:
Patients not allergic to penicillin and who have not received a penicillin more than
once in the previous month
ADULT amoxycillin 1 g by intramuscular injection3 (in 2.5 mL lignocaine hydrochloride
1% injection) jest before induction then 500 mg by mouth 6 hours later
CHILD under 10 years, half adult dose4
or
ADULT amoxycillin 3 g by month 4 hours before procedure then a further 3 g as soon
as possible after procedure
CHILD under 5 years, quarter adult dose; 5-10 years half adult dose
or
ADULT amoxycillin 3 g by mouth and probenecid 1 g by mouth 4 hours before
procedure
Special risk patients who should be referred to hospital:
Patients who are to have a general anaesthetic and who are allergic to penicillin or
have had a penicillin more than once in the previous month
Patients who have had a pervious attack of endocarditis
For recommendations for these patients see BNF section 5.1, table 2
1. Amoxycillin is liable to cause irritating rashes, especially in people with infectious

mononucleosis (glandular fever) in whom it should be avoided.
2. Erythromycin (stearate) 1.5g may cause nausea.
3. If the interamuscular route is considered necessary it may be preferable for the procedure to be
carried out in hospital.
4. Whenever possible painful intramuscular injections should be avoided in children.
815
Oral Side-effects of Drugs
Drug-induced disorders of the month may be due to a local action on the mouth or to a
systemic effect manifested by oral changes.
Oral mucosa
Medicaments applied directly to the oral mucosa can lead to inflammation and
ulceration.
Elderly patients may have difficulty swallowing tablets; if left in the mouth, ulceration
may develop. They should always take their tablets or capsules with fluid, and in some
cases it may be wise to prescribe capsules if available.
Aspirin tablets allowed to dissolve in the sulcus for the treatment of toothache can
lead to a white patch followed by painful ulceration. Choline salicylate gels are also
irritant and are particularly troublesome if placed under dentures.
Potassium chloride ustained-release tablets are irritant to the mucosa.
Crystal violet, another irritant, is no longer used on mucous membranes.
Flavouring agents, particularly essential oils, may cause contact oils, may cause
contact hypersensitivity prominent.
The oral mucosa is particularly vulnerable to ulceration in patients treated with

cytotoxic drugs, especially methotrexate.
An occasional complication of long-term phenytoin treatment is macrocytic anaemia,

leading to oral manifestations such as sore tongue or severe aphthous stomatitis.
Systemic administration of some NSAIDs, e.g. indomethacin, may cause ulceration of

the mucosa; this is not a topical effect but the precise mechanism is not clear. Other
drugs capable of causing severe oral ulceration include methyldopa, allopurinol,
gold (anuranofin and aurothiomalate), and penicillamine. Captopril can cause
stomatosis.
Erythema multiforme may follow the use of certain drugs, especially suphonamides,
co-trimoxazole, antiepileptics, penicillin, and chlorpropamide. The oral mucosa
may be extensively ulcerated, with characteristic target lesions on the skin. Oral
lesions of toxic epidermal necrolysis have been reported for a similar range of drugs.
Lichenoid eruptions can be clinically indistinguishable from lichen planus. Drugs

associated with the appearance of white striae and plaques, atrophic changes and
ulceration include NSAIDs, methyldopa, chloroquine, oral antidiabetics, diuretics,
phenothiazines, and gold (auranofin and aurothiomalate).
Thrush and other types of candidiasis complicate treatment with antibiotics and
immunosuppressants. Oropharyngeal thrush is an occasional side-effect of
corticosteroid inhalers.
Teeth
Brown staining of the teeth frequently follows the use of chlorhexidine mouthwash or
gel; this can readily be removed by polishing at the end of the course of treatment.
Ferric salts in liquid form can stain the enamel black.
816
Intrinsic staining of the teeth is most commonly due to tetracyclines. The will affect the
teeth if given at any time from about the fourth month in utero until the age of twelve
years. All tetracyclines cause this; the colour varies from yellow to grey.
Excessive ingestion of fluoride leads to dental fluorosis with mottling of the enamel
and areas of hypoplasia or pitting; fluoride tablets or drops may cause mild mottling
(white patches) if the dose is too large for the child’s age or for the fluoride content of
the local drinking water.
Periodontium
Gingivitis and ulceration are common in patients receiving cytotoxics or
mmunosuppressants.
Hyperplasia of the gingivae is a side-effect of phenytoin and sometimes of cyclosporin

or nifedipine. The degree of hyperplasia varies but can reach the extent that the
crowns of the teeth are virtually covered.
Thrombocytopenia may be drug related, and cause bleeding of the gingival margins,
which may follow mild trauma, such as toothbrushing, or eventually be spontaneous.
Salivary glands
The main effect of drugs on the salivary glands is a reduction in flow (xerostomia).
Patients with a persistently dry mouth may develop a burning or scalded sensation,
and have poor oral hygiene, increased dental caries, periodontal disease, intolerance
of dentures, and oral infections (particularly candidiasis).
Many drugs have been implicated in xerostomia, particularly antimuscarinics

(anticholinergics) and tricyclic antidepressants. Excessive use of diuretics can also
result in xerostomia.
Increased production of saliva is not a problem unless the patients has difficulty in
swallowing.
Pain in the salivary glands has been reported following the use of some
antihypertensives (e.g. bethanidine, clonidine, methyldopa) and the vinca alkaloids.
Seelling of the salivary glands may be idiopathic but it has been described rarely in
association with iodides, antithyroid drugs, phenothiazines, and sulphonamides.
Taste
Taste acuity may be decreased or there can be an alteration in taste sensation. Drugs
implicated include penicillamine, griseofulvin, captopril and enalapril, lincomycin,
carbimazole, clofibrate, phenindione, lithium salts, gold (auranofin and
aurothiomalate), and metronidazole.
Antiseptics and Cleansers (See Appendix-15 & also section 12)
Superficial infections of the mouth are often helped by warm mouthwashes; they have
a mechanical cleansing effect and cause some local hyperaemia. However, they must
be used both frequently and vigorously to have nay effect, and some can lead to
irritation of the oral mucosa.
817
A warm saline mouthwash is ideal and can be prepared either by dissolving half a
teaspoonful of salt in a tumblerful of warm water or by diluting sodium chloride
compound mouthwash with an equal volume of warm water.
Mouthwashes containing an oxidising agent such as hydrogen peroxide, may be

useful in the treatment of acute ulcerative gingivitis (Vincent’s infection) as the
organisms responsible are anaerobes. Hydrogen peroxide also has a mechanical
cleansing action since it froths on contact with oral debris. Sodium perborate has a
similar effect, but should not generally be used for periods longer than 7 days because
of possible absorption of borate.
Chlorhexidine is an effective antiseptic which has the advantage of inhibiting plaque

formation on the teeth. It does not, however, completely control plaque deposition and
is not a substitute for effective toothbrushing. Moreover it does not penetrate
significantly into stagnation areas and is therefore of little value in the control of dental
caries or of periodontal disease once pocketing has developed.
Chlorhexidine can be used as a mouthwash for secondary infection in mucosal

ulceration. The mouthwash or the gel may be used for controlling gingivitis, as an
adjunct to other oral hygiene measures. The mouthwash or the gel may also be used
as an alternative to toothbrushing where there is a painful periodontal condition (e.g.
primary herpetic stomatitis) or if the patients has a haemorrhagic disorder, or is
handicapped.
Povidone-iodine is another effective antiseptic. The mouthwash is a useful

preparation in dealing plaque accumulation. Caution must be exercised in prolonged
use as a significant amount of iodine is absorbed.
Neither chlorhexidine nor povidone-iodine mouthwashes have any beneficial effect in

the control of acute ulcerative gingivitis.
Thymol is a weak antiseptic of negligible value for treating oral infections. Mouthwash
solutiontablets are sued to rinse out the mouth to remove unpleasant tastes.
Compound thymol glycerin may be used as a mechanical rinse instead of a saline
mouthwash.
Zine sulphate mouthwash is a traditional astringent mouthwash and has little

antibacterial activity. Some also find it useful for palliating recurrent aphthae.
CHLORHEXIDINE GLOUCONATE
Indications : oral hygiene (including endocarditis prophylaxis, p.5); plaque inhibition

side-effects : idiosyncratic mucosal irritation; reversible brown staining of teeth
Chlorhexidine Dental Gel, chlorhexidine gluconate 1%,

Brush on teeth once or twice daily
Chlorhexidine Mouthwash, chlorhexidine gluconate 0.2%. Aniseed- or mint-
flavoured available; net price 300 mL = £ 1.25
Rinse mouth with 10 mL for about 1 minute twice daily.
OXIDISING AGENTS
Indications : oral hygiene
818
Hydrogen Peroxide Mouthwash, consists of hydrogen peroxide solution (6% =

aprox, 20-volume) BP
Rinse mouth for 2-3 minutes with 15 mL in half a tumblerful of warm water 2-3 times
daily
sodium Perborate Mouthwash, sodium perborate 70% (buffered).

Use 1 sachet in 30 mL of water 3 times daily; not recommended in renal impairment or
for children under 5 years
POVIDONE-IODINE

Cautions : pregnancy; breast-feeding
Side-effects : idiosyncratic mucosal irritation and hypersensitivity reactions
Povidone-iodine Mouthwash, povidoneiodine 1%.

Use undiluted or diluted with equal volume of warm water every 2-4 hours if necessary
SODIUM CHLORIDE
Indication : oral hygiene
Sodium Chloride Mouthwash, Compound, BP, sodium chloride 1.5%.

Use diluted with equal volume of warm water
THYMOL
Compound Thymol Glycerin BP, glycerol 10%, thymol 0.05%, with colouring and
flavouring
Use undiluted or diluted with 3 volumes of warm water
Mouthwash Solution-tablets, consist of tablets which may contain antimicrobial,

colouring, and flavouring agents in a suitable soluble effervescent basis to make a
mouthwash suitable for dental purposes.
Dissolve 1 tablet in a tumblerful of warm water
Note : Mouthwash solution-tablets may contain ingredients such as thymol.
CORTICOSTEROIDS AND OTHER DRUGS FOR ORAL ULCERATION AND

INFLAMMATION
Ulceration of the oral mucosa be caused by trauma (physical or chemical), recurrent

aphthae, infections, carcinoma, dermatological disorders, nutritional deficiencies,
gastro-intestinal disease, haematopoietic disorders, and drug therapy. It is important
to establish the diagnosis in each case as the majority of these lesions require specific
management in addition to local treatment. Local treatment aims at protecting the
ulcerated area, or at relieving pain or reducing inflammation.
819
SIMPLE MOUTHWASHES. A saline or compound thymol glycerin mouthwash may

relieve the pain of traumatic ulceration. The mouthwash is made up with warm water
and used at frequent intervals until the discomfort and swelling subsides.
ANTISEPTIC MOUTHWASHES. Secondary bacterial infection may be a feature of

any mucosal ulceration; it can increase discomfort and delay healing. Use of a
chlorhexidine or povidone-iodine mouthwash is often beneficial and may accelerate
healing of recurrent aphthae.
MECHANICAL PROTECTION. Carmellse gelatin paste may relieve some discomfort

arising from ulceration, by protecting the ulcer site. The paste adheres to the mucosa,
but is difficult to apply effectively to some parts of the mouth.
ZINC SULPHATE, Zinc sulphate mouthwash is an astringent. Some patients find it

beneficial in recurrent aphthae.
CORTICOSTEROIDS. Topical corticosteroid therapy may be used for different forms

of oral ulceration. In the case of aphthous ulcers it is most effective if applied in the
“prodromal phase”.
Thrush or other types of candidiasis are recognised complications of corticosteroid
treatment.
Hydrocortisone lozenges are allowed to dissolve next to an ulcer and are useful in
recurrent aphthae, corsive lichen planus, discoid lupus crythematosus, and benign
mucous membrane pemphigoid.
Triamcinolone dental paste is designed to keep the corticosteroid in contact with the
mucosa for long enough to permit penetration of the lesion, but is difficult for patients
to apply effectively to some parts of the mouth.
Hydrocortisone cream is used in treating uninfected inflammatory lesions on the lips
and perioral skin. Hydrocortisone and miconazole cream or ointment is useful
where infection by susceptible organism and inflammation co-exist, particularly for
initial treatment (up to about 7 days). Organisms susceptible to miconazole include
candida spp. and many Gram-positive bacteria including streptococcus and staphy-
lococcus. Systemic corticosteriod therapy for severe conditions such as pemphigus
vulgaris is best reserved for the physician because of potential side-effects.
LOCAL ANALGESICS. Local analgesics have a limited role in the management of oral
ulceration. When applied topically their action is of a relatively short duration so that
analgesia cannot be maintained continuously throughout the day. The main indication
for a topical analgesic is to relieve the pain of otherwise intractable oral ulceration
particularly when it is due to major aphthae. For this purpose lignocaine 5% ointment
is applied to the ulcer. Care must be taken not to produce anaesthesia of the pharynx
before meals as this might lead to choking.
Benzydamine mouthwash may be useful in palliating the discomfort associated with
a variety of ulcerative conditions. It reduces the discomfort of post-irradiation
mucositis. If the full-strength preparation causes some stinging it can be diluted with
an equal volume of water. The spray may also be useful.
Choline salicylate dental gel has some analgesic action and may provide relief for
recurrent aphthae, but excessive application or confinement under a denture irritates
the mucosa and can itself cause ulceration. Benefit in teething may merely be due to
pressure of application (comparable with biting a teething ring); excessive use can
lead to salicylate poisoning.
DRY MOUTH. This condition may be caused by irradiation of the head and neck
region, damage to or disease of the salivary glands, or by the administration of drugs
820
with antimuscarinic (anticholinergic) side-effects, for example antispasmodics, tricyclic

antidepressants, and some antipsychotic drugs. It may be relieved in many patients by
simple measures such as frequent sips of cool drinks, sucking pieces of ice or sugar-
free fruit pastilles, or by the use of an different hospitals and are commercially
available. They are usually viscous, slightly flavoured, aqueous liquids.
BENZYDAMINE HYDROCHLORIDE
Indications : painful inflammatory conditions of orpharynx

Side-effects : occasional numbness or stinging
Benzydamine Mouthwash, benzydamine hydrochloride 0.15%. Rinse or gargle,
1
using 15 mL, diluted if necessary, every 1 2 -3 hours as required, usually for not more
than 7 days; not suitable for children under 12 years
Benzydamine Oral Spray, benzydamine hydrochloride 0.15%.
1 1
4-8 puffs onto affected area every 12 -3 hours; CHILD 6-12 years 4 puffs every 12 -3
hours
CARMELLOSE SODIUM
Indications : mechanical protection of oral and perioral lesions

Carmellose Gelatin Paste, geltain, pectin, carmellose sodium, 16.58% of each in a
suitable basis.
Apply a thin layer when necessary after meals
CORTICOSTEROIDS
Indications : mechanical protection of oral and perioral lesions

Contra-indications : untreated oral infection
Hydrocortisone Lozenges BP, hydrocortisone 2.5 mg (as sodium succinate).

Dissolve 1 lozenge slowly in the mouth in close contact with the lesion initially 4 times
daily; if ulcers recur rapidly treatment may be continued for a period at reduced
dosage
Hydrocortisone Cream BP, hydrocortisone 1%1.
Apply sparingly 2-4 times daily
1. The BP does not specify one particular strength but when hydrocortisone cream is
prescribed by a dental practitioner on form FP14 (GP14 in Scotland) a cream
containing 1% will be dispensed.
Triamcinolone Dental Paste BP, traincinolone acctonide 0.1% in an adhesive basis.
Apply a thin layer 2-4 times daily
With antifungal
Hydrocortisone and Miconazole Cream, hydrocortisone 1% and miconazole nitrate
2%,
Hydrocortisone and Miconazole Ointment, hydrocortisone 1% and miconazole
nitrate 2%,
For angular cheilitis apply sparingly 2-3 times daily; do not use for longer use for
longer than 7 days
821
LIGNOCAINE HYDROCHLORIDE
Indications : relief of pain in oral lesions

Cautions : avoid prolonged use; hypersensitivity may occur
Lignocaine 5% Ointment, lignocaine 5% in a suitable basis. Rub gently into affected
1
areas. Max. dose for 70 kg man 200 mg lignocaine (= 4 tube)
SALICYLATES
Indications : mild oral and perioral lesions

Cautions : frequent application, especially in children, may give rise to salicylate
poisoning
Note. The recent CSM warning on aspirin and Reye’s syndrome does not apply to
non-aspirin salicylates or to topical preparations such as teething gels.
Choline Salicylate Dental Gel BP, choline salicylate 8.7% in a flavoured gel basis.
Apply ever 3-4 hours with gentle massage before food and at bedtime
ARTIFICIAL SALIVA
Indications : dry mouth
Artificial Saliva, consists of a suitable inert, slightly viscous, aqueous liquid; it may
contain a suitable antimicrobial preservative, normal salivary constituents, small
amounts of fluoride, and colouring and flavouring agents.
ZINC SULPHATE
Indications : see notes above
Zinc Sulphate Mouthwash, consists of zinc sulphate lotion BP

Dilute 1 part with 4 parts of warm water
VITAMINS
vitamin deficiency due to inadequate dietary intake is rare in Bangladesh but can
develop in elderly people or alcoholics. Most other patients with develop a nutritional
deficiency have malabsorption and if this is suspected the patient should be referred
to a physician.
It is unjustifiable to treat stomatitis or glossitis with mixtures of vitamin preparations;
this delays diagnosis and correct treatment.
Severe cases of scurvy cause gingival swelling and bleeding margins as well as
petechiae on the skin. This is, however, exceedingly rare and a patient with this
appearance is more likely to have leukaemia. Investigation should not be delayed by a
trial period of vitamin treatment.
ASCORBIC ACID (Vitamin C)
Indications : prevention and treatment of scurvy

Dose : prophylactic, 25-75 mg daily; therapeutic, not less than 250 mg daily in divided
doses
822
Ascorbic Acid Tablets BP, ascorbic acid 25 mg; 50 mg, 20 = 6; 50 mg, 200 mg, 500
mg.
Vitamin B Tablets, Compound, strong, brown, f/c or s/c, nicotinamide 20 mg,
pyrodoxine hydrochloride 2 mg, riboflavine 2 mg, thiamine hydrochloride 5 mg.
Dose : treatment of vitamin D deficiency, 1-2 tablets 3 times daily
FLUORIDES
Availability of adequate fluoride confers significant resistance to dental caries. It is now

considered that the topical action fluoride on enamel and plaque is more important
than the systemic effect.
Where the natural fluoride content of the drinking water is significantly less than 1 mg
per litre (one part per million) artificial fluoridation is the most economical method of
supplementing fluoride intake.
Daily administration of tablets or drops is a suitable alternative, but systemic fluoride
supplements should not be prescribed without prior reference to the fluoride contents
of the local water supply; they are not advisable when the water contains more than
700 micrograms per liter (0.7 parts per million). In addition, it is now recommended
that infants need not receive fluoride supplements until age of 6 months.
Use of dentifrices which incorporate sodium fluoride and/or monofluorophosphate is
also a convenient source of fluoride.
Individuals who are either particularly caries prone or medically compromised may be
given additional protection by use of fluoride rinses or by application of fluoride gets.
Rinses may be used daily or weekly; daily use of a less concentrated rinse is more
effective than weekly use of a more concentrated one. Gets must be applied on a
regular basis under professional supervision; extreme caution is necessary to prevent
the child form swallowing any excess. Less concentrated gets have recently become
available for home use. Varnishes are also available and children since they adhere to
the teeth and set in the presence of moisture.
SODIUM FLUORIDE
Note. Sodium fluoride 2.2 mg provides approx. 1 mg fluoride ion

Indications : prophylaxis of dental caries-see notes above
Contra-indications : not for areas where drinking water is fluoridated
Side-effects : occasional white flecks on teeth with recommended doses; rarely
yellowish-brown discoloration if recommended doses are exceeded
Dose : Child, as fluoride ion :
Water content less than 300 micrograms/litre, up to 6 months none; 6 months-2 years,
250 micrograms daily; 2-4 years, 500 micrograms daily; over 4 years, 1 mg daily
Water contend between 300 and 700 micrograms/litre, up to 2 years, none; 2-4 years,
250 micrograms daily; over 4 years, 500 micrograms daily
Fluoride preparations are listed below; they are not prescribable on form FP14
(GP14 in Scotland).
There are arrangements for health authorities to supply fluoride tablets in the
course of preschool dental schemes, and they may also be supplied in school
dental schemes, and they may also be supplied in school dental schemes.
Tablets
COUNSELLING. Tablets should be sucked or dissolved in the mouth and taken
preferably in the evening.
En-De-Kay® (Sfafford-Miller)
Fluotabs 0-2 years, sodium fluoride 550 micrograms (250 micrograms F¯).
823
Fluotabs 2-4 years, natural orange-flavoured, scored, sodium fluoride 1.1 mg (500
micrograms F¯).
Fluor-a-days® (Dental Health)
Tablets, fuff, scored, sodium fluoride 2.2 mg (1 mg F¯).
Fluorigard® (RMT)
Tablets 0.5, purple, sodium fluoride 1.1 mg (500 micrograms F¯).
Tablets 1.0, sodium fluoride 2.2 mg (i mg F¯).
Oral-B Fluoride® (Oral-B Labs)
Tablets, sodium fluoride 1.1 mg (500 micrograms F¯).
Zymafluor® (Zyma)
Tablets, sodium fluoride 550 micrograms (250 micrograms F¯).
Tablets, yellow-grey, sodium fluoride 2.2 mg (1 mg F¯).
Oral drops
Note. Fluoride supplements no longer considered necessary below 6 months of age.
En-De-Kay® (Sfafford-Miller)
Fluodrops® (=paediatric drops), sugar-free, sodium fluoride 500 micrograms (250
micrograms F¯)/0.15 mL.
Fluorigard® (RMT)
Paediatric drops, sodium fluoride 275 micrograms (125 micrograms F¯)/drop.
Oral-B Fluoride® (Oral-B Labs)
Drops, sodium fluoride 0.15% (250 micrograms F¯/8 drops).
Mouthwashes
Rinse mouth for 1 minute and spit out COUNSELLING. Avoid eating, drinking, or
rinsing mouth for 15 minutes after use
En-De-Day® (Stafford-Miller)
Fluorinse (= mouthwash), red, sodium fluoride 2%.
For daily use, dilute 5 drops to 10 mL of water; for weekly use, dilute 20 drops to 10
mL
Fluorigard ® (RMT)
Daily dental rinse (= mouthwash), blue, sodium fluoride 0.5%.
Antihistamines (See Section 4)

There is no evidence that any one of the older antihistamines is superior to another in
antihistamine activity but they differ in duration of action and incidence of the main
side-effects, namely antimuscarinic (anticholinergic) effects and drowsiness.
Most antihistamines are relatively short acting but some, such as promethazine
hydrochloride, are active for up to 12 hours. All are of potential value i nasal allergy,
urticaria, and allergic rashes associates with drug allergy. The majority has the serious
disadvantage of causing drowsiness (some of the newer antihistamines less so, see
BNF section 3.4.1).
Antihistamines are widely used as antemetics; it has been suggested that these drugs
may be useful in dental surgery for patients with an over-active vomiting reflex, but
diazepam is likely to be more effective.
824
INDEX OF PHARMACEUTICAL MANUFACTURERS IN BANGLADESH
INDEX OF PHARMACEUTICAL
MANUFACTURERS IN BANGLADESH
Generic Suppliers to the Hospitals only:
1. M/s. EDCL (Bogra) Thonthonia, Bogra.

2. M/s. EDCL (Dhaka) 395-397, Tajgoan I/A, Dhaka.
For National Pharma Market:
Name of the Pharmaceutical Address and Licence No.

Manufacturer
1. M/s. ACI HealthCare Limited Treepordi, Sonargaon, Narayangonj
Mfg. Licence No. Non-Biological-519, Biological-312
2. M/s. ACI Ltd. Majeeganj Road, Godnail, Narayangonj
3. M/s. Acme Laboratories Ltd. Dhamrai, Dhaka
4. M/s. Acmunio International Ltd. Hemayetpur, Savar, Dhaka
Mfg. Licence No. Biological-280
5. M/s. Active Fine Chemicals Ltd. West Moktarpur, Munshiganj
6. M/s. Ad-din Pharmaceuticals BSCIC I/A, Jessore.
Ltd. Mfg. Licence No. Non-Biological-53, Biological-202
7. M/s. Advent Pharma Ltd. Plot No. B 50-54, BSCIC I/A, Dhamrai, Dhaka
8. M/s. Albion Laboratories Ltd. South Rahmatnagar, Shitakunda, Chittagong
9. M/s. Alco Pharma Ltd. House No. 3/B, Plot No. 33, Section-7, Mirpur, Dhaka
Mfg. Licence No. Non-Biological - 430, Biological- 193
10. M/s. Alkad Laboratories Alamnagar, Rangpur
11. M/s. Allied Pharmaceuticals Bogair, P.O. : Ashugonj, P.S.: Ashugonj, B.Baria
Ltd. Mfg. Licence No. Biological : 299, Non-Biological-498
12. M/s. Al-Modina 1/1. Tilargati, Tongi, Gazipur
Pharmaceuticals Ltd. Mfg. Licence No. Biological : 266, Non-Biological-440
13. M/s. Ambee Pharmaceuticals 184/1 Tejgaon I/A, Dhaka
14. M/s. Amico Laboratories Ltd. Khagan, Burilia, Savar, Dhaka
Mfg. Licence No. Non-Biological- 58, Biological-28
15. M/s. Amulet Pharmaceuticals Singdighi, Mauna, Sreepur, Gazipur
Ltd. Mfg. Licence No. Biological : 287, Non-Biological-418,
16. M/s. APC Pharma Ltd. Lokhpur, Fakirhat, Bagerhat
17. M/s. Apex Pharmaceuticals Ltd Shafipur, Kaliakair, Gazipur
18. M/s. Apollo Pharmaceutical Plot No. 10, Sec.7, Mirpur I/A, Dhaka
Laboratories Ltd. Mfg. Licence No. Non-Biological-330, Biological-92
19. M/s. Aristopharma Ltd. Plot No. 21, Road 11, Shyampur, Kadamtali I/A,
Dhaka
20. M/s. Aristopharma Ltd., Gachha, Gazipur Sadar, Gazipur
Gazipur Mfg. Licence No. Biological-304
21. M/s. Asiatic Laboratories Ltd. 253, Tongi I/A, Gazipur
22. M/s. Astra Biopharmaceuticals Gouripur, Ashulia, Savar, Dhaka.
825

23. M/s. Aztec Pharmaceuticals Ujirpur, Damurhuda, Chuadanga
Mfg. Licence No. Non-Biological- 396, Biological-155
24. M/s. Bangladesh Antibiotic Mouchak, Kaliakoir, Gazipur
Industries Ltd. Mfg. Licence No. Biological : 255
25. M/s. Bangladesh Industrial BSCIC I/A, Tarotia, Tangail
Gases Mfg. Licence No. Non-Biological-461
26. M/s. Bangla-German Latex Plot No. 178 & 179, DEPZ, Savar, Dhaka
Co., Ltd. Mfg. Licence No. Non-Biological-469
27. M/s. Beacon Pharmaceuticals Khatali, Bhaluka, Mymensingh
Ltd. Mfg. Licence No. Non-Biological-477, Biological : 258
28. M/s. Belsen Pharma Ltd. Kamlapur, Faridpur
29. M/s. Bengal Drugs & Chemical Kandirpar, Comilla.
Works Pharm. Ltd. Mfg. Licence No. Non-Biological-105, Biological-242
30. M/s. Bengal Remedies Ltd. A-114, BSCIC I/A, Tongi, Gazipur
31. M/s. Benham Pharmaceutical Plot No. 1, Aicha Nwaddah, Raja Shon Road, Savar,
Ltd. Dhaka. Mfg. Licence No. Non-Biological-212
32. M/s. Beximco Pharmaceuticals Tongi, Gazipur.
33. M/s. Beximco Pharmaceuticals Kaliakoir, Gazipur
Ltd. Mfg. Licence No. Biological : 262
34. M/s. Bio Pharma Ltd. A-116, Tongi, Gazipur.
35. M/s. Biogen Pharmaceuticals Plot No. 8, 9 and 10, BSCIC I/A, Patuakhali
Ltd., Mfg. Licence No. Non-Biological-243, Biological-121
36. M/s. Bios Pharmaceutical Ltd. Gazipur
Mfg. Licence No. Non-Biological-304
37. M/s. Bridge Pharmaceuticals West Tengra, Demra, Dhaka
38. M/s. Bristol Pharma Ltd. Konabari, Gazipur
39. M/s. Celltron Electro Block-B, Road No. 2, House No. 206, Bosila,
Manufacturing Services Ltd. Mohammadpur, Dhaka, Mfg. Licence No.Non-
Biological-516
40. M/s. Centeon Pharma Limited Chawkpara, Mawna, Sreepur, Gazipur
Mfg. Licence No.Non-Biological-510 & Biological-307
41. M/s. Central Pharmaceutical 2A/1, South West Darus Salam Rd, Mirpur, Sec-1,
Ltd. Dhaka. Mfg. Licence No.Non-Biological-310 &
Biological-76
42. M/s. Chemist Laboratories Ltd. College Road, Barisal
Mfg. Licence No. Non-Biological-133 & Biological-63
43. M/s. Cipla Ltd. Jahangirabad, Fultola, Bogra.
Mfg. Licence No.Non-Biological-305 & Biological-104
44. M/s. City Pharmaceutices Nasirabad, Chittagong.
Mfg. Licence No.Non-Biological-173
45. M/s. Concord Pharmaceuticals C-18, BSCIC I/A, Sonargaon, Narayanganj.
Ltd. Mfg. Licence No. Non-Biological-426 & Biological-187
46. M/s. Cosmic Pharmaceuticals Rupnagar I/A, Mirpur Dhaka-1216
47. M/s. Cosmo Pharma BSCIC Industrial Estate, Konabari, Gazipur.
Laboratories Ltd. Mfg. Licence No. Non-Biological-434, Biological-231
48. M/s. Crystal Pharmaceuticals BSCIC Industrial Estate, Comilla.
49. M/s. Decent Pharma Ltd. Vill.- Raghpur, P.O.-Rajapur, Dist. - Comilla.
50. M/s. Delta Chemicals Ltd. K/604, Dewliabari, College Gate, Konabari, Gazipur
Mfg. Licence No. Non-Biological-447,
51. M/s. Delta Pharma Ltd. Pakundia, Kishorganj
826

52. M/s. Desh Pharmaceuticals Rupnagar, Mirpur, Dhaka
53. M/s. Doctor TIMS Konabari, Joydapur, Gazipur
Pharmaceuticals Ltd. Mfg. Licence No. Non-Biological-436, Biological-199
54. M/s. Doctor’s Chemicals Works Fulbari, Bogra
55. M/s. Drug International Ltd. 13A & 14/A, Tongi Industrial Area, Squib Road, Tongi,
Unit-2 Gazipur
Mfg. Liscence No. Biological-220
56. M/s. Drug International Ltd. Tongi I/A, Gazipur
57. M/s. EDCL (Bogra) Thonthonia, Bogra.
Mfg. Licence No.Non-Biological-399, Biological-146
58. M/s. EDCL (Dhaka) 395-397, Tajgoan I/A, Dhaka.
59. M/s. Edruc Ltd. Sitlai House, Pabna.
60. M/s. EMCS Pharma Ltd. Dobadia, P.S: Uttarkhan, Dhaka-1230
61. M/s. Eon Pharmaceuticals Ltd. 217/5, Chandana, Joydebpur, Gazipur
Mfg. Licence No. Biological : 282, Non-Biological-57
62. M/s. Eskayef Bangladesh Ltd. 400, Tongi/ I/A. Squibb Road, Gazipur.
63. M/s. Eskayef Pharmaceuticals 2/C, North East, Darus Salam, Mirpur, Dhaka.
Ltd. Mfg. Licence No.Non-Biological-130, Biological-385
64. M/s. Eskayef Pharmaceuticals Murapara, Rupganj, Narayanganj
Ltd. Mfg. Licence No.Non-Biological-509, Biological-306
65. M/s. Ethical Drug Ltd. Godnail, Siddergonj, Narayangonj.
66. M/s. Euro Pharma Ltd. 385, West Jurain, Shampur, Dhaka
Mfg. Licence No. Biological 256, Non-Biological 475
67. M/s. Everest Pharmaceuticals Plot No. 45-46, BSCIC I/A, Kanchpur, Sonargaon,
Ltd. Narayanganj
Mfg. Licence No.Non-Biological-178
68. M/s. F N F Pharmaceuticals Rautoli, Nagarbathan, Jhenaidah.
69. M/s. GA Company Ltd. Tejgoan I/A Dhaka.
Mfg. Licence No. Non-Biological-102 , Biological-24
70. M/s. Gemvio Pharma Ltd. Villege : Bagan, P.O. Trishal, District : Mymensingh
71. M/s. General Pharmaceutical Kaliakair, Gazipur
Ltd. Mfg. Liscence No. Non-Biological-406, Biological-162
72. M/s. General Pharmaceutical Karolsurichala, Mouchak, Kaliakair, Gazipur
Ltd. (Unit-2) Mfg. Liscence No. Non-Biological- , Biological-283
73. M/s. Gentry Pharmaceuticals Vangnahati, Sreepur, Gazipur
74. M/s. Get Well Limited Habigonj Industrial Park, Olipur, Shjibazar,
Syestagonj, Habiganj
75. M/s. Glaxo Smith kline (Bd) Fauzderhat I/A, Chittagong
Ltd. Mfg. Licence No. Non-Biological-182 , Biological-42
76. M/s. Global Capsule Ltd. Bogra Road, Rupatali, Barisal
77. M/s. Global Capsule Ltd. Bogra Road, Rupatali, Barisal
(Gelatin Division) Mfg. Licence No. Biological-210
78. M/s. Global Heavy Chemicals Keranigonj, Dhaka.
Ltd. Mfg. Licence No. Non-Biological-466,
79. M/s. Globe Pharmaceuticals Begumgonj. I/A, Noakhali.
Ltd. Mfg. Licence No. Non-Biological- 455, Biological-226
827
80. M/s. Globex Pharmaceuticals Kamalpur (Pagla), Fatullah, Narayangonj.

81. M/s. Gonoshasthya Antibiotics Nayarhat, Savar, Dhaka
Ltd. Mfg. Licence No. Biological-232
82. M/s. Gonoshasthya Chemicals Tongi I/A, Gazipur
Ltd. Mfg. Licence No. Non-Biological-452
83. M/s. Gonoshasthya Nayarhat, Savar, Dhaka
84. M/s. Goodmann Bhagnahati, Sreepur, Gazipur
85. M/s. Greenland BSCIC I/A, Tongi, Gazipur.
86. M/s. Guardian Healthcare Ltd. Amtola, Kathgora, Zirabo, Ashulia, Savar, Dhaka
Mfg. Licence No. Biological-490, Non-Biological-286
87. M/s. Hallmark Pharmaceuticals B-63, BSCIC I/E, Tongi, Gazipur
Ltd., Mfg. Licence No. Non-Biological-240, Biological-207
88. M/s. Health Care Rajendrapur, Gazipur.
Pharmaceuticals Ltd. Mfg. Licence No. Non-Biological- 459, Biological-234
89. M/s. Hope Pharmaceutical Ltd. Bhairab Bazar, Kishorgong.
90. M/s. Hudson Pharmaceutical Mouchak, Kaliakoir, Gazipur.
91. M/s. Ibn Sina Pharmaceutical Kaliakoir, Gazipur
Ind. Ltd. Mfg. Licence No. Non-Biological-405, Biological-150
92. M/s. Incepta Chemicals Ltd. Barabaria, Dhankora, Saturia, Manikganj
93. M/s. Incepta Hygiene & Krishnapura, Sahabelishor, Dharmari, Dhaka
Hospicare Ltd. Mfg. Licence No. Biological-303
94. M/s. Incepta Pharmaceuticals Jirabo, Saver, Dhaka
95. M/s. Incepta Pharmaceuticals Krishnapura, Sahabelishor, Dhamrai, Dhaka
Ltd. (Dhamrai Unit) Mfg. Licence No. Non-Biological-494, Biological-290
96. M/s. Incepta Vaccine Ltd. Bara Rangamatia, Zirabo, Ashulia, Savar, Dhaka
97. M/s. Incepta Vaccine Ltd. Krishnapura, Sahabelishor, Dhamrai, Dhaka
(Animal Vaccine Division) Mfg. Licence No. Biological-308
98. M/s. Indo-Bangla College Road, Barisal.
99. M/s. Inova Pharmaceutical Ltd. Plot No. I/8, & 9, Road No. 5, Section-7, Mirpur I/A,
Pallabi, Dhaka, Mfg. Licence No. Non-Biological-
324, Biological-153
100. M/s. Institute of Public Health Mohakhali, Dhaka
101. M/s. Institute of Public Health 46 Tejkunipara, Dhaka
102. M/s. Islam Oxygen (Pvt) Ltd. Tarabo, Rupganj, Narayanganj
103. M/s. J & J Medical Bangladesh Plot No. 150, DEPZ, Ganakbari, Savar Dhaka
104. M/s. Jalalabad Kanchpur, Sonargaon, Narayangonj
Pharmaceuticals Ltd. Mfg. License No. Non-Biological-411, Biological 167
105. M/s. Jayson Pharmaceuticals 231, Tejgoan I/A, Dhaka.
Ltd. Mfg. Licence No. Non-Biological-82 , Biological-03
106. M/s. JMI Hospital Requisite Vitikandi, Gozaria, Munshiganj
Manufacturing Ltd. Mfg. Licence No. Biological-298
107. M/s. JMI Industrial Gas Ltd. Maddam Bausia, Gajaria, Munshiganj
108. M/s. JMI Syringes & Medical Rajandrapur, Chaowddhagiam, Comilla
Devices Ltd. Mfg. License No. Biological-237
109. M/s. Julphar Bangladesh Ltd. Faridpur, Sreepur, Gazipur
828

110. M/s. Kemiko Pharmaceuticals Ticapara, Ghoramara, Rajshahi.
111. M/s. Khulna Essential Latex Gilatola, Fultala, Khulna
Plant Mfg. Licence No. Non-Biological-485
112. M/s. Kumudini Pharma Ltd. 72, Sirajuddowla Road, Narayangonj
113. M/s. Labaid Pharmaceuticals 15, Genda, Savar, Dhaka
114. M/s. Leon Pharmaceuticals Ltd. Satkhamair, Sreepur, Gazipur
115. M/s. Libra Pharmaceuticals Ltd. 1/7, Section-2, Mirpur, Dhaka.
116. M/s. Linde Bangladesh Ltd. 185, Tejgoan I/A, Dhaka.
117. M/s. Maks Drugs Ltd. Konabari, Gazipur
118. M/s. Marker Pharmaceuticals Kalampur, Gazipur
Ltd. (Shamsul Alamin) Mfg. Licence No. Non-Biological-387, Biological-243
119. M/s. Marksman Genda, Savar, Dhaka
120. M/s. Medicon Pharmaceuticals Plot No. 17/A/1, Avenue-1, Block-D, Section-10,
Ltd. Mirpur, Dhaka
Mfg. Liscence No. Non-Biological-402, Biological-148
121. M/s. Medimet Pharmaceuticals Rupatali, Barisal
122. M/s. MedRx Life Science Ltd. Plot No. A-88 & A-89, BSCIC I/A, Nandanpur, B.
Baria.
123. M/s. Millat Pharmaceuticals 65-66, Postogol I/A, Dhaka
124. M/s. Modern Pharmaceuticals Jhenaidah
125. M/s. Momtaz Pharmaceuticals Plot No. 551(P), Bara Deora, Tongi, Gazipur
126. M/s. Monico Pharma Ltd. South Dhanua, Sreepur, Gazipur
127. M/s. Monomedi Bangladesh Nagbari, Post. : K. Nagbari, Ghatail, Tangail
128. M/s. MST Pharma and Bishua Kuribari, Gazipur Sadar, Gazipur
Healthcare Ltd. Mfg. Licence No. Non-Biological-181, Biological-43
129. M/s. Mundipharma Bangladesh Mirzapur, Sadar, Gazipur
(Pvt) Ltd. Mfg. Licence No. Non-Biological-495
130. M/s. Naafco Pharma Ltd. Bandai, Bhaluka, Mymensingh
131. M/s. Navana Pharmaceuticals Rupshi, Rupganj, Narayanganj.
132. M/s. Newtec Pharmaceutials Boro Dhormopur, Comilla
133. M/s. Nip Chemical and Shahid Nagar, Daspara, Daudkandi, Comilla
Pharmaceuticals Ltd. Mfg. Licence No. Non-Biological-471
134. M/s. Nipa Pharmaceuticals Ltd. 1/5, Rupnagar, Mirpur, Dhaka.
135. M/s. NIPRO JMI Company Ltd. Vitikandi, Gozaria, Munshigonj
136. M/s. NIPRO JMI Pharma Ltd. Rajandrapur, Chauddagram, Comilla
137. M/s. Novartis (Bangladesh) Ltd. Squibb Road, Tongi, Gazipur.
138. M/s. Novelta Bestway Singair Road, Hemayetpur, Savar, Dhaka
829

139. M/s. Novo Healthcare and Plot # 2, Road # 11, Block # C, Section # 6, Mirpur,
Pharma Ltd. Pallabi, Dhaka, Mfg. Licence No. Non-Biological:
474, Biological: 251
140. M/s. Novo Healthcare and East Norshingha Pur, Savar, Dhaka
Pharma Ltd. (Unit-2) Mfg. Licence No. Biological: 271, Non-Biological: 481
141. M/s. Novus Pharmaceuticals Tatul Jhara, Raj Fulbaria, Savar, Dhaka
142. M/s. Nuvista Pharma Ltd. 97-98, Tongi I/A, Gazipur.
(Organon Bd. Ltd.) Mfg. Licence No. Non-Biological-375, Biological-38
143. M/s. Oasis Laboratories Afzal Khan Road Sirajgonj.

144. M/s. OMC Healthcare Pvt. Ltd. Rupnagar IA., Plot No. 44, Block-K, Mirpur, Dhaka
145. M/s. One Pharma Ltd. Plot No. C-23-24, BSCIC I/A, Bogra
146. M/s. Opso Saline Ltd. Bogra Road, Barisal
147. M/s. Opsonin Chemical Rupatali, Barisal.
Industries Ltd. (Chemical Mfg. Licence No. Non-Biological-448, Biological-212
Division)
148. M/s. Opsonin Pharma Ltd. Bogra Road, Barisal.
149. M/s. Orbit Pharmaceuticals Ltd. Shah Mirpur, P.S.:Karnaphufy, Chittagong
Mfg. Licence No. Non-Biological-204, Biological : 253
150. M/s. Organic Health Care Ltd. Gilar Chala, Sreepur, Gazipur
151. M/s. Orion Infusion Ltd. Maikali Rupgonj, Narayangonj
152. M/s. Orion Pharma Ltd. 154, Tejgaon I/A Dhaka.
153. M/s. Oyster Pharmaceuticals Borhan Uddin Road, Sylhet
Ltd. Mfg. Licence No. Biological-279; Non-Biological-162,
154. M/s. Pacific Pharmaceuticals BSCIC, Kanchpur, Narayangonj.
155. M/s. Paradise Chemical Hospital Road, Barisal.
Industries. Mfg. Licence No. Non-Biological-223, Biological-138
156. M/s. Peoples Pharma Ltd. 105-106, Tongi I/A, Gazipur.
157. M/s. Pharmacil Ltd. B-34, BSCIC Industrial Area, Tangi, Gazipur.
158. M/s. Pharmadesh Laboratories 239, Tejgoan I/A, Dhaka.
159. M/s. Pharmasia Ltd. Gazariapara, Bhawal, Mirzapur, Gazipur
160. M/s. Pharmatek Chemicals Ltd. Aushpara, Beximco Complex, Tongi, Gazipur.
161. M/s. Pharmik Laboratories Ltd. 4/5, Zakir Hossain Road, Khulshi, Chittagong.
162. M/s. Phoenix Chemical 16/1, Vagdi, Narshingdi
Laboratory (BD) Ltd. Mfg. Licence No. Non-Biological-20, Biological-15
163. M/s. Popular Pharmaceuticals 164, Tongi I/A, Gazipur
164. M/s. Premier Pharmaceuticals Anantapur, Begumgonj, Noakhali
165. M/s. Prime Pharmaceuticals Tapirbari, Shishu Polli Road, Sreepur, Gazipur
166. M/s. Quality Pharmaceuticals 9, Bhujango Bhusan Lane, Kushtia
(Pvt.) Ltd. Mfg. Licence No. Non-Biological-439, Biological-204
830
167. M/s. Radiant Pharmaceuticals Tongi I/A, Gazipur

168. M/s. Rampart Power (BD) Ltd. Porabari, Gazipur.
169. M/s. Rangs Pharmaceuticals 226 Tejgoan I/A, Dhaka.
170. M/s. Reckitt & Benckiser 58-59, Nasirabad I/A, Chittagong.
Bangladesh Ltd. Mfg. Licence No. Non-Biological-373
171. M/s. Reliance Pharmaceuticals Elixir Town Area, Utttar Khan, Uttara, Dhaka
Ltd. Mfg. Licence No.Non-Biological- 367, Biological-112
172. M/s. Reman Drug Laboratories Plot No. 62-B, Block-C, Tongi, Gazipur.
173. M/s. Remo Chemicals Ltd. 235 Tejgaon I/A, Dhaka.
Mfg. Licence No. Non-Biological-457, (Bio-246
Cancel)
174. M/s. Renata Ltd. Sec-11, Mirpur, Dhaka.
175. M/s. Renata Ltd., Gazipur Rajendrapur, Gazipur
176. M/s. Renata Oncology Limited Noyapara, Dogri, Rajendrapur, Gazipur
177. M/s. Rephco Pharmaceuticals Mathuranath Public School Road, Nutan Bazar,
Ltd. Barisal.
178. M/s. RN Pharmaceuticals Eidgah Compound, Kanchijuli, Mymensingh
179. M/s. S. N. Pharmaceuticals Ltd. Plot No. B-35, BSCIC I/E, Kanchpur, Narayanganj
Mfg. Licence No. Non-Biological 61, Biological-110
180. M/s. Salton Pharmaceuticals Rajfulbaria, Savar, Dhaka

181. M/s. Sanofi Aventis Ltd. Tongi I/A, Gazipur.
182. M/s. Save Pharmaceuticals 14, Cathalic Mission School Road, Mymensingh.
183. M/s. Seema Pharmaceuticals Shahid Cort, Fulbari, Savar, Dhaka
184. M/s. Sharif Pharmaceuticals Barabo, Tarabo, Rupganj, Narayanganj
185. M/s. Sheba Laboratories Ltd. Bhadra, Kazla, Rajshahi
186. M/s. Silco Pharmaceuticals Ltd. BSCIC I/E, Khadim Nagar, Sylhet
187. M/s. Silva Pharmaceuticals Ltd. Plot No 137, Joykrishnarampur, Maijdi Court, Noakhali
188. M/s. SMC Enterprise Ltd. Zamiradia, Bhaluka, Mymensingh
189. M/s. Sodical Chemical Ltd. D-203, BSCIC I/A, Tongi, Gazipur
Mfg. Licence No. Non-Biological-435,
190. M/s. Somatec Pharmaceutical Dailla, P.O. Sharulia Bazar, Demra, Dhaka
191. M/s. Sonear Laboratories Ltd. 11/2, Toyenbi Circular Road, Dhaka
192. M/s. Spectra Oxygen Limited 64, Esail, P.O. : Uthaly, P.S. Shibalaya, Manikganj
193. M/s. Square Formulations Ltd. Momin Nagar, Gorai, Mirzapur, Tangail
194. M/s. Square Pharmaceutical Salgaria, Pabna
195. M/s. Square Pharmaceuticals Kaliakoir, Gazipur (Dhaka Unit)
831

196. M/s. Square Pharmaceuticals Salgaria, Pabna
Ltd., (Chemical Division) Mfg. Licence No. Non-Biological-202, Biological-438
197. M/s. Standard Laboratories Ltd. 85, Batali Hill, Flora Pass Road, Ambagan, Chittagong
Mfg. Licence No. Non-Biological-55, Biological- 30
198. M/s. Sun Pharmaceutical Chandana, Joydevpur, Gazipur, Dhaka
(Bangladesh) Ltd. Mfg. Licence No. Non-Biological-472l
199. M/s. Sunman-Birdem Pharma Village-Hobirbari, Ward-07, Bhaluka, Mymensingh
Ltd. Mfg. Licence No. Non-Biological-513. Biological-310
200. M/s. Sunypun Organics Ltd. North Daulatdia, Goalando, Rajbari
201. M/s. Super Power Belabo, Narsingdi
Pharmaceuticals Ltd. Mfg. Licence No. Non-Biological-443. Biological-269
202. M/s. Supreme Pharmaceuticals Palashbari, Ashulia, Dhaka
Ltd. Mfg. Licence No. Non-Biological- 369, Biological-160
203. M/s. Team Pharmaceuticals Bscic I/E, Shapura Rajshahi
204. M/s. Techno Drugs Ltd. Satipara, Narsingdi
205. M/s. Techno Drugs Ltd., Unit-2 BSCIC I/A, Kararchar, Narshingdi
206. M/s. Techo Drugs (Unit-2) BSCIC Industrial Area, Kararchar, Narsingdi
207. M/s. Theraputics (BD) Ltd. Kalurghat, BSCIC I/A, Chittagong
208. M/s. Unimed & Unihealth BK Bari, Gazipur Sadar, Gazipur
Manufacturers Ltd. Mfg. Licence No. Non-Biological-121, Biological-219
209. M/s. Union Pharmaceutical Ltd. Sadhapur, Puranbari, Savar, Dhaka
210. M/s. Unique Pharmaceutical Barisur, Keraniganj, Dhaka.
211. M/s. United Chemical & 33/E, FIDC Road, Kalur Ghat, Chittagong.
212. M/s. Veritas Pharmaceuticals Vannara, Mouchak, Kaliakoir, Gazipur
213. M/s. Virgo Pharmaceuticals Kaultia, Gazipura, Gazipur
214. M/s. White Horse Pharma Rajfulbaria, Savar, Dhaka
215. M/s. World Chemical Industry 211, Taknogopara, Chandona, Gazipur-1702
Ltd. Mfg. Licence No. Non-Biological-517
216. M/s. Zenith Pharmaceuticals Trunk Road, Feni.
217. M/s. Ziska Pharmaceuticals Karolsurichala, Shafipur, Kaliakoir, Gazipur
832
ABBREVIATIONS & SYMBOLS
SOME OF THE ABBREVIATIONS & SYMBOLS

USED IN THE FORMULARY
ASCO DM
American Society of Clinical Oncology Diabetes Mellitus
ACE DU
Angiotensin Converting Enzyme Dhaka University
ARI DMC
Acute Respiratory Tract Infection Dhaka Medical College
BBB DMARD
Blood Brain Barrier Disease Modifying Anti-Rheumatic
Drugs
BIRDEM
(ED)
Bangladesh Institute for Research &
Rehabilitation in Diabetes, Endocrine Essential Drugs
and Metabolic Disorders
ECG
BMC Electrocardiogram
Bangladesh Medical College
FAO
BSMMU Food and Agricultural Organization
Bangladesh Sheikh Mujib Medical
University GIT
Gastrointestinal Tract
BPS
Bangladesh Pharmaceutical Society gm
Gram
(CD)
Controlled Drugs HIV

Human Immuno-deficiency Virus
CVS
(I)
Cardiovascular System
Imported Drugs
CNS
Central Nervous System IEH
Islamia Eye Hospital
CSF
Cerebrospinal Fluid i.e.
that means
CTC
Central Addiction Treatment Center IM
Intramuscular
DA
Drugs Administration IV
Intravenous
DGHS
Director General of Health Services Ig
Immunoglobulin
833
ABBREVIATIONS & SYMBOLS
HDL
High Density Lipoprotein SR
Sustained Release
JU
Jahangirnagar University SSMC
Sir Salimullah Medical College
Kg
Kilogram STD
Sexually Transmitted Diseases
LDL
Low Density Lipoprotein USTC
University of Science & Technology,
MMC Chittagong
Mymensingh Medical College
UTI
NHF Urinary Tract Infection
National Heart Foundation
VD
NICVD Venereal Diseases
National Institute of Cardiovascular
Diseases Viz.
For example
NITOR
National Institute of Trauma, VLDL
Orthopaedics & Rehabilitation Very Low Density Lipoprotein
NIPSOM WHO
National Institute of Preventive & Social World Health Organization
Medicine
Wt.
NSAIDs Weight
Non-Steroidal Inflammatory Drugs
W/V
O/W Weight by Volume
Oil-in-Water
W/W
PGA Weight by Weight
Pharmacy Graduates’ Association
SIAPS
 Systems for Improved Access to
Registered Drug, Proprietary Name Pharmaceuticals and Services
RU MSH
Rajshahi University Management Sciences for Health
RTI PF
Respiratory Tract Infection Prefilled Syringe
SC
Subcutaneous
834
GENERAL INDEX
GENERAL INDEX
A Acitrin-L .................................................. 425

Aclasta ................................................... 234
1a-hydroxycholecalciferol ......................529 Aclene .................................................... 433
5-Fu PhaRes ..........................................472 Acliz Plus ............................................... 308
AB kit ......................................................240 Acliz ....................................................... 308
A-B1 .......................................................524 Aclo ........................................................ 330
Abacavir ...................................................75 Aclobet N ............................................... 418
Abaclor .....................................................14 Aclobet ................................................... 417
Abdorin .....................................................95 Acme IV Infusion.................................... 152
Abecab ...................................................141 Acme’s Milk of Magnesia ....................... 118
Aben .........................................................83 Acmecilin ................................................... 9
Abentel .....................................................83 Acmegra................................................. 259
Abetis Plus .............................................134 ACN ....................................................... 330
Abetis .....................................................134 Acnecare ................................................ 437
Abiraterone acetate ................................492 Acnegel .................................................. 433
AC PR ....................................................330 A-Cold .................................................... 189
A-Cal D ...................................................519 Acora ...................................................... 165
A-Cal ......................................................517 Acorex .................................................... 187
A-Calm ...................................................352 Acos ......................................................... 31
Acarbose ....................................... 213, 214 Acrivastine ............................................. 190
A-Card ....................................................139 Acryth ....................................................... 33
Ace ................................................ 289, 290 Actemra.................................................. 346
Acecard ..................................................131 Act-HIB................................................... 449
Aceclofen................................................330 Acticol .................................................... 187
Aceclofenac ............................................330 Actidex ................................................... 331
Acecol .....................................................330 Actifast ................................................... 336
Acefenac ................................................330 Actilac .................................................... 117
Acelex.......................................................13 Actilyse................................................... 166
Acemetacin ............................................330 Actinomycin D ........................................ 470
Acemox ..................................................379 Activa ..................................................... 259
Aceon .....................................................131 Active Plus ............................................. 533
Acep .............................................. 289, 290 Activit Gold ............................................. 531
Acepril ....................................................130 Activit Silver ........................................... 531
Aceptin-R................................................101 Actol ....................................................... 289
Aceril ......................................................131 Actolin .................................................... 178
Acerux ..................................... 70, 366, 413 Actose .................................................... 210
Aceta ............................................. 289, 290 Actrapid .................................................. 202
Acetazolamide ............................... 152, 378 Actrim ................................................ 43 266
Acetor .....................................................129 Actrim-DS ................................................ 43
Acetram ..................................................290 Acunac ................................................... 369
ACF ........................................................330 Acupain .................................................. 336
ACI ORS.................................................112 Acuren.................................................... 148
Acicaft .....................................................371 Acyclovir......................................... 387, 400
Acical ......................................................517 Acyvir ............................................... 70, 366
Acical-C ..................................................519 Adaben .................................................. 433
Acical-D ..................................................519 Adafil ...................................................... 259
Acical-M..................................................521 Adair ....................................................... 186
AcIclovir ................................... 69, 366, 413 Adalimumab ........................................... 343
Acicot ............................................. 367, 388 Adapalene .............................................. 432
Acifix .......................................................109 Adapel .................................................... 433
Aciflox .......................................................42 Adarbi..................................................... 132
Acilog ......................................................203 Adcal D .................................................. 519
Acin ........................................................101 Adcovit ................................................... 526
Acipam ...................................................279 Adebrox.................................................. 187
Aciphin ......................................................24 Adecard.................................................. 153
Aciprin CV ..............................................291 Adecef ...................................................... 13
Acira .......................................................191 Adecin ...................................................... 38
Acitretin ..................................................432 Adefovir Dipivoxil ..................................... 71
Acitrin .....................................................422 Adegra ................................................... 259
Adegut...................................................... 99
835
GENERAL INDEX
Adelax ....................................................273 Alafen ..................................................... 184

Adelev ......................................................39 Alafree.................................................... 424
Adenosine ..............................................153 Alagra..................................................... 424
Adethro .....................................................33 Alanil ...................................................... 424
Adetil ........................................................16 Alarid .............................................. 184, 372
Adexim .....................................................19 Alarm ........................................................ 83
Adflox .........................................................6 Alaron..................................................... 425
Adfovir ......................................................72 Alarup..................................................... 427
Adgar ......................................................433 Alatin ...................................................... 422
Adglim ....................................................206 Alatrol ..................................................... 422
Adiponil...................................................312 Albamax DS ............................................. 83
Adiva ........................................................78 Albasine ......................................... 146, 313
Adiz ..........................................................31 Albendazole ....................................... 82, 84
Adlina .....................................................211 Albendol ................................................... 83
Admira ....................................................206 Albevate-N ............................................. 417
Admox ........................................................8 Albezen .................................................... 83
Adnix ........................................................67 Albiquin .................................................... 64
Adnor ......................................................428 Albi-Tasty Ispaghul ................................ 115
Adocil ........................................................12 Albi-Whitfield .......................................... 408
Adora ........................................................12 Albizox ..................................................... 67
Adpas .....................................................210 Albumin Human ..................................... 514
Adrenaline ............................. 157, 193, 194 Albutein .................................................. 514
Adribin ....................................................470 Alcadin ................................................... 371
Adrin .......................................................158 Alcaft ...................................................... 371
Adrinor ....................................................158 Alcafta .................................................... 371
Adryl .............................................. 424, 428 Alcaftadine ............................................. 371
ADS ........................................................513 Alcet ....................................................... 425
Adsorbed diphtheria ...............................449 Alclor ........................................................ 15
Aduvit .....................................................526 Alcohol ................................................... 437
Advel ......................................................334 Alconil Mouthwash ................................. 402
Advixa .....................................................344 Alcot ......................................................... 43
Adze .........................................................83 Alda .......................................................... 83
Aerodyl ...................................................177 Aldex ........................................................ 83
Aerofen ...................................................184 Aldonist .................................................. 151
Aeron FT ................................................185 Aldopa .................................................... 303
Aeron ......................................................184 AL-DS ...................................................... 83
Aeronid ...................................................182 Alen-D .................................................... 233
Aeropac ....................................................94 Alendon .................................................. 232
Aerovil ........................................... 192, 426 Alendronic Acid ...................................... 232
Aexidal ........................................... 191, 426 Alercon ........................................... 373, 395
A-Fenac K ..............................................331 Alerfast ................................................... 424
A-Fenac Plus ..........................................333 Alerjess .................................................. 191
A-Fenac ..................................................332 Alertadin ................................................. 423
Afinitor ....................................................477 Alervil ............................................. 192, 426
Afix 19 Alexa ...................................................... 160
Afixime ......................................................19 Alexid ....................................................... 11
A-Flox .........................................................6 Aleze ...................................................... 425
Afm .........................................................368 Alfacalcidol ............................................. 529
AFM-Plus................................................368 Alfacort ................................................... 221
AFM-T ....................................................368 Alfa-E ..................................................... 530
A-Forte ...................................................524 Alfasin .................................................... 254
Afrin ........................................................396 Alfazosin ................................................ 254
Afun ............................................... 242, 408 Alfa Tocopheryl Acetate ........................ 530
Aggra ......................................................259 Alfuzosin ................................................ 254
Agotin .....................................................284 Algicid ...................................................... 93
Agoxin ....................................................147 Algicon ..................................................... 93
AH ...........................................................83 Algin ......................................................... 96
Airnaaf ....................................................184 Algirex .................................................... 333
Aknill .......................................................434 Alice Lotion ............................................ 414
Alaclov ......................................................70 Alimag ...................................................... 92
Alacot .....................................................373 Alin 101
Aladay ....................................................373 Alinix ........................................................ 67
836
GENERAL INDEX
Aliskiren ..................................................136 Ambrisan ................................................ 174

Aljen .......................................................372 Ambrisentan ........................................... 174
Alkamax..................................................261 Ambronaaf ............................................. 188
Allergy ....................................................190 Ambronil ................................................. 188
Allerkit.....................................................184 Ambrosol ................................................ 188
Allermine ................................................191 Ambrotil .................................................. 188
Allernil .....................................................422 Ambroton ............................................... 188
Allet ........................................................373 Ambrox................................................... 188
Allopecia .................................................465 Ambroxol ........................................ 187, 188
Allopurinol...................................... 347, 475 Ambryl .................................................... 188
Allphen ...................................................427 Amdin ..................................................... 140
Almetil.....................................................276 Amdocal ................................................. 140
Almex .......................................................83 Amdova .................................................. 171
Almitan ...................................................293 A-Meb ...................................................... 98
Almitrine ........................................ 145, 312 Amekast ................................................. 185
Alneed Gold .................................. 496, 527 Ametil ..................................................... 276
Alomide ..................................................372 Amibac ..................................................... 29
Alona ......................................................330 Amidol .................................................... 541
Aloquin .....................................................64 Amidron.................................................. 154
Aloten Forte ............................................140 Amifen .................................................... 337
Alpam .....................................................266 Amiflox ..................................................... 38
Alpatin ....................................................372 Amifostine .............................................. 468
Alphanate ...............................................507 A-Migel ........................................... 401, 411
Alphapress .................................... 136, 254 Amikacin ............................................ 29, 46
Alphaten .................................................378 Amikast .................................................. 185
Alphin .......................................................83 Amikin ...................................................... 29
Alprax .....................................................266 Amilac .................................................... 512
Alprazol ..................................................266 Amilax .................................................... 273
Alprazolam .............................................266 Amiloride ................................................ 150
Alprostadil...............................................239 Amino Acid ............................................. 511
Alsium .....................................................267 Aminocaproic acid ................................. 167
Altapan .....................................................96 Aminoglutethimide ................................. 490
Altason ...................................................221 Aminomax .............................................. 512
Alteplase.................................................166 Aminophyllne ................................. 180, 193
Alterin .....................................................332 Aminoplex .............................................. 512
Alton .......................................................104 Aminosalicylates .................................... 114
Altretamine .............................................474 Aminosin Plus ........................................ 511
Altrip ................................................. 74,302 Aminosin ................................................ 512
Alucil-S .....................................................92 Aminosol ................................................ 512
Aluctin .....................................................268 Amiodarone .......................................... 153
Alurol ......................................................347 Amisol Gold ........................................... 511
Alve ..........................................................97 Amisol .................................................... 512
Alvenor ...................................................120 Amistar ..................................................... 29
Alverate ....................................................97 Amitriptyine ............................................ 282
Alverine Citrate .........................................97 Amitriptyline ................................... 216, 292
Alvital ......................................................533 Amival-F ................................................. 284
Alvolex ....................................................178 Amlex ..................................................... 400
Alzed ........................................................83 Amlexanox ............................................. 400
Alzolam ...................................................266 Amlip ...................................................... 171
Amantadine ..................................... 73, 302 Amlocard Plus ........................................ 140
Amantril ........................................... 74, 302 Amlocard ................................................ 140
Amarin ........................................... 192, 426 Amlocom ................................................ 140
Amaryl ....................................................206 Amlodipine ...................................... 135,141
Amason ..................................................218 Amlodipine ............................................ 140
Ambeecal ...............................................517 Amlopin .................................................. 140
Ambeecal-D ...........................................519 Amlosartan ............................................. 135
Ambix .....................................................188 Amlotab .................................................. 140
Ambolin ..................................................188 Amloten .................................................. 140
Ambolyt ..................................................188 Amlovas ......................................... 135, 140
Ambosil...................................................188 Amlowide ............................................... 140
Amboten .................................................188 Amlozep ................................................. 141
Ambozin .................................................188 Amocal ........................................... 140, 141
837
GENERAL INDEX
Amocin .......................................................8 Anilic ...................................................... 293

Amodis .....................................................65 Animet .................................................... 497
Amotid ........................................................8 Anitid ...................................................... 101
Amotrex ....................................................65 Anleptic .................................................. 296
Amovast .................................................171 Anlet ....................................................... 163
Amoxicillin ......................................... 7, 398 Anobac ..................................................... 50
Amoxizen....................................................8 Anodyne ......................................... 332, 370
Ampexin .....................................................9 Anofer .................................................... 499
Amphotericin .............................. 29,54, 400 Anorel..................................................... 119
Ampicillin ....................................... 7, 8, 398 Anoxa ..................................................... 269
Ampirex ......................................................9 Anquil ..................................................... 320
Ampress ........................................ 140, 141 Anreb ..................................................... 133
Amsiv......................................................188 Anril ........................................................ 139
Amtenol ..................................................140 Anset ...................................................... 309
Amurun ...................................................101 Ansulin 30/70 ......................................... 203
Amx ............................................................8 Ansulin 50/50 ......................................... 203
A-Mycin ........................................... 33, 434 Ansulin N ............................................... 204
Anabolic Steroids ...................................228 Ansulin R ............................................... 202
Anacort ...................................................219 Antac ...................................................... 102
Anadol ....................................................288 Antacid MAX ............................................ 94
Anaesthesia ...........................................315 Antacid ............................................... 91, 92
Anaflam ......................................... 331, 334 Antameal .................................................. 92
Anaflex .......................................... 105, 337 Antanil Plus .............................................. 94
AnaflexMax ............................................338 Antanil ...................................................... 92
Analac ....................................................336 Antazol ................................................... 396
Anapril ....................................................130 Antazoline .............................................. 371
Anasec ...................................................106 Antepsin ................................................. 110
Anastrol ..................................................491 Anthisan ................................................. 426
Anastrozole ............................................490 Anti hemophilic factor ............................ 507
Anaxyl .....................................................168 Antial ...................................................... 313
Anbendazole ............................................83 Antigall ................................................... 120
Ancef ........................................................13 Antigiardial drugs ..................................... 66
Ancipro .....................................................38 Antigrain ................................................. 295
Ancliz ......................................................308 Antison ................................................... 273
Anclog ....................................................163 Antista ............................................. 191,422
Ancor Plus ..............................................124 Antiva ....................................................... 72
Ancor ......................................................124 Antizoa ..................................................... 67
Ancotil .....................................................266 Antoris .................................................... 145
Andep .....................................................281 Antox ...................................................... 533
Andepram ...............................................279 Antrenex................................................... 96
Andriol ....................................................227 Antrenyl .................................................... 96
Androgens ..............................................490 Antrin ...................................................... 422
Anespine ................................................328 Anustat ................................................... 119
Anexate ..................................................327 Anvert..................................................... 308
Anfasil .....................................................409 Anxio ...................................................... 266
Anfenac ..................................................370 Anxiolytics .............................................. 319
Anflu .......................................................284 Anxionil .................................................. 266
Anfree .....................................................273 Anxirel .................................................... 266
Angentz ..................................................273 Anxopam ................................................ 266
Angicard .................................................139 Anzet ...................................................... 273
Angifix.....................................................139 Anzitor .................................................... 170
Angilat ....................................................126 Anzole ...................................................... 65
Angilock Plus ..........................................133 AP ......................................................... 163
Angilock ..................................................133 Apagrel................................................... 164
Angimet ..................................................145 Apain Plus .............................................. 333
Angimil....................................................143 Apain ...................................................... 332
Anginox ..................................................145 Apalene .................................................. 433
Angirid ....................................................145 Apcocid .................................................... 92
Angist .....................................................139 Apedrox.................................................... 92
Angitrim ..................................................145 Apefol-TR ............................................... 497
Angivas...................................................145 Apegestrol .............................................. 490
Angivent .................................................145 Apevit- M ................................................ 531
838
GENERAL INDEX
A-Phenico ...............................................358 Arlin .......................................................... 51

Apicard ...................................................123 Arnex...................................................... 337
Apidone ....................................................99 Arnigen........................................... 135, 137
Apidra SoloStar ......................................203 Arocef....................................................... 12
Apitac .....................................................330 Arodin............................................. 401, 439
APN ........................................................513 Arofil ....................................................... 180
Apnac .....................................................332 Aroflo ...................................................... 182
Apocal D .................................................519 Arokast ................................................... 185
Apocal DM ..............................................521 Aromatin................................................. 491
Apodin ....................................................439 Aronem .................................................... 28
Appras ....................................................164 Aropen ..................................................... 28
Aprepitant .................................................98 Aros ........................................................ 330
Apresin ...................................................284 Arotide.................................................... 182
Aprocin ............................................ 38, 360 Arotril ...................................................... 296
Aprodex ......................................... 361, 390 Arotrix..................................................... 415
Apsol ......................................................400 Arovan.................................................... 135
Aptin .............................................. 211, 212 Arovent................................................... 185
Apuldon ....................................................99 A-Rox ....................................................... 34
Aqua Care ..............................................437 Aroxol ..................................................... 188
Aqua .......................................................383 Arpolax ................................................... 279
Aquafresh ...............................................383 Artear ..................................................... 384
Aqualax ..................................................118 Artemet .................................................... 60
Aquatear .................................................384 Artex......................................................... 61
Aquavit ...................................................532 Arth A ............................................. 352, 353
Arain .......................................................293 Arthrofen Plus ........................................ 333
Araten .....................................................133 Arthrosin................................................. 352
Arbecin ...................................................237 Artica ...................................................... 425
Arbitan ....................................................133 Articulex ................................................. 352
Arbitel ............................................ 135, 141 Artigo ...................................................... 306
Arbium ....................................................133 Artoflex ................................................... 331
Arcet .......................................................422 Artorix..................................................... 333
Ardium ....................................................120 Aruxil .............................................. 146, 313
Arduan ....................................................325 Asaf .......................................................... 42
Arexel .......................................................60 Asaline ................................................... 112
Argolin ....................................................264 Ascab ..................................................... 414
Arilol .......................................................125 Ascabiol ................................................. 414
Aripen .....................................................272 Asclop .................................................... 163
Aripra ......................................................272 Ascobex ................................................. 528
Ariprazole ...............................................272 Ascon ..................................................... 181
Ariprex ....................................................273 Ascorbic Acid ................................. 260, 528
Aripriprazole ...........................................272 Ascoson ................................................. 528
Aristen ....................................................365 Asector ................................................... 104
Aristo Gold .............................................531 Asfen ...................................................... 184
Aristo Kid ................................................532 Asibalin .................................................. 299
Aristo Mom .............................................532 Asiben ...................................................... 83
Aristobet-N ............................ 367, 388, 417 Asibion ................................................... 527
Aristocal D ..............................................519 Asiclin....................................................... 50
Aristocal M..................................... 521, 531 Asidox ...................................................... 36
Aristocal..................................................517 Asiflocin.................................................... 39
Aristocort Plus ........................................409 Asigen ............................................ 359, 390
Aristocort ................................................420 Asilac ..................................................... 117
Aristocrom ..................................... 372, 395 Asilee ............................................... 40, 361
Aristoferon ..............................................496 Asinar ..................................................... 102
Aristomol ................................................377 Asinol ..................................................... 377
Aristomox ...................................................8 Asipan ........................................ 95, 96, 308
Aristophen ..............................................358 Asipine ................................................... 377
Aristoplex................................................526 Asitrax ...................................................... 84
Aristovit M...............................................532 Asitrol ..................................................... 422
Aristovit X ...............................................532 Asitrum Cod ........................................... 532
Aristovit ...................................................526 Asitrum Gold .......................................... 532
Aritone ....................................................526 Asitrum Silver ......................................... 532
Arixon .......................................................24 Asivert .................................................... 308
839
GENERAL INDEX
Asivit ZI...................................................496 Autotear ................................................. 384

Asivit .......................................................526 AV ......................................................... 135
Asixone.....................................................24 Avamys .................................................. 394
Asizime .....................................................22 Avas ....................................................... 170
Asizith .......................................................31 Avaspray ................................................ 394
Aslor .......................................................423 Avastin ................................................... 484
Asmacon ................................................180 Avatan .................................................... 380
Asmafen .................................................184 Avatan-T ................................................ 380
Asmalin...................................................178 Avator..................................................... 170
Asmaloc..................................................180 Avaxim ................................................. 456
Asmatab .................................................185 Avenac ................................................... 330
Asmol ............................................ 289, 290 Avert plus ............................................... 308
Asmont ...................................................185 Avert ....................................................... 308
Asorin .....................................................291 Avidol ..................................................... 125
Asozit ......................................................104 Avifanz ..................................................... 78
A-Spasm...................................................96 Avifix ........................................................ 79
Aspirel ....................................................163 Avil ................................................. 192, 426
Aspirin .................................... 162,216, 291 Avintol .................................................... 146
Aspra ......................................................106 Avison .................................................... 409
Astac ......................................................102 A-Vit ....................................................... 524
Aster .......................................................170 Avlocid Plus ............................................ 94
Astin .......................................................170 Avlocid MS ............................................... 93
Astiva ......................................................170 Avloclav...................................................... 9
Asul ........................................................178 Avlomox ..................................................... 8
Asunra ....................................................504 Avloquin ................................................... 61
Asurel .....................................................164 Avlosef ..................................................... 13
Asynta ......................................................93 Avlotrin ..................................................... 43
Atasin .....................................................170 Avloxin ..................................................... 13
Atebit ......................................................123 Avodil VI ................................................. 135
Atechlor ..................................................124 Avolac .................................................... 117
Ateloc .....................................................123 Avolose .................................................. 117
Atenolol ..................................................123 Avomine ......................................... 311, 427
A-Tetra ............................................ 36, 364 Avona ..................................................... 309
Ateval .....................................................284 Avonex ................................................... 308
Atezen ....................................................123 Avonoid .................................................. 120
Atidon .......................................................99 Avost ...................................................... 380
Atier ED ..................................................383 Avotil ...................................................... 276
Atin .........................................................123 Avox ....................................................... 256
Atinid ........................................................67 Avro ........................................................ 380
Atonor .....................................................170 Axeclav .................................................... 17
Atopen ................................... 289, 290, 291 Axet .......................................................... 16
Atorvast ..................................................169 Axetil ........................................................ 16
Atorvastatin ............................................170 Axicef ....................................................... 16
Atostin ....................................................170 Axim ................................................... 16, 17
Atova ......................................................170 Aximin ...................................................... 52
Atovin .....................................................170 Axinat ..................................................... 179
AtoZ Premium ........................................532 Axodin .................................................... 424
AtoZ Senior ............................................532 Axofen .................................................... 424
ATP ........................................................289 Axon ......................................................... 24
Atracurium ..............................................324 Axosin ...................................................... 24
Atralin .....................................................281 Axsol ...................................................... 188
Atreon .......................................................28 AZ ................................................... 31, 358
Atrizin .....................................................422 Azalid ....................................................... 31
Atrogen ...................................................375 Azaltic ...................................................... 31
Atropine .......................... 95, 158, 318, 375 Azasite ..................................................... 31
Atropine-Jayson .......................................95 Azathioprine ...........344, 429, 465, 485, 503
Atropine-OSL .........................................375 Azbec ..................................................... 181
Atrovast ..................................................170 Azecol ............................................ 386, 533
ATS ........................................................459 Azelaic Acid ................................... 405, 433
AU-20 .....................................................106 Azelec .................................................... 433
Augment .....................................................9 Azepam .................................................. 267
Aup .........................................................108 Azicin ............................................... 31, 358
840
GENERAL INDEX
Aziget .......................................................31 Barbipan ................................................ 302

Azikil .........................................................31 Barit ........................................................ 302
Azilsartan................................................132 Barbiturates ........................................... 315
Azimex......................................................31 Barcavir .................................................... 72
Azimon .....................................................31 Barif ........................................................ 348
Azin ..........................................................31 Barium............................................. 539,540
Azinaaf .....................................................31 Basiliximab ............................................. 486
Azisan .....................................................132 B-card .................................................... 123
Azithral .....................................................31 BCG Immunotherapeutics ..................... 488
Azithro ......................................................31 BCG Medac ........................................... 447
Azithrocin..................................................31 BCG Vaccine ......................................... 447
Azithrogen ................................................32 B-Cort..................................................... 367
Azithromax ...............................................32 BEC........................................................ 533
Azithromycin .................................... 31, 357 Beclocort ................................................ 181
Azix ...........................................................32 Beclomet ................................................ 393
Azmasol..................................................178 Beclometasone .............................. 181, 393
Azmin ................................................ 32, 34 Beclomin ................................................ 181
Azole ........................................................83 Beclovan ................................................ 350
Azolin ......................................................396 Beconase ............................................... 393
Azomac ....................................................32 Beconex ZI ............................................. 527
Azonam ....................................................28 Beconex ................................................. 526
Azopres ..................................................379 Becospray .............................................. 393
Azopt ......................................................379 Becovent ................................................ 181
Azro ..........................................................32 Becovir ..................................................... 76
Aztreonam .............................. 26,28, 39, 45 Beklo ...................................................... 350
Aztrum Gold ...........................................532 Belocef ..................................................... 13
A-Zyme ...................................................121 Ben-A ....................................................... 83
Benadip .................................................. 141
Benalgin ......................................... 289, 290
B Bencart................................................... 352
Benda....................................................... 83
B126 .......................................................527 Bendex ..................................................... 84
B-50 Forte ..............................................526 Bendil ..................................................... 428
Babivit .....................................................531 Benfast ..................................................... 83
Baby Saline ............................................513 Benmet..................................................... 65
Baby Sol Junior ......................................513 Benosol .................................................. 414
Baby Sol .................................................513 Benoxiclin .............................................. 433
Baby Zinc ...............................................522 Benozole ................................................ 379
Babykion.................................................531 Bensal .................................................... 408
Babysol Junior ........................................513 Bentid ..................................................... 102
Babysol...................................................513 Benvit - M ............................................... 532
Bacampicillin ..............................................7 Benvit -B ................................................ 526
Bacifen ...................................................350 Benzac ................................................... 433
Backtone ................................................350 Benzapen ................................................... 4
Baclium ...................................................350 Benzathine penicillin .................................. 4
Baclodol..................................................350 Benzit ..................................................... 273
Baclofen .................................................349 Benzocaine ............................................ 327
Bacloflex .................................................350 Benzodiazepines ........................... 265, 319
Baclon ....................................................350 Benzopam .............................................. 266
Bacmax ..................................................350 Benzoyl Peroxide ................................... 433
Bacofen ..................................................350 Benzyl benzoate .................................... 414
Bacron ....................................................412 Benzyl Penicillin ......................................... 4
Bactamox ...................................................8 Beovit ..................................................... 524
Bactin D ..................................................361 Bepogen ................................................ 371
Bactin HC ...............................................390 Bepotas .................................................. 371
Bactin ............................................... 38,360 Bepotastine Besilate .............................. 371
Bactoderm ..............................................406 Beractant ............................................... 187
Bactokil .....................................................13 Berdinal .................................................. 302
Bactroban ...............................................406 Berin Plus .............................................. 527
Bactrocin ................................................406 Berin ....................................................... 524
Bambelor ................................................177 Besibac .................................................. 360
Bambuterol .............................................177 Besiflox .................................................. 360
Banxyt ....................................................273
841
GENERAL INDEX
Besifloxacin ............................................360 Bfenac .................................................... 369

Besigen ..................................................360 Bicalutamide .......................................... 492
Besiven...................................................360 Bicozin I ......................................... 496, 527
Bestcef .....................................................19 Bicozin ................................................... 527
Bestcol ....................................................172 Big B ...................................................... 526
Beta ........................................................127 Bigmet .................................................... 208
Bet-A ............................................. 218, 416 Biguanides ............................................. 207
Betabis ...................................................124 Bilicir ...................................................... 120
Betacal ...................................................140 Bimaprost ............................................... 380
Betacard .................................................126 Bimast .................................................... 379
Beta-carotene .........................................533 Bimatoprost ............................................ 379
Betacin-N....................................... 367, 388 Bimator................................................... 380
Betacor ...................................................124 Bimuty .................................................... 522
Betaderm N ............................................417 Binzotim ................................................. 378
Betaderm ................................................416 Biocid MH ................................................ 92
Betadine ......................................... 439,401 BIocid Plus ............................................... 94
Betafix ....................................................124 Biocid ....................................................... 92
Betagan ..................................................377 Biocin ............................................. 191, 422
Betahistine .................................... 305, 392 Biocort .................................................... 369
Betaloc ...................................................126 Biofez ..................................................... 497
Betamesal ..............................................441 Biofo ....................................................... 466
Betameson-N .........................................417 Bionex .................................................... 168
Betamethasone Valerate .............. 416, 417 Biopen ........................................................ 5
Betamethasone ............. 217, 341, 367, 388 Bioron..................................................... 496
Betamycin...............................................417 Biotest Human Albumin ......................... 514
Betaone ..................................................126 Biotrex ...................................................... 84
Betapro ...................................................124 Biotrim ...................................................... 43
Betasef .....................................................13 Biovit E ................................................... 530
Betasil .....................................................371 Biovit Gold ............................................. 532
Betason-N ..............................................388 Biovit PDD ............................................. 531
Betastin ..................................................371 Biovit Plus .............................................. 496
Betaval N ................................................417 Biovit PN ................................................ 533
Betaval ...................................................416 Biovit Silver ............................................ 532
Betavate CL ...........................................416 Biovit ...................................................... 526
Betavate-N .............................................417 Biovit-M .................................................. 532
Betaxolol.................................................377 Bioxim ...................................................... 19
Bet-CL ....................................................416 Biozinc ................................................... 522
Beticin .....................................................422 Biozinc-I ......................................... 496, 527
Betnelan ........................................ 218, 416 Biozyl ....................................................... 65
Betnovate CL .........................................416 Biphasic Insulin ...................................... 203
Betnovate-N ...........................................417 Bipinor .................................................... 126
Betricin ...................................................367 Bisacodyl ............................................... 116
Betricin-N................................................388 Bislol Plus .............................................. 124
Betson ....................................................416 Bislol ...................................................... 124
Betson-N ................................................417 Bisocor ................................................... 124
Beucal D .................................................519 Bisoloc ................................................... 124
Beuflox D ................................................361 Bisopress ............................................... 124
Beuflox .................................... 38, 360, 390 Bisopro ................................................... 124
Bevacimab .............................................484 Bisopro-A ............................................... 125
Bevastim.................................................484 Bisoprolol ............................................... 124
Bevixa .................................................... See Bisoren ................................................... 124
Bexen .......................................................12 Biva ........................................................ 159
Bexidal ........................................... 191, 426 Bizi ......................................................... 527
Bexipred ........................................ 221, 369 Bizoran ................................................... 141
Bexitrol F ................................................182 Bleocin ................................................... 470
Bextram Gold .........................................532 Bleomycin .............................................. 470
Bextram KIDZ .........................................532 Bloatstop .................................................. 94
Bextram Silver ........................................532 Bludrop................................................... 384
Bextram Teen HM ..................................532 B-mycin .................................................. 406
Bextram Teen HR ..................................532 BN ................................................ 367, 388
Bextram ..................................................532 Bomaz .................................................... 266
BFC ........................................................369 Bon One ................................................ 529
842
GENERAL INDEX
Boncare ..................................................233 Broxidil ................................................... 188

Bondronat ...............................................233 Broxine ................................................... 189
Bondrova ................................................233 Broxolin .................................................. 188
Bone .......................................................233 Broxolit ................................................... 188
B-One .....................................................524 Broze ...................................................... 266
Bonec .....................................................517 Brozep.................................................... 266
Bonemass ..............................................233 BS ......................................................... 408
Bonfix .....................................................233 BSH........................................................ 369
Bonflex ...................................................352 Budemet................................................. 182
Boni D .....................................................519 Budenide ................................................ 393
Boni ............................................... 517, 521 Budesonide .................................... 181, 393
Bonizol ....................................................234 Budicort .......................................... 182, 393
Bonmax ..................................................233 Budison F-80 ......................................... 182
Bonova ...................................................233 Bufen SR ............................................... 334
Bontiv .....................................................353 Bufocort.................................................. 182
Bontoni ...................................................521 Bumecard .............................................. 149
Bopam ....................................................266 Bumetanide ............................................ 149
Bortez .....................................................475 Bupi Heavy ............................................ 328
Bortezomib .............................................475 Bupi ........................................................ 328
Bosentan ................................................174 Bupivacaine .................................. 328, 381
Boxol ......................................................188 Bupropion .............................................. 285
BPcal ............................................. 517, 519 Burna ..................................................... 407
BPdon .......................................................99 Burnless ................................................. 407
B-Plus .....................................................527 Burnrid ................................................... 407
B-Prolol...................................................124 Burnsil .................................................... 407
Breathlin .................................................180 Buscon ..................................... 95, 308, 319
Bredicon .................................................249 Busper.................................................... 270
Brevoxyl..................................................433 Buspirone ............................................... 270
Bricoma ..................................................378 Busulfan ................................................. 468
Brilinta ....................................................165 Busulphan .............................................. 468
Brimo ......................................................378 Butapan...................................... 95, 96, 308
Brimodin Plus .........................................378 Butason .................................................... 96
Brimodin .................................................378 Butefin .................................................... 408
Brimonidine ...........................................378 Buterol.................................................... 177
Brimopres ...............................................378 Butibac ..................................................... 23
Brinzolamide ..........................................379 Buticef ...................................................... 23
Brinzopt ..................................................379 Buviren ..................................................... 73
Bristol Neoset .........................................102 Buzz ....................................................... 527
Brocast ...................................................185 B-Zn ....................................................... 522
Broculyt ..................................................188
Brodactam ................................................10
Brodil ......................................................178 C
Brofex .....................................................189
Broket .....................................................184 C-2 ........................................................... 16
Brolon .....................................................266 C-3 ........................................................... 19
Brolyt ......................................................189 C-4 ......................................................... 519
Bromazep ...............................................266 Cab ........................................................ 140
Bromazepam ..........................................266 Cabazitaxel ............................................ 481
Bromhexine ............................................188 Cabergol ................................................ 264
Bromnac .................................................369 Cabergoline ........................................... 263
Bromocriptine ................................ 261, 303 Cabita..................................................... 471
Bromodel ....................................... 262, 303 Cabolac .................................................. 264
Bromofen ................................................369 Cabolin ................................................... 264
Bromofenac ............................................369 CaC-1000 .............................................. 519
Bromolac ....................................... 262, 303 Cacetor .................................................. 141
Bromotex ................................................189 Cadmin Plus .......................................... 521
Bromotine ...............................................262 Cadmin................................................... 519
Bromoxol ................................................189 Cadnyl .................................................... 131
Bronchodex ............................................189 Cadolin ................................................... 519
Broncotrol ...............................................178 Cafedon ................................................. 290
Brostin ....................................................189 Cafenol................................................... 290
Brox ........................................................188 Cafeta .................................................... 290
Caffo ...................................................... 290
843
GENERAL INDEX
Caf-N ......................................................290 Caldical .................................................. 518

Caftadin ..................................................371 Caldical-D .............................................. 519
Caftyl ......................................................290 Caldil Plus .............................................. 519
Caid ........................................................291 Caldil ...................................................... 518
Cal D Plus ..............................................521 Caldivit ................................................... 519
Cal D ......................................................519 Caldolin .................................................. 519
Cal .........................................................517 Calfor D .................................................. 519
Calac ......................................................518 Calfor ..................................................... 518
Calamilon ...............................................427 Calget..................................................... 519
Calamine ....................................... 427, 428 Calm....................................................... 267
Calbeta ...................................................140 Calmet D ................................................ 520
Calbo D vita ............................................519 Calmet.................................................... 518
Calbo fort ................................................521 Calmi ...................................................... 518
Calbo ......................................................517 Calmi-D .................................................. 520
Calbo-C ..................................................519 Calmi-M.................................................. 521
Calbon M ...............................................521 Calnor .................................................... 141
Calbon Plus ............................................521 Calock Plus ............................................ 141
Calbon ....................................................517 Calock .................................................... 140
Calbon-D ................................................519 Calofast .................................................. 518
Calboplex ...............................................521 Calorate Kit ............................................ 233
Calboral-D ..............................................519 Calorate ................................................. 518
Calborate ................................................518 Caloren .................................................. 530
Calcarb ...................................................517 Calos ...................................................... 518
Calchek ..................................................140 Calpin ..................................................... 140
Calci .......................................................519 Calpress ................................................. 140
Calcibo ...................................................517 Calsart.................................................... 141
Calcibo-D................................................519 Calsil M .................................................. 521
Calcibost.................................................517 Calsil .............................................. 518, 520
Calcibost-D .............................................519 Calson .................................................... 518
Calcicar ..................................................518 Calsto ............................................. 518, 520
Calci-D plus ............................................519 Caltate.................................................... 518
Calcid .....................................................518 Caltonic .................................................. 518
Calci-D ....................................................519 Caltonic-D .............................................. 520
Calciferol ................................................529 Caltrol..................................................... 530
Calcifil ............................................ 518, 519 Calvasc .................................................. 140
Calcin .....................................................518 Calvimax Plus ........................................ 521
Calcinate ................................................519 Calvimax ................................................ 520
Calcin-D..................................................519 Calzirin ................................................... 428
Calcin-M .................................................521 Camide................................................... 375
Calcipotriol .............................................429 Camiton.................................................. 146
Calcitate .................................................518 Camlodin ................................................ 140
Calciton ..................................................518 Camlopril ................................................ 141
Calcitonin................................................234 Camlosart .............................................. 141
Calcitriol......................................... 529, 530 Camouflagers ........................................ 441
Calcium ambee ......................................518 Camoval ................................................. 135
Calcium Carbonate ................................517 Campto .................................................. 483
Calcium Folinate ....................................466 campylobacter ......................................... 33
Calcium Forte Plus .................................521 Canasa................................................... 114
Calcium Forte .........................................521 Canazole ................................................ 409
Calcium Gluconate .................................518 Cancidas .................................................. 57
Calcium leucovorin .................................466 Candesa ................................................ 132
Calcium levoleucovorine ........................466 Candesartan Cilexetil ............................ 132
Calcium- M .............................................521 Candex................................................... 412
Calcium Orotate ............................ 233, 518 Candid.................................................... 409
Calcium Pentothenate ............................519 Candidal ................................................. 410
Calcium ..................................................518 Candinil .................................................. 410
Calcium-C Forte .....................................521 Candirox................................................. 408
Calcium-C Plus ......................................521 Candoral ........................................ 401, 411
Calcium-Jayson ......................................518 Canider .................................................. 142
Calcizen DS ...........................................518 Cantina................................................... 408
Calcizen..................................................518 Capdol.................................................... 290
Calcoral-D ..............................................520 Capecitabine .......................................... 471
844
GENERAL INDEX
Capotril ...................................................129 Cartace .................................................. 131

Capreomycin ............................................46 Cartibon ................................................. 353
Caprolex .................................................167 Carticare ........................................ 352, 353
Caprolycin ..............................................167 Carticel Plus ........................................... 352
Capsaicin................................................428 Cartifit..................................................... 352
Captopril .................................................129 Cartigen ................................................. 352
Captropril ................................................129 Cartilage Plus ........................................ 352
Carbachol ...............................................376 Cartilex ................................................... 353
Carbamazepine ..................... 292, 231, 295 Carva ..................................................... 291
Carbamazine ............................................85 Carved ................................................... 125
Carbanem.................................................28 Carvedilol ............................................... 125
Carbate...................................................237 Carvetab ................................................ 125
Carbazine ...............................................296 Carvicard ............................................... 125
Carben -D ...............................................520 Carvipress .............................................. 125
Carben ....................................................518 Carvista .................................................. 125
Carbetocin ..............................................237 Casalt ..................................................... 518
Carbimazole .................................. 197, 198 Casalt-D ................................................. 520
Carnomazole ..........................................198 Castin ..................................................... 189
Carbizol ..................................................198 Catalan................................................... 370
Carbocal ........................................ 518, 520 Catapres ................................................ 138
Carbocal-D .................................... 266, 520 Catnil ...................................................... 386
Carbocisteine .........................................189 Catopil .................................................... 129
Carbolin ..................................................189 Catrix...................................................... 386
Carbomet................................................497 Cavapro ................................................. 133
Carboplat ................................................480 Cavazide ................................................ 133
Carboplatin .............................................480 Cavelon .................................................. 125
Carbos ....................................................214 Cavic C .................................................. 519
Carboten DS ..........................................189 Cavic-C Plus .......................................... 521
Carbotin ..................................................480 Cavic Plus .............................................. 519
Carboxypenicillin ......................................10 Cavinton ................................................. 146
Cardex ....................................................125 Cavir......................................................... 72
Cardicor ..................................................124 Caviral ...................................................... 72
Cardifort..................................................140 Caviton ................................................... 146
Cardil ......................................................142 Cazep..................................................... 296
Cardilock ................................................123 C-bon ..................................................... 528
Cardimet .................................................145 CCB ....................................................... 140
Cardinex .................................................160 Cden ...................................................... 518
Cardinor..................................................124 Ceb ........................................................ 533
Cardipin ..................................................140 Cebeta ................................................... 533
Cardipro..................................................123 Cebex....................................................... 19
Cardiron..................................................154 Cebumax ................................................. 23
Cardisan .................................................133 Cebuten ................................................... 23
Cardisef ......................................... 124, 142 Ceclav ...................................................... 17
Cardival Plus .........................................135 Ceclofen ................................................. 330
Cardival ..................................................135 Cecon..................................................... 528
Cardivas .................................................125 Cednir ...................................................... 18
Cardizem ................................................142 Cedril ........................................................ 12
Cardobis .................................................124 Ceegram ................................................ 528
Cardon ....................................................133 Ceemet .................................................. 528
Cardoneb................................................126 Ceevit ..................................................... 528
Cardopa..................................................156 Cef ........................................................... 19
Cardoplus ...............................................133 Cef-3 ........................................................ 19
Cardopril .................................................129 Cefaclav ................................................... 17
Cardovan ................................................135 Ccefaclor .................................................. 14
Cardual ...................................................171 Cefadin..................................................... 13
Caress ........................................... 433, 439 Cefadroxil ................................................. 12
Carin .......................................................189 Cefalexin .................................................. 12
Carmapine ..................................... 296, 465 Cefamax................................................... 23
Carmelus ................................................383 Cefaten .................................................... 23
Carocet ...................................................533 Cefaz........................................................ 24
Carplatin .................................................480 Cefazid ..................................................... 22
Carsec ....................................................124 Cefcil ........................................................ 19
845
GENERAL INDEX
Cefdinir .....................................................18 Centagan ....................................... 191, 422

Cefditor .....................................................19 Centoxin ................................................. 147
Cefdox ......................................................21 Centradol ............................................... 288
Cefepime ........................................... 19, 25 Central Gold ........................................... 532
Cefexta .....................................................18 Century Forte ......................................... 532
Ceficap .....................................................19 Century Select ....................................... 532
Cefiget ......................................................19 Cepdoxim ................................................. 21
Cefim ........................................................19 Cephalexin ............................................... 12
Cefipod .....................................................21 Cephid...................................................... 13
Cefix .........................................................19 Cephracap ............................................... 13
Cefixim .....................................................19 Cephradine .............................................. 13
Cefixime .......................................... 19, 391 Cepilep ................................................... 296
Ceflin ........................................................13 Ceporex ................................................... 13
Ceflon .......................................................15 Ceptiva ................................................... 247
Cefobac ............................................. 16, 17 Cerenin .................................................. 146
Cefobid .....................................................21 Cereton .................................................. 147
Cefodim ....................................................21 Cerevas.................................................. 147
Cefokid .....................................................21 Cerivin .................................................... 147
Cefomin ....................................................21 Cero .................................................. 38,360
Cefone ......................................................24 Cerodex ......................................... 361, 390
Cefopen ....................................................12 Cerox ................................................. 16, 18
Cefoperazone ...........................................12 Ceroxime ................................................. 16
Ceforan.....................................................21 Certican.................................................. 477
Cefot .................................................. 15, 21 Cervarix.................................................. 452
Cefotax .............................................. 15, 21 Cesalin ................................................... 481
Cefotaxime ........................................ 18, 20 Cesonide ................................................ 182
Cefotil ................................................ 16, 17 Cetal ............................................... 289, 290
Cefotime ............................................ 15, 21 Cetam ............................................ 289, 290
Cefpxitin ...................................................15 Cetaxone ................................................. 24
Cefozil ......................................................16 Cetirizine ........................................ 190, 422
Cefpirome .................................................26 Cetizin .................................................... 422
Cefpod ......................................................21 Cetriben ................................................. 422
Cefpodoxime ...................................... 21,22 Cetri-Mak ............................................... 422
Cefprozil ...................................................15 Cetrimide ............................................... 438
Ceftax ................................................ 15, 21 Cetrin ..................................................... 422
Ceftazidime ..............................................22 Cetriz...................................................... 422
Ceftazim ...................................................22 Cetrol ..................................................... 422
Cefteria .....................................................23 Cetrorelix ............................................... 263
Ceftiben ....................................................23 Cetrotide ................................................ 263
Ceftibuten .......................................... 18, 23 Cevalin ................................................... 528
Ceftid ........................................................19 Cevion .................................................... 528
Ceftipime ..................................................25 Cfl ........................................................... 15
Ceftizone ..................................................24 Chear ..................................................... 281
Ceftobac ...................................................24 Chewce .................................................. 528
Ceftoren....................................................19 Chlorambucil .......................................... 468
Ceftriaxone ........................................ 18, 23 Chloramphenicol ..................... 49, 358, 389
Ceftrix .......................................................24 Chlorhexidine ................................ 401, 437
Ceftron ......................................................24 Chlormet ................................................ 358
Cefunix .....................................................16 Chlorodex .............................................. 358
Cefurim .............................................. 16, 17 Chloroquine ..................................... 61, 344
Cefuroxime ................... 11, 16,17, 364, 391 Chlorovis ................................................ 358
Celbarin ....................................................74 Chloroxylenol ........................................ 438
Celecoxib................................................330 Chlorphen ....................................... 358,389
Celenta ...................................................331 Chlorpheniramine .........191, 193, 393, 422
Cellcept ..................................................485 Chlorpromazine ............................ 273, 306
Celofen ...................................................330 Chlorpropamide ............................. 205, 231
Celoxib ...................................................331 Cholcut ................................................... 172
Celozin ...................................................422 Cholera Saline ....................................... 112
Celudex ......................................... 367, 388 Cholera .................................................. 462
Celulose .................................................116 Chorionic gonadotropin ......................... 226
Cenet ......................................................518 Chrocee ................................................... 74
Cenolon ......................................... 221, 395 Chuben .................................................... 83
846
GENERAL INDEX
Ciaton .....................................................259 Citritol ..................................................... 530

Cibact .......................................................38 Civodex .......................................... 361, 390
Ciclesonide .................................... 182, 393 Civox ................................................ 38, 360
Ciclopirox Olamine .................................408 Clamox ..................................................... 10
Ciclosporin ............................ 430, 486, 503 Clarex..................................................... 423
Ciflocin ....................................................360 Claricin ..................................................... 33
Ciflocin ......................................................38 Clarigen.................................................. 425
Ciflox ......................................................389 Clarin ........................................................ 33
Cikolin.....................................................313 Clarith....................................................... 33
Cildip ......................................................141 Clarithromycin .......................................... 32
Cilocin .......................................................38 Clarizol ................................................... 365
Cilosta ....................................................146 Clarox....................................................... 33
Cilostazol ................................................146 Clas ........................................................ 163
Cinagen ..................................................362 Clavuran................................................... 22
Cinamycin Plus ......................................434 Clavurox ................................................... 18
Cinamycin.................................................50 Clavusef ................................................... 18
Cinarex D ...............................................360 Claxo ...................................................... 160
Cinarex ...................................................359 Claz ........................................................ 206
Cinaron ...................................................306 Cleanser......................................... 401, 439
Cinaryl ....................................................306 C-Lemon ................................................ 528
Cinarzin Plus ..........................................306 Cleocin ..................................................... 50
Cinazin ...................................................306 Cleodin ..................................................... 50
Cinemat ..................................................303 Clexane .................................................. 160
Cinnarizine .............................................306 Climycin ................................................... 50
Cinon ......................................................419 Clinacyn T .............................................. 434
Cinrim .....................................................306 Clinacyn ................................................... 50
Cip .......................................... 38, 360, 389 Clincin ...................................................... 50
Cipcin .............................................. 38, 360 Clinda ....................................................... 50
Cipcin-DX ...............................................361 Clindabac ................................................. 50
Cip-D ............................................. 361, 390 Clindacin Plus ........................................ 434
Ciprin ............................................... 38, 360 Clindacin .......................................... 50, 433
Cipro A ...................................................360 Clindamet ................................................. 50
Cipro D ...................................................361 Clindamycin ....................... 50,405,433, 435
Cipro .........................................................38 Clindaver .................................................. 50
Ciprobey ...................................................38 Clindax Plus ........................................... 434
Ciprocin ................................... 38, 360, 390 Clindax ..................................... 50, 243, 433
Ciprocort .................................................390 Clinex Plus ............................................. 434
Ciprofloxacin ........................... 37, 360, 389 Clinex ............................................... 50, 433
Cipronaaf ..................................................38 Clinface .................................................. 434
Cipronil .....................................................38 Clinorel ................................................... 339
Ciprox ...................................... 38, 360, 390 Clinosol Gold ......................................... 512
Ciproxy IV .................................................38 Clinosol .................................................. 512
Ciproxy .......................................... 360, 389 Clit ........................................................... 61
Ciprozen ...................................................38 Cloavurox ................................................. 18
Ciprozid ........................................... 38, 360 Clob ........................................................ 267
Ciprozid-DX ................................... 361, 390 Clobac ...................................................... 15
Cipwell ......................................................38 Clobam................................................... 267
Cisatracurium .........................................324 Clobazam ............................................... 267
Cispenam .................................................27 Clobederm ............................................. 417
Cisplat ....................................................481 Clobesol ......................................... 417, 418
Cisplatin............................ 29, 465, 480,481 Clobetasol ............................................. 417
Citalam ...................................................279 Clobex ........................................................ 5
Citalex ....................................................279 Clobid ..................................................... 267
Citalon ....................................................279 Clocef ....................................................... 15
Citalopram ..............................................278 Clocin ..................................................... 433
Citamin ...................................................528 Clodal ..................................................... 408
Citapram .................................................279 Clod-B .................................................... 189
Citazar ....................................................298 Cloderm ................................................. 408
Citicol ......................................................313 Clofazimine .............................................. 48
Citicoline .................................................313 Clofenac Plus ......................................... 333
Citin ........................................................422 Clofenac ................................................. 332
Citra-K ....................................................261 Clofenta.................................................. 330
847
GENERAL INDEX
Clogfree ..................................................163 Coavlon .................................................... 60

Clognil ....................................................163 Co-Axet .................................................... 18
Cloma .....................................................296 Co-Careldopa ........................................ 303
Clomifen .................................................226 Cod Plus ................................................ 532
Clomin ............................................ 191,423 Co-Diovan .............................................. 135
Clon ........................................................296 Co-Disys ................................................ 135
Clonaben ................................................296 Codomix ................................................. 532
Clonapin .................................................296 Co-dopa ................................................. 303
Clonate NN .............................................418 Codvita ................................................... 532
Clonate ...................................................417 Coflyt ...................................................... 189
Clonatril ..................................................296 Cognitol .................................................. 147
Clonazepam .......................... 295, 296, 297 Cogniz .................................................... 313
Clonidine ................................................138 Colagel ................................................... 436
Clonidine ................................................138 Colamin .................................................. 526
Clonium ..................................................296 Colchicine .............................................. 346
Clont .......................................................163 Coldflu .................................................... 189
Clontas ...................................................163 Colical .................................................... 529
Clopam ...................................................296 Colicon ..................................................... 95
Clopicard Plus ........................................163 Colik ......................................... 95, 308, 319
Clopid .....................................................163 Colimax .................................................. 347
Clopid-AS ...............................................163 Colipan ..................................................... 96
Clopidogrel ..................................... 162,163 Colitrol .................................................... 530
Clopidol Plus ..........................................163 Colostat .................................................. 170
Clopidol ..................................................163 Coluric .................................................... 347
Clopigel Plus ..........................................163 Combair ................................................. 179
Clopigel ..................................................163 Combat .................................................. 378
Clopilet A ................................................163 Combicard ............................................. 140
Clopirel ...................................................163 Combipen .................................................. 5
Clopirox ..................................................408 Combiplat ............................................... 163
Clopivas..................................................163 Combipres ............................................. 378
Clopixol Acuphase .................................278 Combiver ............................................... 179
Clopixol Depot ........................................278 Combivit ................................................. 526
Cloplet ....................................................163 Combocef ................................................ 22
Cloram D ................................................358 Combomax ............................................ 255
Cloram ....................................................358 Comet .................................................... 208
Cloramin ........................................ 191, 423 Comipen................................................. 226
Clorel ......................................................163 Comol..................................................... 417
Clorel-A ..................................................163 Comol-NN .............................................. 418
Clori HC ..................................................420 Compiron ............................................... 496
Clorocef ....................................................15 Complavit ............................................... 526
Cloron .....................................................296 Comprid ................................................. 206
Closalic ...................................................418 Comtan .................................................. 304
Closten ...................................................408 C-On ...................................................... 528
Clotinex ..................................................160 Conacream ............................................ 409
Clotison ..................................................420 Conart .................................................... 149
Clotrim ........................................... 242, 408 Conasyd ................................................. 413
Clotrimazole ... 242, 365, 387, 390, 408,420 Conaz..................................................... 410
Clotzol ....................................................408 Conbis .................................................... 124
Clovate N................................................418 Concivit Z ............................................... 497
Clovate .......................................... 417, 418 Condia.................................................... 206
Clover .....................................................413 Condoms ............................................... 252
Clovir ......................................................366 Confree .................................................. 396
Cloxacillin ...................................................5 Conicol ............................................ 358,389
Clox-F .........................................................6 Conjugated oestrogens ......................... 222
Cloxin .........................................................5 Conlax .................................................... 117
Clozapin .................................................273 Conpan .................................................. 296
Clozapine ...............................................273 Conrena-R ............................................. 247
Clozol VT ................................................242 Conrif ..................................................... 373
Clozox ....................................................409 Consucon ............................................... 206
CNV ........................................................532 Contract Lenses..................................... 386
Coal TAR ................................................430 Contifil .................................................... 180
Co-amoxiclav .............................................9 Contilex .................................................. 353
848
GENERAL INDEX
Contine ...................................................180 Cromolin................................................. 372

Contova ..................................................373 Cronix..................................................... 414
Contraceptive Devices .................. 244, 251 Crotamiton ............................................. 414
Contrast Media .......................................535 Cryoprecipitate ....................................... 507
Convules ................................................301 CTZ ........................................................ 422
Copeg .......................................................74 Cubimox ................................................... 41
Copixol ...................................................278 Cufnot .................................................... 424
Cora ........................................................520 Curacid........................................... 104, 106
Corabid ...................................................144 Curazith.................................................... 32
Corabon..................................................520 Curin ...................................................... 425
Coral .......................................................520 CuT 200B ............................................... 252
Coralcal-D ..............................................520 CuT 380 ................................................. 252
Coralex ...................................................520 Cutisone ................................................. 419
Corangi ...................................................144 Cutivate .................................................. 419
Corbic .......................................................40 Cuvir....................................................... 366
Cordema.................................................383 Cvnor ..................................................... 140
Corestin ..................................................172 Cvnor-A .................................................. 141
Cortan ............................................. 221,369 Cyclid ..................................................... 304
Cortef ......................................................219 Cyclomide .............................................. 469
Cortefin ........................................... 395,420 Cyclopan .................................................. 95
Cortider ...................................................419 Cyclophosphamide ................................ 465
Cortiflo ....................................................218 Cyclorin .................................................. 383
Cortimax .................................................218 Cycloserine .............................................. 46
Cortimet ..................................................419 Cyclosporine ............................ 29, 344, 383
Cortinex ..................................................219 Cyclotox ................................................. 469
Cortisol .......................................... 221, 369 Cyclovex ................................................ 366
Cosarin ...................................................353 Cyclovin ................................................... 95
Cosat ........................................................43 Cymevene ................................................ 71
Cosec .....................................................106 Cynocort................................................. 221
Cosium ...................................................267 Cynomin ................................................. 500
Cosmotrin ...............................................434 Cynta...................................................... 288
Costin .....................................................518 Cyphos ................................................... 469
Cosy .........................................................99 Cyporin................................................... 383
Cotrazen ...................................................43 Cyproterone acetate ...................... 227, 492
Cotrim .......................................................43 Cyproterone ........................................... 492
Co-trimoxazole .................... 42,43,391, 398 Cytabin ................................... 191, 423, 471
Cotson ....................................................219 Cytaplex M ............................................. 532
Co-Valtin.................................................135 Cytarabine ............................................. 471
Covan .......................................................54 Cytarabine ............................................. 471
Coveram .................................................131 Cytocarb................................................. 480
Coversyl plus ..........................................131 Cytocid ..................................................... 92
Coversyl .................................................131 Cytogem................................................. 472
Cox B ......................................................331 Cytomis .................................. 110, 239, 240
Cox-E .....................................................333 Cytonic ................................................... 386
Coxet ......................................................333 Cytotoxic antibiotics ............................... 470
Coxfree ...................................................333 cytotoxic drugs ....................................... 464
Coxia ......................................................333 CZ ......................................................... 422
Coxitor ....................................................333 C-Zinc .................................................... 522
Coxpain ..................................................333
Coxsafe ..................................................333
Cozopt ....................................................379 D
CP ...........................................................21
Creston ...................................................172 Dabigatran ............................................. 161
Creva ......................................................172 Dacarbazine ................................... 465, 475
Crezyme .................................................121 Daclavir .................................................... 72
Crinone ...................................................225 Daclin ..................................................... 433
Criptine ...................................................262 Daclin ....................................................... 50
Criptine ...................................................303 Daclizumab ............................................ 486
Crisantaspase ........................................474 Dactinomycin ......................................... 470
Criston ....................................................474 Dactus .................................................... 206
Crodex ....................................................414 Daflon..................................................... 120
Croma .....................................................185 Dakla ........................................................ 72
Dakovir ..................................................... 72
849
GENERAL INDEX
Dakrin .....................................................401 Defogen ................................................. 223

Dakrin .....................................................411 Deformin ................................................ 208
Dalacin Plus ...........................................434 Defrol ..................................................... 529
Dalacin .....................................................50 Defzort ................................................... 218
Dalteparin Sodium..................................159 Dejac ...................................................... 258
Danamet .................................................263 Delanix ................................................... 103
Danazol ................................. 262, 263, 503 Delentin .................................................... 84
Dancel ....................................................441 Deleta..................................................... 273
Danlene ..................................................351 Delfavir ..................................................... 78
Danoxta ..................................................161 Delice ..................................................... 415
Dantrolene Sodium ................................350 Delipid .................................................... 169
Danxit .....................................................273 Delkof ..................................................... 189
Danzol ....................................................263 Delosia ................................................... 423
Daomin ...................................................208 Delot ....................................................... 423
Dapagliflozin ...........................................212 Delotad................................................... 423
Dapaglip ........................................ 213, 214 Deloxi ............................................. 216, 282
Daporex ..................................................258 Delpark................................................... 305
Dapotin ...................................................258 Delpino ................................................... 144
Dapoxen .................................................258 Deltapred ............................................... 221
Dapsone ...................................................48 Deltasone ............................................... 221
Darbetin ..................................................502 Demacro .................................................. 32
Darifen ....................................................256 Demarin ................................................. 339
Darifenacin .............................................256 Demeclocycline...................................... 231
Darilax ....................................................256 Demelon................................................. 313
Darmacort...............................................417 Demovo........................................... 105,338
Dasanix ..................................................475 Demoxiclave ............................................ 10
Daunorubicin HCl ...................................470 Demoxil ...................................................... 8
Daxetin ...................................................258 Denicol ................................................... 358
Dayhista ........................................ 191, 426 Denixil .................................................... 296
Dayhista .................................................426 Denvar ..................................................... 19
Dayprox ..................................................339 Deon-3 ................................................... 529
Dazine ....................................................407 Deorix..................................................... 415
D-Cap .....................................................529 Depnox SR ............................................ 286
D-Cetamol ..............................................289 Depo Provera ......................................... 250
DCF ........................................................332 Depodrol ................................................ 219
D-clot ......................................................163 Depomed ............................................... 219
D-Cort ............................................ 218, 367 Depo-Pred ............................................. 219
D-Cough .................................................189 Depram .................................................. 283
DC-Plus ..................................................290 Deprex ................................................... 275
D-Dopa ...................................................303 De-rash .................................................. 440
D-Dopamine ...........................................156 Derat ...................................................... 423
Decabolon ..............................................228 Derbicil ................................................... 412
Decabutamol ..........................................178 Derfin ..................................................... 412
Deca-Durabolin ......................................228 Derma .................................................... 410
Decafos ..................................................218 Dermalog ............................................... 419
Decagyl ....................................................65 Dermanix ............................................... 415
Decalor ...................................................358 Dermasim ...................................... 242, 409
Decapepty ..............................................263 Dermaso N ............................................. 418
Decarbazine Medac ...............................475 Dermasol ............................... 417, 418, 454
Decarbazine ...........................................475 Dermex N ............................................... 418
Decason .................................................218 Dermex .................................................. 417
Decason .................................................358 Dermicon ............................................... 410
Decomit ......................................... 181, 393 Dermidex ............................................... 418
Decon .....................................................438 Dermoban .............................................. 406
Dedom ......................................................99 Dermovate ............................. 417, 418, 454
Deen .......................................................423 Dermupin ............................................... 406
Defaz ......................................................497 Dersole................................................... 417
Defiron ....................................................499 Derson ................................................... 416
Deflacort .................................................218 Des ......................................................... 423
Deflazacort .................... 217, 218, 341, 421 Desatrol.................................................. 423
Deflazit ...................................................218 Desbac ..................................................... 21
Deflux .......................................................99 Desferal.................................................. 504
850
GENERAL INDEX
Desferrioxamine .....................................504 Dextrosal-ISO ........................................ 513

Desgud ...................................................423 Dextrosal-Mini ........................................ 513
Deslor Kidz .............................................423 Dextrose......................................... 512, 513
Deslor .....................................................423 D-Fen ..................................................... 295
Desloratadine ................................ 190, 423 D-Fo ....................................................... 208
Deslorin ..................................................423 Diab ........................................................ 206
Desmopressin ........................................231 Diacer..................................................... 353
Desodin ..................................................423 Diactin .................................................... 207
Desogestrel ............................................249 Diaglit ..................................................... 210
Desolet ...................................................423 Dialina .................................................... 211
Desolon ..................................................247 Dialiptin M .............................................. 212
Desonide ................................................418 Dialiptin .................................................. 211
Desopra ..................................................103 Dialon ..................................................... 206
Desotop ..................................................418 Dia-M ..................................................... 208
Desta ......................................................423 Diamicron ............................................... 206
Destin .....................................................423 Diamin .................................................... 208
Detrusin LA ............................................258 Dianak .................................................... 112
Dettol ......................................................438 Dianide ..................................................... 67
Deu .........................................................106 Diapack .................................................. 541
Devomit ..................................................308 Diapamiro .............................................. 541
Dexa .......................................................218 Diapiotab ................................................ 210
Dexacol ..................................................358 Diaplus ................................................... 207
Dexacort ........................................ 367, 389 Diaprid.................................................... 206
Dexadron ................................................389 Diapro .................................................... 206
Dexaflox ........................................ 361, 390 Diar .......................................................... 67
Dexagen C .............................................358 Diarrhoea ...............................................See
Dexagen G .............................................361 Diaryl ...................................................... 206
Dexagen ................................ 218, 360, 367 Diascan .................................................. 540
Dexaguard ..............................................358 Diaset ..................................................... 214
Dexam ....................................................218 Diasol ..................................................... 112
Dexamet .................................................218 Diasulin 30/70 ........................................ 203
Dexamethasone ........... 193, 217, 218, 219 Diasulin 50/50 ........................................ 203
Dexamin .................................................219 Diasulin N .............................................. 204
Dexamox ................................................363 Diasulin R .............................................. 202
Dexan .....................................................219 Diatag..................................................... 210
Dexaqua .................................................512 Diatrol..................................................... 206
Dexasia ..................................................368 Diavir ...................................................... 206
Dexchlor .................................................358 Diavix ....................................................... 76
Dexcilo ............................................ 361,390 Diazem ................................................... 267
Dexibrupofen ..........................................331 Diazemet ................................................ 267
Dexilant ..................................................103 Diazepam ............................................... 267
Dexit .......................................................273 Diazepam ............................... 267, 319, 351
Dexketoprofen ........................................331 Diazid ..................................................... 206
Dexlan ....................................................103 Diazipi .................................................... 207
Dexlansoprazole ....................................103 Dibenol ................................................... 205
Dexogut ..................................................103 Dicalat .................................................... 496
Dexon .................................... 219, 361, 368 Dicaltrol .................................................. 530
Dexonex ........................ 219, 358, 368, 389 Dicef ......................................................... 13
Dexoride .................................................513 Dicephin ................................................... 24
Dexpofen ................................................189 Diclofen Plus .......................................... 333
Dexpro ....................................................331 Diclofen .................................................. 332
Dexsol ....................................................189 Diclofen .................................................. 370
Dextason ................................................219 Diclofenac Potassium ............................ 331
Dextor C .................................................358 Diclofenac Sodium ........................ 331, 370
Dextor ............................................ 219, 360 Diclofenac .............................................. 322
Dextran 40 ..............................................514 Diclon ..................................................... 370
Dextran 70 ..............................................515 Diclonac ......................................... 332, 333
Dextrobac ...............................................360 Diclonil ................................................... 332
Dextromethorphan ........................ 189, 190 Diclovir ................................................... 332
Dextropac ...............................................512 Dicloxacillin ............................................ 5, 6
Dextrosal ................................................513 Dicon ...................................................... 205
Dextrosal-Baby.......................................513 Diconten ................................................. 273
851
GENERAL INDEX
Dicot .......................................................409 Dipyridamole .......................................... 163

Dicycloverine HCl .....................................95 Diretic ..................................................... 151
Didryl ......................................................428 Dirin .......................................................... 95
Dieta .......................................................206 Dirozyl ...................................................... 65
Diethylcarbamazine..................................84 Disartan.................................................. 141
Diethylstillbestrol ....................................489 Dismonal .................................................. 97
Dietil .......................................................312 Disophyramide ....................................... 154
Difin ........................................................428 Dispazinc ............................................... 522
Diflorasone Diacetate .............................418 Disprin .................................................... 291
Diflu ........................................................410 Disys ...................................................... 135
Diflupred .................................................369 Dithranol................................................. 429
Digecid Plus .............................................93 Divastin .................................................. 170
Digoxen ..................................................147 Diverin ...................................................... 95
Digoxin ...................................................147 Dixar ....................................................... 190
Dihert ......................................................148 Dixicon ..................................................... 41
Dilapress ................................................125 Dlac ........................................................ 117
Dilarof .....................................................186 DM-Sone ................................................ 368
Dilast ......................................................150 Dobuject ................................................. 155
Dilate plus...............................................375 Dobumin................................................. 155
Dilate ......................................................375 Dobutamine ........................................... 155
Dilatol .....................................................178 Dobutin................................................... 155
Dilator .....................................................177 Docetaxel ............................................... 482
Dilatrend .................................................125 Docetex .................................................. 482
Dilgard ....................................................125 Docexan ................................................. 482
Diliner .....................................................216 Docosanol .............................................. 413
Diliner .....................................................283 Dofixim ..................................................... 21
Dilocard ..................................................125 Dogrel Plus ............................................ 163
Dilock ......................................................332 Dogrel .................................................... 163
Diltazem HCl ..........................................141 Dolonil .................................................... 288
Diltiazem.................................................142 Dolorex................................................... 288
Diltizem...................................................142 Doltro ..................................................... 336
Dilup .......................................................151 Dolwin .................................................... 337
Dilyt ........................................................188 Doma ....................................................... 99
Dimerol ...................................................206 Dometic .................................................... 99
Dimethothiazine Mesylate ......................423 Domidon................................................... 99
Dinac ......................................................370 Domilin ..................................................... 99
Dinafex ...................................................424 Domilux .................................................... 99
Dinovo TM ..............................................338 Domin....................................................... 99
Dinovo ....................................................105 Dominaaf ................................................. 99
Diohes ....................................................120 Dominat.................................................... 99
Diola .......................................................125 Domiren ................................................... 99
Dionem .....................................................26 Domperidone ........................... 99, 292, 306
Diorin ......................................................120 Domperon ................................................ 99
Diosmin with Hesperidin ........................120 Dompi....................................................... 99
Diout .......................................................208 Don-A ....................................................... 99
Diovan ....................................................135 D-One ............................................ 368, 389
Dipa ........................................................427 Donepezil ............................................... 313
Diphenhydramine HCl ...........................192 Dopac....................................................... 36
Diphenhydramine .................. 190, 423, 428 Dopadon .................................................. 99
Diptheria Vaccine with Tetanus .............449 Dopamet ................................................ 138
Diptheria Vaccine ...................................447 Dopamine ...................................... 156, 193
Diptheria Pertussis Tetanus Combined Dopegyt.................................................. 138
Vaccine ............................................447 Dorel Plus .............................................. 163
Dipinol ....................................................140 Dorel ...................................................... 163
Diplor ......................................................140 Dorenta .......................................... 424, 428
Dipred .....................................................369 Doriject ..................................................... 26
Diprobet ..................................................417 Dorinem ................................................... 26
dipropionate ...........................................181 Doripen .................................................... 26
Diprosal ..................................................441 Doripenem ............................................... 26
Diproxen .................................................337 Dormax .................................................. 319
Diptheria vaccines ..................................447 Dormilat.................................................. 319
Diptheria ................................ 447, 448, 449 Dormir .................................................... 273
852
GENERAL INDEX
Dormitol ..................................................319 Dysma ...................................................... 96

DOS ........................................................520 Dysmen .................................................. 337
Dostimid .................................................349 Dysnov ..................................................... 99
Dot ...........................................................98 Dytan .............................................. 424, 428
Dotarin ......................................................98 Dytor ...................................................... 150
Dover ........................................................98 Dyvon Plus ............................................. 430
Dovonex .................................................430 Dyvon ..................................................... 430
Dox P ........................................................36 Dyzin ...................................................... 422
Doxazosin...............................................254 DZ-20 ..................................................... 522
Doxepin ..................................................428
Doxicap ....................................................36
Doxicline ...................................................36 E
Doxico ......................................................36
Doxiderm ................................................428 Easium ................................................... 267
Doxigen ....................................................36 Easy ORS Plus Saline ........................... 112
Doxin ........................................................36 Easy ORS .............................................. 112
Doxizen ....................................................36 Easybak ................................................. 350
Doxorub ..................................................470 Ebanex ................................................... 424
Doxorubicin ............................................470 Ebaril ...................................................... 424
Doxy .........................................................36 Ebastine ................................................. 424
Doxycycline ................................ 35, 36,435 Ebatin ..................................................... 424
Doxysina...................................................36 Ebatrol.................................................... 424
D-Pam ....................................................267 Eburic ..................................................... 348
D-Pira .....................................................305 Eburn ..................................................... 407
DPT Vaccine ................ 445, 447, 448, 449 E-Cap ..................................................... 530
D-Rise ....................................................529 Eclo ........................................................ 417
Drometa..................................................234 Ecocort ................................................... 409
Drospirenone .........................................248 Ecoderm................................................. 409
Drotapan...................................................98 Ecolet ..................................................... 409
Drovin .......................................................98 Ecolon .................................................... 409
Drucil ......................................................472 Econal .................................................... 409
Drylief .....................................................383 Econate Plus .......................................... 409
DT Vaccine .............................................449 Econate VT ............................................ 242
D-Toin .....................................................299 Econate .................................................. 409
Duac .......................................................433 Econate-G .............................................. 409
Duet ........................................................290 Econazole ................................ 58, 242, 409
Dukoral ...................................................463 Ecoren T ................................................ 409
Dulong ....................................................258 Ecoren............................................ 242, 409
Dulox .............................................. 216,283 Ecosprin Plus ......................................... 163
Duloxen .......................................... 216,283 Ecosprin ................................................. 291
Duloxetine ..................................... 216, 282 Ecostat ................................................... 409
Dumaflox ..................................................38 Ecotin ..................................................... 533
Dumax ....................................................258 Ecotrim ................................................... 409
Duo ...........................................................22 Ecovit ..................................................... 530
Duoblock ................................................141 Ecox ....................................................... 333
Duocard ..................................................141 Ecozol Plus ............................................ 409
Duopres ..................................................141 Ecozol .................................................... 409
Duovas ...................................................141 Ecozol-VT .............................................. 242
Duphaston ..............................................224 Ecsota .................................................... 441
Durabolin ................................................228 Eczena ................................................... 418
Duralax ...................................................116 Edegra ................................................... 259
Duran ......................................................102 Edeloss .................................................. 151
Duratocin ................................................237 Edemide ................................................. 151
Duric .......................................................347 Edenil ..................................................... 151
Durogesic ...............................................320 Edolac .................................................... 333
Durol .......................................................125 Edone....................................................... 99
Duvent ....................................................427 Edopain .................................................. 333
Duxil ............................................... 146,313 Edysta .................................................... 259
Duzela ....................................................216 Efaclor ...................................................... 15
DxProxil ....................................................21 Efavirenz .................................................. 78
Dydrogesterone ......................................224 Efaxim ...................................................... 52
Dyno .......................................................422 Efdinir ....................................................... 18
Efepime .................................................... 25
853
GENERAL INDEX
Effical ......................................................518 Encatrol .................................................. 530

Efigrel .....................................................164 Encavir ..................................................... 72
E-fill ........................................................530 Encilor .................................................... 425
Efirel .......................................................164 Enclot ..................................................... 168
Efo Cozycap ...........................................177 Encoprin ................................................. 291
Efodio .......................................................99 Encorate chrono .................................... 301
Eformoterol .............................................177 Encorate................................................. 300
Efynal .....................................................530 Endamycin ............................................... 50
E-Gel ......................................................530 Endofree ........................................ 490, 491
E-Gut ........................................................99 Endoxan ................................................. 469
Eladin .....................................................425 Enegra ................................................... 259
Electrodex ..............................................513 Enfuvirtide ................................................ 81
Electrolytes .............................................509 Engerix-B ...............................................See
Electrosal................................................510 Enigma ................................................... 259
Eletam ....................................................298 Enjofil ..................................................... 259
Elidel .......................................................432 Enliven ................................................... 477
Elimate Plus ...........................................415 Enocam .................................................. 340
Elimate ...................................................415 Enocef ...................................................... 24
Elocan ....................................................420 Enoparin ................................................ 160
Elocon ....................................................409 Enoxaparin ............................................. 160
Elodep ....................................................279 Enso ....................................................... 103
Eloxatin...................................................481 Entacapone ............................................ 303
Eltrom ....................................................508 Entacyd Plus ............................................ 94
Eltroxin ...................................................196 Entacyd .................................................... 92
Ema ............................................... 104, 106 Entavir ...................................................... 72
Emadin ...................................................372 Enteca ...................................................... 72
Emaprox ......................................... 105,338 Entecavir .................................................. 72
Emcil.........................................................11 Entonox .................................................. 317
Emcon 1 .................................................249 Entresto.......................................... 136, 137
Emcon ....................................................249 Enviral ...................................................... 72
Emego ....................................................308 Envit-M ................................................... 532
Emend ....................................................307 Enyl ........................................................ 290
Emenil ....................................................308 Epa ......................................................... 104
Emep ......................................................104 Epam...................................................... 269
Emer .......................................................302 Eparin..................................................... 160
Emeren ...................................................309 Eperisone ............................................... 351
Emergency contraception ......................253 Ephedrine .............................. 156, 193, 395
Emestop .................................................307 Ephidin ................................................... 156
Emetogenics ..........................................465 EPI & Immunization schedule ............... 446
Emezin ...................................................308 EPI in Bangladesh ................................. 446
Emidom ....................................................99 Epiclon ................................................... 296
Emiprox ....................................................21 Epidron................................................... 156
Emistat ...................................................309 Epilep ..................................................... 296
Emiston ..................................................309 Epilim ............................................. 300, 301
Emitab ....................................................276 Epinal ..................................................... 302
Emixef ......................................................20 Epinast ................................................... 372
Emla .......................................................328 Epinastine ............................................. 372
Emlon .....................................................140 Epinephrine ............................................ 157
Emodol .......................................... 336, 370 Epirubicin ............................................... 470
Emogin .....................................................96 Epirubicin ............................................... 471
Emolent ..................................................436 Episindan ............................................... 471
Emonium ..................................................96 Epitra ...................................................... 296
Empa ......................................................213 Epival Chrono ........................................ 301
Empagliflozin ..........................................213 Epival ..................................................... 300
Empazin .................................................213 Epizam ................................................... 296
Emprila ...................................................328 Epizol ..................................................... 104
Emulyt ....................................................188 EPL ........................................................ 497
Ena .........................................................330 E-Plan Max ............................................ 249
Enalapril ......................................... 129,130 E-plan..................................................... 249
Enaril ......................................................130 Eplerenone ............................................ 150
Enazif .....................................................497 Epleron................................................... 151
Enazol ....................................................409 Eplon ...................................................... 271
854
GENERAL INDEX
Epoetin afla ............................................501 Esita ....................................................... 279

Epoetin beta And alfa .............................501 Eslicar .................................................... 297
Epoetin Beta ...........................................502 Eslo ........................................................ 104
Epoetin ...................................................501 Esloric .................................................... 347
Eporen ....................................................501 Esmax .................................................... 104
Eposid ....................................................474 Esmeron................................................. 325
Eposin ....................................................474 Esmo ...................................................... 139
Eposis .....................................................501 Esmogel ................................................. 104
Epram .....................................................279 Esmoprazole .................................. 103, 104
Eprazol ...................................................104 Esmosec ................................................ 104
Eprel .......................................................351 Esmotac ................................................. 104
Eprex ......................................................501 ESO ....................................................... 104
Eprim ......................................................437 Esobest .................................................. 104
E-Proton .................................................104 Esocon ................................................... 104
Eprox ......................................................337 Esofour................................................... 104
Eptase ....................................................166 E-Soft ..................................................... 530
Eptifibatide .............................................163 Esogap ................................................... 104
Equate ....................................................532 Esoge ..................................................... 104
Equra ......................................................437 Esogut ...................................................... 99
Erafix ........................................................20 Esoking .................................................. 104
Eraspa ......................................................95 Esolin ..................................................... 104
Erasprin ..................................................291 Esolok .................................................... 104
Erata .......................................................298 Esomenta ............................................... 104
Eraxis .......................................................57 Esomep .................................................. 104
Erazole ...................................................104 Esomeprazole ........................................ 105
Erdon Plus ..............................................333 Esomium ................................................ 104
Erdon .............................................. 332,370 Esomo .................................................... 104
Erecta .....................................................259 Esona ............................................. 105, 338
Ergometrine .................................. 237, 293 Esonaaf .................................................. 104
Erian .......................................................119 Esonix .................................................... 104
Erixin ........................................................34 Eso-Plus................................................. 105
Erlocent ..................................................476 Eso-plus ................................................. 338
Erlonix ....................................................476 Esopra.................................................... 104
Erloren ....................................................476 Esoprex .................................................. 104
Erlotin .....................................................476 Esoprol ........................................... 104, 106
Erlotinib ..................................................476 Esoral ..................................................... 104
Ermac .......................................................34 Esorant................................................... 104
Ero ...........................................................34 Esotac .................................................... 105
Erocin .......................................................34 Esotem ................................................... 105
Eroflam ...................................................333 Esotid ..................................................... 105
Erom .........................................................34 Esotor..................................................... 105
Eromac .....................................................34 Esover .................................................... 105
Eromycin ......................................... 34, 434 Esovir ..................................................... 105
Eronix .......................................................34 Esoxen ................................................... 338
Erosa ........................................................34 Esoz ....................................................... 105
Erosite ......................................................34 Espa ......................................................... 98
Errin ..........................................................34 Esprazo .................................................. 105
Ertapenem ................................................26 Estazol ..................................................... 83
Ertyhrox ....................................................34 Esters ..................................................... 226
Erubin .....................................................471 Estracon ................................................. 222
Ery ...........................................................34 Estrimox ................................................. 222
Erybac ......................................................34 Estrogens ............................................... 489
Erymex .....................................................34 Esypan ................................................... 296
Eryrox DS .................................................34 Eszopiclone ........................................... 270
Erythin ......................................................34 E-Tab ..................................................... 530
Erythromycin DS ......................................34 Etform .................................................... 208
Erythromycin ................... 33, 400, 405, 434 Ethambutol ............................................... 43
Eryzen ......................................................34 Ethinor.................................................... 225
Esamin ...................................................512 Ethinylestradiol ...................................... 222
Escap .....................................................104 Ethinyloestradiol .................................... 222
Escitalopram ..........................................279 Ethionamide ............................................. 46
Esipram ..................................................279 Etnol ....................................................... 124
855
GENERAL INDEX
Etocox ....................................................333 Eyephen ................................................. 358

Etodolac .................................................333 Eye-q ...................................................... 386
Etogesic..................................................333 Eyetear................................................... 384
Etolac ............................................ 336, 370 Eyetin ..................................................... 371
Etomid ....................................................315 Eyevi ...................................................... 386
Etomidate ...............................................315 Eyevi ...................................................... 533
Etopira ....................................................301 Eylon ...................................................... 368
Etoposide ...............................................473 Eytex ...................................................... 360
Etorac .....................................................370 EZ ......................................................... 105
Etoricoxib................................................333 Ezair ....................................................... 185
Etoriflex ..................................................333 Ezeta ...................................................... 173
Etorix ......................................................333 Ezetim .................................................... 173
Etosis ......................................................333 Ezetimibe ............................................... 173
Etovan ....................................................333 Ezetrol .................................................... 173
Etoxib .....................................................333 Ezevent .................................................. 185
ETP ........................................................508 Ezex ....................................................... 417
Etrax .........................................................84 Eziflo ...................................................... 255
Etriam .....................................................409 Eziride .............................................. 95, 308
Etrocin ......................................................34 Ezolid ....................................................... 51
Etropen .....................................................27 Ezonide .................................................. 182
Eucera ....................................................437 Ezy Xinc ................................................. 522
Eucon .....................................................102 Ezylax .................................................... 117
Eucron ....................................................206
Eudrate ...................................................437
Eukrim ....................................................437 F
Eumovate ...............................................417
Euphor ....................................................284 Facid HC ................................................ 405
Eupi ........................................................106 Facid ................................................. 53,405
Eurocal .......................................... 518, 520 Facticin..................................................... 39
Europan ..................................................108 Factiq ....................................................... 39
Eusef ........................................................13 Famicef .................................................... 16
Euthycin..................................................196 Famiclav................................................... 18
Evagren ..................................................532 Famina ................................................... 497
Evalin ......................................................267 Famodin ................................................. 100
Evarin .......................................................98 Famotack ............................................... 101
Everolimus .............................................477 Famotid .................................................. 101
Evit 530 Famotidine ...................................... 100,101
Evo .................................................. 40, 361 Fap ................................................. 289, 290
Exelon Patch .........................................314 Fapdol .................................................... 291
Exelon ....................................................313 Farevan .................................................. 161
Exemestane .................................. 490, 491 Fast ................................................ 289, 290
Exephin ....................................................24 Fastdol ................................................... 291
Exepress ................................................125 Fatisol .................................................... 513
Exforge ...................................................135 Faxan ....................................................... 52
Exinil .......................................................409 FCX ............................................................ 6
Exipro .....................................................108 Fea Plus ................................................. 290
Exium .....................................................105 Fea ......................................................... 289
Exmart ........................................... 105, 106 Fea-XR................................................... 289
Exome ........................................... 105, 106 Feburen.................................................. 348
Exor ........................................................105 Febus ..................................................... 348
Exovate N ...............................................418 Febustat ................................................. 348
Exovate ..................................................417 Febux ..................................................... 348
Expecto ..................................................189 Febuxostat ............................................. 348
Expilin .....................................................191 Fecel TR ................................................ 497
Expres ....................................................279 Fecon ..................................................... 496
Extracef ....................................................13 Fecon-Z.................................................. 497
Extranil ...................................................305 Fedrin ..................................................... 156
Eyebet ............................................ 367,388 Feelnor ................................................... 145
Eyedew...................................................383 Fefun ...................................................... 412
Eyefen ....................................................370 Feluric .................................................... 348
Eye-gel ...................................................533 Femanol ................................................. 274
Eyemox ..................................................362 Femara................................................... 491
Femastin ................................................ 223
856
GENERAL INDEX
Femex ....................................................188 Fexo ....................................................... 424

Femixit ....................................................274 Fexocon ................................................. 424
Femzole..................................................491 Fexodin .................................................. 424
Fenacin...................................................330 Fexofast ................................................. 424
Fenadin ..................................................424 Fexofen .................................................. 424
Fenamic..................................................337 Fexofenadine ................................. 190, 424
Fenargic .................................................424 Fexomin ................................................. 424
Fenat .............................................. 184,372 Fexon ..................................................... 424
Fenat ......................................................372 Fexona ................................................... 424
Fenaton ..................................................337 Fexotab .................................................. 424
Fenatrol ..................................................169 Fexten .................................................... 425
Fenaxo ...................................................424 Fezin ...................................................... 497
Fenazine.................................................274 Feziplex.................................................. 496
Fenimex..................................................192 Fiberlax .................................................. 115
Fenimex..................................................426 Fibolac ................................................... 117
Fenobac .................................................350 Fibre ....................................................... 169
Fenobate ................................................169 Fibril ....................................................... 169
Fenocap .................................................169 Fibrino .................................................... 168
Fenofex ..................................................424 Fibropress .............................................. 253
Fenofibrate .............................................169 Fibrostat ................................................. 168
Fenolid ....................................................169 Ficef ......................................................... 12
Fenorat ...................................................169 Ficlox.......................................................... 5
Fentanyl..................................................320 Filastin.................................................... 503
Fenticonazole ......................... 242,243, 409 Filazine..................................................... 85
Fentigal.......................................... 243, 409 Filfresh ................................................... 269
Fentizol .......................................... 243, 409 Filgen ..................................................... 503
Fentyl ......................................................320 Filgrast ................................................... 503
Feocron Plus ..........................................497 Filgrastim ....................................... 467, 502
Feofer .....................................................499 Filin ........................................................ 180
Feofol TR................................................497 Filmet ....................................................... 65
Feona Z ..................................................496 Filtear ..................................................... 384
Feosphate ..............................................496 Filwel Gold ............................................. 532
Ferasirrox ...............................................504 Filwel Kids .............................................. 532
Feraz ......................................................497 Filwel Silver ............................................ 532
Feridex ...................................................495 Fimox ......................................................... 8
FeridexTR...............................................497 Fimoxyclav ............................................... 10
Ferimax ..................................................499 Fimoxyl....................................................... 8
Ferinject..................................................498 Finasteride ..................... 227,228, 435, 442
Feripon ...................................................504 Finater .................................................... 412
Feristar ...................................................499 Finix ....................................................... 109
Fero TR ..................................................497 Fintop ..................................................... 408
Ferocit Z .................................................497 Fiprox ....................................................... 38
Ferofol-Z .................................................497 Firmac ...................................................... 34
Feroplus TR ...........................................495 Firmagon ................................................ 493
Feroplus Z ..............................................497 Fix-A ......................................................... 20
Feroplus .................................................496 Fixal ....................................................... 425
Feropreg .................................................497 Fixen ...................................................... 425
Ferospan ................................................497 Fixocard ................................................. 140
Feroven ..................................................499 Fixonac .................................................. 330
Ferreton-S ..............................................496 Fixvel ........................................................ 73
Ferroglobin .............................................496 FizyCal ................................................... 520
Ferrolin TR .............................................497 Flacol ....................................................... 94
Ferrous Fumarate ..................................495 Flacort .................................................... 218
Ferrous Gluconate .................................495 Flagyl ....................................................... 65
Ferrous Sulphate....................................495 Flamex ................................................... 334
Fertil .......................................................226 Flamex-DX ............................................. 331
Fer-V ......................................................497 Flamic .................................................... 337
Fer-Z.......................................................497 Flamyd ................................................... 243
Festam ...................................................335 Flamyd .............................................. 65,406
Fevac ......................................................289 Flatameal DS ........................................... 94
Fevedol...................................................291 Flatulex .................................................... 94
Feviz ............................................... 496,527 Flatunil ..................................................... 94
857
GENERAL INDEX
Flavit .......................................................526 Flugal ..................................................... 410

Flavit-M...................................................532 FLU-K......................................................... 6
Flavox .....................................................257 Flukzol.................................................... 410
Flavoxate ...............................................256 Fluma ..................................................... 410
Flegnil .....................................................189 Flumazenil ............................................ 326
Flexi ........................................................330 Flumeth .................................................. 368
Flexibac ..................................................350 Flumetol ................................................. 183
Flexicam .................................................339 Flumetra ................................................. 274
Flexidol ...................................................330 Flumyc ................................................... 410
Flexifen ...................................................350 Flunac .................................................... 410
Flexilax ...................................................350 Flunol ..................................................... 410
Flexor .....................................................350 Flunova .................................................. 410
Flixonase ................................................394 Fluorescein ............................................ 385
Flocet ........................................................41 Fluoroquinolones ................................... 360
Flogem .....................................................39 Fluorouracil .................................... 466, 472
Flomont ..................................................185 Fluoxetine ............................... 279,280, 311
Flomox......................................................41 Flupen ........................................................ 6
Flomyst ...................................................182 Flupenthixol .................................. 273, 274
F-Lon ......................................................368 Fluphenazine ......................................... 274
Flonasin ..................................................394 Fluracil ................................................... 472
Flonaspray .............................................394 Flurane ................................................... 317
Flonor .....................................................255 Flurate .................................................... 368
Flontin .......................................................38 Flurazepam ............................................ 268
Florobex .................................................360 Flurazine ................................................ 277
Floromox ................................................362 Flurbiprofen ..................................... 334,370
Flouride ..................................................522 Flurif ........................................................... 6
Flovo .........................................................40 Flurocin .................................................. 385
Floxabid ........................................... 38, 360 Flurodent ................................................ 402
Floxacin ..................................................360 Flurolon .................................................. 368
Floxaget....................................................40 Flurom .................................................... 368
Floxalone ................................................362 Fluromet ................................................. 368
Floxapen.....................................................6 Fluromethalone ...................... 368, 369, 380
Floxigat ...................................................361 Flurone ................................................... 368
Floximox .................................................362 Flurosia .................................................. 368
Floxipar .....................................................42 Fluroxan ................................................. 472
Floxiquin .................................................360 Flustar ........................................................ 6
Floxy .........................................................38 Flutamide ....................................... 492, 493
Fluanxol ..................................................274 Flutica .................................................... 394
Flubac .........................................................6 Fluticare ................................................. 419
Flubex.........................................................6 Fluticasone ........................... 182, 394, 419
Fluc .............................................................6 Fluticon .......................................... 182, 394
Flucinolone .............................................418 Flutiderm ................................................ 419
Fluclox ........................................................6 Flutinex .................................................. 410
Flucloxacillin ...............................................6 Flutisal.................................................... 183
Flucloxin .....................................................6 Flutrip ..................................................... 284
Flucocin ......................................................6 Fluvas .................................................... 171
Flucoder .................................................410 Fluvastatin ............................................. 171
Flucon .....................................................410 Fluvate ................................................... 419
Fluconaaf................................................410 Fluvent ................................................... 394
Fluconal ..................................................410 Fluvin-OD ............................................... 410
Fluconazole ..................... 55, 365, 409, 410 Flux ............................................................ 6
Flucopen.....................................................6 Fluxanol ................................................. 273
Flucort ....................................................368 Fluxi ........................................................... 6
Flucostan ................................................410 Fluxicap...................................................... 6
Fluda ......................................................410 Fluxit ...................................................... 274
Fludara ...................................................472 Fluzo ...................................................... 410
Fludarabine ............................................471 Fluzole ................................................... 410
Fludin ......................................................366 Flxzen ........................................................ 6
Fludrocortisone ......................................216 Fodexil ..................................................... 12
Flufex......................................................425 Folac ...................................................... 500
Fluflam ....................................................368 Folate ..................................................... 500
Flufun .....................................................410 Folcasin.................................................. 466
858
GENERAL INDEX
Folic Acid ................................................500 Fucloxacillin ............................................... 5

Folic ........................................................500 Fucort ..................................................... 405
Folicasia .................................................500 Fulcin ......................................................... 7
Folic-Son ................................................500 Fulcinex............................................ 58, 411
Folin SR..................................................497 Fulfeel .................................................... 259
Folinex ....................................................466 Fulspec .................................................... 28
Folinic ............................................. 466,500 Funam .................................................... 273
Folison ........................................... 274, 500 Fungata .................................................. 410
Folized ....................................................497 Fungicort ................................................ 409
Follitropin Alfa & Beta ............................230 Fungidal HC ........................................... 411
Folus .......................................................500 Fungidal ................................. 401, 411, 419
Folvit CI ..................................................496 Fungin .................................................... 409
Folvit .............................................. 496, 497 Fungistin ................................................ 412
Fona Plus ...............................................433 Fungizol ................................................. 365
Fona ...................................................... See Funzole .................................................. 410
Forane ....................................................317 Furasep .................................................. 407
Forbon ....................................................518 Furex ........................................................ 16
Force ........................................................26 Furia ....................................................... 425
Forgen ......................................................25 Furo ........................................................ 151
Formestane ............................................490 Furocef ..................................................... 16
Formet ....................................................208 Furoclav ................................................... 18
Formoterol .............................. 176, 177,182 Furoget............................................... 16, 18
Formula E ...............................................530 Furosemide ............................................ 149
Fortior .......................................................50 Furotil ....................................................... 17
Fortison ..................................................405 Furotixol ................................................... 17
Fosamin....................................................51 Furotone................................................. 151
Fosfen ....................................................299 Fusibac-H .............................................. 405
Fosfestrol Tetra Sodium .........................489 Fusicort .................................................. 405
Fosfomycin ...............................................51 Fusid .............................................. 149, 151
Fosphenytoin ..........................................299 Fusidate ................................................. 405
Fossical ..................................................520 Fusidate-H ............................................. 405
Fostat .....................................................348 Fusidic Acid ................................... 363, 405
Foviral .......................................................76 Fusidin Leo .............................................. 53
Frabex ....................................................168 Fusigal ................................................... 405
Fragmin ..................................................160 Fusithal .................................................. 363
Freegest .................................................185 Fusitop ................................................... 405
Freemax .................................................330 Fusitrim .................................................. 405
Frelax .....................................................117
Frenia .....................................................277
Frenvas ..................................................170 G
Frenxit ....................................................274
Fresh Breath ..........................................401 Gaba .............................................. 297, 299
Fresh Frozen Plasma .............................506 Gabamax ............................................... 297
Fresh Plasma .........................................506 Gabamet ................................................ 299
Fresh ......................................................284 Gabapen ................................................ 297
Freshlook Gel .........................................433 Gabapentin .................................... 295, 297
Freshtear ................................................384 Gabarol .................................................. 299
Fresofol ..................................................316 Gabastar ................................................ 297
Frisium....................................................267 Gabatin .................................................. 297
Fritt .........................................................337 Gabon .................................................... 297
Frudema .................................................149 Gacozema ............................................. 429
Frulac .....................................................151 Gadodiamide ................................. 540, 541
Frunep ....................................................149 Gadoscan .............................................. 540
Fruselac..................................................151 Galantamine .......................................... 313
Frusemide ..............................................149 Galfin ...................................................... 410
Frusin ............................................ 149, 151 Galvus Met ............................................. 212
Frusiton ..................................................151 Galvus .................................................... 211
Fruspa ....................................................151 G-amlo ................................................... 140
FSH50 ....................................................230 Gamma Globulin .................................... 460
Fucil ............................................................6 Ganciclovir ....................................... 70, 366
Fucithalmic .............................................363 G-Antacid MH .......................................... 92
Fuclav .......................................................18 G-Antacid ................................................. 93
G-Antihistamine ............................. 191, 423
859
GENERAL INDEX
G-Antiseptic ............................................438 Gemzar .................................................. 472

Gap .........................................................106 Gen-3 ....................................................... 20
Gardasil ..................................................452 Gen-4 ....................................................... 25
Gascon .....................................................92 Genac Plus ............................................ 333
Gasnil .......................................................94 Genac .................................................... 332
G-aspirin .................................................291 Genacaft ................................................ 371
Gastab ....................................................102 Genacort ................................................ 419
Gastalfet .................................................110 Genacyn........................... 30, 359, 390, 405
Gastid .......................................................93 Genagel ................................................. 383
Gastrocon .................................................93 Genamox ................................................... 8
Gastroloc ................................................102 Genaplex ............................................... 526
Gatibac ...................................................361 Genazopt ............................................... 379
Gatiflox ES .............................................361 Genclovir ................................................ 366
Gatiflox ...................................................361 Genevir .................................................... 72
Gatifloxacin ............................................361 Genisia ................................................... 317
Gatigen ...................................................361 Genolev............................................ 40, 361
Gatinol ....................................................361 Gentabac HC ......................................... 389
Gatison ...................................................361 Gentabac ................................. 30, 390, 391
G-atorvast...............................................170 Gentacin................................................. 359
G-Atropine ............................... 95, 158, 375 Gentamicin ....................... 29, 359, 390, 405
Gatsina ...................................................361 Gentanix................................................... 30
G-Azathiopine ........................................485 Gentian Violet ........................................ 438
G-B Benzoate .........................................414 Gentin ...................................... 30, 359, 405
G-Benzathine Penicillin ..............................4 Gento HC ............................................... 405
G-Benzosal ............................................408 Gento ..................................................... 390
G-Bupivacaine Heavy ............................328 Gentob ................................................... 359
G-Calcium Gluconate .............................518 Gento-Hc ....................................... 389, 391
G-Calcium Lactate .................................518 Gentrim .................................................... 43
G-Cetirizine ............................................422 Geoflox..................................................... 39
G-Cipro ...................................................360 G-Ephedrine .......................................... 156
G-Cloxacillin ...............................................5 Gepin ..................................................... 102
G-Co-aspirin ...........................................163 Gepril ..................................................... 131
G-con ......................................................396 Gerdo ..................................................... 105
G-Cotrimoxazole ......................................43 G-Ergometrine ....................................... 237
G-Cromo.................................................395 Germiso ................................................. 438
G-Cyclophosphamide ............................469 G-Erythromycin ........................................ 34
G-Dexamethasone .................................219 Gesic ...................................................... 290
G-diazepam ............................................267 Gestop ................................................... 248
Gefcin .......................................................39 Getbion .................................................. 527
Geficent ..................................................477 Gevril ...................................................... 306
Gefinix ....................................................477 G-FIX ....................................................... 20
Gefitinib ..................................................477 G-fresh ................................................... 383
Geflox .......................................................38 G-Furosemide ........................................ 149
Gelatin ....................................................515 G-G VIN ................................................. 411
Gelicon ...................................................169 G-Gentamicin ................................. 359, 390
Gelora ............................................ 401, 411 G-gliclazide ............................................ 206
Geloxin .....................................................39 G-haloperidol ......................................... 274
Gemcitabin Aqvida .................................472 G-heparin ............................................... 159
Gemcitabin Hexal ...................................472 G-Hyoscine ...................................... 96, 319
Gemcitabin Medac .................................472 Giane .............................................. 228,435
Gemcitabine ...........................................472 Gifon ...................................................... 206
Gemcitin .................................................472 Gigacef..................................................... 13
Gemfibrozil ............................................169 Gipid ....................................................... 206
Gemfil .....................................................169 Gipix ....................................................... 207
Gemicin ....................................................39 G-Ipra ..................................................... 179
Gemif ........................................................39 Giran ...................................................... 132
Gemiflox ...................................................39 G-Iron ..................................................... 496
Geminox ...................................................39 Gisin -H ........................................... 389,391
Gemison ........................................ 411, 419 Gisin ............................................... 359, 390
Gemitab ....................................................39 Gitrabin .................................................. 472
Gemolol ..................................................377 G-Ketamine ............................................ 316
Gemoxen ................................................472 Gl ......................................................... 206
860
GENERAL INDEX
Glad ........................................................206 Glucotin-plus .......................................... 353

Glamor....................................................383 Glucovis ................................................. 377
Glarine ....................................................204 Glucozid ................................................. 206
Glaxipro ....................................................38 Glucozon ................................................ 210
Gle .........................................................206 Gludex.................................... 219, 368, 389
Glemep ...................................................206 Glumol.................................................... 377
Glibenclamide ........................................205 Glunor .................................................... 208
Glibeno ...................................................205 Glupain................................................... 352
Gliclazide ................................................205 Gluretor .................................................. 210
Gliclid ......................................................206 Glustin ............................................ 352, 353
Glicron ....................................................206 Gluvan............................................ 211, 212
Gliden .....................................................205 Gluvil ...................................................... 211
Gliflozin ...................................................212 Gluzit ...................................................... 206
G-Lignocaine ..........................................327 Gly ........................................................... 65
Glikazid ...................................................206 Glycema ................................................. 213
Glimepiride .................................... 206, 207 Glyceryl Trinitrate................................... 139
Glimerol ..................................................207 Glycine ........................................... 260, 261
Glimet .....................................................210 Glycopyrronium ...................................... 318
Glimicron ................................................206 Glymin .................................................... 208
Glimirid ...................................................207 Glytear ................................................... 384
Glims ......................................................207 Glytrin..................................................... 139
Glipita M .................................................212 Glyza ...................................................... 211
Glipita .....................................................211 G-Mag Sulph .................................. 118,521
Glipizide..................................................207 G-Metformin ........................................... 208
Glirid .......................................................207 G-Methotrexate ...................................... 473
Glirol .......................................................206 G-Miconazole ......................................... 411
Glitab ......................................................206 G-Misoprostol ........................................ 110
Glitazon ..................................................210 G-Misoprostol ........................................ 239
Glitin .......................................................211 G-Morphine ............................................ 287
Glitz ........................................................206 G-Neostigmine ....................................... 326
Glivec .....................................................477 Gold Kid ................................................. 532
Glivir .......................................................206 Goldage ................................................. 532
Glix .........................................................206 Goldpac.................................................. 532
Glizid ......................................................206 G-Omeprazole ....................................... 106
Glomox ...................................................362 Gonadorelin analogues ................. 491, 492
G-Lomustin .............................................469 Gonadorelin ........................................... 228
Glophen ..................................................358 Gonadotrophin ....................................... 226
Glory .......................................................497 Gonadotropins ............................... 229, 262
G-losartan...............................................133 Gonal F .................................................. 230
Glovolac .................................................117 Gored ..................................................... 206
Gloxen ....................................................337 G-ORS ................................................... 112
Glucagon ................................................215 G-Oseltamivir ........................................... 74
Glucerin ..................................................353 Goserelin ........................................ 490,492
Glucium ..................................................353 Goustat .................................................. 348
Gluco ......................................................214 Goutil ...................................................... 348
Glucoact .................................................206 G-Paracetamol ....................................... 289
Glucocare ...............................................206 G-Penicillin V ............................................. 5
Glucohart ................................................510 Gpentin .................................................. 297
Glucolin DS ............................................512 G-Pethidine ............................................ 287
Glucomet ................................................208 G-Phenobarbitone ................................. 302
Glucomin ................................................208 G-Prazosin ............................................. 137
Glucon ....................................................205 G-Prednisolone ...................................... 221
Gluconil ..................................................205 G-Propranolol ........................................ 127
Gluconor .................................................207 G-Ramipril .............................................. 131
Glucorid ..................................................207 Granisetron .................................... 307, 465
Glucort ....................................................219 G-Ranitidine ........................................... 102
Glucosal M .............................................513 Granocyte .............................................. 503
Glucosal .................................................513 Grastim .................................................. 503
Glucosamine .................................. 352,353 Gravite ................................................... 518
Glucose ................................. 199, 512, 513 Griseofulvin ...................................... 57, 410
Glucostat ................................................206 Grisovin FP ...................................... 58, 411
Glucotin ..................................................353 Grisozen........................................... 58, 411
861
GENERAL INDEX
G-Salbutamol .........................................178 Hemotrax ............................................... 168

G-Suxamethonium .................................326 Henlix ....................................................... 52
G-Tamoxifen ..........................................491 Henxit ..................................................... 274
G-Tetracycline ..........................................36 Hepa .............................................. 289, 290
GTetracycline .........................................364 Hepa-B ................................................... 455
G-Theophylline .......................................180 Hepalac .................................................. 117
G-Thiopental ..........................................317 Heparin Leo ........................................... 159
GTN ........................................................139 Heparin .......................................... 158, 159
Guamin ...................................................208 Heparon ................................................. 159
G-Vitamin B Complex ............................526 Hepatab ................................................... 52
G-Vitamin B1 ..........................................524 Hepatitis A Vaccine ............................... 456
G-Vitamin B2 ..........................................525 Hepatitis B Vaccine ............................... 455
G-Vitamin B6 ..........................................525 Hepavax ................................................. 455
G-Vitamin ...................................... 500, 528 Hepavir..................................................... 76
G-Xylometazoline ...................................396 Hepaximin ................................................ 52
Gynastin .................................................243 Heptamin ............................................... 496
Gyned .....................................................243 Herceptin ............................................... 484
Gynepro..................................................243 Herpigel.................................................. 366
Gynomix .................................................243 Herplex................................................... 366
Gynoril ....................................................243 Hetastarch ............................................. 515
Gynoxin ..................................................243 Hexaxim ................................................. 450
G-Zinc .....................................................522 Hexicor ........................................... 305, 438
Hexiscrub ............................................... 438
Hexisol ................................................... 438
H Hexitane ................................................. 438
Hi-C ........................................................ 528
Halcinonide ............................................419 Hi-Met .................................................... 208
Halobet ...................................................419 Hi-Mox........................................................ 8
Halobetasol ............................................419 Hiposul ................................................... 526
Halocort ..................................................419 Hipre .............................................. 140, 141
Halomethasone ......................................419 Hisnul .............................................. 191,423
Halop ......................................................274 Hison ...................................................... 219
Halopen ......................................................7 Histacin .......................................... 192, 423
Haloperidol ..................................... 272,274 Histaco ........................................... 192, 423
Halopid ...................................................274 Histal .............................................. 192, 423
Halosin ...................................................317 Histalex .......................................... 192, 423
Halothane ...............................................317 Histam ............................................ 192, 423
Handirub .................................................438 Histanol .................................................. 192
Handiwash .............................................438 Histason ................................................. 192
Handscrub ..............................................438 Histatab .................................................. 192
Happynap ...............................................440 Histavil ................................................... 427
Hapytab ..................................................285 Hi-Tac .................................................... 102
Hartman..................................................510 Hitagen........................................... 192, 423
Hartsol ....................................................510 HIV 74
hay fever.................................................190 Hizin ....................................................... 527
HBIg .......................................................460 H-Nap..................................................... 338
HCG .......................................................230 Holoxan .................................................. 469
Healer .....................................................106 Homatropine .......................................... 375
Hedex .....................................................290 Honvan................................................... 489
Helben ......................................................83 Hopetavir ................................................. 73
Helmisole..................................................84 Hopso....................................................... 73
Hemagrel ................................................164 HPC ....................................................... 224
Hemo Plus ..............................................497 HPR ....................................................... 337
Hemo Z...................................................497 H-selax ................................................... 178
Hemobin .................................................496 H-Trimazole ........................................... 420
Hemofer..................................................499 HTZ ........................................................ 148
Hemofix FZ .............................................497 Humaglobin ............................................ 460
Hemofix ......................................... 496, 497 Humalog mix ......................................... 203
Hemofol- TR ...........................................497 Humalog................................................. 203
Hemomin ................................................375 Human Albumin Baxter .......................... 514
Hemoral ..................................................120 Human Albumin Solution ....................... 514
Hemorif ...................................................120 Human gama globulin ............................ 460
Hemostat ................................................168
862
GENERAL INDEX
Humulin 70/30 ........................................203 Ifozin-SR ................................................ 497

Humulin N...............................................203 Igen ........................................................ 359
Humulin-R ..............................................202 I-Gold ............................................. 386, 533
Hyalgun ......................................... 353, 385 I-guard............................................ 358, 389
Hyanid ....................................................382 Iluca ....................................................... 410
Hybolin ...................................................228 Imacef ...................................................... 24
Hybrox ....................................................188 Imanix .................................................... 477
Hybucin ........................................... 96, 308 Imax ....................................................... 105
Hybut ............................................... 96, 308 Imbac ....................................................... 27
Hycort .....................................................219 Imet ........................................................ 335
Hydeca .......................................... 228, 477 Imidazole ............................................... 365
Hydrochlorothiazide ...............................148 Iminem ..................................................... 27
Hydrocort ................................................419 Imipramine ........................ 27,216,282, 283
Hydrocortisone .............. 216, 219, 389, 419 Imiro ....................................................... 541
Hydrogen peroxide .................................439 Immense ................................................ 259
Hydronix .................................................477 immunoglobulins ..................... 445, 460,500
Hydrosy ..................................................441 Imojev .................................................... 459
Hydroxycarbamide .................................477 Imotil ...................................................... 112
Hydroxychloroquine ...............................344 Imovane ................................................. 271
Hydroxyprogesterone Hexanoate ..........224 Impedox ................................................... 36
Hydroxyurea ...........................................477 Impreja ................................................... 258
Hydroxyzine HCl ...................................192 Improcal ................................................. 530
Hydroxy Carbamide ...............................477 Imural ..................................................... 487
Hygea Gold ............................................532 Imuran .................................................... 485
Hyloron ...................................................384 Inarzin .................................................... 306
Hyoscine........................................... 95,318 Inbuten ..................................................... 23
Hypen .....................................................148 Inclaud ................................................... 146
Hyperosmotic agents .............................379 Inclox.......................................................... 7
Hypersol .................................................383 Incrit ............................................... 211, 212
Hypertonic Sodium .................................383 Indamid .................................................. 148
Hypezide ................................................148 Indapa .................................................... 148
Hypnoclone ............................................271 Indapamide ............................................ 148
Hypnofast ...............................................319 Indapa-plus ............................................ 131
Hypomer .................................................383 Indapril ................................................... 131
Hypro ......................................................383 Indever ................................................... 127
Hypromellose .........................................383 Indimide ................................................. 148
Hyronate ........................................ 384, 385 Indinavir ................................................... 79
Hysomide ................................ 96, 308, 319 Indo-A .................................................... 335
Indomet .................................................. 335
Indomethacin ................................. 334, 335
I Indoramin ............................................... 254
Inducin ................................................... 239
I-Bestin ...................................................371 Indula .............................................. 110,239
I-Care .....................................................532 Infanrix-Hexa ......................................... 450
Ibandron .................................................233 Infecef ...................................................... 24
Ibandronic Acid ......................................233 Infladex .......................................... 360, 368
Iben ........................................................334 Inflagen .................................................. 368
Ibrutix......................................................476 Inflagic.................................................... 221
Ibspa .........................................................95 Inflam ..................................................... 331
Ibuprofen ........................................ 322,334 Inflam-D ................................................. 334
I-Cap .......................................................522 Inflavis .................................................... 368
Icid .........................................................363 Inflect ..................................................... 338
Icol ................................................ 358, 389 Infliximab ................................................ 345
Iconal ........................................................56 Influvax................................................... 451
Icrom ......................................................372 Informat .................................................. 208
Idatix .......................................................148 Infovir ....................................................... 72
Idoxuridine ..............................................366 Infud ................................................. 58, 412
Idrofos ....................................................233 Infudex ................................................... 512
Ifamide....................................................469 Infusol Plus ............................................ 513
Ifol Plus...................................................497 Infusol .................................................... 513
Ifomes .....................................................468 Ingovax .................................................. 451
I-Fort .......................................................384 Inhibita ................................................... 106
Ifosfamide ...............................................469
863
GENERAL INDEX
Initer .......................................................501 Invega .................................................... 276

Innocan...................................................410 Iodine ............................................. 198, 522
Inofar ......................................................499 Iodixanol ............................................... 541
Inolac ......................................................117 Iohexol ................................................... 541
Inosit .......................................................146 Iopamidol .............................................. 541
Inositol ....................................................146 Iopanoic Acid ......................................... 541
Inospiron.................................................151 Ipec Super ............................................. 497
Inoten .....................................................340 Ipec ........................................................ 496
Inovit .......................................................530 Ipec-Plus ................................................ 497
Inpro .......................................................106 I-Penam ................................................... 28
Inran .......................................................102 Ipical ....................................................... 518
Insaid ......................................................335 Ipical-D ................................................... 520
Insimet ....................................................208 Ipical-M .................................................. 521
Instasia ...................................................327 Ipide ....................................................... 148
Instina .......................................................21 I-Pil Max ................................................. 249
Insul 30/70 ..............................................203 I-Pil ......................................................... 249
Insul 50/50 ..............................................203 Ipralin ..................................................... 179
Insul Glargine .........................................204 Ipramid ................................................... 179
Insul Lispro .............................................203 Iprasol .................................................... 179
Insul N ....................................................204 Ipratop .................................................... 179
Insul R ....................................................202 Ipratropium Bromide ...................... 179, 396
Insulatard Penfill .....................................204 Iprex ....................................................... 179
Insulet 30/70 ...........................................203 I-Proton .................................................. 106
Insulet 50/50 ...........................................203 Iracet ...................................................... 298
Insulet GN ..............................................204 Iragon ..................................................... 257
Insulet N .................................................204 Irbes ....................................................... 133
Insulet R .................................................202 Irbesartan ............................................... 132
Insulet ............................................ 203, 204 Iriban ........................................................ 98
Insulin Aspart .........................................202 Irigon ...................................................... 261
Insulin Gargine .......................................204 Irinotecan ............................................... 483
Insulin Glulisne .............................. 202, 203 Irinotecan Medac ................................... 483
Insulin Insularated ..................................203 Irinotecan Sandoz .................................. 483
Insulin Lispro ..........................................202 Irinotesin ................................................ 483
Insulin Mixtard 30 HM ............................203 Irinox ...................................................... 483
Insulin Mixtard 50 HM ............................203 Irisyn ........................................................ 98
Insulin Zinc .............................................204 Irobest .................................................... 496
Insulin ....................................................201 Irofol ....................................................... 495
Insuman Basal .......................................204 Irolic ....................................................... 495
Insuman Rapid .......................................202 Iromia ..................................................... 496
Insuman-Comb .......................................203 Iron ........................................................ 497
Intafenac K .............................................331 Iron Dextran ........................................... 498
Intafenac Plus ........................................333 Ironic ...................................................... 496
Intafenac........................................ 332, 370 Iropen ....................................................... 27
Intamycin ..................................................30 Irosuc ..................................................... 499
Intas ........................................................330 Irotrex Plus ............................................. 496
Intasone......................................... 219, 419 Irrigation Solution ................................... 261
Integril .....................................................164 Isart ........................................................ 133
Iinterferon Alfa ........................................487 Ism ......................................................... 139
Interferons ....................................... 73, 487 Isoclox ........................................................ 7
Interon ....................................................488 Isoconazole ............................................ 242
Intez ........................................................491 Isodex .................................................... 513
Intimate...................................................259 Isoflourance ........................................... 317
Intobac ....................................................359 I-Sol ........................................................ 383
Intracal ....................................................518 Isoline IV ................................................ 510
Intracef .....................................................13 Isolon ..................................................... 369
Intralipid ..................................................513 Isoniazid ................................................... 44
Intramol ..................................................377 Isonil ......................................................... 96
Intrapen ....................................................28 Isophane Insulin..................................... 203
Intravas...................................................160 Isoprenaline .......................................... 156
intravenous fluids ...................................193 Isoride .................................................... 513
Intravenous Potassium ..........................510 Isosorbide Mononitrate .......................... 139
Intrax ......................................................168 Isotear .................................................... 383
864
GENERAL INDEX
Isotretinoin ..................................... 432, 434 Kanis ...................................................... 409

Isotrex.....................................................434 Kapron ..................................................... 38
Isovent ....................................................110 Karvedil .................................................. 125
Isovent ....................................................239 Kayon ..................................................... 531
Ispaghula Husk ......................................115 KCL ........................................................ 511
Ispergul...................................................115 Kdrin ....................................................... 305
Itchin .............................................. 372, 395 Kdrox Plus .............................................. 94
Itchlor ......................................................425 Kefim ........................................................ 20
Itop-BZ....................................................496 Kefton..................................................... 184
Itop-Z ......................................................497 Kefuclav ................................................... 18
Itra 56 Kelorac ................................................... 336
Itraconazole ..................................... 56, 411 Kemadrin ............................................... 304
Ivabradine...............................................144 Kemet....................................................... 65
Ivactin .......................................................85 Kemin ..................................................... 208
Ivana .......................................................233 Keolax .................................................... 267
Ivanor .....................................................144 Keprofen ................................................ 335
Ivaprex....................................................144 Kepros.................................................... 336
Ivaten ......................................................144 Kerasol ................................................... 437
Iventi .......................................................362 Kerolac ................................................... 336
Iventi .........................................................41 Ketalar.................................................... 316
Ivermectin ........................................ 85, 414 Ketamine ................................................ 315
I-Vita .......................................................533 Ketaride.................................................. 316
Ketifen .................................................... 184
Keto........................................................ 331
J Keto-A .................................................... 335
Ketocon ..................................... 56,411, 441
Jaktor......................................................346 Ketoconazole ................................. 365, 411
Jakvi .......................................................479 Ketocure................................................. 184
Janmet ....................................................212 Ketof ............................................... 184, 372
Janvia .....................................................211 Ketofast .......................................... 335, 336
Jardian ....................................................213 Ketoflex .................................................. 336
Jardiance ................................................213 Ketofun............................................. 56, 411
Jasocaine .............................. 155, 327, 429 Ketolab ................................................... 336
Jasocaine-A ...........................................328 Ketolac ................................................... 372
Jasocal ...................................................518 Ketomar ......................................... 184, 372
Jasochlor ..................................................61 Ketonaaf ................................................ 336
Jasophylin ..............................................180 Ketonic ................................................... 336
Jasoprim ...................................................62 Ketopac .................................................. 184
Jasoquin ...................................................64 Ketoprix .................................................. 336
Jasotrim ....................................................43 Ketoprofen ............................................. 335
Jevtana ...................................................482 Ketorif..................................................... 184
Jmycin ......................................................36 Ketorin.................................................... 336
Joinix Plus ..............................................353 Ketorolac ................................. 323, 335,370
Joinix ............................................. 352, 353 Ketoroz................................................... 336
Jointec ....................................................353 Ketoshot ................................................. 336
Jointin .....................................................353 Keto-SR ................................................. 335
Jpdrox.......................................................92 Ketotifen .......................................... 184,372
Juci .........................................................528 Ketovir .................................................... 336
Jumex .....................................................304 Ketozol ................................................... 441
Junivit .....................................................532 Ketromin......................................... 336, 370
Juvain .....................................................305 Ketron D ................................................. 331
Ketron .................................................... 335
K Kevil ....................................................... 425
Kevilon ................................................... 438
K-MM ......................................................531 Kevirub ................................................... 438
Kabiven ..................................................513 Kezid ...................................................... 206
Kacin ........................................................29 Kfore ........................................................ 17
Kadol ......................................................288 Kidcal ..................................................... 518
Kain ........................................................316 Kidcef ....................................................... 21
Kalinac ....................................................331 Kiddi ....................................................... 532
Kamoxy ......................................................8 Kidifer ..................................................... 499
Kanaprim ..................................................62 Kidizinc................................................... 526
865
GENERAL INDEX
Kidovit .....................................................532 Lactu ...................................................... 117

Kidzin ......................................................522 Lactulose ............................................... 117
Kilbac ........................................................17 Lactulose-H ............................................ 117
Kilgen .....................................................362 Lafil .......................................................... 85
Kilmax.......................................................17 Lafrost .................................................... 413
Kilpan .....................................................336 Lameptil ................................................. 298
Kingdol ...................................................288 Lamicet .................................................. 298
Kit-63 ......................................................240 Lamidin .................................................... 76
Klabex ......................................................33 Lamitrin .................................................. 298
Klabid .......................................................33 Lamivir ..................................................... 76
Klaricid ......................................................33 Lamivudine ........................................ 75, 76
Klarix ........................................................33 Lamogin ................................................. 298
Kmi ...........................................................39 Lamotrigine ............................................ 297
Kofen ............................................. 184, 372 Lanozole ................................................ 103
Kolchin ....................................................347 lanreotide ............................................... 493
Koloride ..................................................112 Lansec ................................................... 103
Konakion ................................................531 Lansina .................................................. 103
Kontrol ....................................................335 Lanso ..................................................... 103
Kop .........................................................335 Lansocon ............................................... 103
Kpam ......................................................266 Lansodin ................................................ 103
K-Pol .......................................................290 Lansoprazole ......................................... 103
K-Saline Fruity........................................112 Lansopril ................................................ 103
K-Saline N ..............................................112 Lansoprol ............................................... 103
KT .........................................................511 Lantid ..................................................... 103
Ktin .........................................................184 Lantus Cartridge .................................... 204
Kuracef .....................................................20 Lantus Optiset ........................................ 204
K-Vit D ....................................................529 Lantus SoloStar ..................................... 204
Kvit Gold .................................................532 Lantus .................................................... 204
Kvit I .......................................................534 Lanz ....................................................... 103
Kvit seas .................................................533 Lap 103
Kvit 527, 529 Lapacent ................................................ 478
Kvit-C ......................................................528 Lapatinib ................................................ 477
Kvit-M .....................................................532 Lara ........................................................ 423
Kvit-N ......................................................526 Larb ........................................................ 133
KX .........................................................259 Larcadip ................................................. 142
Kynol D ...................................................331 Largactil ................................................. 306
Kynol ......................................................335 Largix ..................................................... 427
Larimef ..................................................... 62
Lasilactone ............................................. 151
L Lasix....................................................... 150
Lasocon ................................................. 103
Labcal D .................................................520 Latanoprost ............................................ 380
Labecard ................................................126 Laxativ.................................................... 117
Labegest.................................................126 Laxatives ................................................ 115
Labeta ....................................................126 Laxenna ................................................. 116
Labetalol .................................................125 Laxitol..................................................... 117
Lacicard ..................................................142 Laxol ...................................................... 117
Lacidip ....................................................142 Laxolac................................................... 117
Lacidipine ...............................................142 Laxonil.................................................... 266
Lacitab ....................................................142 Laxur ...................................................... 151
Laciten ....................................................142 Laxyl ....................................................... 266
Lacitone ..................................................151 L-cardin .................................................. 142
Laclose ...................................................117 Leanxit ................................................... 274
Lacrima ...................................................383 Leaxe ..................................................... 117
Lacrison ..................................................368 Lebac ....................................................... 13
Lactameal .................................................92 Lecet ...................................................... 425
Lacticon ..................................................117 Leecain .................................................. 327
Lactitol ....................................................117 Leflox ................................................ 40,362
Lactolax ..................................................117 Leflunomide ........................................... 345
Lactomose ..............................................117 Lefoam ..................................................... 94
Lactoride.................................................510 Lemovit .................................................. 528
Lactoring.................................................510 Lemovit-C .............................................. 528
Lactro .....................................................336
866
GENERAL INDEX
Lenograstim .................................. 467, 503 Libott-S Jr .............................................. 513

Lenor ......................................................491 Libott-S................................................... 513
Leo ................................................... 40,361 Libracin .................................................... 38
Leoflox ......................................................40 Librazol .................................................... 65
Leofran ...................................................310 Libret ...................................................... 102
Leozinc ...................................................522 Licef ......................................................... 12
Lepath ......................................................17 Licerin .................................................... 415
Leprox ......................................................21 Liconor ................................................... 120
Leptal ......................................................299 Lido ........................................................ 328
Leptic ......................................................297 Lidocaine ............................................... 154
Lequin .....................................................361 Lidocaine ............................................... 328
Lercanidipine ..........................................142 Lifcin ................................................. 40, 362
Lerex ......................................................425 Life Gold................................................. 532
Leroxin ....................................................196 Life Silver ............................................... 532
Lerozol ....................................................491 Lifil ......................................................... 530
Lescol .....................................................171 Ligazid.................................................... 211
Lesero ......................................................22 Lignocaine ..................................... 154, 327
Lesterol...................................................171 Lijenta .................................................... 211
Letrogen .................................................491 Likazid .................................................... 206
Letrol ......................................................491 Limaryl ................................................... 207
Letrozole........................................ 490, 490 Limbix..................................................... 267
Leucofil ...................................................188 Limerid ................................................... 207
Leucovorine ............................................466 Limogel .................................................. 436
Leukeran ................................................468 Limpet .................................................... 207
Leukin .....................................................473 Lin ................................................... 40, 362
Levamisole ...............................................83 Linacin...................................................... 50
Leveron ..................................................298 Linadi ..................................................... 211
Levetiracetam .........................................298 Linadus .................................................. 211
Levin .........................................................40 Linaglip................................................... 211
Levo ..........................................................40 Linagliptine ............................................. 211
Levobac ........................................... 40, 362 Linajen ................................................... 211
Levobunolol ............................................377 Linaptin .................................................. 211
Levocet ...................................................425 Linarol .................................................... 211
Levocetrizine ................................. 190, 425 Linatab ................................................... 211
Levofed...................................................157 Linax ...................................................... 211
Levoflox ............................. 39, 40, 361, 362 Lincocin .................................................... 50
Levofolinic acid .......................................466 Lindac .................................................... 339
Levoking ...................................................40 Lindamax Plus ....................................... 434
Levolo .............................................. 40, 362 Lindamax ......................................... 50, 433
Levomax .......................................... 40, 362 Linda-DS ................................................ 239
Levonix .....................................................40 Linexil ....................................................... 51
Levonorgestrel .............................. 249, 250 Linezolid ................................................... 50
Levopa ....................................................303 Linita ...................................................... 211
Levopil ....................................................247 Lino ........................................................ 211
Levoquin .................................................362 Lintin ...................................................... 211
Levora ......................................................40 Linzolid ..................................................... 51
Levorex...................................................425 Liorel ...................................................... 350
Levosina .......................................... 40, 362 Lioresal .................................................. 350
Levotiz ....................................................425 Lipex ...................................................... 170
Levox ............................................... 40, 362 Lipicon.................................................... 170
Levoxin ............................................ 40, 362 Lipicut..................................................... 169
Lexazen ....................................................40 Lipidof .................................................... 169
Lexel .......................................................491 Lipigem .................................................. 169
Lexin .........................................................13 Lipigent .......................................... 170, 171
Lexnil ......................................................267 Lipired .................................................... 169
Lexopil ....................................................267 Lipitin...................................................... 170
Lexotanil .................................................267 Liplo ............................................... 169, 170
Lexvo ........................................................40 Liploss .................................................... 172
Lezon ........................................................40 Lipobi ..................................................... 170
Liam ........................................................185 Lipostat .................................................. 171
Libott .......................................................513 Lipovast.................................................. 171
Libott-M ..................................................513 Lipozil ..................................................... 169
867
GENERAL INDEX
Lipril ........................................................130 Lopamid ................................................. 112

Liptor ......................................................171 Lopamiro ................................................ 541
Liqu-E .....................................................530 Lopenta .................................................. 288
Liquical ...................................................530 Loperamide ..................................... 112,113
Liquid Paraffin ........................................116 Loperin ................................................... 112
Liquifilm Tear ..........................................384 Lopez ..................................................... 275
Lirel .........................................................163 Lopidam ................................................. 541
Lirica .......................................................299 Lopirel .................................................... 163
Lisinopril .................................................130 Loplaqor ................................................. 171
Lispril ......................................................130 Loplate Plus ........................................... 163
Listacare .................................................402 Loplate ................................................... 163
Lister.......................................................402 Lopo ....................................................... 133
Listoral Cool Mint ...................................402 Lopos ..................................................... 133
Listoral Original ......................................402 Lopoten .................................................. 133
Lit .........................................................210 Lopres .................................................... 124
Lithin .......................................................275 Lora ........................................................ 426
Lithium ....................................................275 Loracef ..................................................... 15
Lithosun ..................................................275 Loradin ................................................... 426
Litiam ......................................................275 Lorapam ................................................. 269
Livacin ............................................. 40, 362 Lorat ....................................................... 426
Livacor ....................................................120 Loratadine .............................. 190, 425, 426
Livax .......................................................117 Loratin Fast ............................................ 426
Liveric .....................................................120 Loratin .................................................... 426
Liviol .......................................................223 Lorazem ................................................. 269
Livita ............................................... 496,527 Lorazepam ..................................... 268, 465
Livit-C .....................................................528 Loreta ..................................................... 491
Livoton ....................................................117 Lorfast .................................................... 426
Livwel .....................................................532 Loridon ..................................................... 99
LK .........................................................133 Loril ........................................................ 133
L-Lysine ..................................................436 Lorin ....................................................... 426
Locaine ...................................................328 Lorix Plus ............................................... 415
Locard ........................................... 140, 141 Lorix ....................................................... 415
Locin ................................ 40, 105, 338, 362 Losa ............................................... 133, 134
Locol .......................................................171 Losacard ........................................ 133, 134
Locopain .................................................332 Losacor .......................................... 133, 134
Loctoz .....................................................117 Losan ............................................. 133, 134
Locular Plus ...........................................378 Losapot .......................................... 133, 134
Locular....................................................378 Losapress .............................................. 133
Lodiben...................................................141 Losar ...................................................... 133
Lodical ........................................... 140, 141 Losarcar ................................................. 133
Lodicard..................................................141 Losardil .......................................... 133, 134
Lodin .......................................................425 Losaron .................................................. 133
Lodipin ....................................................140 Losart ............................................. 133, 134
Lodoxamide ............................................372 Losartan ................................................. 133
Lofat .......................................................169 Losarva .......................................... 133, 134
Lofens .....................................................330 Losatan .......................................... 133, 134
Logibac .....................................................23 Losectil ................................................... 106
Lograin ...................................................293 Losek ..................................................... 107
Lok .........................................................133 Losita ..................................................... 279
Lomebac.................................................362 Losium ........................................... 133, 134
Lomecin ..................................................391 Lospan ................................................... 350
Lomeflox .......................................... 40, 362 Losucon ................................................. 207
Lomefloxacin ........................... 40, 362, 391 Loteba .................................................... 368
Lomegen ................................................362 Loteflam T .............................................. 368
Lomequin................................................362 Loteflam ................................................. 368
Lomexa...................................................362 Lotemycin .............................................. 368
Lomustine ...............................................469 Lotenate ................................................. 368
Lonet ......................................................124 Lotenol T ................................................ 368
Long Acting Insulin .................................203 Lotenol ........................................... 361, 368
Longpara ................................................289 Lotensin ................................................. 377
Lopadine........................................ 373, 395 Lotensyl.................................................. 142
Lopadol...................................................370 Lotepred ................................................. 368
868
GENERAL INDEX
Loteprednol Etabonate ...........................368 Maclon ................................................... 526

Lotepro Plus ...........................................368 Macro ....................................................... 34
Lotepro .......................................... 361, 368 Macrobid .................................................. 33
Lotil .........................................................107 Macrocin .......................................... 34, 434
Lotrel ......................................................368 Macrogol ................................................ 118
Lotrimin...................................................409 Macrolides ............................................... 31
Lovapress ...............................................140 Macrozith ................................................. 32
Lovastatin ...............................................171 Maczith..................................................... 32
Lovatin ....................................................171 Magacil Plus ............................................ 93
Loverin ......................................................95 Magacil..................................................... 93
Lovicin ............................................. 40, 362 Magaldrate ............................................... 93
Lox Eye ..................................................360 Magalrat Plus ........................................... 93
Loxa ............................................................5 Maganta Plus ........................................... 93
Loxetine ......................................... 216, 283 Magaplus ................................................. 93
Loxyl ...........................................................8 Magaplus-X .............................................. 93
Lozana ....................................................263 Magfin .................................................... 117
Lozicum ..................................................269 Magmil ................................................... 118
Lozide .....................................................206 Magnason .............................................. 118
Lozin .......................................................425 Magnesium Hydroxide ........................... 118
LPD ........................................................368 Magnesium Sulphate ............................. 118
Lubgel .....................................................383 Magnesium Trisilicate .............................. 92
Lubilax ....................................................116 Magnesium ............................................ 521
Lubiprostone ..........................................115 Magnogel ................................................. 92
Lubistone ................................................116 Magnova .................................................. 25
Lubric D .................................................383 Magsum ................................................. 521
Lubric Extra ............................................383 Makcid Plus ............................................. 94
Lubric ......................................................383 Makferon ................................................ 496
Lubrimax.................................................383 Malacide................................................... 63
Lubtear ...................................................383 Manisol................................................... 152
Lucan ......................................................410 Mannisol A ............................................. 152
Lucent .....................................................530 Mannitol ......................................... 151, 379
Lucidol ....................................................288 Maprocin .................................................. 38
Lucrin Depot ...........................................493 Maprotiline ............................................ 283
Ludiomil ..................................................283 Maraviroc ................................................. 81
Lumast ....................................................186 Marincal ................................................. 520
Lumenta .................................................185 Mariprist ................................................. 240
Lumeran .................................................102 Marlox Plus .............................................. 93
Lumertam .................................................60 Marlox ...................................................... 93
Lumex............................................ 362, 391 Marvelon ................................................ 247
Lumigin ...................................................380 Masfen ................................................... 372
Lumona ..................................................185 Mastel ............................................. 191,426
Luretic .....................................................150 Mastguard ...................................... 372, 395
Lutin Plus................................................534 Matropin ................................................. 375
Lutisone ................................. 182, 394, 419 Maturex .................................................. 258
LVC ........................................................425 Mave ........................................................ 98
Lyflox ......................................................362 Maxair .................................................... 185
Lynes ......................................................248 Maxbon .................................................. 233
Lynestrenol .............................................224 Maxbuten ................................................. 23
Lynoestrenol ..........................................224 Maxcef ............................................... 15, 21
Lyric ........................................................299 Maxclin ..................................................... 50
Lyrinex ....................................................300 MaxD ...................................................... 529
Lyta 28 Pill ..............................................247 Maxical ........................................... 518, 520
Lytex .......................................................188 Maxidim.................................................... 22
Maxifer ................................................... 499
Maxiflox .................................... 41, 117, 362
M Maxima .................................................. 105
Maxineb ................................................. 126
M Boss ...................................................188 Maxipen ................................................... 27
Mabthera ................................................487 Maxiron .................................................. 497
Mac ...........................................................34 Maxocol.................................................. 100
Macas .......................................................34 Maxof ..................................................... 188
Macazi ......................................................32 Maxolax.................................................. 350
Macery......................................................34
869
GENERAL INDEX
Maxomega .............................................173 Meliva..................................................... 279

Maxpime ...................................................25 Melixol .................................................... 274
Maxpro ...................................................105 Melizin .................................................... 308
Maxrin .....................................................255 Meloderm ............................................... 394
Maxsulin 30/70 ......................................203 Meloxicam .............................................. 337
Maxsulin 50/50 ......................................203 Melphalan .............................................. 465
Maxsulin R .............................................202 Melphin .................................................... 84
Maxsulin .................................................204 Meltix...................................................... 274
Maxzon .....................................................24 Melxit ...................................................... 274
Mazic ......................................................522 Memopil ................................................. 305
Mb .........................................................526 Menactra ................................................ 452
Mbroxol...................................................188 Menaril ............................................ 306,392
M-Card ...................................................140 Menem ..................................................... 28
M-Dazole ..................................................65 Menilet ..................................................... 65
Measles Vaccine ....................................453 Menogia ................................................. 225
Mebastin ......................................... 191,426 Menogon ................................................ 230
Mebendazole ............................... 82, 84, 98 Menol ....................................................... 65
Mebeverine ..............................................98 Menoral .................................................. 225
Mebhydrolin .................................... 191,426 Menorest ................................................ 223
Mebidal .......................................... 191, 426 Mepcort .................................................. 219
Mebiz ........................................................98 Mepen ...................................................... 28
Mebolin .......................................... 191, 426 Mepyramine ................................... 425, 426
Mecabis ..................................................415 Mercaptopurine ............................... 465,472
Mecillinams ..............................................11 Mercazole .............................................. 198
Meclid .....................................................100 Merison .......................................... 306, 392
Meclixin ..................................................308 Merobac ................................................... 28
Meclizine ................................................307 Merocar .................................................... 28
Mecobal ..................................................526 Merocef .................................................... 17
Mecobalamin ..........................................525 Merocil ..................................................... 28
Mecol ......................................................526 Merocon ................................................... 28
Mecolagin ...............................................526 Meroject ................................................... 28
Mecolin ...................................................526 Meromax .................................................. 28
Mecopen.................................................526 Meronix .................................................... 28
Mecozol ....................................................65 Meropen ................................................... 28
Med-Cal ..................................................518 Meropenem ........................................ 26, 27
Medikast .................................................185 Merotrax ................................................... 28
Medogen ....................................... 249, 250 Merozolyn .............................................. 149
Medora ...................................................249 Mervan ................................................... 330
Medrina ..................................................249 Mesagut ................................................. 114
Medrogest ..............................................249 Mesalazine ............................................. 114
Medrol ....................................................219 Mesna .................................................... 468
Medrolin......................................... 191, 426 Mespa ...................................................... 98
Medroxy......................................... 249, 250 Met ......................................................... 208
Medroxyprogesterone ....... 25, 250,249,489 Metacard ................................................ 145
Mefenamic Acid ......................................337 Metadaxan ..................................... 368, 389
Meflocin ..................................................362 Metalone Plus ........................................ 368
Meflon .......................................................62 Metalone ................................................ 368
MefloquinE ...............................................61 Metalyse................................................. 166
Mefoglip ..................................................209 Metarin Plus ........................................... 210
Meforex ..................................................208 Metarin ................................................... 208
Meforin ...................................................208 Metaspray .............................................. 394
Meformin ................................................208 Metavas ................................................. 145
Megacilin ..................................................10 Metazid .................................................. 209
Megafil ....................................................260 Metazine ................................................ 145
Megatrim ..................................................43 Metco ....................................................... 65
Megestol .................................................490 Metfar ..................................................... 208
Meglu ......................................................208 Metfil ........................................................ 65
Meladinine ..............................................431 Metfo ...................................................... 208
Melanxit ..................................................274 Metfomin ......................................... 207,208
Melatrin ...................................................441 Metform .................................................. 208
Melcam ...................................................337 Metglip ................................................... 209
Melipen ...................................................274 Meth ....................................................... 473
870
GENERAL INDEX
Methasol ........................................ 367, 388 Micosone ....................................... 411, 419

Methasol-N .............................................388 Micovit .................................................... 531
Metherspan ............................................237 Micozole ......................................... 411, 419
Methicol ..................................................526 Microgest ............................................... 226
Methipred ...............................................219 Midazolam ............................................. 319
Metholone...............................................368 Midolam ................................................. 320
Methotrax ...............................................473 Midopril .................................................. 131
Methotrexate .......... 345, 430, 465, 466,473 Midzo ..................................................... 319
Methovate...............................................119 MIF ......................................................... 240
Methox....................................................473 Mifepristone ........................................... 239
Methoxsalen ...........................................431 Mifeston ................................................. 240
Methsolon ...............................................219 Mifetab ................................................... 240
Methyl Cellulose ............................ 116, 312 Migen ..................................................... 100
Methyldopa .............................................138 Miglitol ................................................... 214
Methylprednisolone ............... 219, 341, 421 Migranil .................................................. 295
Metin .......................................................208 Migratol .................................................. 293
Metlife .....................................................208 Migrex .................................................... 293
Metmin ....................................................208 Mikacin ..................................................... 29
Metnor ....................................................208 Miki................................................. 411, 420
Metocard ................................................126 Milam ..................................................... 320
Metoclopramide .................... 100, 292, 308 Milast ...................................................... 186
Metocol ...................................................100 Milnacipan .............................................. 280
Metok ......................................................185 Milran ..................................................... 280
Metolazone .............................................148 Miltefos..................................................... 68
Metomin..................................................208 Miltefosin .................................................. 68
Metonid.....................................................65 Mimox ........................................................ 8
Metoprol .................................................126 Mini 28 ................................................... 247
Metoprolol...............................................126 Minia ...................................................... 184
Metorax ..................................................473 MinipressXL ........................................... 137
Metrion .....................................................65 Minirin Melt ............................................ 231
Metro ........................................................65 Minisol ...................................................... 84
Metrobac ..................................................65 Minista.................................................... 427
Metromax .................................................65 Minocap ................................................. 167
Metronidazole .................................. 64, 405 Minocycline ............................................ 435
Metrozen ..................................................65 Minolac................................................... 336
Metryl ........................................................65 Minomal ................................................. 180
Metsa ......................................................208 Minoxidil ................................................. 436
Metsina .....................................................65 Miotics .................................................... 376
Meverine...................................................98 Miotrol .................................................... 294
Mevin ........................................................98 Miovit .............................................. 526, 527
Mexclav ....................................................18 Mirabeg .................................................. 257
Mexiderm................................................417 Miracal ................................................... 518
Mexiderm-N ............................................417 Miracal-D ............................................... 520
Mexlo ............................................... 40, 362 Miracal-M ............................................... 521
Mextil ........................................................17 Miragon .................................................. 257
Mez ..........................................................65 Mirapin ................................................... 284
Mezest ....................................................490 Mircera ................................................... 502
MFC XG .................................................363 Mirez ...................................................... 284
MFC ........................................................362 Mirtaz ..................................................... 284
M-Form ...................................................208 Mirtazapine .................................... 281, 284
M-Fort .....................................................208 Mirzalux.................................................. 284
MHC .............................................. 411, 419 Misoclear ....................................... 110, 239
Miacalcic.................................................235 Misole....................................................... 84
Mic HC ........................................... 411, 419 Misopa ................................................... 110
Mic ................................................. 401,411 Misopa ................................................... 239
Miclo .......................................................417 Misopil .................................................... 110
Micoderm................................................411 Misopil .................................................... 239
Micogyl .....................................................65 Misoprostol + Mifepristone .................... 240
Miconazole ............... 58, 242, 400, 401,411 Misoprostol .................................... 110, 239
Miconex ..................................................411 Misotab .......................................... 110, 239
Miconil ........................................... 411, 419 Misotec........................................... 110, 239
Micoral ........................................... 401, 411 Misotol............................................ 110, 239
871
GENERAL INDEX
Mitaprex..................................................284 Monti Fast .............................................. 185

Mitomycin ...............................................471 Montica .................................................. 185
Mitomycin-C Kyowa ...............................471 Montilab ................................................. 185
Mitosan Plus ...........................................135 Montilet .................................................. 185
Mitosan ...................................................135 Montiluk.................................................. 185
Mitrazin ...................................................284 Montiva .................................................. 185
Mixavit ....................................................533 Montril .................................................... 185
Mizolastine .............................................426 Moodon .................................................. 284
M-Kast ....................................................185 Moov ...................................................... 332
M-Loc .....................................................126 Morphine ................................ 286, 287, 320
M-Lucas..................................................185 Morphinex .............................................. 287
MM Kit ....................................................240 Motifast .................................................... 99
M-Min .....................................................209 Motigen .................................................. 100
Mobicam .................................................340 Motigut ................................................... 100
Mobife............................................ 332, 370 Motilon ................................................... 100
Mobifen Plus ..........................................333 Motinorm ................................................ 100
Modern Milk of Magnesia .......................118 Motistat .................................................. 100
Modipran ....................................... 280, 311 Motoral ................................................... 345
Mokast ....................................................185 Movera ................................................... 249
Molgramostim .........................................467 Movex .................................................... 330
Molukat ...................................................185 Movonac ................................................ 332
Mom .......................................................118 Mox ............................................................ 8
Momento ................................................423 Moxacil ....................................................... 8
Momeson....................................... 394, 420 Moxaclav .................................................. 10
Mometa ..................................................420 Moxalactum ........................................... 388
Mometasone Furoate .................... 394, 420 Moxapen .................................................... 8
Momtas ...................................................420 Moxarif ....................................................... 8
Momtec ...................................................420 Moxibac XG ........................................... 363
Mon ........................................................185 Moxibac............................................. 41,362
Monabacin ..............................................406 Moxico........................................................ 8
Monaclox-F ................................................7 Moxidex.................................................. 363
Monadox...................................................36 Moxif ...................................................... 362
Monalast .................................................185 Moxiflox .................................................... 41
Monamox....................................................8 Moxifloxacin ..................................... 40, 362
Monamycin .............................................405 Moxigen ......................................... 362, 363
Monas .....................................................185 Moxigram ............................................... 362
Monatrex ..................................................36 Moxikem................................................. 362
Monipro ....................................................38 Moxilocin .......................................... 41, 362
Moniten...................................................139 Moxin ......................................................... 8
Monitoring...............................................502 Moxivin ................................................... 362
Monivis .....................................................96 Moxlocin ................................................. 362
Monkast ..................................................185 Moxonidine ............................................ 138
Monkon...................................................185 Moxquin XG ........................................... 363
Monocal D ..............................................520 Moxquin ........................................... 41, 362
Monocal ..................................................518 M-Pol ...................................................... 289
Monocard ...............................................139 Mprix ...................................................... 240
Monocast ................................................185 MSL Oral ................................................ 287
Monsulfiram ............................................414 M-Son .................................................... 394
Monotrate ...............................................139 MTP Kit .................................................. 240
Monovas .................................................185 Mtrex ...................................................... 473
Monprox .................................................185 M-Trim...................................................... 43
Montair ...................................................185 Mucobrox ............................................... 188
Montek ....................................................185 Mucodil................................................... 189
Montekast ...............................................185 Mucola ................................................... 189
Montela...................................................185 Mucolyt................................................... 189
Montelon.................................................185 Muconil................................................... 189
Monteluk .................................................185 Mucosol.................................................. 188
Montelukast ............................................184 Mucospel ............................................... 189
Montemax...............................................185 Mucoten ................................................. 189
Montenaaf ..............................................185 Mucovan ................................................ 188
Montene .................................................185 Mucut ..................................................... 189
Montex....................................................185 Muderm .................................................. 406
872
GENERAL INDEX
Mudiral ....................................................281 Nabulex .................................................. 321

Mukofix ...................................................188 Nacromin ............................................... 395
Multi Seas...............................................533 Naf ......................................................... 412
Multicod ..................................................533 Nafamin.................................................. 371
Multiparin ................................................159 Nafcillin ...................................................... 5
Multisina .................................................531 Naid ........................................................ 338
Multivit Plus ............................................532 Nalbun.................................................... 321
Mulyt .......................................................189 Nalbutin .................................................. 321
Mumps VAC ...........................................453 Nalid ......................................................... 41
Munil .......................................................189 Nalidex ..................................................... 41
Mupi ........................................................406 Nalidixic Acid ........................................... 41
Mupiderm ...............................................406 Naligram................................................... 41
Mupirocin ................................................406 Nalipsy ................................................... 300
Mupirocin ................................................406 Naloxone Hydrochloride ........................ 326
Mupiron ..................................................406 Nalphin ................................................... 321
Murein ........................................................7 Nameso.......................................... 105, 338
Muroderm ...............................................406 Namicin .................................................. 362
Muron .....................................................406 Namitol ................................................... 293
Musclex ..................................................352 Nandrolone ............................................ 228
Muslofen .................................................350 Nandron ................................................. 228
Mute .......................................................189 Nap ........................................................ 289
Muterol ...................................................177 Napa .............................................. 289, 290
Mycal ............................................. 518, 520 Napadol.................................................. 291
Mycocin ..................................................412 Napcon................................................... 371
Mycoder..................................................410 Napexa................................................... 338
Mycofin ............................................ 58, 412 Napguard ............................................... 440
Mycofree.......................................... 58, 412 Naphalon ............................................... 371
Mycon ............................................ 401, 411 Napix ...................................................... 338
Mycophenolate Mofetil ..........................485 Napren ES ..................................... 105, 338
Mycophenolat-Mofetil sandoz ................485 Napren ................................................... 338
Mycosina ....................................... 401, 411 Napreso ......................................... 105, 338
Mycotil ....................................................485 Napro A .................................................. 338
Mydrate ..................................................375 Napro ..................................................... 338
Mydri-Atropin ................................. 375, 377 Napro-A Plus ................................. 105, 338
Myelin .....................................................527 Naprocid................................................. 338
Myfortic ...................................................485 Naproflex ....................................... 105, 338
Mylofen ...................................................350 Naproson ............................................... 338
Mylostat ..................................................477 Naprosyn Plus ............................... 105, 338
Myocal ....................................................518 Naprosyn ............................................... 338
Myocard..................................................124 Naprotec ........................................ 106, 338
Myocor ....................................................124 Naprox Plus ................................... 106, 338
Myolax ....................................................352 Naprox ................................................... 338
MyolaxPlus .............................................352 Naproxen Plus ............................... 106, 338
Myomine .................................................156 Naproxen ............................... 106, 337, 338
Myonil .....................................................351 Naproxin................................................. 338
Myorel .....................................................350 Naproxzia ....................................... 106, 338
Myoson ...................................................352 Naprozen ............................................... 338
Myotril .....................................................297 Naprozol......................................... 106, 339
Myoxan ...................................................352 Napryn ................................................... 338
Myoxant ..................................................352 Napsec ........................................... 106, 339
Mypril ......................................................131 Napsod................................................... 338
Myrica .....................................................300 Napxon........................................... 106, 339
Myrox......................................................188 Nasalox .................................................. 396
Mysprin ...................................................291 Nasochrom .................................... 372, 395
Mytil ........................................................189 Nasomet................................................. 394
Nasonex ................................................. 394
Nasopain ........................................ 106, 339
N N-Aspa ..................................................... 98
Naspro ........................................... 105, 338
Naafcal-D ...............................................520 Natagen ................................................. 365
Naafco ORS ...........................................112 Natal ....................................................... 532
Naafzinc .................................................522 Natamycin .............................................. 364
Nab Xelpac .............................................482
873
GENERAL INDEX
Natapro...................................................365 Neorice ORS .......................................... 112

Natazol ...................................................396 Neorice................................................... 112
Nateglinide .............................................209 Neosaline ............................................... 112
Natoph ....................................................365 Neosol DS .............................................. 513
Natrilix ....................................................148 Neosol .................................................... 513
Naurif ......................................................307 Neos-R ................................................... 326
Nauset ....................................................310 Neosten HC ........................................... 420
Navaclo ......................................................6 Neosten.......................................... 242, 409
Navix Plus ..............................................163 Neostig ................................................... 326
Navix ......................................................163 Neostigmine .................................... 326,349
Navsol ....................................................385 Neosuxa ................................................. 326
Naxin ......................................................338 Neotack .................................................. 102
Naz .........................................................365 Neotear .................................................. 383
Nazin ......................................................371 Neotin..................................................... 102
Nazolin ...................................................396 Neotison ................................................. 394
NCL ........................................................383 Neotracin ............................................... 406
Nebanol Plus ..........................................406 Neotrax .................................................... 84
Nebanol ..................................................406 Neoxit ..................................................... 274
Nebaskin Plus ........................................406 Neozine .................................................. 407
Nebazin ..................................................406 Nepafenac ............................................. 370
Nebicard .................................................126 Nepag .................................................... 370
Nebifast ..................................................126 Nepco..................................................... 300
Nebilol ....................................................127 Nepranol ................................................ 406
Nebita .....................................................127 Nepsy ..................................................... 297
Nebium ...................................................267 Neptor .................................................... 105
Nebivas ..................................................127 Nerbo ............................................. 526, 527
Nebivolol.................................................126 Nerkein................................................... 328
Nectum ...................................................269 Nerupa ................................................... 427
Nedocromil .............................................183 Nervalin .................................................. 300
Neeper....................................................415 Nervex.................................................... 526
Nelfinavir ..................................................79 Nervin..................................................... 526
Nelod ......................................................140 Nerviplex ................................................ 527
Nenol ......................................................406 Nerviton.................................................. 526
Neo Kit ....................................................111 Nesifin .................................................... 117
Neo-B .....................................................406 Neso............................................... 106, 339
Neobacin ................................................406 Nesotem......................................... 106, 339
Neobet ....................................................417 Nestor .................................................... 172
Neobion ..................................................527 Neubin.................................................... 527
Neocal ....................................................518 Neucos-B ....................................... 526, 527
Neoceptin ...............................................102 Neufil ...................................................... 503
Neocilor ..................................................423 Neugalin ................................................. 300
Neocin Plus ............................................406 Neulastin ................................................ 503
Neocipran ...............................................280 Neupogen .............................................. 503
Neocitrin .................................................406 Neural .................................................... 526
Neoclomide ............................................469 Neuralgin ............................................... 527
Neocort ...................................................417 Neuratam ............................................... 305
Neodrop....................................................94 Neurega ................................................. 300
Neofenac ................................................332 Neurep ................................................... 527
Neofloxin D .................................... 361, 390 NeurexB ................................................. 527
Neofloxin ................................. 38, 360, 390 Neurica................................................... 300
Neogen plus ...........................................406 Neuroaid ................................................ 527
Neolor .....................................................423 Neuro-B.................................................. 527
Neomycin Sulphate ..................................30 Neurobest ...................................... 526, 527
Neomycin .............................. 359, 388, 406 Neurocare .............................................. 527
Neopanta ................................................108 Neurocet ................................................ 299
Neopara..................................................290 Neurofen ................................................ 334
Neopenem ................................................28 Neurolep ................................................ 305
Neoplat ...................................................481 Neurolin.................................................. 300
Neopra ....................................................107 Neuropen ............................................... 297
Neopred..................................................369 Neurotonic ............................................. 527
Neoprox ....................................................21 Neurovan ............................................... 300
Neorex ......................................................13 Neuvital .......................................... 526, 527
874
GENERAL INDEX
Nevan .....................................................370 Nitoxin ...................................................... 67

Nevirapine ................................................78 Nitrazepam ............................................ 269
Nevola ....................................................285 Nitrest..................................................... 271
Newage ..................................................532 Nitrin ....................................................... 139
Newseas.................................................533 Nitro ....................................................... 139
Nexcap ...................................................105 Nitrocard ................................................ 139
Nexcital...................................................279 Nitrocontin .............................................. 139
Nexe .......................................................105 Nitrodil .................................................... 139
Nexito .....................................................279 Nitrofix .................................................... 139
Nexol ......................................................188 Nitrofur ..................................................... 52
Nexrab ....................................................109 Nitrofurantoin ........................................... 51
Nexum ....................................................105 Nitrofurazone ......................................... 406
Nexyl ......................................................168 Nitrogina................................................. 139
NGS ........................................................368 Nitromint................................................. 139
Niapid .....................................................174 Nitrosol ................................................... 139
Nicin .......................................................365 Nitrous Oxide ......................................... 317
Niconic ........................................... 174, 525 Nitrous.................................................... 317
Nicor .......................................................144 Nitrovas .................................................. 139
Nicorandil ...............................................144 Nixalo ..................................................... 266
Nicosit .....................................................146 Nixar ......................................................... 67
Nicoson ..................................................525 Nixpan .................................................... 108
Nicotinic Acid ..........................................525 Nizoder........................................... 411, 441
Nicud ........................................................67 Nizox ........................................................ 67
Nid .........................................................522 Nlepsin ........................................... 118, 521
Nidazyl ......................................................65 N-Mycin .................................................. 365
Nidependiol ............................................358 Noak ....................................................... 330
Nidependiol-D ........................................358 Nobac....................................................... 41
Nidipine SR ............................................142 Nobesit ................................................... 209
Nidocard .................................................139 Noburn ................................................... 100
Nidor .........................................................67 Noclog .................................................... 163
Nidozox ....................................................67 Noctin ..................................................... 269
Nife .........................................................142 Nodep ............................................ 280, 311
Nifedipine ...................................... 142, 240 Nodepress ..................................... 280, 311
Nifin ........................................................142 Nodia ...................................................... 345
Night Fresh .............................................384 Nofenac.................................................. 330
Nightus ...................................................267 Nofiate.................................................... 169
Nilac .......................................................434 Noficon ................................................... 169
Nilotinib...................................................478 Noler ...................................................... 422
Nimocal ..................................................143 Nomark .................................................. 433
Nimodi ....................................................143 Nomesis ................................................. 308
Nimodipine .............................................142 Nomi....................................................... 294
Nine Seas ...............................................533 Nomigran ............................................... 294
Nintoin ......................................................52 Nomopil .................................................. 210
Nipaplex .................................................526 Nomosic ................................................. 308
Nipotin ....................................................501 Nomotil ................................................... 112
Nipoxen ..................................................338 Nop ........................................................ 130
Nipozin ...................................................522 Nopain............................................ 331, 370
Nipro Gold ..............................................532 Nor Q ..................................................... 325
Niprolac ..................................................118 Norad Plus ............................................. 532
Nirvana ...................................................260 Norad ..................................................... 533
Nispore .......................................... 365, 410 Norain .................................................... 107
Nitalet .......................................................67 Norbit ..................................................... 154
Nitanid ......................................................67 Nordette ................................................. 247
Nitasis .......................................................67 Norditropin Simplex ............................... 229
Nitasol ......................................................67 Nordrine ................................................. 156
Nitax .........................................................67 Norestin.................................................. 225
Nitaxen .....................................................67 Noret ...................................................... 248
Nitaxide ....................................................67 Norethinodrel ......................................... 223
Nitazet ......................................................67 Norethisterone ............................... 225, 489
Nitazox .....................................................67 Norflu ..................................................... 284
Nitazoxanide ............................................66 Norglic .................................................... 206
Nitide ........................................................67 Norline.................................................... 157
875
GENERAL INDEX
Normacid ................................................102 Nutrition.................................................. 509

Norma-H .................................................102 Nutrivit-B ................................................ 526
Normal Saline .........................................510 Nutrivit-C ......................................... 528,530
Normalin ................................................510 Nutrivit-MV ............................................. 531
Normanal ................................................120 Nutrovita................................................. 526
Normasol ................................................510 Nutrum 50+ ............................................ 532
Normaten................................................124 Nutrum Bone .......................................... 532
Normens .................................................225 Nutrum Eye ............................................ 534
Normoglobin .......................................... See Nutrum Gold .......................................... 532
Norpill ............................................ 247,249 Nutrum Junior ........................................ 532
Norpress .................................................124 Nutrum PN ............................................. 533
Norsol .....................................................383 Nutrum Super ........................................ 532
Nortin ......................................................284 Nuvace ................................................... 131
Nortriptyline ........................... 216, 282, 283 Nuvicort .................................................. 218
Norvis .......................................................96 Nvmet..................................................... 209
Norzin .....................................................284 NVP........................................................ 308
Noscab ...................................................415 NX-1 ....................................................... 338
Nosedex .................................................425 Nyclobate NN ......................................... 418
Nosemin .................................................422 Nyclobate ............................... 417, 418, 454
No-Spa .....................................................98 Nyscan ................................................... 412
Nospot ....................................................441 Nyst ........................................................ 412
Nostrin ....................................................330 Nystat VT ............................................... 243
Notens ....................................................267 Nystat ..................................................... 412
Noteron...................................................225 Nystatin ....................58, 242, 387, 400, 512
Novacal-D...............................................520
Novarin ...................................................332
Novastin .................................................172 O
Novatac ..................................................101
Novelon ..................................................248 O Fruity .................................................. 112
Novelta .....................................................93 O Saline ................................................. 112
Novin ......................................................396 O-20 ....................................................... 107
Novirax HC .............................................413 Obactin............................................ 363,391
Novirax ............................................ 70, 413 Obemet .................................................. 209
Novo Rapid Flex Pen .............................203 Obid ....................................................... 209
Novo Zinc ...............................................522 O-Cal Kit ................................................ 233
Novocaine ..............................................381 O-Cal ...................................................... 518
NovoRapid Penfill ...................................203 Oceancal- D ........................................... 520
Novoxen ........................................ 106, 339 Oceancal ................................................ 520
Nox .........................................................532 Ocimax ..................................................... 38
Nozma ....................................................185 Ocin ........................................................ 239
NPH ........................................................389 Oclazid ................................................... 206
N-Sol ......................................................383 Oclube.................................................... 384
NTZ ..........................................................67 Octagam ................................................ 460
Nuba Plus ...............................................406 Octrim ...................................................... 43
Nubis ......................................................124 Ocubrom ................................................ 370
Nufex ........................................................13 Ocubronac ............................................. 370
Nugesic ..................................................527 Ocuclor................................................... 358
Nuloc ......................................................105 Ocudex................................................... 368
Nuprafen.................................................338 Ocufen ................................................... 370
Nupralgin Plus ........................................339 Ocuflox ................................................... 362
Nupralgin ............................... 106, 338, 339 Ocugel.................................................... 383
Nuprazol .................................................107 Oculant................................................... 384
Nuprin .....................................................406 Oculogen ............................................... 371
Nurisol ....................................................512 Ocunat ................................................... 365
Nuropa ....................................................527 Ocunep .................................................. 371
Nusartan .................................................134 Ocupres ................................................. 377
Nutramid .................................................100 Ocustin ................................................... 371
Nutribon ..................................................520 Ocutear .................................................. 383
Nutridex ..................................................513 Ocutif ...................................................... 372
Nutrilve ...................................................512 Ocutifen.................................................. 372
Nutrimin D ..............................................512 Ocutob ................................................... 359
Nutrimin ..................................................512 Ocutrex .................................................. 358
Ocuvit ..................................................... 534
876
GENERAL INDEX
OD Phylline ............................................180 Omeprazole ........................... 103, 106, 107

Odacef ......................................................20 Omeprol ................................................. 107
Odafen ................................................... See Omesil .................................................... 107
Odatrix ......................................................24 Omesoft ................................................. 173
Odaz .........................................................32 Ometac .................................................. 107
Odazyth ....................................................32 Ometem ................................................. 107
Odazyth ..................................................358 Ometid ................................................... 107
Odeson ...................................................219 Ometor ................................................... 107
Oditen .......................................................23 Omevir ................................................... 107
Odmon ....................................................185 Omex ..................................................... 107
Odrel .......................................................163 OMG-3 ................................................... 173
Odycin ....................................................362 Omidex................................................... 107
Oestriol ...................................................223 Omidon .................................................. 100
Off-H .......................................................102 Omirex ................................................... 107
Oflacin ......................................................41 Omitac.................................................... 107
Ofloxacin ................................. 41, 363, 391 Omitin..................................................... 107
Ofpain ............................................ 336, 370 Omizit ..................................................... 107
Ofran ......................................................310 Omniclear .............................................. 541
Ofuran ......................................................52 Omniflox ................................................... 42
Oily Phenol Injection ..............................120 Omnipaque ............................................ 541
Okical .....................................................520 Omniscan ............................................... 540
Olacing ...................................................373 Omnitrope .............................................. 229
Olanap ....................................................275 O-morphon ............................................. 287
Olanor.....................................................275 Omsec.................................................... 107
Olanza ....................................................275 Onaseron ............................................... 310
Olanzapine .............................................275 Onasia.................................................... 310
Olarif .......................................................373 Oncodex................................................. 310
Oleanz ....................................................275 Ondamax ............................................... 310
Olif .........................................................410 Ondantor ................................................ 310
Olistat .....................................................312 Ondaron ................................................. 310
Olmecar ..................................................134 Ondason ................................................ 310
Olmepres ....................................... 134, 171 One Alpha .............................................. 529
Olmesan .................................................134 Onecal.................................................... 520
Olmesart .................................................134 Onecof ................................................... 188
Olmesartan .............................................134 Onefix....................................................... 20
Olmesta ......................................... 134, 141 Onepro ................................................... 105
Olmetic -plus ..........................................134 Oni ......................................................... 416
Olmetic ...................................................134 Onicon.................................................... 410
Olmevas ........................................ 134, 141 Onium ...................................................... 96
Olmezest AM ..........................................141 Onlac ...................................................... 118
Ologen ....................................................373 Onmet .................................................... 209
Olon-DS..................................................373 Onsat ..................................................... 310
Olopan ........................................... 373, 395 Ontaxel...................................................See
Olopatadine ................................... 372, 395 Ontin ...................................................... 422
Olopred Plus ..........................................368 Onzid ...................................................... 206
Olopred...................................................368 OP max .................................................. 107
Olopta .....................................................373 OP ......................................................... 107
Olpadin ...................................................373 Opagrel .................................................. 164
Olsart ......................................................134 Opal ....................................................... 107
Omastin ..................................................410 Opalgic ................................................... 288
Ome ........................................................107 Opanac .................................................. 371
Omeben..................................................107 Opatin .................................................... 373
Omecron.................................................107 Opcol ...................................................... 384
Omeflox ..................................... 40, 41, 362 OPD ....................................................... 373
Omega-3-Acid Ethyl Esters....................173 Opdex ............................................ 361, 390
Omegut...................................................107 Opegus .................................................... 74
Omelet ....................................................107 Open .......................................................... 5
Omelock .................................................107 Opezen .................................................. 107
Omenaaf.................................................107 Opifen .................................................... 320
Omenix ...................................................107 Opsocrom .............................................. 395
Omenta...................................................107 Opsomycetin .......................................... 358
Omep ......................................................107 Opsonil ................................................... 306
877
GENERAL INDEX
Opso–Rinse ...........................................385 Orbidex .................................. 360, 368, 389

Opsovit MM ............................................532 Orcef ........................................................ 20
Opsovit ...................................................526 Orcenac ................................................. 330
Optabac ..................................................358 Orcical .................................................... 518
Optacarpine ............................................377 Orcipro ..................................................... 38
Optacid ...................................................363 Orcon ..................................................... 410
Optadin ...................................................373 Orextil....................................................... 17
Optafenac ...............................................371 Orfenac Plus .......................................... 333
Optagel .......................................... 383, 384 Orfenac .................................................. 332
Optagold .................................................534 Orgabion ........................................ 526, 527
Optaloc ...................................................377 Orgafen .................................................. 332
Optavit ............................................ 386,534 Orgalev .................................................... 40
Optear ....................................................384 Orgametril .............................................. 225
Opthacol ......................................... 358,389 Orgamox .................................................... 8
Opthaflox ................................................362 Orgaxim ................................................... 20
Optibet ....................................................377 Orgazinc................................................. 522
Optichlor .................................................358 Orgazith ................................................... 32
Opticol ....................................................358 Oricef ....................................................... 24
Opticol-D ................................................358 Oricox..................................................... 333
Optifen ....................................................370 Orifen ..................................................... 330
Optiflox ...................................................362 Orin ........................................................ 426
Optilom ...................................................362 Orinex .................................................... 423
Optimide .................................................363 Oriodox .................................................... 36
Optimox ........................................... 41, 362 Orioplex.................................................. 526
Optipeg-A ...............................................488 Orioplex-M ............................................. 532
Optison-N ...................................... 367, 388 Orizone .................................................... 24
Optivir .....................................................366 Orket ...................................................... 335
Opton ......................................................105 Orlev ........................................................ 40
OR Saline ...............................................112 Orlifit ....................................................... 312
OR-500 .....................................................66 Orlistat.................................................... 312
Orabis .....................................................124 Ormico ........................................... 401, 411
Oracal .....................................................518 Ormin ..................................................... 209
Oracal-DT ...............................................520 Ornical.................................................... 312
Oracal-M.................................................521 Ornid ........................................................ 66
Oracyn-K ....................................................5 Ornidazole ............................................... 65
Oradin .....................................................426 Ornil ......................................................... 66
Oradol .....................................................336 Ornizol...................................................... 66
Oradol .....................................................370 Ornys ..................................................... 412
Oragel ............................................. 401,411 Orocal .................................................... 233
Oral Iron .................................................494 Orocare .......................................... 401, 411
Oral Iron .................................................494 Oroclean Coolmint ................................. 402
Oral Nutrition ..........................................515 Oroclean Original ................................... 402
Oral Rehydration Salts ...........................111 Oroconazol .................................... 401, 411
Oralax .....................................................118 Orofer ..................................................... 496
Oral-C .....................................................401 Orogel ............................................ 327, 402
Oralis Cavicare .......................................402 Orogurd ........................................... 401,411
Oralis ......................................................402 Orostar Cool Mint................................... 402
Oralon .....................................................401 Orostar Original ..................................... 402
Oralsaline Sweety ..................................112 Orostar plus ........................................... 402
Oralsaline ...............................................112 Orotifen .................................................. 184
Oralzin ....................................................522 ORS ....................................................... 112
Oramet ...................................................209 Ortac ...................................................... 102
Oranex....................................................168 Orthocal ................................................. 518
Orasol .....................................................112 Orthocal-D ............................................. 520
Orasquin ...................................................39 Ortical..................................................... 519
Oratics ............................................ 327,402 Orva ....................................................... 171
Orazid .....................................................206 Orvatin ................................................... 171
Orazinc ...................................................522 Osartan .................................................. 134
Orbapin...................................................141 Osartil..................................................... 134
Orbas ......................................................134 Oscal ...................................................... 518
Orbidex C ...............................................358 Oscal-D .................................................. 520
Orbidex G ...............................................361 Oscal-M.................................................. 521
878
GENERAL INDEX
Oscard ....................................................134 Oxecylin ................................................... 36

Oselta .......................................................74 Oxet ....................................................... 533
Oseltamivir ...............................................74 Oxetin..................................................... 312
Osetron...................................................310 Oxicam ................................................... 340
Osicent 80 ..............................................476 Oxidex .................................................... 532
Osmolax .................................................118 Oxifun..................................................... 412
Osmosol .................................................152 Oxifyl CR ................................................ 146
Osmotic laxatives ...................................117 Oxigel ..................................................... 433
Osnil .......................................................233 Oxiplat .................................................... 481
Ostacid ...................................................518 Oxsoralen .............................................. 431
Ostacid-D ...............................................520 Oxtreotide .............................................. 493
Ostel .......................................................232 Oxybuprocaine ....................................... 381
Ostelac ...................................................336 Oxybutyrin .............................................. 257
Ostel-D ...................................................233 Oxycaine ................................................ 381
Osteo ......................................................529 Oxycol .................................................... 120
Osticare ..................................................353 Oxycort................................................... 182
Ostimet .......................................... 518, 520 oxygen ................................................... 193
Ostium-D ................................................520 Oxymetazoline .........391, 393, 395,396,398
Ostium-Gold ...........................................532 Oxynex ................................................... 396
Ostocal D................................................520 Oxyphenonium Bromide .......................... 96
Ostocal DX .............................................520 Oxytetracycline ........................................ 36
Ostocal JR ..............................................518 Oxytocin .......................................... 231,238
Ostocal .......................................... 518, 519 Oxyton.................................................... 239
Ostocal-M ...............................................521 Ozink-B .................................................. 527
Ostocin ...................................................428
Ostoflex ..................................................330
Ostogen C Plus ......................................519 P
Ostogen C ..............................................519
Ostogen D ..............................................520 P+C ........................................................ 290
Ostogen ..................................................518 P-20 ....................................................... 108
Ostomax .................................................232 P-40 ....................................................... 108
Ostorin ....................................................353 Pac ......................................................... 290
Ostovit ....................................................521 Pacet ...................................................... 154
Ostriol .....................................................530 Pacibion ................................................. 527
Otholon ...................................................368 Pacin .......................................................... 5
Oticef ........................................................15 Paclitaxel Actavis ................................... 482
Oticlor .......................................................15 Paclitaxel Aqvida ................................... 482
Otophenicol ............................................389 Paclitaxel medac.................................... 482
Otosil ......................................................427 Paclitaxel Sandoz .......................... 482, 483
Otosporin ................................................389 Paclitaxel ............................................... 482
Ovazol ....................................................491 Paclitex .................................................. 483
Ovel .................................................. 40,362 Pactorin .................................................. 139
Ovestin ........................................... 223,241 Paftrol..................................................... 427
Ovidril .....................................................230 Pagerd ................................................... 108
Ovit-A .....................................................524 Paino ...................................................... 330
Ovit-E .....................................................530 Pair .................................................. 336,370
Ovorest ...................................................247 Pairox ..................................................... 338
Ovostat Gold ..........................................248 Palimax .................................................. 276
Ovuclon ..................................................226 Palnox .................................................... 310
Ovulet .....................................................226 Palonosetron .......................................... 310
Oxacillin ......................................................5 Paloron................................................... 310
Oxaliplat .................................................481 Paloset ................................................... 310
Oxaliplatin....................................... 480,481 Palosis ................................................... 310
Oxalitin medac .......................................481 Palostar .................................................. 310
Oxalotin ..................................................481 Paloxi ..................................................... 310
Oxapro ....................................................279 Paloxiron ................................................ 310
Oxaprozin ...............................................339 Palzen .................................................... 310
Oxat ........................................................281 Pamix ............................................. 289, 290
Oxcarbamazepine ..................................299 Pamulin .................................................. 407
Oxecone ............................................ 92, 93 Panadol .................................................. 290
Oxecone-MS ............................................93 Panalon .................................................. 325
Oxecone-S ...............................................94 Panamox .................................................. 84
Pancreatin .............................................. 121
879
GENERAL INDEX
Pancuronium ..........................................324 Parkifen .................................................. 305

Pancuroniun rotex ..................................325 Parlox ....................................................... 42
Pandeflu ...................................................74 Parnil DS .................................................. 83
Pandura ..................................................297 Parotin.................................................... 281
Panfast ...................................................108 Paroxet................................................... 281
Panfre .....................................................332 Paroxetine .............................................. 280
Panirid ....................................................281 Parten ............................................ 133, 134
Panium .....................................................96 Pase ....................................................... 297
Panlid .....................................................333 Patadin ................................................... 373
Panodin ..................................................333 Patalon ................................................... 373
Panol ............................................. 289, 290 Patanix ................................................... 109
Panoral ...................................................108 Patron .................................................... 310
Panoset ..................................................310 Pausogest .............................................. 222
Panotem .................................................108 Pavigard ................................................. 172
Panovir .....................................................73 Paxel ...................................................... 483
Panoz .....................................................108 Pazopanib .............................................. 478
Panprazo ................................................108 P-caine ................................................... 381
Panpro ....................................................108 P-cort ..................................................... 221
Pansec ...................................................108 P-Dol ...................................................... 291
Pansiv .....................................................108 PDS........................................................ 493
Pansos ...................................................108 Peak ....................................................... 259
Pantac ....................................................108 Pedeamin ....................................... 424, 428
Pantex ....................................................108 Pediavit .................................................. 533
Pantid .....................................................108 Pedicef ..................................................... 22
Pantium ..................................................108 Pedicon .................................................... 94
Panto ......................................................108 Pedicord ................................................. 438
Pantoaid .................................................108 Pedilar ............................................ 424, 428
Pantobex ................................................108 Pedilid ...................................................... 34
Pantochem .............................................108 Pediphen ........................................ 424, 428
Pantodac ................................................108 Pedipred ................................................ 221
Pantogen ................................................108 Pedisol DS ............................................. 513
Pantogut .................................................108 Pedisol ................................................... 513
Pantolok .................................................108 Pedi-Z .................................................... 522
Pantomax ...............................................108 Pednisol ................................................. 369
Panton ....................................................108 Peflox ....................................................... 41
Pantonix .................................................108 Pefloxacin Mesylate ................................. 41
Pantopra .................................................108 Peg Intron .............................................. 488
Pantoprazole ................................. 103, 108 Pegalin ................................................... 300
Pantoprox ...............................................108 Pegamax ................................................ 300
Pantosec ................................................108 Pegasys ................................................. 488
Pantosil...................................................108 Pegferon ................................................ 488
Pantoson ................................................519 Pegfilastin .............................................. 503
Pantover .................................................109 Pegfilgrast .............................................. 503
Pantozol .................................................109 Pegin ...................................................... 488
Pantrol ....................................................109 Peginterferon alfa .................................. 488
Panzer ....................................................109 Pegneufil ................................................ 503
Panzol ....................................................109 Pehin ...................................................... 287
Papaveretum ..........................................319 Pelverin .................................................... 97
Para ........................................................289 Pem DS.................................................. 496
Para-C ....................................................290 Pem ........................................................ 522
Paracetamol .......................... 216, 289, 323 Pen G ......................................................... 4
Paradil ....................................................290 Pen-A ......................................................... 9
Parafen ...................................................290 Penamin ......................................... 192, 423
Parafresh ................................................384 Penco ......................................................... 5
Paragesic ...............................................290 Pendol .................................................... 288
Parapyrol ................................................290 Pendoril .................................................. 131
Paratadol ................................................291 Penfil ...................................................... 260
Parenteral Iron .......................................494 Penicillin V ................................................. 4
Paricel ....................................................109 Penicillin ............................. 3, 391, 399, 400
Paridon ...................................................100 Penomer .................................................. 28
Parinox ...................................................160 Pentadol ................................................. 288
Parixol ....................................................304 Pentaglobin ............................................ 460
880
GENERAL INDEX
Penticin...................................................274 Phenoson ............................................... 302

Pentosa ..................................................109 Phenoxymethyl Penicillin ....................... 398
Pentoxifylline ..........................................146 Phenylketonuria ..................................... 515
Pentyl .....................................................316 Phenytoin ............................................... 299
Penvik .........................................................5 Pheramin ....................................... 192, 423
Pep .........................................................522 Phylopen .................................................... 7
Peptacid ...................................................94 Phyton .................................................... 526
Peptil H ...................................................102 Piazol ..................................................... 107
Peptin DS ...............................................523 Pidogrel .................................................. 163
Peptosol .................................................102 Pidus ...................................................... 210
Peptral ....................................................107 Pifen ....................................................... 295
Perex ......................................................533 Piglit ....................................................... 210
Pergonal .................................................230 Pigrain .................................................... 295
Pericam ..................................................275 Pigzon .................................................... 210
Pericard Plus ..........................................131 Pilestop .................................................. 120
Pericard ..................................................131 Pileus ..................................................... 410
Peridol ....................................................274 Pilocarpine ..................................... 376, 377
Perigen ...................................................274 Pilodrop .................................................. 377
Perinase .................................................394 Piloma .................................................... 377
Perindal ..................................................131 Pime ......................................................... 25
Perindopril ..............................................130 Pimecrolimus ......................................... 431
Perinem ....................................................26 Pimplex .................................................. 433
Perion .....................................................100 Pinor ....................................................... 283
Periset ....................................................310 Piodar..................................................... 210
Perix .........................................................24 Piodin ..................................................... 401
Perjeta ....................................................479 Pioglitazone ........................................... 210
Perkidopa ...............................................303 Piol 2 ......................................................... 10
Perkinil....................................................304 Piolit ....................................................... 210
Perkirol ...................................................304 Pipecuronium ........................................ 325
Perls .......................................................415 Pipericillin ................................................. 10
Perlutex ..................................................249 Piracetam ............................................... 305
Perma .....................................................415 Piramax .................................................. 305
Permet ....................................................415 Piramed.................................................. 301
Permethrin ..............................................415 Piramil .................................................... 131
Permin ....................................................415 Piratam................................................... 305
Permisol .................................................415 Piriton ............................................. 192, 423
Permival .................................................284 Piroxicam ............................................... 339
Perol .......................................................275 Pitavas ................................................... 172
Perosa ....................................................415 Pitavastatin ............................................ 171
Pertilos Plus ...........................................134 Pitocin .................................................... 239
Pertilos ...................................................133 Pivacain ................................................. 328
Pertussis vaccine ...................................447 Pivalo ..................................................... 172
Pertuza ...................................................479 Pivasta ................................................... 172
Pethidine ...................................... 287, 321 Pivicil ........................................................ 11
Peuli .......................................................253 Pivmecillinam ........................................... 11
Pevaryl ...................................................409 Pizo-A .................................................... 295
Pevil ........................................................192 Pizofen TS ............................................. 295
Pevil ........................................................426 Pizofen ................................................... 295
Pevisia ....................................................409 Pizotifen ................................................. 295
Pevisone.................................................409 Pizotin .................................................... 295
Pevitin .....................................................409 Placent-M ............................................... 533
PG .........................................................300 Pladex .................................................... 163
Phacovit..................................................386 Pladex-A ................................................ 163
Pharmorubicin ........................................471 Plagrin Plus ............................................ 163
Phenadryl ...................................... 424, 428 Plagrin .................................................... 163
Phenerex ................................................427 Planex Plus ............................................ 430
Phenergan ..............................................427 Planex .................................................... 430
Pheniramine ................................... 190,192 Plasma ................................................... 514
Pheno .....................................................302 Plasmex ................................................. 515
Phenoba .................................................302 Platinex .................................................. 481
Phenocept ..............................................485 Plavix-Plus ............................................. 163
Phenol ...................................................120 P-Lock .................................................... 109
881
GENERAL INDEX
Pneumo 23 .............................................457 Prasurel.................................................. 164

Pneumococcal vaccines ........................456 Prasuva .................................................. 164
Pneumovax 23 .......................................457 Prazia ..................................................... 105
Podo .........................................................22 Prazo ...................................................... 107
Pofol .......................................................316 Prazole ................................................... 107
Pol .........................................................290 Prazolin .................................................. 109
Polan ......................................................425 Prazolok .......................................... 137,254
Polimine..................................................496 Prazomax ............................................... 107
Polio vaccine ..........................................453 Prazopress ..................................... 137, 255
Poliomyelits Vaccine ..............................452 Prazosin ......................................... 136, 254
Poly Ethylene .........................................118 Prazover................................................. 107
Poly ........................................................359 Prazple ................................................... 107
Polycef ......................................................13 Preampak-C ........................................... 222
Polydex-N ...............................................359 Prebalin .................................................. 300
Polyforte .................................................359 Precare .................................................. 533
Polygel ....................................................384 Preclot AS .............................................. 163
Polymix ...................................................359 Preclot .................................................... 163
Polymix-H ...............................................389 Precodil .................................................. 221
Polymyxin B .................................. 363, 407 Precon.................................................... 134
Polymyxin ...............................................444 Pred ....................................................... 221
Polypro ...................................................384 Predasin ................................................. 369
Polyron ...................................................496 Predflam................................................. 369
Polysaccharide Typhoid Vaccine ...........449 Predixa ................................................... 219
Polysol ....................................................384 Prednelan .............................................. 221
Polytracin................................................359 Prednicort .............................................. 369
Polyvinyl alcohol .....................................384 Prednisolone217,220,221,340, 341, 368, 421
Polyvit Kids .............................................533 Prednol................................................... 369
Polyvit Plus A to Z Gold .........................532 Pregaba ................................................. 300
Polyvit .....................................................530 Pregabalin .............................................. 299
Polyvit-B .................................................526 Pregaben ............................................... 300
Ponos .....................................................330 Pregalex ................................................. 300
Pop-D .....................................................249 Pregan ................................................... 300
Potacit ....................................................261 Pregel..................................................... 109
Potassium Chloride ................................511 Pregnyl ................................................... 230
Potassium Citrate ...................................261 Prelica .................................................... 300
Povicidal .................................................439 Prelin ...................................................... 300
Poviclean ................................................439 Preloc ..................................................... 126
Povid ......................................................439 Premarin ........................................ 222, 242
Povidex...................................................439 Premesis ................................................ 118
Povidine..................................................439 Premicon ................................................ 222
Povidon ..................................................439 Premil ..................................................... 210
Povidone Iodine .....................................401 Prenat Plus ............................................ 497
Povidone ....................................... 384, 439 Prenat .................................................... 497
Povidon-I ................................................439 PrenatCl ................................................. 497
Povilect ...................................................384 Preneed Cl ............................................. 497
Povin ............................................. 384, 401 Preroid ................................................... 253
Povisep.................................. 243, 401, 439 Presec .................................................... 107
Povital .....................................................527 Preservin ................................................ 330
Powersol Plus ........................................512 Presonil .................................................. 126
Powersol.................................................512 Presulock ............................................... 134
Poyban ...................................................406 Pretin ...................................................... 426
Poy Pred.................................................359 Pretor ..................................................... 300
P-Phos ......................................................62 Preva ...................................................... 456
PPI .........................................................107 Prevas .................................................... 107
Pramax ...................................................109 Previp ....................................................... 96
Pramin ....................................................283 Prevnar .................................................. 457
Pramipexole ...........................................304 Prexim ...................................................... 20
Prandil ....................................................210 Pricard.................................................... 131
Prapid .....................................................164 Pride....................................................... 207
Prasugen ................................................164 Prifid ....................................................... 210
Prasugrel ................................................164 Priga....................................................... 300
Prasulet ..................................................164 Primace .................................................. 131
882
GENERAL INDEX
Primaquine ...............................................62 Prosalic .................................................. 441

Primocef ...................................................17 Proscan .................................................. 493
Primrose Oil ...........................................437 Prosectil ................................................. 107
Priocin ......................................................34 Prosfin .................................................... 228
Priorix .....................................................454 Prosma........................................... 184, 372
Pristin .....................................................140 Prosol ..................................................... 512
Pristin-all.................................................141 Prostacin D ............................................ 255
Probac ......................................................17 Prostaglandin Analogue ........................ 379
Probis ............................................ 124, 125 Prostam.................................................. 255
Probitor ...................................................107 Prostanil ................................................. 255
Procain ...................................................381 Prostigmin .............................................. 326
Procaine benzylpenicillin ............................5 Prosulf .................................................... 162
Procaine penicillin ......................................5 Protace H ............................................... 132
Procap ....................................................107 Protace................................................... 131
Procarbazine ..........................................481 Protamine Sulfate .................................. 161
Procef .......................................................14 Protasol .................................................. 418
Proceptins ..............................................107 Protear ................................................... 384
Procet .....................................................422 Protebon D ............................................. 520
Prochlorperazine ................... 275, 292, 310 Protebon M ............................................ 521
Procilin ....................................................305 Protebon ........................................ 518, 519
Procin D.......................................... 390,361 Protec-R ................................................. 102
Procin .............................. 38, 360, 361, 390 Protemin................................................. 512
Procyclidine ...........................................304 Protet ..................................................... 461
Prodep ........................................... 280, 312 Protide.................................................... 183
Profast ....................................................109 Protinavit ................................................ 255
Profenac L ..............................................333 Protinex .................................................. 512
Profenac .................................................370 Protium................................................... 109
Profenid ..................................................335 Protocid .................................................. 109
Profinied .................................................335 Protoloc .................................................. 109
Proflam ...................................................332 Protolon.................................................. 103
Progesic ........................................ 106, 339 Proton .................................................... 109
Progesterone ..........................................225 Protonil ................................................... 109
Proglid ....................................................206 Proton-P ................................................. 109
Progut .....................................................105 Protozin .................................................. 109
Progut-N ........................................ 106, 339 Provair.................................................... 185
Prokind .....................................................96 Proval ............................................. 300, 301
Prolert ............................................ 280, 312 Provenor ................................................ 249
Proliv ......................................................512 Provera .................................................. 250
Proliv-Plus ..............................................512 Provia ..................................................... 439
Prolok .....................................................107 Proxa-A .................................................... 67
Prolong ...................................................258 Proxivir ..................................................... 76
Prolonga .................................................260 Prozen.................................................... 427
Promalex ................................................427 Prozium .................................................. 267
Pro-Medrol .............................................220 Pruritus................................................... 192
Promergan .................................... 311, 427 Psudonil ................................................... 29
Promethazine ........................ 193, 311, 426 Ptrim ......................................................... 43
Promezin ................................................427 Pulmicort ................................................ 393
Promezol ................................................107 Pulmocare .............................................. 178
Promocal ................................................530 Pulmolin ................................................. 178
Prompton ................................................109 Pulmont .................................................. 185
Promtil ....................................................276 Pulmoten ................................................ 186
Pronapen ....................................................5 Puregon ................................................. 230
Pronex ....................................................105 Puri Nethol ............................................. 473
Pronil ........................................................66 Purifen.................................................... 331
Pronor .....................................................228 Purified immunoglobulin ........................ 460
Propantheline ........................... 96,216, 257 Purinol .................................................... 347
Proparacaine ..........................................381 Purotrol .................................................. 425
Propofol lipuro ........................................316 Pycuron .................................................. 325
Propofol ..................................................316 Pylopac .................................................. 111
Propranol ............................... 127, 197, 270 Pyra ........................................................ 290
Propranolol .............................................270 Pyrac ...................................................... 290
Propylthiouracil .......................................197 Pyralgin .................................................. 290
883
GENERAL INDEX
Pyrantel Pamoate.....................................84 Radex..................................................... 274

Pyrazinamide ...........................................45 Radimet.................................................. 209
Pyrazone ................................................348 Radioablation ......................................... 197
Pyridostigmine ........................................349 Radirif..................................................... 321
Pyridoxine...................................... 500, 525 Radola.................................................... 113
Pyrimac ..................................................308 Ralozine ................................................. 145
Pyrimethamine .........................................63 Raltegravir ............................................... 80
Pyrol .......................................................525 Raltitrexed .............................................. 473
Pyrostig ..................................................349 Raltrox.................................................... 321
Pz .........................................................109 Ramace.................................................. 131
Ramdex.................................................. 358
Ramicard Plus ....................................... 132
Q Ramicard ............................................... 131
Ramil ...................................................... 131
Qcin ..........................................................50 Ramilok .................................................. 131
Qmax ......................................................276 Ramilon .................................................. 131
Q-Nol ........................................................38 Ramipril .................................................. 131
Qpine ......................................................276 Ramipro ................................................. 131
Q-Rash ...................................................440 Ramoril Plus .......................................... 132
Qrip .........................................................330 Ramoril................................................... 131
Quetiapine ..............................................276 Ramphen ....................................... 358, 389
Quetinil ...................................................276 Rampril................................................... 131
Quiet .......................................................276 Ranid ...................................................... 102
Quilev .......................................................40 Ranidin ................................................... 102
Quinine .....................................................63 Ranison .................................................. 102
Quinoflox ..................................................42 Ranisyn .................................................. 102
Quinolex ...................................................61 Ranitid .................................................... 102
Quinox ......................................................39 Ranitidine ....................................... 101, 102
Quintor......................................................39 Ranitidine-R ........................................... 102
Quixin .......................................................40 Ranitor ................................................... 102
Qutap ......................................................276 Ranix ...................................................... 102
Qutipin ....................................................276 Ranola.................................................... 145
Ranolazine ............................................. 144
R Ranolin ................................................... 145
Ranoxen Plus ........................................ 106
R- 20 .......................................................109 Ransys ........................................... 134, 141
Rabasine ................................................312 Rantec.................................................... 102
Rabe .......................................................109 Rantoin..................................................... 52
Rabeca ...................................................109 Ranul ...................................................... 102
Rabecon .................................................109 Rapid C .................................................. 528
Rabemax ................................................109 Rapilax ................................................... 326
Rabepes .................................................109 Rapine.................................................... 284
Rabepra..................................................109 Rashguard ............................................. 440
Rabeprazole .................................. 103, 109 Rasilez HCT ........................................... 136
Rabesec .................................................109 Rasilez ................................................... 136
Rabetem .................................................109 Rasonix .................................................. 109
Rabies Vaccine ......................................457 Rasoz ..................................................... 109
Rabifast ..................................................109 Ratinol Forte .......................................... 524
Rabigut ...................................................109 Raubasine .............................................. 145
Rabipep ..................................................109 Ravia ...................................................... 102
Rabipur ...................................................457 Razole .................................................... 109
Rabix-IG .................................................462 Recast .................................................... 185
Rabix VC ................................................457 Recin HC ............................................... 389
Rabizol ...................................................109 Recin ...................................................... 390
Rabonac .................................................109 Recocid Plus ............................................ 94
Rabprazo ................................................109 Recodin .................................................. 102
Racard ....................................................131 Recof ...................................................... 188
Race .......................................................533 Recogen ................................................ 501
Racecadotril ...........................................113 Recol ...................................................... 172
Racedot ..................................................113 Reconil ................................................... 345
Racetril ...................................................113 Recormon .............................................. 502
Ractovit ..................................................386 Recox ..................................................... 333
884
GENERAL INDEX
Rectocare ...............................................139 Repanid.................................................. 210

Recular ...................................................370 Repaprost .............................................. 380
Recur ......................................................228 Repitol .................................................... 304
Redia ............................................. 211, 212 Replet Plus ............................................ 163
Rediglip M ..............................................212 Replet..................................................... 163
Rediglip ..................................................211 Repopain ............................................... 336
Reef ........................................................520 Repose................................................... 281
Reelife ....................................................267 Repotyn Max .......................................... 512
Reetac-R ................................................102 Repotyn.................................................. 512
Refain .....................................................332 Repres Plus ........................................... 131
Refeel .....................................................260 Repres ................................................... 148
Refemoline .............................................368 Reprove ................................................. 371
Refenac ..................................................370 Reptylin .................................................. 282
Refresh I .................................................383 Resadol .................................................. 291
Regab .....................................................300 Resant.................................................... 284
Regain ....................................................436 Resco ..................................................... 277
RE-gel ....................................................524 Resectin ................................................. 102
Regerd ....................................................107 Reservix ................................................. 330
Regulose ................................................118 Reset ...................................................... 290
Regumen ................................................248 Residon .................................................. 277
Rehydril ..................................................113 Resol ...................................................... 188
Rejoin .....................................................353 Respamox ................................................ 41
Rejubion .................................................527 Respazit ................................................... 32
Rejuven ......................................... 518, 520 Respite ................................................... 109
Relacs ....................................................118 Respolin ................................................. 178
Reladol ...................................................288 Resquin ............................................ 40, 362
Relafin ....................................................280 Restat..................................................... 172
Relaxen ..................................................267 Restobac ................................................ 350
Relaxium ................................................267 Restol ..................................................... 267
Relaxo ....................................................351 Restovit M ...................................... 531, 532
Relaxton .................................................324 Retabac.................................................. 407
Relentus .................................................351 Retapamulin ........................................... 407
Relergy ...................................................423 Retapex.................................................. 407
Relestat ..................................................372 Reticap ................................................... 434
Releve ....................................................338 Retigel .................................................... 434
Relitch ....................................................417 Retin-A ................................................... 435
Reliv .......................................................290 Retinoids ................................................ 432
Relvis ........................................................96 Reumacap ............................................. 335
Relye ......................................................370 Reumafen .............................................. 334
Relyto .....................................................487 Reumazin ....................................... 115, 345
Remac ......................................................33 Reutren .................................................. 332
Remadrin ................................................396 Revacin .................................................. 362
Remap ....................................................188 Revam.................................................... 533
Remaquin .................................................62 Reversair ............................................... 185
Rembac ..................................................350 Revert .................................................... 306
Remens ..................................................225 Revigor................................................... 532
Remicade ...............................................345 Revira....................................................... 70
Remifentanil ...........................................321 Revistar ...................................................... 7
Remood ..................................................274 Revital ................................................... 532
Remus ....................................................432 Revodil ................................................... 125
Remylin ..................................................526 Revoldae ................................................ 508
Renamycin .............................. 36, 389, 407 Rex......................................................... 533
Renep .....................................................527 Rexovit ................................................... 533
Renete ....................................................102 Rezoven ................................................... 72
Renorma.................................................223 Rheudene .............................................. 339
Renova ...................................................290 Rhine...................................................... 102
Renovit ...................................................526 Rhinil ...................................................... 422
Renxit .....................................................274 Rhinocort ............................................... 393
Reomen ..................................................226 Rhinor ............................................ 191, 426
Reoplex Plus ..........................................496 Rhophlac ................................................ 460
Repaglid .................................................210 Ribavirin ................................................... 74
Repaglinide ............................................209 Riboflavin ............................................... 525
885
GENERAL INDEX
Riboflavin................................................525 Rivotril .................................................... 297

Ribomin ..................................................525 Rixmin ...................................................... 52
Ribosina .................................................525 Riz ......................................................... 422
Riboson ..................................................525 Rizamig .................................................. 293
Ribox ......................................................334 Rizat ....................................................... 293
Ribozen ..................................................525 Rizatriptan .............................................. 293
Rice ORS ...............................................112 Roaccutane ............................................ 434
Rice Saline .............................................112 Robentyl ................................................... 95
Ridel .......................................................174 Robic ........................................................ 66
Ridon ......................................................100 Rocal- D Vita .......................................... 520
Rifabac .....................................................52 Rocal ...................................................... 518
Rifabutin ...................................................47 Rocal-D .................................................. 520
Rifacol ......................................................52 Rocal-M.................................................. 521
Rifagut ......................................................52 Rocaltrol ................................................. 530
Rifagyl ......................................................52 Rocef ........................................................ 14
Rifamax ....................................................52 Rocipro..................................... 39, 360, 361
Rifampicin + Isoniazid ..............................44 Rocky ....................................................... 34
Rifampicin.......................................... 44, 49 Rocovas ................................................. 172
Rifampicin+Isoniazid+Pyrazinamide ........44 Rocuron ................................................. 325
Rifaximin...................................................52 Rocuronium ........................................... 325
Rifaxin ......................................................52 Rofecin ..................................................... 24
Rimactazid ...............................................44 Roferon-A .............................................. 488
Rimstar 4-FDC .........................................44 Rofixim ..................................................... 20
Rinase ........................................... 179, 396 Roflast .................................................... 186
Ring Fight ...............................................429 Roflu ....................................................... 186
Ringer’s Solution For Injection ...............510 Rofuclav ................................................... 18
Ringer’s Solution ....................................510 Rofumil ................................................... 186
Rinotin ....................................................425 Rofurox .................................................... 17
Rinzin .....................................................422 Roin .......................................................... 23
Ripril .......................................................131 Roket...................................................... 336
Riscord ...................................................277 Rolac ...................................................... 336
Risdon ....................................................277 Rolid ......................................................... 34
Risedon ..................................................234 Rolip ....................................................... 172
Risedronate Sodium ..............................233 Rome ..................................................... 107
Rislock ....................................................277 Romfen .................................................. 370
Risomax .................................................277 Romycin ........................................... 32, 358
Rison ......................................................352 Ronac Plus ............................................ 333
Risonet ...................................................234 Ronem ..................................................... 28
Rispa ......................................................277 Ropenem ................................................. 28
Risperdalconsta .....................................277 Ropenia.................................................. 503
Risperdex ...............................................277 Ropinirole ............................................... 304
Risperidone ............................................276 Ropinol ................................................... 304
Rispolux..................................................277 Ropitor ................................................... 172
Rit ...........................................................24 Roquin.................................................... 345
Ritch .......................................................425 Rosatan.................................................. 134
Rito .........................................................334 Rosela .................................................... 427
Ritodrine Hydrochloride .........................240 Rosen..................................................... 248
Ritopar ....................................................241 Rosetor .................................................. 172
Rituxim ...................................................487 Rosiglitazone ......................................... 210
Rituximab ...............................................487 Rostab.................................................... 172
Rituximab ...............................................487 Rostatin .................................................. 172
Rivaban ..................................................161 Rostil ........................................................ 98
Rivacap ..................................................314 Rosu....................................................... 172
Rivamer ..................................................314 Rosugen ................................................ 172
Rivarin ......................................................74 Rosunor ................................................. 172
Rivarox ...................................................161 Rosutin ................................................... 172
Rivaroxaban ...........................................161 Rosuva ................................................... 172
Rivascol ..................................................314 Rosuvastatin Calcium ............................ 172
Rivastigmine ...........................................313 Rosvin .................................................... 172
Rivaxa ....................................................161 Rotacal ................................................... 519
Rivin .......................................................525 Rotarac .................................................. 370
Rivo ........................................................297 Rotarix.................................................... 458
886
GENERAL INDEX
Rotateq ...................................................458 Safamin ........................................... 192,423

Rotavirus Vaccine ..................................458 Safetisol ................................................. 438
Rotek ......................................................336 Safoxol ................................................... 188
Rotomycin ................................................34 Safquin ................................................... 362
Rova .........................................................98 Saga ......................................................... 42
Rovamycin ...............................................35 Sagdon................................................... 100
Rovantin ...................................................22 Saglit ...................................................... 210
Rovast ....................................................172 Salazine ......................................... 115, 346
Rovedilol.................................................125 Salbu ...................................................... 178
Rovex .....................................................172 Salbut ..................................................... 178
Rovidone ................................................384 Salbutal .................................................. 178
Roxair .....................................................186 Salbutamol .....................176, 177, 178, 193
Roxarel ...................................................161 Salcatonin .............................................. 234
Roxcef ......................................................17 Salflu ...................................................... 183
Roxcin ......................................................34 Saliben ................................................... 408
Roxetil ......................................................22 Salicid .................................................... 437
Roxicef .....................................................14 Salicylic Acid .................................. 436, 437
Roxicil .......................................................17 Salidex ................................................... 437
Roxim .......................................................20 Saline R ................................................. 112
Roxithromycin ..........................................34 Saline ..................................................... 112
Rozith .......................................................32 Salinor .................................................... 510
RP-20 .....................................................109 Salison ................................................... 441
R-PIL ......................................................132 Salitic ..................................................... 437
R-Saline N ..............................................112 Salix ....................................................... 178
R-Saline..................................................112 Salmeterol .............................. 176, 179, 182
Rubalon ..................................................368 Salmol .................................................... 178
Rubavax .................................................453 Salmolin ................................................. 178
Rubella Vac ............................................453 Salocin ..................................................... 42
Rubest ....................................................427 Salomax ................................................. 178
Rubicin ...................................................470 Saloride .................................................. 510
Rufast .....................................................427 Salost ..................................................... 234
Rufecta ...................................................427 Salpac .................................................... 510
Rupa .......................................................427 Salpium .................................................. 180
Rupaday .................................................427 Samisil ................................................... 179
Rupadin ..................................................427 Sandimmun Neoral ................................ 487
Rupafen ..................................................427 Sandocal D ............................................ 520
Rupaler ...................................................427 Sandocal ................................................ 518
Rupamin .................................................427 Sandom.................................................. 100
Rupanex .................................................427 Sandostatin ............................................ 493
Rupastin .................................................427 Sangril .................................................... 120
Rupatadine .............................................427 Sanit ....................................................... 284
Rupatan ..................................................427 Sanityza ................................................. 438
Rupatid ...................................................427 Sanoket .................................................. 336
Rupatrol ..................................................427 Santinal MR ........................................... 163
Rupenta ..................................................427 Santox ............................................ 532, 534
Rupex .....................................................427 Sapox ......................................................... 8
Rupin ......................................................427 Saquinavir ................................................ 79
Rupoma ..................................................427 Sarcet..................................................... 422
Rutipa .....................................................427 Sardopa ................................................. 138
Rutix .........................................................41 Sarelox ..................................................... 22
Ruvastin .................................................172 Sarinex ................................................... 423
Ruzmet ...................................................209 Sartra ..................................................... 281
Rymin ............................................ 424, 428 Sasolin ................................................... 255
Rynaspray ..............................................396 Saver........................................................ 20
Rynex .....................................................396 Savlon .................................................... 438
Ryth ..........................................................34 SB-Amloator 5/10 .................................. 171
Rythmosin ..............................................155 SB-Amlod ............................................... 140
SB-Ator .................................................. 171
SB-Azit ..................................................... 32
S SB-Cora ................................................. 520
SB-Emec ................................................ 105
S-32 Gold ...............................................532 SB-Glic ................................................... 206
Sabitar ........................................... 136, 137
887
GENERAL INDEX
SB-Glim ..................................................207 Seretide Accuhaler ................................ 183

SB-Lina...................................................211 Seretide Evohaler .................................. 183
SB-Met ...................................................209 Sergel..................................................... 105
SB-Metsita ..............................................212 Serifen.................................................... 331
SB-MetVilda ...........................................212 Serlin ...................................................... 281
SB-Monec...............................................185 Sermorelin ............................................. 229
SB-Rostin ...............................................172 Serolux ................................................... 281
SB-Sita ...................................................211 Serontin.................................................. 297
SB-Vilda .................................................211 Seropam ................................................ 279
Scabex .......................................... 414, 415 Seropin................................................... 276
Scabfre ...................................................415 Seroquet ................................................ 276
Scabisol ..................................................414 Seroxyn .................................................. 183
Scabo .......................................................85 Serozid ..................................................... 22
Scaper ....................................................415 Sertal ...................................................... 281
Scarin .....................................................415 Sertalin ................................................... 281
S-citapram ..............................................279 Sertlin ..................................................... 281
Scopolamine ..........................................318 Sertraline ............................................... 281
Seacal ....................................................520 Servex .................................................... 330
Seasonix.................................................425 Servimeta ............................................... 335
Seasvita..................................................533 Servinaprox ............................................ 338
Seclo ......................................................107 Servipep ................................................. 101
Seclogen ................................................107 Setfree ................................................... 249
Secnid ......................................................66 Setir ........................................................ 422
Secnidal....................................................66 Seton ...................................................... 310
Secnidazole ..............................................66 Setorib.................................................... 334
Secnizol ....................................................66 Setra ...................................................... 281
Secoclav ...................................................18 Sevirax ................................................... 366
Secomax ..................................................17 Sevitan ................................................... 134
Secrin .....................................................207 Sevitan-HTZ ........................................... 134
Seda .......................................................267 Sevoflurane ............................................ 317
Sedapan .................................................268 Sevoran.................................................. 318
Sedazam ................................................267 Sevorane ............................................... 318
Sedil .......................................................268 Sex Hormones ............................... 221, 488
Sedilux....................................................192 SGN ............................................... 211, 212
Sedno .....................................................423 Sharpkil .............................................. 17, 18
Sedron ....................................................234 Sibalyn ................................................... 407
Seduxen .................................................268 Sicef ......................................................... 14
Seebri Breezhaler ..................................318 Sicorten Plus .......................................... 419
Sefanid .....................................................12 Sicorten .................................................. 419
Sefin .........................................................14 Sidobac .................................................... 22
Sefrad .......................................................14 Sidopin ................................................... 140
Sefril .........................................................14 Sidoplus ................................................. 141
Sefty .........................................................14 Sidplatin ................................................. 481
Sefur .................................................. 17, 18 Siesta ..................................................... 267
Sefurox .....................................................17 Sifen ....................................................... 332
Segal ......................................................410 Siflam ..................................................... 334
Segorin .....................................................17 Siglimet .................................................. 212
Selegiline ................................................304 Siglita ..................................................... 211
Selomet ..................................................126 Silagra .................................................... 259
Selotin ....................................................281 Sildenafil ....................................... 187, 259
Semecon ..................................................94 Silfil ........................................................ 259
Semprex .................................................190 Silinor ..................................................... 211
Senna .....................................................116 Silora ...................................................... 426
Sensimet ................................................210 Silox ........................................................... 7
Sensipin..................................................273 Silvadazin .............................................. 407
Sensit .....................................................274 Silvage ................................................... 532
Sentix .....................................................273 Silvec ..................................................... 407
Septra .......................................................43 Silver Sulfadiazine ................................. 407
Seraflo ....................................................183 Silverax .................................................. 407
Seravent .................................................179 Silverzine ............................................... 407
Serelam ..................................................266 Silzin ...................................................... 407
Serelose .................................................118 Simacor .................................................. 172
888
GENERAL INDEX
Simcod ...................................................533 Slipaid ............................................. 282,428

Simecol.....................................................94 Slipam .................................................... 268
Simet ........................................................94 Sliptin ............................................. 211, 212
Simethicone .............................................93 Smallpox ................................................ 462
Simpli........................................................32 Socolate .......................................... 372,395
Simplovir.......................................... 70, 413 Sodicarb ................................................. 261
Simulect..................................................486 Sodicarb ................................................. 510
Simvastatin .............................................172 Sodicrom ................................................ 372
Simvatin..................................................172 Sodinate .......................................... 261,510
Sina Gold................................................532 Sodium Cromoglycate ...183, 396, 372, 395
Sinaban ..................................................406 Sodium Bi Carbonate ............................ 261
Sinaceph ..................................................14 Sodium chloride .................................... 510
Sinacet ...................................................425 Sodium fusidate ....................................... 52
Sinaclox ......................................................6 Sodium Hyaluronate .............................. 353
Sinacort ..................................................417 Sodium Lactate Infusion ........................ 510
Sinaferon ....................................... 495, 496 Sodium stibogluconate ............................ 68
Sinaflox.......................................................7 Sodium Valporate .................................. 300
Sinafort ...................................................527 Sodival ................................................... 301
Sinafresh ................................................383 Sofenib ................................................... 479
Sinalac ....................................................118 Sofo.......................................................... 73
Sinalax....................................................117 Sofomax ................................................... 73
Sinamin .......................................... 192,423 Soforal...................................................... 73
Sinamox .....................................................8 Sofosbuvir ................................................ 72
Sinapol ...................................................290 Sofovir ...................................................... 73
Sinatrim ....................................................43 Softi ........................................................ 440
Sinazid ....................................................206 Softner ................................................... 118
Sindaoxplatin ..........................................481 Sohagra ................................................. 259
Sindroxocin ............................................470 Solas ........................................................ 84
Sintel ........................................................83 Sola Scren ............................................. 440
Sirdalud ..................................................351 Solbion ................................................... 527
Sistin .......................................................422 Solicare .................................................. 257
Sitagil ............................................. 211, 212 Solider .................................................... 257
Sitamet ...................................................212 Solifen .................................................... 257
Sitap .......................................................211 Solifenacin Succinate ............................ 257
Sitavia ............................................ 211, 212 Solivo ............................................. 106, 339
Sitazid .....................................................211 Solo ........................................................ 510
Sitomet ...................................................212 Solodex .................................................. 513
Sivicaine .................................................328 Solodex JR ............................................ 513
Sivolac ....................................................118 Solotear.................................................. 384
Sixvit .......................................................525 Solrin ...................................................... 291
Sizatoin...................................................299 Solu Medrol ............................................ 220
Sizodon ..................................................277 Soluble Insulin ....................................... 202
Sizonil ............................................ 277, 311 Solupred ........................................ 219, 220
Sizopin ....................................................273 Soluzinc ................................................. 523
Sizopra ...................................................273 Solvit ...................................................... 527
SK Cef ......................................................14 Solvit-M .................................................. 532
Skelofen .................................................350 Solvitone ................................................ 527
Skilin .......................................................415 Somarant ............................................... 269
Skilox ..........................................................7 Somatostatin analogues ........................ 493
Skimico ...................................................411 Somatostatin .......................................... 229
Skinabin............................................ 58,412 Somatropin ............................................ 229
Skinaderm ..............................................420 Somna.................................................... 271
Skinalar ..................................................418 Somopin ................................................. 282
Skinalar-N...............................................419 Sompraz................................................. 105
Skinovate................................................418 Somprazol .............................................. 105
Skisia ......................................................328 Sonap..................................................... 338
S-Kit ........................................................184 Soneta.................................................... 420
SK-Mox.......................................................8 Sonexa ............................................ 219,368
Sleepon ..................................................270 Sonexa-C ............................................... 358
Sleepwell ................................................270 Sonib ...................................................... 479
Slimfast...................................................312 Sono ....................................................... 270
Slimi........................................................312 Soracent................................................. 479
889
GENERAL INDEX
Sorafenib ................................................479 Stela ....................................................... 277

Soranix ...................................................479 Stelone ................................................... 420
Sorbitol Citrate .......................................498 Stemetil .................................................. 276
Sorex ......................................................400 Stener .................................................... 120
Soricap ...................................................432 Stenicol .................................................. 358
Soritar ............................................ 415, 430 Steradin.................................................. 181
Soritec ....................................................432 Sterisol ................................................... 261
Soritene ..................................................434 Steron .................................................... 219
SOS Plus Mango ....................................112 Steron .................................................... 368
SOS ........................................................112 Steron-T ................................................. 360
Sotalax ...................................................127 Stiba ....................................................... 424
Sotalol ....................................................127 Stigmin ................................................... 326
Sovalvir .....................................................73 Stignal .................................................... 326
Soventa ....................................................73 Stilamin .................................................. 229
Spadyl ......................................................96 stillbestrol ............................................... 489
Spaflex ...................................................350 Stimulin .................................................. 207
Spakem ..................................................350 STK ........................................................ 166
Spalax ......................................................95 Stosec .................................................... 107
Span .........................................................98 Strazyl ...................................................... 65
Spanil ............................................... 96,308 Streptase ............................................... 166
Spanium ...................................................96 Streptokinase ......................................... 166
Spar ..........................................................42 Streptomycin ...................................... 30, 45
Sparflox ....................................................42 Stresin .................................................... 216
Sparfloxacin .............................................42 Stresin .................................................... 283
Sparlin ......................................................42 Stril ......................................................... 130
Sparonex ..................................................42 Sucal ...................................................... 518
Spasmoson ..................................... 96, 319 Sucal-D .................................................. 520
Spasmozen ............................................308 Sucleer ................................................... 206
Spason .....................................................96 Suclovir .................................................. 413
Spasverin .................................................97 Sucomet ................................................. 209
Specbac ...................................................28 Suconal .................................................. 413
Spectazole .............................................409 Sucorid ................................................... 207
Spectinomycin ..........................................53 Sucosit ................................................... 211
Spectra ...................................................360 Sucotab .................................................. 206
Spectra ...................................................390 Sucovil ........................................... 211, 212
Sperdal ...................................................277 Sucralfate ............................................... 110
Spinafen .................................................350 Sucraven ................................................ 499
Spino ......................................................328 Sudac ..................................................... 339
Spiramycin ...............................................35 Sugamet................................................. 209
Spiretic ...................................................151 Sugatrol.................................................. 214
Spirocard ................................................151 Sugel ........................................................ 92
Spironolactone .......................................151 Sugred ................................................... 206
Splendora ...............................................436 Sulbutamol ............................................. 241
Sporium ......................................... 383, 487 Sulfacol ........................................... 115,346
Sporium ..................................................487 Sulfamin ................................................... 63
Spotclen Plus .........................................441 Sulfazin ........................................... 115,346
Spotclen .................................................441 Sulfinpyrazone ....................................... 348
Spulyt .....................................................189 Sulfonylurease ....................................... 205
Sputen ....................................................189 Sulidac ................................................... 339
SQ-Mycetin .................................... 358,389 Sulindac ................................................. 339
Stacor .....................................................171 Sulphacetamide ..................................... 363
Stafen ............................................. 184,372 Sulphasalazine .............................. 114, 345
Staflu ..........................................................7 Sulphatrim ................................................ 43
Stafoxin ......................................................7 Sulpiride ................................................. 277
Stalevo ...................................................303 Sultolin ................................................... 178
Stamaril ..................................................458 Sumatriptan ........................................... 293
Stapkil.........................................................7 Sunitinib ................................................. 479
Starcal D.................................................520 Sunitix .................................................... 479
Starcef ......................................................20 Sunscreen .............................................. 440
Starin ........................................................22 Super Saline .......................................... 112
Starlex ....................................................209 Superpime ............................................... 25
Stedex ....................................................219 Supotaria ............................................... 318
890
GENERAL INDEX
Supra B ..................................................527 Tadalafil ................................................. 259

Supra ......................................................527 Tafecta ..................................................... 76
Supracef ...................................................14 Tafil ........................................................ 260
Supracod ................................................533 Taflan ..................................................... 380
Suprafol TR ............................................497 Tag ......................................................... 361
Suprafol ZTR ..........................................497 Tagris ..................................................... 476
Suprafol ..................................................495 Talopram ................................................ 279
Supraphen plus ......................................389 Tamen .................................................... 290
Supraphen ..............................................389 Tamenol ................................................. 291
Supraquin .................................................61 Tamfast .................................................. 255
Supravit ..................................................532 Tamiflu ..................................................... 74
Supravit-M ..............................................532 Tamino ................................................... 290
Supravit-PN ............................................533 Tamisol .................................................. 255
Supraxim ..................................................20 Tamlosin ................................................ 255
Surgidol ..................................................336 Tamolex ................................................. 491
Surmontil ................................................281 Tamona .................................................. 491
Surpim ............................................ 336,370 Tamosin ................................................. 255
Survanta .................................................187 Tamoxen ................................................ 491
Survec ....................................................325 Tamoxifen ...................................... 490, 491
Susten ....................................................258 Tamsin D ............................................... 255
Sustogen ................................................227 Tamsule ................................................. 255
Sutac ......................................................102 Tamsulosin .................................... 254, 255
Suvic .......................................................528 Tamurin .................................................. 255
Suvirux .....................................................73 Tanox ..................................................... 533
Suvotol ...................................................269 Tanox-Plus ............................................. 534
Suxalax...................................................326 Tanzil ..................................................... 132
Suxamethonium .....................................325 Tapendol ................................................ 288
Suxen .....................................................338 Tapenta .................................................. 288
Suxonium ...............................................326 Tapentadol ............................................. 287
Suzaron ..................................................306 Tapexia .................................................. 288
Suzium ...................................................267 Tarceva .................................................. 476
Suzyme ..................................................121 Targocid ................................................... 53
S-Vom ....................................................308 Tasigna .................................................. 478
Sycal .......................................................518 Tasti ....................................................... 533
Sycal-D ...................................................520 Tav 98
Symbion .................................................182 Taven ..................................................... 171
Sympathomimetics ........................ 155, 378 Taverin ..................................................... 98
Syndol ........................................... 288, 291 Taxceph ............................................. 15, 21
Syndopa .................................................303 Taxenes .......................................... 465,481
Synergy ..................................................532 Taxetil ...................................................... 22
Synflex....................................................353 Taxiclot................................................... 168
Synflorix..................................................457 Taxim ................................................. 15, 21
Synovate ................................................418 Taxotere ................................................. 482
Syntar .....................................................383 Tazarotene ............................................. 434
Syntocin..................................................239 Tazicef ..................................................... 23
Sypam ....................................................297 Tazid ........................................................ 23
Syskem ...................................................384 Tazimax ................................................... 23
Systear ...................................................384 Tazocilin ................................................... 10
Systope ..................................................406 Tazonid .................................................... 67
Tazopen ................................................... 10
Tazoskin................................................. 434
T Tazosyn ................................................... 10
Tazox ....................................................... 67
T. VaccinumTetani .................................454 T-cef ......................................................... 20
Tab .........................................................350 TCL-R .................................................... 171
Tabis .......................................................124 T-cort ...................................................... 395
Tacrol .....................................................432 Tealis ..................................................... 260
Tacrolim..................................................432 Tear........................................................ 383
Tacrolimus Sandoz ................................487 Tearex .................................................... 384
Tacrolimus ..................................... 432, 487 Tearfresh ............................................... 383
Tada .......................................................260 Teargen.................................................. 384
Tadafil .....................................................260 Tearin ..................................................... 383
Tadalis ....................................................260
891
GENERAL INDEX
Tearon ........................................... 383, 384 Tenoviral .................................................. 76

Tebast ....................................................424 Tenoxicam ............................................. 339
Tecavir ......................................................72 Tenoxim ................................................. 340
Tegretol ..................................................296 Tensfree ................................................. 267
Teicoplanin ...............................................53 Tensnil ................................................... 267
Tek 330 Tenvira ..................................................... 76
Tekast.....................................................185 Teolex .................................................... 180
Telabid ....................................................277 Teramycin ................................................ 36
Telamlo...................................................141 Terazon .......................................... 137, 255
Telazine ......................................... 277, 311 Terazosin ....................................... 137, 255
Telcardis Plus .........................................135 Terbex .................................................... 412
Telcardis .................................................135 Terbifin ................................................... 412
Telfast .....................................................425 Terbinafine ............................... 58, 408, 412
Telfex......................................................425 Terbutaline Sulphate ............................. 179
Telfin .........................................................58 Terbutaline ..................................... 176, 177
Telide ........................................................32 Tercenib ................................................. 476
Telmisartan ............................................135 Tergocin ................................................... 53
Telukast ..................................................185 Tericin ...................................................... 55
Temazepam ...........................................269 Terlipressin ............................................ 231
Temazin..................................................269 Termider................................................. 412
Temcal....................................................520 Terminex ................................................ 240
Temcox...................................................334 Ternilla ................................................... 330
Temfin ....................................................290 Terovit .................................................... 500
Temoket .................................................336 Tervent ................................................... 179
Temol .....................................................290 Testanon ................................................ 227
Temonix......................................... 469, 479 Testosterone .......................................... 226
Temovate ...............................................418 Tetanus Antitoxin ................................... 459
Temozolamide ....................... 469, 475, 479 Tetanus Toxoid ...................... 448, 449, 454
Tempil.....................................................290 Tetanus Vaccine .................... 447, 449, 454
Tempol .......................................... 290, See Tetanus .................................................. 447
Tempol-D................................................291 Tetclin ...................................................... 36
Temrif .....................................................290 Tetracef .................................................... 25
Temzinc ..................................................523 Tetracomb .............................................. 420
Tenac .....................................................332 Tetract-HIB ............................................ 449
Tenafet .....................................................19 Tetracycline ...... 35, 36, 216, 363, 400, 435
Tenafin ...................................................408 Tetracycline-H .......................................... 36
Tenapam ................................................267 Tetraderm .............................................. 407
Tenaxit ....................................................274 Tetrahydrofolic ....................................... 500
Tendia ....................................................288 Tetramycin ............................................... 36
Tendonil..................................................330 Tetrasina .................................................. 36
Tenecteplase ..........................................166 Tetrasol .................................................. 415
Tenicar ...................................................134 Tetrax ....................................................... 36
Tenil ........................................................267 Tetuman Berna ...................................... 461
Tenivasc .................................................141 Teviral ...................................................... 72
Tenizide ..................................................135 Texa ....................................................... 360
Tenobis- Plus ........................................125 T-fovir ....................................................... 76
Tenobis...................................................124 T-Get ...................................................... 361
Tenocab .................................................141 Tgocef ...................................................... 20
Tenocard ................................................124 Thenglate ............................................... 180
Tenodin ..................................................141 Thenxet .................................................. 274
Tenoflex..................................................340 Theofast ................................................. 180
Tenofovir Alafenamide .............................76 Theophylline modified-release .............. 180
Tenofovir Disoproxil .................................76 Theophylline .......................................... 180
Tenofovir ..................................................76 Theovent ................................................ 180
Tenoloc...................................................124 Thiamine ................................................ 524
Tenomin .................................................124 Thiamine HCl ......................................... 524
Tenopain ................................................340 Thianomin .............................................. 524
Tenopin ..................................................141 Thiason .................................................. 524
Tenoren Plus ..........................................124 Thiaton ................................................... 317
Tenoren ..................................................124 Thiopen .................................................. 317
Tenorix ...................................................340 Thiopentone ........................................... 316
Tenovir ...................................................124 Thiosina ................................................. 524
892
GENERAL INDEX
Thixtra ....................................................274 Tinimet ..................................................... 97

Throcin .....................................................34 Tiniril ............................................... 306,392
Thromax ...................................................32 Tinium ...................................................... 97
Thynor ....................................................196 Tinizol DS ................................................ 66
Thyrin .....................................................196 Tino .......................................................... 97
Thyroid Hormones..................................195 Tinobac .................................................... 53
Thyrolar ..................................................196 Tiny-Z ..................................................... 523
Thyrotab .................................................196 Tioconazole ............................................. 59
Thyrox ....................................................196 Tioxil ................................................ 386,534
Thyroxine Sodium ..................................196 Tiozol ..................................................... 413
Tiagra .....................................................260 Tispa ........................................................ 97
Tiapine....................................................276 Titacin ...................................................... 36
Tibeta .....................................................124 Titos ......................................................... 97
Tibo ........................................................223 Tium ......................................................... 97
Tibolone..................................................223 Tivion ..................................................... 223
Tibon ......................................................223 Tivis.......................................................... 97
Tibonor ...................................................223 Tivit ........................................................ 524
Tibucef ......................................................23 Tixocin.................................................... 274
Ticacard..................................................165 Tixol ....................................................... 274
Ticagrelor ...............................................164 Tizabet ................................................... 169
Ticalog ....................................................165 Tizadin ................................................... 351
Ticamet...................................................183 Tizalud ................................................... 351
Ticarel .....................................................165 Tizanidine .............................................. 351
Ticas .......................................................419 Tizime ...................................................... 23
Ticason ...................................................419 T-Mycin Plus .......................................... 360
Ticlopidine ..............................................164 T-Mycin .................................................. 359
Ticoflex ...................................................338 Tobi ........................................................ 359
Ticoma B ................................................378 Tobicort .................................................. 360
Ticoma....................................................377 Tobidex .................................................. 360
Ticonazole .............................. 242,412, 413 Tobirax ................................................... 359
Tiemonium Methylsulphate ......................96 Tobrabac ................................................ 359
Tienum .....................................................96 Tobram................................................... 359
Tifen .......................................................184 Tobramin ................................................ 359
TIG ................................................ 460, 461 Tobramycin .............................. 31, 359, 388
Tigarol ....................................................165 Tobrel ..................................................... 359
Tigecycline ...............................................53 Tocef ........................................................ 20
Tigicon ....................................................169 Tocilizumab ............................................ 346
Tiginor ....................................................171 Tocit ....................................................... 346
Tigirate ...................................................169 Tocomin ................................................. 530
Tigocin ....................................................406 Todol .............................................. 336, 370
Tilex Max ................................................353 Tofa ........................................................ 338
Tilkotil .....................................................340 Tofacent ................................................. 346
Timem ......................................................96 Tofacitinib .............................................. 346
Timidal ....................................................290 Tofanib ................................................... 346
Timoben ...................................................96 Tofatin .................................................... 346
Timocare ................................................377 Tofen .............................................. 184, 372
Timolat....................................................377 Tofranil ................................................... 283
Timolol - OSL .........................................378 Togent .................................................... 428
Timolol ............................................ 377,378 Tolcalm .................................................. 352
Timonac....................................................96 Tolec ...................................................... 336
Timonate ..................................................96 Tolfenac-SR ........................................... 332
Timonil ......................................................96 Tolfenamic Acid ..................................... 292
Timopress...............................................378 Tolfi ........................................................ 293
Timothy.....................................................96 Tolmetin ................................................. 340
Timotor .....................................................97 Tolmic .................................................... 293
Timozin .....................................................97 Tolmus ................................................... 352
Tinaderm ................................................413 Tolnaftate ............................................... 413
Tinadin ....................................................102 Tolorin .................................................... 258
Tinatrim ..................................................409 Tolpa ...................................................... 352
Tinazol ....................................................409 Tolperisone ............................................ 351
Tinidazole .................................................66 Tolson .................................................... 352
Tinilux .......................................................97 Tolter ...................................................... 258
893
GENERAL INDEX
Tolterodine Tartrate................................257 Tranal ..................................................... 288

Toltrex ....................................................258 Traneta................................................... 211
Toma ......................................................184 Tranexamic Acid .................................... 167
Tomephen ..............................................190 Tranexil .................................................. 168
Tomin ............................................ 359, 360 Tranquil .................................................. 267
Tomycin D ..............................................360 Trapex .................................................... 269
Tomycin ..................................................359 Trastunix ................................................ 484
Tone .......................................................524 Trastuzumab .......................................... 483
Tonemide ...............................................151 Travagen ................................................ 380
Toperin ...................................................352 Travast Plus ........................................... 380
Topibet ...................................................416 Travast ................................................... 380
Topicacin ................................................428 Travolar .................................................. 380
Topican...................................................328 Travoprost .............................................. 380
Topicazole ..................................... 411, 420 Traxef ....................................................... 25
Topiclo NN .............................................418 Traxon ...................................................... 25
Topiclo S ................................................418 Traxyl ..................................................... 168
Topiclo ....................................................418 Trazapin ................................................. 284
Topicort ..................................................419 Trec .......................................................... 56
Topidin ....................................................439 Trecilon .................................................. 221
Topiramate .............................................301 Trego...................................................... 406
Topirva ...................................................301 Trena...................................................... 435
Topium DPI ............................................380 Trental Dragee ....................................... 146
Toplon ......................................................39 Tretinoin ................................. 434, 435, 484
Topmate .................................................301 Trevox ...................................................... 40
Toposar ..................................................474 Trexam ................................................... 168
Topotecan PhaRes ................................483 Trexonate ............................................... 473
Topotecan ..............................................483 Triacin .................................................... 221
Topra ......................................................109 Trialon .................................................... 221
Topress ..................................................126 Trialon .................................................... 420
Topsil ......................................................189 Triamcinolone Acetonide ....... 389, 394, 420
TopUp .....................................................260 Triamcinolone ........................................ 421
Toradol ...................................................336 Triamon .................................................. 221
Toramax .................................................336 Triazoles ................................................ 365
Torasemide ............................................150 Tri-B ....................................................... 527
Torax ......................................................336 Tribac ....................................................... 25
Torbi .......................................................334 Tribion .................................................... 527
Torcin .....................................................359 Tricalm ................................................... 305
Toremifene .............................................490 Trichomonocides ..................................... 66
Torimon ..................................................334 Triderm................................................... 409
Toroaid ...................................................336 Tridopa ................................................... 303
Toroaid ...................................................370 Trifix ......................................................... 20
Torolac ...................................................336 Trifluoperazine ............................... 311, 277
Torped ............................................... 15, 21 Trifluridine .............................................. 366
Tory ........................................................334 Trigent .................................................... 169
Tos 210 Trigger.................................................... 259
Toti 184 Trihexy ................................................... 305
Totifen ....................................................184 Trihexyphenidyl...................................... 305
Toza .........................................................67 Triject ....................................................... 25
TPC ........................................................527 Trileptal .................................................. 299
TPS ........................................................317 Trilix ....................................................... 148
TR Care ..................................................383 Trilock .................................................... 186
Tracid .....................................................168 Trilostane ............................................... 490
Tracrium .................................................324 Trimazole ............................................... 409
Trado ......................................................288 Trimcort .................................................. 221
Tramadol HCl ........................................288 Trimebutine Maleate ................................ 97
Tramadol ....................................... 288, 322 Trimela ................................................... 441
Tramanil .................................................288 Trimet ..................................................... 145
Tramapan ...............................................288 Trimetazidine ......................................... 145
Tramatol .................................................291 Trimotil ..................................................... 97
Tramavir .................................................288 Trimovax ................................................ 454
Tramic ....................................................168 Triocef ...................................................... 20
Tramp .....................................................291 Triocim ..................................................... 20
894
GENERAL INDEX
Trioclav .....................................................22 Tynium ..................................................... 97

Triovix .......................................................76 Typan ................................................ 96,308
Triphin ......................................................25 Typhim VI ............................................... 450
Triple vaccine .........................................447 Typhoid Vaccine .................................... 449
Triprim ......................................................43 Tyroid ..................................................... 196
Triptorelin ...............................................263 Tyrokin ...................................................See
Triptorelin ...............................................492 Tyronib ................................................... 477
Trispray ..................................................395 Tysinior .................................................. 471
Tritace ....................................................132 T-Zol ......................................................... 66
Trizidim .....................................................23
Trizin .......................................................422
Trizon .......................................................25 U
Trocer .....................................................139
Trofurit ....................................................150 U4 ......................................................... 274
Trolen .....................................................351 Ubilon ..................................................... 223
Troniz .......................................................66 Ucardol................................................... 125
Trophen ..................................................375 Ucol ........................................................ 258
Tropicam ................................................375 Ucorex.................................................... 347
Tropicamide OSL ...................................375 Udca....................................................... 120
Tropicamide ...........................................375 Udihep.................................................... 121
Tropicamin .............................................375 Ufol ......................................................... 316
Tropidil Plus ...........................................375 Ulcar ....................................................... 102
Tropidil ....................................................375 Ulicon ..................................................... 253
Tropigen Plus .........................................375 Ulipristal Acetate .................................... 253
Tropigen .................................................375 Uliroid ..................................................... 253
Trova ......................................................171 Uliv 121
Troy ........................................................336 Ulsec ...................................................... 110
Trubid .......................................................12 Ulticort .................................................... 419
Trucef .......................................................22 Ultracaine Heavy ................................... 328
Trufen .....................................................334 Ultracaine ............................................... 328
Trugain ...................................................436 Ultracal-C ............................................... 519
Trum .........................................................23 Ultracal-D ............................................... 520
Trumen ...................................................288 Ultraclav ................................................... 10
Trupan ....................................................109 Ultracor .................................................. 171
Trusil .......................................................375 Ultradin................................................... 102
Truso ........................................................20 Ultrafen L ............................................... 333
Truxil .......................................................146 Ultrafen .................................................. 332
Truxil .......................................................313 Ultramox..................................................... 8
TT Vax ....................................................454 Ultrapime ................................................. 25
Tuffox .....................................................330 Unidox ...................................................... 36
Tufnil .......................................................293 Unifer ..................................................... 499
Tulac .......................................................118 Uniflam ................................................... 334
Tulip ........................................................253 Unigal ............................................. 411, 420
Tulos .......................................................118 Unikon .................................................... 180
Tulsi ........................................................189 Unilin ...................................................... 180
Tumy ......................................................518 Uni-medrol ............................................. 219
Tupime .....................................................25 Unipim ...................................................... 25
Turbocef ...................................................17 Unipril ..................................................... 132
Twicef .......................................................12 Unisaline Fruity ...................................... 112
Twist .......................................................106 Unisaline ................................................ 112
Tycil ............................................................8 Unitac ..................................................... 102
Tyclav .......................................................10 UnivetPlus .............................................. 527
Tyclox .........................................................6 Univit Plus .............................................. 527
Tycon .............................................. 243,413 Unix ........................................................ 415
Tydin .........................................................14 Unix-C .................................................... 415
Tyflam .....................................................334 Urbifen ................................................... 334
Tyflox ........................................................39 Urea ....................................................... 437
Tykerb ....................................................478 Urgotin ................................................... 237
Tymin ......................................................192 Uricon..................................................... 257
Tymox.........................................................8 Urikal ...................................................... 261
Tynaxie ...................................................267 Urilax ...................................................... 257
Tynisol ....................................................531 Urilit ........................................................ 261
Urinide.................................................... 149
895
GENERAL INDEX
Urinom ....................................................255 Vasco ..................................................... 528

Uriset ......................................................261 Vasocil ................................................... 146
Uriten ......................................................254 Vasopin .......................................... 140, 141
Uritol .......................................................258 Vasopressin ........................................... 231
Uritone ....................................................151 Vasopril .................................................. 130
Urobak ......................................................52 Vasotrop................................................. 375
Urocap ....................................................255 Vaspine .................................................. 328
Urocap-D ................................................255 Vastadin ................................................. 145
Urocure .....................................................52 Vastocor ................................................. 172
Uroflo ......................................................255 Vastor..................................................... 169
Urofollitropin ...........................................230 Vave ....................................................... 100
Urokinase ...............................................166 Vaxar ...................................................... 300
Urokit ......................................................261 Vaxigrip .................................................. 451
Urolosin D...............................................255 Vaxigriptetra ........................................... 451
Urolosin ..................................................255 Vaxitet .................................................... 454
Uromax ...................................................255 Vaxitet-IG ............................................... 460
Uromax-D ...............................................255 Vaxphoid ................................................ 450
Uromitexan .............................................468 Vcap ....................................................... 244
Uronase ..................................................167 V-cillin ...................................................... 11
Uropass ..................................................255 Veagra ................................................... 259
Urosin .....................................................255 Vecef ........................................................ 14
Urostat ....................................................348 Vectra.............................................. 306,392
Urotam....................................................255 Vecuron.................................................. 325
Uroxime ....................................................17 Vecuronium ............................................ 325
Urso ........................................................121 Vedilol .................................................... 125
Ursocol ...................................................121 Veelac .................................................... 118
Ursodeoxycholic Acid .............................120 Veesina .................................................. 528
Ursodil ....................................................121 Vegecap-E ............................................. 531
Ursolic ....................................................121 Velcade .................................................. 475
Utal .........................................................253 Velogen .................................................... 14
Utracet ....................................................291 Velox ........................................................ 14
Utramal ...................................................288 Velpatasvir ............................................... 73
Utrobin ....................................................257 Velvin ..................................................... 474
Utromeg..................................................257 Vencur.................................................... 325
Vencuron ............................................... 325
Veniron................................................... 499
V Venium ................................................... 267
Veniz XR ................................................ 285
Vaccines and antisera ............................447 Venlafaxine ............................................ 284
Vaccines .................................................443 Venlax .................................................... 285
Valaciclovir ...................................... 70, 413 Venol ...................................................... 178
Valdipin...................................................141 Venoxen ................................................. 338
Valenty ...................................................260 Venterol.................................................. 177
Valex ......................................................301 Ventil .............................................. 178, 180
Valoate ...................................................301 Ventisal .................................................. 178
Valovir ......................................................70 Ventol ..................................................... 178
Valpress .................................................135 Ventolin Evohaler................................... 179
Valsartan ................................................135 Ventolin .................................................. 178
Valsartil...................................................135 Veracal ................................................... 143
Valset .....................................................135 Veralgin .................................................... 97
Valtin ......................................................135 Veramil ................................................... 143
Valzide ....................................................135 Verapamil ............................................... 143
Vancard ....................................................54 Verben ..................................................... 83
Vancobac .................................................54 Vercef....................................................... 22
Vancomin .................................................54 Vergon ................................................... 276
Vancomycin ................................ 29,54, 363 Veridin .................................................... 102
Vanila .....................................................531 Verimet................................................... 209
Vanmycin..................................................54 Veripel ...................................................... 98
Vanprox ....................................................22 Verizin .................................................... 425
Vardena ..................................................260 Vermicom ................................................. 84
Varicella Vaccine ........................... 457, 458 Vermid...................................................... 83
Varilrix ....................................................458 Vermin DS ............................................... 83
Varox ......................................................161
896
GENERAL INDEX
Vermizol ...................................................84 Virine ...................................................... 366

Veron ........................................................98 Virlon ...................................................... 140
Verorab...................................................457 Virobion .................................................. 527
Versia .....................................................326 Virodacla .................................................. 72
Versil ......................................................131 Vironil ....................................................... 76
Vertex .......................................................25 Viroxi ........................................................ 70
Vertina ....................................................308 Virunil ....................................................... 70
Vesanoid ................................................484 Virux HC................................................. 413
Veserc ............................................ 306,392 Virux ....................................................... 413
Vesodil ....................................................125 Virux ......................................................... 70
Vesol N ...................................................418 Virzith ....................................................... 32
Vesotan ..................................................132 Vis ......................................................... 524
Vestar .....................................................145 Visagra ................................................... 259
Vexotil .......................................................17 Visarin ...................................................... 97
Viamax ...................................................259 Viscer ....................................................... 97
Viax ........................................................259 Visceral .................................................... 97
Vibrenta Penset ......................................204 Viscocid.................................................... 93
Vibrenta ..................................................204 Viscogel ................................................. 383
Victorin .....................................................22 Visegin ..................................................... 97
Vida ........................................................211 Viset ......................................................... 97
Vidaplus..................................................212 Visipaque 320 ........................................ 541
Viev ........................................................260 Visnil ........................................................ 97
Viewgut...................................................540 Visnor ....................................................... 97
Vifas .......................................................425 Visomox D ............................................. 363
Vigamet ..................................................212 Visomox ................................................. 362
Vigatin ....................................................211 Visonium .................................................. 97
Viglimet...................................................212 Vispazin ................................................... 97
Viglita ......................................................211 Visral ........................................................ 97
Vigorex ...................................................259 Vista ....................................................... 363
Vigosol ....................................................512 Vista ....................................................... 391
Vildagil M ................................................212 Visugall .................................................. 541
Vildagil ....................................................211 Visugut ................................................... 540
Vildamet .................................................212 Vita M ..................................................... 531
Vildapin plus ...........................................212 Vita-1 ...................................................... 524
Vildapin...................................................212 Vitabion .................................................. 527
Vildus ......................................................212 Vita-C ..................................................... 528
Vinap ......................................................338 Vitace M ................................................. 532
Vinblastine Sulphate ..............................474 Vitace ..................................................... 533
Vincet .....................................................147 Vitachild ................................................. 532
Vincrist ....................................................474 Vitaflower-Z ............................................ 527
Vincristine Sulphate ...............................474 Vitafol ..................................................... 386
Vincristine .............................. 465, 474, 503 Vitaforce S ............................................. 532
Vinorelbin Actavis...................................474 Vitaforce ................................................. 533
Vinorelbin Sandoz ..................................474 Vitagrow ......................................... 527, 532
Vinorelbine .............................................474 Vitalens .................................................. 386
Vinpocetine ............................................146 Vitalex Cod ............................................ 533
Vinsetine.................................................147 Vitalex .................................................... 527
Vinstin .....................................................474 VitalexZ .................................................. 527
Vinton .....................................................147 Vitalgin ................................................... 532
Viodin .....................................................401 Vitamin C ....................................... 528, 533
Viodin .....................................................439 VitaminD3B.O.N .................................... 529
Viola .......................................................439 Vitamin-K ............................................... 531
Viptin Plus ..............................................212 Vitaone ................................................... 524
Viptin ......................................................212 Vitasil B .................................................. 527
Vir ...........................................................72 Vitazin I .................................................. 527
Viracin ......................................................74 Vitcod ..................................................... 533
Viradin ......................................................76 Vitilen Lotion .......................................... 431
Virdin ......................................................102 Vitilimus.................................................. 432
Virdon .....................................................100 Vitonic .................................................... 527
Virenta ......................................................72 Vitrum Gold ............................................ 532
Virflox .......................................................39 Vitrum Silver .......................................... 532
Virgos .....................................................112 Vivis ....................................................... 534
897
GENERAL INDEX
VM Gold .................................................532 X-din ....................................................... 425

V-nerve ...................................................527 Xefrim....................................................... 17
V-Nil ........................................................308 Xegal ...................................................... 361
Vocet ......................................................425 Xelcard ................................................... 140
Voligel .....................................................332 Xelcom ..................................................... 97
Volinac ....................................................332 Xeldrin .................................................... 107
Voltafen ..................................................332 Xelitor ..................................................... 171
Voltalin Forte ..........................................333 Xelix ....................................................... 148
Voltalin ....................................................332 Xelobine ................................................. 471
Voluven ..................................................515 Xeloda .................................................... 471
Vomec ....................................................308 Xelopes .................................................. 108
Vomino ...................................................100 Xelpac .................................................... 483
Vomiset ..................................................310 Xelpid ..................................................... 171
Voriconazole ............................................56 Xemi ......................................................... 39
Votrient ...................................................478 Xemocid ................................................. 512
V-Plex Plus .............................................532 Xenap...................................... 106,338, 339
V-Plex ............................................ 527, 531 Xenapro ................................................. 338
Xenim ....................................................... 25
Xenobese ............................................... 312
W Xenocort................................................. 418
Xenoderm .............................................. 418
Wakoflex.................................................335 Xenofer .................................................. 499
Warfarin ..................................................161 Xenogrow ............................................... 436
Warin ......................................................161 Xenole ............................................. 106,339
Washed RBCs ........................................506 Xenolev .................................................... 40
Welon .....................................................438 Xenosal .................................................. 418
Whitefield................................................408 Xenosol .................................................. 510
Widebac ...................................................53 Xenovate ................................................ 418
Winbac .....................................................39 Xentoin ................................................... 299
Windel ....................................................179 Xepadon ................................................ 100
Winkof ....................................................188 Xeroder .................................................. 410
Winkol.....................................................192 Xerokof................................................... 188
Winner ......................................................25 Xerosec .................................................. 108
Winnipime.................................................25 Xerova.................................................... 171
Winop ............................................. 337,370 Xetril ....................................................... 297
Winpain ..................................................288 Xevirol ............................................ 476, 477
Wintack...................................................102 Xfin ......................................................... 412
Wtrix .......................................................437 Xflam ...................................................... 331
Xibrofen.................................................. 370
X Xiclav ....................................................... 18
Xicotil ..................................................... 340
X ride ......................................................258 Xido ........................................................ 206
Xalacom .................................................380 Xidolac ............................................ 337,370
Xalanol ...................................................380 Xifamin ..................................................... 52
Xalaprost ................................................380 Xifos ....................................................... 469
Xalatan ...................................................380 Xil ......................................................... 300
Xalcort ....................................................218 Ximeclav .................................................. 18
Xaloplat ..................................................481 Ximepime ................................................. 25
Xamic .....................................................168 Ximeprox .................................................. 22
Xanax .....................................................266 Ximetil ...................................................... 17
Xanide ......................................................67 Xinc B..................................................... 527
Xanita .......................................................67 Xinc ........................................................ 523
Xanthine .................................................180 Xindal ....................................................... 50
Xantid .....................................................102 Xinolax ........................................... 216, 283
Xanuric ...................................................348 Xinoplex ......................................... 497, 527
Xbac .........................................................39 Xioclon ................................................... 297
Xcel ........................................................290 Xionil ...................................................... 267
Xcid ........................................................518 Xiopam ................................................... 267
X-cite ......................................................259 Xiotic ...................................................... 266
Xclor .........................................................15 Xirocip ...................................................... 39
X-Cold ....................................................188 Xirom...................................................... 370
Xderm .....................................................418 Xisol ....................................................... 438
898
GENERAL INDEX
Xitabin ....................................................471 Zatral ...................................................... 254

Xitil ...........................................................17 Zeal ........................................................ 523
Xitob .......................................................359 Zecef ........................................................ 14
Xmec ......................................................308 Zedex DS ............................................... 523
Xofena ....................................................425 Zedoxim ................................................... 22
Xoferon ...................................................499 Zeefol Cl................................................. 497
Xolam .....................................................266 Zeltas Nasal ........................................... 394
Xolamid ..................................................379 Zemalog ................................................. 419
Xoleron ...................................................234 Zemicef .................................................... 20
Xolide .......................................................32 Zemin ..................................................... 523
Xolitra .....................................................274 Zemycin ................................................... 32
Xorel .......................................................109 Zenicin ..................................................... 32
Xorubion .................................................470 Zenidine ................................................. 102
Xovir .........................................................70 Zenifol Plus ............................................ 495
Xoviral ....................................................366 Zenifor ...................................................... 17
Xpa .........................................................290 Zenil ....................................................... 102
Xpa-C .....................................................290 Zenilac ................................................... 118
Xpain ......................................................330 Zenistin .................................................. 412
X-pectoran ..............................................189 Zenith ..................................................... 112
Xpro ........................................................338 Zenopan ................................................. 109
X-rays .......................................................86 Zenoquine ................................................ 61
Xtabac ......................................................22 Zenosyn ................................................. 338
Xten ........................................................340 Zentolin .................................................. 179
Xtracal ....................................................518 Zenxit ..................................................... 274
Xtracal-D ................................................520 Zenzide .................................................. 206
Xtracal-M ................................................521 Zeosaline ............................................... 112
Xtrapel ....................................................288 Zep Junior .............................................. 523
Xvit 496 Zep ......................................................... 523
Xyfen ......................................................330 Zepam .................................................... 267
Xyflo .......................................................186 Zepiron .......................................... 497, See
Xylocon...................................................396 Zeprion Plus ........................................... 497
Xylogel ....................................................328 Zerin ....................................................... 290
Xylomet ..................................................396 Zerin-XP ................................................. 290
Xylometazoline .......................................396 Zeromig .................................................. 295
Xylone Plus ............................................328 Zeropain ................................................. 337
Xylone ....................................................328 Zerotens ................................................. 267
Xylose .....................................................118 Zesprin ................................................... 163
Xylovin ....................................................396 Zesup ..................................................... 523
Xynocard ................................................139 Zeum ........................................................ 97
Xynor ........................................................66 Zibac ................................................. 32,358
Xynovir .....................................................76 Zico ........................................................ 523
Xyotil .............................................. 134, 135 Zicovit-B ................................................. 527
Xyril ........................................................425 Zidicef ...................................................... 23
Xytrex .....................................................275 Zidim ........................................................ 23
Xzema ....................................................405 Zidimax .................................................... 23
Zidovudine ....................................... 76, 413
Zif ......................................................... 497
Y Zif-CI ...................................................... 497
Ziliron B ........................................... 496,497
Yamadin .................................................101 Ziliron ..................................................... 497
Yellow Fever Vaccine ............................458 sZilon ..................................................... 108
Yonediles................................................483 Zilsart ..................................................... 132
Zilvit ........................................................ 497
Z Zimax ....................................................... 32
Zimax ..................................................... 358
Zadifen ...................................................184 Zinc Oxide ............................................. 440
Zadit ............................................... 184,372 Zinc Salts ............................................... 522
Zalcitabine ................................................77 Zinc Sulphate ......................................... 523
Zaleplon..................................................270 Zinc ................................................ 522, 523
Zantac ....................................................102 Zincare ................................................... 523
Zapenia ..................................................273 Zinc-DT .................................................. 523
Zarzio .....................................................503 Zincin ..................................................... 306
899
GENERAL INDEX
Zincol ......................................................523 Zolfin ...................................................... 330

Zinex .........................................................32 Zolium .................................................... 266
Zinga ......................................................523 Zolmitriptan ............................................ 294
Zinnat .......................................................17 Zolomide ........................................ 469, 480
Zinofa .....................................................523 Zolonac .................................................. 330
Zipol ........................................................523 Zolpidem Tartrate .................................. 271
Ziqui ........................................................523 Zoltero .................................................... 234
Zirgan .....................................................366 Zometa ................................................... 234
Zis .........................................................523 Zomitan .................................................. 294
Ziska .......................................................112 Zonan ....................................................... 67
Ziskavit ...................................................527 Zopan ..................................................... 109
Zismo B ..................................................527 Zopi ........................................................ 271
Zismo ......................................................523 Zopiclone ............................................... 271
Zistacin ...................................................192 Zopilone ................................................. 270
Zita ...........................................................32 Zopime ..................................................... 26
Zita .........................................................358 Zorep ...................................................... 102
Zithracin....................................................32 Zosert ..................................................... 281
Zithrin .......................................................32 Zoton ...................................................... 104
Zithrox ......................................................32 Zoventa .................................................... 23
Ziton .......................................................523 Zovia Kids .............................................. 533
Zitum ........................................................23 Zovia Teen B ......................................... 532
Zivit .........................................................528 Zovia Teen G ......................................... 532
Zixol ........................................................523 Zox ........................................................... 67
Z-lidocaine ..............................................328 Zoxan ....................................................... 67
Zn .........................................................523 Zoxanid .................................................... 67
Zn-B ........................................................528 ZS ......................................................... 523
Znkid .......................................................523 ZT ......................................................... 523
Zoana .......................................................67 Zuclopenthixol ....................................... 278
Zoben .......................................................83 Zulfidin ................................................... 115
Zocare ....................................................371 Zulfidin ................................................... 346
Zoclast ....................................................234 Zumab .................................................... 484
Zocort .....................................................419 Zuvas ..................................................... 171
Zodin ......................................................102 Zybex ..................................................... 286
Zofen ......................................................295 Zycin ........................................................ 32
Zofer MD ................................................310 Zydol ...................................................... 289
Zofra .......................................................310 Zymar ..................................................... 361
Zol .........................................................410 Zymarin .................................................. 361
Zolamid ...................................................379 Zymet ..................................................... 121
Zolax .......................................................266 Zytiga ..................................................... 492
Zoledron .................................................234 Zytix ....................................................... 492
Zolendronic Acid ....................................234
Zolenic ....................................................234
Zolexin ....................................................271
900

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BDNF

• Bangladesh Medical Association

Notes on drugs and preparations

Appendices and Indices

Dental Practitioners’ Formulary 799-824

Chairman Additional Secretary

EDITORIAL BOARD WORKING COMMITTEE

Brigadier General Dipak Kumar Paul Md. Razibul Habib

Professor Sultana Ferdousi

Professor Eliza Omar Eva

Hossain Sheikh Mohammed, Dr., Ophthalmologist, National Institute of Ophthalmology &

Sultana Nashid, Dr., Associate Professor of Pharmacology, Delta medical College

The opening Chapter of the BDNF includes a Guideline on Prescriptions, which

Indications, Cautions, Contra-indications, Side-effects, Interactions and Doses are

Appropriate prescribing implies the choice of medicines based on efficacy, safety,

Patient compliance means adherence to a prescribedtreatment schedule. Patient

Doctor compliance is no less important and relates to his/her professional obligations

DRUG INFORMATION: ROLE OF BDNF

ESSENTIAL DRUG CONCEPT: IMPORTANCE IN PRESCRIBING

Prescribing fromthe list of essential drugs is considered to be relatively effective and

DRUG NAMES IN PRESCRIPTION

However, when it is considered important to ensure consistency of a product in

In the prescription, unit dose strength should be clearly stated

The quantity to be supplied may be specified in numbers or volume; it may also be

PRESCRIBING FOR THE ELDERLY

important to check the patient’s compliance by counting the remaining tablets or

PRESCRIBING FOR CHILDREN

PRESCRIIBING IN PALLIATIVE CARE

Control of Common symptoms:

Pain: Non-opioids (paracetamol, NSAIDs) opioids (codeine, morphine) analgesics;

Dyspnea: Breathlessness at rest may be relieved by carefully titrated doses of

Anorexia: Anorexia may be due to a tumor or its complication, treatment by

Dysphagia: Dysphagia may be due to a tumor itself, treatment, neurological damage

Convulsions: Convulsions are common in patients with cerebral tumor or uraemia.

PRESCRIBING CONTROLLED DRUGS

Prescription requirements in respect of controlled drugs are as follows:

1. A registered medical practitioner or a dentist as per clause (m) and (e) of

5. If a patient under care of a physicianbecomes an addict requiring treatment,

STORAGE AND DISPENSING OF CONTROLLED DRUGS

1. Controlled Drugs, especially A-Class and B-Class narcotics and psychotropic

ADVERSE REACTIONS TO DRUGS

To prevent adverse drug reactions—

1. Do not prescribe a drug unless there is a good indication. If the patient is an

Reporting Adverse Drug Reactions:

Doctors working in public hospitals or health complexes or in private hospitals/clinics

1.1 Antibacterial drugsp.3

1. ANTI-INFECTIVE DRUGS ANTI-INFECTIVE DRUG THERAPY:

continue to present therapeutic whether pregnant or breast-feeding or

sites of surgery and their prevailing * - Watch group antibiotics

NARROW SPECTRUM necessary increase to 2.4 g daily or more

BENZYLPENICILLIN[A] BENZATHINE PENICILLIN[ED] [A]

PHENOXYMETHYL PENICILLIN [ED] [A] Procaine penicillin NOT suitable for

under 2 years, quarter of adult dose; 2- Cholestatic Jaundice may occur up to

Tycil(Beximco), Cap., 500 mg, Tk.

PIVMECILLINAM HYDROCHLORIDE[A] Cephalosporins are broad-spectrum,