INSERT INTO `generic_details` (`id`, `generic_id`, `indications`, `pharmacology`, `dosage_and_administration`, `interaction`, `contraindications`, `side_effects`, `pregnancy_and_lactation`, `precautions_and_warnings`, `overdose_effects`, `therapeutic_class`, `storage_conditions`, `use_in_special_populations`, `created_at`, `updated_at`) VALUES
(1270, 1270, '<ul>\r\n	<li>Potent long-acting antihistamine with additional anti-emetic and sedative/calming effects.</li>\r\n	<li>Indicated in symptomatic treatment of allergic conditions of the respiratory tract and skin.</li>\r\n	<li>Sensitization reactions to drug or foreign proteins, anaphylactic reactions.</li>\r\n	<li>For sedation, allergic rhinitis, urticaria and insomnia.</li>\r\n	<li>As an adjunct in pre-operative sedation in surgery and obstetrics.</li>\r\n	<li>As a paediatric sedative</li>\r\n</ul>', '<p>Promethazine is a phenothiazine derivative which blocks postsynaptic mesolimbic dopaminergic receptors in the brain. It exhibits strong &alpha;-adrenergic blocking effect and depresses the release of hypothalamic and hypophyseal hormones. It competes with histamine for the H1-receptor; muscarinic blocking effect may be responsible for antiemetic activity. It also reduces stimuli to the brainstem reticular system.<br />\r\n<br />\r\nPromethazine is well absorbed from the gastrointestinal tract. Clinical effects are apparent within 20 minutes after oral administration and generally last four to six hours, although they may persist as long as 12 hours. Promethazine is metabolized by the liver to a variety of compounds; the sulfoxides of promethazine and N-demethylpromethazine are the predominant metabolites appearing in the urine.</p>', '<p><strong>Adults</strong>: Initial dose one 25 mg tablet at night; may be increased to two or three 25 mg tablets at night if necessary. In allergic conditions more frequently administration, twice or three times daily, may be necessary, starting with one or two 10 mg tablets and increasing as required.<br />\r\n<br />\r\n<strong>Elderly</strong>: No specific dosage recommendations.<br />\r\n<br />\r\n<strong>Children</strong>: They may be treated more conveniently by the elixir containing 5 mg/5 ml.<br />\r\n<br />\r\nAs an antihistamine in allergy:</p>\r\n\r\n<ul>\r\n	<li>Children of 2-5 years: 5-15 mg</li>\r\n	<li>Children of 5-10 years: 10-25 mg</li>\r\n	<li>In the case where two doses in 24 hours are required, the lower dose stated should be given.</li>\r\n</ul>\r\n\r\n<p>As a sedative:</p>\r\n\r\n<ul>\r\n	<li>Children of 2-5 years: 15-20 mg</li>\r\n	<li>Children of 5-10 years: 20-25 mg</li>\r\n	<li>Given as a single night-time dose</li>\r\n</ul>', '<ul>\r\n	<li>Promethazine Hydrochloride may enhance the action of any anticholinergic agent, tricyclic antidepressant, sedative or hypnotic, Alcohol should be avoided during drug treatment.</li>\r\n	<li>Phenergan may interfere with immunologic urine pregnancy tests to produce false-positive or false-negative results.</li>\r\n	<li>Phenergan should be discontinued at least 72 hours before the start of skin tests using allergen extracts as it may inhibit the cutaneous histamine response thus producing false-negative results.</li>\r\n</ul>', '<ul>\r\n	<li>Promethazine is contraindicated for use in children less than two years of age</li>\r\n	<li>Hypersensitivity to promethazine or to any of the excipients.</li>\r\n	<li>Phenergan should not be used in patients who are in a coma or suffering from CNS depression of any cause. It must not be given to neonates or premature infants.</li>\r\n	<li>Phenergan should be avoided in patients who have been taking monoamine oxidase inhibitors within the previous 14 days</li>\r\n</ul>', '<ul>\r\n	<li>Nervous system disorders: Frequency Unknown: Neuroleptic Malignant Syndrome the elderly are particularly susceptible to the anticholinergic efects and confusion due to Promethazine, somnolence, dizziness, headaches, extrapyramidal efects including muscle spasm, tic-like movements of the head and face. A very serious and sometimes deadly health problem called neuroleptic malignant syndrome (NMS) may happen. Stop treatment and call your doctor right away if you have high fever, muscle cramps or stifness, dizziness, very bad headache, fast heartbeat, confusion, agitation, hallucinations, or are sweating a lot.</li>\r\n	<li>Immune System Disorders- Frequency unknown: Allergic reactions, including urticaria, rash, pruritus, and anaphylaxis, have been reported.</li>\r\n	<li>Skin and Subcutaneous Tissue Disorders- Frequency unknown: Photosensitivity reaction</li>\r\n	<li>Metabolism and Nutrition Disorders- Frequency unknown: Anorexia</li>\r\n	<li>Gastrointestinal Disorders- Frequency unknown: Epigastric discomfort, dry mouth</li>\r\n	<li>Eye Disorders- Frequency unknown: Blurred vision</li>\r\n	<li>Blood and Lymphatic System Disorders- Frequency unknown: Blood dyscrasias including hemolytic anemia, agranulocytosis</li>\r\n	<li>Renal and Urinary Disorders- Frequency unknown: Urinary retention</li>\r\n	<li>Psychiatric Disorders- Frequency unknown: Infants, newborns and premature are susceptible to the anticholinergic efects of promethazine, while other children may display paradoxical hyperexcitability, restlessness, nightmares, disorientation</li>\r\n	<li>Cardiac Disorders- Frequency unknown: Palpitations, arrhythmias</li>\r\n	<li>Vascular disorders- Frequency unknown: Hypotension</li>\r\n	<li>Hepatobiliary disorders- Frequency unknown: Jaundice</li>\r\n	<li>General Disorders and Administration Site Conditions- Frequency unknown: Tiredness</li>\r\n</ul>\r\n\r\n<p>Use this drug only as recommended. Do not exceed the recommended dose. There have been case reports of promethazine abuse. Do not take for longer than 10 days.</p>', '<p>There is epidemiological evidence for the safety of promethazine in pregnancy and animal studies have shown no hazard, nevertheless, it should not be used in pregnancy unless the physician considers it essential. The use of Phenergan is not recommended in the two weeks prior to delivery in view of the risk of irritability and excitement in the neonate. When promethazine has been given in high doses during late pregnancy, promethazine has caused prolonged neurological disturbances in the infant. Promethazine should be used in pregnancy only if the potential benefts to the patient are weighed against the possible risk to the fetus. Promethazine is excreted in breastmilk. There are risks of neonatal irritability and excitement.</p>', '<ul>\r\n	<li>The use of promethazine should be avoided in children and adolescents with signs and symptoms suggestive of Reye&rsquo;s syndrome.</li>\r\n	<li>Promethazine may thicken or dry lung secretions and impair expectoration. It should therefore be used with caution in patients with asthma, bronchitis or bronchiectasis.</li>\r\n	<li>Use with care in patients with severe coronary artery disease.</li>\r\n	<li>Use with care in patients with narrow angle glaucoma.</li>\r\n	<li>Use with care in patients with epilepsy.</li>\r\n	<li>Use with care in patients with hepatic insufciency.</li>\r\n	<li>Use with care in patients with renal insufciency.</li>\r\n	<li>Caution should be exercised in patients with bladder neck obstruction.</li>\r\n	<li>Caution should be exercised in patients with pyloro-duodenal obstruction.</li>\r\n</ul>', '<p>Symptoms of severe over dosage are variable. They are characterised in children by various combinations of excitation, ataxia, incoordination, athetosis and hallucinations, while adults may become drowsy and lapse into coma. Convulsions may occur in both adults and children; coma or excitement may precede their occurrence. Tachycardia may develop. Cardiorespiratory depression is uncommon. If the patient is seen soon enough after ingestion, it should be possible to induce vomiting with ipecacuanha despite the antiemetic efect of promethazine; alternatively, gastric lavage may be used. Treatment is otherwise supportive with attention to maintenance of adequate respiratory and circulatory status. Convulsions should be treated with diazepam or other suitable anticonvulsant.</p>', '<p>Anti-emetic drugs, Miscellaneous sedatives &amp; hypnotics, Sedating Anti-histamine.</p>', '<p>Protect from light. Do not use later than the date of expiry. Keep all medicines out of the reach of children. To be dispensed only on the prescription of a registered physician.</p>', NULL, '2022-03-16 05:01:09', '2022-03-16 05:01:09'),
(1271, 1271, '<p>Promethazine hydrochloride injection is indicated for the following conditions:</p>\r\n\r\n<ul>\r\n	<li>Amelioration of allergic reactions to blood or plasma.</li>\r\n	<li>In anaphylaxis as an adjunct to epinephrine and other standard measures after the acute symptoms have been controlled.</li>\r\n	<li>For other uncomplicated allergic conditions of the immediate type when oral therapy is impossible or contraindicated.</li>\r\n	<li>For sedation and relief of apprehension and to produce light sleep from which the patient can be easily aroused.</li>\r\n	<li>Active treatment of motion sickness.</li>\r\n	<li>Prevention and control of nausea and vomiting associated with certain types of anesthesia and surgery.</li>\r\n	<li>As an adjunct to analgesics for the control of postoperative pain.</li>\r\n	<li>Preoperative, postoperative, and obstetric (during labor) sedation.</li>\r\n	<li>Intravenously in special surgical situations, such as repeated bronchoscopy, ophthalmic surgery, and poor-risk patients, with reduced amounts of meperidine or other narcotic analgesic as an adjunct to anesthesia and analgesia.</li>\r\n</ul>', '<p>Promethazine is a phenothiazine derivative which blocks postsynaptic mesolimbic dopaminergic receptors in the brain. It exhibits strong &alpha;-adrenergic blocking effect and depresses the release of hypothalamic and hypophyseal hormones. It competes with histamine for the H1-receptor; muscarinic blocking effect may be responsible for antiemetic activity. It also reduces stimuli to the brainstem reticular system.<br />\r\n<br />\r\nClinical effects are generally apparent within 5 minutes of an intravenous injection and within 20 minutes of an intramuscular injection. Duration of action is four to six hours, although effects may persist up to 12 hours. Promethazine hydrochloride injection is metabolized in the liver, with the sulfoxides of promethazine and N-desmethylpromethazine being the predominant metabolites appearing in the urine. Following intravenous administration in healthy volunteers, the plasma half-life for promethazine has been reported to range from 9 to 16 hours. The mean plasma half-life for promethazine after intramuscular administration in healthy volunteers has been reported to be 9.8&plusmn;3.4 hours.</p>', '<p><strong>Allergic Conditions</strong>: The average adult dose is 25 mg. This dose may be repeated within two hours if necessary, but continued therapy, if indicated, should be via the oral route as soon as existing circumstances permit. After initiation of treatment, dosage should be adjusted to the smallest amount adequate to relieve symptoms. The average adult dose for amelioration of allergic reactions to blood or plasma is 25 mg.<br />\r\n<br />\r\n<strong>Sedation</strong>: In hospitalized adult patients, nighttime sedation may be achieved by a dose of 25 to 50 mg of Promethazine Hydrochloride injection.<br />\r\n<br />\r\n<strong>Nausea and Vomiting</strong>: For control of nausea and vomiting, the usual adult dose is 12.5 to 25 mg, not to be repeated more frequently than every four hours. When used for control of postoperative nausea and vomiting, the medication may be administered either intramuscularly or intravenously and dosage of analgesics and barbiturates reduced accordingly.<br />\r\n<br />\r\n<strong>Preoperative and Postoperative Use</strong>: As an adjunct to preoperative or postoperative medication, 25 to 50 mg Promethazine Hydrochloride injection in adults may be combined with appropriately reduced doses of analgesics and atropine-like drugs as desired. Dosage of concomitant analgesic or hypnotic medication should be reduced accordingly.</p>', '<p><strong>CNS Depressants</strong>: Promethazine hydrochloride (promethazine hydrochloride injection) may increase, prolong, or intensify the sedative action of central-nervous-system depressants, such as alcohol, sedative-hypnotics (including barbiturates), general anesthetics, narcotics, narcotic analgesics, tranquilizers, etc. When given concomitanty with promethazine hydrochloride (promethazine hydrochloride injection), the dose of barbiturates should be reduced by at least one-half, and the dose of narcotics should be reduced by one-quarter to one-half. Dosage must be individualized. Excessive amounts of promethazine hydrochloride (promethazine hydrochloride injection) relative to a narcotic may lead to restlessness and motor hyperactivity in the patient with pain; these symptoms usually disappear with adequate control of the pain.<br />\r\n<br />\r\n<strong>Epinephrine</strong>: Although reversal of the vasopressor effect of epinephrine has not been reported with promethazine hydrochloride (promethazine hydrochloride injection), it is recommended that epinephrine NOT be used in the case of promethazine hydrochloride (promethazine hydrochloride injection) overdose.</p>', '<p>Promethazine hydrochloride injection is contraindicated in comatose states and in patients who have demonstrated an idiosyncrasy or hypersensitivity to promethazine or other phenothiazines. Under no circumstances should Promethazine hydrochloride injection be given by intra-arterial injection due to the likelihood of severe arteriospasm and the possibility of resultant&nbsp;gangrene.<br />\r\n<br />\r\nPromethazine hydrochloride injection should not be given by the&nbsp;subcutaneous&nbsp;route; evidence of chemical irritation has been noted, and&nbsp;necrotic&nbsp;lesions have resulted on rare occasions following subcutaneous injection. The preferred parenteral route of administration is by deep&nbsp;intramuscularinjection.</p>', '<p><strong>CNS Effects</strong>: Drowsiness is the most prominent CNS effect of the drug. Extrapyramidal reactions may occur with high doses; this is almost always responsive to a reduction in dosage. Other reported reactions include dizziness, lassitude, tinnitus, incoordination, fatigue, blurred vision, euphoria, diplopia, nervousness, insomnia, tremors, convulsive seizures, oculogyric crises, excitation, catatonic-like states, hysteria, and hallucinations.<br />\r\n<br />\r\n<strong>Cardiovascular Effects</strong>: Tachycardia, bradycardia, faintness, dizziness, and increases and decreases in blood pressure have been reported following the use of Promethazine hydrochloride injection. Venous thrombosis at the injection site has been reported.<br />\r\n<br />\r\n<strong>Gastrointestinal Effects</strong>: Nausea and vomiting have been reported, usually in association with surgical procedures and combination drug therapy.<br />\r\n<br />\r\n<strong>Allergic Reactions</strong>: These include urticaria, dermatitis, asthma, and photosensitivity. Angioneurotic edema has been reported.<br />\r\n<br />\r\n<strong>Other Reported Reactions</strong>: Leukopenia and agranulocytosis, usually when promethazine has been used in association with other known marrow-toxic agents, have been reported. Thrombocytopenic purpura and jaundice of the obstructive type have been associated with the use of promethazine. The jaundice is usually reversible on discontinuation of the drug. Subcutaneous injection has resulted in tissue necrosis. Nasal stuffiness may occur. Dry mouth has been reported.</p>', '<p>Pregnancy Category C. Teratogenic effects have not been demonstrated in rat-feeding studies at doses of 6.25 and 12.5 mg/kg (approximately 2.1 and 4.2 times the maximum recommended human daily dose) of Promethazine hydrochloride injection . Daily doses of 25 mg/kg intraperitoneally have been found to produce fetal mortality in rats.<br />\r\n<br />\r\nThere are no adequate and well-controlled studies of Promethazine hydrochloride injection in pregnant women. Because animal reproduction studies are not always predictive of human response, Promethazine hydrochloride injection should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.</p>', '<p><strong>General</strong>: Drugs having anticholingeric properties should be used with caution in patients with narrow-angle&nbsp;glaucoma, prostatic&nbsp;hypertrophy, stenosing&nbsp;peptic ulcer, pyloroduodenal obstruction, and bladder-neck obstruction. Promethazine hydrochloride (promethazine hydrochloride injection) should be used cautiously in persons with&nbsp;cardiovascular disease&nbsp;or impairment of liver function.<br />\r\n<br />\r\n<strong>Carcinogenesis, Mutagenesis&nbsp;</strong>and<strong>&nbsp;Impairment of Fertility</strong>: Long term animal studies have not been performed to assess the carcinogenic potential of promethazine hydrochloride (promethazine hydrochloride injection), nor are there other animal or human data concerning carcinogenicity, mutagenicity, or impairment of fertility. Promethazine hydrochloride was nonmutagenic in the Ames&nbsp;Salmonella&nbsp;test system.</p>', '<p><strong>Signs and symptoms</strong>&nbsp;of overdosage range from mild depression of the&nbsp;central nervous system&nbsp;and&nbsp;cardiovascular system&nbsp;to profound&nbsp;hypotension, respiratory depression, and unconsciousness.<br />\r\n<br />\r\nStimulation may be evident, especially in pediatric patients and geriatric patients. Convulsions may rarely occur. A paradoxical reaction has been reported in pediatric patients receiving single doses of 75 mg to 125 mg orally, characterized by hyperexcitability and nightmares.<br />\r\n<br />\r\nAtropine-like and symptoms: dry mouth, fixed, dilated pupils, flushing, etc., as well as&nbsp;gastrointestinal&nbsp;symptoms, may occur.<br />\r\n<br />\r\n<strong>Treatment</strong>: Treatment of overdosage is essentially&nbsp;symptomatic&nbsp;and supportive. Only in cases of extreme overdosage or individual sensitivity do vital signs, including respiration, pulse, blood pressure, temperature, and EKG, need to be monitored. Attention should be given to the reestablishment of adequate respiratory exchange through provision of a patent airway and institution of assisted or controlled ventilation. Diazepam may be used to control convulsions.&nbsp;Acidosis&nbsp;and&nbsp;electrolyte&nbsp;losses should be corrected. Note that any depressant effects of promethazine hydrochloride (promethazine hydrochloride injection) are not reversed by&nbsp;naloxone.<br />\r\n<br />\r\nAvoid analeptics, which may cause convulsions. The treatment of choice for resulting hypotension is administration of intravenous fluids, accompanied by repositioning if indicated. In the event that vasopressors are considered for the management of severe hypotension which does not respond to intravenous fluids and repositioning, the administration of levarterenol or phenylephrine should be considered.&nbsp;EPINEPHRINE&nbsp;SHOULD NOT BE USED, since its use in a patient with partial adrenergic blockade may further lower the blood pressure. Extrapyramidal reactions may be treated with&nbsp;anticholinergic&nbsp;antiparkinson agents, diphenhydramine, or barbiturates. Oxygen may also be administered. Limited experience with&nbsp;dialysis&nbsp;indicates that it is not helpful.</p>', '<p>Anti-emetic drugs, Miscellaneous sedatives &amp; hypnotics, Sedating Anti-histamine.</p>', '<p>Store between 15-30&deg; C. Protect from light..</p>', '<p><strong>Pediatric Patients</strong>: Promethazine hydrochloride are contraindicated for children under 2 years of age. In pediatric patients 2 years of age and older, the dosage should not exceed half that of the suggested adult dose. As an adjunct to premedication, the suggested dose is 0.5 mg per lb. of body weight in combination with an appropriately reduced dose of narcotic or barbiturate and the appropriate dose of an atropine-like drug. Antiemetics should not be used in vomiting of unknown&nbsp;etiology&nbsp;in pediatric patients&nbsp;<br />\r\n<br />\r\n<strong>Geriatric Patients&nbsp;(approximately 60 years or older)</strong>: Since therapeutic requirements for sedative drugs tend to be less in geriatric patients, the dosage should be reduced for these patients.</p>', '2022-03-16 05:03:22', '2022-03-16 05:03:22'),
(1272, 1272, '<p>Promethazine Theoclate Tablets are an anti-emetic (anti-sickness drug) which helps to prevent, and treat nausea and vomiting, including travel sickness, and vertigo. Promethazine Theoclate contains promethazine which belongs to a group of medicines called phenothiazines. Your doctor may prescribe this medicine for giddiness or light-headedness (vertigo), or for sickness after an operation, and in such cases the tablets should be taken as instructed by your doctor.</p>', '<p>Promethazine Theoclate works by stopping histamine from binding to its receptors in&nbsp;an area in the brain known as the vomiting centre. The vomiting centre is responsible for causing feelings of sickness and for the vomiting reflex. It is activated when it receives nerve messages from the vestibular apparatus in the middle ear.<br />\r\n<br />\r\nThe vestibular apparatus provides constant feedback to the brain about the position of our body. When something disturbs the vestibular apparatus, such as movements of the head when travelling by boat or car, nerve signals are sent from the vestibular apparatus to the vomiting centre. This can cause the symptoms of motion sickness, such as nausea, dizziness or spinning sensations (vertigo) and vomiting.<br />\r\n<br />\r\nBy blocking the histamine receptors in the vomiting centre, Promethazine Theoclate&nbsp;prevents disturbances in the middle ear from activating the vomiting centre.</p>', '<p><strong>To prevent travel sickness on short journeys</strong>: Promethazine Theoclate should be taken at least one or two hours before travelling. Adults and children aged over 10 years&nbsp;should take one tablet. Children aged 5 to 10 years should be given half a tablet.<br />\r\n<br />\r\n<strong>To prevent travel sickness on&nbsp;long journeys</strong>: Promethazine Theoclate should be taken at bedtime each night during the journey, starting&nbsp;the night before you travel.&nbsp;Adults and children&nbsp;aged over 10 years&nbsp;should take one tablet.&nbsp;Children aged 5 to 10 years should be given half a tablet.<br />\r\n<br />\r\n<strong>To treat travel sickness</strong>:&nbsp;Adults and children over 10 years should take one tablet as soon as you feel sick, followed by a second tablet the same evening. Take a third tablet the following evening if necessary. Children aged 5 to 10 years should treated in the same way, but with half a tablet each time.<br />\r\n<br />\r\n<strong>For sickness and vomiting due to other causes, and for treating vertigo</strong>: Adults and children aged over 10 years should take one tablet up to three times a&nbsp;day. Children aged 5 to 10 years should be given half a tablet up to three times a day.&nbsp;Alternatively&nbsp;you should follow the instructions given by your doctor.</p>', '<p>It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start taking Promethazine Theoclate. Similarly, check with your doctor or pharmacist before taking any new medicines while taking Promethazine Theoclate, to make&nbsp;sure that the&nbsp;combination is safe.<br />\r\n<br />\r\nPromethazine Theoclate&nbsp;should not be taken by anyone who has&nbsp;taken&nbsp;a type of antidepressant called a monoamine oxidase inhibitor (MAOI), eg&nbsp;phenelzine,&nbsp;tranylcypromine,&nbsp;isocarboxazid,&nbsp;in the previous 14 days.<br />\r\n<br />\r\nYou are more likely to feel drowsy if you take Promethazine Theoclate&nbsp;with any of the following (which can also cause drowsiness):</p>\r\n\r\n<ul>\r\n	<li>alcohol</li>\r\n	<li>antipsychotic medicines, eg&nbsp;chlorpromazine</li>\r\n	<li>barbiturates, eg&nbsp;phenobarbital</li>\r\n	<li>benzodiazepines, eg&nbsp;diazepam,&nbsp;temazepam</li>\r\n	<li>sedating antihistamines, eg&nbsp;chlorphenamine,&nbsp;brompheniramine,&nbsp;hydroxyzine</li>\r\n	<li>sleeping tablets, eg&nbsp;zopiclone</li>\r\n	<li>strong opioid painkillers, eg&nbsp;morphine,&nbsp;codeine,&nbsp;dihydrocodeine, tramadol</li>\r\n	<li>tricyclic antidepressants, eg&nbsp;amitriptyline.</li>\r\n</ul>', '<ul>\r\n	<li>Children under five&nbsp;years of age.</li>\r\n	<li>People with reduced awareness, slow reactions or extreme drowsiness caused by medicines or illnesses&nbsp;that reduce activity in the central nervous system.</li>\r\n	<li>People who have taken a type of medicine called a&nbsp;monoamine-oxidase inhibitor antidepressant&nbsp;(MAOI) in the past 14 days.</li>\r\n	<li>Children and adolescents who have signs and symptoms suggestive of Reye&#39;s syndrome.</li>\r\n	<li>People who are allergic to any ingredients of the tablets.</li>\r\n	<li>Promethazine Theoclate tablets contain lactose and should not be taken by people with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption.</li>\r\n</ul>', '<p>Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with promethazine. Just because a side effect is stated here does not mean that all people using Promethazine Theoclate will experience that or any side effect.</p>\r\n\r\n<ul>\r\n	<li>Drowsiness or feeling tired.</li>\r\n	<li>Dizziness.</li>\r\n	<li>Restlessness.</li>\r\n	<li>Headache.</li>\r\n	<li>Nightmares.</li>\r\n	<li>Blurred vision.</li>\r\n	<li>Difficulty passing urine.</li>\r\n	<li>Dry mouth.</li>\r\n	<li>Confusion.</li>\r\n	<li>Feeling disorientated.</li>\r\n	<li>Unexpected increase in excitability in children.</li>\r\n	<li>Increased sensitivity of the skin to sunlight (photosensitivity). If affected you should avoid sun lamps and direct sunlight while you are taking this medicine.</li>\r\n	<li>Loss of appetite.</li>\r\n	<li>Awareness of your heartbeat (palpitations).</li>\r\n	<li>Abnormal heartbeats (arrhythmias).</li>\r\n	<li>Low blood pressure (hypotension).</li>\r\n	<li>Abnormal movements of the hands, legs, face, neck and tongue, eg tremor, twitching, rigidity (extrapyramidal effects).</li>\r\n	<li>Blood disorders.</li>\r\n</ul>', '<p>If you are pregnant you should not take Promethazine Theoclate without consulting your doctor first. Promethazine Theoclate should only be used&nbsp;during pregnancy if essential, and&nbsp;only if the expected benefit to the mother outweighs any potential risks to the developing baby. It&nbsp;should not be used during the last two weeks of&nbsp;pregnancy, because if taken during this time it may cause irritability or excitement in the baby after birth. Seek further medical advice from your doctor.<br />\r\n<br />\r\nSmall amounts of Promethazine Theoclate may pass into breast milk. This is not expected to be harmful to a nursing infant with occasional short-term use of Promethazine Theoclate, but there&nbsp;is a risk that it may cause drowsiness,&nbsp;irritability or excitement in a newborn baby. If you are breastfeeding you should not take Promethazine Theoclate without getting medical advice from your doctor first.</p>', '<p>Promethazine Theoclate tablets can make some people feel drowsy, dizzy, confused or disorientated and this&nbsp;may reduce your ability to drive or operate machinery safely.&nbsp;Do not drive or operate machinery until you know how this medicine affects you&nbsp;and you are sure it won&#39;t affect your performance.&nbsp;If your child is affected in this way they should avoid potentially hazardous activities such as riding bikes. You should not leave your child unattended after giving them this medicine.<br />\r\n<br />\r\nAvoid drinking&nbsp;alcohol&nbsp;while taking Promethazine Theoclate&nbsp;because this is likely to make the above effects more likely&nbsp;or worse.<br />\r\n<br />\r\nPromethazine Theoclate tablets may make your skin more sensitive to sunlight than usual, so you should avoid exposing your skin to direct sunlight or sunlamps until you know how your skin reacts. If you can&#39;t avoid strong sunlight you should use a sunscreen lotion or make sure your skin is protected with clothing.<br />\r\n<br />\r\nThis medicine may interfere with some&nbsp;pregnancy tests, causing false negative or false positive results.<br />\r\n<br />\r\nIf you are due to have any&nbsp;skin prick tests&nbsp;to diagnose allergies you should stop taking Promethazine Theoclate at least 72 hours before the tests. This is because antihistamines can prevent or lessen the skin reactions that indicate an allergy, and so can make the test results unreliable.</p>', NULL, '<p>Anti-emetic drugs, Miscellaneous sedatives &amp; hypnotics, Sedating Anti-histamine.</p>', '<p>Store between 15-30&deg; C. Protect from light.</p>', NULL, '2022-03-16 05:05:32', '2022-03-16 05:05:32'),
(1273, 1273, '<p>Propafenone is indicated for the treatment of paroxysmal atrial fibrillation/flutter (PAF), paroxysmal supraventricular tachycardia (PSVT). Propafenone is also indicated for the treatment of documented ventricular arrhythmias.</p>', '<p>Propafenone works by slowing the influx of sodium ions into the cardiac muscle cells, causing a decrease in excitability of the cells. Propafenone is more selective for cells with a high rate, but also blocks normal cells more than class Ia or Ib. Propafenone differs from the prototypical class Ic antiarrhythmic in that it has additional activity as a beta-adrenergic blocker which can cause bradycardia and bronchospasm.</p>', '<p>The dose of Propafenone must be individually titrated on the basis of response and tolerance. It is recommended that therapy be initiated with Propafenone 150 mg given every eight hours (450 mg/day). Dosage may be increased at a minimum of 3 to 4 day intervals to 225 mg every 8 hours (675 mg/day) and if necessary, to 300 mg every 8 hours (900 mg/day). The usefulness and safety of dosages exceeding 900 mg per day have not been established.</p>', '<p>Propafenone is metabolized by CYP2D6 (major pathway) and CYP1A2 and CYP3A4. Drugs that inhibit CYP2D6 (such as desipramine, paroxetine, ritonavir, sertraline), CYP1A2 (such as amiodarone) and CYP3A4 (such as ketoconazole, ritonavir, saquinavir, erythromycin and grapefruit juice) can be expected to cause increased plasma levels of propafenone. In addition, propafenone is an inhibitor of CYP2D6. Coadministration of propafenone with drugs metabolized by CYP2D6 (such as desipramine, imipramine, haloperidol, venlafaxine) might lead to increase plasma concentrations of these drugs.</p>', '<p>Propafenone is contraindicated in the presence of uncontrolled congestive heart failure, cardiogenic shock, sinoatrial, atrioventricular and intraventricular disorders of impulse generation and/or conduction (e.g. sick sinus node syndrome, atrioventricular block) in the absence of an artificial pacemaker, bradycardia, marked hypotension, bronchospastic disorders, manifest electrolyte imbalance and known hypersensitivity to the drug.</p>', '<p>Adverse reactions associated with propafenone occur most frequently in the gastrointestinal, cardiovascular and central nervous systems. Change in taste, constipation, diarrhea, dizziness, drowsiness, dry mouth, gas, headache, light-headedness, nausea, tiredness etc. may happen. Severe allergic reactions also reported with propafenone.</p>', '<p><strong>Pregnancy:</strong>&nbsp;Propafenone has been assigned to&nbsp;pregnancy category C by the FDA.&nbsp;There are no controlled data in human&nbsp;pregnancy. Limited data indicate that&nbsp;propafenone has been administered&nbsp;during the third trimester of pregnancy&nbsp;without adverse maternal or fetal&nbsp;effects. Propafenone should be given&nbsp;during pregnancy only when benefit&nbsp;outweighs risk.<br />\r\n<br />\r\n<strong>Nursing Mothers:</strong>&nbsp;It is not known whether this drug is&nbsp;excreted in human milk. Because many&nbsp;drugs are excreted in human milk and&nbsp;because of the potential for serious&nbsp;adverse reactions in nursing infants&nbsp;from propafenone, a decision should be&nbsp;made whether to discontinue nursing or&nbsp;to discontinue the drug, taking into&nbsp;account the importance of the drug to&nbsp;the mother.</p>', '<p><strong>Hepatic Dysfunction:</strong>&nbsp;Propafenone is highly metabolized by&nbsp;the liver and should therefore, be&nbsp;administered cautiously to patients with impaired hepatic function. As a result,&nbsp;the dose of propafenone given to patients with impaired hepatic function&nbsp;should be approximately 20 to 30% of&nbsp;the dose given to patients with normal&nbsp;hepatic function.<br />\r\n<br />\r\n<strong>Renal Dysfunction:</strong>&nbsp;A considerable percentage of propafenone metabolites (18.5% to 38% of the&nbsp;dose/48 hours) are excreted in the urine. Until further data are available, propafenone should be administered&nbsp;cautiously to patients with impaired&nbsp;renal function.<br />\r\n<br />\r\n<strong>Neuromuscular Dysfunction:</strong>&nbsp;Exacerbation of myasthenia gravis has been reported during propafenone&nbsp;therapy.</p>', NULL, '<p>Membrane stabilizing agent (Sodium channel blockers).</p>', '<p>Store at 25&deg; C. Store in a cool and dry place, protected from light. Keep out of children&rsquo;s reach.</p>', '<p><strong>Pediatric Use:&nbsp;</strong>The safety and effectiveness of&nbsp;propafenone in pediatric patients have&nbsp;not been established.<br />\r\n<br />\r\n<strong>Geriatric Use:&nbsp;</strong>Clinical studies of propafenone did not&nbsp;include sufficient numbers of subjects&nbsp;aged 65 and over to determine whether&nbsp;they respond differently from younger&nbsp;subjects. In general, dose selection for&nbsp;an elderly patient should be cautious.</p>', '2022-03-16 05:07:17', '2022-03-16 05:07:17'),
(1274, 1274, '<p>Propantheline Bromide is indicated in the treatment of-</p>\r\n\r\n<ul>\r\n	<li>Adjunctive therapy in the treatment of peptic ulcer (gastric and duodenal)</li>\r\n	<li>Relief of the symptoms of gastritis (stomach upset, gastrointestinal bleeding, blood in vomit, blood in stool, persistent pain)</li>\r\n	<li>Symptomatic treatment of the diarrhoea related irritable bowel syndrome (irritable colon, spastic colon, acute enterocolitis, functional Gl disorders etc)</li>\r\n	<li>Urinary incontinence</li>\r\n	<li>Control of salivation and enuresis</li>\r\n	<li>Improves lactose intolerance</li>\r\n	<li>Prevents excessive sweating (Hyperhidrosis)</li>\r\n</ul>', '<p>Propantheline Bromide acts by dual mechanism of action.</p>\r\n\r\n<ul>\r\n	<li>Specific anticholinergic effect (antimuscarinic) at the acetylcholine-receptor sites</li>\r\n	<li>Direct effect upon smooth muscle (musculotropic).</li>\r\n</ul>\r\n\r\n<p>This medication is a muscarinic antagonist having antispasmodic properties. It reduces the effect of acetylcholine, a chemical released from nerves that stimulates muscles, by blocking the receptors for acetylcholine on smooth muscle. It also has a direct relaxing effect on smooth muscle. In addition, Propantheline inhibits gastrointestinal motility and decreases gastric acid secretion and controls excessive pharyngeal, tracheal and bronchial secretions. Other secretions like pancreatic juice, sweat and saliva are also reduced.</p>', '<p>The usual initial adult dose of Propantheline Bromide is 75 mg daily. One tablet 30 min before each meal (15 mg three times daily). Two tablets at bedtime Dosage adjustment should be made according to the patient&#39;s individual response and tolerance. But the maximum daily dosage should not exceed 120 mg.<br />\r\n<br />\r\nPediatric use: Safety and effectiveness in pediatric patients have not been established.</p>', '<p>Antacids or Absorbent Antidiarrhoeals may reduce the absorption of propantheline bromide, therefore resulting in a reduction of its therapeutic effectiveness. Therefore, take two to three hours apart from doses of propantheline bromide. Anticholinergics may delay absorption of other medication given concomitantly. Significant drug interaction also occurs with concomitant use of digoxin, haloperidol, corticosteroides, ketoconazole, levodopa, opioid analgesics, phenothiazines, urinary alkalizers.</p>', '<p>Propantheline Bromide is contraindicated in patients with-</p>\r\n\r\n<ul>\r\n	<li>Hypersensitivity to Propantheline bromide or other anticholinergic agents;</li>\r\n	<li>Glaucoma;</li>\r\n	<li>Obstructive disease of the gastrointestinal tract (pyloroduodenal stenosis, paralytic ileus etc.);</li>\r\n	<li>Obstructive uropathy (e.g. prostatic hypertrophy) intestinal atony of elderly;</li>\r\n	<li>Myasthenia gravis.</li>\r\n</ul>', '<p>The adverse effects of Propantheline Bromide are usually dose-related and are usually reversible when the therapy is discontinued. Variable degrees of dry mouth, dry skin, mydriasis might be noted. Other reported adverse effects include urinary retention, nausea, vomiting, constipation, headache, nervousness, mental confusion etc.</p>', '<p>Propantheline Bromide is in pregnancy category C. Animal reproduction studies have not been conducted with propantheline bromide. Propantheline bromide should be given to a pregnant woman only if clearly needed. It is not known whether this drug is excreted in milk. Because many drugs are excreted in milk, caution should be exercised when propantheline bromide is administered to a nursing woman. Suppression of lactation may occur with anticholinergic drugs.</p>', '<p>Propantheline Bromide should be used with caution in the elderly and in all patients with autonomic neuropathy, hepatic or renal disease, hyperthyroidism, coronary heart disease, congestive heart failure, cardiac tachyarrhythmias, hypertension, since anticholinergics may aggravate this condition.</p>', '<p>The symptoms of overdosage with Propantheline Bromide progress from an intensification of the usual side effects (from nausea and vomiting) to CNS disturbances (from restlessness and excitement to psychotic behaviour), circulatory changes, (flushing, fall in blood pressure, circulatory failure), respiratory failure, paralysis.</p>', '<p>Anticholinergics (antimuscarinics)/ Anti-spasmodics.</p>', '<p>Do not store above 30&deg;C. Keep away from light and out of the reach of children.</p>', NULL, '2022-03-16 05:09:04', '2022-03-16 05:09:04'),
(1275, 1275, '<p>Proparacaine is indicated for procedures in which a topical ophthalmic anesthetic is indicated: corneal anesthesia of short duration, e.g. tonometry, gonioscopy, removal of corneal foreign bodies, and for short corneal and conjunctival procedures. It is also indicated for use prior to surgical operations such as cataract extraction.</p>', '<p>The main site of anesthetic action is the nerve cell membrane where proparacaine interferes with the large transient increase in the membrane permeability to sodium ions that is normally produced by a slight depolarization of the membrane. As the anesthetic action progressively develops in a nerve, the threshold for electrical stimulation gradually increases and the safety factor for conduction decreases; when this action is sufficiently well developed, block of conduction is produced. Several studies indicate that local anesthetics may limit sodium ion permeability by closing the pores through which the ions migrate in the lipid layer of the nerve cell membrane.</p>', '<p><strong>Deep anesthesia as in cataract extraction</strong>: Instill 1 drop to the eye every 5 to 10 minutes for 5 to 7 doses.<br />\r\n<br />\r\n<strong>Removal of sutures</strong>: Instill 1 or 2 drops to the eye 2 or 3 minutes before removal of stitches.<br />\r\n<br />\r\n<strong>Removal of foreign bodies</strong>: Instill 1 or 2 drops to the eye prior to operating.<br />\r\n<br />\r\n<strong>Tonometry</strong>: Instill 1 or 2 drops to the eye immediately before measurement.</p>\r\n\r\n<p>&nbsp;</p>', NULL, '<p>Proparacaine eye drops should be considered contraindicated in patients with known hypersensitivity to any of the ingredients of this preparation.</p>', '<p>Occasional temporary stinging, burning and conjunctival redness may occur with the use of Proparacaine.</p>', '<p><strong>Use in pregnancy</strong>: It is not known whether Proparacaine can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Proparacaine should be administered to a pregnant woman only if clearly needed.<br />\r\n<br />\r\n<strong>Use in lactation</strong>: It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Proparacaine is administered to a nursing mother.</p>', '<p>Prolonged use of a topical ocular anesthetic is not recommended. It may produce permanent corneal opacification with accompanying visual loss.</p>', NULL, '<p>Ocular perioperative drugs.</p>', '<p>Store bottles under refrigeration at 2&deg; to 8&deg; C &amp; protect from light. It is desirable that the contents should not be used more than 4 weeks after first opening of the bottle. If solution shows more than a faint yellow color, it should not be used. Keep bottle tightly closed.</p>', '<p><strong>Pediatric Use:</strong>&nbsp;Safety and effectiveness of Proparacaine ophthalmic solution in pediatric patients have been established. Use of Proparacaine is supported by evidence from adequate and well-controlled studies in adults and children over the age of twelve, and safety information in neonates and other pediatric patients.<br />\r\n<br />\r\n<strong>Geriatric Use:</strong>&nbsp;No overall clinical differences in safety or effectiveness have been observed between the elderly and other adult patients.</p>', '2022-03-16 05:10:43', '2022-03-16 05:10:43');
INSERT INTO `generic_details` (`id`, `generic_id`, `indications`, `pharmacology`, `dosage_and_administration`, `interaction`, `contraindications`, `side_effects`, `pregnancy_and_lactation`, `precautions_and_warnings`, `overdose_effects`, `therapeutic_class`, `storage_conditions`, `use_in_special_populations`, `created_at`, `updated_at`) VALUES
(1276, 1276, '<p>Induction and maintenance of general anaesthesia. Sedation during intensive care. Sedation for surgical and diagnostic procedures.</p>', '<p>Propofol is a sedative-hypnotic agent for use in the induction and maintenance of anesthesia or sedation. Intravenous injection of a therapeutic dose of propofol produces hypnosis rapidly with minimal excitation, usually within 40 seconds from the start of an injection (the time for one arm-brain circulation).&nbsp;The action of propofol involves a positive modulation of the inhibitory function of the neurotransmitter gama-aminobutyric acid (GABA) through GABA-A receptors.</p>', '<p>Adults:</p>\r\n\r\n<p><strong>Induction of general anaesthesia</strong>: The dosage of Propofol should be titrated individually against the response of the patient. The ordinary initial dosage in adults is 40 mg (4 ml) by slow intravenous bolus injection at intervals of 10 seconds until the clinical signs show the onset of anaesthesia. The ordinary induction dose in healthy patient below 55 years of age is 2.2-2.5 mg/kg. A dose of 1.0-1.5 mg/kg is often sufficient for older patient. Lower doses, most often 20 mg (2 ml) at intervals of 10 seconds, are recommended for patient of ASA grades 3 and 4.<br />\r\n<br />\r\n<strong>Maintenance of general anaesthesia</strong>: Anaesthesia can be maintained by administering Propofol either by continuous infusion or by repeat bolus injections to maintain sufficient anaesthesia.&nbsp;<br />\r\n<br />\r\n<strong>Continuous infusion</strong>: The required rate of infusion varies considerably between patients. At the onset of anaesthesia (during roughly the first 10-20 minutes), some patient may require a slightly higher infusion rate (8-10 mg/kg/h). However, sufficient anaesthesia is normally achieved by infusing 4-6 (up to 12) mg/kg/h of Propofol. Repeat bolus injections: 25-50 mg (2.5-5.0 ml) bolus injections, depending on response.<br />\r\n<br />\r\n<strong>Sedation during intensive care</strong>: A bolus injection of 1.0-2.0 mg/kg should be given first, followed by continuous infusion adjusted according to required degree of sedation. An infusion rate of 0.3-4 mg/kg/h is usually sufficient.<br />\r\n<br />\r\n<strong>Sedation for surgical and diagnostic procedures</strong>: Dosages shall be adjusted individually. Sufficient sedation for surgical and diagnostic procedures can usually be achieved by administering initially 0.5-1 mg/kg during 1-5 minutes, and maintained by continuous at a rate of 1-4.5 mg/kg/h. Bolus dose of 10-20 mg can be given in addition, should deeper sedation be suddenly required. Lower doses of Propofol are often sufficient for patient of ASA grades 3 and 4, and for older patient.&nbsp;<br />\r\n&nbsp;</p>\r\n\r\n<p>Children:</p>\r\n\r\n<p>Propofol is not recommended for use in children less then 3 years of age as its safety has not been demonstrated.&nbsp;<br />\r\n<br />\r\n<strong>Induction of general anaesthesia</strong>: Dosage of Propofol in children shell be adjusted for weight and age. The mean induction dosage in children over 8 years is 2.5 mg/kg, given by slow intravenous injection until the clinical signs show the onset of anaesthesia. Younger children may need slightly higher doses of propofol per kilogram of weight. Lower dosages are recommended for children of ASA grades 3 and 4.<br />\r\n<br />\r\n<strong>Maintenance of general anaesthesia</strong>: Anaesthesia can be maintained by administering Propofol either by continuous infusion or by repeat bolus injections. Dosage shall be adjusted individually, but an infusion rate of 9-15 mg/kg/h is usually sufficient to achieve satisfactory anaesthesia.<br />\r\n<br />\r\n<strong>Sedation during intensive care, surgical diagnostic procedures</strong>: Propofol is not recommended for sedation in children as its efficacy and safety have not been demonstrated. Although no casual relationship has been established, serious adverse events (including fatalities) have been reported in cases, where propofol has been used against recommendations. Adverse events have most commonly been seen in children with respiratory tract infections given doses in excess of those recommended for adults.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p><strong>Method of administration</strong>: In order to reduce pain on injection, the induction dose of propofol may be mixed immediately before injection in the palstic syringe with lidocaine 10 mg/ml injection, in a ratio of 1 part of lidocaine injection for 20 parts of Propofol.<br />\r\n<br />\r\nPropofol can be administered either undiluted or diluted for infusion. Before injection or dilution, each ampoule or vial shall be ispected for any irregularity. Should any changes be observed, the product shall not be used. Suitable equipment shall be used to ensure correct rate of infusion. Volumetric infusion pumps and syringe pumps, for example, are suitable for this purpose. The ordinary infusion set used alone is not sufficient to prevent accidential overdosage reliably enough.<br />\r\n<br />\r\n<strong>Compatibility</strong>: Propofol may be diluted only with 5% dextrose infusion. Dilution shall not exceed 1 in 5 (containing 2 mg/ml Propofol) and shall be prepared in a PVC infusion bag or glass infusion bottle. If a PVC infusion bag is used, the bag should be full and the dilution be prepared by withdrawing a volume of infusion fluid and replacing it with an equal volume of Propofol. Special attention shall be paid to preparing the dilution aseptically, immediately before administration. Any diluted solution shall be used within 6 hours of preparation. Any remaining solution shall be discarded.</p>', '<p>Propofol has been used in association with spinal and epidural anaesthesia as well as with various types of premedicants, muscle relaxants, inhalation anaesthetics and analgetics. No pharmacological incompatibility has been observed. Lower doses of Propofol may be sufficient in case Propofol is used as an adjunct to local anaesthetic techniques. In doses applied clinically, propofol will not inhibit the synthesis of adrenocortical hormones. Simultaneous administration of opiates may potentiate respiratory depression caused by Propofol.</p>', '<p>Allergy to propofol or any other ingredient in the preparation.</p>', '<p><strong>Local</strong>: Propofol is normally well tolerated. Its most common undesirable effect is pain at the site of injection that can be reduced by mixing the preparation with lidocaine or by injecting it into one of the larger veins of the forearm or the intercubital fossa. Thrombosis and phlebitis are rare.<br />\r\n<br />\r\n<strong>General</strong>: Hypotension and transient apnea may occur at the induction of anaesthesia, and may be severe especially in patients who are in a poor general condition. Epileptic movement, convulsions and dystonic reactions have been seen in rare cases. Pulmonary oedema has also been reported. Headache, nausea and, more rarely, vomiting may occur in some patients during recovery. Recovery may also be associated with another short period of impaired consciousness. Hypersensitivity has been reported in some cases, connected with anaphylactic symptoms such as marked hypotension, bronchospasm, oedema and facial erythema. Some cases of cardiac arrest have occurred in connection with the administration of propofol. In connection with long-term administration of propofol, green or reddish brown discolouration of urine may occur. This is caused by the quinol metabolites of propofol, and is not dangerous. As with other anaesthetics, altered sexual behaviour may occur.</p>', '<p>Due to insufficient experience, propofol shall not be used during pregnancy. Propofol is rapidly distributed to the foetus and shall therefore not be used for obstetric anaesthesia. Safety to the neonate has not been established in cases, where propofol has been administered to lactating women.</p>', '<p>Propofol should only be given by specialists in anaesthesiology or under their supervision. The physician performing a surgical or diagnostic procedure should not administer propofol. Facilities for resuscitation in case of any complication should be available at the treatment unit. During the administration of Propofol, patients shall be monitored continuously to observe possible hypotension, obstruction in the respiratory tract, hypoventilation or insufficient oxygen intake at a sufficiently early stage. Special attention shall be paid to patients sedated by Propofol for a surgical or diagnostic procedure, who are not artificially ventilated. Caution shall be taken in administering Propofol to patients with cardiac, respiratory, renal or hepatic insufficiency. Hypovolemic patients and those with poor general condition form another risk group.<br />\r\n<br />\r\nSince propofol lacks vagolytic activity, bradycardia, even asystole, may occur. Intravenous administration of an anticholinergic agent before induction and during maintenance of anaesthesia should be considered, especially if propofol is used in conjunction with other agents likely to cause bradycardia and in situations where vagal tone is likely to predominate. Since Propofol is a lipid emulsion, appropriate care should be applied in patients with severe disorders of fat metabolism such as pathological hyperlipidemia. If Propofol is administered to a patient for whom excessive fat intake may be risky, blood lipid values shall be monitored and Propofol dosage decreased if necessary. If the patient is receiving other paranteral lipid emulsions in addition to Propofol, the amount of lipid in Propofol (0.1 g/ ml) shall be taken into account, when calculating the total intake of fat. In epileptic patients, propofol may lead to convulsions. The analgetic effect of propofol as such is insufficient. Analgetics shall be used to ensure sufficient analgesia. Full recovery from general anaesthesia shall be confirmed prior to discharge. It shall be noted that the aftermath of general anaesthesia may impair the patient&#39;s ability to understand instructions given postoperatively.</p>', '<p>Overdosage may cause cardiorespiratory depression. Respiratory depression should be treated by artificial ventilation with oxygen, and cardiovascular depression by lowering of the patient&#39;s head and elevating of his/her legs. Pressor agents and plasma expanders or Ringer-type electrolyte solutions may be used, if necessary.</p>', '<p>General (Intravenous) anesthetics.</p>', '<p>Propofol should be stored at a temperature not exceeding 25&ordm; C. It must not be frozen. Any unused solution shall be discarded.</p>', '<p><strong>Use in children</strong>: Propofol is not recommended for use in children less then 3 years of age as its safety has not been demonstrated.</p>', '2022-03-16 05:13:00', '2022-03-16 05:13:00'),
(1277, 1277, '<p>Propranolol is indicated in:</p>\r\n\r\n<ul>\r\n	<li>Essential hypertension</li>\r\n	<li>Angina pectoris</li>\r\n	<li>Cardiac arrhythmia</li>\r\n	<li>Thyrotoxicosis</li>\r\n	<li>Anxiety</li>\r\n	<li>Prophylaxis of migraine, etc.</li>\r\n</ul>', '<p>Propranolol Hydrochloride is a B-adrenergic receptor blocking drug which is widely used in hypertension and angina pectoris. Propranolol antagonizes catecholamines at B-adrenergic receptors, thus prevents excess rate and force of contraction of the heart and decreases the excess consumption of oxygen by the heart.<br />\r\n<br />\r\nPropranolol is almost completely absorbed from the gastrointestinal tract, but a portion is immediately metabolized by the liver when passing through the portal circulation. Peak plasma concentration occurs in 1 to 1.5 hours after oral administration. The plasma half-life of propranolol is from 3 to 6 hours. The metabolites of propranolol are excreted through the urine.</p>', '<p>Adult (above 18 years):</p>\r\n\r\n<ul>\r\n	<li><strong>Hypertension</strong>: Initially 80 mg twice daily, may be increased at weekly intervals and then maintenance dose of 160-320 mg daily is recommended.</li>\r\n	<li><strong>Angina pectoris</strong>: Initially 40 mg 2-3 times daily and then maintenance dose of 120-240 mg daily is given.</li>\r\n	<li><strong>Thyrotoxicosis</strong>: 10-40 mg, 3-4 times daily is given.</li>\r\n	<li><strong>Anxiety</strong>: 40 mg once daily, may&nbsp;be increased to three times daily.</li>\r\n	<li><strong>Prophylaxis of migraine</strong>: Initially 40 mg 2-3 times daily; then maintenance dose of 80-160 mg daily is recommended.</li>\r\n</ul>\r\n\r\n<p>Child (From day 1 to 18 years): Hypertension:</p>\r\n\r\n<ul>\r\n	<li><strong>Neonate</strong>: 0.25-0.5 mg/kg 3 times daily, adjusted according to response.</li>\r\n	<li><strong>Child 1 month</strong>: 12 years: 0.25-1 mg/kg 3 times daily, maximum dose 5 mg/kg daily in divided dose.</li>\r\n	<li><strong>Child 12-18 years</strong>: initially 80 mg twice daily, maintain 160-320 mg daily.</li>\r\n</ul>', '<p>Patients receiving verapamil, salbutamol, Levosalbutamol, ergot alkaloids, lidocain, phenobarbital drugs should be closely observed during therapy.</p>', '<p>Bronchospasm, cardiogenic shock, second or third degree heart block, diabetes mellitus etc.</p>', '<p>Cold extremities, lassitude, nausea, dizziness, insomnia, paresthesia etc.</p>', '<p>Pregnancy category C, should not be used in pregnant women. Propranolol is excreted in human milk. Caution should be taken when propranolol is administered to a nursing mother.</p>', '<p>It should be taken with caution in hepatic and renal impairment, pregnancy and lactating mother.</p>', NULL, '<p>Beta-adrenoceptor blocking drugs, Beta-blockers.</p>', '<p>Store in a cool and dry place, protected from light.</p>', NULL, '2022-03-16 05:14:40', '2022-03-16 05:14:40'),
(1278, 1278, '<p><strong>Chronic Lymphocytic Leukemia (CLL)</strong>: Bendamustine is indicated for the treatment of patients with&nbsp;chronic lymphocytic leukemia. Efficacy relative to first line therapies other than chlorambucil has not been established.<br />\r\n<br />\r\n<strong>Non-Hodgkin Lymphoma (NHL)</strong>: Bendamustineis indicated for the treatment of patients with indolent B-cell non-Hodgkin lymphoma that has progressed during or within six months of treatment with rituximab or a rituximab-containing regimen.<br />\r\n<br />\r\nAlso indicated in&nbsp;Multiple myeloma.</p>', '<p>Bendamustine is a bifunctional mechlorethamine derivative capable of forming electrophilic alkyl groups that covalently bond to other molecules. Through this function as an alkylating agent, bendamustine causes intra- and inter-strand crosslinks between DNA bases resulting in cell death. It is active against both active and quiescent cells, although the exact mechanism of action is unknown.</p>', '<p><strong>Chronic lymphocytic leukaemia</strong>:&nbsp;100 mg/m2&nbsp;infused over 30-60 min on days 1 and 2 of a 28-day cycle for up to 6 cycles. For severe haematological or non-haematological toxicity: Reduce dose to 50 mg/m2&nbsp;on days 1 and 2 of each cycle. If severe haematological toxicity recurs, further reduce dose to 25 mg/m2&nbsp;on days 1 and 2 of each cycle. May consider dose re-escalation in subsequent cycles.<br />\r\n<br />\r\n<strong>Multiple myeloma</strong>:&nbsp;120-150 mg/m2&nbsp;infused over 30-60 min on days 1 and 2 of a 28-day cycle. IV or oral prednisone may be given at a dose of 60 mg/m2&nbsp;on days 1-4 of the cycle.<br />\r\n<br />\r\n<strong>Non-Hodgkin&#39;s lymphoma</strong>:&nbsp;120 mg/m2&nbsp;infused over 30-60 min on days 1 and 2 of a 21-day cycle for up to 8 cycles. For severe haematological or non-haematological toxicity: Reduced to 90 mg/m2&nbsp;on days 1 and 2 of each cycle. If severe toxicity recurs, further reduce dose to 60 mg/m2&nbsp;on days 1 and 2 of each cycle.</p>', '<p>May increase plasma levels with CYP1A2 inhibitors (e.g. ciprofloxacin, fluvoxamine). May reduce plasma levels with CYP1A2 inducers (e.g. omeprazole and tobacco smoking).</p>', '<p>Patient with history of hypersensitivity (e.g. anaphylaxis and anaphylactoid reactions); jaundice, severe bone marrow suppression, low leukocyte or platelet count. Severe hepatic impairment. Major surgery &lt;30 days prior to treatment.</p>', '<p>Malignant and pre-malignant disease; pyrexia, nausea, vomiting, cough, headache, fatigue, diarrhoea, constipation, anorexia, wt decrease, rash, stomatitis, lymphopenia, anaemia, thrombocytopenia, leucopenia, neutropenia.</p>', '<p>Pregnancy category D. There is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).</p>', '<p>Mild to moderate hepatic and renal impairment. Pregnancy and lactation.</p>', '<p><strong>Symptoms</strong>: Cardiotoxicity, thrombocytopenia.<br />\r\n<br />\r\n<strong>Management</strong>: May perform bone marrow transplantation and transfusions to control haematological effects. It is dialysable to a small extent.</p>', '<p>Cytotoxic Chemotherapy</p>\r\n\r\n<p><strong>Reconstitution</strong></p>\r\n\r\n<p>Reconstitute powder for inj by adding 5 ml or 20 ml of sterile water for inj to a vial containing 25 mg or 100 mg, respectively to provide a soln containing 5 mg/ml. The lyophilised powder should be dissolved w/in 5 min, shake well to facilitate dissolution. within 30 min of reconstitution, the appropriate volume should be withdrawn from the vial to further dilute in 500 ml of either NaCl 0.9% inj or dextrose 2.5% and NaCl 0.45% inj to a final concentration of 0.2-0.6 mg/ml.</p>', '<p><strong>Chronic Lymphocytic Leukemia (CLL)</strong>: Bendamustine is indicated for the treatment of patients with&nbsp;chronic lymphocytic leukemia. Efficacy relative to first line therapies other than chlorambucil has not been established.<br />\r\n<br />\r\n<strong>Non-Hodgkin Lymphoma (NHL)</strong>: Bendamustineis indicated for the treatment of patients with indolent B-cell non-Hodgkin lymphoma that has progressed during or within six months of treatment with rituximab or a rituximab-containing regimen.<br />\r\n<br />\r\nAlso indicated in&nbsp;Multiple myeloma.</p>', '<p>Hepatic Impairment: Moderate: Reduce dose by 30%.</p>', '2022-03-17 04:41:46', '2022-03-17 04:45:20'),
(1279, 1279, '<p>Retapamulin is indicated for use in adults and pediatric patients aged 9 months and older for the topical treatment of impetigo (up to 100 cm 2 in total area in adults or 2% total body surface area in pediatric patients aged 9 months or older) due to Staphylococcus aureus (methicillin-susceptible isolates only) or Streptococcus pyogenes. Safety in patients younger than 9 months has not been established. To reduce the development of drug-resistant bacteria and maintain the effectiveness of Retapamulin and other antibacterial drugs, Retapamulin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.</p>', '<p>Retapamulin selectively inhibits bacterial protein synthesis by interacting at a site on the 50S subunit of the bacterial ribosome through an interaction that is different from that of other antibiotics. This binding site involves ribosomal protein L3 and is in the region of the ribosomal P-site and peptidyl transferase center. By virtue of binding to this site, pleuromutilins inhibit peptidyl transfer, block P-site interactions, and prevent the normal formation of active 50S ribosomal subunits. Retapamulin is bacteriostatic against Staphylococcus aureus and Streptococcus pyogenes at the Retapamulin in vitro minimum inhibitory concentration (MIC) for these organisms.</p>', '<p>A thin layer of Topibac should be applied to the affected area (up to 100 cm2&nbsp;in total area in adults or 2% total body surface area in pediatric patients aged 9 months or older) twice daily for 5 days. The treated area may be covered with a sterile bandage or gauze dressing if desired.</p>', '<p>The effect of concurrent application of Retapamulin and other topical products to the same area of skin has not been studied.</p>', '<p>Contraindicated in patients with hypersensitivity of any ingredient of this preparation.</p>', '<p>Adverse effects: Application site irritation (&lt;2% of patients may experience).</p>', '<p>Pregnancy Category B. It is not known whether Retapamulin is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Retapamulin is administered to a nursing woman.</p>', '<p>Local Irritation: In the event of sensitization or severe local irritation from Retapamulin, usage should be discontinued. Not for Systemic or Mucosal Use: Retapamulin is not intended for ingestion or for oral, intranasal, ophthalmic, or intravaginal use.</p>', NULL, '<p>Topical Antibiotic preparations.</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-17 23:52:49', '2022-03-17 23:52:49'),
(1280, 1280, '<p>This oral solution is indicated in the treatment of acute and chronic inflammations of the mucosas of the mouth, gums and throat (Aphthous Ulcer, Cold Sore, Gingivitis, Periodontitis, Dental Hypersensitivity, Dental Plaque, Denture Irritation).</p>', '<p>Salicylic acid works by blocking the action of a substance in the body called cyclo-oxygenase. This extract contains anthraquinone glycosides, which relieve inflammation. This is well absorb into the oral mucosa.</p>', '<p><strong>Adults</strong>: To be applied to the inflamed oral mucosa (after removing any dentures) 3 to 4 times daily using the brush provided. Avoid rinsing the mouth or eating for 15 minutes after application. Always keep the cap closed immediately after every use.<br />\r\n<br />\r\n<strong>Children</strong>: As per consultation with a registered physician, it is recommended below the age of 12 years.</p>', '<p>There are no known interactions with the preparation documented.</p>', '<p>Hypersensitivity to any of the constituents.</p>', '<p>A transient local burning sensation at the site of application occurs very commonly. Temporary discoloration of teeth or oral mucosa has been described commonly following administration of the oral solution.</p>', '<p><strong>Pregnancy</strong>: Animal studies are insufficient with respect to effects on pregnancy and-or embryonal/foetal development. The potential risk for humans is unknown. Caution should be exercised when prescribing to pregnant women.<br />\r\n<br />\r\n<strong>Lactation</strong>: Anthraquinone glycosides derived from rhubarb may be excreted in breast milk. However, at therapeutic doses of oral solution, it is not known whether these or salicylic acid are excreted in breast milk. A decision on whether to continue breast feeding or to continue therapy with an oral solution should be made taking into account the benefit of breast-feeding to the child and benefit of oral solution therapy to the woman.</p>', '<p>Each bottle of the oral solution should be used by only one person.</p>', '<p>Overdose associated with a local application is unlikely, although the extent of systemic absorption of salicylic acid and anthraquinone derivatives is not known. Systemic overdose following ingestion might lead to abdominal cramping, diarrhea, and possibly salicylism (presenting as hyperventilation, tinnitus, deafness, vasodilation, sweating).</p>', '<p>Oral preparations</p>', '<p>Store in a cool and dry place, protected from light.</p>', NULL, '2022-03-18 00:54:21', '2022-03-18 00:54:21'),
(1281, 1281, '<p>Ribavirin is indicated for the treatment of chronic hepatitis C (CHC) virus infection in combination with other antiviral drugs in patients with compensated liver disease not previously treated with interferon alpha and in adult CHC patients coinfected with HIV. Ribavirin should not be used alone.</p>', '<p>Ribavirin is a synthetic nucleoside which has inhibitory action against respiratory syncytial virus, influenza virus and herpes simplex virus. The mechanism of action is not clear. It may act at several sites including cellular enzymes to interfere with viral nucleic acid synthesis. The mono- and triphosphate derivatives are known to be responsible for the antiviral action of the compound.</p>', '<p>The recommended duration of treatment for patients previously untreated with interferon is 24 to 48 weeks. After 24 weeks of treatment virologic response should be assessed. Treatment discontinuation should be considered in any patient who has not achieved an HCV RNA below the limit of detection of the assay by 24 weeks. There are no safety and efficacy data on treatment for longer than 48 weeks in the previously untreated patient population. In patients who relapse following interferon therapy, the recommended duration of treatment is 24 weeks. There are no safety and efficacy data on treatment for longer than 24 weeks in the relapse patient populations.<br />\r\n<br />\r\n<strong>Ribavirin + Interferon:&nbsp;</strong>Genotype Ribavirin Daily Interferon alpha-2a Duration or interferon alpha-2b.</p>\r\n\r\n<ul>\r\n	<li><strong>All &lt;75 kg:&nbsp;</strong>(400+600) mg 3 MIU 3 times weekly 48 weeks Genotypes subcutaneously (Genotype1&amp;4)</li>\r\n	<li><strong>&gt;75 kg:&nbsp;</strong>(600+600) mg 24 weeks (Genotype2&amp;3)</li>\r\n</ul>\r\n\r\n<p><strong>Ribavirin + Peg-Interferon:&nbsp;</strong>Genotype Ribavirin Daily Peg-Interferon alpha-2a Duration or Peg-interferon alpha-2b:</p>\r\n\r\n<ul>\r\n	<li><strong>1 &amp; 4 &lt; 75 kg</strong>: (400+600) mg 180 gm once weekly 48 weeks</li>\r\n	<li><strong>&gt; 75 kg</strong>: (600+600) mg subcutaneously 2 &amp; 3 (400+400) mg 24 weeks</li>\r\n</ul>\r\n\r\n<p>Ribavirin may be administered without regard to food, but should be administered in a consistent manner. Drink plenty of water while being treated with this medication; drinking water will decrease the risk of serious side effects.</p>', '<p>Nucleoside reverse transcriptase inhibitors or reduce dose or discontinue interferon, ribavirin or both with worsening toxicities<br />\r\n<br />\r\nAzathioprine: Concomitant use of azathioprine with ribavirin has been reported to induce severe pancytopenia and may increase the risk of azathioprine-related myelotoxicity.</p>', '<p>Women who are pregnant. Ribavirin&nbsp;may cause fetal harm when administered to a pregnant woman. Ribavirin&nbsp;is contraindicated in women who are or may become pregnant. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus. Patients with hemoglobinopathies (e.g., thalassemia major or sickle-cell anemia). In combination with didanosine. Reports of fatal hepatic failure, as well as peripheral neuropathy, pancreatitis and symptomatic hyperlactatemia/lactic acidosis have been reported in clinical trials.</p>', '<p>The most common adverse reactions in adults receiving combination therapy are psychiatric and central nervous system effects, severe ocular disorder, dental and periodontal disorders &amp; growth inhibition in children and adolescents that may be irreversible in some patients. The most common adverse reactions in pediatric subjects were similar to those seen in adults.</p>', '<p><strong>Pregnancy&nbsp;</strong>Category X. Ribavirin produced significant embryocidal and/or teratogenic effects in all animal species in which adequate studies have been conducted. Malformations of the skull, palate, eye, jaw, limbs, skeleton and gastrointestinal tract were noted. The incidence and severity of teratogenic effects increased with escalation of the drug dose. Survival of fetuses and offspring was reduced.<br />\r\n<br />\r\n<strong>Nursing Mothers</strong>: It is not known whether Ribavirin is excreted in human milk. Because many drugs are excreted in human milk and to avoid any potential for serious adverse reactions in nursing infants from ribavirin, a decision should be made either to discontinue nursing or therapy with Ribavirin, based on the importance of the therapy to the mother.</p>', '<p><strong>Birth defects and fetal death with ribavirin</strong>: Do not use in pregnancy and for 6 months after treatment. Patients must have a negative pregnancy test prior to therapy, use at least 2 forms of contraception and undergo monthly pregnancy tests. For a male patient, it is very important for his female partner to avoid becoming pregnant during treatment and during the 7 months after treatment and do not have sex with a pregnant women.</p>', NULL, '<p>Hepatic viral infections (Hepatitis C)</p>', '<p>Keep out of the reach of children. Keep in a cool &amp; dry place. Protect from light.</p>', '<p><strong>Pediatric Use</strong>: Safety and effectiveness of Ribavirin in combination with Peginterferon has not been established in pediatric patients below the age of 3 years.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: The risk of toxic reactions to this drug may be greater in patients with impaired renal function. The dose of Ribavirin&nbsp;should be reduced in patients with creatinine clearance less than or equal to 50 ml/min; and the dose of Interferon should be reduced in patients with creatinine clearance less than 30 ml/min.</p>', '2022-03-18 03:48:00', '2022-03-18 03:48:00'),
(1282, 1282, '<p>To prevent and to treat deficiencies of vitamin B2 such as cheilosis, angular stomatitis, glossitis, keratitis, seborrhoeic dermatitis.</p>', '<p>Riboflavin or vitamin B2 is an easily absorbed, water-soluble micronutrient with a key role in maintaining human health. Like the other B vitamins, it supports energy production by aiding in the metabolising of fats, carbohydrates, and proteins. Vitamin B2 is also required for red blood cell formation and respiration, antibody production, and for regulating human growth and reproduction. It is essential for healthy skin, nails, hair growth and general good health, including regulating thyroid activity. Riboflavin also helps in the prevention or treatment of many types of eye disorders, including some cases of cataracts.<br />\r\n<br />\r\nBinds to riboflavin hydrogenase, riboflavin kinase, and riboflavin synthase. Riboflavin is the precursor of flavin mononucleotide (FMN, riboflavin monophosphate) and flavin adenine dinucleotide (FAD). The antioxidant activity of riboflavin is principally derived from its role as a precursor of FAD and the role of this cofactor in the production of the antioxidant reduced glutathione. Reduced glutathione is the cofactor of the selenium-containing glutathione peroxidases among other things. The glutathione peroxidases are major antioxidant enzymes. Reduced glutathione is generated by the FAD-containing enzyme glutathione reductase.</p>', '<p><strong>For treating low levels of riboflavin (riboflavin deficiency) in adults</strong>: 5-30 mg of riboflavin daily in divided doses.<br />\r\n<br />\r\n<strong>For preventing migraine headaches</strong>: 400 mg of riboflavin (Vitamin B2) per day. It may take up to three months to get best results.<br />\r\n<br />\r\n<strong>For preventing cataracts</strong>: approximately 2.6 mg of riboflavin (Vitamin B2)</p>', '<p>Drying medications (Anticholinergic drugs), Medications for depression (Tricyclic antidepressants), Phenobarbital, Probenecid.</p>', '<p>Hypersensitivity to Riboflavin.</p>', '<p>Riboflavin is likely safe for most people. In some people, Riboflavin can cause the urine to turn a yellow- orange color. When taken in high doses, Riboflavin might cause diarrhea, an increase in urine, and other side effects.</p>', '<p>Riboflavin is likely safe for pregnant or breastfeeding women when taken in the amounts recommended.</p>', '<p>Riboflavin is non-toxic. No warnings or precautions have been established .</p>', NULL, '<p>Vitamin-B preparations.</p>', '<p>Store at a cool and dry place. Protect from light.</p>', NULL, '2022-03-18 03:49:50', '2022-03-18 03:49:50'),
(1283, 1283, '<p>In the treatment of both&nbsp;tuberculosis&nbsp;and the meningococcal carrier state, the small number of resistant cells present within large populations of susceptible cells can rapidly become the predominant type. Bacteriologic cultures should be obtained before the start of therapy to confirm the susceptibility of the organism to&nbsp;rifampinand they should be repeated throughout therapy to monitor the response to treatment. Since resistance can emerge rapidly, susceptibility tests should be performed in the event of persistent positive cultures during the course of treatment. If test results show resistance to rifampin and the patient is not responding to therapy, the drug regimen should be modified.</p>', '<p>Rifampicin suppresses initiation of chain formation for RNA synthesis in susceptible bacteria by binding to the &beta; subunit of DNA-dependent RNA polymerase, thus blocking RNA transcription.</p>', '<p>Rifampin can be administered by the oral route or by IV infusion. IV doses are the same as those for oral.<br />\r\n<br />\r\nTuberculosis:</p>\r\n\r\n<ul>\r\n	<li><strong>Adults</strong>: 10 mg/kg, in a single daily administration, not to exceed 600 mg/day, oral or IV</li>\r\n	<li><strong>Pediatric Patients</strong>: 10&ndash;20 mg/kg, not to exceed 600 mg/day, oral or IV</li>\r\n</ul>\r\n\r\n<p>It is recommended that oral rifampin be administered once daily, either 1 hour before or 2 hours after a meal with a full glass of water.<br />\r\n<br />\r\nRifampin is indicated in the treatment of all forms of tuberculosis. A three-drug regimen consisting of rifampin, isoniazid, and pyrazinamide is recommended in the initial phase of shortcourse therapy which is usually continued for 2 months. The Advisory Council for the Elimination of Tuberculosis, the American Thoracic Society, and the&nbsp;Centers for Disease Control and Prevention&nbsp;recommend that either streptomycin or ethambutol be added as a fourth drug in a regimen containing isoniazid (INH), rifampin and pyrazinamide for initial treatment of tuberculosis unless the likelihood of INH resistance is very low. The need for a fourth drug should be reassessed when the results of susceptibility testing are known. If community rates of INH resistance are currently less than 4%, an initial treatment regimen with less than four drugs may be considered.<br />\r\n<br />\r\nFollowing the initial phase, treatment should be continued with rifampin and isoniazid for at least 4 months. Treatment should be continued for longer if the patient is still sputum or culture positive, if resistant organisms are present, or if the patient is HIV positive.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>Should be taken on an empty stomach. Best taken on an empty stomach 1 hr before or 2 hr after meals.</p>', '<p>May accelerate the metabolism and reduce the effect of drugs that are metabolised by CYP450 enzymes (e.g. quinidine, phenytoin, theophylline). Decreased concentrations of atovaquone and increased concentrations of rifampicin when taken concomitantly. Concurrent use of ketoconazole and rifampicin may result in decreased serum concentrations of both drugs. May decrease serum concentrations of enalaprilat. Reduced absorption by antacids. Increased risk of hepatotoxicity with halothane or isoniazid.</p>', '<p>Rifampicin is contraindicated in patients with a history of hypersensitivity to rifampin or any of the components, or to any of the rifamycins. Rifampin is contraindicated in patients who are also receiving ritonavir-boosted saquinavir due to an increased risk of severe hepatocellular toxicity.<br />\r\n<br />\r\nRifampin is contraindicated in patients who are also receiving atazanavir, darunavir, fosamprenavir, saquinavir, or tipranavir due to the potential of rifampin to substantially decrease plasma concentrations of these antiviral&nbsp;drugs, which may result in loss of antiviral efficacy and/or development of viral resistance.</p>', '<p>Facial flushing and itching, with or without a rash, flu-like syndrome characterised by episodes of fever, chills, headache, dizziness, bone pain, shortness of breath, and malaise; GI adverse effects (e.g. nausea, vomiting, anorexia, diarrhoea, epigastric distress), pseudomembranous colitis, eosinophilia, leucopenia, haemolytic anaemia; alterations in kidney function and renal failure, menstrual disturbances, oedema, myopathy, muscular weakness; orange-red discolouration of the urine, faeces, sweat, saliva, sputum, tears, and other body fluids; thrombophlebitis, local irritation and inflammation after prolonged IV infusion. Rarely, eye irritation and visual disturbances, anaphylaxis or shock.</p>', '<p><strong>Pregnancy</strong>: When administered during the last few weeks of pregnancy, rifampin can cause post natal hemorrhages in the mother and infant for which treatment with&nbsp;vitamin K&nbsp;may be indicated.<br />\r\n<br />\r\n<strong>Nursing Mothers</strong>: Because of the potential for tumorigenicity shown for rifampin in animal studies, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.</p>', '<p>Rifampicin has been shown to produce liver dysfunction. Fatalities associated with&nbsp;jaundice&nbsp;have occurred in patients with&nbsp;liver disease&nbsp;and in patients taking rifampin with other&nbsp;hepatotoxic&nbsp;agents. Patients with impaired liver function should be given rifampin only in cases of necessity and then with caution and under strict medical supervision. In these patients, careful monitoring of liver function, especially&nbsp;SGPT/ALT and SGOT/AST should be carried out prior to therapy and then every 2 to 4 weeks during therapy. If signs of hepatocellular damage occur, rifampin should be withdrawn.<br />\r\n<br />\r\nIn some cases, hyperbilirubinemia resulting from competition between rifampin and bilirubin for excretory pathways of the liver at the cell level can occur in the early days of treatment. An isolated report showing a moderate rise in bilirubin and/or transaminase level is not in itself an indication for interrupting treatment; rather, the decision should be made after repeating the tests, noting trends in the levels, and considering them in conjunction with the patient&#39;s clinical condition.<br />\r\n<br />\r\nRifampin has enzyme-inducing properties, including induction of delta amino levulinic acid synthetase. Isolated reports have associated&nbsp;porphyria&nbsp;exacerbation with rifampin administration.</p>', '<p>Nausea, vomiting, abdominal pain, pruritus, headache, and increasing lethargy&nbsp;will probably occur within a short time after ingestion; unconsciousness may occur when there is severe hepatic disease. Transient increases in liver enzymes and/or bilirubin may occur. Brownish-red or orange discoloration of the skin, urine, sweat, saliva, tears, and feces will occur, and its intensity is proportional to the amount ingested.<br />\r\n<br />\r\nLiver enlargement, possibly with tenderness, can develop within a few hours after severe overdosage; bilirubin levels may increase and&nbsp;jaundice&nbsp;may develop rapidly. Hepatic involvement may be more marked in patients with prior impairment of hepatic function. Other physical findings remain essentially normal. A direct effect upon the hematopoietic&nbsp;system,&nbsp;electrolyte&nbsp;levels, or&nbsp;acid-base balance&nbsp;is unlikely.<br />\r\n<br />\r\nFacial or periorbital edema has also been reported in pediatric patients. Hypotension, sinus tachycardia, ventricular arrhythmias, seizures and cardiac arrest were reported in some fatal cases.</p>', '<p>Anti-Tubercular Antibiotics.</p>', '<p>Store between 15-30&deg; C. Avoid excessive heat and protect from light.</p>', '<p><strong>Geriatric Use</strong>: Clinical studies of Rifampicin did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. Caution should therefore be observed in using rifampin in elderly patients.</p>', '2022-03-18 03:51:57', '2022-03-18 03:51:57'),
(1284, 1284, '<p>Rifampicin and Isoniazid belongs to a group of medicines called antituberculosis agents. It is a fixed combination of two very effective antituberculosis agents which stop the growth of mycobacteria. These mycobacteria cause tuberculosis. Rifampicin and Isoniazid is used for the continuation phase treatment of tuberculosis.</p>', '<p>Rifampicin and isoniazid are active bactericidal anti-TB drugs which are particularly active against the rapidly growing extracellular organisms and also have bactericidal activity intracellularly. Rifampicin inhibits DNA-dependent RNA polymerase activity in susceptible cells. Specifically, it interacts with bacterial RNA polymerase but does not inhibit the mammalian enzyme. Cross-resistance to rifampicin has only been shown with other rifamycins. It has activity against slow-and intermittently-growing M. tuberculosis. Isoniazid acts against actively growing tubercle bacilli.</p>', '<p><strong>Body weight &lt;50 kg</strong>: 3 tablet of 150/100 once daily or 1 tablet of 450/300 once daily<br />\r\n<strong>Body weight &gt;50 kg</strong>: 2 tablet of 300/150 once daily.<br />\r\n<strong>Hepatic impairment</strong>: Max: 8 mg/kg daily.</p>', '<p>May reduce effectivity of hormonal contraceptives. Reduced absorption with antacids. May decrease plasma concentrations of antivirals (e.g. atazanavir, darunavir, fosamprenavir), atovaquone with rifampicin. Rifampicin may reduce serum levels of anticonvulsants (e.g. phenytoin), antiarrhythmics (e.g. disopyramide), oral anticoagulants, antifungals (e.g. ketoconazole), barbiturates, ?-blockers, Ca channel blockers (e.g. diltiazem), chloramphenicol, clarithromycin, corticosteroids, ciclosporin, cardiac glycosides, clofibrate, dapsone, diazepam, doxycycline, fluoroquinolones (e.g. ciprofloxacin), haloperidol, oral hypoglycemic agents (sulfonylureas), levothyroxine, methadone, narcotic analgesics, progestins, quinine, tacrolimus, theophylline, TCAs (e.g. amitriptyline, nortriptyline) and zidovudine. Increased risk of hepatotoxicity with halothane.<br />\r\n<br />\r\nIsoniazid may inhibit the metabolism of anticonvulsants (e.g. carbamazepine, phenytoin), benzodiazepines (e.g. diazepam), haloperidol, ketoconazole, theophylline, and warfarin. May enhance the CNS effects of meperidine, cycloserine, and disulfiram with isoniazid. Loss of glucose control in patients on oral hypoglycaemics with isoniazid.</p>', '<p>Known or suspected hypersensitivity to rifamycins and/or to INH, and/or to any of the excipients including a history of drug-induced hepatitis; acute liver diseases, regardless of their origin; peripheral neuritis.</p>', '<p>Unwanted effects which may occur during continuous daily or intermittent therapy: Rifampicin: Rifampicin may cause reddish discolouration of body fluids and occasionally other body secretions eg, urine, sputum, lacrimal fluid, faeces, saliva and sweat. It may permanently discolour soft contact lenses.<br />\r\n<br />\r\n<strong>Hepatic Effects</strong>: Very common (&gt;10%) is an asymptomatic increase in liver enzymes; severe life-threatening hepatic reactions eg, hepatic failure and acute fulminant hepatitis are uncommon (&gt;0.1% and &lt;1%). In isolated cases (&lt;0.01 %), a fatal outcome was observed.<br />\r\n<br />\r\n<strong>Renal Effects</strong>: Elevations of BUN and serum uric acid, haemolysis, haematuria, interstitial nephritis, renal insufficiency. Gastrointestinal Effects: Nausea, abdominal pains, vomiting or diarrhoea, pseudomembranous colitis.<br />\r\n<br />\r\n<strong>Central and Peripheral Nervous System Effects</strong>: Tiredness, drowsiness, headache, dizziness, ataxia, mental confusion, muscular weakness, visual disturbances. Haematological Changes: Leucopenia, eosinophilia, thrombocytopenia and thrombocytopenic purpura. Effects on Skin and Appendages: Flushing, itching with or without skin rash, urticaria, reddening of the eyes, exudative conjunctivitis or generalised hypersensitivity reactions involving the skin eg, exfoliative dermatitis, Lyell&#39;s syndrome and pemphigoid reactions. Endocrine Effects: Disturbances in the menstrual cycle, induction of crisis in Addison patients. Unwanted effects chiefly occurring during intermittent therapy or upon resumption of treatment after temporary interruption</p>', '<p>Pregnancy Category C. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.</p>', '<p>Use of isoniazid should be carefully monitored in the following:</p>\r\n\r\n<ul>\r\n	<li>Daily users of alcohol. Daily ingestion of alcohol may be associated with a higher incidence of isoniazid hepatitis.</li>\r\n	<li>Patients with active chronic liver disease or severe renal dysfunction.</li>\r\n	<li>Age &gt;35.</li>\r\n	<li>Concurrent use of any chronically administered medication.</li>\r\n	<li>History of previous discontinuation of isoniazid.</li>\r\n	<li>Existence of peripheral neuropathy or conditions predisposing to neuropathy. Pregnancy.</li>\r\n	<li>Injection drug use.</li>\r\n	<li>Women belonging to minority groups, particularly in the post-partum period.</li>\r\n	<li>HIV seropositive patients.</li>\r\n</ul>', NULL, '<p>Combined anti- Tubercular Preparations</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-18 03:53:39', '2022-03-18 03:53:39');
INSERT INTO `generic_details` (`id`, `generic_id`, `indications`, `pharmacology`, `dosage_and_administration`, `interaction`, `contraindications`, `side_effects`, `pregnancy_and_lactation`, `precautions_and_warnings`, `overdose_effects`, `therapeutic_class`, `storage_conditions`, `use_in_special_populations`, `created_at`, `updated_at`) VALUES
(1285, 1285, '<p>Rifampin, isoniazid, and pyrazinamide is indicated in the initial phase of the short-course treatment of pulmonary tuberculosis. During this phase, which should last 2 months, this drug should be administered on a daily, continuous basis.&nbsp;<br />\r\n&nbsp;<br />\r\nFollowing the initial phase and treatment with this drug, treatment should be continued with rifampin and isoniazid for at least 4 months. Treatment should be continued for a longer period of time if the patient is still sputum or culture positive, if resistant organisms are present, or if the patient is HIV positive.<br />\r\n<br />\r\nIn the treatment of tuberculosis, the small number of resistant cells present within large populations of susceptible cells can rapidly become the predominant type. Since resistance can emerge rapidly, susceptibility tests should be performed in the event of persistent positive cultures during the course of treatment. Bacteriologic smears or cultures should be obtained before the start of therapy to confirm the susceptibility of the organism to rifampin, isoniazid, and pyrazinamide and they should be repeated throughout therapy to monitor response to the treatment. If test results show resistance to any of the components of this drug and the patient is not responding to therapy, the drug regimen should be modified.</p>', '<p>Rifampicin, isoniazid and pyrazinamide are all active bactericidal antituberculosis drugs. Rifampicin and isoniazid are particularly active against the rapidly growing extracellular organisms and have an intracellular bactericidal activity. Rifampicin also inhibits DNA-dependent RNA polymerase activity in susceptible cells and it has activity against slow and intermittently-growing M tuberculosis. Pyrazinamide, particularly in the acid pH environment of macrophages is active against intracellular organisms. Combination of these agents covers activity against the 3 different bacterial populations.</p>', '<p>Total Dosage Requirement:</p>\r\n\r\n<ul>\r\n	<li><strong>Rifampicin</strong>: 10 (8-12) mg/kg body mass/day.</li>\r\n	<li><strong>Isoniazid</strong>: 5 (4-6) mg/kg body mass/day.</li>\r\n	<li><strong>Pyrazinamide</strong>: 25 (20-30) mg/kg body mass/day.</li>\r\n</ul>\r\n\r\n<p><strong>Pediatric Patients:&nbsp;</strong>The ratio of the drugs may not be appropriate in pediatric patients under the age of 15 (e.g., higher mg/kg doses of isoniazid are usually given in pediatric patients than adults).<br />\r\n<br />\r\nThe tablets should be given as a single dose, preferably on an empty stomach, at least 30 min before breakfast to ensure a high peak serum concentration.<br />\r\n<br />\r\nTablets are recommended in the initial intensive phase of the short course treatment of tuberculosis. During this phase which lasts for 2 months</p>', '<p>Rifampicin may reduce effectivity of hormonal contraceptives, ACE inhibitors (e.g. enalapril, imidapril), antiemetics (e.g. aprepitant), antineoplastics (e.g. imatinib), diuretics (e.g. eplerenone), drugs for erectile dysfunction (e.g. tadalafil), oral hypoglycaemics (e.g. nateglinide, repaglinide), NSAIDs (e.g. etoricoxib). Rifampicin may reduce serum levels of atovaquone, ketoconazole. Antacids may reduce absorption of rifampicin. Anaesthetics and halothane may increase risk for hepatotoxicity with rifampicin and isoniazid.<br />\r\n<br />\r\nIsoniazid may increase serum levels of phenytoin and theophylline; and may decrease carbamazepine metabolism. Stavudine may increase risk of distal sensory neuropathy with isoniazid. Antacids may reduce isoniazid absorption. May increase plasma levels of isoniazid with para-aminosalicylic acid. Increased risk of CNS toxicity when isoniazid is used concomitantly with cycloserine.<br />\r\n<br />\r\nPyrazinamide antagonizes the effects of probenecid and sulfinpyrazone.<br />\r\n<br />\r\nPotentially Fatal: Concominant use with saquinavir/ritonavir may increase risk of severe hepatotoxicity. May reduce antiviral efficacy of atazanavir, darunavir, fosamprenavir, saquinavir, or tipranavir.</p>', '<p>Known or suspected hypersensitivity to rifamycins and/or to isoniazid and to pyrazinamide and/or to any of the excipients including a history of drug-induced hepatitis, acute liver diseases regardless of their origin, and peripheral neuritis.</p>', '<p><strong>Unwanted effects which may occur during continuous daily or intermittent therapy</strong>: Rifampicin: Rifampicin may cause reddish discolouration of body fluids and occasionally other body secretions eg, urine, sputum, lacrimal fluid, faeces, saliva and sweat. It may permanently discolour soft contact lenses.<br />\r\n<br />\r\n<strong>Hepatic Effects</strong>: Very common (&gt;10%) is an asymptomatic increase in liver enzymes; severe life-threatening hepatic reactions eg, hepatic failure and acute fulminant hepatitis are uncommon (&gt;0.1% and &lt;1%). In isolated cases (&lt;0.01 %), a fatal outcome was observed.<br />\r\n<br />\r\n<strong>Renal Effects:</strong>&nbsp;Elevations of BUN and serum uric acid, haemolysis, haematuria, interstitial nephritis, renal insufficiency.<br />\r\n<br />\r\n<strong>Gastrointestinal Effects</strong>: Nausea, abdominal pains, vomiting or diarrhoea, pseudomembranous colitis.<br />\r\n<br />\r\n<strong>Central and Peripheral Nervous System Effects:</strong>&nbsp;Tiredness, drowsiness, headache, dizziness, ataxia, mental confusion, muscular weakness, visual disturbances.<br />\r\n<br />\r\n<strong>Haematological Changes:</strong>&nbsp;Leucopenia, eosinophilia, thrombocytopenia and thrombocytopenic purpura.<br />\r\n<br />\r\n<strong>Effects on Skin and Appendages:</strong>&nbsp;Flushing, itching with or without skin rash, urticaria, reddening of the eyes, exudative conjunctivitis or generalised hypersensitivity reactions involving the skin eg, exfoliative dermatitis, Lyell&#39;s syndrome and pemphigoid reactions.<br />\r\n<br />\r\n<strong>Endocrine Effects:</strong>&nbsp;Disturbances in the menstrual cycle, induction of crisis in Addison patients.<br />\r\n<br />\r\nUnwanted effects chiefly occurring during intermittent therapy or upon resumption of treatment after temporary interruption</p>', '<p>Pregnancy Category C. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks</p>', '<p>Caution is advised in patients with impaired renal or liver function, diabetes mellitus, chronic alcoholism and undernourished patients, patients with a history of gout and patients suffering from convulsive disorders and acute porphyria. Precautions need to be taken: Blood counts and liver function tests (SGPT, SGOT) should be performed periodically (especially in prolonged treatment) and at baseline, if possible.<br />\r\n<br />\r\nPatients with current chronic liver disease or impaired liver function should be treated with caution and under strict medical supervision. Careful monitoring of liver function should be carried out and attention should be paid to possible prodromal symptoms of hepatitis eg, fatigue, weakness, malaise, anorexia, nausea or vomiting. If these symptoms appear or if signs suggestive of hepatic damage are detected, treatment should be discontinued promptly. The occurrence of severe and sometimes fatal hepatitis associated may develop even after many months of treatment.</p>', NULL, '<p>Combined anti- Tubercular Preparations.</p>', '<p>Should be stored in cool and dry place.</p>', NULL, '2022-03-18 04:09:00', '2022-03-18 04:09:00'),
(1286, 1286, '<p>Treatment of both pulmonary and extrapulmonary tuberculosis in the intensive initial phase of treatment.</p>', '<p><strong>Rifampicin:</strong>&nbsp;It is a semisynthetic derivative of rifamycin, suppresses bacterial RNA synthesis by binding to the &beta;-subunit of DNA-dependent RNA polymerase, thus inhibiting the attachment of the enzyme to DNA, blocking RNA transcription and elongation. It does not inhibit the counterpart mammalian enzyme.<br />\r\nRifampicin has a bactericidal action and a potent sterilizing effect against both intracellular and extracellular tubercle bacilli. Cross-resistance has been shown only with other rifamycin derivatives.<br />\r\n<br />\r\n<strong>Isoniazid:</strong>&nbsp;It kills actively growing tubercle bacilli by inhibiting the biosynthesis of mycolic acids, which are the major components of the bacterial cell wall of Mycobacterium tuberculosis.<br />\r\n<br />\r\n<strong>Pyrazinamide:</strong>&nbsp;Pyrazinamide, an antituberculous drug, is the pyrazine analog of nicotinamide. The precise mechanism of action of pyrazinamide is not known. Its metabolite, pyrazinoic acid, which is less active in vitro may possibly be involved in the in vivo activity of pyrazinamide.<br />\r\n<br />\r\n<strong>Ethambutol:</strong>&nbsp;Ethambutol diffuses slowly into actively growing Mycobacteria cells eg, tubercle bacilli. It inhibits the synthesis of 1 or more metabolites, thus causing impaired cell metabolism, arrest cell multiplication and induce cell death. No cross-resistance with other agents has been demonstrated.<br />\r\n<br />\r\n<strong>Spectrum of Activity:</strong>&nbsp;Rifampicin, isoniazid, pyrazinamide, and ethambutol, at therapeutic levels, have demonstrated bactericidal activity against both intracellular and extracellular Mycobacterium tuberculosis organism.</p>', '<p><strong>Adults:</strong>&nbsp;3 tablets/day for an average body weight of 50 kg.<br />\r\n<br />\r\nPatients weighing-&nbsp;</p>\r\n\r\n<ul>\r\n	<li><strong>&gt;70 kg</strong>: 5 tablets</li>\r\n	<li><strong>55-70 kg</strong>: 4 tablets</li>\r\n	<li><strong>38-54 kg</strong>: 3 tablets</li>\r\n	<li><strong>30-37 kg</strong>: 2 tablets</li>\r\n</ul>\r\n\r\n<p>All doses to be taken once daily for 2 months on intensive phase.</p>', '<p><strong>Rifampicin:</strong>&nbsp;Induces microsomal enzymes (accelerates clearance of methadone, oral anticoagulants, glucocorticoids, oestrogen, oral hypoglycaemic agents, digitoxin, antiarrhythmics, theophylline, anticonvulsants, azole antifungal, cyclosporin).<br />\r\n<br />\r\n<strong>Isoniazid:</strong>&nbsp;Inhibits metabolism of antiepileptics, benzodiazepines, warfarin, theophylline. Increases metabolism of enflurane. Alcohol, ASA, Al-containing antacids, corticosteroids, ketoconazole, propranolol.<br />\r\n<br />\r\n<strong>Pyrazinamide:</strong>&nbsp;Decreases efficacy of gout therapy agents.<br />\r\n<br />\r\n<strong>Ethambutol:</strong>&nbsp;Neurotoxic agents.</p>', '<p>Hypersensitivity to rifampicin, isoniazid, pyrazinamide or ethambutol.<br />\r\n<br />\r\n<strong>Isoniazid</strong>: Previous isoniazid-associated hepatic injury; severe adverse reactions to isoniazid eg, fever, chills and arthritis; acute liver disease of any etiology, a history of previous hypersensitivity reaction to isoniazid including drug-induced hepatitis.</p>', '<p><strong>Rifampicin:</strong>&nbsp;Reddish discolouration of body fluids, asymptomatic increase in liver enzymes, elevations of BUN &amp; uric acid, hemolysis, hematuria, intestinal nephritis, renal insufficiency, Gl discomfort, CNS effects, hematological changes, skin rash, endocrine effects.<br />\r\n<br />\r\n<strong>Isoniazid:</strong>&nbsp;Disturbances of liver function, hepatitis, Gl disturbances, peripheral neuropathy, dizziness, lightheadedness, hematological changes, allergic reactions.<br />\r\n<br />\r\n<strong>Pyrazinamide:</strong>&nbsp;Transient rise in serum transaminases, hepatotoxicity, hepatomegaly, jaundice, hyperuricemia, intestinal nephritis, dysuria, Gl disturbances, hematological changes, allergic reactions.<br />\r\n<br />\r\n<strong>Ethambutol:</strong>&nbsp;Confusion, disorientation, headache, visual disturbances, jaundice, transient liver dysfunction, Gl disturbances, hematological changes, allergic effects, acute gout (rare).</p>', '<p><strong>Rifampicin:</strong>&nbsp;Since rifampicin has been reported to cross the placental barrier and appear in cord blood and in maternal milk, neonates and newborns of rifampicin-treated mothers should be carefully observed for any evidence of untoward effects.<br />\r\n<br />\r\n<strong>Ethambutol:</strong>&nbsp;While administration of ethambutol to pregnant human patients has produced no detectable effect upon the fetus, the possible teratogenic potential in women capable of bearing children would be weighed carefully against the benefits of therapy. There are published reports of 5 women who received ethambutol during pregnancy without apparent adverse effect upon the fetus.</p>', '<p>Impaired renal or liver function, DM, chronic alcoholism, undernourishment, history of gout, patients with convulsive disorders, acute porphyria. Elderly. Pregnancy &amp; lactation. Perform periodic blood counts &amp; liver function tests. Avoid use with soft contact lenses.<br />\r\n<br />\r\nChildren &lt;8 year or patients who are not able to communicate visual disturbances. Check visual ability before starting treatment &amp; monitor during treatment.</p>', NULL, '<p>Combined anti- Tubercular Preparations.</p>', '<p>Store at temperatures not exceeding 30&deg;C.</p>', '<p><strong>Use in children:</strong>&nbsp;Ethambutol is not recommended for use in children &lt;13 years since safe conditions for use have not been established.</p>', '2022-03-18 04:12:10', '2022-03-18 04:12:10'),
(1287, 1287, '<p>Rifaximin is indicaed in-</p>\r\n\r\n<ul>\r\n	<li>Treatment of traveler&#39;s diarrhea by noninvasive strains of E. coli</li>\r\n	<li>reduction in risk of overt hepatic encephalopathy</li>\r\n	<li>bacterial overgrowth of irritable bowel syndrome.</li>\r\n</ul>', '<p>Rifaximin is a semisynthetic, rifamycin-based non-systemic antibiotic. Very little of the drug will pass the gastrointestinal wall into the circulation as is common for other types of orally administered antibiotics. Rifaximin inhibits bacterial RNA synthesis by its action on the beta-subunit of the DNA-dependent RNA polymerase. It shows the same broad spectrum activity as rifamycin which exerts bactericidal action against many species of Gram-positive and Gram-negative, aerobic and anaerobic bacteria.</p>', '<p><strong>Traveler&#39;s Diarrhea</strong>: For patients &ge;12 years of age: 200 mg 3 times daily for 3 days.<br />\r\n<strong>Hepatic Encephalopathy:&nbsp;</strong>For patients &ge;18 years of age: 550 mg 2 times daily.<br />\r\n<strong>Bacterial overgrowth of irritable bowel syndrome</strong>: 400 mg 3 times daily for 10 days or 550 mg 3 times daily for 14 days. Can be taken with or without food.</p>', '<p>In an in vitro study has suggested that Rifaximin induces CYP3A4. However, in patients with normal liver function, Rifaximin at the recommended dosing regimen is not expected to induce CYP3A4.</p>', '<p>Contraindicated in patients with a hypersensitivity to Rifaximin or to any of the rifamycin antimicrobial agents, or any components of this product.</p>', '<p>Side effects include flatulence, headache, abdominal pain, rectal tenesmus, defecation urgency, nausea, constipation, pyrexia, vomiting. Reactions have been reported, including anaphylaxis, angioneurotic edema, and exfoliative dermatitis.</p>', '<p>Pregnancy category C. It is not known whether Rifaximin is excreted in human milk or not.</p>', '<p>Rifaximin is not found to be effective in patients with diarrhea complicated by fever and/or blood in the stools. Rifaximin therapy should be discontinued if diarrhea symptoms get worse or persist for more than 24-48 hours and alternative antibiotic therapy should be considered. Pseudomembranous colitis has been reported with nearly all antibacterial agents and may range in severity from mild to life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea subsequent to the administration of antibacterial agents.</p>', '<p>No specific information is available on the treatment of over dosage with Rifaximin. In case of over dosage, discontinue Rifaximin, treat symptomatically and institute supportive measures as required.</p>', '<p>4-Quinolone preparations.</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', '<p><strong>Renal Impairment</strong>: The pharmacokinetics of Rifaximin in patients with impaired renal function has not been studied.<br />\r\n<strong>Hepatic Impairment</strong>: The systemic exposure of Rifaximin was markedly elevated in patients with hepatic impairment compared to healthy subjects.</p>', '2022-03-18 04:14:54', '2022-03-18 04:14:54'),
(1288, 1288, '<p>Riluzole is indicated for the treatment of amyotrophic lateral sclerosis (ALS).</p>', '<p>The mode of action of riluzole is unknown. Its pharmacological properties include the following, some of which may be related to its effect:</p>\r\n\r\n<ul>\r\n	<li>An inhibitory effect on glutamate release (activation of glutamate reuptake),</li>\r\n	<li>Inactivation of voltage-dependent sodium channels,&nbsp;</li>\r\n	<li>Ability to interfere with intracellular events that follow transmitter binding at excitatory amino acid receptors.</li>\r\n</ul>', '<p>The recommended dosage for Riluzole is 50 mg taken orally twice daily. Riluzole should be taken at least 1 hour before or 2 hours after a meal.&nbsp;Measure serum aminotransferases before and during treatment with Riluzole.</p>', '<p><strong>Strong to moderate CYP1A2 inhibitors</strong>: Coadministration may increase Riluzole-associated adverse reactions<br />\r\n<br />\r\n<strong>Strong to moderate CYP1A2 inducers</strong>: Coadministration may result in decreased efficacy&nbsp;<br />\r\n<br />\r\n<strong>Hepatotoxic drugs</strong>: Riluzole-treated patients that take other hepatotoxic drugs may be at increased risk for hepatotoxicity.</p>', '<p>Riluzole is contraindicated in patients with a history of severe hypersensitivity reactions to riluzole or to any of its components (anaphylaxis has occurred).</p>', '<p>The following adverse reactions are described below and elsewhere in the labeling: Hepatic Injury, Neutropenia, Interstitial lung disease.</p>', '<p><strong>Pregnancy</strong>: Based on animal data, may cause fetal harm<br />\r\n<br />\r\n<strong>Lactation</strong>: It is not known if riluzole is excreted in human milk. Riluzole or its metabolites have been detected in milk of lactating rat. Women should be advised that many drugs are excreted in human milk and that the potential for serious adverse reactions in nursing infants from Riluzole is unknown.</p>', '<p><strong>Hepatic Injury</strong>: Cases of drug-induced liver injury, some of which were fatal, have been reported in patients taking Riluzole. Asymptomatic elevations of hepatic transaminases have also been reported, and in some patients have recurred upon rechallenge with Riluzole.<br />\r\n<br />\r\nIn clinical studies, the incidence of elevations in hepatic transaminases was greater in Riluzoletreated patients than&nbsp;placebo-treated patients. The incidence of elevations of ALT above 5 times the upper limit of normal (ULN) was 2% in Riluzole-treated patients. Maximum increases in ALT occurred within 3 months after starting Riluzole. About 50% and 8% of Riluzoletreated patients in pooled Studies 1 and 2, had at least one elevated ALT level above ULN and above 3 times ULN, respectively&nbsp;<br />\r\n<br />\r\nMonitor patients for signs and symptoms of hepatic injury, every month for the first 3 months of treatment, and periodically thereafter. The use of Riluzole is not recommended if patients develop hepatic transaminases levels greater than 5 times the ULN. Discontinue Riluzole if there is evidence of liver dysfunction (e.g., elevated bilirubin).<br />\r\n<br />\r\n<strong>Neutropenia</strong>: Cases of severe neutropenia (absolute neutrophil count less than 500 per mm3) within the first 2 months of Riluzole treatment have been reported. Advise patients to report febrile illnesses.<br />\r\n<br />\r\n<strong>Interstitial Lung Disease</strong>: Interstitial lung disease, including hypersensitivity pneumonitis, has occurred in patients taking Riluzole. Discontinue Riluzole immediately if interstitial lung disease develops.</p>', '<p>Reported symptoms of overdose following ingestion of Riluzole ranging from 1.5 to 3 grams (30 to 60 times the recommended dose) included acute toxic encephalopathy, coma, drowsiness, memory loss, and methemoglobinemia. No specific antidote for the treatment of Riluzole overdose is available.</p>', '<p>Neurodegenerative Disease Drugs / Neuromuscular Disorder Drugs.</p>', '<p>Store at controlled room temperature, 20&deg;C to 25&deg;C, and protect from bright light.</p>', NULL, '2022-03-18 04:17:13', '2022-03-18 04:17:13'),
(1289, 1289, '<p>Rimexolone ophthalmic suspension is indicated for the treatment of postoperative inflammation following ocular surgery and in the treatment of anterior uveitis.</p>', '<p>Rimexolone is a glucocorticoid receptor agonist. The antiinflammatory actions of corticosteroids are thought to involve lipocortins, phospholipase A2 inhibitory proteins which, through inhibition of arachidonic acid, control the biosynthesis of prostaglandins and leukotrienes. By binding to the glucocorticoid receptor, this drug ultimately leads to changes in genetic transcription involving the lipocortins and prostaglandins.</p>', '<p><strong>Post-Operative Inflammation</strong>: Apply one to two drops of Rimexolone&nbsp;1% Ophthalmic Suspension into the&nbsp;conjunctivalsac of the affected eye four times daily beginning 24 hours after surgery and continuing throughout the first 2 weeks of the postoperative period.<br />\r\n<br />\r\n<strong>Anterior Uveitis</strong>: Apply one to two drops of Rimexolone&nbsp;1% Ophthalmic Suspension into the conjunctival sac of the affected eye every hour during waking hours for the first week, one drop every two hours during waking hours of the second week, and then taper until uveitis is resolved.</p>', '<p>No information provided</p>', '<p>Rimexolone 1% (rimexolone ophthalmic suspension) is contraindicated in epithelial herpes simplex keratitis (dendritic keratitis), vaccinia,&nbsp;varicella, and most other viral diseases of the cornea and conjunctiva; mycobacterial infection of the eye;&nbsp;fungal&nbsp;diseases of the eye; acute purulent untreated infections which, like other diseases caused by microorganisms, may be masked or enhanced by the presence of the&nbsp;steroid; and in those persons with hypersensitivity to any component of the formulation.</p>', '<p>Reactions associated with ophthalmic steroids include elevated&nbsp;intraocular pressure, which may be associated with optic nerve damage, visual acuity and field defects, posterior subcapsular cataract formation, secondary ocular infection from pathogens including herpes simplex, and perforation of the globe where there is thinning of the&nbsp;cornea&nbsp;or&nbsp;sclera.<br />\r\n<br />\r\nOcular adverse reactions occurring in 1 - 5% of patients in clinical studies of Rimexolone&nbsp;1% (rimexolone ophthalmic suspension) included&nbsp;blurred vision, discharge, discomfort, ocular pain, increased intraocular pressure, foreign body sensation, hyperemia and&nbsp;pruritus.<br />\r\n<br />\r\nOther ocular adverse reactions occurring in less than 1% of patients included sticky sensation, increased&nbsp;fibrin, dry eye, conjunctival edema, corneal staining,&nbsp;keratitis, tearing,&nbsp;photophobia, edema, irritation, corneal ulcer, browache, lid margin crusting, corneal edema,&nbsp;infiltrate, and corneal erosion.<br />\r\n<br />\r\nNon-ocular adverse reactions occurred in less than 2% of patients. These included headache, hypotension, rhinitis, pharyngitis, and taste perversion.</p>', '<p><strong>Pregnancy</strong>&nbsp;Category C. Rimexolone has been shown to be&nbsp;teratogenic&nbsp;and embryotoxic in rabbits following subcutaneous administration at the lowest dose tested (0.5 mg/kg/day, approximately 2 times the recommended human ophthalmic dose). Corticosteroids are recognized to cause fetal resorptions and malformations in animals. There are no adequate and well-controlled studies in&nbsp;pregnant&nbsp;women. Rimexolone 1% (rimexolone ophthalmic suspension) should be used in pregnant women only if the potential benefit to the mother justifies the potential risk to the&nbsp;fetus.<br />\r\n<br />\r\n<strong>Nursing Mothers</strong>: It is not known whether topical ophthalmic administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in human breast milk. Nevertheless, caution should be exercised when topical corticosteroids are administered to a nursing woman; a decision should be made whether to discontinue nursing or discontinue therapy, taking into consideration the importance of the drug to the mother.</p>', '<p>Fungal infections of the cornea are particularly prone to develop coincidentally with long-term local steroid application. Fungal invasion must be considered in any persistent corneal ulceration where a steroid has been or is in use.<br />\r\n<br />\r\nFor ophthalmic use only. Use of the same bottle for both eyes is not recommended with topical eye drops that are used in association with&nbsp;surgery.<br />\r\n<br />\r\nThe initial&nbsp;prescription&nbsp;and renewal of the medication order beyond 14 days should be made by a physician only after examination of the patient with the aid of magnification, such as slit lamp biomicroscopy and where appropriate, fluorescein staining. If signs and symptoms fail to improve after two days, the patient should be reevaluated. If this product is used for 10 days or longer,intraocular&nbsp;pressure should be monitored even though it may be difficult in children and uncooperative patients</p>', NULL, '<p>Ophthalmic Steroid preparations.</p>', '<p>Store upright between 2-25&deg; C. Do not freeze. Shake well before use.</p>', '<p><strong>Pediatric Use</strong>: Safety and effectiveness in pediatric patients have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: No overall differences in safety or effectiveness have been observed between elderly and younger patients.</p>', '2022-03-18 04:20:00', '2022-03-18 04:20:00'),
(1290, 1290, '<p>Ringer&#39;s lactate solution is indicated for diarrhea, dehydration, water and electrolytes imbalance, alkalinizing agent, diabetic coma, cholera. This solution is very often used for fluid resuscitation after a&nbsp;blood loss&nbsp;due to&nbsp;trauma,&nbsp;surgery, or a&nbsp;burn injury. Ringer&#39;s lactate solution is used because the by-products of lactate metabolism in the liver counteract&nbsp;acidosis, which is a chemical imbalance that occurs with acute fluid loss or renal failure.</p>', '<p>Lactated Ringer&#39;s solution contains isotonic concentrations of electrolytes in water for inj. It is used for parenteral replacement of extracellular losses of fluid and electrolytes.&nbsp;Lactated Ringer&rsquo;s Injection, produces a metabolic alkalinizing effect. Lactate ions are metabolized ultimately to carbon dioxide and water, which requires the consumption of hydrogen cations.<br />\r\n<br />\r\n<strong>Calcium chloride</strong>&nbsp;is used to prevent or treat negative calcium balance. It also regulates action potential excitation threshold to facilitate nerve and muscle performance.<br />\r\n<br />\r\n<strong>Potassium chloride</strong>&nbsp;is a major cation of the intracellular fluid. It plays an active role in the conduction of nerve impulses in the heart, brain and skeletal muscle; contraction of cardiac skeletal and smooth muscles; maintenance of normal renal function, acid-base balance, carbohydrate metabolism and gastric secretion.<br />\r\n<br />\r\n<strong>Sodium chloride</strong>&nbsp;is the major extracellular cation. It is important in electrolyte and fluid balance, osmotic pressure control and water distribution as it restores sodium ions. It is used as a source of electrolytes and water for hydration, treatment of metabolic acidosis, priming solution in haemodialysis and treatment of hyperosmolar diabetes. It is also used as diluents for infusion of compatible drug additives.</p>', '<p>The IV dose of Ringer&#39;s lactate solution is usually calculated by estimated fluid loss and presumed fluid deficit. For fluid resuscitation the usual rate of administration is 20 to 30 ml/kg body weight/hour. RL is not suitable for maintenance therapy (i.e., maintenance fluids) because the sodium content (130 mEq/L) is considered too low, particularly for children, and the potassium content (4 mEq/L) is too low, in view of electrolyte daily requirement. Moreover, since the lactate is converted into bicarbonate, longterm use will cause patients to become&nbsp;alkalotic. Ringer&#39;s lactate and other crystalloids are also used as vehicles for the IV delivery of drugs.<br />\r\n<br />\r\nIn a large-volume resuscitation over several hours, LRS maintains a more stable blood pH than normal saline.</p>', '<p>There are no known drug interactions and none well documented.</p>', '<p>Hypersensitivity.</p>', '<p>Reactions which may occur because of the solution or the technique of administration include febrile response, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, extravasation, and hypervolemia.</p>', '<p><strong>Pregnancy</strong>&nbsp;Category C. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks<br />\r\n<br />\r\n<strong>Nursing Mothers</strong>: It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when 5% Dextrose in Lactated Ringer&rsquo;s Injection is administered to a nursing woman.</p>', '<p>IV infusion is obsolete in metabolic acidosis and carries the risk of producing lactic acidosis, particularly in seriously ill patients with poor tissue perfusion and on impaired hepatic function.</p>', NULL, '<p>Intravenous fluid preparations.</p>', NULL, NULL, '2022-03-18 04:21:38', '2022-03-18 04:21:38'),
(1291, 1291, '<p>This is in a group of medicines called bisphosphonates. It alters the cycle of bone formation and breakdown in the body. It slows bone loss while increasing bone mass, which may prevent bone fractures. Risedronate is a prescription medicine used:</p>\r\n\r\n<ul>\r\n	<li>To prevent and treat osteoporosis in postmenopausal women.</li>\r\n	<li>To increase bone mass in men with osteoporosis.</li>\r\n	<li>To prevent and treat osteoporosis in men and women that is caused by treatment with steroid medicines such as prednisone.</li>\r\n	<li>To treat Paget&rsquo;s disease of bone in men and women.</li>\r\n</ul>', '<p>Risedronate has an affinity for hydroxyapatite crystals in bone and acts as an antiresorptive agent. At the cellular level, Risedronat inhibits osteoclasts. The osteoclasts adhere normally to the bone surface, but show evidence of reduced active resorption.</p>', '<p><strong>Treatment of postmenopausal osteoporosis, to reduce the risk of vertebral fractures. Treatment of&nbsp;established postmenopausal osteoporosis, to reduce the risk of hip fractures</strong>: The recommended&nbsp;dose is Risedronate Sodium 5 mg once daily or Risedronate Sodium 35 mg once weekly on the same day each week or Risedronate Sodium 150 mg once monthly.&nbsp;<br />\r\n<br />\r\n<strong>Prevention of osteoporosis in postmenopausal women with increased risk of osteoporosis</strong>: The&nbsp;recommended dose is Risedronate Sodium 5 mg once daily.&nbsp;<br />\r\n<br />\r\n<strong>To maintain or increase bone mass in postmenopausal women undergoing long-term (more than&nbsp;3 months):&nbsp;</strong>Systemic corticosteroid treatment at doses 7.5 mg/day prednisone or equivalent. The&nbsp;recommended dose is Risedronate Sodium 5 mg once daily.&nbsp;<br />\r\n<br />\r\n<strong>Treatment of osteoporosis in men at high risk of fractures</strong>: The recommended dose is Risedronate Sodium 35 mg once weekly. The tablet should be taken on the same day&nbsp;each week.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>The absorption of Risedronate Sodium is affected by food, thus to ensure adequate absorption patients should take Risedronate tablets at least 30 minutes before the first food,&nbsp;other medicinal product or drink (other than plain water) of the day. In the particular instances&nbsp;that before breakfast dosing is not practical, Risedronate 5 mg tablet can be taken between meals or in&nbsp;the evening at the same time everyday, with strict adherence to the following instructions, to&nbsp;ensure Risedronate Sodium tablet is taken on an empty stomach-Between meals:<br />\r\n<br />\r\nRisedronate&nbsp;Sodium tablet should be taken at least 2 hours before and at least 2 hours after any food,&nbsp;medicinal product or drink (other than plain water). In the evening:<br />\r\n<br />\r\nRisedronate Sodium tablet&nbsp;should be taken at least 2 hours after the last food, medicinal product or drink (other than plain&nbsp;water) of the day.&nbsp;If a dose is missed: Risedronate 5 mg tablet: If an occasional dose is missed, Risedronate 5 mg tablet can be&nbsp;taken before breakfast, between meals, or in the evening according to the instructions above.<br />\r\n<br />\r\n<strong>Risedronate 35 mg tablet</strong>: Patients should be instructed that if a dose is missed, just take one Risedronate&nbsp;35 mg tablet on the morning after remember. Patients should then return to taking one tablet&nbsp;once a week on the day the tablet is normally taken. Two tablets should not be taken on the&nbsp;same day.<br />\r\n<br />\r\n<strong>Risedronate 150 mg tablet</strong>: Patient should be instructed that if a dose is missed and the next month&rsquo;s&nbsp;schedule dose is more than 7 days away, then should take the missed tablet in the morning after&nbsp;the day it is remembered. Patients should then return to taking one tablet once a month normally taken.The tablet must be swallowed whole and not sucked or chewed. To aid delivery of&nbsp;the tablet to the stomach Risedronate tablet is to be taken while in an upright position with a glass of&nbsp;plain water (120 ml or more). Patients should not lie down for 30 minutes after taking the tablet. Supplemental calcium and vitamin D should be considered if the dietary intake is inadequate.</p>', '<p>Please tell your doctor if you are taking or have recently taken any other medicines, including medicines obtained without a prescription specially aspirin or other NSAIDs. Antacids, supplements, or medicines that contain aluminum, calcium, magnesium, or other minerals can interfere with how your body absorbs Risedronate Sodium. If you use these other medicines, do not take them for at least 30 minutes after taking a Risedronate Sodium tablet.</p>', '<p>Risedronate Sodium tablet is contraindicated in patients with known hypersensitivity to Risedronate Sodium and in patients with hypocalcaemia, severe renal&nbsp;impairment (creatinine clearance lower than 30 ml/min), during pregnancy and lactation.</p>', '<p>Serious side effects:</p>\r\n\r\n<ul>\r\n	<li>chest pain;</li>\r\n	<li>difficulty or pain when swallowing;</li>\r\n	<li>pain or burning under the ribs or in the back;</li>\r\n	<li>new or worsening heartburn;</li>\r\n	<li>severe joint, bone, or muscle pain; or</li>\r\n	<li>jaw pain, numbness, or swelling.</li>\r\n</ul>\r\n\r\n<p>Less serious side effects:</p>\r\n\r\n<ul>\r\n	<li>mild heartburn or stomach upset;</li>\r\n	<li>diarrhea, gas,or constipation;</li>\r\n	<li>mild joint or back pain;</li>\r\n	<li>headache.</li>\r\n</ul>', '<p><strong>Pregnancy:</strong>&nbsp;Risedronate Sodium is meant for use only in postmenopausal women. Therefore, Risedronate Sodium should not be taken during pregnancy. If you take it by accident during pregnancy, stop taking it straight away and talk to your doctor.<br />\r\n<br />\r\n<strong>Breast-feeding:</strong>&nbsp;Risedronate Sodium is meant for use only in postmenopausal women. Therefore, breast-feeding women should not take this medicine. If you take it by accident during breast-feeding, stop taking it straight away and talk to your doctor.</p>', '<p>Take special care with Risedronate if you:</p>\r\n\r\n<ul>\r\n	<li>Have low blood calcium (hypocalcemia)</li>\r\n	<li>Cannot sit or stand up for 30 minutes</li>\r\n	<li>Have kidneys that work poorly</li>\r\n	<li>Have an allergy to Risedronate Sodium</li>\r\n</ul>\r\n\r\n<p>Before taking Risedronate talk to doctor if you:</p>\r\n\r\n<ul>\r\n	<li>Are pregnant or may become pregnant. We do not know if Risedronate Sodium can harm your unborn child.</li>\r\n	<li>Are breast-feeding or plan to breast-feed. We do not know if Risedronate Sodium can passthrough your milk and if it can harm your baby.</li>\r\n	<li>Have kidney problems Risedronate Sodium may not be right for you.</li>\r\n	<li>Risedronate sodium is not intended for use in children.</li>\r\n</ul>\r\n\r\n<p>During treatment, if you experience an allergic reaction (such as swelling of the face, tongue or throat, difficulty in breathing or swallowing, skin rash), you must stop taking Risedronate sodium and seek medical advice immediately. If you have stopped treatment due to hypersensitivity reactions you should not re-start therapy with Risedronate sodium.</p>', '<p>Seek emergency medical attention if you think you have used too much of this medicine. Drink a full glass of milk right away. Do not make yourself vomit and do not lie down.<br />\r\n<br />\r\nOverdose symptoms may include nausea, heartburn, stomach pain, diarrhea, muscle cramps, numbness or tingling, tight muscles in your face, seizure (convulsions), irritability, and unusual thoughts or behavior.</p>', '<p>Bisphosphonate preparations</p>', '<p>Store in a cool and dry place. Protect from light &amp; moisture. Keep out of the reach of children.</p>', '<p><strong>Elderly</strong>: No dosage adjustment is necessary since bioavailability, distribution and elimination were&nbsp;similar in elderly (60 years of age or older) compared to younger subjects. This has also been&nbsp;shown in the very elderly, 75 years old and above postmenopausal population.&nbsp;<br />\r\n<br />\r\n<strong>Renal impairment</strong>: No dosage adjustment is required for those patients with mild to moderate&nbsp;renal impairment. The use of Risedronate Sodium is contra-indicated in patients with severe&nbsp;renal impairment (Creatinine clearance lower than 30ml/min).</p>', '2022-03-18 04:23:38', '2022-03-18 04:23:38'),
(1292, 1292, '<p>Risperidone injection is an atypical antipsychotic indicated:</p>\r\n\r\n<ul>\r\n	<li>For the treatment of schizophrenia.</li>\r\n	<li>As monotherapy or as adjunctive therapy to lithium or valproate for the maintenance treatment of Bipolar I Disorder.</li>\r\n</ul>', '<p>The mechanism of action of risperidone in schizophrenia is unclear. The drug&rsquo;s therapeutic activity in schizophrenia could be mediated through a combination of dopamine Type 2 (D2) and serotonin Type 2 (5HT2) receptor antagonism. The clinical effect from risperidone results from the combined concentrations of risperidone and its major active metabolite, 9-hydroxyrisperidone (paliperidone). Antagonism at receptors other than D2 and 5HT 2 may explain some of the other effects of risperidone.</p>', '<p>For patients who have never taken oral Risperidone, tolerability should be established with oral Risperidone prior to initiating treatment with Risperidone.<br />\r\n<br />\r\nAdminister by deep intramuscular (IM) deltoid or gluteal injection. Each injection should be administered by a health care professional using the appropriate enclosed safety needle (1-inch for deltoid administration alternating injections between the two arms and 2-inch for gluteal administration alternating injections between the two buttocks). Do not administer intravenously.<br />\r\n<br />\r\n25 mg intramuscular (IM) every 2 weeks. Patients not responding to 25 mg may benefit from a higher dose of 37.5 mg or 50 mg. The maximum dose should not exceed 50 mg every 2 weeks.<br />\r\n<br />\r\nOral Risperidone (or another antipsychotic medication) should be given with the first injection of Risperidone, and continued for 3 weeks (and then discontinued) to ensure adequate thera peutic plasma concentrations from Risperidone<br />\r\n<br />\r\nUpward dose adjustment of Risperidone should not be made more frequently than every 4 weeks. Clinical effects of each upward dose adjustment should not be anticipated earlier than 3 weeks after injection.<br />\r\n<br />\r\nAvoid inadvertent administration into a blood vessel.</p>', '<ul>\r\n	<li>Due to CNS effects, use caution when administering with other centrally-acting drugs. Avoid alcohol.</li>\r\n	<li>Due to hypotensive effects, hypotensive effects of other drugs with this potential may be enhanced.</li>\r\n	<li>Effects of levodopa and dopamine agonists may be antagonized.</li>\r\n	<li>Cimetidine and ranitidine increase the bioavailability of risperidone.</li>\r\n	<li>Clozapine may decrease clearance of risperidone.</li>\r\n	<li>Fluoxetine and paroxetine increase plasma concentrations of risperidone.</li>\r\n	<li>Carbamazepine and other enzyme inducers decrease plasma concentrations of risperidone.</li>\r\n</ul>', '<p>Known hypersensitivity to risperidone, paliperidone, or to any excipients in Risperidone.</p>', '<ul>\r\n	<li>Increased mortality in elderly patients with dementia-related psychosis</li>\r\n	<li>Cerebrovascular adverse events, including stroke, in elderly patients with dementia-related psychosis</li>\r\n	<li>Neuroleptic malignant syndrome</li>\r\n	<li>Tardive dyskinesia</li>\r\n	<li>Metabolic changes</li>\r\n	<li>Hyperprolactinemia</li>\r\n	<li>Orthostatic hypotension</li>\r\n	<li>Falls</li>\r\n	<li>Leukopenia/Neutropenia and Agranulocytosis</li>\r\n	<li>Potential for cognitive and motor impairment</li>\r\n	<li>Seizures</li>\r\n	<li>Dysphagia</li>\r\n	<li>Priapism</li>\r\n	<li>Thrombotic Thrombocytopenic Purpura (TTP)&nbsp;</li>\r\n	<li>Disruption of body temperature regulation</li>\r\n	<li>Avoidance of inadvertent injection into a blood vessel</li>\r\n</ul>', '<p><strong>Pregnancy</strong>: Advise patients to notify their healthcare provider if they become pregnant or intend to become pregnant during treatment with Risperidone<br />\r\n<br />\r\n<strong>Lactation</strong>: Advise breastfeeding women using Risperidone to monitor infants for somnolence, failure to thrive, jitteriness, and extrapyramidal symptoms (tremors and abnormal muscle movements) and to seek medical care if they notice these signs.</p>', '<ul>\r\n	<li>Increased Mortality in Elderly Patients with Dementia-Related Psychosis</li>\r\n	<li>Cerebrovascular Adverse Events, Including Stroke, in Elderly Patients with Dementia-Related Psychosis</li>\r\n	<li>Neuroleptic Malignant Syndrome</li>\r\n	<li>Tardive Dyskinesia</li>\r\n	<li>Hyperprolactinemia</li>\r\n	<li>Orthostatic Hypotension</li>\r\n</ul>', '<p>Atypical neuroleptic drugs</p>', '<p>The entire dose pack should be stored in the refrigerator (2&deg;-8&deg;C) and protected from light. Keep out of reach of children.</p>', NULL, '<p><strong>Renal or Hepatic Impairment</strong>: dose appropriately with oral Risperidone prior to initiating treatment with Risperidone. A lower starting dose of Risperidone of 12.5 mg may be appropriate in some patients.<br />\r\n<br />\r\n<strong>Pediatric Use</strong>: safety and effectiveness not established in patients less than 18 years of age.<br />\r\n<br />\r\n<strong>Elderly</strong>: dosing for otherwise healthy elderly patients is the same as for healthy nonelderly. Elderly may be more predisposed to orthostatic effects than nonelderly.</p>', '2022-03-18 04:25:45', '2022-03-18 04:25:45'),
(1293, 1293, '<p>Risperidone tablet is indicated for the treatment of-</p>\r\n\r\n<ul>\r\n	<li>Acute and chronic psychoses</li>\r\n	<li>Mania</li>\r\n	<li>Schizophrenia</li>\r\n</ul>', '<p>Risperidone is a selective monoaminergic antagonist having a high affinity for serotoninergic 5-HT2&nbsp;and dopaminergic D2&nbsp;receptors. Risperidone binds also to alpha1&nbsp;adrenergic receptors and with lower affinity, to H1&nbsp;histamine and alpha2&nbsp;adrenergic receptors. Risperidone has no affinity for 8 cholinergic receptors. Risperidone, as a potent D2&nbsp;antagonist, improves the positive symptoms of schizophrenia but causes less depression of motor activity. Balanced central serotonin and dopamine antagonism may reduce extrapyramidal side effect liability and extend the therapeutic activity to the negative and affective symptoms of schizophrenia.</p>', '<p><strong>Psychoses</strong>:</p>\r\n\r\n<ul>\r\n	<li>2 mg in 1-2 divided doses on 1st&nbsp;day then 4 mg in 1-2 divided doses on second day (Slower titration appropriate in some patients);</li>\r\n	<li>Usual dose range 4-6 mg daily; doses above 10 mg daily only if benefit considered to outweigh risk (max. 16 mg daily).</li>\r\n	<li>Elderly (or in hepatic or renal impairment) initially 1 mg daily in two divided doses increased in steps of 1-2 mg twice daily.</li>\r\n	<li>Child under 15 years not recommended.</li>\r\n</ul>\r\n\r\n<p><strong>Mania</strong>:</p>\r\n\r\n<ul>\r\n	<li>Initially, 2 mg once daily increased if necessary in step of 1 mg daily; usual dose range 1-6 mg daily;</li>\r\n	<li>Elderly (or in hepatic or renal impairment) initially 1 mg daily in two divided doses increased in steps of 1-2 mg twice daily.</li>\r\n</ul>\r\n\r\n<p><strong>Schizophrenia</strong>:</p>\r\n\r\n<ul>\r\n	<li>Risperidone should be generally administered at 1 mg BID initially, with increases in increments of 1 mg BID on the second and third day, as tolerated, to a target dose of 3 mg BID by the third day.</li>\r\n	<li>Further dosage adjustments, if indicated, should generally occur at intervals of not less than 1 week. When dosage adjustments are necessary, small dose increments/decrements of 1-2 mg are recommended.</li>\r\n</ul>', '<p>Risperidone May antagonize the effects of levodopa and dopamine agonists. Chronic administration with Carbamazepine reduces plasma clearance of Risperidone. Chronic administration with Clozapine may decrease the clearance of Risperidone. Risperidone may enhance the effects of certain antihypertensives.</p>', '<p>Risperidone is contraindicated in patients with a known hypersensitivity to the product.</p>', '<p>Insomnia, agitation, anxiety, headache, less commonly drowsiness, impaired concentration, fatigue, blurred vision, constipation, nausea and vomiting, dyspepsia, abdominal pain, hyperprolactinaemia, urine incontinence, tachycardia, hypertension, edema, rash, rhinitis, cerebrovascular accident, neurtropenia and thrombocytopenia have been reported.</p>', '<p>Although, in experimental animals, Risperidone did not show direct reproductive toxicity, some indirect, prolactin- and CNS-mediated effects were observed, No teratogenicity effect of Risperidone was noted in any study. The safety of Risperidone for use during human pregnancy has not been established. In animal studies, Risperidone and 9-hydroxyrisperidone are excreted in the milk. It has been demonstrated that Risperidone and 9-hydroxyrisperidone are also excreted in human breast milk. Therefore, women receiving Risperidone should not breastfeed.</p>', '<p>Special precaution should be taken in case of preexisting cardiovascular diseases, discontinue use if signs and symptoms of tardive dyskinesia occur, renal and hepatic impairment, elderly epilepsy, Parkinson&#39;s disease and in pregnancy.</p>', NULL, '<p>Atypical neuroleptic drugs.</p>\r\n\r\n<p>&nbsp;</p>', '<p>Do not store above 30&deg;C. Keep away from light and out of the reach of children.</p>', NULL, '2022-03-18 04:34:17', '2022-03-18 04:34:17');
INSERT INTO `generic_details` (`id`, `generic_id`, `indications`, `pharmacology`, `dosage_and_administration`, `interaction`, `contraindications`, `side_effects`, `pregnancy_and_lactation`, `precautions_and_warnings`, `overdose_effects`, `therapeutic_class`, `storage_conditions`, `use_in_special_populations`, `created_at`, `updated_at`) VALUES
(1294, 1294, '<p>Ritodrine is indicated for the treatment of uncomplicated premature labour.</p>', '<p>A selective &beta;2-adrenoceptor agonist with its main action on the uterus, causing relaxation. It reduces the intensity and frequency of contractions. Heart rate is also increased while diastolic pressure is reduced. May cause bronchial relaxation but this is not clinically significant in its usage.</p>', '<p><strong>By intravenous infusion</strong>: Initially 50 mcg/minute, increased gradually according to response by 50 mcg/minute every 10 minutes until contractions stop or maternal heart rate reaches 140 beats/minute; continue for 12&ndash;48 hours after contractions cease (usual rate 150&ndash;350 mcg/minute); maximum rate 350 mcg/minute.<br />\r\n<br />\r\n<strong>Intramuscular injection</strong>: 10 mg in every 3&ndash;8 hours continued for 12&ndash;48 hours after contractions have ceased; then by mouth.<br />\r\n<br />\r\n<strong>Oral maintenance treatment</strong>: One tablet (10 mg) may be given approximately 30 minutes before termination of intravenous therapy, repeated every 2 hours for 24 hours, followed by 10&ndash;20 mg every 4&ndash;6 hours, maximum oral dose 120 mg daily.</p>', '<p>Increased risk of hypokalamia if high doses of corticosteroids, diuretics (acetazalamide, loop diuretics and thiazides) or theophylline given with high doses of ritodrine. A sufficient time interval should elapse prior to administration of another sympathomimetic drug. &beta;&ndash;adrenergic blocking drugs inhibit its action; coadministraton of these drugs should, therefore, be avoided. With anesthetics used in surgery, the possibility that hypotensive effects may be potentiated should be considered.</p>', '<p>It is contraindicated in patients with known hypersensitivity to the active ingredient or any of the excipients of this component. &beta;2-agonists are contra-indicated in cardiac disease and in patients with significant risk factors for myocardial ischaemia; they should also be avoided in antepartum haemorrhage, intra-uterine infection, intra-uterine fetal death, placenta praevia,&nbsp;abruptio placenta, threatened miscarriage, cord compression, and eclampsia or severe preeclampsia.</p>', '<p>The common side-effects of ritodrine hydrochloride are nausea, vomiting, flushing, sweating, tremor, hypokalaemia, tachycardia, palpitations, hypotension (left lateral position throughout infusion to minimize risk), uterine bleeding, pulmonary oedema; chest pain or tightness, arrhythmias and salivary gland enlargement. On prolonged administration for several weeks may cause leucopenia and agranulocytosis; liver function abnormalities including increased transaminases and hepatitis.</p>', '<p>Ritodrine is a drug of pregnancy category B. There are no adequate and well controlled studies of effects in pregnant women before 20 weeks gestation; therefore, this drug should not be used before the 20th week of pregnancy. Studies in pregnant women from the 20th week of gestation onwards have not shown increased risk of fetal abnormalities. Nonetheless, although clinical studies did not indicate a risk of permanent adverse fetal effects from ritodrine, the possibility cannot be excluded; therefore, it should be used only when clearly indicated. In frequently reported neonatal symptoms include hypoglycemia and ileus. In addition, hypocalcemia and hypotension have been reported in neonates whose mothers were treated with other beta mimetic agents. Caution should be exercised unless the potential benefit of treatment to the mother outweighs any possible risk of the infants.</p>', '<p>It should be used cautiously in patient with suspected cardiac diseases, hypertension, hyperthyroidism, hypokalaemia, diabetes mellitus, mild to moderate preeclampsia, monitor blood pressure and pulse rate and avoid over-hydration during taking ritodrine hydrochloride.</p>', '<p>Symptoms of overdosage are tachycardia (maternal and fetal), palpitation, cardiac arrhythmia, hypotension, nervousness, tremor, nausea and vomiting. If an excess of ritodrine tablets is ingested, gastric lavage or induction of emesis should be carried out followed by administration of activated charcoal. When symptoms of overdose occur as a result of parenteral administration, ritodrine should be discontinued; an appropriate &beta;-blocking agent may be used<br />\r\nas an antidote.</p>', '<p>Drugs acting on the Uterus.</p>', '<p>Keep away from the reach of the children. Store in cool &amp; dry place protected from light.</p>', NULL, '2022-03-18 04:37:12', '2022-03-18 04:37:12'),
(1295, 1295, '<p><strong>Non-Hodgkin&#39;s Lymphoma</strong>&nbsp;(NHL): Rituximab is indicated for the treatment of patients with-</p>\r\n\r\n<ul>\r\n	<li>Relapsed or&nbsp;refractory, low-grade or follicular, CD20-positive, B-cell NHL as a single agent</li>\r\n	<li>Previously untreated follicular, CD20-positive, B-cell NHL in combination with first line&nbsp;chemotherapy&nbsp;and, in patients achieving a complete or partial response to Rituxan in combination with chemotherapy, as single-agent&nbsp;maintenance therapy.</li>\r\n	<li>Non-progressing (including stable disease), low-grade, CD20-positive, B-cell NHL as a single agent after first-line CVP chemotherapy</li>\r\n	<li>Previously untreated diffuse large B-cell, CD20-positive NHL in combination with CHOP or other&nbsp;anthracycline-based chemotherapy regimens</li>\r\n</ul>\r\n\r\n<p><strong>Chronic Lymphocytic Leukemia</strong>&nbsp;(CLL): Rituximab is indicated, in combination with fludarabine and cyclophosphamide (FC), for the treatment of patients with previously untreated and previously treated CD20-positive&nbsp;CLL.<br />\r\n<br />\r\n<strong>Rheumatoid Arthritis</strong>&nbsp;(RA): Rituximab in combination with methotrexate is indicated for the treatment of adult patients with moderately- to severely- active&nbsp;rheumatoid arthritis&nbsp;who have had an inadequate response to one or more&nbsp;TNF&nbsp;antagonist&nbsp;therapies.<br />\r\n<br />\r\n<strong>Granulomatos Is With Polyangiitis (GPA) (Wegener&#39;s Granulomatosis) and Microscopic Polyangiitis (MPA)</strong>: Rituximab, in combination with glucocorticoids, is indicated for the treatment of adult patients with Granulomatosis with Polyangiitis (GPA) (Wegener&#39;s Granulomatosis) andMicroscopic&nbsp;Polyangiitis (MPA).</p>', '<p>Rituximab is a chimeric monoclonal antibody to CD20 antigen which regulates cell cycle initiation. It binds to the antigen on the cell surface, activating complement-dependent B-cell cytotoxicity; and to human Fc receptors, mediating cell killing through an antibody-dependent cellular toxicity.<br />\r\n<br />\r\n<strong>Duration</strong>: Detectable in serum 3-6 mth after completion of therapy; B-cell recovery 6-12 mth following completion of therapy.</p>', '<p>Intravenous (Adult)-<br />\r\n<br />\r\n<strong>Non-Hodgkin&#39;s lymphoma, Refractory or relapsed follicular lymphoma</strong>: As a single agent, 375 mg/m2&nbsp;infusion once wkly, for 4 doses at an initial rate of 50 mg/hr. May increase by 50 mg/hr every 30 min. If tolerated, subsequent infusions can be started at 100 mg/hr and increased by 100 mg/hr every 30 min. Max rate: 400 mg/hr. When used with CVP (cyclophosphamide, vincristine and prednisolone) for follicular lymphoma or CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) for diffuse large B-cell lymphoma, 375 mg/m2&nbsp;given on day 1 of the chemotherapy cycle after corticosteroid regimen, for up to 8 cycles. For patients who were treated with 6-8 cycles of CVP chemotherapy and have not progressed, 375 mg/m2&nbsp;may be given once wkly for 4 doses, may repeat every 6 mth, for up to 16 doses. Maintenance: 375 mg/m2&nbsp;given once every 3 mth (those who have responded to induction chemotherapy), once every 2 mth initiated 2 mth after the last dose of induction chemotherapy (previously untreated) for a max period of 2 yr.<br />\r\n<br />\r\n<strong>Chronic lymphocytic leukaemia</strong>: 375 mg/m2, given on the day prior to chemotherapy in cycle 1, followed by 500 mg/m2&nbsp;on day 1 (every 28 days) of cycles 2-6.<br />\r\n<br />\r\n<strong>Rheumatoid arthritis:</strong>&nbsp;Given as two 1 g IV infusion doses, separated by 2 wk and in combination with methotrexate. Corticosteroids may be given before each infusion to minimise the risk and severity of infusion reactions.</p>', '<p>Increased risk of renal toxicity with cisplatin.</p>', '<p>Hypersensitivity to murine proteins. Patients with active, severe infections. Severely immunocompromised state. Concomitant use with live viral vaccines. Lactation.</p>', '<p>Reactivation of hepatitis B virus. Fever and rigors. Pruritus, skin rashes, dyspnoea, bronchospasm, angioedema, transient hypotension, and flushing, asthenia, headache, rhinitis, thrombocytopenia, neutropenia, anaemia, abdominal pain, bowel obstruction, and perforation. Exacerbation of heart failure and angina pectoris. Reversible interstitial pneumonia and interstitial fibrosis. Depletion of immunoglobulin concentrations.</p>', '<p><strong>Pregnancy Category C.</strong>&nbsp;Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.</p>', '<p>Extensive tumour burden, pulmonary insufficiency or pulmonary tumour infiltration; history of cardiac disease. Pregnancy.</p>', NULL, '<p>Cytotoxic immunosuppressants</p>', '<p>Store between 2-8&deg; C.</p>', NULL, '2022-03-18 04:38:55', '2022-03-18 04:38:55'),
(1296, 1296, '<p><strong>Rivaroxaban 2.5 mg</strong>:</p>\r\n\r\n<ul>\r\n	<li>For the prevention of atherothrombotic events in adult patients after an Acute Coronary Syndrome (ACS) with elevated cardiac biomarkers (Troponin or CK-MB). It is co-administered with Aspirin alone or with Aspirin plus Clopidogrel orTidopidine.</li>\r\n</ul>\r\n\r\n<p><strong>Rivaroxaban 10-20 mg</strong>:</p>\r\n\r\n<ul>\r\n	<li>To reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation</li>\r\n	<li>Deep vein thrombosis (DVT) &amp; pulmonary embolism (PE) and reduction in the risk of recurrence of DVT and of PE</li>\r\n	<li>For the prophylaxis of DVT, which may lead to PE in patients undergoing knee or hip replacement surgery</li>\r\n</ul>', '<p>Rivaroxaban is a highly selective direct factor Xa inhibitor. Inhibition of factor Xa interrupts the intrinsic and extrinsic pathway of the blood coagulation cascade, inhibits thrombin formation. Rivaroxaban does not inhibit thrombin (activated factor II) and no effects on platelets have been demonstrated.</p>', '<p>Rivaroxaban 2.5 mg:</p>\r\n\r\n<ul>\r\n	<li><strong>The recommended dose</strong>: 2.5 mg twice daily. Patients should also take a daily dose of 75-100 mg Aspirin or a daily dose of 75-100 mg Aspirin in addition to either a daily dose of 75 mg clopidogrel or a standard daily dose of ticlopidine.</li>\r\n</ul>\r\n\r\n<p>Rivaroxaban 10-20 mg:</p>\r\n\r\n<ul>\r\n	<li><strong>Nonvalvular Atrial Fibrillation</strong>: For patients with Creatinin Clearance &gt;50 mL/min: 20 mg orally, once daily with the evening meal. For patients with Creatinin Clearance 15-50 ml/min: 15 mg orally, once daily with the evening meal.</li>\r\n	<li><strong>Treatment of DVT &amp; PE</strong>: 15 mg orally twice daily with food for the first 21 days for the initial treatment of acute DVT or PE. After the initial treatment period, 20 mg orally once daily with food for the remaining treatment.</li>\r\n	<li><strong>Prevention in the risk of recurrence of DVT and of PE</strong>: 20 mg once daily with food.</li>\r\n	<li><strong>Prophylaxis of DVT following Hip replacement surgery</strong>: 10 mg once daily for 35 days.</li>\r\n	<li><strong>Prophylaxis of DVT following knee replacement surgery</strong>: 10 mg once daily for 12 days.</li>\r\n</ul>\r\n\r\n<p>May be taken with or without food.</p>', '<p>Concomitant use with drugs that are combined P-gp and CYP3A4 inhibitors (ketoconazole, ritonavir, clarithromycin, erythromycin, fluconazole, diltiazem, verapamil, dronedarone) increases in Rivaroxaban exposure and pharmacodynamic effects (i.e., factor Xa inhibition and PT prolongation), that&rsquo;s why should be avoided. Co-administration of Rivaroxaban with a combined P-gp and strong CYP3A4 inducer (e.g., rifampicin, phenytoin, carbamazepine) decreases the efficacy of Rivaroxaban and also should be avoided. The concomitant use of other drugs like anti-platelet agents, heparin, fibrinolytic therapy, NSAIDs may cause an increased risk of bleeding.</p>', '<p>It is contraindicated in patients with known hypersensitivity of Rivaroxaban or any of the excipients of the product. It is also contraindicated in patients with active pathological bleeding.</p>', '<p>The most common side effects of Rivaroxaban have increased chance of bleeding, spinal or epidural hematoma and increased risk of stroke after discontinuation in nonvalvular atrial fibrillation.</p>', '<p>Rivaroxaban is a pregnancy category C drug. There are no adequate or well-controlled studies of Rivaroxaban in pregnant women, and dosing for pregnant women has not been established. It is not known if Rivaroxaban is excreted in human milk. The safety and efficacy of Rivaroxaban has not been established in breastfeeding women.</p>', '<p>Early discontinuation of Rivaroxaban, in the absence of adequate alternative anticoagulation increases the risk of thrombotic events. Rivaroxaban increases the risk of bleeding that can be fatal in presence of following risk factors- bleeding disorders, uncontrolled severe arterial hypertension, gastrointestinal disease (e.g., inflammatory bowel disease, oesophagitis, gastritis and gastroesophageal reflux disease), vascular retinopathy, bronchiectasis, history of pulmonary bleeding. Signs or symptoms of neurological impairment should be monitored in case of neuraxial anesthesia (spinal/epidural anesthesia) or spinal puncture as epidural or spinal hematoma can occur. Rivaroxaban is not recommended in patients with pulmonary embolism who present with hemodynamic instability or who may receive thrombolysis or pulmonary embolectomy.</p>', '<p>Overdose of Rivaroxaban may lead to hemorrhage. Rivaroxaban systemic exposure is not further increased at single doses &gt;50 mg due to limited absorption. A specific antidote for Rivaroxaban is not available. The use of activated charcoal to reduce absorption in case of Rivaroxaban overdose may be considered. Partial reversal of laboratory anticoagulation parameters may be achieved with use of plasma products.</p>', '<p>Oral Anti-coagulants</p>', '<p>Store in a cool (below 30&deg;C) &amp; dry place protected from light. Keep away from the reach of children.</p>', NULL, '2022-03-18 04:43:39', '2022-03-18 04:43:39'),
(1297, 1297, '<p>Symptomatic treatment of mild to moderately severe Alzheimer&#39;s dementia.&nbsp;Symptomatic treatment of mild to moderately severe dementia in patients with Idiopathic Parkinson&#39;s disease.</p>', '<p>Rivastigmine is a carbamate derivative that is structurally related to physostigmine, but not to donepezil and tacrine. The precise mechanism of rivastigmine has not been fully determined, but it is suggested that rivastigmine binds reversibly with and inactivates chlolinesterase (eg. acetylcholinesterase, butyrylcholinesterase), preventing the hydrolysis of acetycholine, and thus leading to an increased concentration of acetylcholine at cholinergic synapses. The anticholinesterase activity of rivastigmine is relatively specific for brain acetylcholinesterase and butyrylcholinesterase compared with those in peripheral tissues.</p>', '<p>Rivastigmine capsule-</p>\r\n\r\n<ul>\r\n	<li><strong>Initial dose</strong>: Rivastigmine 1.5 mg twice a day.</li>\r\n	<li><strong>Dose titration:</strong>&nbsp;The starting dose is Rivastigmine 1.5 mg twice a&nbsp;day. If this dose is well tolerated after a minimum of two weeks of treatment, the dose&nbsp;may be increased to Rivastigmine 3 mg twice a day. Subsequent&nbsp;increases to 4.5 mg and then 6 mg twice a day should also be based on good tolerability&nbsp;of the current dose and may be considered after a minimum of two weeks of treatment at&nbsp;that dose level.</li>\r\n	<li><strong>Maintenance dose</strong>: The effective dose is 3 mg to 6 mg twice a day; to achieve maximum therapeutic benefit patients should be maintained on their highest well tolerated dose. The recommended maximum&nbsp;daily dose is 6 mg twice a day. Maintenance treatment can be&nbsp;continued for as long as a therapeutic benefit for the patient exists.&nbsp;</li>\r\n	<li><strong>Re-initiation of therapy</strong>: If treatment is interrupted for more than several days, it should be re-initiated at 1.5 mg twice daily. Dose titration should then be carried out as described above.</li>\r\n</ul>\r\n\r\n<p>Rivastigmine transdermal patch: Apply patch on intact skin for a 24-hour period; replace with a new patch every 24 hours.</p>\r\n\r\n<ul>\r\n	<li><strong>Initial Dose</strong>: Initiate treatment with 4.6 mg/24 hours Rivastigmine transdermal patch.</li>\r\n	<li><strong>Dose Titration</strong>: After a minimum of 4 weeks, if tolerated, increase dose to 9.5 mg/24 hours, which is the minimum effective dose. Following a minimum additional 4 weeks, may increase dosage to maximum dosage of 13.3 mg/24 hours.</li>\r\n	<li><strong>Mild to Moderate Alzheimer&#39;s Disease and Parkinson&rsquo;s Disease Dementia</strong>: Rivastigmine transdermal patch 9.5 mg/24 hours or 13.3 mg/24 hours once daily.</li>\r\n	<li><strong>Severe Alzheimer&rsquo;s Disease</strong>: Rivastigmine transdermal patch 13.3 mg/24 hours once daily.</li>\r\n	<li>For treatment interruption longer than 3 days, retitrate dosage starting at 4.6 mg per 24 hours.</li>\r\n</ul>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>Rivastigmine should be administered twice a day, with morning and&nbsp;evening meals.</p>', '<p>As a cholinesterase inhibitor, Rivastigmine may&nbsp;exaggerate the effects of succinylcholine-type muscle relaxants during anaesthesia.&nbsp;Caution is recommended when selecting anaesthetic agents. Possible dose adjustments&nbsp;or temporarily stopping treatment can be considered if needed. In view of its&nbsp;pharmacodynamic effects, rivastigmine should not be given concomitantly with other&nbsp;cholinomimetic substances and might interfere with the activity of anticholinergic&nbsp;medicinal products. No pharmacokinetic interaction was observed between rivastigmine&nbsp;and digoxin, warfarin, diazepam or fluoxetine in studies in healthy volunteers. The increase in prothrombin time induced by warfarin is not affected by administration of&nbsp;rivastigmine. No untoward effects on cardiac conduction were observed following&nbsp;concomitant administration of digoxin and Rivastigmine.</p>', '<p>The use of this medicinal product is contraindicated in patients with hypersensitivity to the active substance or other carbamate derivatives.</p>', '<p>The most commonly reported adverse reactions are gastrointestinal,&nbsp;including nausea (38%) and vomiting (23%), especially during titration. Female patients&nbsp;in clinical studies were found to be more susceptible than male patients to&nbsp;gastrointestinal adverse reactions and weight loss.</p>', '<p>For Rivastigmine no clinical data are available.&nbsp;Rivastigmine should not be used during pregnancy unless clearly necessary. In animals,&nbsp;rivastigmine is excreted into milk. It is not known if rivastigmine is excreted into human&nbsp;milk. Therefore, women on rivastigmine should not breast-feed.</p>', '<p>Patients with sick sinus syndrome or conduction defects, resp diseases. Cholinergic stimulation may increase gastric acid secretion. May exacerbate urinary obstruction and seizures. Pregnancy. Renal impairment, mild to moderate hepatic impairment. Monitor body wt. Asthma or obstructive pulmonary disease. May worsen extrapyramidal symptoms. Lactation.</p>', '<p>Most cases of accidental overdose have not been associated with any clinical signs or symptoms and almost all of the patients concerned continued rivastigmine treatment. Where symptoms have occurred, they have included nausea, vomiting and diarrhoea, hypertension or hallucinations. Due to the known vagotonic effect of cholinesterase inhibitors on heart rate, bradycardia and/or syncope may also occur. Ingestion of 46 mg occurred in one case; following conservative management the patient fully recovered within 24 hours. As rivastigmine has a plasma half-life of about 1 hour and a duration of acetylcholinesterase inhibition of about 9 hours, it is recommended that in cases of asymptomatic overdose no further dose of rivastigmine should be administered for the next 24 hours. In overdose accompanied by severe nausea and vomiting, the use of antiemetics should be considered. Symptomatic treatment for other adverse reactions should be given as necessary. In massive overdose, atropine can be used. An initial dose of 0.03 mg/kg intravenous atropine sulphate is recommended, with subsequent doses based on clinical response. Use of scopolamine as an antidote is not recommended.</p>', '<p>Drugs for Dementia.</p>', '<p>Store in a cool and dry place, protected from light.</p>', '<p><strong>Renal and hepatic impairment</strong>: Due to increased exposure in moderate renal and mild to&nbsp;moderate hepatic impairment, dosing recommendations to titrate according to individual tolerability should be closely followed<br />\r\n<br />\r\n<strong>Use in children</strong>: Rivastigmine is not recommended for use in children.</p>', '2022-03-18 04:46:43', '2022-03-18 04:46:43'),
(1298, 1298, '<p>Rizatriptan Benzoate is indicated for the acute treatment of&nbsp;migraine&nbsp;with or without aura in adults and in pediatric patients 6 to 17 years old.</p>', '<p>Rizatriptan binds with high&nbsp;affinity&nbsp;to human cloned 5-HT1B/1D receptors. Rizatriptan Benzoate presumably exerts its therapeutic effects in the treatment of&nbsp;migraine headache&nbsp;by binding to 5-HT1B/1D receptors located on intracranial blood vessels and sensory nerves of the trigeminal system.</p>', '<p><strong>Dosing Information In Adults</strong>: The recommended starting dose of Rizatriptan Benzoate is either 5 mg or 10 mg for the acute treatment of migraines in adults. The 10-mg dose may provide a greater effect than the 5-mg dose, but may have a greater risk of adverse reactions.<br />\r\n<br />\r\n<strong>Redosing In Adults</strong>: Although the effectiveness of a second dose or subsequent doses has not been established in placebocontrolled trials, if the migraine headache returns, a second dose may be administered 2 hours after the first dose. The maximum daily dose should not exceed 30 mg in any 24-hour period. The safety of treating, on average, more than four headaches in a 30-day period has not been established.<br />\r\n<br />\r\n<strong>Dosing Information In Pediatric Patients (Age 6 to 17 Years)</strong>: Dosing in pediatric patients is based on the patient&#39;s body weight. The recommended dose of Rizatriptan Benzoate is 5 mg in patients weighing less than 40 kg, and 10 mg in patients weighing 40 kg or more.<br />\r\n<br />\r\nThe efficacy and safety of treatment with more than one dose of Rizatriptan Benzoate within 24 hours in pediatric patients 6 to 17 years of age have not been established.<br />\r\n<br />\r\n<strong>Dosage Adjustment For Patients On Propranolol</strong>: Sections or subsections omitted from the full prescribing information are not listed.</p>\r\n\r\n<ul>\r\n	<li><strong>Adult Patients</strong>: In adult patients taking propranolol, only the 5-mg dose of Rizatriptan Benzoate is recommended, up to a maximum of 3 doses in any 24-hour period (15 mg)</li>\r\n	<li><strong>Pediatric Patients</strong>: For pediatric patients weighing 40 kg or more, taking propranolol, only a single 5-mg dose of Rizatriptan Benzoate is recommended (maximum dose of 5 mg in a 24-hour period). Rizatriptan Benzoate should not be prescribed to</li>\r\n</ul>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>Administration of Rizatriptan Benzoate Tablets, administration with liquid is not necessary. Orally disintegrating tablets are packaged in a blister within an outer aluminum pouch and patients should not remove the blister from the outer pouch until just prior to dosing. The blister pack should then be peeled open with dry hands and the orally disintegrating tablet placed on the tongue, where it will dissolve and be swallowed with the&nbsp;saliva.</p>', '<p><strong>Propranolol</strong>: The dose of Rizatriptan should be adjusted in propranolol-treated patients, as propranolol has been shown to increase the plasma AUC of rizatriptan by 70%&nbsp;<br />\r\n<br />\r\n<strong>Ergot-Containing Drugs</strong>: Ergot-containing drugs have been reported to cause prolonged vasospastic reactions. Because these effects may be additive, use of ergotamine-containing or ergot-type medications (like dihydroergotamine or methysergide) and Rizatriptan within 24 hours is contraindicated<br />\r\n<br />\r\n<strong>Other 5-HT1 Agonists</strong>: Because their vasospastic effects may be additive, co-administration of Rizatriptan and other 5-HT1 agonists within 24 hours of each other is contraindicated&nbsp;<br />\r\n<br />\r\n<strong>SSRIs /SNRIs And Serotonin Syndrome</strong>: Cases of serotonin syndrome have been reported during co-administration of triptans and selective serotonin&nbsp;reuptake&nbsp;inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs)&nbsp;<br />\r\n<br />\r\n<strong>Monoamine Oxidase Inhibitors</strong>: Rizatriptan is contraindicated in patients taking MAO-A inhibitors and non-selective MAO inhibitors. A specific MAO-A inhibitor increased the systemic exposure of rizatriptan and its metabolite.</p>', '<p>Rizatriptan Benzoate is contraindicated in patients with:</p>\r\n\r\n<ul>\r\n	<li>Ischemic&nbsp;coronary artery disease&nbsp;(angina pectoris, history of&nbsp;myocardial infarction, or documented silent ischemia), or other significant underlying&nbsp;cardiovascular disease</li>\r\n	<li>Coronary artery vasospasm including Prinzmetal&#39;s&nbsp;angina</li>\r\n	<li>History of&nbsp;stroke&nbsp;or&nbsp;transient ischemic attack&nbsp;(TIA)&nbsp;</li>\r\n	<li>Peripheral vascular disease&nbsp;(PVD)&nbsp;</li>\r\n	<li>Ischemic bowel disease&nbsp;</li>\r\n	<li>Uncontrolled hypertension&nbsp;</li>\r\n	<li>Recent use (i.e., within 24 hours) of another 5-HT1&nbsp;agonist, ergotamine-containing medication, or&nbsp;ergot-type medication (such as dihydroergotamine or methysergide)&nbsp;</li>\r\n	<li>Hemiplegic&nbsp;or&nbsp;basilar&nbsp;migraine</li>\r\n	<li>Concurrent administration or recent discontinuation (i.e., within 2 weeks) of a MAO-A inhibitor</li>\r\n	<li>Hypersensitivity to Rizatriptan Benzoate (angioedema and&nbsp;anaphylaxisseen)</li>\r\n</ul>', '<p>The following adverse reactions are discussed in more detail in other sections of the labeling:</p>\r\n\r\n<ul>\r\n	<li>Myocardial&nbsp;Ischemia,&nbsp;Myocardial Infarction, and Prinzmetal&#39;s&nbsp;Angina&nbsp;</li>\r\n	<li>Arrhythmias&nbsp;</li>\r\n	<li>Chest, Throat, Neck and/or Jaw Pain/Tightness/Pressure&nbsp;</li>\r\n	<li>Cerebrovascular&nbsp;Events&nbsp;</li>\r\n	<li>Other Vasospasm Reactions&nbsp;</li>\r\n	<li>Medication Overuse Headache&nbsp;</li>\r\n	<li>Serotonin&nbsp;Syndrome&nbsp;</li>\r\n	<li>Increase in Blood Pressure</li>\r\n</ul>', '<p><strong>Pregnancy</strong>: Inform patients that Rizatriptan Benzoate should not be used during pregnancy unless the potential benefit justifies the potential risk to the fetus<br />\r\n<br />\r\n<strong>Nursing Mothers</strong>: It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Rizatriptan Benzoate is administered to a nursing woman. Rizatriptan is extensively excreted in rat milk, with levels in milk at least 5-fold higher than levels in maternal plasma.</p>', '<p>Elderly; mild to moderate hepatic or renal impairment; coronary artery disease; pregnancy, lactation. May cause drowsiness. History of seizures. Ensure an interval of at least 24 hr after stopping an ergotamine compound and starting a serotonin (5-HT1) agonist.</p>', '<p>May cause hypertension and CV symptoms. Gastric lavage using activated charcoal may be considered. Monitor ECG and clinical status of the patient.</p>', '<p>5-HT Agonists</p>', '<p>Store at 15-30&deg; C.</p>', '<p><strong>Pediatric Use</strong>: Safety and effectiveness in pediatric patients under 6 years of age have not been established. The efficacy and safety of Rizatriptan in the acute treatment of migraine in patients aged 6 to 17 years was established in an adequate and well-controlled study. The incidence of adverse reactions reported for pediatric patients in the acute clinical trial was similar in patients who received Rizatriptan to those who received placebo. The adverse reaction pattern in pediatric patients is expected to be similar to that in adults.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Clinical studies of Rizatriptan did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients.<br />\r\n<br />\r\nAlthough the pharmacokinetics of rizatriptan were similar in elderly (aged &ge;65 years) and in younger adults (n=17), in general, dose selection for an elderly patient should be cautious, starting at the low end of the dosing range. This reflects the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.<br />\r\n<br />\r\nGeriatric patients who have other cardiovascular risk factors (e.g., diabetes, hypertension, smoking, obesity, strong family history of coronary artery disease) should have a cardiovascular evaluation prior to receiving Rizatriptan<br />\r\n<br />\r\n<strong>Renal Impairment</strong>: For mild-moderate impairment, initate with 5 mg. Further dose of 5 mg may be taken after an interval of at least 2 hr. Max: 10 mg/24 hr. Avoid in severe impairment.<br />\r\n<br />\r\n<strong>Hepatic Impairment</strong>:&nbsp;For mild-moderate impairment, initate with 5 mg. Further dose of 5 mg may be taken after an interval of at least 2 hr. Max: 10 mg/24 hr. Avoid in severe impairment.</p>', '2022-03-18 04:49:32', '2022-03-18 04:49:32'),
(1299, 1299, '<p>Rocuronium is indicated -</p>\r\n\r\n<ul>\r\n	<li>As an adjunct to general anesthesia to facilitate tracheal intubation during routine induction, and during rapid sequence induction when suxamethonium is contraindicated</li>\r\n	<li>To provide skeletal muscle relaxation during surgery</li>\r\n	<li>As an adjunct in the intensive care unit (ICU) to facilitate intubation and mechanical ventilation</li>\r\n</ul>', '<p>Rocuronium acts by competing for cholinergic receptors at the motor end-plate. This action is antagonized by acetylcholinesterase inhibitors, such as neostigmine and edrophonium. Rocuronium acts by competitively binding to nicotinic cholinergic receptors. The binding of vecuronium decreases the opportunity for acetylcholine to bind to the nicotinic receptor at the postjunctional membrane of the myoneural junction. As a result, depolarization is prevented, calcium ions are not released and muscle contraction does not occur. Evidence also suggests that nondepolarizing agents can affect ACh release. It has been hypothesized that nondepolarzing agents bind to postjunctional (&quot;curare&quot;) receptors and may therefore interfere with the sodium and potassium flux, which is responsible for depolarization and repolarization of the membranes involved in muscle contraction.</p>', '<p><strong>Dosage</strong>: Like other neuromuscular blocking agents, Rocuronium should only be administered by, or under supervision of, experienced clinicians who are familiar with the action and use of these agents. The dosage of Rocuronium should be individualized in each patient. The method of anesthesia and the expected duration of surgery, the method of sedation and the expected duration of mechanical ventilation, the possible interaction with other medicines that are administered concomitantly and the condition of the patient should be taken into account when determining the dose. The use of an appropriate neuromuscular monitoring technique is recommended for the evaluation of neuromuscular block and recovery. Inhalational anesthetics do potentiate the neuromuscular blocking effects of Rocuronium. This potentiation, however, becomes clinically relevant in the course of anesthesia, when the volatile agents have reached the tissue concentrations required for this interaction. Consequently, adjustments with Rocuronium should be made by administering smaller maintenance doses at less frequent intervals or by using lower infusion rates of Rocuronium during long lasting procedures (longer than 1 hour) under inhalational anesthesia. In adult patients the following dosage recommendations may serve as a general guideline for tracheal intubation and muscle relaxation for short to long lasting surgical procedures, and for use in the intensive care unit.&nbsp;<br />\r\n<br />\r\n<strong>Surgical Procedures</strong>:&nbsp;Tracheal Intubation: The standard intubating dose during routine anesthesia is 0.6mg Rocuronium Bromide per kg body weight, after which adequate intubation conditions are established within 60 seconds in nearly all patients. A dose of 1.0mg Rocuronium Bromide per kg body weight is recommended for facilitating tracheal intubation conditions during rapid sequence induction of anesthesia, after which adequate intubation conditions are also established within 60 seconds in nearly all patients. If a dose of 0.6mg Rocuronium Bromide per kg body weight is used for rapid sequence induction of anesthesia, it is recommended to intubate the patient 90 seconds after administration of Rocuronium Bromide. In patients undergoing Caesarean section it is recommended to only use a dose of 0.6mg Rocuronium Bromide per kg body weight, since a 1.0mg/kg dose has not been investigated in this patient group.&nbsp;<br />\r\n<br />\r\n<strong>Maintenance Dosing</strong>:&nbsp;The recommended maintenance dose is 0.15mg Rocuronium Bromide per kg body weight; in the case of long-term inhalational anesthesia this should be reduced to 0.075-0.1mg Rocuronium Bromide per kg body weight. The maintenance doses should best be given when twitch height has recovered to 25% of control twitch height, or when 2-3 responses to train of four stimulation are present.&nbsp;<br />\r\n<br />\r\n<strong>Continuous Infusion</strong>:&nbsp;If Rocuronium Bromide is administered by continuous infusion, it is recommended to give a loading dose of 0.6mg Rocuronium Bromide per kg body weight and, when neuromuscular block starts to recover, to start administration by infusion. The infusion rate should be adjusted to maintain twitch response at 10% of control twitch height, or to maintain 1 to 2 responses to train of four stimulation. In adults under intravenous anesthesia, the infusion rate required to maintain neuromuscular block at this level ranges from 0.3-0.6mg/kg/hr and under inhalational anesthesia the infusion rate ranges from 0.3-0.4mg/kg/hr. Continuous monitoring of neuromuscular block is recommended since infusion rate requirements vary from patient to patient and with the anaesthetic method used.&nbsp;<br />\r\n<br />\r\n<strong>Dosing in Paediatric Patients</strong>:&nbsp;Children (1-14 years) and infants (1-12 months) under halothane anesthesia manifest similar sensitivity to Rocuronium Bromide as adults. Onset of action is faster in infants and children than in adults. Clinical duration is shorter in children than in adults. For continuous infusion in paediatrics, the infusion rates, with exception of children, are the same as for adults. For children higher infusion rates might be necessary. For children the same initial infusion rates as for adults are recommended and this should be adjusted to maintain twitch response at 10% of control twitch height or to maintain 1 or 2 responses to train of four stimulation during the procedure. There are insufficient data to support dose recommendations for the use of Rocuronium Bromide in neonates (0-1 month). The experience with Rocuronium Bromide in rapid sequence induction in paediatric patients is limited. Rocuronium Bromide is therefore not recommended for facilitating tracheal intubation conditions during rapid sequence induction in paediatric patients.&nbsp;<br />\r\n<br />\r\n<strong>Dosing in Geriatric patients and patients with Hepatic and/or Biliary tract disease and/or Renal Failure</strong>:&nbsp;The standard intubation dose for geriatric patients and patients with hepatic and/or biliary tract disease and/or renal failure during routine anesthesia is 0.6mg Rocuronium Bromide per kg body weight. A dose of 0.6mg per kg body weight should be considered for rapid sequence induction of anesthesia in patients in which a prolonged duration of action is expected. Regardless of the anesthetic technique used, the recommended maintenance dose for these patients is 0.075-0.1mg Rocuronium Bromide per kg body weight, and the recommended infusion rate is 0.3-0.4mg/kg/hr.&nbsp;<br />\r\n<br />\r\n<strong>Dosing in Overweight and Obese Patients</strong>:&nbsp;When used in overweight or obese patients (defined as patients with a body weight of 30% or more above ideal body weight) doses should be reduced taking into account ideal body weight.&nbsp;<br />\r\n<br />\r\n<strong>Intensive Care Procedures (</strong><strong>Tracheal Intubation)</strong>: For tracheal intubation, the same doses should be used as described above under surgical procedures.&nbsp;<br />\r\n<br />\r\n<strong>Maintenance Dosing</strong>:&nbsp;The use of an initial loading dose of 0.6mg Rocuronium Bromide per kg body weight is recommended, followed by a continuous infusion as soon as twitch height recovers to 10% or upon reappearance of 1 to 2 twitches to train of four stimulation. Dosage should always be titrated to effect in the individual patient. The recommended initial infusion rate for the maintenance of a neuromuscular block of 80-90% (1 to 2 twitches to TOF stimulation) in adult patients is 0.3-0.6mg/kg/hr during the first hour of administration, which will need to be decreased during the following 6-12 hours, according to the individual response. Thereafter, individual dose requirements remain relatively constant. A large between patient variability in hourly infusion rates has been found in controlled clinical studies, with mean hourly infusion rates ranging from 0.2-0.5mg/kg/hr depending on nature and extent of organ failure(s), concomitant medication and individual patient characteristics. To provide optimal individual patient control, monitoring of neuromuscular transmission is strongly recommended. Administration up to 7 days has been investigated.&nbsp;<br />\r\n<br />\r\n<strong>Special Populations</strong>:&nbsp;Rocuronium Bromide is not recommended for the facilitation of mechanical ventilation in the intensive care in paediatric and geriatric patients due to a lack of data on safety and efficacy.</p>', '<p>The following agents have been shown to influence the magnitude and/or duration of action of non-depolarizing neuromuscular blocking agents:</p>\r\n\r\n<p>Effect of other agents on Rocuronium Bromide-</p>\r\n\r\n<p><strong>Increased Effect</strong>: Halogenated volatile anesthetics potentiate the neuromuscular block of Rocuronium Bromide. The effect only becomes apparent with maintenance dosing. Reversal of the block with anti-cholinesterase inhibitors could also be inhibited. Long-term concomitant use of corticosteroids and Rocuronium Bromide in the ICU may result in prolonged duration of neuromuscular block or myopathy.<br />\r\n<br />\r\nOther drugs:&nbsp;</p>\r\n\r\n<ul>\r\n	<li>Antibiotics: aminoglycoside, lincosamide and polypeptide antibiotics, acylamino-penicillin antibiotics.&nbsp;</li>\r\n	<li>Diuretics, quinidine and its isomer quinine, magnesium salts, calcium channel blocking agents, lithium salts, local anaesthetics (lidocaine i.v., bupivacaine epidural) and acute administration of phenytoin&nbsp;</li>\r\n	<li>Recurarization has been reported after post-operative administration of: aminoglycoside, lincosamide, polypeptide and acylamino-penicillin antibiotics, quinidine, quinine and magnesium.</li>\r\n</ul>\r\n\r\n<p><strong>Decreased Effect</strong>: Prior chronic administration of phenytoin or carbamazepine. Protease inhibitors (gabexate, ulinastatin)&nbsp;<br />\r\n<br />\r\n<strong>Variable Effect</strong>: Administration of other non-depolarizing neuromuscular blocking agents in combination with Rocuronium Bromide may produce attenuation or potentiation of the neuromuscular block, depending on the order of administration and the neuromuscular blocking agent used. Suxamethonium given after the administration of Rocuronium Bromide may produce potentiation or attenuation of the neuromuscular blocking effect of Rocuronium Bromide.&nbsp;<br />\r\n<br />\r\n<strong>Effect of Rocuronium Bromide on other drugs</strong>: Rocuronium Bromide combined with lidocaine may result in a quicker onset of action of lidocaine.</p>', '<p>Hypersensitivity to Rocuronium or to the Bromide ion or to any of the excipients.</p>', '<p>In clinical trials, the most common adverse reactions (2%) are transient hypotension and hypertension. Other are:</p>\r\n\r\n<ul>\r\n	<li>Anaphylaxis&nbsp;</li>\r\n	<li>Residual paralysis&nbsp;</li>\r\n	<li>Myopathy&nbsp;</li>\r\n	<li>Increased pulmonary vascular resistance</li>\r\n</ul>\r\n\r\n<p>Although very rare, severe anaphylactic reactions to neuromuscular blocking agents, including Rocuronium Bromide, have been reported. Anaphylactic/anaphylactoid reactions are: bronchospasm, cardiovascular changes (e.g. hypotension, tachycardia, circulatory collapse - shock), and cutaneous changes (e.g. angioedema, urticaria). These reactions have, in some cases, been fatal. Due to the possible severity of these reactions, one should always assume they may occur and take the necessary precautions.&nbsp;<br />\r\n<br />\r\nSince neuromuscular blocking agents are known to be capable of inducing histamine release both locally at the site of injection and systemically, the possible occurrence of itching and erythematosus reactions at the site of injection and/or generalized histaminoid (anaphylactoid) reactions (see also under Anaphylactic Reactions above) should always be taken into consideration when administering these agents.&nbsp;In clinical studies only a slight increase in mean plasma histamine levels has been observed following rapid bolus administration of 0.3 0.9mg/kg Rocuronium Bromide.<br />\r\n<br />\r\n<strong>Prolonged neuromuscular block</strong>: The most frequent adverse reaction to nondepolarizing blocking agents as a class consists of an extension of the agent&#39;s pharmacological action beyond the time period needed. This may vary from skeletal muscle weakness to profound and prolonged skeletal muscle paralysis resulting in respiratory insufficiency or apnoea.&nbsp;<br />\r\n<br />\r\n<strong>Myopathy</strong>: Myopathy has been reported after the use of various neuromuscular blocking agents in the ICU in combination with corticosteroids.<br />\r\n<br />\r\n<strong>Local injection site reactions</strong>: During rapid sequence induction of anesthesia, pain on injection has been reported, especially when the patient has not yet completely lost consciousness and particularly when propofol is used as the induction agent. In clinical studies, pain on injection has been noted in 16% of the patients who underwent rapid sequence induction of anesthesia with propofol and in less than 0.5% of the patients who underwent rapid sequence induction of anesthesia with fentanyl and thiopental.</p>', '<p><strong>Pregnancy</strong>:&nbsp;For Rocuronium Bromide, no clinical data on exposed pregnancies are available. Animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal/foetal development, parturition or postnatal development. Caution should be exercised when prescribing Rocuronium Bromide to pregnant women.<br />\r\n<br />\r\n<strong>Caesarean section</strong>: In patients undergoing Caesarean section, Rocuronium Bromide can be used as part of a rapid sequence induction technique, provided no intubation difficulties are anticipated and a sufficient dose of anesthetic agent is administered or following suxamethonium facilitated intubation. Rocuronium Bromide, administered in doses of 0.6mg/kg, has been shown to be safe in parturient undergoing Caesarean section. Rocuronium Bromide does not affect Apgar score, foetal muscle tone nor cardio-respiratory adaptation. From umbilical cord blood sampling it is apparent that only limited placental transfer of Rocuronium Bromide occurs which does not lead to the observation of clinical adverse effects in the newborn.<br />\r\n<br />\r\n<strong>Lactation</strong>:&nbsp;It is unknown whether Rocuronium Bromide is excreted in human breast milk. Animal studies have shown insignificant levels of Rocuronium Bromide in breast milk. Animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal/foetal development, parturition or postnatal development. Rocuronium Bromide should be given to lactating women only when the attending physician decides that the benefits outweigh the risks.</p>', '<p><strong>Instructions for use/handling</strong>: Compatibility studies with the following infusion fluids have been performed. In nominal concentrations of 0.5mg/mL and 2.0mg/mL, Rocuronium Bromide has been shown to be compatible with: 0.9% NaCl, 5% dextrose, 5% dextrose in saline, sterile water for injections, Lactated Ringers and Haemaccel. Administration should be commenced immediately after mixing, and should be completed within 24 hours. Unused solutions should be discarded.<br />\r\n<br />\r\n<strong>For use/handling</strong>: If Rocuronium Bromide is administered via the same infusion line that is also used for other medicines, it is important that this infusion line is adequately flushed (e.g. with 0.9% NaCl) between administration of Rocuronium Bromide and medicines for which incompatibility with Rocuronium Bromide has been demonstrated or for which compatibility with Rocuronium Bromide has not been established.</p>', '<p>In the event of overdosage and prolonged neuromuscular block, the patient should continue to receive ventilatory support and sedation. In this situation there are two options for the reversal of neuromuscular block:<br />\r\n<br />\r\nSugammadex can be used for reversal of intense (profound) and deep block. The dose of sugammadex to be administered depends of the level of neuromuscular block.<br />\r\n<br />\r\nAn acetylcholinesterase inhibitor (e.g. neostigmine, edrophonium, pyridostigmine), with appropriate vagolytic (e.g atropine) can be used at reappearance of T2 or at the first signs of clinical recovery and should be administered in adequate doses. When administration of an acetylcholinesterase inhibiting agent fails to reverse the neuromuscular effects of Rocuronium Bromide, ventilation must be continued until spontaneous breathing is restored. Repeated dosage of an acetylcholinesterase inhibitor can be dangerous.</p>', '<p>Non depolarizing muscle relaxants.</p>', '<p>Rocuronium Bromide should be stored in the refrigerator at 2-8&deg; C and not be frozen.</p>', NULL, '2022-03-18 04:52:20', '2022-03-18 04:52:20');
INSERT INTO `generic_details` (`id`, `generic_id`, `indications`, `pharmacology`, `dosage_and_administration`, `interaction`, `contraindications`, `side_effects`, `pregnancy_and_lactation`, `precautions_and_warnings`, `overdose_effects`, `therapeutic_class`, `storage_conditions`, `use_in_special_populations`, `created_at`, `updated_at`) VALUES
(1300, 1300, '<p>Roflumilast is indicated:</p>\r\n\r\n<ul>\r\n	<li>As add-on therapy to bronchodilator treatment.</li>\r\n	<li>For the maintenance treatment of severe Chronic Obstructive Pulmonary Disease (COPD) associated with chronic bronchitis (i.e. patients with a history of chronic cough and sputum) in adult patients with a history of frequent exacerbations.</li>\r\n</ul>\r\n\r\n<p>Roflumilast should not be used as a rescue medication.</p>', '<p>Roflumilast is a phosphodiesterase-4 (PDE-4) inhibitor which, due to its selective inhibition of the PDE4 isoenzyme, has potential antiinflammatory and antimodulatory effects in the pulmonary system. It is thought that the increased levels of intracellular cyclic AMP are responsible for the therapeutic actions of Roflumilast.</p>', '<p>The recommended dosage for patients with COPD is one 500 mcg tablet daily, with or without food.</p>', '<p>A major step in Roflumilast metabolism is the N-oxidation of Roflumilast to Roflumilast N-oxide by CYP3A4 and CYP1A2. Therefore, the use of strong cytochrome P450 enzyme inducers (e.g. rifampicin, phenobarbital, carbamazepine, phenytoin) with Roflumilast is not recommended. The co-administration of Roflumilast with CYP3A4 inhibitors or dual inhibitors that inhibit both CYP3A4 and CYP1A2 simultaneously (e.g., erythromycin, ketoconazole, fluvoxamine, enoxacin, cimetidine) may increase Roflumilast systemic exposure and may result in increased adverse reactions. The co-administration of Roflumilast with oral contraceptives containing gestodene and ethinyl estradiol may increase roflumilast systemic exposure and may result in increased side effects.</p>', '<p>Hypersensitivity to Roflumilast or to any of the excipients. Moderate to severe liver impairment.</p>', '<p><strong>General disorders</strong>: Fatigue.<br />\r\n<strong>Metabolism and nutrition disorders</strong>: Decreased appetite, Weight decreased.<br />\r\n<strong>Musculoskeletal and connective tissue disorders</strong>: Back pain, muscle spasms.<br />\r\n<strong>Nervous system disorders</strong>: Dizziness, Headache, Tremor.<br />\r\n<strong>Psychiatric disorders</strong>: Anxiety, Depression, Insomnia.</p>', '<p>Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. Roflumilast should not be used during pregnancy &amp; lactation.</p>', '<p>Not as emergency treatment for relief of acute brochospasm. Monitor body wt regularly. Severe immunological disease, severe acute infections, cancers (except basal cell carcinoma) or patients on immunosuppressants; CHF (NYHA grades III &amp; IV). History of depression associated with suicidal ideation or behavior. Galactose intolerance, Lapp-lactase deficiency or glucose-galactose malabsorption. Hepatic impairment. Pregnancy &amp; lactation.</p>', '<p>No case of overdose has been reported in clinical studies with Roflumilast. However, during the Phase I studies of Roflumilast, at an increased rate after a single oral dose of 2500 mcg and a single dose of 5000 mcg,<br />\r\n<br />\r\n<strong>The following symptoms were observed</strong>:&nbsp;headache, gastrointestinal disorders, dizziness, palpitations, lightheadedness, clamminess and arterial hypotension.<br />\r\n<br />\r\n<strong>Missed Dose</strong>: Patients should be advised that if they forget to take a tablet at the usual time, they should take the tablet as soon as they remember or continue on the next day with the next tablet at the usual time. Patients should not take a double dose to make up for a forgotten dose.</p>', '<p>Antihistamines anti-allergies &amp; hypo-sensitisation.</p>', '<p>Store below 30&deg; C, keep away from light, moisture. Keep out of the reach of children.</p>', '<p><strong>Geriatrics ( 65 years of age)</strong>: There were no overall differences in safety and effectiveness of Roflumilast in the elderly compared to younger patients with COPD. Therefore, no dose adjustment is necessary.<br />\r\n<br />\r\n<strong>Pediatrics (&lt;18 years of age)</strong>: Safety and effectiveness of Roflumilast in children and adolescents below 18 years of age have not been established.<br />\r\n<br />\r\n<strong>Hepatic Impairment</strong>: Roflumilast is not recommended for use in patients with moderate or severe liver impairment.<br />\r\n<br />\r\n<strong>Renal impairment</strong>: No dosage adjustment is necessary for patients with renal impairment</p>', '2022-03-18 04:54:04', '2022-03-18 04:54:04'),
(1301, 1301, '<p>Ropinirole is indicated for the treatment of the signs and symptoms of idiopathic Parkinson&#39;s disease. It is also indicated for the treatment of moderate-to-severe primary Restless Legs Syndrome (RLS).</p>', '<p>Ropinirole is a non-ergoline dopamine agonist. Ropinirole has the highest affinity at the D3 receptors, which are concentrated in the limbic areas of the brain and may be responsible for some of the neuropsychiatric effects. The exact mechanism of action of ropinirole as a treatment for Parkinson&rsquo;s disease is unknown, however, it is believed to be related to its ability to selectively stimulate dopamine D2 receptors within the caudate-putamen system in the brain. This system affects body movement. Negligible affinity is seen for ropinirole at &alpha;2 adrenoreceptors in the periphery and 5HT-1 receptor. Ropinirole has no affinity at the D1-like receptors, benzodiazepine or GABA receptors. The precise mechanism of action of ropinirole as a treatment for Restless Legs Syndrome is unknown, however, it is believed to be related to its ability to stimulate dopamine receptors.</p>', '<p><strong>Dosing for Parkinson&#39;s disease</strong>: The recommended starting dose for Parkinson&#39;s disease is 0.25 mg three times daily. Based on individual patient therapeutic response and tolerability, if necessary, the dose should then be titrated with weekly increments as described below. Maximum recommended total daily dose of 24 mg (8 mg three times daily).</p>\r\n\r\n<ul>\r\n	<li><strong>Week 1</strong>: 0.25 mg 3 times daily. Total Daily Dose 0.75 mg</li>\r\n	<li><strong>Week 2</strong>: 0.5 mg 3 times daily. Total Daily Dose 1.50 mg</li>\r\n	<li><strong>Week 3</strong>: 0.75 mg 3 times daily. Total Daily Dose 2.25 mg</li>\r\n	<li><strong>Week 4</strong>: 1 mg 3 times daily. Total Daily Dose 3 mg</li>\r\n</ul>\r\n\r\n<p><strong>Dosing for Restless Legs Syndrome</strong>: The recommended adult starting dose for RLS is 0.25 mg once daily 1 to 3 hours before bedtime. After 2 days, if necessary, the dose can be increased to 0.5 mg once daily, and to 1 mg once daily at the end of the first week of dosing, then as shown below as needed to achieve efficacy. Titration should be based on individual patient therapeutic response and tolerability, up to a maximum recommended dose of 4 mg daily.</p>\r\n\r\n<ul>\r\n	<li><strong>Days 1 and 2</strong>: 0.25 mg, 1 to 3 hours before bedtime, to be taken once daily</li>\r\n	<li><strong>Days 3-7</strong>: 0.5 mg, 1 to 3 hours before bedtime, to be taken once daily</li>\r\n	<li><strong>Days 2</strong>: 1 mg, 1 to 3 hours before bedtime, to be taken once daily</li>\r\n	<li><strong>Days 3</strong>: 1.5 mg, 1 to 3 hours before bedtime, to be taken once daily</li>\r\n	<li><strong>Days 4</strong>: 2 mg, 1 to 3 hours before bedtime, to be taken once daily</li>\r\n	<li><strong>Days 5</strong>: 2.5 mg, 1 to 3 hours before bedtime, to be taken once daily</li>\r\n	<li><strong>Days 6</strong>: 3 mg, 1 to 3 hours before bedtime, to be taken once daily</li>\r\n	<li><strong>Days 7</strong>: 4 mg, 1 to 3 hours before bedtime, to be taken once daily</li>\r\n</ul>', '<p>Because Ropinirole is a dopamine agonist, it is possible that dopamine antagonists such as neuroleptics (phenothiazines, butyrophenones, thioxanthenes) or metodopramide may reduce the efficacy of Ropinirole.</p>', '<p>It is contraindicated in patients known to have a hypersensitivity to Ropinirole.</p>', '<p>The most common side effects of Ropinirole include fainting, drowsiness, hallucinations, dizziness, nausea or vomiting, uncontrolled sudden movements, leg swelling, fatigue, confusion, headache, upset stomach, abdominal pain or discomfort, increased sweating etc.</p>', '<p>Pregnancy category C. There is no adequate and well-controlled studies in pregnant women. It should be used during pregnancy only if the potential benefit outweighs the potential risk to the fetus. Ropinirole inhibits prolactin secretion in human and could potentially inhibit lactation.</p>', '<p>Patients treated with Ropinirole have reported falling asleep while engaged in activities of daily living. Dopamine agonists in clinical trials and clinical experience appear to impair the systemic regulation of blood pressure, with resulting orthostatic hypotension.</p>', NULL, '<p>Antiparkinson drugs.</p>', '<p>Protect from light and moisture, store below 25&deg;C. Keep out of the reach of children.</p>', NULL, '2022-03-18 04:59:18', '2022-03-18 04:59:18'),
(1302, 1302, '<p>Rosiglitazone is indicated</p>\r\n\r\n<ul>\r\n	<li>As monotherapy for glycemic control.</li>\r\n	<li>For use in combination with a sulfonylurea, metformin, or insulin when diet, exercise, and a single agent do not result in adequate glycemic control.</li>\r\n	<li>Also for use in combination with a sulfonylurea plus metformin when diet, exercise, and both agents do not result in adequate glycemic control.</li>\r\n</ul>', '<p>Rosiglitazone, a member of the thiazolidinedione class of antidiabetic agents, improves glycemic control by improving insulin sensitivity. Rosiglitazone is a highly selective and potent agonist for the peroxisome proliferator-activated receptor gamma (PPAR-&gamma;). In humans, PPAR receptors are found in key target tissues for insulin action such as adipose tissue, skeletal muscle, and liver. Activation of PPAR-&gamma; nuclear receptors regulates the transcription of insulinresponsive genes involved in the control of glucose production, transport, and utilization. In addition, PPAR-&gamma;-responsive genes also participate in the regulation of fatty acid metabolism. Pharmacological studies in animal models indicate that Rosiglitazone improves sensitivity to insulin in muscle and adipose tissue and inhibits hepatic gluconeogenesis. Rosiglitazone maleate is not chemically or functionally related to the sulfonylureas, the biguanides, or the alpha glucosidase inhibitors.</p>', '<p>The management of antidiabetic therapy should be individualized. Rosiglitazone may be administered either at a starting dose of 4 mg as a single daily dose or divided and administered in the morning and evening. For patients who respond inadequately following 8 to 12 weeks of treatment, as determined by reduction in FPG, the dose may be increased to 8 mg daily as monotherapy or in combination with metformin, sulfonylurea, or sulfonylurea plus metformin. Rosiglitazone may be taken with or without food.<br />\r\n<br />\r\n<strong>Monotherapy</strong>: The usual starting dose of Rosiglitazone is 4 mg administered either as a single dose once daily or in divided doses twice daily. In clinical trials, the 4 mg twice daily regimen resulted in the greatest reduction in FPG and HbA1c.<br />\r\n<br />\r\n<strong>Combination therapy</strong>: When Rosiglitazone is added to existing therapy, the current dose(s) of the agent(s) can be continued upon initiation of Rosiglitazone therapy.<br />\r\n<br />\r\n<strong>Sulfonylurea</strong>: When used in combination with sulfonylurea, the usual starting dose of Rosiglitazone is 4 mg administered as either a single dose once daily or in divided doses twice daily. If patients report hypoglycemia, the dose of the sulfonylurea should be decreased.<br />\r\n<br />\r\n<strong>Metformin</strong>: The usual starting dose of Rosiglitazone in combination with metformin is 4 mg administered as either a single dose once daily or in divided doses twice daily. It is unlikely that the dose of metformin will require adjustment due to hypoglycemia during combination therapy with Rosiglitazone.<br />\r\n<br />\r\n<strong>Insulin</strong>: For patients stabilized on insulin, the insulin dose should be continued upon initiation of therapy with Rosiglitazone. Rosiglitazone should be dosed at 4 mg daily. Doses of Rosiglitazone greater than 4 mg daily in combination with insulin are not currently indicated. It is recommended that the insulin dose be decreased by 10% to 25% if the patient reports hypoglycemia or if FPG concentrations decrease to less than 100 mg/dL. Further adjustments should be individualized based on glucose-lowering response.<br />\r\n<br />\r\n<strong>Sulfonylurea plus metformin</strong>: The usual starting dose of Rosiglitazone in combination with a sulfonylurea plus metformin is 4 mg administered as either a single dose once daily or in divided doses twice daily. If patients report hypoglycemia, the dose of the sulfonylurea should be decreased.<br />\r\n<br />\r\n<strong>Maximum Recommended Dose</strong>: The dose of Rosiglitazone should not exceed 8 mg daily, as a single dose or divided twice daily. The 8 mg daily dose has been shown to be safe and effective in clinical studies as monotherapy and in combination with metformin, sulfonylurea, or sulfonylurea plus metformin. Doses of Rosiglitazone greater than 4 mg daily in combination with insulin are not currently indicated. No dosage adjustments are required for the elderly. No dosage adjustment is necessary when Rosiglitazone is used as monotherapy in patients with renal impairment.</p>', '<p>In vitro drug metabolism studies suggest that Rosiglitazone does not inhibit any of the major P450 enzymes at clinically relevant concentrations. A decrease in the dose of Rosiglitazone may be needed when gemfibrozil is introduced. Dosage adjustment is also required when administered with rifampin. Rosiglitazone was shown to have no clinically relevant effect on the pharmacokinetics of nifedipine and oral contraceptives.</p>', '<p>Rosiglitazone is contraindicated in patients with known hypersensitivity to this product or any of its components.</p>', '<p>The incidence and types of adverse events reported in clinical trials of Rosiglitazone as monotherapy are similar to that of placebo. Overall, the types of adverse experiences reported when Rosiglitazone was used in combination with a sulfonylurea or metformin were similar to those during monotherapy with Rosiglitazone. Events of anemia and edema tended to be reported more frequently at higher doses, and were generally mild to moderate in severity and usually did not require discontinuation of treatment with Rosiglitazone.</p>', '<p>There are no adequate and well-controlled studies in pregnant women. Rosiglitazone should not be used during pregnancy unless the potential benefit justifies the potential risk to the fetus. Drug-related material was detected in milk from lactating rats. It is not known whether Rosiglitazone is excreted in human milk. Because many drugs are excreted in human milk, Rosiglitazone should not be administered to a nursing woman.</p>', '<p>Due to its mechanism of action, Rosiglitazone is active only in the presence of endogenous insulin. Therefore, Rosiglitazone should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. Rosiglitazone, like other thiazolidinediones, alone or in combination with other antidiabetic agents, can cause fluid retention, which may exacerbate or lead to heart failure. Patients should be observed for signs and symptoms of heart failure. In combination with insulin, thiazolidinediones may also increase the risk of other cardiovascular adverse events. Rosiglitazone should be discontinued if any deterioration in cardiac status occurs. Rosiglitazone should be used with caution in patients with edema. Liver enzymes should be checked prior to the initiation of therapy with Rosiglitazone in all patients and periodically thereafter per the clinical judgement of the healthcare professional. Therapy with Rosiglitazone should not be initiated in patients with increased baseline liver enzyme levels (ALT &gt;2.5X upper limit of normal).</p>', NULL, '<p>Thiazolidinedione Group.</p>', '<p>Protect from light and moisture. Store in a cool and dry place.</p>', '<p><strong>Use in Children</strong>: The safety and effectiveness of Rosiglitazone in pediatric patients have not been established.</p>', '2022-03-18 05:01:06', '2022-03-18 05:01:06'),
(1303, 1303, '<p>This is indicated as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus who are not adequately controlled on Metformin alone. Management of type 2 diabetes mellitus should include diet control. Caloric restriction, weight loss, and exercise are essential for the proper treatment of the diabetic patient because they help improve insulin sensitivity. This is important not only in the primary treatment of type 2 diabetes but also in maintaining the efficacy of drug therapy.</p>', '<p>Combination of two antidiabetic agents with different mechanisms of action to improve glycemic control in patients with type 2 diabetes: Rosiglitazone maleate, a member of the thiazolidinedione class, and Metformin hydrochloride, a member of the biguanide class. Thiazolidinediones are insulin sensitizing agents that act primarily by enhancing peripheral glucose utilization, whereas biguanides act primarily by decreasing endogenous hepatic glucose production.<br />\r\n<br />\r\nRosiglitazone is a highly selective and potent agonist for the peroxisome proliferator&ndash;activated receptor-gamma (PPAR&gamma;). Activation of PPAR&gamma; nuclear receptors regulates the transcription of insulin-responsive genes involved in the control of glucose production, transport, and utilization. In addition, PPAR&gamma;-responsive genes also participate in the regulation of fatty acid metabolism.<br />\r\n<br />\r\nThe pharmacologic mechanism of action of Metformin is different from other classes of oral antihyperglycemic agents. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and increases peripheral glucose uptake and utilization. Unlike sulfonylureas, With Metformin therapy, insulin secretion remains unchanged while fasting insulin levels and day-long plasma insulin&nbsp;response may actually decrease.</p>', '<p>The selection of the dose of Rosiglitazone and Metformin combination should be based on the patient&rsquo;s current doses of Rosiglitazone and/or Metformin. The safety and efficacy of Rosiglitazone and Metformin combination as initial therapy for patients with type 2 diabetes mellitus have not been established.<br />\r\n<br />\r\nThe following recommendations regarding the use of Rosiglitazone and Metformin combination in patients inadequately controlled on Rosiglitazone and Metformin monotherapies are based on clinical practice experience with Rosiglitazone and Metformin combination therapy.</p>\r\n\r\n<ul>\r\n	<li>The dosage of antidiabetic therapy with Rosiglitazone and Metformin combination should be individualized on the basis of effectiveness and tolerability while not exceeding the maximum recommended daily dose of 8 mg/2,000 mg.</li>\r\n	<li>Rosiglitazone and Metformin combination should be given in divided doses with meals, with gradual dose escalation. This reduces GI side effects (largely due to Metformin) and permits determination of the minimum effective dose for the individual patient.</li>\r\n	<li>Sufficient time should be given to assess adequacy of therapeutic response. Fasting plasma glucose (FPG) should be used to determine the therapeutic response to Rosiglitazone and Metformin combination . After an increase in Metformin dosage, dose titration is recommended if patients are not adequately controlled after 1 to 2 weeks. After an increase in Rosiglitazone dosage, dose titration is recommended if patients are not adequately controlled after 8 to 12 weeks.</li>\r\n</ul>\r\n\r\n<p><strong>For patients inadequately controlled on Metformin monotherapy</strong>: The usual starting dose of Rosiglitazone and Metformin combination is 4 mg Rosiglitazone (total daily dose) plus the dose of Metformin already being taken.<br />\r\n<br />\r\n<strong>For patients inadequately controlled on Rosiglitazone monotherapy</strong>: The usual starting dose of Rosiglitazone and Metformin combination is 1,000 mg Metformin (total daily dose) plus the dose of Rosiglitazone already being taken.</p>', '<p>If an inhibitor or an inducer of CYP2C8 (such as gemfibrozil or rifampin) is started or stopped during treatment with Rosiglitazone, changes in diabetes treatment may be needed based upon clinical response.<br />\r\n<br />\r\nAlthough drug interactions with cationic drugs (e.g., amiloride, digoxin, morphine, procainamide, quinidine, quinine, ranitidine, triamterene, trimethoprim, and vancomycin) remain theoretical (except for cimetidine), careful patient monitoring and dose adjustment of combination of Rosiglitazone and Metformin and/or the interfering drug is recommended in patients who are taking cationic medications that are excreted via the proximal renal tubular secretory system.<br />\r\n<br />\r\nWhen drugs that produce hyperglycemia which may lead to loss of glycemic control are administered to a patient receiving combination of Rosiglitazone and Metformin, the patient should be closely observed to maintain adequate glycemic control.</p>', '<p>Combination of Rosiglitazone and Metformin tablets are<br />\r\ncontraindicated in patients with:</p>\r\n\r\n<ul>\r\n	<li>Renal disease or renal dysfunction which may also result from conditions such as cardiovascular collapse (shock), acute myocardial infarction, and septicemia</li>\r\n	<li>Congestive heart failure requiring pharmacologic treatment.</li>\r\n	<li>Known hypersensitivity to Rosiglitazone maleate or Metformin hydrochloride.</li>\r\n	<li>Acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma. Diabetic ketoacidosis should be treated with insulin.</li>\r\n</ul>\r\n\r\n<p>Combination of Rosiglitazone and Metformin should be temporarily discontinued in patients undergoing radiologic studies involving intravascular administration of iodinated contrast materials, because use of such products may result in acute alteration of renal function.</p>', '<p>The incidence and types of adverse events reported in clinical trials of Rosiglitazone as monotherapy are upper respiratory tract infection, headache, back pain, hyperglycemia, fatigue, sinusitis, diarrhea, and hypoglycemia. Adverse reactions reported in greater than 5% of the Metformin patients, and that were more common in Metformin- than placebo-treated patients are diarrhea, nausea, vomiting, flatulence, asthenia, indigestion, abdominal discomfort, headache.</p>', '<p>Pregnancy Category C. Because current information strongly suggests that abnormal blood glucose levels during pregnancy are associated with a higher&nbsp;incidence of congenital anomalies as well as increased neonatal morbidity and mortality, most experts recommend that insulin monotherapy be used during pregnancy to maintain blood glucose levels as close to normal as possible. Combination of Rosiglitazone and Metformin should not be used during pregnancy unless the potential benefit justifies the potential risk to the fetus. There are no adequate and well-controlled studies in pregnant women with combination of Rosiglitazone and Metformin or its individual components.<br />\r\n<br />\r\nIt is not known whether Rosiglitazone and/or Metformin are excreted in human milk. Because many drugs are excreted in human milk,&nbsp;a combination of Rosiglitazone and Metformin should not be administered to a nursing woman.</p>', '<p>When a patient stabilized on any diabetic regimen is exposed to stress such as fever, trauma, infection, or surgery, a temporary loss of glycemic control may occur. At such times, it may be necessary to withhold combination of Rosiglitazone and Metformin and temporarily administer insulin. Combination of Rosiglitazone and Metformin may be reinstituted after the acute episode is resolved. Combination of Rosiglitazone and Metformin should be used with caution in patients with edema.</p>', NULL, '<p>Combination Oral hypoglycemic preparations.</p>', '<p>Store in a cool dry place protected from light. Keep out of reach of children.</p>', '<p><strong>Pediatric Use</strong>: Safety and effectiveness of&nbsp;combination of Rosiglitazone and Metformin in pdiatric patients have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Because aging is associated with&nbsp;reduced renal function, combination of Rosi litazone and Metformin should be used with caution as age increases. Care should be taken in dose selection and should be based on careful and regular monitoring of renal function. Generally, elderly patients should not be titrated to the maximum dose of combination of Rosiglitazone and Metformin.</p>', '2022-03-18 05:02:54', '2022-03-18 05:02:54'),
(1304, 1304, '<p>Rosuvastatin is indicated in-</p>\r\n\r\n<ul>\r\n	<li>Heterozygous Hypercholesterolemia (Familial and Non familial)</li>\r\n	<li>Homozygous Hypercholesterolemia (Familial)</li>\r\n	<li>Mixed Dyslipidemia (Fredrickson Type IIa and IIb)</li>\r\n	<li>Primary prevention of cardiovascular disease</li>\r\n</ul>', '<p>Rosuvastatin is a selective and competitive inhibitor of HMG-CoA reductase, the rate-limiting enzyme that converts 3-hydroxy-3-methyl glutaryl coenzyme A to mevalonate, a precursor of cholesterol. Rosuvastatin produces its lipid-modifying effects in two ways. First, it increases the number of hepatic LDL receptors on the cell surface to enhance uptake and catabolism of LDL. Second, Rosuvastatin inhibits hepatic synthesis of VLDL, which reduces the total number of VLDL and LDL particles.</p>', '<p><strong>Dose range</strong>: 5-40 mg once daily. Use 40 mg dose only for patients not reaching LDL-C goal with 20 mg<br />\r\n<br />\r\n<strong>HoFH</strong>: Starting dose 20 mg/day.<br />\r\n<br />\r\n<strong>Pediatric patients with HeFH</strong>: 5-10 mg/day for patients 8 to less than 10 years age, and 5-20 mg/day for patients 10 to 17 years of age.<br />\r\n<br />\r\n<strong>Pediatric patients with HoFH</strong>: 20 mg/day for patients 7 to 17 years of age.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>Rosuvastatin can be taken with or without food, at any time of day.</p>', '<p>Remarkable drug interactions of Rosuvastatin are-</p>\r\n\r\n<ul>\r\n	<li><strong>Cyclosporine</strong>: Combination increases Rosuvastatin exposure. Rosuvastatin dose should be limited to 5 mg once daily.</li>\r\n	<li><strong>Gemfibrosil</strong>: Combination should be avoided. If used together, Rosuvastatin dose should be limited to 10 mg once daily.</li>\r\n	<li><strong>Lopinavir/Ritonavir or atazanavir/ritonavir</strong>: Combination increases Rosuvastatin exposure. Rosuvastatin dose should be to 10 mg once daily.</li>\r\n	<li><strong>Coumarin anticoagulants</strong>: Combination prolongs international normalized ratio (INR). Stable INR should be achieved prior to starting Rosuvastatin. INR should be monitored frequently until stable upon initiation or alteration of Rosuvastatin therapy.</li>\r\n	<li><strong>Concomitant lipid-lowering therapies</strong>: Use with fibrates and niacin products may increase the risk of skeletal muscle effects.</li>\r\n</ul>', '<p>Rosuvastatin is contraindicated if-</p>\r\n\r\n<ul>\r\n	<li>Known hypersensitivity to product components</li>\r\n	<li>Liver disease, which may include unexplained persistent elevations in hepatic transaminase levels</li>\r\n	<li>Pregnant women and women who may become pregnant</li>\r\n	<li>Nursing mothers</li>\r\n</ul>', '<p>Rosuvastatin is generally well tolerated. The most frequent adverse events thought to be related to Rosuvastatin were headache, myalgia, constipation, asthenia, abdominal pain and nausea.</p>', '<p>The safety in pregnant women has not been established. It is not known whether Rosuvastatin is excreted in human milk or not.</p>', '<p><strong>Skeletal muscle effects (e.g., myopathy and rhabdomyolysis)</strong>: Risks increase with use of 40 mg dose, advanced age (&gt;65 year), hypothyroidism, renal impairment and combination use with cyclosporine, lopinavir/ritonavir, atazanavir/ritonavir or certain other lipid-lowering drugs. Patients should be advised to promptly report unexplained muscle pain, tenderness or weakness. Rosuvastatin can be discontinued if signs or symptoms appear.<br />\r\n<br />\r\n<strong>Liver enzyme abnormalities and monitoring</strong>: Persistent elevations in hepatic transaminases can occur.<br />\r\n<br />\r\nLiver enzymes should be monitored before and during treatment</p>', NULL, '<p>Other Anti-anginal &amp; Anti-ischaemic drugs, Statins.</p>', '<p>Keep below 30oC temperature, protected from light &amp; moisture. Keep out of the reach of children.</p>', '<p><strong>Use in children</strong>: The safety and effectiveness in pediatric patients have not been established.</p>', '2022-03-18 05:04:49', '2022-03-18 05:04:49'),
(1305, 1305, '<p>Rotavirus vaccine is indicated for the prevention of rotavirus gastroenteritis in infants and children caused by Types G1, G2, G3, G4, and G9 when administered as a 3-dose series to infants between the ages of 6 to 32 weeks. The first dose of Rotavirus vaccine should be administered between 6 and 12 weeks of age.<br />\r\n<br />\r\nThe vaccination series consists of 3 ready-to-use liquid doses of Rotavirus vaccine administered orally starting at 6 to 12 weeks of age, with the subsequent doses administered at 4- to 10-week intervals. The third dose should not be given after 32 weeks of age.</p>', '<p>Rotavirus is one of the important causes of severe acute gastroenteritis in infants and young children. There are 2 commercially available forms of rotavirus vaccine. Rotavirus is a live, attenuated monovalent vaccine derived from human strain indicated for prevention of rotavirus gastroenteritis caused by G1, G3, G4 and G9 serotypes; Rotavirus as a live, pentavalent human-bovine reassortant vaccine indicated for prevention of gastreoenteritis caused by rotavirus serotypes G1, G2, G3 and G4. Although presence of porcine cirovirus (PCV1 and PCV2) DNA have been detected in the rotavirus vaccine, current available information shows that there is no evidence that PCV1 or PCV2 poses a safety risk to humans. Exact immunologic mechanism of action is not fully understood although it is known that vaccine viruses replicate in the small intestine and promote active immunity.</p>', '<p>The vaccination course consists of two doses. The first dose may be administered from the age of 6 weeks. There should be an interval of at least 4 weeks between the dosages. The vaccination course should be completed by the age of 24 weeks. Lyophilised vaccine to be recostituted with a liquid diluent before oral administration. After reconstitution, 1 dose (1 ml) contains- live attenuated human rotavirus RIX4414 strain not less than 106&nbsp;CCID50. Repeat dosing is not indicated if an infant should spit out, regurgitate or vomit during or after the administration of the vaccine. The vaccination course should be completed as recommended above. There are no restrictions on the infant&#39;s consumption of food or liquid, including breast-milk, either before or after vaccination.</p>', '<p>Rotavirus vaccine can be given concomitantly with any of the following administered either as monovalent or as combination vaccines: Diphtheria-tetanus-whole cell pertussis vaccine&nbsp;(DTPw), Diphtheria-tetanus-acellular pertussis vaccine (DTPa), Haemophilus influenzae type b vaccine (Hib). inactivated Polio vaccine (IPV), Hepatitis B vaccine and Pneumococcal vaccine.<br />\r\n<br />\r\nConcomitant administration of Rotavirus vaccine and oral polio vaccine (OPV) does not affect the immune response to the polio antigens. Although concomitant administration of OPV may slightly reduce the immune response to rota virus vaccine there is currently no evidence that clinical protection against severe rotavirus gastroenteritis would be affected. The immune response to Rotavirus vaccine is unaffected when OPV is administered two weeks apart from Rotavirus vaccine. Effects on ability to drive and use machines- not applicable.</p>', '<p>Subjects with history of intussusception. Subjects with Severe Combined Immunodeficiency (SCID) disorder The presence of a minor infection, such as a cold, is not a contraindication for immunisation.</p>', '<p>In controlled clinical studies, the adverse reaction profile observed in the subjects receiving Rotavirus vaccine was similar to the adverse reaction profile observed in subjects receiving placebo. No increase in the incidence or severity of these reactions was seen with the second dose.<br />\r\n<br />\r\nHowever, some adverse reactions considered as being at least possibly related to Rotavirus vaccine vaccination were reported. Very common areirritability, loss of appetite; common arediarrhoea, vomiting, flatulence, abdominal pain, regurgitation of food, fever, fatigue; uncommon are- crying, sleep disorder, somnolence, constipation rare; upper respiratory tract infection hoarseness, rhinorrhoea, dermatitis, rash, muscle cramp; very rare- gastro-enteritis. In a large safety trial, subjects vaccinated with Rotavirus vaccine gave evidence of no increased risk of intussusception when compared with subjects receiving a placebo.</p>', '<p>Pregnancy Category C. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.</p>', '<p>It is good clinical practice that vaccination should be preceded by a review of the medical history (especially with regard to previous vaccination and possible occurrence of undesirable events) and a clinical examination. Parents/ guardians should be advised to seek medical advice promptly where these signs/symptoms are evident. There is a potential risk for transmission to non-vaccinated contacts. It should be administered with caution to infants with close contacts who are immunodeficient, such as household members with malignancies or who are otherwise immunocompromised or receiving immunosuppressive therapy. Contacts of recent vaccinees should be advised to observe personal hygiene</p>', NULL, '<p>Vaccines, Anti-sera &amp; Immunoglobulin.</p>', '<p>Store refrigerated at 2&deg; to 8&deg;C. Protect vials from light.</p>', NULL, '2022-03-18 05:06:32', '2022-03-18 05:06:32'),
(1306, 1306, '<p>For the treatment of disorders of the upper gastro intestinal region that are due to an excess of hydrochloric acid in the gastric juice, i.e. duodenal ulcers, benign gastric ulcers. Also for prophylaxis of recurrent gastric and duodenal ulcers.</p>', '<p>Roxatidine acetate suppresses the effect of histamine on the parietal cells of the stomach (H2-receptor antagonist). This suppressive action is dose-dependent. As a result, the production and secretion, particularly of gastric acid, are reduced. Roxatidine acetate has no antiandrogenic effects and does not influence drug-metabolizing enzymes in the liver.<br />\r\n<br />\r\nThe H2 antagonists are competitive inhibitors of histamine at the parietal cell H2 receptor. They suppress the normal secretion of acid by parietal cells and the meal-stimulated secretion of acid. They accomplish this by two mechanisms: histamine released by ECL cells in the stomach is blocked from binding on parietal cell H2 receptors which stimulate acid secretion, and other substances that promote acid secretion (such as gastrin and acetylcholine) have a reduced effect on parietal cells when the H2 receptors are blocked.</p>', '<p><strong>Zollinger-Ellison syndrome</strong>:&nbsp;75 mg bid.<br />\r\n<br />\r\n<strong>Gastro-oesophageal reflux disease</strong>:&nbsp;75 mg bid or 150 mg at bedtime for 6-8 wk.<br />\r\n<br />\r\n<strong>Premedication before&nbsp;</strong>anaesthesia:&nbsp;75 mg in the evening on the day before surgery and repeated 2 hr before induction of anaesthesia. Alternatively, 150 mg once on the night before surgery.<br />\r\n<br />\r\n<strong>Peptic ulcer</strong>:&nbsp;150 mg at bedtime or 75 mg bid daily for 4-6 wk. Maintenance: 75 mg at bedtime.<br />\r\n<br />\r\n<strong>Gastritis</strong>:&nbsp;75 mg once daily in the evening..</p>', '<p>May affect serum levels of protease inhibitors.</p>', '<p>Lactation, Porphyria.</p>', '<p>Occasional headache, GI disturbances, gynaecomastia, alopecia, blood dyscrasias, pancreatitis, sleep disturbances, restlessness, rarely dizziness. Hypersensitivity reactions e.g. rash and itching reported occasionally. Changes in pulse rate and transient impairment of sexual drive. Possible increase in liver enzyme activity. May reduce leucocytes and/or thrombocytes.</p>', '<p>Pregnancy category is not classified. Contraindications in lactation.</p>', '<p>Renal and hepatic impairment, pregnancy. May mask the symptoms of gastric malignancy.</p>', NULL, '<p>H2 receptor antagonist.</p>', NULL, '<p><strong>Renal Impairment:</strong><br />\r\n<br />\r\nZollinger-Ellison syndrome:</p>\r\n\r\n<ul>\r\n	<li>CrCl &lt;20: 75 mg every 2 days.</li>\r\n	<li>CrCl 20-50: 75 mg at bedtime.</li>\r\n</ul>\r\n\r\n<p>Gastro-oesophageal reflux disease:</p>\r\n\r\n<ul>\r\n	<li>CrCl &lt;20: 75 mg every 2 days.</li>\r\n	<li>CrCl 20-50: 75 mg at bedtime.</li>\r\n</ul>\r\n\r\n<p>Peptic ulcer:</p>\r\n\r\n<ul>\r\n	<li>CrCl &lt;20: 75 mg every 2 days.</li>\r\n	<li>CrCl 20-50: 75 mg at bedtime.</li>\r\n</ul>\r\n\r\n<p>Gastritis:</p>\r\n\r\n<ul>\r\n	<li>CrCl &lt;20: 75 mg every 2 days.</li>\r\n	<li>CrCl 20-50: 75 mg at bedtime.</li>\r\n</ul>', '2022-03-18 05:08:22', '2022-03-18 05:08:22'),
(1307, 1307, '<p>Roxithromycin is indicated in the treatment of infections caused by susceptible microorganisms-</p>\r\n\r\n<ul>\r\n	<li><strong>Respiratory infections</strong>&nbsp;like pneumonia, acute and chronic bronchitis, and bronchopneumonia</li>\r\n	<li><strong>ENT infections</strong>&nbsp;like tonsillitis, pharyngitis, sinusitis and otitis media.</li>\r\n	<li><strong>Skin infections</strong>&nbsp;like folliculitis, furuncles, cellulitis, carbuncles, pyoderma, impetigo and infected dermatitis.</li>\r\n	<li><strong>Genital infections</strong>&nbsp;like urethritis, prostatitis, cervicitis and salpingitis especially if produced by Chlamydia trachomatis.</li>\r\n</ul>', '<p>Roxithromycin inhibits protein synthesis by irreversibly binding to the 50s ribosomal subunits thus blocking the transpeptidation or translocation reactions of susceptible organisms resulting in stunted cell growth.</p>', '<p><strong>Adult dose</strong>: The usual dose for adults is one 300 mg tablet once daily or one 150 mg tablet twice a day for at least two days after resolution of symptoms, a normal course of therapy is between 5 and 10 days. Roxithromycin is best administered on empty stomach. In severe hepatic impairment the dose is 150 mg once daily.<br />\r\n<br />\r\n<strong>Pediatric dose</strong>: The dose for children is 2.5 to 5 mg/kg body weight twice a day. The following general guidelines can be followed</p>\r\n\r\n<ul>\r\n	<li><strong>6 to 11 Kg</strong>: 25 mg Roxithromycin 12 hourly.</li>\r\n	<li><strong>12 to 23 Kg</strong>: 50 mg Roxithromycin 12 hourly.</li>\r\n	<li><strong>24 to 40 Kg</strong>: 100 mg Roxithromycin 12 hourly.</li>\r\n</ul>\r\n\r\n<p>A normal course of therapy is between 5 and 10 days.</p>', '<p>Roxithromycin does not have any affinity for cytochrome P-450 binding sites and thus is unlikely to produce drug interaction mediated by this enzymatic system. Roxithromycin shows mild interaction with theophylline though this has not been found to produce clinically relevant effects. Alteration in the pharmacokinetics of carbamazepine or warfarin has not been found. Antacids, H2- receptor antagonists and food has no effect on the absorption of Roxithromycin.</p>', '<p>Roxithromycin should not be administered simultaneously with ergotamine or its derivatives as it may provoke arterial spasm and severe ischaemia.</p>', '<p>Roxithromycin is well tolerated by patients of all age groups. Less than 4% of treated patients complain of side effects mainly nausea, abdominal pain, diarrhoea and hypersensitivity rash. Other side effects reported include vomiting, dizziness, headache, pruritus, dyspepsia, flatulence, tinnitus, vertigo and constipation. These are in general minor and do not necessitate withdrawal of therapy.</p>', '<p>The safety of Roxithromycin in pregnancy has not been established. It appears in breast milk in small amounts and dose not produce adverse effects in the breast fed infant.</p>', '<p>Roxithromycin should not be used in patients with a history of hypersensitivity to the drug. In patients with hepatic diseases the dose of Roxithromycin should not exceed 150 mg twice a day.</p>', NULL, '<p>Macrolides.</p>', NULL, NULL, '2022-03-18 05:09:50', '2022-03-18 05:09:50'),
(1308, 1308, '<p>Rupatadine is indicated for the symptomatic treatment of Seasonal &amp; Perennial Allergic Rhinitis and Urticaria.</p>', '<p>Rupatadine is a long-acting, non-sedative antagonist of histamine H1-receptors. It also antagonizes the platelet activating factor (PAF). Both histamine and PAF cause broncho constriction which leads to an increase in the vascular permeability and act as a mediator in the inflammatory process. With the dual mode of action, Rupatadine shows better therapeutic effect than an isolated antihistamine. Rupatadine possesses other anti allergic properties such as the inhibition of the degranulation of mast cells induced by immunological and non immunological stimuli and inhibition of the release of cytokines, particularly of the tumor necrosis factor alpha (TNF &alpha;) in human mastocytes and monocytes.</p>', '<p>Adults and adolescents (over 12 years): The recommended dose is 10 mg once a day. Rupatadine may be taken with or without food.<br />\r\n<br />\r\nChildren aged 2 to 11 year:</p>\r\n\r\n<ul>\r\n	<li>Children weighing 25 kg or more: 1 teaspoonful (5 ml) of the oral solution once daily with or without food.</li>\r\n	<li>Children weighing equal or more than 10 kg to less than 25 kg: 1/2 teaspoonful (2.5 ml) oral solution once daily with or without food.</li>\r\n</ul>', '<p>With medicine: The concomitant administration of Rupatadine 20 mg and ketoconazole or erythromycin increases the systemic exposure. Rupatadine should be used with caution when it is administered concomitantly with these drug substances and other inhibitors of the isozyme CYP3A4. Rupatadine should be used with caution when it is co-administered with statins, CNS depressants or alcohol.<br />\r\n<br />\r\nWith food: Grapefruit and Grapefruit juice should not be taken simultaneously with Rupatadine</p>', '<p>Hypersensitivity to Rupatadine or to any of the excipients..</p>', '<p>Common: Asthenia, dizziness, drowsiness. Uncommon: Appetite increased, arthralgia, back pain, concentration impaired, constipation, cough, diarrhea, dry throat, epistaxis, fever, gastrointestinal discomfort, increased risk of infection, irritability, malaise, myalgia, nasal dryness, nausea, oropharyngeal pain, rash, thirst, vomiting, weight increased. Rare: Palpitations, tachycardia.</p>', '<p>There is no clinical data available on the exposure of Rupatadine during pregnancy. Pregnant women should therefore not use Rupatadine unless the potential benefit outweighs the potential risk for the infant. No information is available, whether Rupatadine is excreted in the mother&#39;s milk. Therefore, it should not be used during lactation, unless the potential benefits for the mother justify the potential risk to the infant.</p>', '<p>Rupatadine should be used with caution in patients with known prolongation of the QT interval, patients with uncorrected hypokalemia, and patients with ongoing proarrhythmic conditions, such as clinically significant bradycardia or acute myocardial ischemia. Rupatadine should be used with caution in elderly patients (65 years and older). As there is no clinical experience in patients with impaired kidney or liver function, the use of Rupatadine 10 mg tablets is at present not recommended in these patients.</p>', '<p>The most common adverse reaction was somnolence. If accidental ingestion of very high doses occurs, symptomatic treatment together with the required supportive measures should be given.</p>', '<p>Non-sedating antihistamines.</p>', '<p>Store in cool &amp; dry place below 30&deg;C, protect from light &amp; moisture. Keep out of reach of children.</p>', '<p><strong>Elderly:</strong>&nbsp;Rupatadine should be used with caution in elderly. No information is available that indicates the requirement of any dose adjustment in this population.<br />\r\n<br />\r\n<strong>Children:</strong>&nbsp;Neither the safety nor the efficacy of Rupatadine has been established in patients less than 12 years of age.<br />\r\n<br />\r\n<strong>Patients with renal or hepatic insufficiency:</strong>&nbsp;Use of Rupatadine is not recommended in patients with renal or hepatic insufficiency. As no relevant clinical data is available.</p>', '2022-03-18 05:11:48', '2022-03-18 05:11:48');

INSERT INTO `generic_details` (`id`, `generic_id`, `indications`, `pharmacology`, `dosage_and_administration`, `interaction`, `contraindications`, `side_effects`, `pregnancy_and_lactation`, `precautions_and_warnings`, `overdose_effects`, `therapeutic_class`, `storage_conditions`, `use_in_special_populations`, `created_at`, `updated_at`) VALUES
(1317, 1317, '<p>This is a vaccine indicated for active immunization for the prevention of varicella in individuals 12 months of age and older.</p>', '<p>Varicella Virus Vaccine induces both cell-mediated and humoral immune responses to varicella-zoster virus. The relative contributions of humoral immunity and cell-mediated immunity to protection from varicella are unknown.</p>', '<p>Each 0.5 mL dose of Varicella Virus Vaccine is administered subcutaneously. Inject the vaccine subcutaneously into the outer aspect of the deltoid region of the upper arm or into the higher anterolateral area of the thigh.<br />\r\n<br />\r\n<strong>Children (12 months to 12 years of age)</strong>: The first dose is administered at 12 to 15 months of age but may be given anytime through 12 years of age. The second dose is administered at 4 to 6 years of age. At least 3 months should elapse between a dose of varicella-containing vaccine. At least 1 month should elapse between a dose of measles-containing vaccine and a dose of Varicella Virus Vaccine if the vaccines are not given concurrently.<br />\r\n<br />\r\n<strong>Adolescents (&ge;13 years of age) and Adults</strong>: Two doses of Varicella Virus Vaccine are administered at a minimum interval of 4 weeks.</p>', '<p>Reye syndrome has been reported in children and adolescents following the use of salicylates during wild-type varicella infection. Administration of immune globulins and other blood products concurrently with Varicella Virus Vaccine vaccine may interfere with the expected immune response. Varicella Virus Vaccine vaccination may result in a temporary depression of purified protein derivative (PPD) tuberculin skin sensitivity.</p>', '<p><strong>Severe Allergic Reaction</strong>: Do not administer Varicella Virus Vaccine to individuals with a history of anaphylactic or severe allergic reaction to any component of the vaccine (including neomycin and gelatin) or to a previous dose of a varicella-containing vaccine.<br />\r\n<br />\r\n<strong>Immunosuppression</strong>: Do not administer Varicella Virus Vaccine to individuals who are immunodeficient or immunosuppressed due to disease or medical therapy. Disseminated varicella disease and extensive vaccine associated rash have been reported in individuals who are immunosuppressed or immunodeficient who were inadvertently vaccinated with a varicella-containing vaccine.<br />\r\n<br />\r\n<strong>Moderate or Severe Febrile Illness</strong>: Do not administer Varicella Virus Vaccine to individuals with an active febrile illness with fever &gt;38.5&deg;C.<br />\r\n<br />\r\n<strong>Active Untreated Tuberculosis</strong>: Do not administer Varicella Virus Vaccine to individuals with active, untreated tuberculosis (TB).<br />\r\n<br />\r\n<strong>Pregnancy</strong>: Do not administer Varicella Virus Vaccine to individuals who are pregnant or planning on becoming pregnant in the next 3 months. Wild-type varicella is known to cause fetal harm.</p>', '<p>Frequently reported (&ge;10%) adverse reactions in children ages 1 to 12 years include:</p>\r\n\r\n<ul>\r\n	<li>fever &ge;102.0&deg;F (38.9&deg;C) oral: 14.7%</li>\r\n	<li>injection-site complaints: 19.3%</li>\r\n</ul>\r\n\r\n<p>Frequently reported (&ge;10%) adverse reactions in adolescents and adults ages 13 years and older include:</p>\r\n\r\n<ul>\r\n	<li>fever &ge;100.0&deg;F (37.8&deg;C) oral: 10.2%</li>\r\n	<li>injection-site complaints: 24.4%</li>\r\n</ul>\r\n\r\n<p>Other reported adverse reactions in all age groups include:</p>\r\n\r\n<ul>\r\n	<li>varicella-like rash (injection site)</li>\r\n	<li>varicella-like rash (generalized)</li>\r\n</ul>', '<p>Varicella Virus Vaccine&nbsp;is contraindicated for use in pregnant women because the vaccine contains live, attenuated varicella virus, and it is known that wild-type varicella virus, if acquired during pregnancy, can cause congenital varicella syndrome. No increased risk for miscarriage, major birth defect or congenital varicella syndrome was observed in a pregnancy exposure registry that monitored outcomes after inadvertent use. There are no relevant animal data.<br />\r\n<br />\r\nIt is not known whether varicella vaccine virus is excreted in human milk. The developmental and health benefits of breastfeeding should be considered along with the mother&rsquo;s clinical need for Varicella Virus Vaccine, and any potential adverse effects on the breastfed child from Varicella Virus Vaccine or from the underlying maternal condition. For preventive vaccines, the underlying maternal condition is susceptibility to disease prevented by the vaccine.</p>', '<p>Evaluate individuals for immune competence prior to administration of Varicella Virus Vaccine if there is a family history of congenital or hereditary immunodeficiency. Avoid close contact with high-risk individuals susceptible to varicella because of possible transmission of varicella vaccine virus. Immune Globulins (IG) and other blood products should not be given concomitantly with Varicella Virus Vaccine. Avoid use of salicylates for 6 weeks following administration of Varicella Virus Vaccine to children and adolescents.</p>', NULL, '<p>Vaccines, Anti-sera &amp; Immunoglobulin</p>', '<p>Store between 2-8&deg; C. Do not freeze. Protect from light. Keep out of the reach of children.</p>', '<p><strong>Pediatric Use</strong>: No clinical data are available on safety or efficacy of varicella virus vaccine in children less than 12 months of age.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Clinical studies of varicella virus vaccine did not include sufficient numbers of seronegative subjects aged 65 and over to determine whether they respond differently from younger subjects.</p>', '2022-03-18 20:11:24', '2022-03-18 20:11:24'),
(1318, 1318, '<p>Vecuronium Bromide is indicated as an adjunct to general anaesthesia to facilitate tracheal intubation and to provide skeletal muscle relaxation during surgery.</p>', '<p>Vecuronium bromide is a non-depolarising neuromuscular blocking agent. It blocks the transmission process between the motor nerve-ending and striated muscle by binding competitively with acetylcholine to the nicotinic receptors located in the motor end-plate region of striated muscle.<br />\r\n<br />\r\nUnlike depolarising neuromuscular blocking agents, such as suxamethonium, Vecuronium bromide does not cause muscle fasciculations.<br />\r\n<br />\r\nWithin the clinical dosage range, Vecuronium bromide exerts neither vagolytic nor ganglion blocking activity.</p>', '<p>Like other neuromuscular blocking agents, Vecuronium should only be administered by, or under supervision of, experienced clinicians who are familiar with the action and use of these agents.<br />\r\n<br />\r\nLike with other neuromuscular blocking agents, the dosage of Vecuronium should be individualised in each patient. The anaesthetic method used, the expected duration of surgery, the possible interaction with other medicines that are administered before or during anaesthesia and the condition of the patient should be taken into account when determining the dose. The use of an appropriate neuromuscular monitoring technique is recommended to monitor neuromuscular block and recovery.<br />\r\n<br />\r\nInhalational anaesthetics do potentiate the neuromuscular blocking effects of Vecuronium. This potentiation however, becomes clinically relevant in the course of anaesthesia, when the volatile agents have reached the tissue concentrations required for this interaction. Consequently, adjustments with Vecuronium should be made by administering smaller maintenance doses at less frequent intervals or by using lower infusion rates of Vecuronium during long lasting procedures (longer than 1 hour) under inhalational anaesthesia.<br />\r\n<br />\r\nIn adult patients the following dosage recommendations may serve as a general guideline for tracheal intubation and muscle relaxation for short to long lasting surgical procedures.<br />\r\n<br />\r\nTracheal intubation: The standard intubating dose during routine anaesthesia is 0.08 to 0.1 mg vecuronium bromide per kg body weight, after which adequate intubation conditions are established within 90 to 120 seconds in nearly all patients.<br />\r\n&nbsp;</p>\r\n\r\n<p><strong>Dosages of Vecuronium for surgical procedures after intubation with suxamethonium:</strong></p>\r\n\r\n<p>Recommended doses:</p>\r\n\r\n<ul>\r\n	<li>0.03 to 0.05 mg vecuronium bromide per kg body weight.</li>\r\n	<li>If suxamethonium is used for intubation, the administration of Vecuronium should be delayed until the patient has clinically recovered from the neuromuscular block induced by suxamethonium.</li>\r\n</ul>\r\n\r\n<p>Maintenance dosing:</p>\r\n\r\n<ul>\r\n	<li>The recommended maintenance dose is 0.02 to 0.03 mg vecuronium bromide per kg body weight. These maintenance doses should best be given when twitch height has recovered to 25% of control twitch height.</li>\r\n	<li>Dose requirements for administration of Vecuronium by continuous infusion.</li>\r\n	<li>If Vecuronium is administered by continuous infusion, it is recommended to give a loading dose first (see &#39;Tracheal intubation&#39;) and, when neuromuscular block starts to recover, to start administration of Vecuronium by infusion. The infusion rate should be adjusted to maintain twitch response at 10% of control twitch height or to maintain 1 to 2 responses to train of four stimulation. In adults, the infusion rate required to maintain neuromuscular block at this level, ranges from 0.8 to 1.4 &micro;g vecuronium bromide/kg/min. For neonates and infants, see below. Repeat monitoring of neuromuscular block is recommended since infusion rate requirements vary from patient to patient and with the anaesthetic method used.</li>\r\n</ul>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Dosing in elderly patients</strong>:</p>\r\n\r\n<ul>\r\n	<li>The same intubation and maintenance doses as for younger adults (0.08-0.1 mg/kg and 0.02-0.03 mg/kg, respectively) can be used. However, the duration of action is prolonged in elderly compared to younger subjects due to changes in pharmacokinetic mechanisms. The onset time in elderly is similar to younger adults.</li>\r\n	<li>In caesarean section and neonatal surgery the dose should not exceed 0.1 mg/kg.</li>\r\n</ul>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Dosing in paediatric patients:</strong></p>\r\n\r\n<p>Because of the possible variation of the sensitivity of the neuromuscular junction, especially in neonates (up to 4 weeks) and probably in infants up to 4 months of age, an initial test dose of 0.01 to 0.02 mg vecuronium bromide per kg body weight followed by incremental doses until 90 to 95% depression of twitch response is achieved is recommended. In neonatal surgery the dose should not exceed 0.1 mg/kg. Dose requirements in neonates and infants (1-12 months) are the same as in adults. However, since the onset time of Vecuronium in these patients is considerably shorter than in adults and children, the use of high intubating doses in general is not required for early development of good intubating conditions.<br />\r\nSince the duration of action and recovery time with Vecuronium is longer in neonates and infants than in children and adults, maintenance doses are required less frequently.<br />\r\n<br />\r\nDose requirements in children (2-10 years) are higher. However, the same intubation and maintenance doses as for adults (0.08-0.1 mg/kg and 0.02-0.03 mg/kg, respectively) are usually sufficient. Since the duration of action is shorter in children, maintenance doses are required more frequently.<br />\r\n<br />\r\nAlthough there is very little information on dosage in adolescents, it is advised to use the same dose as in adults, based on the physiological development at this age.<br />\r\nDosing in overweight and obese patients<br />\r\nWhen used in overweight or obese patients (defined as patients with a body weight of 30% or more above ideal body weight) doses should be reduced taking into account an ideal body weight.<br />\r\n<br />\r\nHigher doses: Should there be reason for selection of larger doses in individual patients; initial doses ranging from 0.15 mg up to 0.30 mg vecuronium bromide per kg body weight have been administered during surgery both under halothane and neurolept anaesthesia without adverse cardiovascular effects being noted as long as ventilation is properly maintained. The use of these high dosages of Vecuronium pharmacodynamically decreases the onset time and increases the duration of action.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>Vecuronium should be administered following reconstitution. Vecuronium is administered intravenously either as a bolus injection or as a continuous infusion</p>', '<p>The following agents have been shown to influence the magnitude and/or duration of action of non-depolarizing neuromuscular blocking agents:<br />\r\n&nbsp;</p>\r\n\r\n<p><strong>Effect of Other Agents on Vecuronium:</strong></p>\r\n\r\n<p><strong>Increased Effect:</strong></p>\r\n\r\n<ul>\r\n	<li>Halogenated volatile anaesthetics potentiate the neuromuscular block of Vecuronium. The effect only becomes apparent with maintenance dosing (see also Dosage and Administration). Reversal of the block with anticholinesterase inhibitors could also be inhibited.&nbsp;</li>\r\n	<li>After intubation with suxamethonium</li>\r\n	<li>Long-term concomitant use of corticosteroids and Vecuronium in the ICU may result in prolonged duration of neuromuscular block or myopathy.</li>\r\n</ul>\r\n\r\n<p>Other medicines:</p>\r\n\r\n<ul>\r\n	<li>antibiotics: aminoglycoside, lincosamide and polypeptide antibiotics, acylaminopenicillin antibiotics,&nbsp;</li>\r\n	<li>diuretics, quinidine, magnesium salts, calcium channel blocking agents, lithium salts, cimetidine, lidocaine and acute administration of phenytoin or &beta;-blocking agents&nbsp;</li>\r\n	<li>Recurarization has been reported after post-operative administration of: aminoglycoside, lincosamide, polypeptide and acylamino-penicillin antibiotics, quinidine and magnesium salts</li>\r\n</ul>\r\n\r\n<p><strong>Decreased Effect</strong>&nbsp;(possible higher dose requirements):</p>\r\n\r\n<ul>\r\n	<li>prior chronic administration of phenytoin or carbamazepine&nbsp;</li>\r\n	<li>Variable Effect</li>\r\n	<li>Administration of other non-depolarizing neuromuscular blocking agents in combination with Vecuronium may produce attenuation or potentiation of the neuromuscular block, depending on the order of administration and the neuromuscular blocking agent used.&nbsp;</li>\r\n	<li>Suxamethonium given after the administration of Vecuronium may produce potentiation or attenuation of the neuromuscular blocking effect of Vecuronium.&nbsp;</li>\r\n</ul>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Effect of Vecuronium on other agents:</strong></p>\r\n\r\n<p>Effect of Vecuronium on lidocaine: Vecuronium combined with lidocaine may result in a quicker onset of action of lidocaine.</p>', NULL, '<p>Side effects are rare (&lt;1/1000). The most commonly occurring side effects include changes in vital signs and prolonged neuromuscular block. The most frequently reported side effects during post-marketing surveillance is &#39;anaphylactic and anaphylactoid reactions&#39; and associated symptoms (reporting frequency &lt;1/100,000).</p>', '<p>There are insufficient data on the use of Vecuronium during animal or human pregnancy to assess potential harm to the foetus. Vecuronium should be given to a pregnant woman only when the attending physician decides that the benefits outweigh the risks.<br />\r\n<br />\r\n<strong>Caesarean section</strong>: Studies with Vecuronium, administered in doses up to 0.1mg/kg, have shown its safety for use in caesarean section. In caesarean section the dose should not exceed 0.1mg/kg. In several clinical studies Vecuronium did not affect Apgar score, foetal muscle tonus or cardiorespiratory adaptation. From umbilical cord blood sampling it is apparent that only very little placental transfer of Vecuronium occurs which did not lead to the observation of any clinical adverse effect in the newborn.<br />\r\n<br />\r\nReversal of a Vecuronium induced neuromuscular block may be inhibited or unsatisfactory in patients receiving magnesium sulphate for toxaemia of pregnancy because magnesium salts enhance neuromuscular block.Therefore, in patients receiving magnesium sulphate, the dosage of Vecuronium should be reduced and be carefully titrated to twitch response.<br />\r\n<br />\r\n<strong>Lactation</strong>: There are no human data on the use of Vecuronium during lactation. Vecuronium should be given to lactating women only when the attending physician decides that the benefits outweigh the risks.</p>', '<p>Since Vecuronium causes paralysis of the respiratory muscles, ventilatory support is mandatory for patients treated with this medicine until adequate spontaneous respiration is restored.<br />\r\n<br />\r\nAs with other neuromuscular blocking agents, residual curarization has been reported for Vecuronium. In order to prevent complications resulting from residual curarization, it is recommended to extubate only after the patient has recovered sufficiently from neuromuscular block. Other factors which could cause residual curarization after extubation in the post-operative phase (such as medicine interactions or patient condition) should also be considered. If not used as part of standard clinical practice, the use of a reversal agent should be considered, especially in those cases where residual curarization is more likely to occur.<br />\r\nAnaphylactic reactions can occur following the administration of neuromuscular blocking agents. Precautions for treating such reactions should always be taken. Particularly in the case of previous anaphylactic reactions to muscle relaxants, special precautions should be taken since allergic cross-reactivity to muscle relaxants has been reported.<br />\r\n<br />\r\nSince Vecuronium has no cardiovascular effects within the clinical dosage range, it does not attenuate bradycardia that may occur due to the use of some types of anaesthetics and opiates or due to vagal reflexes during surgery. Therefore, reassessment of the use and/or dosage of vagolytic medicines such as atropine for premedication or at induction of anaesthesia, may be of value for surgical procedures during which vagal reactions are more likely to occur (e.g. surgical procedures where anaesthetic medicines with known vagal stimulatory effects are used, ophthalmic, abdominal or anorectal surgery, etc).<br />\r\n<br />\r\nIn general, following long term use of neuromuscular blocking agents in the ICU, prolonged paralysis and/or skeletal muscle weakness has been noted. In order to help preclude possible prolongation of neuromuscular block and/or overdosage it is strongly recommended that neuromuscular transmission is monitored throughout the use of muscle relaxants. In addition, patients should receive adequate analgesia and sedation. Furthermore, muscle relaxants should be titrated to effect in the individual patients by or under supervision of experienced clinicians who are familiar with their actions and with appropriate neuromuscular monitoring techniques. Myopathy after long term administration of non-depolarizing neuromuscular blocking agents in the ICU in combination with corticosteroid therapy has been reported frequently. Therefore, for patients receiving both neuromuscular blocking agents and corticosteroids, the period of use of the neuromuscular blocking agent should be limited as much as possible.</p>', '<p>In the event of overdosage and prolonged neuromuscular block, the patient should continue to receive ventilatory support and sedation. Upon start of spontaneous recovery an acetylcholinesterase inhibitor (e.g. neostigmine, edrophonium, pyridostigmine) should be administered in adequate doses.<br />\r\nWhen administration of an acetylcholinesterase-inhibiting agent fails to reverse the neuromuscular effects of Vecuronium, ventilation must be continued until spontaneous breathing is restored. Repeated dosage of an acetylcholinesterase inhibitor can be dangerous.</p>', '<p>Non depolarizing muscle relaxants.</p>', '<p>Store between 20-25&deg; C. Protect from light.</p>', NULL, '2022-03-18 20:13:55', '2022-03-18 20:13:55'),
(1319, 1319, '<p>Venlafaxine tablets is indicated for the treatment of major depressive disorder.<br />\r\n<br />\r\nThe efficacy of venlafaxine tablets, in the treatment of major depressive disorder was established in 6 week controlled trials of adult outpatients whose diagnoses corresponded most closely to the&nbsp;DSM-III or DSM-III-R category of&nbsp;major depression&nbsp;and in a 4 week controlled trial of inpatients meeting diagnostic criteria for major depression with&nbsp;melancholia<br />\r\n<br />\r\nA major depressive episode implies a prominent and relatively persistent depressed or dysphoric mood that usually interferes with daily functioning (nearly every day for at least 2 weeks); it should include at least 4 of the following 8 symptoms: change in appetite, change in sleep, psychomotor agitation or retardation, loss of interest in usual activities or decrease in sexual drive, increased fatigue, feelings of guilt or worthlessness, slowed thinking or impaired concentration, and a suicide attempt or suicidal ideation.<br />\r\n<br />\r\nThe efficacy of venlafaxine hydrochloride extended-release capsules in maintaining an&nbsp;antidepressant&nbsp;response for up to 26 weeks following 8 weeks of acute treatment was demonstrated in a placebocontrolled trial. The efficacy of venlafaxine tablets in maintaining an antidepressant response in patients with&nbsp;recurrent&nbsp;depression who had responded and continued to be improved during an initial 26 weeks of treatment and were then followed for a period of up to 52 weeks was demonstrated in a second placebo-controlled trial (see&nbsp;Clinical Trials). Nevertheless, the physician who elects to use venlafaxine tablets / extended-release capsules for extended periods should periodically re-evaluate the long-term usefulness of the drug for the individual patient.</p>', '<p>The exact mechanism of action of venlafaxine is unknown, but appears to be associated with the its potentiation of neurotransmitter activity in the CNS. Venlafaxine and its active metabolite, O-desmethylvenlafaxine (ODV), inhibit the reuptake of both serotonin and norepinephrine with a potency greater for the 5-HT than for the NE reuptake process. Both venlafaxine and the ODV metabolite have weak inhibitory effects on the reuptake of dopamine but, unlike the tricyclics and similar to SSRIs, they are not active at histaminergic, muscarinic, or alpha(1)-adrenergic receptors.</p>', '<p><strong>Initial Treatment</strong>: The recommended starting dose for venlafaxine tablets is 75 mg/day, administered in two or three divided doses, taken with food. Depending on tolerability and the need for further clinical effect, the dose may be increased to 150 mg/day. If needed, the dose should be further increased up to 225 mg/day. When increasing the dose, increments of up to 75 mg/day should be made at intervals of no less than 4 days. In&nbsp;outpatient&nbsp;settings there was no evidence of usefulness of doses greater than 225 mg/day for moderately depressed patients, but more severely depressed inpatients responded to a mean dose of 350 mg/day. Certain patients, including more severely depressed patients, may therefore respond more to higher doses, up to a maximum of 375 mg/day, generally in three divided doses&nbsp;<br />\r\n<br />\r\n<strong>Dosage For Elderly Patients</strong>: No dose adjustment is recommended for elderly patients on the basis of age. As with any antidepressant, however, caution should be exercised in treating the elderly. When individualizing the dosage, extra care should be taken when increasing the dose.<br />\r\n<br />\r\n<strong>Maintenance Treatment</strong>: It is generally agreed that acute episodes of major depressive disorder require several months or longer of sustained pharmacological therapy beyond response to the acute episode. In one study, in which patients responding during 8 weeks of acute treatment with venlafaxine hydrochloride extendedrelease capsules were assigned&nbsp;randomly&nbsp;to placebo or to the same dose of venlafaxine hydrochloride extended-release capsules (75, 150, or 225 mg/day, qAM) during 26 weeks of maintenance treatment as they had received during the acute stabilization phase, longer-term efficacy was demonstrated. A second longer-term study has demonstrated the efficacy of venlafaxine tablets in maintaining an antidepressant response in patients with recurrent depression who had responded and continued to be improved during an initial 26 weeks of treatment and were then randomly assigned to placebo or venlafaxine tablets for periods of up to 52 weeks on the same dose (100 to 200 mg/day, on a&nbsp;b.i.d.&nbsp;schedule) (see&nbsp;Clinical Trials). Based on these limited data, it is not known whether or not the dose of venlafaxine tablets / extended-release capsules needed for maintenance treatment is identical to the dose needed to achieve an initial response. Patients should be periodically reassessed to determine the need for maintenance treatment and the appropriate dose for such treatment.<br />\r\n<br />\r\n<strong>Discontinuing Venlafaxine Tablet</strong>: Symptoms associated with discontinuation of venlafaxine tablets, other SNRIs, and SSRIs, have been reported. Patients should be monitored for these symptoms when discontinuing treatment. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the physician may continue decreasing the dose but at a more gradual rate.</p>', '<p>Increased risk of serotonin syndrome with TCA, SSRI, SNRI, lithium, sibutramine, tramadol. May increase serum levels with CYP3A4 inhibitors (e.g. ketoconazole, atazanavir, clarithromycin). May increase serum levels of haloperidol. May decrease serum levels of indinavir. May increase bleeding risk with aspirin, NSAIDs, warfarin and other anticoagulants.</p>', '<p>Concomitant use with MAOIs or within 14 days of discontinuing the MAOI. Use with linezolid or IV methylene blue.</p>', '<p>Changes in behaviour, suicidal ideation, agitation, tremor, nervousness, anxiety, insomnia, confusions, abnormal dreams, HTN, nausea, headache, asthenia, somnolence, dizziness, dry mouth, vomiting, constipation, diarrhoea, dyspepsia, abdominal pain, anorexia, sexual dysfunction, urinary frequency, visual disturbances, mydriasis, vasodilatation, paraesthesia, hypertonia, chills or fever, palpitations, wt gain or loss, arthralgia, myalgia, tinnitus, pruritus, dyspnoea, yawning, rashes, sweating, increased serum cholesterol, may impair platelet aggregation.</p>', '<p>Treatment Of Pregnant Women During The Third Trimester<br />\r\nNeonates exposed to venlafaxine tablets, USP, other SNRIs, or SSRIs, late in the third trimester have developed complications requiring prolonged hospitalization, respiratory support, and&nbsp;tube feeding. When treating pregnant women with venlafaxine tablets during the third trimester, the physician should carefully consider the potential risks and benefits of treatment.</p>', '<p>History of MI or unstable cardiac disease, seizure; hypomania or mania, increased intraocular pressure or at risk of acute narrow-angle galaucoma, at risk of bleeding. Renal and hepatic impairment. Gradual dose reduction is recommended rather than abrupt withdrawal. Pregnancy and lactation. Patient Counselling May impair ability to drive or operate machinery.</p>', '<p><strong>Symptoms</strong>: Sweating, dizziness, somnolence, mydriasis, convulsions, vomiting, ECG changes, cardiac arrhythmias and seizures.<br />\r\n<br />\r\n<strong>Management</strong>: Symptomatic and supportive treatment. Ensure adequate airway, oxygenation and ventilation. Initiate gastric lavage immediately after ingestion. Admin activated charcoal to reduce absorption. Monitor cardiac rhythm and vital signs.</p>', '<p>Serotonin-norepinephrine reuptake inhibitor (SNRI).</p>', '<p>Store between 20-25&deg; C.</p>', '<p><strong>Dosage For Patients With Hepatic Impairment</strong>: Given the decrease in clearance and increase in elimination half-life for both venlafaxine and ODV that is observed in patients with hepatic&nbsp;cirrhosis&nbsp;and mild and moderate hepatic impairment compared to normal subjects, it is recommended that the total daily dose be reduced by 50% in patients with mild to moderate hepatic impairment. Since there was much individual variability in clearance between subjects with cirrhosis, it may be necessary to reduce the dose even more than 50%, and individualization of dosing may be desirable in some patients.<br />\r\n<br />\r\n<strong>Dosage For Patients With Renal Impairment</strong>: Given the decrease in clearance for venlafaxine and the increase in elimination half-life for both venlafaxine and ODV that is observed in patients with renal impairment (GFR = 10 to 70 mL/min) compared to normals, it is recommended that the total daily dose be reduced by 25% in patients with mild to moderate renal impairment. It is recommended that the total daily dose be reduced by 50% in patients undergoing&nbsp;hemodialysis. Since there was much individual variability in clearance between patients with renal impairment, individualization of dosing may be desirable in some patients.</p>', '2022-03-18 20:15:49', '2022-03-18 20:15:49'),
(1320, 1320, '<p>Verapamil Tablet:</p>\r\n\r\n<ul>\r\n	<li>Essential hypertension</li>\r\n	<li>Angina pectoris and prevention of re-infarction</li>\r\n	<li>Supraventricular arrhythmias</li>\r\n</ul>\r\n\r\n<p>Verapamil Injection:</p>\r\n\r\n<ul>\r\n	<li>Tachycardias such as: Paroxysmal supraventricular tachycardias</li>\r\n	<li>Atrial fibrillation with rapid ventricular response (except WPWS)</li>\r\n	<li>Atrial flutter with rapid conduction</li>\r\n	<li>Extrasystoles</li>\r\n	<li>Acute hypertension</li>\r\n	<li>Acute coronary insufficiency</li>\r\n</ul>\r\n\r\n<p>For the prophylaxis and / or therapy of ectopic arrhythmias (predominantly ventricular extrasystoles) in halothane anaesthesia and in the application of adrenaline in halothane anaesthesia respectively.</p>', '<p>Verapamil is an L-type calcium channel blocker with antiarrhythmic, antianginal, and antihypertensive activity. Immediate-release verapamil has a relatively short duration of action, requiring dosing 3 to 4 times daily, but extended-release formulations are available that allow for once-daily dosing. As verapamil is a negative inotropic medication (i.e. it decreases the strength of myocardial contraction), it should not be used in patients with severe left ventricular dysfunction or hypertrophic cardiomyopathy as the decrease in contractility caused by verapamil may increase the risk of exacerbating these pre-existing conditions.</p>', '<p>Verapamil Tablet:</p>\r\n\r\n<ul>\r\n	<li>The dose of Verapamil should be individualized by titration and the drug should be administered with food.</li>\r\n	<li>For essential hypertension the initial dose should be given 180 mg in the morning. If adequate response is not obtained with 180 mg of Verapamil then the dose may be titrated by following manner: 240 mg each morning. 180 mg each morning plus 180 mg each evening. 240 mg every 12 hourly.</li>\r\n	<li>For angina the usual dose is 80 mg to 120 mg three times a day.</li>\r\n	<li>For arrythmias in digitalized patients, Verapamil should be given 240 mg to 360 mg in divided doses, depending on the severity of the condition. Divided doses up to 180 mg/day may occasionally be needed.</li>\r\n</ul>\r\n\r\n<p>Verapamil Injection:</p>\r\n\r\n<p><strong>Adults</strong>: 5 mg slowly intravenously, in tachycardias and hypertensive crises, if necessary repeat after 5 to 10 minutes. Drip infusion to maintain the therapeutic effect: 5-10 mg/hour in physiological saline, glucose, laevulose or similar solutions, on average up to a total dose of 100 mg/day.&nbsp;<br />\r\n<br />\r\n<strong>Children</strong>:</p>\r\n\r\n<ul>\r\n	<li><strong>Newborn</strong>: 0.75-1 mg (0.3-0.4 ml)</li>\r\n	<li><strong>Infants</strong>: 0.75-2 mg (0.3-0.8 ml)</li>\r\n	<li><strong>Children age 1-5 years</strong>: 2-3 mg (0.8-1.2 ml)</li>\r\n	<li><strong>Age 6-14 years</strong>: 2.5-5 mg (1-2 ml)</li>\r\n</ul>\r\n\r\n<p>of Verapamil, given intravenously, depending on age and action. The injection should be made slowly under electrocardiographic control and only until onset of the effect. Intravenous infusion in hypertensive crises: initially 0.05-0.1 mg/kg/hour; if the effect proves to be insufficient, the dose is increased at 30-60 minute intervals until twice the dose or more is reached. Average total dose up to 1.5 mg/kg/day.</p>', '<p>May increase plasma level with CYP3A4 inhibitors (e.g. erythromycin, ritonavir), cimetidine. May decrease plasma level with CYP3A4 inducers (e.g. rifampicin), phenobarbital, sulfinpyrazone. Increased risk of bleeding with aspirin. May increase bradycardic and hypotensive effect with telithromycin. Increased AV blocking effect with clonidine. May increase plasma level of cardiac glycosides (e.g. digoxin, digitoxin), &beta;-blockers (e.g. propranolol, metoprolol), &alpha;-blockers (e.g. terazosin, prazosin), immunosuppressants (e.g. sirolimus, ciclosporin, tacrolimus, everolimus), lipid lowering agents (e.g. lovastatin, simvastatin, atorvastatin), colchicines, quinidine, carbamazepine, imipramine, glibenclamide, doxorubicin, midazolam, buspirone, almotriptan, theophylline. May potentiate hypotensive effect with diuretics, antihypertensives, vasodilators. May increase neurotoxic effect of lithium.</p>', '<ul>\r\n	<li>Severe left ventricular dysfunction</li>\r\n	<li>Hypotension or cardiogenic shock</li>\r\n	<li>Sick sinus syndrome (except in patients with a functioning artificial ventricular pacemaker)</li>\r\n	<li>Second or third-degree atrioventricular (AV) block (except in patients with a functioning artificial pacemaker)</li>\r\n	<li>Patients with atrial flutter or atrial fibrillation and an accessory by pass tract (eg. Wolff-Parkinson-White, Lown-Ganong-Levine syndrome)</li>\r\n	<li>Patients with known hypersensitivity to verapamil hydrochloride</li>\r\n</ul>', '<p>Verapamil is generally well tolerated. The following reaction to orally administered Verapamil appeared clearly drug-related or occurred at rates greater than 1% in clinical trials with approximately 5000 patients.</p>\r\n\r\n<ul>\r\n	<li><strong>Digestive system</strong>: Constipation, nausea;</li>\r\n	<li><strong>Cardiovascular system</strong>: Hypotension, edema, CHF, pulmonary edema, bradycardia, AV block;</li>\r\n	<li><strong>Respiratory system</strong>: Upper respiratory tract infections;</li>\r\n	<li><strong>Nervous system</strong>: Dizziness, headache, fatigue;</li>\r\n	<li><strong>Skin</strong>: Rash, flashing;</li>\r\n	<li><strong>Hepatic</strong>: Elevated liver enzyme.</li>\r\n</ul>', '<p>There are no adequate and well-controlled studies in pregnant women, so this drug should be used during pregnancy only if clearly needed. Verapamil crosses the placental barrier and can be detected in umbilical vein blood during delivery. Verapamil is excreted in breast milk. So nursing should be discontinued while Verapamil is administered.</p>', '<p>Care should be taken in 1st degree AV block, bradycardia &lt;50 beats/minutes, hypotension &lt;90 mm Hg systolic pressure, atrial fibrillation/flutter and simultaneous pre-excitation syndrome e.g. WPW syndrome, heart failure (previous compensation with cardiac glycosides/diuretics required). Verapamil may impair ability to drive or operate machinery, particularly in the initial stages of treatment and with concomitant consumption of alcohol. Verapamil markedly slows down the elimination of alcohol and prolongs the duration of the effects of alcohol.</p>', '<p>Treatment of overdose should be supportive. Beta-adrenergic stimulation or parenteral administration of calcium solution may increase calcium ion flux across the slow channel and have been used in the treatment of overdose with Verapamil. Verapamil cannot be removed by hemodialysis.</p>', '<p>Calcium-channel blockers.</p>', '<p>Do not store above 30&deg;C. Keep away from light and out of the reach of children.</p>', NULL, '2022-03-18 20:17:59', '2022-03-18 20:17:59'),
(1321, 1321, '<p>Verteporfin therapy is indicated for the treatment of patients with predominantly classic subfoveal choroidal neovascularization due to&nbsp;age-related macular degeneration, pathologic myopia or presumed&nbsp;ocular&nbsp;histoplasmosis.<br />\r\n<br />\r\nThere is insufficient evidence to indicate Verteporfin for the treatment of predominantly occult subfoveal choroidal neovascularization.</p>', '<p>Verteporfm, when activated by low-intensity nonheat-generating laser light at a wavelength corresponding to its absorption peak, generates highly reactive, shortlived singlet 02 and reactive 02 radicals that cause local damage to neovascular endothelium, resulting in vessel occlusion. It appears to accumulate preferentially in the neovasculature e.g. choroidal neovasculature.</p>', '<p>A course of verteporfin therapy is a two-step process requiring administration of both drug and light. The first step is the intravenous infusion of Verteporfin. The second step is the activation of Verteporfin with light from a nonthermal diode laser. The physician should reevaluate the patient 3 months after treatment and if choroidal neovascular leakage is detected on&nbsp;fluorescein angiography, therapy may be repeated.<br />\r\n<br />\r\n<strong>Lesion Size Determination</strong>: The greatest linear dimension (GLD) of the&nbsp;lesion&nbsp;should be estimated by fluorescein&nbsp;angiography&nbsp;and color fundus photography. All classic and occult CNV, blood and/or blocked fluorescence, and any serous detachments of the&nbsp;retinal pigment epithelium should be included for this measurement. Fundus cameras with magnification within the range of 2.4-2.6X are recommended. The GLD of the lesion on the fluorescein angiogram must be corrected for the magnification of the fundus camera to obtain the GLD of the lesion on the&nbsp;retina.<br />\r\n<br />\r\n<strong>Spot Size Determination</strong>: The treatment spot size should be 1000 microns larger than the GLD of the lesion on the retina to allow a 500 micron border, ensuring full coverage of the lesion. The maximum spot size used in the clinical trials was 6400 microns.<br />\r\n<br />\r\nThe&nbsp;nasal&nbsp;edge of the treatment spot must be positioned at least 200 microns from the temporal edge of the&nbsp;optic disc, even if this will result in lack of photoactivation of CNV within 200 microns of the&nbsp;optic nerve.</p>', '<p>Increased rate of verteporfm uptake by the vascular endothelium with calcium channel blockers, polymyxin B or radiation therapy. Increased photosensitivity with photosensitizing agents (e.g. tetracyclines, sulfonamides, phenothiazines, sulfonylurea hypoglycaemic agents, thiazide diuretics and griseofulvin). Decreased verteporfm efficacy with compounds that quench active oxygen species or scavenge radicals e.g. dimethyl sulfoxide, betacarotene, ethanol, formate and mannitol. Decreased verteporfm efficacy with drugs that decrease clotting, vasoconstriction or platelet aggregation e.g. thromboxane A2 inhibitors. Anaesthetics may cause haemodynamic effects.</p>', '<p>Verteporfin is contraindicated for patients with porphyria or a known hypersensitivity to any component of this preparation.</p>', '<p>Visual disturbances; severe vision loss with or without subretinal or vitreous bleeding; inj site reactions; nausea; photosensitivity; asthenia; cataracts; blepharitis; conjunctivitis; dry eyes; ocular itching; flu-like syndrome; atrial fibrillation; hypertension; peripheral vascular disorder; varicose veins; eczema; constipation; Gl cancers; fever; lachrymation disorder; hypersensitivity reactions; increased LFT.</p>', '<p>Pregnancy Category- C. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.</p>', '<p>Moderate to severe hepatic disorders; biliary disorders. Pregnancy. Use the largest arm vein possible (e.g. antecubital) especially in elderly and avoid small veins in the back of the hand. Stop infusion if extravasation occurs and protect extravasation area from direct light and apply cold compresses. Patient to be under close monitoring during verteporfm infusion and exercise caution when general anaesthesia is considered. Avoid exposure of unprotected skin, eyes or other body organs to direct sunlight or bright indoor light for 5 days after treatment. Protect all parts of skin and eyes by wearing protective clothing and dark sunglasses (sunscreens are ineffective) if going outdoors in daylight is necessary. Exposure to ambient indoor light is encouraged as it helps in gradual inactivation of any remaining drug.</p>', '<p>Overdose of drug and/or light in the treated eye may result in non-perfusion&nbsp;of normal retinal vessels with the possibility of severe decrease in vision that could be permanent. An overdose of drug will also result in the prolongation of the period during which the patient remains photosensitive to bright light. In such cases, it is recommended to extend the photosensitivity precautions for a time proportional to the overdose.</p>', '<p>Drugs for Age-Related Macular Degeneration (AMD)</p>', NULL, '<p><strong>Pediatric Use</strong>: Safety and effectiveness in pediatric patients have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Approximately 90% of the patients treated with Verteporfin in the clinical efficacy trials were over the age of 65. A reduced treatment effect was seen with increasing age.</p>', '2022-03-18 20:19:48', '2022-03-18 20:19:48'),
(1322, 1322, '<p>This is indicated in-</p>\r\n\r\n<ul>\r\n	<li>For the maintenance treatment of patients with chronic obstructive pulmonary disease (COPD).</li>\r\n	<li>For the maintenance treatment of asthma in patients aged 18 years and older.</li>\r\n</ul>', '<p>This cozycap is an inhalation powder drug product for delivery of a combination of futicasone furoate (an ICS), umeclidinium (an anticholinergic), and vilanterol (a LABA) to patients by oral inhalation. The pharmacologic efects of beta 2-adrenoceptor agonist drugs, including vilanterol, are at least in part attributable to stimulation of intracellular adenyl cyclase, the enzyme that catalyzes the conversion of adenosine triphosphate (ATP) to cyclic-3, 5 -adenosine monophosphate (cyclic AMP). Increased cyclic AMP levels cause relaxation of bronchial smooth muscle and inhibition of release of mediators of immediate hypersensitivity from cells, especially from mast cells.<br />\r\n<br />\r\nThe precise mechanism through which futicasone furoate afects COPD and asthma symptoms is not known. Infammation is an important component in the pathogenesis of COPD and asthma. Corticosteroids have been shown to have a wide range of actions on multiple cell types (e.g., mast cells, eosinophils, neutrophils, macrophages, lymphocytes) and mediators (e.g., histamine, eicosanoids, leukotrienes, cytokines) involved in infammation.<br />\r\n<br />\r\nUmeclidinium is a long-acting muscarinic antagonist, which is often referred to as an anticholinergic. It has similar afnity to the subtypes of muscarinic receptors M1 to M5 . In the airways, it exhibits pharmacological efects through inhibition of M3 receptor at the smooth muscle leading to bronchodilation.</p>', '<p>Adults: 18 years or older: For oral inhalation only. Should be taken by revolizer. Should be used at the same time every day, not more than 1 time every 24 hours. If shortness of breath or other asthma symptoms arise in the period between doses, an inhaled SABA should be taken for immediate relief.</p>\r\n\r\n<ul>\r\n	<li>Maintenance treatment of COPD: 1 inhalation of cozycap once daily.</li>\r\n	<li>Maintenance treatment of asthma: 1 inhalation of cozycap once daily.</li>\r\n	<li>Limitation of use: Not indicated for relief of acute bronchospasm.</li>\r\n</ul>', '<ul>\r\n	<li>Strong cytochrome P450 3A4 inhibitors (e.g., ketoconazole): Use with caution. May cause systemic corticosteroid and cardiovascular effects.</li>\r\n	<li>Monoamine oxidase inhibitors and tricyclic antidepressants: Use with extreme caution. May potentiate the effect of vilanterol on the vascular system.</li>\r\n	<li>Beta-blockers: Use with caution. May block bronchodilatory effects of beta-agonists and produce severe bronchospasm.</li>\r\n	<li>Diuretics: Use with caution. Electrocardiographic changes and/or hypokalemia associated with non&ndash;potassium-sparing diuretics may worsen with concomitant beta-agonists.</li>\r\n	<li>Anticholinergics: May interact additively with concomitantly used anticholinergic medications. Avoid administration of this preparation with other anticholinergic-containing drugs.</li>\r\n</ul>', '<ul>\r\n	<li>Primary treatment of status asthmaticus or acute episodes of COPD or asthma requiring intensive measures</li>\r\n	<li>Severe hypersensitivity to milk proteins or any ingredients.</li>\r\n</ul>', '<p><strong>COPD</strong>: Most common adverse reactions (incidence &ge;1%) are upper respiratory tract infection, pneumonia, bronchitis, oral candidiasis, headache, back pain, arthralgia, infuenza, sinusitis, pharyngitis, rhinitis, dysgeusia, constipation, urinary tract infection, diarrhea, gastroenteritis, oropharyngeal pain, cough, and dysphonia.<br />\r\n<br />\r\n<strong>Asthma</strong>: Most common adverse reactions (incidence &ge;2%) are pharyngitis/nasopharyngitis, upper respiratory tract infection/viral upper respiratory tract infection, bronchitis, respiratory tract infection/viral respiratory tract infection, sinusitis/acute sinusitis, urinary tract infection, rhinitis, infuenza, headache, and back pain.</p>', '<p>Insufficient data on the use of this preparation in pregnant women and lactating mothers.</p>', '<ul>\r\n	<li>LABA monotherapy increases the risk of serious asthma-related events.</li>\r\n	<li>Do not initiate in acutely deteriorating COPD or asthma. Do not use to treat acute symptoms.</li>\r\n	<li>Do not use in combination with additional therapy containing a LABA because of risk of overdose.</li>\r\n	<li>Candida albicans infection of the mouth and pharynx may occur. Monitor patients periodically. Advise the patient to rinse his/her mouth with water without swallowing after inhalation to help reduce the risk.</li>\r\n	<li>Increased risk of pneumonia in patients with COPD. Monitor patients for signs and symptoms of pneumonia.</li>\r\n	<li>If paradoxical bronchospasm occurs, discontinue and institute alternative therapy.</li>\r\n	<li>Use with caution in patients with cardiovascular disorders because of beta-adrenergic stimulation.</li>\r\n	<li>Worsening of urinary retention may occur. Use with caution in patients with prostatic hyperplasia or bladder-neck obstruction.</li>\r\n	<li>Use with caution in patients with convulsive disorders, thyrotoxicosis, diabetes mellitus, and ketoacidosis.</li>\r\n</ul>', NULL, '<p>Combined bronchodilators.</p>', '<p>Store below 25&deg;C, protect from light &amp; moisture. Keep out of reach of children.</p>', '<p><strong>Elderly population</strong>: Based on available data, no adjustment of the dosage in geriatric patients is necessary, but greater sensitivity in some older individuals cannot be ruled out.<br />\r\n<strong>Renal impairment</strong>: It has not been studied in subjects with renal impairment.<br />\r\n<strong>Hepatic impairment</strong>: It has not been studied in subjects with hepatic impairment.<br />\r\n<strong>Pediatric population</strong>: It is not indicated for use in children and adolescents. The safety and efficacy in pediatric patients (aged 17 years and younger) have not been established.</p>', '2022-03-18 20:21:47', '2022-03-18 20:21:47');
INSERT INTO `generic_details` (`id`, `generic_id`, `indications`, `pharmacology`, `dosage_and_administration`, `interaction`, `contraindications`, `side_effects`, `pregnancy_and_lactation`, `precautions_and_warnings`, `overdose_effects`, `therapeutic_class`, `storage_conditions`, `use_in_special_populations`, `created_at`, `updated_at`) VALUES
(1323, 1323, '<p>This is indicated in-</p>\r\n\r\n<ul>\r\n	<li>Long-term, once-daily, maintenance treatment of airflow obstruction and reducing exacerbations in patients with chronic obstructive pulmonary disease (COPD).</li>\r\n	<li>Once-daily treatment of asthma in patients aged 18 years and older.</li>\r\n</ul>', '<p>This preparation contains both futicasone furoate and vilanterol, the mechanisms of action described below for the individual components. These drugs represent 2 diferent classes of medications (a synthetic corticosteroid and a LABA) that have diferent efects on clinical and physiological aspects. The pharmacologic efects of beta 2-adrenoceptor agonist drugs, including vilanterol, are at least in part attributable to stimulation of intracellular adenyl cyclase, the enzyme that catalyzes the conversion of adenosine triphosphate (ATP) to cyclic-3, 5-adenosine monophosphate (cyclic AMP). Increased cyclic AMP levels cause relaxation of bronchial smooth muscle and inhibition of release of mediators of immediate hypersensitivity from cells, especially from mast cells. The precise mechanism through which futicasone furoate afects COPD and asthma symptoms is not known. Infammation is an important component in the pathogenesis of COPD and asthma. Corticosteroids have been shown to have a wide range of actions on multiple cell types (e.g., mast cells, eosinophils, neutrophils, macrophages, lymphocytes) and mediators (e.g., histamine, eicosanoids, leukotrienes, cytokines) involved in infammation.</p>', '<p>Should be administered as 1 inhalation once daily by the orally inhaled route only.</p>\r\n\r\n<ul>\r\n	<li><strong>For COPD</strong>: 100 micrograms cozycap: 1 inhalation once daily. Should be taken by revolizer.</li>\r\n	<li><strong>For Asthma</strong>: 100 micrograms or 200 micrograms cozycap: 1 inhalation once daily. The maximum recommended dosage of 200 micrograms cozycap: 1 inhalation once daily. Should be taken by revolizer.</li>\r\n</ul>', '<ul>\r\n	<li>Other adrenergic drugs may potentiate efect. Use with caution.</li>\r\n	<li>Xanthine derivatives, steroids, diuretics or non-potassium sparing diuretics may potentiate hypokalemia or EDG changes. Use with caution.</li>\r\n	<li>Diuretics: Use with caution.</li>\r\n	<li>Monoamine oxidase inhibitors and tricyclic antidepressants: Use with extreme caution. May potentiate the effect of formoterol fumarate on cardiovascular system.</li>\r\n	<li>Beta-Blockers: Use with caution and only when medically necessary.</li>\r\n	<li>Anticholinergics: May interact additively with concomitantly used anticholinergic medications. Avoid administrations of Beviprex with other anticholinergic-containing drugs.</li>\r\n</ul>', NULL, '<p><strong>Common side efects in COPD</strong>: Most common adverse reactions (incidence &ge;3%) are nasopharyngitis, upper respiratory tract infection, headache, oral candidiasis, back pain, pneumonia, bronchitis, sinusitis, cough, oropharyngeal pain, arthralgia, hypertension, infuenza, pharyngitis, and pyrexia.<br />\r\n<br />\r\n<strong>Common side efects in Asthma</strong>: Most common adverse reactions (incidence &ge;2%) are nasopharyngitis, oral candidiasis, headache, infuenza, upper respiratory tract infection, bronchitis, sinusitis, oropharyngeal pain, dysphonia, and cough.</p>', '<p>Insufficient data on the use of this preparation in pregnant women and lactating mothers.</p>', '<ul>\r\n	<li>Candida albicans infection of the mouth and pharynx may occur. Monitor patients periodically. Advise the patient to rinse his/her mouth with water without swallowing after inhalation to help reduce the risk.</li>\r\n	<li>Increased risk of pneumonia in patients with COPD. Monitor patients for signs and symptoms of pneumonia.</li>\r\n	<li>Potential worsening of infections (e.g., existing tuberculosis; fungal, bacterial, viral, or parasitic infections; ocular herpes simplex). Use with caution in patients with these infections. More serious or even fatal course of chickenpox or measles can occur in susceptible patients.</li>\r\n</ul>', NULL, '<p>Respiratory corticosteroids</p>', '<p>Store below 25&deg;C. Protect from light &amp; moisture. Keep out of the reach of children.</p>', '<p><strong>Elderly population</strong>: It can be used at the recommended dose in elderly patients.<br />\r\n<strong>Renal impairment</strong>: No dosage adjustment is required in patients with renal impairment.<br />\r\n<strong>Hepatic impairment</strong>: Caution should be observed in patients with moderate or severe hepatic impairment.<br />\r\n<strong>Pediatric population</strong>: The safety and efficacy of this combination in children have not been established. No data are available.</p>', '2022-03-18 20:24:02', '2022-03-18 20:24:02'),
(1324, 1324, '<p>Vildagliptin is indicated as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus as monotherapy and in dual combination with Metformin, a Sulphonylurea, a Thiazolidinedione, or Insulin when diet, exercise and a single antidiabetic agent do not result in adequate glycemic control.</p>', '<p>Vildagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor, which is believed to exert its actions in patients with type 2 diabetes by slowing the inactivation of incretin hormones. Incretin hormones, including glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), are released by the intestine throughout the day, and levels are increased in response to a meal. These hormones are rapidly inactivated by the enzyme, DPP-4. The incretins are part of an endogenous system involved in the physiologic regulation of glucose homeostasis. When blood glucose concentrations are normal or elevated, GLP-1 and GIP increase insulin synthesis and release from pancreatic beta cells by intracellular signaling pathways involving cyclic AMP. GLP-1 also lowers glucagon secretion from pancreatic alpha cells, leading to reduced hepatic glucose production. By increasing and prolonging active incretin levels, Vildagliptin increases insulin release and decreases glucagon levels in the circulation in a glucose-dependent manner.</p>', '<p>The recommended dose of Vildagliptin is-</p>\r\n\r\n<ul>\r\n	<li>50 mg or 100 mg daily for monotherapy.</li>\r\n	<li>50 mg twice daily (morning and evening) when used in dual combination with Metformin or a Thiazolidinedione;</li>\r\n	<li>50 mg once daily in the morning when used in dual combination with a Sulphonylurea.</li>\r\n</ul>\r\n\r\n<p>Vildagliptin may be taken with or without a meal. No dosage adjustment is required in the elderly, or in patients with mild renal impairment.<br />\r\n<br />\r\n<strong>Pediatric use</strong>: Vildagliptin is not recommended in patients 18 years of age.</p>', '<p>In pharmacokinetic studies, no interactions were seen with pioglitazone, metformin, glibenclamide, digoxin, warfarin, amlodipine, ramipril, valsartan or simvastatin. As with other oral antidiabetic medicinal products the glucose-lowering effect of Vildagliptin may be reduced by certain active substances, including thiazides, corticosteroids, thyroid products and sympathomimetics.</p>', '<p>Vildagliptin is contraindicated in patients with:</p>\r\n\r\n<ul>\r\n	<li>Hypersensitivity to the active substance or to any of the excipients</li>\r\n	<li>Patients with moderate to severe renalImpairment</li>\r\n	<li>Patients with Hepatic Impairment: patients with pre-treatment alanine aminotransferase (ALT) or aspartate aminotrasferase (AST) &gt;3 times the upper limit of normal (ULN).</li>\r\n	<li>Patients with type 1 diabetes</li>\r\n</ul>', '<p>The majority of adverse reactions were mild and transient, not requiring treatment discontinuations. A rare case of hepatic dysfunction is seen. Clinical trials of up to and more than 2 years duration did not show any additional safety signals or unforeseen risks when using this combination.</p>', '<p>Vildagliptin should not be used in pregnancy. Vildagliptin should not be used during lactation.</p>', '<p>Caution should be exercised in patients aged 75 years and older due to limited clinical experience. It is recommended that LFTs are monitored prior to initiation of Vildagliptin, at three-monthly intervals in the first year and periodically thereafter. If transaminase levels are increased, patients should be monitored with a second liver function evaluation to confirm the finding and be followed thereafter with frequent liver function tests until the abnormality returns to normal. If AST or ALT persists at 3xULN, Vildagliptin treatment should be stopped. Patients who develop jaundice or other signs of liver dysfunction should discontinue Vildagliptin. Following the withdrawal of treatment with Vildagliptin and LFT normalization, treatment with Vildagliptin should not be reinitiated. Due to limited clinical experience, use with caution in patients with congestive heart failure of New York Heart Association (NYHA) functional class I-II, and do not use in patients with NYHA functional class III IV.</p>', NULL, '<p>Dipeptidyl Peptidase-4 (DPP-4) inhibitor.</p>', '<p>Store below 30&deg;C temperature &amp; keep away from light &amp; moisture. Keep out of reach of children.</p>', NULL, '2022-03-18 20:26:17', '2022-03-18 20:26:17'),
(1325, 1325, '<p>This tablet is indicated as an adjunct to diet and exercises to improve glycaemic control in patients with type 2 diabetes mellitus whose diabetes is not adequately controlled on Metformin Hydrochloride or Vildagliptin alone or who are already treated with the combination of Vildagliptin and Metformin Hydrochloride, as separate tablets.</p>', '<p>Vildagliptin acts primarily by inhibiting DPP-4 (Dipeptidyl peptidase-4), the enzyme responsible for the degradation of the incretin hormones GLP-1 (glucagon-like peptide-1) and GIP (glucose-dependent insulinotropic polypeptide). The administration of Vildagliptin results in a rapid and complete inhibition of DPP-4 activity resulting in increased fasting and postprandial endogenous levels of the incretin hormones GLP-1 and GIP. By increasing the endogenous levels of these incretin hormones, Vildagliptin increases insulin secretion from the pancreatic beta cell and decreases glucagon secretion from alpha cell. The enhanced increase in the insulin/glucagon ratio during hyperglycaemia due to increased incretin hormone levels results in a decrease in fasting and postprandial hepatic glucose production, leading to reduced glycaemia.<br />\r\n<br />\r\nMetformin Hydrochloride is a biguanide type oral antihyperglycemic drug used in the management of type 2 diabetes. It lowers both basal and postprandial plasma glucose. Its mechanism of action is different from those of sulfonylureas and it does not produce hypoglycemia. Glucomin decreases hepatic glucose production, decreases intestinal absorption of glucose and improves insulin sensitivity by an increase in peripheral glucose uptake and utilization.</p>', '<p><strong>Adults</strong>: Based on the patient&#39;s current dose of Metformin, this combination may be initiated at twice daily, 1 tablet in the morning and the other in the evening. Patients receiving Vildagliptin and Metformin from separate tablets may be switched to this combination containing the same doses of each component. Doses higher than 100 mg of vildagliptin are not recommended. There is no clinical experience of Vildagliptin and Metformin in triple combination with other antidiabetic agents. Taking this combination with or just after food may reduce gastrointestinal symptoms associated with Metformin.</p>', '<p>No clinically relevant pharmacokinetic interaction was observed when Vildagliptin (100 mg once daily) was co-administered with Metformin Hydrochloride (1,000 mg once daily). Vildagliptin has a low potential for drug interactions. Since Vildagliptin is not a cytochrome P (CYP) 450 enzyme substrate nor does it inhibit nor induces CYP 450 enzymes, it is not likely to interact with co-medications that are substrates, inhibitors or inducers of these enzymes. As a result of these studies no clinically relevant interactions with other oral antidiabetics (glibenclamide, pioglitazone, metformin hydrochloride), amlodipine, digoxin, ramipril, simvastatin, valsartan or warfarin were observed after co-administration with vildagliptin. On the other hand, furosemide, nifedipine and glyburide increase Cmax and blood AUC of Metformin with no change in renal clearance of Metformin.</p>', '<p>This combination is contraindicated in patients with known hypersensitivity to Vildagliptin or Metformin Hydrochloride or to any of the excipients. It is contraindicated in patients with renal disease or renal dysfunction, acute myocardial infarction, and septicaemia. It is also contraindicated in patients with congestive heart failure patients and in patients with acute or chronic metabolic acidosis, including diabetic ketoacidosis, with or without coma. It should be temporarily discontinued in patients undergoing radiologic studies involving intravascular administration of iodinated contrast materials, because use of such products may result in acute alteration of renal function.</p>', '<p>The most common side effects are headache, tremor, dizziness, nausea, hypoglycaemia etc.</p>', '<p>There are no adequate and well controlled studies in pregnant women and therefore, this combination should not be used during pregnancy unless the potential benefit justifies the potential risk to the foetus.&nbsp;No studies have been conducted with the components of this combination. As it is not known whether Vildagliptin and/or Metformin Hydrochloride is excreted in human milk this combination should not be administered to breast-feeding women.</p>', '<p>Lactic acidosis can occur due to Metformin accumulation. If metabolic acidosis is suspected, treatment should be discontinued and the patient should be hospitalized immediately. Serum creatinine should be monitored at least once a year in patients with normal renal function and 2&ndash;4 times a year in patients with serum creatinine levels at the upper limit of normal and in elderly patients. Special caution should be exercised in elderly patients where renal function may become impaired (e.g. when initiating antihypertensives, diuretics or NSAIDs). It is recommended that Liver Function Tests (LFTs) are monitored prior to initiation of this drug, at three-monthly intervals in the first year and periodically thereafter. If transaminase levels are increased, patients should be monitored with a second liver function evaluation to confirm the finding and be followed thereafter with frequent liver function tests until the abnormality return to normal. If AST or ALT persist at 3 x ULN, Vildagliptin &amp; Metformin tablets should be stopped Patients who develop jaundice or other signs of liver dysfunction. Following withdrawal of treatment with Vildagliptin &amp; Metformin and LFT normalization, treatment with Vildagliptin &amp; Metformin should not be reinitiated. Vildagliptin &amp; Metformin tablets should be discontinued 48 hours before elective surgery with general anaesthesia and should not usually be resumed earlier than 48 hours afterwards.</p>', NULL, '<p>Combination Oral hypoglycemic preparations.</p>', '<p>Keep in a dry place away from light and heat. Keep out of the reach of children.</p>', '<p><strong>Use in pediatric patients</strong>: The safety and effectiveness of this combination in pediatric patients have not been established. Therefore, this combination is not recommended for use in children below 18 years of age.<br />\r\n<br />\r\n<strong>Use in geriatric patients</strong>: As Metformin is excreted via the kidney, and elderly patients have a tendency to decreased renal function, elderly patients taking this combination should have their renal function monitored regularly. This combination should only be used in elderly patients with normal renal function.<br />\r\n<br />\r\n<strong>Patients with renal impairment</strong>: This combination should not be used in patients with renal failure or renal dysfunction, e.g. serum creatinine levels &gt; 1.5 mg/dl (&gt;135 micro mol/L) in males and &gt; 1.4 mg/dl (&gt;110 micro mol/L) in females.<br />\r\n<br />\r\n<strong>Patients with hepatic impairment</strong>: This combination is not recommended in patients with hepatic impairment including patients with a pre-treatment ALT or AST &gt;3 X the upper limit of normal.</p>', '2022-03-18 20:27:56', '2022-03-18 20:27:56'),
(1326, 1326, '<p>Vinblastine is effective as a single agent, but its therapeutic effect is enhanced when used in combination with other antineoplastic drugs. Vinblastine has been used in the treatment of Hodgkin&rsquo;s disease (Stages III and IV) in combination therapy (with adriamycin (doxorubicin), bleomycin and dacarbazine as ABVD) and in the treatment of advanced testicular carcinoma (with cisplatin and bleomycin). Vinblastine has been used in the palliative treatment of lymphocytic lymphoma, histiocytic lymphoma, advanced stages of mycosis fungoides, Kaposi&#39;s sarcoma and Histiocytosis X.<br />\r\n<br />\r\nVinblastine may be used in the treatment of choriocarcinoma resistant to other chemotherapeutic agents; carcinoma of the breast, unresponsive to appropriate endocrine surgery and hormonal therapy. One of the most effective single agents for treatment of Hodgkin&rsquo;s disease is vinblastine. A protocol substituting cyclophosphamide for nitrogen mustard and vinblastine for vincristine in MOPP&nbsp;is an alternative therapy for previously untreated patients with advanced Hodgkin&rsquo;s disease. Patients suffering relapse have also responded to combination therapy that included vinblastine. Advanced testicular germ-cell cancers are sensitive to vinblastine alone but the administration of vinblastine concomitantly with other antineoplastic agents, produces better clinical results. Bleomycin effectiveness is enhanced when vinblastine is administered 6 to 8 hours prior to bleomycin administration; this schedule permits more cells to be arrested during metaphase, in which bleomycin is active.</p>', '<p>Vinblastine is M phase specific. It binds to microtubular proteins and arrests mitosis at the metaphase by disrupting mitotic spindle formation. It blocks glutamic acid utilization, thus inhibiting purine synthesis, the citric acid cycle, and the formation of urea. It may also interfere with nucleic acid and protein synthesis.</p>', '<p><strong>Adult (Intravenous)</strong>: Initially, 3.7 mg/m2, increase dose wkly based on WBC counts in increments of about 1.8 mg/m2&nbsp;until leukocyte count decreases to about 3000/mm3, or max wkly dose of 18.5 mg/m2&nbsp;reached. Do not increase dose if leukocyte count is reduced to approximately 3000 cells/mm3; administer the max dose that does not cause leucopenia for maintenance. Do not increase subsequent doses if onolytic activity occurs before leucopenic effect. Usual dose: 5.5-7.4 mg/m2&nbsp;per wk. Do not admin next dose, even though 7 days have lapsed unless the leukocyte count has returned to at least 4000/mm3.<br />\r\n<br />\r\n<strong>Child (Intravenous)</strong>: Initial 2.5 mg/m2&nbsp;of BSA, increased dose at wkly intervals in increments of about 1.25 mg/m2&nbsp;until leukocyte count decreases to about 3000/ mm3, or max wkly dose of 12.5 mg/m2&nbsp;reached. Do not increase dose once leukocyte count reaches approximately 3000 cells/mm3, instead, a dose of 1 increment smaller to be admin at wkly intervals for maintenance i.e. patient receives the max dose that does not cause leucopenia. If onolytic activity is encountered before leucopenic effect, then there is no need to increase subsequent doses. Do not admin next dose, even though 7 days have lapsed unless the leukocyte count has returned to at least 4000/mm3. Duration of maintenance therapy depends on disease state and the antineoplastic agent combination.</p>', '<p>Possible increase in vinblastine levels with aprepitant. Reduced vinblastine metabolism with miconazole. Variable interactions with phenytoin, monitor serum phenytoin levels. Reduced immune response with vaccines. Additive myelotoxicity with zidovudine. Concurrent admin of vinblastine with CYP3A inhibitors may cause an earlier onset and/or an increased severity of side effects.</p>', '<p>Severe bone marrow suppression; presence of bacterial infection; maglignant cell infiltration of bone marrow; Inj into extremity with poor circulation; porphyria; granulocytopenia. Elderly with cachexia or extreme skin ulcerations. Pregnancy; lactation. Intrathecal use may result in death.</p>', '<p>Alopecia, constipation, malaise, stomatitis, dose-limiting bone marrow suppression (e.g. granulocytopenia, thrombocytopenia, anaemia), hypertension, central and peripheral neurotoxicity, 8th cranial nerve damage resulting in vestibular and auditory toxicity, ischaemic cardiac toxicity, breathlessness, bone, tumour or jaw pain. Nausea, vomiting, GI bleed, syndrome of inappropriate antidiuretic hormone. Necrosis, cellulitis if extravasation occurs.</p>', '<p>Category D: There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).</p>', '<p>Hepatic impairment; neurotoxicity; ischemic heart disease; preexisting pulmonary dysfunction; extravasation may cause tissue damage and pain. Discontinue immediately if extravasation occurs, with local Inj of hyaluronidase and local heat application to decrease discomfort and risk of cellulitis; remaining Inj to be injected into another vein. Routine prophylaxis against constipation recommended especially in high doses. Nadir in leukocyte count occur 4-10 days after vinblastine admin; recovery observed 7-14 days after treatment.</p>', '<p><strong>Symptoms</strong>: Severe bone marrow suppression and extensions of its usual side effects.<br />\r\n<br />\r\n<strong>Management</strong>: Treatment is supportive. Restrict fluid and use of loop diuretics to counteract the effects of syndrome of inappropriate secretion of antidiuretic hormone. Monitor the patient&#39;s CV system and daily blood counts for transfusion requirement.</p>', '<p>Cytotoxic Chemotherapy.</p>', '<p>Store at 2-8&deg; C.</p>', '<p><strong>Hepatic Impairment:</strong>&nbsp;Serum bilirubin &gt;3 mg/100ml: Reduce dose by 50%.</p>', '2022-03-18 20:29:45', '2022-03-18 20:29:45'),
(1327, 1327, '<p>Vincristine sulfate injection is indicated in&nbsp;acute leukemia. Vincristine sulfate injection has also been shown to be useful in combination with other oncolytic agents in Hodgkin&#39;s disease, non-Hodgkin&#39;s malignant lymphomas (lymphocytic, mixed&nbsp;cell, histiocytic, undifferentiated, nodular and diffuse types),&nbsp;rhabdomyosarcoma,&nbsp;neuroblastoma, and Wilms&#39; tumor.</p>', '<p>Vincristine arrests cell division at the metaphase stage by inhibiting microtubule formation in the mitotic spindle.</p>', '<p><strong>Adult (Intravenous)</strong>: Usual recommended dosage: 1.4-1.5 mg/m2&nbsp;once wkly. Max: 2 mg wkly. Subsequent doses may be modified based on clinical and haematological responses and tolerance of the patient. May be used in combination with other drugs. Prescribers should consult published protocols for the dosage, method and sequence of admin.<br />\r\n<br />\r\n<strong>Child (Intravenous)</strong>: Usual recommended dosage: 1.5-2 mg/m2&nbsp;once wkly; for patients &le;10 kg: Initiate at 0.05 mg/kg once wkly. Subsequent doses may be modified based on clinical and haematological responses and tolerance of the patient. May be used in combination with other drugs. Prescribers should consult published protocols for the dosage, method and sequence of admin.</p>', '<p>Decreased digoxin (tablets) and verapamil absorption with antineoplastic regimens. Increased etoposide serum levels with vincristine. Increased toxicity when ganciclovir given with, immediately before or after vincristine. Reduced vincristine metabolism with miconazole. Increased neurotoxicity with isoniazid, itraconazole, voriconazole, posaconazole and nifedipine. Decreased immune response when used concurrently with vaccines. Increased myelotoxicity with zidovudine. Increased risk of thromboembolic complications with tamoxifen. Increased risk of ototoxicity with ototoxic drugs (e.g. platinum-containing antineoplastic agents). Possible risk of earlier onset and/or increased severity of adverse effects with macrolides. Possible increase in vincristine levels with aprepitant. Possible decrease in antiepileptic levels with vincristine, monitor serum antiepileptic levels and effectiveness of chemotherapy.</p>', '<p>Patients with demyelinating form of Charcot-Marie-Tooth syndrome. Pregnancy and lactation. Intrathecal admin (may be fatal). Patients receiving radiation therapy through ports which include liver.</p>', '<p>Dose limiting neurotoxicity (e.g. motor function impairment, gait abnormalities), hyperuricaemia, bronchospasm, azospermia, amenorrhoea, alopoecia, leucopenia, urinary dysfunction, abdominal cramps, vomiting, diarrhoea, severe constipation, paralytic ileus, convulsions, hypertension, orthostatic hypotension, ptosis, hoarseness, optic neuropathies, hallucinations, blindness, neurological deafness, difficulty in walking, syndrome of inappropriate ADH secretion.</p>', '<p><strong>Pregnancy</strong>&nbsp;Category D: There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).</p>', '<p>Elderly. Preexisting pulmonary dysfunction or neuromuscular disease; leucopenia or a complicating infection; impaired liver function; obstructive jaundice. Routine prophylactic laxative needed to ensure regular bowel movement. Discontinue immediately if extravasation occurs, and inj any remaining drug into another vein, followed by local Inj of hyaluronidase and topical heat application to the affected area to aid in drug removal and reduce discomfort. Discontinue in patients who develop progressive dyspnea. CBC to be checked before each dose admin. Frequent monitoring of uric acid during first 3-4 wk of treatment and watch out for uric acid nephropathy.</p>', '<p><strong>Symptoms</strong>: mainly extensions of its common adverse effects.<br />\r\n<br />\r\n<strong>Management</strong>: Treatment is supportive and includes prevention of side effects from syndrome of inappropriate antidiuretic hormone secretion (SIADH) (e.g. fluid restriction and admin of loop diuretic); admin of anticonvulsants and use of enemas (to prevent ileus). Closely monitor the CV system and determine the blood counts daily to guide transfusion requirements. Folinic acid 100 mg admin IV every 3 hr for 24 hr and then every 6 hr for at least 48 h may be admin. Haemodialysis unlikely to be useful.</p>', '<p>Cytotoxic Chemotherapy.</p>', '<p>Store at 2-8&deg; C. Protect from light.</p>', '<p><strong>Hepatic Impairment:</strong>&nbsp;Dose adjustment may be needed. Serum bilirubin &gt;3 mg/100ml: Reduce dose by 50%.</p>', '2022-03-18 20:31:52', '2022-03-18 20:31:52'),
(1328, 1328, '<p>Vinorelbine is indicated:</p>\r\n\r\n<ul>\r\n	<li>In combination with&nbsp;cisplatin&nbsp;for first-line treatment of patients with locally advanced or metastatic&nbsp;non-small cell lung cancer&nbsp;(NSCLC)</li>\r\n	<li>As a single agent, for the treatment of patients with metastatic NSCLC</li>\r\n</ul>', '<p>Vinorelbine, a semisynthetic vinblastine derivative, binds to tubulin and inhibits microtubule formation. This disrupts the formation of the mitotic spindle thereby arresting the cell at metaphase.</p>', '<p>Intravenous (Adult):</p>\r\n\r\n<p><strong>Cervical cancer</strong>:&nbsp;30 mg/m2&nbsp;days 1 and 8 of a 21-day treatment cycle.<br />\r\n<br />\r\n<strong>Breast cancer, Ovarian cancer</strong>:&nbsp;25 mg/m2&nbsp;dose every 7 days.<br />\r\n<br />\r\n<strong>Non-small cell lung cancer</strong>:&nbsp;</p>\r\n\r\n<ul>\r\n	<li><strong>As single agent</strong>: 30 mg/m2&nbsp;wkly as infusion over 20-30 minutes (after diluting in 125 ml normal saline or glucose 5%) or as slow bolus over 5-10 minutes (after diluting in 20-50 ml normal saline or glucose 5%). Delay subsequent doses if neutrophil count is &lt;2000 cells/mm3&nbsp;until recovery.</li>\r\n	<li><strong>As combination therapy with cisplatin</strong>: 25-30 mg/m2&nbsp;every 7 days.</li>\r\n</ul>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>Oral&nbsp;(Adult):</p>\r\n\r\n<p><strong>Non-small cell lung cancer</strong>:&nbsp;60 mg/m2once wkly for 3 wk, may increase subsequently to 80 mg/m2&nbsp;once wkly. If neutrophil count is &lt; 500 cells/mm3&nbsp;or between 500-1000 cells/mm3&nbsp;on 2 separate occasions, keep dose at 60 mg/m2&nbsp;for next 3 doses.</p>', '<p>Increased risk of granulocytopenia with cisplatin. Increased risk of neurotoxicity with paclitaxel, itraconazole, ketoconazole. Increased radiosensitising effects with prior or concomitant radiation therapy. Increased pulmonary toxicity with mitomycin. Increased myelotoxicity with zidovudine. Earlier onset and/or an increased severity of side effects with CYP3A inhibitors. Possible increase in vincristine levels with aprepitant. Possible infection with live vaccines.</p>', '<p>Hypersensitivity to vinorelbine or other vinca alkaloids; severe current or recent infection (within last 2 wk); neutropenia; thrombocytopenia; severe hepatic impairment. Intrathecal admin. Do not give concomitantly with radiotherapy if liver is in treatment field. Pregnancy, lactation.</p>', '<p>Neurotoxicity, peripheral paraesthesia, loss of deep tendon reflexes, abdominal pain, severe constipation, diarrhoea, alopecia, severe local irritation. Dose limiting granulocytopenia, leukopenia and anaemia. Intestinal obstruction, paralytic ileus, nausea, vomitinh, increased in LFT, chest pain, fatigue. Local pain and thrombophlebitis with repeated Inj.</p>', '<p>Pregnancy&nbsp;Category D. There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).</p>', '<p>Hepatic impairment. Compromised bone marrow reserve due to prior irradiation or chemotherapy; recovering marrow function from the effects of previous chemotherapy. Prior radiation therapy; past history or pre-existing neuropathy. CBC with differentials to be monitored prior to admin of subsequent doses. Delay subsequent doses, if neutrophil count &lt; 2000 cells/mm3. Each admin to be followed by at least 250 ml of normal saline to flush the vein. Avoid extravasation. If extravasation occurs, stop infusion immediately, and flush the vein with normal saline solution; admin the remaining solution in another vein. Do not father a child during and up to six mth after treatment and females of childbearing potential to use effective method of contraception during treatment and three mth thereafter. When admin orally, capsules must be swallowed whole with water and not chewed or sucked.</p>', NULL, '<p>Cytotoxic Chemotherapy.</p>', '<p>Intravenous:&nbsp;Store at 2-8&deg;C. Protect from light. Oral:&nbsp;Store at 2-8&deg;C.</p>', '<p>Hepatic Impairment:<br />\r\nIntravenous:&nbsp;</p>\r\n\r\n<ul>\r\n	<li><strong>Cervical cancer</strong>:&nbsp;Dose adjustments may be needed.</li>\r\n	<li><strong>Breast cancer</strong>, Ovarian<strong>&nbsp;cancer</strong>:&nbsp;Dose adjustments may be needed.</li>\r\n	<li><strong>Non-small cell lung cancer</strong>:&nbsp;Massive liver metastases(&gt;75% of liver volume replaced by the tumour): Decrease dose by&nbsp;1/3. Bilirubin 2.1-3 mg/100 ml: Reduce IV dose by 50%. Bilirubin &gt;3 mg/100 ml: Reduce IV dose by 75%.</li>\r\n</ul>\r\n\r\n<p>Oral:&nbsp;</p>\r\n\r\n<ul>\r\n	<li><strong>Massive liver metastases(&gt;75% of liver volume replaced by&nbsp;</strong>the tumour<strong>)</strong>: Decrease dose by&nbsp;1/3. Bilirubin 2.1-3 mg/100 ml: Reduce IV dose by 50%. Bilirubin &gt;3 mg/100 ml: Reduce IV dose by 75%.</li>\r\n</ul>', '2022-03-18 20:33:36', '2022-03-18 20:33:36'),
(1329, 1329, '<p><strong>Acute Cerebro-Vascular Accidents (Strokes)</strong>: Ischaemic strokes due to cerebral thrombosis, cerebral embolism, acute circulatory disorder, hypertensive crisis; the acute cardiovascular disorders, ischaemic neurological defcit, complete stroke (CS), multiinfarct dementia, cerebral arteriosclerosis, hypertensive encephalopathy, post-apoplectic conditions with the background of haemorrhagic strokes etc.<br />\r\n<br />\r\n<strong>Senile Disorder</strong>: For relief of psychosomatic symptoms in the elderly due to cerebral insufciency eg. forgetfulness, memory disturbances, slow thinking, lack of concentration, dizziness, mood instability, aphasia, sleep disturbances, vasovegetative symptoms of menopausal syndrome etc.<br />\r\n<br />\r\n<strong>Visual Disorder</strong>: Vascular disorders of the choroid and retina due to arteriosclerosis. Vasospasm, macula degenerations, arterial or venous thrombosis or embolism and glaucoma secondary to the above mentioned disorders.<br />\r\n<br />\r\n<strong>Hearing Disorder</strong>: For the treatment of impaired hearing of vascular or toxic (iatrogenic) origin presbyacusis, meniere&#39;s disease, cochleovestibular neuritis, tinnitus and dizziness of labirynth origin.</p>', '<p>Vinpocetine increases cerebral metabolism; it increases glucose and O2 consumption; improves cerebral hypoxia tolerance; shifts glucose metabolism to the energetically more favourable aerobic pathway, but it increases the anaerobic pathway as well; it elevates the ATP concentration and the ATP/AMP ratio in the brain, and elevates the cerebral norepinephrine, dopamine and serotonin levels.<br />\r\n<br />\r\nVinpocetine considerably improves cerebral microcirculation by inhibiting platelet aggregation, reducing the pathologically increased blood viscosity, and increases erythrocyte deformability. It also promotes O2&nbsp;transport into the tissues by reducing the O2&nbsp;affinity of erythrocytes.<br />\r\n<br />\r\nIt selectively and intensely increases cerebral blood flow and the share of the brain in cardiac output, it reduces cerebral vascular resistance without affecting systemic circulation (blood pressure, heart rate, cardiac output, total peripheral resistance). It does not elicit steal phenomenon; on the contrary, it primarily improves the blood supply of the injured and ischaemic area while it remains unchanged in the intact areas (inverse steal effect). It further increases blood flow which is already increased as a result of hypoxia.</p>', '<p><strong>Tablet</strong>: 1-2 tablets thrice daily, the maintenance dose is 1 tablet thrice daily.<br />\r\n<br />\r\n<strong>IM Injection</strong>: Daily dose of 20-40 mg are to be given until improvement of symptoms is reached (for not longer than 10 days) then oral treatment should be applied. If this regimen fails, infusion treatment should be started.<br />\r\n<br />\r\n<strong>IV Infusion</strong>: The daily starting dose is 20 mg in slow drip infusion (2 ampoules in 500-1000 ml infusion solution). This dose can be increased to 1 mg/kg body weight during 3 to 4 days. Treatment should be continued for 10-14 days depending on the tolerance of the patients and the dose should be gradually reduced before discontinuation of treatment.</p>', '<p>The injection is chemically incompatible with heparin, therefore, it should not be injected in the same syringe.</p>', '<p>Parenteral treatment- Severe ischaemic heart disease, severe rhythm disorders and pregnancy.</p>', '<p>Transient hypotension, tachycardia may occur.</p>', '<p>In Pregnancy and Lactation the drug is contraindicated.</p>', '<p>In the acute stage until the improvement of symptoms parenteral treatment is recommended followed by oral treatment. In chronic cases oral therapy should be applied.</p>', NULL, '<p>Cerebral vasodilator &amp; Neurosensory oxygenator drugs</p>', '<p>Store in a cool and dry place, protected from light and moisture.</p>', NULL, '2022-03-18 20:35:11', '2022-03-18 20:35:11'),
(1330, 1330, '<p>Illness due to vitamin A deficiency in ophthalmology such as night blindness, xerophthalmia and dermatological such as changes in skin, hair and nails. Concomitant therapy of mucosa illnesses such as sinusitis, bronchitis, in acne vulgaris, ichthyosis, Darier&#39;s disease, psoriasis etc. To meet vitmin A demand in growth, resistance to infections and night blindness. This&nbsp;is also indicated to meet vitamin A deficiency after diarrhoea and prophylaxis of measles.</p>', '<p>Beta-carotene, retinol, and retinal have effective and reliable vitamin A activity. Retinal and retinol are in chemical equilibrium in the body and have equivalent antixerophthalmic activity. Retinal combines with the rod pigment, opsin, in the retina to form rhodopsin, necessary for visual dark adaptation.<br />\r\n<br />\r\nVitamin A prevents retardation of growth and preserves the epithe-lial cells&#39; integrity. Normal adult liver storage is sufficient to satisfy two years&#39;requirements of vitamin A. Vitamin A is readily absorbed from the gastrointestinal tract, where the biosynthesis of vitamin A from beta-carotene takes place. Vitamin A absorption requires bile salts, pancreatic lipase, and dietary fat. It is transported in the blood to the liver by the chy lomicron fraction of the lymph. Vitamin Ais stored in Kupffer cells of the liver mainly as the palmitate. Normal serum vitamin A is 80-300 Units per 100 mL (plasma range is 30-70 mcg per dl) and for carotenoids 270-753 Units per 100 mL.The normal adult liver contains approximately 100 to 300 micrograms per gram, mostly as retinol palmitate.</p>', '<p>For Adults: 50000 IU-100000 IU daily up to 200000 IU if necessary.<br />\r\n<br />\r\nChildren (Above 1 year):</p>\r\n\r\n<ul>\r\n	<li><strong>Night blindness, Bitot&#39;s spots, Xerophthalmia</strong>: 200000 IU 1st day, 2nd day, 14th day</li>\r\n	<li><strong>Measles</strong>: 200000 IU 1st day, 2nd day</li>\r\n	<li><strong>Diarrhoea, Respiratory tract infection</strong>: 200000 IU every time after disease</li>\r\n	<li><strong>Severe malnutrition</strong>: 200000 IU single-dose or as directed by the registered physician.</li>\r\n</ul>', NULL, '<p>Hypervitaminosis of vitamin A. Sensitivity to any of the ingredients in this preparation.</p>', '<p>Vitamin A intoxication includes irritability, vomiting, loss of appetite, headache, dry and pruritic skin, skin desquamation, fatique, pain in ankles and feet, myalgia, loss of body hair, papilledema, nystagmus, liver sclerosis and cirrhosis.</p>', '<p>Safety of amounts exceeding 6,000 Units of vitamin A daily during pregnancy has not been established at this time. The use of vitamin A in excess of the recommended dietary allowance may cause fetal harm when administered to a pregnant woman. Animal reproduction studies have shown fetal abnormalities associated with over-dosage in several species. Malformations of the central nervous system, the eye, the palate, and the urogenital tract are recorded. Vitamin Ain excess of the recommended dietary allowance is contraindicated in women who are or may become pregnant. If vitamin Ais used during pregnancy, or if the patient becomes pregnant while taking vitamin A, the patient should be apprised of the potential hazard to the fetus.&nbsp;<br />\r\n<br />\r\nThe U.S. Recommended Daily Allowance (RDA) of vitamin A (5,000 Units) is recommended for nursing mothers.</p>', '<p>Ensure Vitamin A free interval after long term therapy with vitamin A. No daily dose over 5000 IU during pregnancy. Vitamin A doses over 50000 IU under medical supervision only.</p>', NULL, '<p>Vitamin-A preparations.</p>', '<p>Keep below 25&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-18 20:37:20', '2022-03-18 20:37:20'),
(1331, 1331, '<p>This is indicated as a daily multivitamin maintenance dosage for adults and children aged 11 years and above receiving parenteral nutrition. It is also indicated in other situations where administration by the intravenous route is required. Such situations include surgery, extensive burns, fractures and other trauma, severe infectious diseases and comatose states, which may provoke a &quot;stress&quot; situation with profound alterations in the body&#39;s metabolic demands and consequent tissue depletion of nutrients.</p>', '<p>This&nbsp;is a sterile, lyophilized powder for injection/infusion which contains nine water-soluble and three fat soluble vitamins. Mixed micelles is used as a solubilizing agent. It is presented as a lyophilized, orange-yellow, sterile powder that is to be reconstituted with 5ml of Water for injections or other parenteral fluids, (e.g. as 0.9% Sodium chloride or 5% Glucose solution), prior to administration by parenteral route.</p>', '<p>Adults and children aged 11 years and above: 1 vial/day</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>The single dose vial&nbsp;is reconstituted by adding 5 ml of sterile Water for injection or other intravenous fluids like 0.9% Sodium Chloride injection or 5% Glucose injection. 5 ml of diluent should be added by means of sterile syringe into the vial and gently mixed to dissolve the lyophilized powder. The entire volume of the resultant solution should then be administered by slow Intravenous injection (at least over 10 minutes) or further diluted for intravenous infusion. To minimize vitamin losses in parenteral nutrition admixtures, add the vitamins immediately prior to administration and complete administration within 24 hours.</p>', '<p>Patients receiving drugs that bind to a1-acid glycoprotein should be closely monitored for increases in response to these drugs, e.g. propranolol, prazosin and quinidine. Folic acid may increase the metabolism of some antiepileptics, such as phenobartbitol, phenytoin and primidone. Pyridoxine can reduce the effect of levo-dopa. Bleomycin can be inactivated by ascorbic acid and riboflavin.</p>', '<p>This&nbsp;is contraindicated in patients with pre-existing hypervitaminosis or known hypersensitivity to any of the active ingredients. This product should not be injected to patients with pre-existing intolerance to thiamine. Similarly, this product should not be administered to patients with impaired hepatic function. This preparation should not be administered to those suffering from hyperparathyroidism due to hypercalcaemic complications.</p>', '<p>Anaphylactic reactions have been reported following large intravenous doses of Thiamine. Urticaria and rash have also been associated with this preparation. There have been very rare reports of anaphylactic reactions following IV injection/infusion with this preparation over 1-4 minutes.</p>', '<p>The use of this preparation has not been studied in human during pregnancy. This&nbsp;should be given to a pregnant woman only if clearly needed. The use of this product in lactating women is not recommended.</p>', '<p>Anaphylactic reactions may occur in allergic subjects who are susceptible to Thiamine (Vitamin B1) and nicotinamide components of this product. Mild allergic reactions such as sneezing or mild asthma are warning signs that further injection/infusion may give rise to anaphylactic shock. Due to glychocolic acid content, repeated and prolonged administration in patients with jaundice of hepatic origin or severe biochemical evidence of cholestatis requires careful monitoring of liver function. Also in the case of impaired kidney function, fat-soluble vitamin levels should be carefully monitored.</p>', NULL, '<p>Specific combined vitamin preparations.</p>', '<p><strong>Before reconstitution</strong>: Store below 25&deg;C. Protect from light and do not freeze.<br />\r\n<br />\r\n<strong>After reconstitution:</strong>&nbsp;The reconstituted product should be used immediately or it should be stored at 2&deg;C to 8&deg;C for no more than 24 hours. Discard any unused portion of the reconstituted solution.</p>', '<p>Accumulation of Vitamin A and Vitamin D may be occured with prolonged administration of high doses.</p>', '2022-03-18 20:39:06', '2022-03-18 20:39:06'),
(1332, 1332, '<p>Vitamin-B complex is indicated for prophylactic or therapeutic nutritional supplementation in physiologically stressful conditions. These include: Conditions causing depletion, or reduced absorption or bioavailability of essential B-vitamins manifested by glossitis, stomatitis, cheilosis, beriberi&nbsp;Vitamin-B complex is indicated for prophylactic or therapeutic nutritional supplementation in physiologically stressful conditions. These include: Conditions causing depletion, or reduced absorption or bioavailability of essential B-vitamins manifested by glossitis, stomatitis, cheilosis, beriberi.</p>', '<p>Vitamin-B complex&nbsp;contains the most important members of the vitamin B group in pure form and in therapeutically balanced proportions. The members of the vitamin B group contained in Vitamin-B complex&nbsp;are components of enzyme systems that regulate various stages of carbohydrate, fat and protein metabolism, each of the components playing a specific biological role. Deficiency of B vitamin causes glossitis, stomatitis, cheilosis, polyneuritis, beriberi, pellagra and vascularisation of cornea.</p>', '<p><strong>Tablet/ capsule:</strong>&nbsp;usual recommended dose is 1-2 tablet/capsule 3 times daily or as directed by the physician.<br />\r\n<br />\r\n<strong>Syrup:</strong>&nbsp;2-3 teaspoonful daily or as directed by the physician.<br />\r\n<br />\r\n<strong>Injection:</strong>&nbsp;It is for intramuscular and intravenous administration. Usual recommended dose is 2 ml daily or as directed by the physician. In addition with&nbsp;Thiamine, Riboflavin, Nicotinamide, Pyridoxine; injectable dosage from contains&nbsp;D-Panthenol 5 mg.</p>', '<p>As little as 5 mg pyridoxine daily can decrease the efficacy of levodopa in the treatment of parkinsonism. Therefore, Vitamin-B complex is not recommended for patients undergoing such therapy.</p>', '<p>Vitamin-B complex is contraindicated in patients hypersensitive to any of its components.</p>', '<p>Adverse reactions have been reported with specific vitamins and minerals, but generally at levels substantially higher than those in Vitamin-B complex. However, allergic and idiosyncratic reactions are possible at lower levels. Iron, even at the usual recommended level has been associated with gastrointestinal intolerance in some patients.</p>', '<p>It is safe to use Vitamin-B complex in pregnancy and lactation.</p>', NULL, NULL, '<p>Specific combined vitamin preparations</p>', NULL, NULL, '2022-03-18 20:40:37', '2022-03-18 20:40:37');
INSERT INTO `generic_details` (`id`, `generic_id`, `indications`, `pharmacology`, `dosage_and_administration`, `interaction`, `contraindications`, `side_effects`, `pregnancy_and_lactation`, `precautions_and_warnings`, `overdose_effects`, `therapeutic_class`, `storage_conditions`, `use_in_special_populations`, `created_at`, `updated_at`) VALUES
(1333, 1333, '<p>Vitamin B complex &amp; Vitamin C is indicated in the treatment of patients with deficiencies of, or increased requirement for, vitamin B-complex and vitamin C. Such patients and conditions include:</p>\r\n\r\n<ul>\r\n	<li>Decreased intake because of restricted or unbalanced diet as in anorexia, diabetes mellitus, obesity and alcoholism.</li>\r\n	<li>Reduced availability during treatment with antimicrobials which alter normal intestinal flora, in prolonged diarrhea and in chronic gastrointestinal disorders.</li>\r\n	<li>Increased requirements due to increased metabolic rate as in fever and tissue wasting, e.g. febrile illness, acute or chronic infections, surgery, burns and fractures.</li>\r\n	<li>Stomatitis, glossitis, cheilosis, paraesthesias, neuralgia and dermatitis.</li>\r\n	<li>Micronutrient deficiencies during pregnancy or lactation.</li>\r\n</ul>', '<p>Vitamin B-Complex and Vitamin C function as cofactors of various enzymes which regulate carbohydrate, protein and fat metabolism. Thiamine (B.,) acts as a cofactor in the decarboxylation of keto acids such as pyruvic acid.<br />\r\n<br />\r\nRiboflavin (B2) plays a vital role in cellular respiratory reactions in conjunction with nicotinamide.<br />\r\n<br />\r\nPyridoxine (B6) takes part in decarboxylation and interconversion of amino acids. It is also required for normal antibody-mediated and cell-mediated immune responses.<br />\r\n<br />\r\nVitamin B12 (cyanocobalamin) is required for synthesis of DNA (deoxyribo-nucleic acid) and maturation of RBCs (red blood cells). Nicotinamide (niacinamide) plays a vital role in cellular respiration in conjunction with riboflavin.<br />\r\n<br />\r\nCalcium Pantothenate functions as a cofactor for enzymes involved in transfer of acetyl groups. It is also required for normal antibody response in conjunction with pyridoxine.<br />\r\n<br />\r\nFolic acid, after conversion in the body to folinic acid, takes part in reactions involved in the synthesis of nucleotides and maturation of RBCs in conjunction with vitamin B12. It also plays an important role in lymphocyte-mediated immune response.<br />\r\n<br />\r\nAscorbic acid (Vitamin C) takes part in biochemical reactions involving oxidation, as in collagen synthesis, and in conversion of folic acid to folinic acid. It is also necessary for normal phagocytic function ofWBCs (white blood cells).<br />\r\n<br />\r\nThus an adequate supply of these water-soluble vitamins is required for the optimum function of various cells and tissues.Except for Vitamin B12, these water-soluble vitamins are not stored in the body to any significant extent, the excess quantities being excreted in the urine. Therefore, a regular and adequate intake of them is necessary to meet the metabolic requirements. Deficiencies of water-soluble vitamins often co-exist because of their overlapping dietary sources and metabolic interdependence. Initially the deficiency of these vitamins may be subclinical and demonstrable only by means of biochemical tests. If not corrected at this stage, it may become manifest as various symptoms, including impaired wound healing and increased susceptibility to infection.&nbsp;Classical deficiency diseases such as beri beri, pellagra and scurvy are rare, whereas mild and subclinical deficiencies are probably more common, even among apparently healthy individuals.</p>', '<p>One capsule daily or as advised by the physician.</p>', NULL, '<p>Hypersensitivity to any of the ingredients of this preparation.</p>', '<p>Hypersensitivity reactions have been reported with thiamine and folic acid, although these are rare.</p>', '<p>No data found.</p>', '<p>The use of this capsule in patients with deficiency or increased requirement of Vitamin B-complex and Vitamin C should be accompanied by specific therapy for the primary illness.<br />\r\n<br />\r\nTreatment with this capsule should be continued only until the deficiency is corrected or the need for supplementation exists. Pyridoxine in this capsule may reduce the therapeutic effects of levodopa in Parkinson&rsquo;s disease.<br />\r\n<br />\r\nRiboflavin in this capsule may color the urine yellow. During treatment with this capsule the urine may give a false positive result for sugar by Benedict&#39;s test because of the presence of ascorbic acid. Therefore, a test not affected by ascorbic acid should be used.</p>', NULL, '<p>Specific combined vitamin preparations.</p>', '<p>Store in a cool and dry place, away from light and children.</p>', NULL, '2022-03-18 20:42:09', '2022-03-18 20:42:09'),
(1334, 1334, '<p>This is indicated for the treatment and prevention of zinc and vitamin B deficiencies.</p>', '<p>Zinc is vital for many biological functions such as immunity enhancement, wound healing, digestion, reproduction, physical growth and mental development. Zinc supports normal growth and development during pregnancy, childhood, and adolescence. Zinc also has some antioxidant properties. Zinc is used to treat ADHD (Attention Deficit Hyper-activity Disorder) in children. In adult, due to zinc deficiency loss of appetite, poor sense of taste and smell, tendency towards depression, white marks on fingernails, frequent infections, low fertility, prostate problems, mental problems, poor wound healing, a poor immune system, diarrhoea, mental lethargy, rough skin and weight loss may occur.<br />\r\n<br />\r\nB-Vitamins are needed to release energy from food. They play an important role in ensuring healthy brain and nerve function, healthy red blood cells formation in children &amp; adults. They are specially needed for healthy growth and development of children. B-Vitamin deficiencies in adult cause profound fatigue and various types of neurologic manifestations, which may include weakness, poor balance, confusion, irritability, memory loss, nervousness, tingling of the limbs and loss of coordination. Additional symptoms of vitamin B deficiency are sleep disturbances, nausea, poor appetite, frequent infections, and skin lesions.</p>', '<p>Syrup-</p>\r\n\r\n<ul>\r\n	<li><strong>Adults</strong>: 10 ml (2 teaspoonful) 2 to 3 times daily or as recommended by the physician.</li>\r\n	<li><strong>Children</strong>: 10 ml (2 teaspoonful) 1 to 3 times daily or as recommended by the physician.</li>\r\n	<li><strong>Infants</strong>: 5 ml (1 teaspoonful) 1 to 2 times daily or as recommended by the physician.</li>\r\n</ul>\r\n\r\n<p>Tablet-</p>\r\n\r\n<ul>\r\n	<li><strong>Adults &amp; Children over 30 kg</strong>: 1 to 2 tablets 2 to 3 times daily or as recommended by the physician.</li>\r\n</ul>', '<p>Concomitant intake of tetracyclines and zinc may decrease the Gl absorption and serum levels of tetracyclines. Similarly concomitant administration of zinc and fluroquinolones may decrease the Gl absorption and serum&nbsp; levels of some fluroquinolones. Coadministration of Niacin and HMG-CoA reductase inhibitors (eg. lovastatin) may result mayopathy and rhabdomyolysis. Pyridoxine reduces levodopa&#39;s effectiveness by increasing its peripheral metabolism. Co-administration of pyridoxine with phenytoin may decrease serum levels of phenytoin.</p>', '<p>Vitamin B Complex &amp; Zinc is contraindicated in patients with a known hypersensitivity to any of the ingredients of this product.</p>', '<p>This is generally well tolerated. However, a few side effects like nausea, vomiting, diarrhoea &amp; stomach upset may occur. Side effects have been reported with specific vitamins but generally at levels substantially higher than recommended doses.</p>', '<p>This is recommended in pregnancy and lactation.</p>', '<p>In acute renal failure, zinc accumulation may occur, so dosage adjustment is needed. This is not intended for the treatment of severe specific deficiencies.</p>', '<p>In case of overdosage, initially epigastric pain, diarrhoea and vomiting can occur. In that case, one should seek emergency medical attention. Initially, an emetic should be given and then gastric lavage and general supportive measures should be employed.</p>', '<p>Specific mineral &amp; vitamin combined preparations.</p>', '<p>Store in a cool &amp; dry place, protected from light. Keep all medicines out of reach of children.</p>', NULL, '2022-03-18 20:44:27', '2022-03-18 20:44:27'),
(1335, 1335, '<p>It is indicated for supportive nutritional supplementation in conditions in which these vitamins are required. These include conditions causing depletion, or reduced absorption or bioavailability of vitamins such as gastrointestinal disorders, chronic alcoholism, febrile illness, prolonged or wasting diseases, hyperthyroidism or poorly controlled diabetes and conditions resulting in increased need for vitamins like pregnancy, severe burns, recovery from surgery. It is also used in beri-beri, peripheral neuritis, Wernicke&rsquo;s encephalopathy, impaired digestion of starch and sugar due to thiamine deficiency, cheilosis, angular stomatitis, glossitis, keratitis, seborrhoeic dermatitis, photophobia and corneal vascularization.</p>', '<p><strong>Thiamine&nbsp;</strong>(Vitamin B1) forms thiamine pyrophosphate by combining with adenosine triphosphate; essential coenzyme in carbohydrate metabolism.<br />\r\n<br />\r\n<strong>Riboflavin&nbsp;</strong>(vitamin B2) is required for energy utilisation from food. It is essential for normal tissue respiration. It is also necessary for the activation of pyridoxine and conversion of tryptophan to nicotinic acid.<br />\r\n<br />\r\n<strong>Pyridoxine</strong>&nbsp;(vitamin B6) is a water-soluble vitamin which functions in the metabolism of carbohydrates, proteins and fats. It is essential in Hb formation and GABA synthesis within the CNS. It also aids in the release of glycogen stored in the liver and muscles.</p>', '<p>Adults: 2 ml every day or alternate days intravenously or intramuscularly.</p>', '<p>Pyridoxine may increase the peripheral metabolism of levodopa, reducing therapeutic efficacy in patients with Parkinson&rsquo;s disease.</p>', '<p>Hypersensitivity to any of its components.</p>', '<p>Adverse reactions have been reported with specific vitamins, and generally at levels substantially higher than those in Vitamin B1, B2 &amp; B6. However, allergic and idiosyncratic reactions are possible at lower levels.</p>', '<p>The recommended dose should not be exceeded without medical advice.</p>', '<p>It should be given cautiously to patients taking levodopa as pyridoxine reduces the effect of levodopa. Hypersensitivity may develop in patients previously given thiamine, specially after repeated injections of concentrated solution; give subsequent injections with care. Discontinue drug if untoward reactions develop. Intramuscular administration may cause transient pain; when used undiluted, administer slowly.</p>', NULL, '<p>Specific combined vitamin preparations, Vitamin-B preparations.</p>', '<p>Store below 25&deg;C in a dry place, away from light.</p>', NULL, '2022-03-18 20:46:05', '2022-03-18 20:46:05'),
(1336, 1336, '<p>Vitamin B1, B6 &amp; B12 is indicated for the treatment of vitamin B1, B6 &amp; B12 deficiency syndrome. It is also indicated for the supportive treatment of neuritis &amp; non-inflammatory diseases of the nerves, e.g.-</p>\r\n\r\n<ul>\r\n	<li>Diabetic neuropathy</li>\r\n	<li>Peripheral neuralgin</li>\r\n	<li>Lumbago</li>\r\n	<li>Myalgia</li>\r\n	<li>Optic neuritis</li>\r\n	<li>Sciatica</li>\r\n	<li>Facial neuralgia</li>\r\n	<li>Intercostal neuralgia</li>\r\n	<li>Spinal pain.</li>\r\n</ul>', '<p>Vitamin B1 converts carbohydrates, fatty acids and amino acids into energy, promotes healthy nerves, improves mood, strengthens the heart. Vitamin B6 forms RBCs, helps cells to make proteins, manufactures neurotransmitters e.g. serotonin and releases stored forms of energy, helps to prevent CVS diseases and stroke, helps to lift depression and eases insomnia. Vitamin B12 is essential for cell replication and important for RBC production, prevents anemia, helps to prevent depression, reduces nerve pain, numbness, tingling and lowers the risk of heart diseases.<br />\r\n<br />\r\nThe vitamin ingredients are absorbed well in per oral reception. It is widely distributed to most tissues and appears in breast milk. Within the cell, thiamine is mostly present as diphosphate. Thiamine is not stored to any appreciable extent in the body and amounts in excess of the body&rsquo;s requirements are excreted in the urine as unchanged thiamine or as metabolites. Pyridoxine, pyridoxal and pyridoxamine are readily absorbed from the GIT following oral administration and are converted to the active forms of pyridoxal phosphate an pyridoxamine phosphate. They are stored mainly in liver where there is oxidation to 4-pyridoxic acid and other inactive metabolites, which are excreted in urine. As the dose increases, proportionally greater amounts are excreted unchanged in the urine.</p>', '<p>Tablet: 1-3 Tablets per day or as advised by the physician.<br />\r\n<br />\r\nInjection:</p>\r\n\r\n<ul>\r\n	<li><strong>In severe (acute) cases</strong>: 1 injection daily until the acute symptoms subside or taken as advised by the physician.</li>\r\n	<li><strong>In mild cases</strong>: 1 injection 2-3 times per week. Ampoules are preferably injected intramuscularly.</li>\r\n</ul>\r\n\r\n<p>Use in children: There is no information on the use of this drug in children.</p>', '<p>No drug interaction has been reported yet.</p>', '<p>Vitamin B1, Vitamin B6 and Vitamin B12 is contraindicated in patients on levodopa therapy, and in patients with hypersensitivity to any of the ingredients of the preparation.</p>', '<p>Generally well tolerated but allergic reactions may be observed in few cases.</p>', '<p>Oral tablet form is recommended but due to the presence of benzyl alcohol, injection is not recommended during pregnancy &amp; lactation.</p>', '<p>Cyanocobalamin should not be given in patients with subacute degeneration of the spinal cord. Cyanocobalamin is not suitable form of vitamin B12 for the treatment of optic neuropathies associated with raised plasma concentrations of cyanocobalamin.</p>', '<p>No overdosage symptoms are to be expected in the recommended dosage. If there is known overdose then treatment is symptomatic &amp; supportive.</p>', '<p>Specific combined vitamin preparations.</p>', '<p>Keep out of reach of children. Store in a cool (below 25&deg;C temperature) and dry place, protected from light.</p>', NULL, '2022-03-18 20:48:47', '2022-03-18 20:48:47'),
(1337, 1337, '<p>This is indicated for the prevention and treatment of Iron, vitamin B12 and Folic acid deficiency. Also indicated for the prevention of Iron deficiency during pregnancy and lactation and as prophylactic therapy of Iron deficiency to cover the recommended daily dietary allowance.</p>', '<p><strong>Vitamin B12 (cyanocobalamin):</strong>&nbsp;Required for the maintenance of normal erthropoiesis, nucleprotein and myelin synthesis, cell reproduction and normal growth; Coenzyme; metabolic functions include protein synthesis and carbohydrate metabolism. Plays role in cell replication and hematopoiesis.<br />\r\n<br />\r\n<strong>Iron:</strong>&nbsp;Essential component in the formation of hemoglobin; adequate amounts of iron are necessary for effective erythropoiesis; also serves as a cofactor of several essential enzymes, including cytochromes that are involved in electron transport. Replacement of iron stores found in hemoglobin, myoglobin, and enzymes; works to transport oxygen via hemoglobin.<br />\r\n<br />\r\n<strong>Folic acid:</strong>&nbsp;Required for nucleoprotein synthesis and the maintenance of normal erythropoiesis; folic acid is converted in the liver and plasma to its metabolically active form, tetrahydrofolic acid, by dihydrofolate reductase; prevents neural tube defects in women of childbearing potential and higher doses required during pregnancy.</p>', '<p><strong>Adult:</strong>&nbsp;1-2 capsules daily; as recommended by the physician.<br />\r\n<strong>Children:</strong>&nbsp;1 capsule daily; as recommended by the physician.<br />\r\n<strong>Infant:</strong>&nbsp;As recommended by the physician.</p>', '<p>Generally no interactions have been observed. Iron may decrease the absorption of antacids, tetracycline, quinolone antibiotics, levodopa, levothyroxine, methyldopa and pencillamine. Folic acid interacts with antiepileptic drugs, no plasma concentrations of Phenobarbital, phenytoin possibly reduced.</p>', '<p>Contraindicated in patients with known hypersensivity to any of its ingredients.</p>', '<p>Generally well tolerated. In individual cases, a few side-effects occur to oral Iron preparation, such as nausea, vomiting, constipation or diarrhoea.</p>', '<p>This preparation can be used in pregnancy and lactation.</p>', '<p>Caution should be applied where there is a risk of Iron overload, e.g. Haemochromatosis, Thalassaemia, Haemosiderosis or Haemolytic anaemia.</p>', '<p>Initially epigastric pain, diarrhea and vomiting can occur of overdose. Metabolic acidosis, convulsions and coma can occur after recovery. In case of overdose an emetic should be given followed by gastric lavage and general supportive measures.</p>', '<p>Iron &amp; Vitamin Combined preparations</p>', '<p>Store in cool and dry place. Protect from light.</p>', NULL, '2022-03-18 20:50:41', '2022-03-18 20:50:41'),
(1338, 1338, '<p>This&nbsp;tablets are indicated for the distinct nutritional requirements of individuals under a physician&#39;s treatment for hyperhomocysteinemia; nutrient malabsorption or inadequate dietary intake; with particular emphasis for individuals with or at risk for atherosclerotic vascular disease in the coronary, peripheral, or cerebral vessels, or neurological disorders.</p>', '<p><strong>Pyrodoxine (Vitamin B6)</strong>&nbsp;is a water-soluble vitamin which functions in the metabolism of carbohydrates, proteins and fats. It is essential in Hb formation and GABA synthesis within the CNS. It also aids in the release of glycogen stored in the liver and muscles.<br />\r\n<br />\r\n<strong>Folic acid (Vitamin B9)</strong>&nbsp;is essential for the production of certain coenzymes in many metabolic systems such as purine and pyrimidine synthesis. It is also essential in the synthesis and maintenance of nucleoprotein in erythropoesis. It also promotes WBC and platelet production in folate-deficiency anaemia.<br />\r\n<br />\r\n<strong>Cyanocobalamin (Vitamin B12)</strong>&nbsp;is vital to growth, hematopoiesis and nucleoprotein and myelin synthesis. As a hematopoietic agent, it is converted to coenzyme B12 needed in the conversion of methylmalonate to succinate and production of methionine from homocysteine, a reaction requiring folate. In the absence of folate, such metabolites cannot be formed and folate deficiency occurs. It is also involved in the maintenance of reduced sulfhydryl (SH) groups which are required by various SH-activated enzyme systems. Through such processes, cyanocobalamin participates in fat and carbohydrate metabolism as well as protein synthesis.</p>', '<p>Usual adult dose is one to two tablets daily or as directed by a physician.</p>', '<p>Pyridoxine Hydrochloride should not be given to patients receiving the drug levodopa, because the action of levodopa is antagonized by Pyridoxine Hydrochloride. However; Pyridoxine Hydrochloride may be used concurrently in patients receiving a preparation containing both carbidopa and levodopa. Concurrent use of phenytoin and folic acid may result in decreased phenytoin effectiveness.</p>', '<p>Known hypersensitivity to any of the components in the product is a contraindication.</p>', '<p>Allergic sensitization has been reported following both oral and parenteral administration of folic acid. Paresthesia, somnolence, nausea and headache have been reported with pyridoxine hydrochlloride. Mild transient diarrhea, polycythemia vera, itching, transitory exanthema, and the feeling of swelling of the entire body has been associated with cyanocobalamin.<br />\r\n<br />\r\nElevate your arsenal by taking things to the next level with&nbsp;louboutin herrenschuhe, two new additions to the collection that mirror Streetwall&#39;s attention to detail with matching perforated ecussons. Men just like herrenschuhe very much.</p>', '<p>Pregnancy category- Not classified.</p>', '<p>Folic acid when administered as a single agent in doses above 0.1 mg daily may obscure pernicious anemia in that hematologic remission can occur while neurological manifestations remain progressive. Unmetabolized Folic Acid has the potential to reduce natural killer cells cytotoxicity, which may result in an impaired immune response.</p>', NULL, '<p>Specific combined vitamin preparations, Vitamin-B preparations.</p>', NULL, NULL, '2022-03-18 20:52:22', '2022-03-18 20:52:22'),
(1339, 1339, '<p>Vitamin C is indicated for prevention and treatment of scurvy. It may be indicated in pregnancy, lactation, infection, trauma, burns, cold exposure, following surgery, fever, stress, peptic ulcer, cancer, methaemoglobinaemia and in infants receiving unfortified formulas. It is also prescribed for haematuria, dental caries, pyorrhea, acne, infertility, atherosclerosis, fractures, leg ulcers, hay fever, vascular thrombosis prevention, levodopa toxicity, succinyl-choline toxicity, arsenic toxicity etc. To reduce the risk of stroke in the elderly, long-term supplementation with Vitamin C is essential.</p>', '<p>vitamin C, the water-soluble vitamin, is readily absorbed from the gastrointestinal tract and is widely distributed in the body tissues. It is believed to be involved in biological oxidations and reductions used in cellular respiration. It is essential for the synthesis of collagen and intracellular material. Vitamin C deficiency develops when the dietary intake is inadequate and when increased demand is not fulfilled. Deficiency leads to the development of well defined syndrome known as scurvy, which is characterized by capillary fragility, bleeding (especially from small blood vessels and the gums), anaemia, cartilage and bone lesions and slow healing of wounds.</p>', '<p>Oral administration-</p>\r\n\r\n<ul>\r\n	<li>For the prevention of scurvy: 1 tablet daily</li>\r\n	<li>For the treatment of scurvy: 1-2 tablets daily; but dose may be increased depending on the severity of the condition.</li>\r\n	<li>For the reduction of risk of stroke in the elderly: 1-2 tablets daily.</li>\r\n	<li>In other cases: 1 tablet daily or as directed by the physician.</li>\r\n	<li>Maximum safe dose is 2000 mg daily in divided doses.</li>\r\n</ul>\r\n\r\n<p>Parenteral administration-</p>\r\n\r\n<ul>\r\n	<li>Vitamin C is usually administered orally. When oral administration is not feasible or when malabsorption is suspected, the drug may be administered IM, IV, or subcutaneously. When given parenterally, utilization of the vitamin reportedly is best after IM administration and that is the preferred parenteral route.</li>\r\n	<li>For&nbsp;intravenous&nbsp;injection, dilution into a large volume parenteral such as Normal&nbsp;Saline, Water for Injection, or&nbsp;Glucose&nbsp;is recommended to minimize the adverse reactions associated with intravenous injection.</li>\r\n	<li>The average protective dose of vitamin C for adults is 70 to 150 mg daily. In the presence of scurvy, doses of 300 mg to 1 g daily are recommended. However, as much as 6 g has been administered parenterally to normal adults without evidence of&nbsp;toxicity.</li>\r\n	<li>To enhance wound healing, doses of 300 to 500 mg daily for a week or ten days both preoperatively and postoperatively are generally considered adequate, although considerably larger amounts have been recommended. In the treatment of burns, doses are governed by the extent of tissue&nbsp;injury. For severe burns, daily doses of 1 to 2 g are recommended. In other conditions in which the need for vitamin C is increased, three to five times the daily optimum allowances appear to be adequate.</li>\r\n	<li>Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever the solution and container permit.</li>\r\n</ul>', '<p><strong>Potentially hazardous interactions</strong>: Ascorbic acid is incompatible in solution with aminophylline, bleomycin, erythromycin, lactobionate, nafcillin, nitrofurantoin sodium, conjugated oestrogen, sodium bicarbonate, sulphafurazole diethanolamine, chloramphenicol sodium succinate, chlorthiazide sodium and hydrocortisone sodium succinate.<br />\r\n<br />\r\n<strong>Useful interactions</strong>: Ascorbic acid increases the apparent half-life of paracetamol and enhances iron absorption from the gastrointestinal tract.</p>', NULL, '<p>Vitamin C has little toxicity and only mega-doses of vitamin C may cause diarrhoea, abdominal bloating, iron over-absorption that is harmful in patients with thalassaemia, sideroblastic anemia, and haemochromatosis; hyperoxaluria, hyperuricosuria, and hemolysis in patients with glucose-6 phosphate dehydrogenase deficiency. A pregnant woman taking more than 5 gm/day may suffer fetal abortion.</p>', '<p>The drug is safe in normal doses in pregnant women, but a daily intake of 5 gm or more is reported to have caused abortion. The drug may be taken safely during lactation.</p>', '<p>Ingestion of megadose (more than 1000 mg daily) of vitamin C during pregnancy has resulted in scurvy in neonates. Vitamin C in mega-doses has been contraindicated for patients with hyperoxaluria. Vitamin C itself is a&nbsp;reactive substance in the redox system and can give rise to false positive reactions in certain analytical tests for glucose, uric acid, creatine and occult blood.</p>', NULL, '<p>Vitamin-C Preparations.</p>', '<p>Should be stored in a dry place below 30˚C.</p>', NULL, '2022-03-18 20:53:52', '2022-03-18 20:53:52'),
(1340, 1340, '<p>Calcium and Vitamin-D is used for the treatment of osteoporosis, osteomalacia, rickets, tetany, and parathyroid disease. Also used in raised calcium requirement for children and adolescents at times of rapid growth, inadequate intake of calcium in the diet due to malnutrition, prevention and treatment of osteoporosis, disorders of osteogenesis and tooth formation (in addition to specific treatment), latent tetany and during pregnancy and lactation. It is also used as routine supplement and phosphate binder in chronic renal failure.</p>', '<p>Ascorbic acid (vitamin C) &amp; Folic acid (also known as Vitamin B9) are water-soluble vitamins. Vitamin D is fat-soluble. Ascorbic acid helps integration &amp; cohesiveness of cells by synthesizing collagen which is also known as biological glue. It is also a powerful antioxidant in the aqueous media. Vitamin D is also known as antirachitic and sun-shine vitamin which displays its roles like a hormone (pro-hormone). Vitamin D spares calcium in the body by reducing excretion and enhancing calcium absorption. Folic acid is crucial for proper brain function and plays an important role in mental and emotional health. It aids in the production of DNA and RNA, the body&#39;s genetic material, and is especially important during periods of high growth, such as infancy, adolescence and pregnancy. It controls blood levels of the amino acid Homocysteine. Elevated levels of this substance appear to be linked to certain chronic conditions such as heart disease. Indications: Deficiency states of Vitamin C, Vitamin D and Folic acid associated with cardiovascular diseases, Deficiency states of Vitamin-C (Scurvy, generalized weakness, gum bleeding, after acute infections, alcoholism and postoperatively), Wound healing, Prevention of cold, flue and influenza, Megaloblastic anemia and anemia of nutritional origin, Deficiency states of Vitamin-D (Intestinal malabsorption, chronic liver disease, osteomalacia, osteopenia, rickets, hypocalcemia, institutionalized patients, persons who use sunscreen, black people, person who covers most of the body surface due to cultural and religious purpose). Familial hypophosphatemia, Hypoparathyroidism, As adjuvant with calcium supplement, Prevention of osteoporosis and fracture alone or in combination with calcium supplement, Conditions where demand for Vitamin-C, Vitamin-D and Folic acid increases (pregnancy, lactation, smoking and old age, person living in polluted environment).</p>', '<p>One tablet twice daily with food or as directed by the physician.</p>', '<p>Concurrent administration of Thiazide diuretics may increase the risk of hypercalcemia. Calcium salts reduce the absorption of a number of other drugs such as Biphosphonates, Fluoride, some Fluoroquinolones and Tetracyclines.</p>', '<ul>\r\n	<li>Hypercalcemia and hyperparathyroidism</li>\r\n	<li>Hypercalciuria and nephrolithiasis</li>\r\n	<li>Hypersensitivity to the component of this preparation</li>\r\n	<li>Severe renal insufficiency</li>\r\n	<li>Concomitant digoxin therapy(requires careful monitoring of serum calcium level)</li>\r\n</ul>', '<p>Vitamin C, Vitamin D3 &amp; Folic acid combination&nbsp;is well tolerated. Mild gastrointestinal disturbances may occur.</p>', '<p><strong>Pregnancy:</strong>&nbsp;There is no contraindication to the use of this preparation in pregnancy.<br />\r\n<br />\r\n<strong>Lactation:</strong>&nbsp;There is no contraindication to the use of this preparation in Lactation. Contraindications: This combination is contraindicated in hypercalcemia, hyperparathyroidism, renal calculi, nephrolithiasis, Zoolinger-Ellison syndrome, concomitant Digoxin therapy (requires careful monitoring of serum calcium level).</p>', '<p>Caution should be taken in patients with Renal impairment, Sarcoidosis, Hypercalcemia and Hypercalciuria, Cardiac disease.</p>', '<p>Over dosage: If over dosage occurs, therapy should be immediately stopped.</p>', '<p>Specific combined vitamin preparations.</p>', NULL, NULL, '2022-03-18 20:55:29', '2022-03-18 20:55:29'),
(1341, 1341, '<p>Keratosis, Rough skin,Wrinkles associated with aging, Alzheimer&#39;s disease, Cancer Prevention, dementia, degenerative diseases, coronary heart diseases, end stage renal disease, growth and repair of body tissue, bone, skin, teeth and hair.</p>', '<p><strong>Vitamin C</strong>: Necessary for collagen formation and tissue repair; plays a role in oxidation/reduction reactions as well as other metabolic pathways including synthesis of catecholamines, carnitine, and steroids; also plays a role in conversion of folic acid to folinic acid.<br />\r\n<br />\r\n<strong>Vitamin E</strong>&nbsp;plays a role in protecting red blood cells against hemolysis; has protective effects against free radicals on polyunsaturated fatty acids found in cell membranes; plays a role in preventing oxidation of vitamin A and C.</p>', '<p>One tablet or capsule daily or as directed by a physician.</p>', '<p><strong>Vitamin C</strong>: Deferroxamine, hormonal contraceptives, flufenazine, warfarin, elemental iron, salicylates, warfarin, fluphenazine, disulfiram, mexiletine, vitamin B12.<br />\r\n<br />\r\n<strong>Vitamin E</strong>: Colestyramine, colestipol, and orlistat may interfere with vitamin E absorption. High doses of vitamin E potentiates the anticoagulant action of warfarin. Large doses of vitamin E may impair response to iron supplementation.</p>', '<p>Patients with a known hypersensitivity to any of the ingredients.</p>', '<p>Generally, this preparation is well-tolerated. Diarrhea may occasionally occur during treatment with beta carotene and the skin may assume a slightly yellow discoloration. The side-effects of vitamin A are reversible. Vitamin C and vitamin E may cause diarrhea and other gastrointestinal disturbances.</p>', '<p>Pregnancy Category A. Adequate and well-controlled human studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).</p>', '<p>Hypervitaminosis. Avoid use in early pregnancy. Patients on anti coagulant therapy should not use ascorbic acid prolonged period of time.</p>', NULL, '<p>Anti-oxidant Multivitamin preparations, Specific combined vitamin preparations</p>', NULL, NULL, '2022-03-18 20:57:10', '2022-03-18 20:57:10'),
(1342, 1342, '<p>This preparation is indicated for Age-related Eye Disease. This is an advanced new antioxidant supplement formulated to provide nutritional support for the eye. The formulation contains essential antioxidant vitamins, minerals, and Lutein.</p>', '<p>Vitamin C is highly concentrated in the lens compared to blood. A long term Vitamin C supplement use (10+ years) has been associated with reduced risk of cataract. Vitamin C has&nbsp;an important role in harmful free radicals scavenging activity.<br />\r\n<br />\r\nIn study, it is found that high serum Vitamin E concentrations have been associated with reduced risk of cataract (exact mechanism of action is not still established). As an antioxidant vitamin, it also plays an important role in harmful free radicals scavenging activity.<br />\r\n<br />\r\nLutein is a carotenoid, specially concentrated in&nbsp;the macula. Clinical and animaldata indicates that this caretenoid could protect the macula from oxidative or light damage.<br />\r\n<br />\r\nAlthough exact mechanism of action is not clear but onelarge&nbsp;study has found that high levels of dietary Lutein is associated with relatively lower risk of AMD (Age-Related Macular Degeneration). Zinc is an essential trace element involved in many enzymes system.<br />\r\n<br />\r\nSymptoms of less severe deficiency include distorted or absent perception of taste, smell and poor wound healing. Severe deficiency causes skin lesion, alopecia, diarrhea, increased susceptibility to infection and failure to thrive in children.<br />\r\n<br />\r\nCopper plays important role in growth, skeletal integrity, and development of nervous system. As a part of various enzymes, it takes part in numerous metabolic conversions.</p>', '<p>One capsule, one or two times daily or as directed by the physician</p>', '<p>No drug interaction has been reported.</p>', '<p>It is contraindicated in persons with a history of hypersensitivity to any of its ingredients.</p>', '<p>Large doses of Vitamin C are reported to cause diarrhoea and other gastrointestinal disturbances. Large doses of Vitamin E may cause diarrhoea, abdominal pain, and other gastrointestinal disturbances; fatigue and weakness have also been reported. Side effects of Zinc salt are abdominal pain and dyspepsia.</p>', '<p>Recommended in Pregnancy &amp; Lactation.</p>', '<p>Vitamin C should be given with care to patients with hyperoxaluria. In patients taking oral anticoagulants or oestrogen, Vitamin E should be given carefully because it has been found to antagonise the effects of vitamin K leading to an increase in blood clotting time in these patient.</p>', NULL, '<p>Anti-oxidant Multivitamin Multimineral preparations, Antioxidant vitamins &amp; minerals for eye.</p>', '<p>Store in a dry place below 25&deg; C. Protect from light.</p>', NULL, '2022-03-18 20:58:42', '2022-03-18 20:58:42'),
(1343, 1343, '<p>Helps to protect cells against oxidative stress.</p>', NULL, '<p>1 tablet per day during 3 to 6 months.</p>', NULL, '<p>Hypersensitivity to the active substance or to any of the excipients.</p>', NULL, NULL, NULL, NULL, '<p>Supplements &amp; adjuvant therapy</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-18 21:02:11', '2022-03-18 21:02:11'),
(1344, 1344, '<p>Voglibose is used in diabetes mellitus (DM) for reduction in Post-Prandial Hyperglycaemia (PPHG), only when diet and/or exercise with lifestyle modification or Oral Hypoglycaemic Agents (OHAs) or insulin preparations, in addition to diet and/or exercise, do not result in an adequate glycaemic control.<br />\r\n<br />\r\nThus, Voglibose is indicated:</p>\r\n\r\n<ul>\r\n	<li>In non-insulin-dependent diabetes mellitus (NIDDM) patients as immunotherapy</li>\r\n	<li>In combination with other OHAs</li>\r\n	<li>In addition to insulin in diabetes mellitus patients</li>\r\n	<li>In prevention of onset of type 2 diabetes mellitus in impaired glucose tolerance (only for Voglibose 0.2 mg Tablets) (However, Voglibose&nbsp;Tablets should be used only when impaired glucose tolerance has not been improved in patients already undergoing appropriate dietary treatment and/or exercise therapy.)</li>\r\n	<li>In elderly patients and in those with hepatic dysfunction or mild to moderate renal impairments in whom other OHAs are contraindicated or they need to be used with caution, Voglibose will be helpful.</li>\r\n	<li>In glycogen storage disease: Voglibose is helpful in prevention of hypoglycaemia in patients with type lb glycogen storage disease, it being an amylase (a glucosidase) inhibitor.</li>\r\n	<li>In non-diabetic Hyperinsulinemia, Voglibose is helpful in preventing hypoglycaemic attacks.</li>\r\n	<li>In steroid induced diabetes mellitus also, Voglibose is helpful. However, clinical data in this setting are limited.</li>\r\n</ul>', '<p>Alpha-glucosidase inhibitors are saccharides that act as competitive inhibitors of enzymes needed to digest carbohydrates: specifically alpha-glucosidase enzymes in the brush border of the small intestines. The membrane-bound intestinal alpha-glucosidases hydrolyze oligosaccharides, trisaccharides, and disaccharides to glucose and other monosaccharides in the small intestine. Acarbose also blocks pancreatic alpha-amylase in addition to inhibiting membrane-bound alpha-glucosidases. Pancreatic alpha-amylase hydrolyzes complex starches to oligosaccharides in the lumen of the small intestine. Inhibition of these enzyme systems reduces the rate of digestion of complex carbohydrates. Less glucose is absorbed because the carbohydrates are not broken down into glucose molecules. In diabetic patients, the short-term effect of these drugs therapies is to decrease current blood glucose levels: the long term effect is a small reduction in hemoglobin-A1c level.</p>', '<p><strong>Normal Adult Dose</strong>: Usually, Voglibose tablets are orally administered in a single dose of 0.2 mg, 3 times a day, before each meal. If the effect is not sufficient, the quantity of a single dose may be increased up to 0.3 mg.<br />\r\n<br />\r\n<strong>Pediatrics</strong>: The safety and effectiveness of Voglibose in children has not been established.<br />\r\n<br />\r\n<strong>Geriatrics</strong>: Since elderly patients generally have a physiological hypofunction, it is desirable that such caution be taken as starting the administration at a lower dose (eg, 0.1 mg at a time). Furthermore, this drug should be carefully administered under close observation, through the course of the disease condition, with careful attention to the blood sugar level and the onset of gastrointestinal symptoms.</p>', '<p>Voglibose should be administered with care when co-administered with the following drugs:<br />\r\n<br />\r\nAntidiabetic drugs: Derivative(s) of sulfonylamide and sulfonylurea, biguanide derivatives, insulin preparations and improving agents for insulin resistance.<br />\r\n<br />\r\nFor the concomitant use of antldlabetlc drugs and the drugs which enhance or diminish the hypoglycaemic action of antldlabetlc drugs:</p>\r\n\r\n<ul>\r\n	<li>Drugs enhancing the hypoglycaemic action of antidiabetic drugs: &beta;-blockers, salicylic acid preparations, monoamine oxidase inhibitors, fibrate derivatives for the treatment of hyperlipemia, warfarin, etc.</li>\r\n	<li>Drugs diminishing the hypoglycemic actton of antidiabetic drugs: Adrenaline, adrenocortical hormone, thyroid hormone, etc.</li>\r\n</ul>', '<p>Contraindicated in patients with Hypersensitivity to Voglibose or to any of the excipients; Diabetic ketoacidosis, diabetic pre-coma; Severe infection, before and after operation or with serious trauma; Gastrointestinal obstruction or predisposed to it.</p>', '<p>Diarrhoea, loose stools, abdominal pain, constipation, loss of appetite, urge to vomit (nausea), vomiting, heartburn, increased gas, and intestinal obstruction like symptoms due to increased intestinal gas. OHAs plus voglibose may cause hypoglycaemia (0.1% to &lt;5%), delay in digestion and absorption of disaccharides, fulminant hepatitis, serious liver dysfunction with increased liver enzymes, jaundice, anaemia, numbness, edema, blurred vision, hot flushes, malaise, weakness, hyperkalemia, increased pancreatic enzyme (serum amylase).</p>', '<p><strong>Pregnancy</strong>: The safety of Voglibose in pregnancy has not been established. However, no adequate and well controlled studies have been done on pregnant women.<br />\r\n<br />\r\n<strong>Lactatlng and Nursing Mothers</strong>: Although the levels of Voglibose reached in human milk are exceedingly low, it is recommended that Voglibose may not be administered to such women.</p>', '<p>Careful Administration (should be administered with care in following patients):</p>\r\n\r\n<ul>\r\n	<li>Patients who are receiving other antidiabetic drugs as hypoglycaemia may occur</li>\r\n	<li>Patients with a history of laparotomy or ileus (intestinal obstruction-like symptoms are liable to develop due to an increase in intestinal gas, etc.)</li>\r\n	<li>Patients with chronic intestinal disease accompanied by a disturbance in digestion and absorption (the action of this drug may aggravate the pathologic conditions)</li>\r\n	<li>Patients with Roemheld&rsquo;s Syndrome, severe hernia, Stenosis or ulceration of the large intestine, etc. (Symptoms may worsen due to an increase in the intestinal gas, etc.)</li>\r\n	<li>Patients with serious hepatic dysfunction (Because of possible changes in metabolic condition, the status of plasma glucose control may greatly vary. In patients with severe liver cirrhosis, hyperammonemia may worsen, followed by disturbance of consciousness.)</li>\r\n	<li>Patients with serious renal dysfunction (Because of possible changes in metabolic conditions, the status of plasma glucose control may greatly vary.)</li>\r\n	<li>Elderly patients</li>\r\n</ul>', '<p>Unlike sulfonylureas or insulin, an overdose of Voglibose tablets will not result in hypoglycaemia. An overdose may result is transient increase in flatulence, diarrhoea and abdominal discomfort. Because of lack of extra-intestinal effects soon with Voglibose, no serious systemic reactions are expected in the event of an overdose.</p>', '<p>Alpha-Glucosidase inhibitor.</p>', '<p>Keep in a cool and dry place. Keep out of the reach of children. Protect from light.</p>', '<p>Dosage in Renal Failure: Voglibose is poorly absorbed after oral doses and renal excretion is negligible, suggesting that no dose adjustment is required. However, pharmacokinetic studies in patients with renal insufficiency are not available.</p>', '2022-03-18 21:04:17', '2022-03-18 21:04:17'),
(1345, 1345, '<p>Voriconazole is an azole antifungal medicine. It is indicated for use in patients 12 years of age and older in the treatment of following fungal infections-</p>\r\n\r\n<ul>\r\n	<li>Invasive aspergillosis</li>\r\n	<li>Candidemia (nonneutropenic) and disseminated candidiasis in skin, abdomen, kidney, bladder wall and wounds</li>\r\n	<li>Esophageal candidiasis</li>\r\n	<li>Serious infections caused by Scedosporium apiospermum and Fusarium Species including Fusarium solani</li>\r\n	<li>Patients intolerant of, or refractory to other therapy.</li>\r\n</ul>', '<p>Voriconazole is a triazole antifungal medication used to treat serious fungal infections. Voriconazole binds and inhibits ergosterol synthesis by inhibiting CYP450-dependent 14-alpha sterol demethylase. The inhibition of 14-alpha sterol demethylase results in a depletion of ergosterol in fungal cell membrane.</p>', '<p>Oral-<br />\r\nVoriconazole tablet and powder for suspension are to be taken at least one hour before or one hour following a meal</p>\r\n\r\n<ul>\r\n	<li><strong>At or over 40 kg body weight</strong>: Loading dose regimen is 400 mg or 10 ml every 12 hours (for the first 24 hours) and maintenance dose (after first 24 hours) is 200 mg or 5 ml twice daily.</li>\r\n	<li><strong>Below 40 Kg body weight</strong>: Loading dose regimen is 200 mg or 5 ml every 12 hours (for the first 24 hours) and maintenance dose (after first 24 hours) is 100 mg or 2.5 ml twice daily. Or, as directed by the registered physician.</li>\r\n</ul>\r\n\r\n<p><br />\r\nInjection-<br />\r\nInvasive Aspergillosisd :</p>\r\n\r\n<ul>\r\n	<li><strong>Loading dose</strong>: 6 mg/kg 12 hourly for the first 24 hours.</li>\r\n	<li><strong>Maintenance Dose</strong>: 4 mg/kg 12 hourly.</li>\r\n</ul>\r\n\r\n<p>Candidemia in nonneutropenic patients and other deep tissue Candida infections:</p>\r\n\r\n<ul>\r\n	<li><strong>Loading dose</strong>: 6 mg/kg 12 hourly for the first 24 hours.</li>\r\n	<li><strong>Maintenance Dose</strong>: 3-4 mg/kg 12 hourly.</li>\r\n</ul>\r\n\r\n<p>Scedosporiosis and Fusariosis:</p>\r\n\r\n<ul>\r\n	<li><strong>Loading dose</strong>: 6 mg/kg 12 hourly for the first 24 hours.</li>\r\n	<li><strong>Maintenance Dose</strong>: 4 mg/kg 12 hourly.</li>\r\n</ul>', '<ul>\r\n	<li>CYP3A4, CYP2C9 and CYP2C19 inhibitors and inducers: Adjust Voriconazole dosage and monitor for adverse reactions or lack of efficacy</li>\r\n	<li>Voriconazole may increase the concentrations and activity of drugs that are CYP3A4, CYP2C9 and CYP2C19 substrates. Reduce doses of these other drugs and monitor for adverse reactions</li>\r\n	<li>Increase maintenance oral and intravenous dosage of Voriconazole with co-administration of Phenytoin or Efavirenz</li>\r\n</ul>', '<p>Known hypersensitivity to Voriconazole or any other components of this drug-</p>\r\n\r\n<ul>\r\n	<li>Co-administration with terfenadine, astemizole, cisapride, pimozide or quinidine, sirolimus due to risk of serious adverse reactions</li>\r\n	<li>Co-administration with rifampin, carbamazepine, long-acting barbiturates, efavirenz, ritonavir, rifabutin, ergot alkaloids and St. John&#39;s Wort due to risk of loss of efficacy</li>\r\n</ul>', '<p>The most common side effects are abdominal pain, anemia, blurred vision, headache, chest pain, nausea and diarrhea.</p>', '<p>There are no adequate and well-controlled studies in pregnant woman. It should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.</p>', '<p>Long term exposure (treatment or prophylaxis) greater than 180 days requires careful assessment of the benefit-risk balance. Squamous cell carcinoma of the skin (SCC) has been reported in relation with long-term voriconazole treatment.</p>', '<p>There is no data found about overdose of Voriconazole.</p>', '<p>Other Antifungal preparations.</p>', '<p>Keep out of reach of children. Store in a dry place, below 25&deg;C temperature and protected from light. Store Voriconazole powder for suspension between 2&deg; to 8&deg;C temperature.</p>', '<p>The efficacy to the children under 12 years of age is not established.</p>', '2022-03-18 21:06:18', '2022-03-18 21:06:18');
INSERT INTO `generic_details` (`id`, `generic_id`, `indications`, `pharmacology`, `dosage_and_administration`, `interaction`, `contraindications`, `side_effects`, `pregnancy_and_lactation`, `precautions_and_warnings`, `overdose_effects`, `therapeutic_class`, `storage_conditions`, `use_in_special_populations`, `created_at`, `updated_at`) VALUES
(1346, 1346, '<p>S-Amlodipine is calcium channel blocker and may be used alone or in combination with other antihypertensive agents for the treatment of hypertension, to lower blood pressure. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions.</p>', '<p>Amlodipine is a dihydropyridine calcium antagonist (calcium ion antagonist or slow channel blocker) that inhibits the transmembrane influx of calcium ions into vascular smooth muscle and cardiac muscle. Experimental data suggest that amlodipine binds to both dihydropyridine and nondihydropyridine binding sites. The contractile processes of cardiac muscle and vascular smooth muscle are dependent upon the movement of extracellular calcium ions into these cells through specific ion channels. Amlodipine inhibits calcium ion influx across cell membranes selectively, with a greater effect on vascular smooth muscle cells than on cardiac muscle cells. Negative inotropic effects can be detected in vitro but such effects have not been seen in intact animals at therapeutic doses. Serum calcium concentration is not affected by amlodipine. Within the physiologic pH range, amlodipine is an ionized compound (pKa=8.6), and its kinetic interaction with the calcium channel receptor is characterized by a gradual rate of association and dissociation with the receptor binding site, resulting in a gradual onset of effect. Amlodipine is a peripheral arterial vasodilator that acts directly on vascular smooth muscle to cause a reduction in peripheral vascular resistance and reduction in blood pressure. Amlodipine is a 1:1 racemic mixture of levamlodipine and dextro amlodipine, it has been demonstrated that levamlodipine is the pharmacologically active, anti-hypertensive isomer.</p>', '<p><strong>Adults</strong>: The usual initial antihypertensive oral dose of S-Amlodipine is 2.5 mg once daily, and the maximum dose is 5 mg once daily. Small, fragile, or elderly patients, or patients with hepatic insufficiency may be started on 1.25 mg once daily and this dose may be used when adding S-Amlodipine to other antihypertensive therapy. Adjust dosage according to blood pressure goals. In general, wait 7 to 14 days between titration steps. Titrate more rapidly, however, if clinically warranted, provided the patient is assessed frequently.<br />\r\n<br />\r\n<strong>Children</strong>: The effective antihypertensive oral dose in pediatric patients ages 6-17 years is 1.25 mg to 2.5 mg once daily. Doses in excess of 2.5 mg daily have not been studied in pediatric patients.</p>', '<p>Impact of Other Drugs on Amlodipine-</p>\r\n\r\n<ul>\r\n	<li><strong>CYP3A Inhibitors</strong>: Co-administration with CYP3A inhibitors (moderate and strong) results in increased systemic exposure to amlodipine and may require dose reduction. Monitor for symptoms of hypotension and edema when amlodipine is co-administered with CYP3A inhibitors to determine the need for dose adjustment&nbsp;</li>\r\n	<li><strong>CYP3A Inducers</strong>: No information is available on the quantitative effects of CYP3A inducers on amlodipine. Blood pressure should be closely monitored when amlodipine is co-administered with CYP3A inducers.</li>\r\n	<li><strong>Sildenafil</strong>: Monitor for hypotension when sildenafil is coadministered with amlodipine.</li>\r\n</ul>\r\n\r\n<p>Impact of Amlodipine on Other Drugs-</p>\r\n\r\n<ul>\r\n	<li><strong>Simvastatin</strong>: Co-administration of simvastatin with amlodipine increases the systemic exposure of simvastatin. Limit the dose of simvastatin in patients on amlodipine to 20 mg daily.</li>\r\n	<li><strong>Immunosuppressants</strong>: Amlodipine may increase the systemic exposure of cyclosporine or tacrolimus when co-administered. Frequent monitoring of trough blood levels of cyclosporine and tacrolimus is recommended and adjust the dose when appropriate</li>\r\n</ul>', '<p>S-Amlodipine is contraindicated in patients with known sensitivity to amlodipine.</p>', '<p>Most common adverse reactions to amlodipine is edema which occurred in a dose related manner. Other adverse experiences not dose related but reported with an incidence &gt;1.0% are fatigue, nausea, abdominal pain and somnolence.</p>', '<p>The limited available data based on post-marketing reports with amlodipine use in pregnant women are not sufficient to inform a drug-associated risk for major birth defects and miscarriage. There are risks to the mother and fetus associated with poorly controlled hypertension in pregnancy.<br />\r\n<br />\r\nLimited available data from a published clinical lactation study reports that amlodipine is present in human milk at an estimated median relative infant dose of 4.2%. No adverse effects of amlodipine on the breastfed infant have been observed. There is no available information on the effects of amlodipine on milk production.</p>', '<p><strong>Hypotension</strong>: Symptomatic hypotension is possible, particularly in patients with severe aortic stenosis. Because of the gradual onset of action, acute hypotension is unlikely.<br />\r\n<br />\r\n<strong>Increased Angina or Myocardial Infarction</strong>: Worsening angina and acute myocardial infarction can develop after starting or increasing the dose of amlodipine, particularly in patients with severe obstructive coronary artery disease.<br />\r\n<br />\r\n<strong>Patients with Hepatic Failure</strong>: Because amlodipine is extensively metabolized by the liver and the plasma elimination half-life (t&frac12;) is 56 hours in patients with impaired hepatic function, titrate slowly when administering amlodipine to patients with severe hepatic impairment.</p>', '<p>Overdosage might be expected to cause excessive peripheral vasodilation with marked hypotension and possibly a reflex tachycardia. In humans, experience with intentional overdosage of amlodipine is limited. Single oral doses of amlodipine equivalent to 40 mg amlodipine/kg and 100 mg amlodipine/kg in mice and rats, respectively, caused deaths. Single oral amlodipine doses equivalent to 4 or more mg amlodipine/kg or higher in dogs (11 or more times the maximum recommended human dose on a mg/m&sup2; basis) caused a marked peripheral vasodilation and hypotension.<br />\r\n<br />\r\nIf massive overdose should occur, initiate active cardiac and respiratory monitoring. Frequent blood pressure measurements are essential. Should hypotension occur, provide cardiovascular support including elevation of the extremities and the judicious administration of fluids. If hypotension remains unresponsive to these conservative measures, consider administration of vasopressors (such as phenylephrine) with attention to circulating volume and urine output. As amlodipine is highly protein bound, hemodialysis is not likely to be of benefit.</p>', '<p>Calcium-channel blockers.</p>', '<p>Store bottles at 20&deg;C to 25&deg;C.</p>', NULL, '2022-03-18 23:26:40', '2022-03-18 23:26:40'),
(1347, 1347, '<p>Saccharin Sodium is used as a sweetening agent. It is an artificial sweetener with effectively no food energy. It is about 300-400 times as sweet as sucrose but has a bitter or metallic aftertaste, especially at high concentrations. Saccharin is used to sweeten products such as drinks, candies, cookies, and medicines.</p>', NULL, '<p>As per advised by a the physician. 1 tab is equivalent in sweetners to 1 tespoon full of sugar.</p>', '<p>There are no known drug interactions and none well documented.</p>', NULL, '<p>Saccharin belongs to a class of compounds known as sulfonamides, which can cause allergic reactions in some individuals. Reactions can include: Headaches Breathing difficulties Diarrhoea and Skin problems</p>', '<p>Saccharin Sodium is safe in pregnancy &amp; lactation.</p>', '<p>Possibility of allergic reactions..</p>', NULL, '<p>Oral nutritional preparations.</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-18 23:28:02', '2022-03-18 23:28:02'),
(1348, 1348, '<p>This is indicated:</p>\r\n\r\n<ul>\r\n	<li>To reduce the risk of cardiovascular death and hospitalization for heart failure in patients with chronic heart failure (NYHA Class ll-IV) and reduced ejection fraction.</li>\r\n	<li>For the treatment of symptomatic heart failure with systemic left ventricular systolic dysfunction in pediatric patients aged one year and older.</li>\r\n	<li>This is usually administered in conjunction with other heart failure therapies, in place of an angiotensin-converting enzyme inhibitor (ACEi) or other ARB.</li>\r\n</ul>', '<p>This tablet contains a neprilysin inhibitor, sacubitril, and an angiotensin receptor blocker, valsartan. This tablet inhibits neprilysin (neutral endopeptidase; NEP) via LBQ657, the active metabolite of the prodrug sacubitril, and blocks the angiotensin II type-1 (AT1 ) receptor via valsartan. The cardiovascular and renal effects of this tablet in heart failure patients are attributed to the increased levels of peptides that are degraded by neprilysin, such as natriuretic peptides, by LBQ657, and the simultaneous inhibition of the effects of angiotensin II by valsartan. Valsartan inhibits the effects of angiotensin II by selectively blocking the AT1 receptor, and also inhibits angiotensin II-dependent aldosterone release.</p>', '<p><strong>Adult Heart Failure</strong>: The recommended starting dose is 49/51 mg orally twice daily. Double the dose after 2 to 4 weeks to the target maintenance dose of 97/103 mg twice daily, as tolerated by the patient.<br />\r\n<br />\r\nReduce the starting dose to 24/26 mg twice daily for:</p>\r\n\r\n<ul>\r\n	<li>Patients not currently taking an angiotensin-converting enzyme inhibitor (ACEi) or an angiotensin II receptor blocker (ARB) or previously taking a low dose of these agents.</li>\r\n	<li>Patients with severe renal impairment.</li>\r\n	<li>Patients with moderate hepatic impairment.</li>\r\n</ul>\r\n\r\n<p><strong>Pediatric Heart Failure</strong>: Refer to Table 1 for the recommended dose for pediatric patients aged one year and older. Take the recommended dose orally twice daily. Adjust pediatric patient doses every 2 weeks, as tolerated by the patient.<br />\r\n<br />\r\n<strong>Recommended Dose Titration-</strong><br />\r\n<br />\r\nPediatric Patients Less than 40 kg:</p>\r\n\r\n<ul>\r\n	<li>Starting: 1.6 mg/kg</li>\r\n	<li>Second: 2.3 mg/kg</li>\r\n	<li>Final: 3.1 mg/kg</li>\r\n</ul>\r\n\r\n<p>Pediatric Patients At least 40 kg, less than 50 kg:</p>\r\n\r\n<ul>\r\n	<li>Starting: 24/26 mg</li>\r\n	<li>Second: 49/51 mg</li>\r\n	<li>Final: 49/51 mg</li>\r\n</ul>\r\n\r\n<p>Pediatric Patients At least 50 kg:</p>\r\n\r\n<ul>\r\n	<li>Starting: 49/51 mg</li>\r\n	<li>Second: 72/78 mg</li>\r\n	<li>Final: 97/103 mg</li>\r\n</ul>', '<p><strong>Dual Blockade of the Renin-Angiotensin-Aldosterone System</strong>: Should not be used with an ACEi, aliskiren in patients with diabetes, and use with an ARB should be avoided.<br />\r\n<strong>Potassium-sparing Diuretics</strong>: Serum potassium level may be increased.<br />\r\n<strong>NSAIDs</strong>: Risk of renal impairment may be increased.<br />\r\n<strong>Lithium</strong>: Increased risk of lithium toxicity.</p>', '<p>This combination is contraindicated:</p>\r\n\r\n<ul>\r\n	<li>In patients with hypersensitivity to any component</li>\r\n	<li>In patients with a history of&nbsp;angioedema&nbsp;related to previous ACE inhibitor or ARB therapy&nbsp;</li>\r\n	<li>With concomitant use of ACE inhibitors. Do not administer within 36 hours of switching from or to an ACE inhibitor&nbsp;</li>\r\n	<li>With concomitant use of aliskiren in patients with&nbsp;diabetes</li>\r\n</ul>', '<p>The most common side effects are Angioedema, Hypotension, Impaired Renal Function, Hyperkalemia, Cough, Dizziness.</p>', '<p><strong>Pediatric Use</strong>: Safety and effectiveness have not been established in pediatric patients less than 1 year of age.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: No relevant pharmacokinetic differences have been observed in elderly (&gt;65 years) or very elderly (&gt;75 years) patients compared to the overall population.<br />\r\n&nbsp;<br />\r\n<strong>Hepatic Impairment</strong>: No dose adjustment is required when administering this tablet&nbsp;to patients with mild hepatic impairment (Child-Pugh A classification). This tablet&nbsp;is not recommended in patients with severe hepatic impairment, as no studies have been conducted in these patients.<br />\r\n<br />\r\n<strong>Renal Impairment</strong>: No dose adjustment is required in patients with mild (eGFR 60 to 90 ml/min/1.73 m2) to moderate (eGFR 30 to 60 ml/min/1.73 m2) renal impairment. The recommended starting dose in patients with severe renal impairment (eGFR &lt;30 ml/min/1.73 m2) is 24/26 mg twice daily.</p>', '<p>This tablet may cause angioedema and must not be used in patients with a known history of angioedema related to previous ACEi or ARB therapy and in patients with hereditary angioedema.<br />\r\n<br />\r\nThis tablet lowers blood pressure and may cause symptomatic hypotension. Closely monitor serum creatinine, and down-titrate or interrupt this tablet in patients who develop a clinically significant decrease in renal function. In patients with renal artery stenosis, monitor renal function.<br />\r\n<br />\r\nMonitor serum potassium periodically and treat appropriately, especially in patients with risk factors for hyperkalemia such as severe renal impairment, diabetes, hypoaldosteronism, or a high potassium diet. Dosage reduction or interruption of this tablet may be required.</p>', '<p>Limited data are available with regard to overdosage in human subjects with this tablet. In healthy volunteers, a single dose of this tablet&nbsp;583 mg sacubitril/617 mg valsartan, and multiple doses of 437 mg sacubitril/463 mg valsartan (14 days) have been studied and were well tolerated. Hypotension is the most likely result of overdosage due to the blood-pressure-lowering&nbsp;effects of this tablet. Symptomatic treatment should be provided. This tablet&nbsp;is unlikely to be removed by hemodialysis because of high protein binding.</p>', NULL, '<p>Keep in a dry place and store below 30&deg;C. Protect from moisture and keep out of the reach of children.&nbsp;</p>', '<p><strong>Pediatric Use:&nbsp;</strong>Safety and effectiveness in pediatric patients have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use:</strong>&nbsp;No relevant pharmacokinetic differences have been observed in elderly (&ge;65 years) or very elderly (&ge;75 years) patients compared to the overall population<br />\r\n<br />\r\nRenal Impairment:</p>\r\n\r\n<ul>\r\n	<li><strong>Severe</strong>: A starting dose of 24/26 mg twice-daily is recommended for patients with severe renal impairment (eGFR &lt;30 mL/min/1.73 m&sup2;). Double the dose of Sacubitril &amp; Valsartan every 2 to 4 weeks to the target maintenance dose of 97/103 mg twice daily, as tolerated by the patient.</li>\r\n	<li><strong>Mild or moderate</strong>: No starting dose adjustment is needed for mild or moderate renal impairment.</li>\r\n</ul>\r\n\r\n<p>Hepatic Impairment:</p>\r\n\r\n<ul>\r\n	<li><strong>Moderate</strong>: A starting dose of 24/26 mg twice-daily is recommended for patients with moderate hepatic impairment (Child-Pugh B classification). Double the dose of Sacubitril &amp; Valsartan every 2 to 4 weeks to the target maintenance dose of 97/103 mg twice daily, as tolerated by the patient.</li>\r\n	<li><strong>Mild</strong>: No starting dose adjustment is needed for mild hepatic impairment.</li>\r\n	<li><strong>Severe</strong>: Use in patients with severe hepatic impairment is not recommended.</li>\r\n</ul>', '2022-03-18 23:30:23', '2022-03-18 23:30:23'),
(1349, 1349, '<p>Salbutamol is indicated as a bronchodilator for use in-</p>\r\n\r\n<ul>\r\n	<li>Asthma</li>\r\n	<li>Chronic Bronchitis</li>\r\n	<li>Emphysema and</li>\r\n	<li>Other conditions associated with airways obstruction.</li>\r\n</ul>', '<p>Salbutamol is a synthetic sympathomimetic agent with predominant beta-2 adrenergic activity. Salbutamol produces bronchodilatation through stimulation of beta-2-adrenergic receptors in bronchial smooth muscles, thereby causing relaxation of bronchial muscle fibers. This action is manifested by an improvement in pulmonary function as demonstrated by spirometric measurements.</p>', '<p><strong>Salbutamol tablet or syrup-</strong><br />\r\nChildren:</p>\r\n\r\n<ul>\r\n	<li>2-6 years: 2.5 ml syrup, 3-4 times daily</li>\r\n	<li>6-12 years: 5 ml syrup, 3-4 times daily</li>\r\n	<li>Over 12 years: 5-10 ml syrup, 3-4 times daily (2-4 mg tablet, 3-4 times daily)</li>\r\n</ul>\r\n\r\n<p>Adults: 2-4 mg tablet, 3-4 times daily. Maximum single dose is 8 mg tablet.<br />\r\n<br />\r\n<strong>Salbutamol Respirator Solution</strong>: To be used with a suitable nebulizer device under the direction of a physician. The solution must not be injected or ingested.<br />\r\n<br />\r\nMethod-1 (Intermittent Administration):</p>\r\n\r\n<ul>\r\n	<li>Adults (and the elderly): 0.5 ml-1.0 ml salbutamol up to four times a day. Up to 40mg per day can be given under strict medical direction in the hospital. 0.5-1 ml solution should be diluted to final volume of 2-4 ml with sterile normal saline solution. It will take time about 10 minutes.</li>\r\n	<li>Salbutamol respiratory solution may be used undiluted for intermittent administration. For this 2.0 ml of the solution is placed in the nebulizer and the patient allowed to inhale until bronchodilation is achieved. This usually takes 3-5 minutes.</li>\r\n	<li>Children under 12 years of age: 0.5 ml of the solution diluted to 2.0-4.0 ml with normal saline. Some children may however require higher doses of up to 1.0 ml of the solution. Intermittent treatment may be repeated four times a day.</li>\r\n</ul>\r\n\r\n<p>Method-2 (Continuous administration): 1-2 ml solution is diluted to make up to 100 ml with normal saline solution. The diluted solution is administered by a suitable nebulizer devise. When there is risk of anoxia through hypoventilation, oxygen should be added to the inspired air.<br />\r\n<br />\r\n<strong>Salbutamol nebulizer solution</strong>: To be used with a suitable nebulizer device under the direction of a physician. The solution must not be injected or ingested.</p>\r\n\r\n<ul>\r\n	<li>Adults &amp; Elderly: 2.5 mg to 5 mg Salbutamol up to 4 times a day. Up to 40 mg/day may be given under strict medical direction in the hospital.</li>\r\n	<li>Children under 12 years: 2.5 mg up to 4 times a day. A higher dose up to 5 mg four times a day may be used if required.</li>\r\n</ul>\r\n\r\n<p><strong>Salbutamol injection</strong>:<br />\r\nAdults:</p>\r\n\r\n<ul>\r\n	<li>Salbutamol I.V. infusion solution is used to prepare a solution for continuous intravenous infusion. It should not be injected undiluted. A suitable solution for infusion may be prepared by diluting 5 mL of Salbutamol I.V. infusion solution (1000 mcg/mL) in 500 mL of a chosen i.v. solution to provide a salbutamol concentration of 10 mcg/mL.</li>\r\n	<li>The only recommended diluents are Sodium Chloride Injection, or Sodium Chloride and Dextrose Injection.</li>\r\n	<li>Infusion rates providing 3 to 20 micrograms salbutamol/minute (0.3 to 2ml/minute of the above infusion solution) are usually adequate. Infusion rates can be started at 5 mcg of salbutamol/min., and can be increased to 10 mcg/min., and 20 mcg/min. at 15 - 30 minute intervals, if necessary.</li>\r\n	<li>As with all parenteral drug products, intravenous admixtures should be inspected visually for clarity, particulate matter, precipitate, discoloration and leakage prior to administration.</li>\r\n	<li>All unused admixtures of Salbutamol infusion solution with infusion fluids should be discarded 24 hours after preparation.</li>\r\n</ul>\r\n\r\n<p>Children and Adolescents (&lt;18 years of age): The dosage of Salbutamol infusion solution in the pediatric age group has not been established. At present, there are insufficient data to recommend a dosage regimen for children.<br />\r\n<br />\r\n<strong>Salbutamol Inhalation Capsule</strong>:</p>\r\n\r\n<ul>\r\n	<li>Adults: For the relief of bronchospasm and for managing intermittent episodes of asthma, one or two inhalation capsule&nbsp;may be administered as a single dose. The usual recommended dosage of Salbutamol inhalation capsule for inhalation for adults for maintenance or prophylactic therapy is the contents of one 200 microgram capsule every 4 to 6 hours using a&nbsp;device. In some patients, the contents of two 200 microgram capsules inhaled every 4 to 6 hours may be required. Large doses or more frequent administration is not recommended. The use of salbutamol powder for inhalation can be continued as medically indicated to control recurring/intermittent episodes of bronchospasm.</li>\r\n	<li>Children: One Salbutamol inhalation capsule is the recommended dose for relief of acute bronchospasm in the maintenance of episodic asthma or before exercise of children 4 years of age and older. One inhalation should be administered for three or four times a day for routine maintenance or prophylactic therapy. This dosage may be increased to inhalation of two inhalation capsule, if necessary. The bronchodilator effect of each administration of inhaled Salbutamol inhalation capsule lasts for at least four hours. Such patients should be warned not to increase the dose of inhaler, but should seek medical advice immediately.</li>\r\n</ul>\r\n\r\n<p>Excercise-induced Asthma:</p>\r\n\r\n<ul>\r\n	<li>Adults: 400 microgram</li>\r\n	<li>Child: 200 microgram, 15-30 minutes prior to any physical exertion.</li>\r\n</ul>', NULL, NULL, '<p>Salbutamol may cause fine tremor of skeletal muscles (particularly the hands), palpitations and muscle cramps. Tachycardia, tenseness, headaches and peripheral vasodilatation have been reported after large doses.</p>', '<p>The drug should be used during pregnancy only if the potential benefit justifies the potential risk of the fetus. It is not known whether this drug is excreted in human milk. Because of the potential of tumorigenecity shown for Salbutamol in some animal studies, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.</p>', '<p>Salbutamol should be used with caution in patients with hyperthyroidism, cardiovascular disease, occlusive vascular disorders, hypertension and aneurysms. Hypokalaemia associated with high doses of Salbutamol may result in increased susceptibility to digitalis-induced cardiac arrhythmia. Tachyphylaxis with resistance may occur with prolonged use of high dosage. Care is necessary when treating patients with diabetes mellitus or closed angle glaucoma, and in those receiving antihypertensive therapy.</p>', '<p>The symptoms with overdosage are angina, headache, nausea, vomiting, tremor etc. The preferred antidote for overdosage with Salbutamol is a cardio-selective beta-blocking agent but beta-blocking drugs should be used with caution in patients with a history of bronchospasm.</p>', '<p>Short-acting selective &amp; &beta;2-adrenoceptor stimulants</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-18 23:33:54', '2022-03-18 23:33:54'),
(1350, 1350, '<p><strong>Bronchospasm</strong>: Salbutamol&nbsp;Inhaler is indicated for the treatment or prevention of bronchospasm in bronchial asthma and for the treatment of reversible airway obstruction associated with bronchitis and emphysema.<br />\r\n<br />\r\n<strong>Exercise-Induced Bronchospasm</strong>: Salbutamol Inhaler may be used to relieve attacks of acute dyspnoea and may also be taken prophylactically before exertion or to prevent exercise-induced asthma.</p>', '<p>Salbutamol is a selective &beta;2-adrenoceptor agonist. At therapeutic doses, it acts on the &beta;2-adrenoceptors of bronchial smooth muscle, with little or no action on the &beta;1-adrenoceptors of cardiac muscle. Salbutamol provides short-acting (4-6 hours) bronchodilatation with a fast onset (within 5 minutes) in reversible airway obstruction. It also has an anti-inflammatory effect on mast cells causing inhibition of release of bronchoconstrictor mediators including histamine, neutrophil chemotactive factor (NCF) and prostaglandin D2.</p>', '<p>Administer Salbutamol Inhaler by oral inhalation only. Shake Salbutamol Inhaler well before each spray.<br />\r\n<br />\r\nFor relief of acute episodes of bronchospasm:</p>\r\n\r\n<ul>\r\n	<li><strong>Adults</strong>: 1 or 2 puffs as necessary. The maximum dose is up to 8 puffs in 24 hours.</li>\r\n	<li><strong>Children</strong>: Half the adult dose.</li>\r\n</ul>\r\n\r\n<p>To prevent allergen-or exercise-induced bronchospasm:</p>\r\n\r\n<ul>\r\n	<li><strong>Adults</strong>: 2 puffs 15 minutes prior to exercise or exposure to the allergen. The maximum dose is 2 puffs, up to 4 times a day.</li>\r\n	<li><strong>Children</strong>: Half the adult dose.</li>\r\n</ul>\r\n\r\n<p>Chronic therapy:</p>\r\n\r\n<ul>\r\n	<li><strong>Adults</strong>: Up to 200 mcg (2 puffs) four times daily.</li>\r\n	<li><strong>Children</strong>: Up to 200 mcg (2 puffs) four times daily.</li>\r\n</ul>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>\r\n\r\n<p>Administration</p>\r\n\r\n<p>Using an Inhaler seems simple, but most patients do not know how to use it in the right way. If the Inhaler is used in the wrong way, less medicine can reach the lungs. Correct and regular use of the Inhaler will prevent or lessen the severity of asthma attacks.<br />\r\n<br />\r\nFollowing simple steps can help to use Inhaler effectively (According to &quot;<strong>National Asthma Guidelines for Medical Practitioners</strong>&quot; published by Asthma Association):</p>\r\n\r\n<ol>\r\n	<li>Take off the cap.</li>\r\n	<li>Shake the inhaler (at least six times) vigorously before each use.</li>\r\n	<li>If the inhaler is new or if it has not been used for a week or more, shake it well and release one puff into the air to make sure that it works.</li>\r\n	<li>Breathe out as full as comfortably possible &amp; hold the inhaler upright.</li>\r\n	<li>Place the actuator into mouth between the teeth and close lips around the mouthpiece.</li>\r\n	<li>While breathing deeply and slowly through the mouth, press down firmly add fully on the canister to release medicine.</li>\r\n	<li>Remove the inhaler from mouth. Continue holding breath for at least for 10 seconds or as long as it is comfortable.</li>\r\n	<li>If doctor has prescribed more than one inhalation per treatment, wait 1 minute between puffs (inhalations). Shake the inhaler well and repeat steps 4 to 7.</li>\r\n	<li>After use, replace the cap on the mouthpiece. After each treatment, rinse mouth with water.</li>\r\n	<li>Check your technique in front of a mirror from time to time, if you see a white mist during the inhalation, you may not have closed your lips properly around mouthpiece, or you may not be breathing in as you press the can. This indicates failure of technique. If this happens, repeat the procedure from step 4 carefully.</li>\r\n</ol>\r\n\r\n<p><strong>Instructions for Cleaning Inhaler</strong>: Clean your Inhaler at least once a week. Remove canister and rinse the plastic actuator and cap in warm water but do not put the metal canister into water. Dry the actuator and cap thoroughly and gently replace the metal canister into the actuator with a twisting motion. Put the cap on the mouthpiece.</p>', '<p>Salbutamol and non-selective beta-blocking drugs such as propranolol should generally not be prescribed together. Potentially serious hypokalaemia may result from &beta;2-agonist therapy. Particular caution is advised in acute severe asthma as this effect may be potentiated by concomitant treatment with xanthine derivatives, steroids, diuretics, and by hypoxia. It is recommended that serum potassium levels are monitored in such situations.</p>', '<p>Salbutamol inhaler is contraindicated in patients with a history of hypersensitivity to salbutamol or any other components of Salbutamol inhaler.</p>', '<p>Salbutamol is generally well tolerated. Few side effects have been observed during inhalation. There are tremors, anxiety, muscle cramps, headache, palpitation, a compensatory small increase in heart rate, cardiac arrhythmias (including atrial fibrillation, supraventricular tachycardia and extrasystoles), tachycardia may occur in some patients. Mouth and throat irritation may occur with inhaled salbutamol.</p>', '<p>Pregnancy Category C. There are no adequate and well-controlled studies of Salbutamol inhaler or salbutamol sulfate in pregnant women. This inhaler should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether the components of Salbutamol inhaler are excreted in human milk. Caution should be exercised when this inhaler is administered to a nursing woman.</p>', '<p><strong>Paradoxical Bronchospasm</strong>: Inhaled salbutamol sulfate can produce paradoxical bronchospasm, which may be life-threatening. If paradoxical bronchospasm occurs, the Salbutamol inhaler should be discontinued immediately and alternative therapy instituted. It should be recognized that paradoxical bronchospasm when associated with inhaled formulations; frequently occurs with the first use of a new canister.<br />\r\n<br />\r\n<strong>Cardiovascular Effects</strong>: Salbutamol inhaler, like all other &beta;2-adrenergic agonists, can produce clinically significant cardiovascular effects in some patients such as changes in pulse rate or blood pressure. If such effects occur, Salbutamol inhaler may need to be discontinued. In addition, beta-agonists have been reported to produce electrocardiograms (ECG) changes, such as flattening of the T wave, prolongation of the QTc interval, and ST-segment depression. The clinical relevance of these findings is unknown. Therefore, Salbutamol inhaler, like all other sympathomimetic amines, should be used with caution in patients with underlying cardiovascular disorders, especially coronary insufficiency, cardiac arrhythmias, and hypertension.<br />\r\n<br />\r\n<strong>Immediate Hypersensitivity Reactions</strong>: Immediate hypersensitivity reactions may occur after administration of salbutamol sulfate inhalation aerosol, as demonstrated by cases of urticaria, angioedema, rash, bronchospasm, anaphylaxis, and oropharyngeal edema. Discontinue Salbutamol inhaler if immediate hypersensitivity reactions occur.<br />\r\n<br />\r\n<strong>Coexisting Conditions</strong>: Salbutamol inhaler, like other sympathomimetic amines, should be used with caution in patients with convulsive disorders, hyperthyroidism, or diabetes mellitus and in patients who are unusually responsive to sympathomimetic amines. Large doses of intravenous salbutamol have been reported to aggravate preexisting diabetes mellitus and ketoacidosis.</p>', NULL, '<p>Short-acting selective &amp; &beta;2-adrenoceptor stimulants.</p>', '<p>Pressurized canister. Do not puncture, break or burn even when apparently empty. Keep away from sunlight and heat. Store below 30&deg;C. Do not freeze. Keep away from eyes. Keep away from children. To be dispensed only on or by the prescription of a registered physician.</p>', '<p><strong>Use in children</strong>: The safety and effectiveness of Salbutamol inhaler in children 4 years of age and older have been established.</p>', '2022-03-19 01:48:07', '2022-03-19 01:48:07'),
(1351, 1351, '<p>This inhalation aerosol is indicated for use in patients with chronic obstructive pulmonary disease (COPD) on a regular aerosol bronchodilator who continues to have evidence of bronchospasm and who requires a second bronchodilator.</p>', '<p>This inhalation aerosol is a combination of Salbutamol (as Sulphate) and Ipratropium Bromide. It is a hydrofluoroalkane (HFA) based environment friendly inhaler. Because it does not contain chlorofluorocarbon (CFC) as propellant which is one of the main reasons of ozone layer depletion.<br />\r\n<br />\r\nSalbutamol is a short acting beta2-adrenergic bronchodilator and Ipratropium Bromide is an anticholinergic bronchodilator. When used in combination, Ipratropium Bromide prevents the increase in intracellular concentration of cyclic guanosine monophosphate, which are caused by interaction of acetylcholine with the muscarinic receptor on bronchial smooth muscle. This inhalation aerosol&nbsp;is expected to maximize the response of the treatment in patients with chronic obstructive pulmonary disease (COPD) by reducing bronchospasm through two distinctly different mechanisms, anticholinergic (parasympatholytic) and sympathomimetic. Simultaneous administration of an anticholinergic (Ipratropium Bromide) and a beta 2-sympathomimetic (Salbutamol) is designed to benefit the patient by producing a greater bronchodilatory effect than when either drug is utilized alone at its recommended dosage.</p>', '<p><strong>Adult dose (Including the elderly)</strong>: 2 puffs of Salpium 4 times a day (Patients may take additional puffs as required but a total number of puffs should not exceed 12 in 24 hours). Or as directed by the physician.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>Using an Inhaler seems simple, but most patients do not know how to use it in the right way. If the Inhaler is used in the wrong way, less medicine can reach the lungs. Correct and regular use of the Inhaler will prevent or lessen the severity of asthma attacks.<br />\r\n<br />\r\nFollowing simple steps can help to use Inhaler effectively (According to &quot;<strong>National Asthma Guidelines for Medical Practitioners</strong>&quot; published by Asthma Association):</p>\r\n\r\n<ol>\r\n	<li>Take off the cap.</li>\r\n	<li>Shake the inhaler (at least six times) vigorously before each use.</li>\r\n	<li>If the inhaler is new or if it has not been used for a week or more, shake it well and release one puff into the air to make sure that it works.</li>\r\n	<li>Breathe out as full as comfortably possible &amp; hold the inhaler upright.</li>\r\n	<li>Place the actuator into mouth between the teeth and close lips around the mouthpiece.</li>\r\n	<li>While breathing deeply and slowly through the mouth, press down firmly add fully on the canister to release medicine.</li>\r\n	<li>Remove the inhaler from mouth. Continue holding breath for at least for 10 seconds or as long as it is comfortable.</li>\r\n	<li>If doctor has prescribed more than one inhalation per treatment, wait 1 minute between puffs (inhalations). Shake the inhaler well and repeat steps 4 to 7.</li>\r\n	<li>After use, replace the cap on the mouthpiece. After each treatment, rinse mouth with water.</li>\r\n	<li>Check your technique in front of a mirror from time to time, if you see a white mist during the inhalation, you may not have closed your lips properly around mouthpiece, or you may not be breathing in as you press the can. This indicates failure of technique. If this happens, repeat the procedure from step 4 carefully.</li>\r\n</ol>\r\n\r\n<p><strong>Instructions for Cleaning Inhaler</strong>: Clean your Inhaler at least once a week. Remove canister and rinse the plastic actuator and cap in warm water but do not put the metal canister into water. Dry the actuator and cap thoroughly and gently replace the metal canister into the actuator with a twisting motion. Put the cap on the mouthpiece.</p>', '<p>This inhalation aerosol has been used concomitantly with other drugs, including sympathomimetic bronchodilators, methylxanthines and steroids, commonly used in the treatment of COPD. No formal drug interaction studies have been performed with this inhalation aerosol and these or other medications commonly used in the treatment of COPD. Ipratropium Bromide should be co-administered cautiously with other anticholinergic agents and sympathomimetic agents, which may increase the risk of adverse cardiovascular effects. Beta-2-agonist containing drugs, like this inhalation aerosol, should be administrated with extreme caution in patients with non-potassium sparing diuretics, monoamine oxidase inhibitors or tricyclic antidepressants.</p>', '<p>This inhalation aerosol is contraindicated in patients with a history of hypersensitivity to Soya-Lecithin or related food products such as soybean and peanut. This inhalation aerosol is also contraindicated in patients hypersensitive to any other components of the drug product or to atropine or its derivatives.</p>', '<p>Due to presence of Salbutamol, mild tremor and headache have been reported. These usually disappear with continuous treatment. There have been very rare reports of treatments muscle cramp, hypersensitivity reactions including angioedema, urticaria, bronchospasm and hypotension.<br />\r\n<br />\r\nFor the presence of Ipratropium Bromide headache, influenza, chest pain, nausea, dyspnea, coughing, pharyngitis, sinusitis are rarely reported.</p>', '<p>Ipratropium Bromide: Pregnancy category B. Studies have demonstrated no teratogenic effects as a result of ipratropium.<br />\r\n<br />\r\nSalbutamol: Pregnancy category C. Salbutamol has been shown to be teratogenic in animals.<br />\r\n<br />\r\nThere are, however no adequate and well-controlled studies of Salpium Inhalation Aerosol (Salbutamol and Ipratropium Bromide combination) in pregnant woman. This inhalation aerosol should be used during pregnancy only if the potential benefit justifies the potential risk of the fetus. It is not known whether the components of the Salpium InhalationAerosol are excreted in human milk. As many drugs are excreted in human milk, Salpium should be cautiously administered to a nursing mother.</p>', NULL, '<p>The effects of overdosage are expected to be related primarily to Salbutamol Sulphate. Manifestations of overdosage with Salbutamol may include anginal pain, hypertension, hypokalemia and tachycardia.</p>', '<p>Combined bronchodilators.</p>', '<p>Do not puncture, break or incinerate the pressurized canister even when apparently empty. Avoid storage in direct sunlight or heat. Store in a cool and dry place. Keep away from children. Keep away from eyes.</p>', '<p>This inhalation aerosol contains Ipratropium Bromide and, therefore, should be used with caution in patients with narrow-angle glaucoma, prostatic hypertrophy or bladder-neck obstruction. Preparations containing sympathomimetic amines such as Salbutamol Sulphate should be used with caution in patients with convulsive disorders, hyperthyroidism, diabetes mellitus and in patients who are unusually responsive to sympathomimetic amines.</p>', '2022-03-19 01:50:09', '2022-03-19 01:50:09'),
(1352, 1352, '<p>Salbutamol sulfate &amp; Ipratropium bromide solution for inhalation is indicated for the treatment of reversible bronchospasm associated with obstructive airway diseases in patients who require more than a single bronchodilator.</p>', '<p>Ipratropium Bromide is quickly absorbed after inhalation. The systemic bioavailability following inhalation is estimated to be less than 10% of the dose. Renal excretion of Ipratropium Bromide is given as 46% of the dose after intravenous administration. The half-life of the terminal elimination phase is about 1.6 hours as determined after intravenous administration. Elimination half-life of drug and metabolites is 3.6 hours as determined after radio labelling. Ipratropium Bromide does not penetrate the blood brain barrier.<br />\r\n<br />\r\nSalbutamoi Sulphate is rapidly and completely absorbed following administration either by inhaled or oral route. Peak plasma Salbutamoi concentrations are seen within three hours of administration and it is excreted unchanged in the urine after 24 hours. The elimination half-life is 4 hours. Salbutamoi will cross the blood brain barrier reaching concentrations amounting to about five percent of the plasma concentrations.<br />\r\n<br />\r\nIt has been shown that co-nebulisation of Ipratropium Bromide and Salbutamoi Sulphate does not potentiate the systemic absorption of either component and that therefore the additive activity of this solution is due to the combined local effect on the lung following inhalation.</p>', '<p>Salbutamol sulfate &amp; Ipratropium bromide solution for inhalation in ampoule may be administered from a suitable nebulizer or an intermittent positive pressure ventilator.</p>\r\n\r\n<ul>\r\n	<li><strong>Adults (including elderly)</strong>: Use one 3 ml ampoule in the nebulizer four times a day. Two additional treatments may be used per day, if needed.</li>\r\n	<li><strong>Children</strong>: Use and dose must be determined by doctor.</li>\r\n</ul>\r\n\r\n<p>Patients should be advised to consult a doctor or the nearest hospital immediately in the case of acute or rapidly worsening dyspnoea if additional inhalations do not produce an adequate improvement.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p><strong>Step 1</strong>: Twist off the top of the ampoule. Be careful to hold the ampoule upright.<br />\r\n<strong>Step 2</strong>: Squeeze the desired amount of the nebulizer solution into the nebulizer chamber.<br />\r\n<strong>Step 3</strong>: If dilution is needed follow the physician&rsquo;s direction.</p>', '<p>The concurrent administration of other beta-mimetics, systemically absorbed anticholinergics and xanthine derivatives may increase the side effects.<br />\r\n<br />\r\nBeta-agonist induced hypokalaemia may be increased by concomitant treatment with xanthine derivatives, glucocorticosteroids and diuretics. This should be taken into account particularly in patients with severe airway obstruction.<br />\r\n<br />\r\nHypokalaemia may result in an increased susceptibility to arrhythmias in patients receiving digoxin. It is recommended that serum potassium levels be monitored in such situations.<br />\r\n<br />\r\nA potentially serious reduction in bronchodilator effect may occur during concurrent administration of beta-blockers.<br />\r\n<br />\r\nBeta-adrenergic agonists should be administered with caution to patients being treated with monoamine oxidase inhibitors or tricyclic antidepressants, since the action of beta adrenergic agonists may be enhanced.<br />\r\n<br />\r\nInhalation of halogenated hydrocarbon anaesthetics such as halothane, trichloroethylene and enflurane may increase the susceptibility to the cardiovascular effects of beta-agonists.</p>', '<p>This is contraindicated in patients with hypertrophic obstructive tachyarrhythmia and in patients with a history of hypersensitivity to atropine or its derivatives, or to any other component of the product.</p>', '<p>In common with other beta-agonists containing products, side effects of this solution can include fine tremor of skeletal muscles and nervousness and less frequently tachycardia, dizziness, palpitations or headache, especially in hypersensitive patients.<br />\r\n<br />\r\nPotentially serious hypokalaemia may result from prolonged and/or high dose beta2 agonist therapy.<br />\r\n<br />\r\nAs with use of other inhalation therapy, cough, local irritation and less commonly inhalation induced bronchospasm can occur. As with other beta-mimetics, nausea, vomiting, sweating, weakness and myalgia/muscle cramps may occur. In rare cases decrease in diastolic blood pressure, increase in systolic blood pressure, arrhythmias, particularly after higher doses, may occur.<br />\r\n<br />\r\nIn individual cases psychological alterations have been reported under inhalation therapy with beta-mimetics.<br />\r\n<br />\r\nThe most frequent non-respiratory anticholinergic related adverse events are dryness of mouth and dysphonia. There have been isolated reports of ocular complications (i.e. mydriasis, increased intraocular pressure, angle closure glaucoma, and eye pain) when aerosolised ipratropium bromide either alone or in combination with adrenergic beta2 agonist, has escaped into the eyes. Ocular side effects, gastrointestinal motility disturbances and urinary retention may occur in rare cases and are reversible.</p>', '<p>Pregnancy category C. Animal studies with Salbutamoi Sulphate have demonstrated a teratogenic effect. It is not known whether this medication is harmful to the fetus. No evidence of abnormalities has been reported in women receiving albuterol during pregnancy. This solution should be used during pregnancy only if the potential benefit justifies. This solution should be used with caution before childbirth in view of Salbutamol&#39;s inhibitory effects on uterine contractions.<br />\r\n<br />\r\nSalbutamol Sulphate and Ipratropium Bromide are probably excreted in breast milk and their effects on neonates are not known. Although lipid-insoluble quaternary bases pass into breast milk, it is unlikely that this will happen to any extent especially when taken by inhalation. However, because many drugs are excreted in breast milk, caution should be exercised when This solution is administered to a nursing woman.</p>', '<p>In the case of acute, rapidly worsening dyspnoea a doctor should be consulted immediately. Immediate hypersensitivity reactions may occur after administration of this solution as demonstrated by rare cases of urticaria, angioedema, rash, bronchospasm and oropharyngeal oedema.</p>', '<p>The effects of overdosage are expected to be primarily related to Salbutamol because acute overdosage with Ipratropium Bromide is unlikely as it is not well absorbed systemically after inhalation or oral administration.<br />\r\n<br />\r\n<strong>Symptoms</strong>: Manifestations of overdosage with salbutamol may include tachycardia, anginal pain, hypertension, hypotension , palpitations, tremor, widening of the pulse pressure, arrhythmia and flushing.<br />\r\n<br />\r\n<strong>Therapy</strong>: Administration of sedatives, tranquillisers; in severe cases, intensive therapy. Beta-receptor blockers, preferably beta1-selective, are suitable as specific antidotes; however, a possible increase in bronchial obstruction must be taken into account and the dose should be adjusted carefully in patients suffering from bronchial asthma.</p>', '<p>Combined bronchodilators</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-19 01:52:22', '2022-03-19 01:52:22');
