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
(468, 468, '<p>Docetaxel is a microtubule inhibitor indicated for:</p>\r\n\r\n<ul>\r\n	<li><strong>Breast Cancer (BC)</strong>: single agent for locally advanced or metastatic BC after chemotherapy failure; and with doxorubicin and cyclophosphamide as adjuvant treatment of operable node-positive BC</li>\r\n	<li><strong>Non-small Cell Lung Cancer (NSCLC)</strong>: single agent for locally advanced or metastatic NSCLC after platinum therapy failure; and with cisplatin for unresectable, locally advanced or metastatic untreated NSCLC</li>\r\n	<li><strong>Castration-Resistant Prostate Cancer (CRPC)</strong>: with prednisone in metastatic castration-resistant prostate cancer</li>\r\n	<li><strong>Gastric Adenocarcinoma (GC)</strong>: with cisplatin and fluorouracil for untreated, advanced GC, including the gastroesophageal junction</li>\r\n	<li><strong>Squamous Cell Carcinoma of the Head and Neck (SCCHN)</strong>: with cisplatin and fluorouracil for induction treatment of locally advanced SCCHN</li>\r\n</ul>', '<p>Docetaxel is an antineoplastic agent, which acts by disrupting the microtubular network in cells that is essential for vital mitotic and interphase cellular functions. Docetaxel promotes the assembly of tubulin into stable microtubules while simultaneously inhibiting their disassembly. Docetaxel binds to free tubulin thereby decreasing the critical intracellular concentration of tubulin. The promoted polymerization of microtubules leads to the production of microtubule bundles without normal function and to the stabilization of microtubules, resulting in the inhibition of mitosis in cells. The binding of Docetaxel to microtubules does not alter the number of protofilaments in the bound microtubules; in that, it differs from other spindle poisons. Docetaxel was found to be cytotoxic in vitro against various murine and human tumor cell lines, and against freshly excised human tumor cells in clonogenic assays. In addition, Docetaxel was found to be active on a number of cell lines overexpressing the p-glycoprotein, which is encoded by the multidrug resistant gene.</p>', '<p>Administer in a facility equipped to manage possible complications (e.g., anaphylaxis). Administer intravenously (IV) over 1 hr every 3 weeks. PVC equipment is not recommended. Use only a 21 gauge needle to withdraw docetaxel from the vial.</p>\r\n\r\n<ul>\r\n	<li><strong>BC locally advanced or metastatic</strong>: 60 mg/m2&nbsp;to 100 mg/m2&nbsp;single agent</li>\r\n	<li><strong>BC adjuvant</strong>: 75 mg/m2&nbsp;administered 1 hour after doxorubicin 50 mg/m2&nbsp;and cyclophosphamide 500 mg/m2&nbsp;every 3 weeks for 6 cycles</li>\r\n	<li><strong>NSCLC</strong>: after platinum therapy failure: 75 mg/m2&nbsp;single agent</li>\r\n	<li><strong>NSCLC</strong>: chemotherapy-naive: 75 mg/m2&nbsp;followed by cisplatin 75 mg/m2&nbsp;</li>\r\n	<li><strong>HRPC</strong>: 75 mg/m2 with 5 mg prednisone twice a day continuously</li>\r\n	<li><strong>GC</strong>: 75 mg/m2&nbsp;followed by cisplatin 75 mg/m2&nbsp;(both on day 1 only) followed by fluorouracil 750 mg/m2&nbsp;per day as a 24-hr IV (days 1-5), starting at end of cisplatin infusion</li>\r\n	<li><strong>SCCHN</strong>: 75 mg/m2&nbsp;followed by cisplatin 75 mg/m2&nbsp;IV (day 1), followed by fluorouracil 750 mg/m2&nbsp;per day as a 24-hr IV (days 1&ndash;5), starting at end of cisplatinin fusion; for 4 cycles</li>\r\n	<li><strong>SCCHN</strong>: 75 mg/m2&nbsp;followed by cisplatin 100 mg/m2&nbsp;IV (day 1), followed by fluorouracil 1000 mg/m2&nbsp;per day as a 24-hr IV (days 1&ndash;4); for 3 cycles</li>\r\n</ul>\r\n\r\n<p><br />\r\nFor all patients:</p>\r\n\r\n<ul>\r\n	<li>Premedicate with oral corticosteroids</li>\r\n	<li>Adjust dose as needed</li>\r\n</ul>', '<p>Docetaxel is a CYP3A4 substrate. In vitro studies have shown that the metabolism of docetaxel may be modified by the concomitant administration of compounds that induce, inhibit, or are metabolized by cytochrome P450 3A4.</p>', '<p>Docetaxel is contraindicated in patients with:</p>\r\n\r\n<ul>\r\n	<li>Neutrophil counts of &lt;1500 cells/mm3</li>\r\n	<li>A history of severe hypersensitivity reactions to docetaxel or to other drugs formulated with polysorbate 80. Severe reactions, including anaphylaxis, have occurred</li>\r\n</ul>', '<p>The most common adverse reactions across all docetaxel indications are infections, neutropenia, anemia, febrile neutropenia, hypersensitivity, thrombocytopenia, neuropathy, dysgeusia, dyspnea, constipation, anorexia, nail disorders, fluid retention, asthenia, pain, nausea, diarrhea, vomiting, mucositis, alopecia, skin reactions, and myalgia. Incidence varies depending on the indication. Adverse reactions are described according to indication. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.</p>', '<p>Based on findings in animal reproduction studies and its mechanism of action, docetaxel can cause fetal harm when administered to a pregnant woman. There is no information regarding the presence of docetaxel in human milk, or on its effects on milk production or the breastfed child. No lactation studies in animals have been conducted.</p>', '<ul>\r\n	<li>Docetaxel should be administered under the supervision of a physician experienced in the use of antineoplastic agents</li>\r\n	<li>There is a higher risk of developing severe adverse reactions including toxic death and fatal gastrointestinal hemorrhage in patients with hepatic impairment</li>\r\n	<li>Docetaxel therapy should not be given to patients with neutrophil counts of less than 1,500 cells/mm3</li>\r\n	<li>Fatal cases of enterocolitis, including ischemic colitis, colitis and neutropenic enterocolitis have been reported&nbsp;</li>\r\n	<li>Severe hypersensitivity reactions, with a potential fatal outcome, requiringb immediate discontinuation of Docetaxel may occur. Patients should be closely monitored&nbsp;</li>\r\n	<li>Treatment related acute myeloid leukemia may occur. No studies have been conducted to assess the carcinogenic potential of Docetaxel</li>\r\n</ul>', '<p>There were a few reports of overdosage. There is no known antidote for docetaxel overdose. In case of overdose, the patient should be kept in a specialised unit and vital functions closely monitored. In case of overdosage, exacerbation of adverse events may be expected. The primary anticipated complications of overdosage would consist of bone marrow suppression, peripheral neurotoxicity and mucositis. Patients should receive therapeutic G-CSF as soon as possible after discovery of overdose. Other appropriate symptomatic measures should be taken, as needed.</p>', '<p>Cytotoxic Chemotherapy</p>', '<p>Store between 2&deg;C and 25&deg;C and protected from light. Freezing does not adversely affect the product.</p>', NULL, '2022-02-19 06:31:16', '2022-06-07 00:17:21'),
(469, 469, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '2022-02-19 06:31:30', '2022-02-19 06:31:30'),
(470, 470, '<p>Docusate Sodium ear drops is indicated as an aid in the removal of ear wax.</p>', '<p>Ear wax which often obstructs the external auditory meatus of the ear contains less than 50% of fatty matter derived from secretions of the sebaceous ceruminous glands. The majority of the wax consists of desquamated epithelium, foreign matter and shed hairs. This non-fatty material forms a matrix holding together the granules of fatty matter to form the ceruminous mass. The addition of oils or solvents binds the mass more firmly together, but aqueous solutions, if they are able to penetrate the matrix, cause a disintegration of the ceruminous mass. Docusate Sodium ear drops, because of their low surface tension and miscibility, rapidly penetrate the dry matrix of the ceruminous mass, reducing the solid ear wax to a semi-solid debris.</p>', '<p><strong>Adults (including the elderly)</strong>: Apply Docusate Sodium ear drops sufficient to fill the affected ear on not more than two consecutive nights.<br />\r\n<br />\r\n<strong>Children (from 1 year)</strong>: As for adult dose.<br />\r\n<br />\r\nIf the Docusate Sodium is not ejected, ear-syringing might be required, patients should consult their doctor.</p>\r\n\r\n<p>To apply, tilt head to one side so that the ear is facing up. Then gently pull the ear lobe up &amp; backward in case of adults and children older than 3 years. In case of pediatric patients gently pull the ear lobe down &amp; backward. Gently drip the Docusate Sodium ear drops into blocked ear until it is full. Moisten a cotton wool ball with Docusate Sodium ear drops. Place the cotton wool ball in the ear to act like a plug. In the morning remove the cotton wool ball.</p>', '<p>Interaction with other medicinal products and other forms of interaction: Unknown.</p>', '<p>Docusate Sodium is contraindicated in patients with perforation of the eardrum or inflammation of the ear.</p>', '<p>Immune system disorders: hypersensitivity/allergic reactions; Skin disorders: contact dermatitis and allergic skin reactions; General disorders: Application site reactions rarely including transient stinging or irritation may occur.</p>', '<p>Docusate Sodium can be used in case of pregnancy &amp; lactation. As it is a non-systemic application, there is no information to suggest that Docusate Sodium ear drops should not be used during pregnancy and lactation.</p>', '<p>If pain or inflammation is experienced, treatment should be discontinued</p>', '<p>Excess Docusate Sodium ear drops may seep from the ear and treatment of any resulting adverse events, such as skin irritation should be symptomatic.</p>', '<p>Cerumenolytic</p>', '<p>Keep away from light and moisture, store below 25&deg;C.</p>', NULL, '2022-02-19 06:31:55', '2022-06-07 00:21:23'),
(471, 471, '<p>Docusate Sodium oral preparations are indicated to prevent and treat chronic constipation, as follows:</p>\r\n\r\n<ul>\r\n	<li>soften hard, dry stools in order to ease defecation and reduce straining at stool;</li>\r\n	<li>in the presence of hemorrhoids and anal fissure, prevent hard, dry stools and reduce straining.</li>\r\n</ul>\r\n\r\n<p>Docusate Sodium oral preparations are also used as an adjunct in abdominal radiological procedures.</p>', '<p>Docusate sodium works by allowing more water to be absorbed by the stool. Docusate does not stay in the gastrointestinal tract, but is absorbed into the bloodstream and excreted via the gallbladder after undergoing extensive metabolism. The effect of docusate may not necessarily be all due to its surfactant properties. Perfusion studies suggest that docusate inhibits fluid absorption or stimulates secretion in the portion of the small intestine known as the jejunum.</p>', '<p>Route of administration: Oral.</p>\r\n\r\n<ul>\r\n	<li><strong>Adults and elderly</strong>: One to five Docusate Sodium oral preparations should be taken daily in divided doses. Treatment should be commenced with large doses, which should be decreased as the condition of the patient improves.</li>\r\n	<li><strong>For use with barium meals</strong>: Four Docusate Sodium oral preparations to be taken with the meal.</li>\r\n	<li><strong>Children under 12 years</strong>: Not recommended.</li>\r\n</ul>', '<p>Docusate Sodium softgel capsules should not be taken concurrently with mineral oil.</p>', '<p>Docusate Sodium softgel capsule is contra-indicated in patients with hypersensitivity to Docusate Sodium.</p>', '<p>Rarely, Docusate Sodium softgel capsules can cause diarrhea, nausea, abdominal cramps or skin rash.</p>', '<p>There are no adequate data from the use of the drug in pregnant women. Animal studies are insufficient with respect to effects on pregnancy and embryonic foetal development. The potential risk for humans is unknown. During wide use, no adverse consequences have been reported. Use in pregnancy only if the benefits outweigh the risks. Docusate sodium is excreted in breast milk and should therefore, be used with caution in lactating mothers.</p>', '<p>Docusate Sodium capsule should not be administered when abdominal pain, nausea, vomiting or intestinal obstruction is present. Patients with rare hereditary problems of fructose intolerance should not take this medicine. Organic disorders should be excluded prior to the administration of any laxative. The treatment of constipation with any medicinal product is only adjuvant to a healthy lifestyle and diet, for example, increased intake of fluids and dietary fiber and advice on appropriate physical activity. If laxatives are needed every day, or if there is persistent abdominal pain, patients need to consult with physicians. Do not use this medicine if patients are intolerant to small quantities of sugar (sorbitol, fructose).</p>', '<p>In rare cases of overdose, excessive loss of water and electrolytes should be treated by encouraging the patient to drink plenty of fluid. Electrolyte loss should be replenished where appropriate.</p>', '<p>Stool softener</p>', '<p>Store in a cool and dry place, protected from light.</p>', NULL, '2022-02-19 06:32:12', '2022-06-07 00:23:39'),
(472, 472, '<p><strong>Dyspeptic symptom complex</strong>, often associated with delayed gastric emptying, gastroesophageal reflux and esophagitis:</p>\r\n\r\n<ul>\r\n	<li>Epigastric sense of fullness, feeling of abdominal distension, upper abdominal pain</li>\r\n	<li>Eructation, flatulence, early satiety</li>\r\n	<li>Nausea and vomiting</li>\r\n	<li>Heartburn with or without regurgitations of gastric contents in the mouth</li>\r\n	<li>Non-ulcer dyspepsia</li>\r\n</ul>\r\n\r\n<p><strong>Acute nausea and vomiting</strong>&nbsp;of the functional, organic, infectious, dietetic origin or induced by radiotherapy or drug therapy or induced in migraine.<br />\r\n<br />\r\n<strong>Parkinson&#39;s disease</strong>: In dopamine-agonist induced nausea and vomiting.<br />\r\n<br />\r\n<strong>Radiological studies</strong>: Speeding barium transit in follow-through radiological studies.</p>', '<p>Domperidone is a dopamine antagonist that principally blocks the dopamine receptors located in the ChemoreceptorTrigger Zone (CTZ) and stomach. Its gastroprokinetic action is based on its blocking effect of dopamine receptors that have an influence on the motility of the gastrointestinal tract. Due to its weak penetration across the blood-brain barrier, Domperidone has almost no effect on the dopaminergic receptors in the brain, therefore, excluding psychotropic and neurologic side effects. Domperidone restores normal motility and tone of the upper gastrointestinal tract, facilitates gastric emptying, enhances antral and duodenal peristalsis and regulates contraction of the pylorus. Domperidone also increases esophageal peristalsis and lower esophageal sphincter pressure, and thus prevents regurgitation of gastric content.</p>', '<p>Domperidone should be taken 15-30 minutes before meals and, if necessary, before retiring.<br />\r\n<br />\r\nThe usual recommended oral dose of Domperidone is as follows:</p>\r\n\r\n<ul>\r\n	<li><strong>Adults</strong>: 10-20 mg (1-2 tablet or 10-20 ml suspension), every 6-8 hours daily. The maximum dose of Domperidone is 80 mg daily.</li>\r\n	<li><strong>Children</strong>: 2-4 ml suspension/10 kg body weight or 0.4-0.8 ml paediatric drops/10 kg body weight, every 6-8 hours daily.</li>\r\n</ul>\r\n\r\n<p>In dyspeptic symptom:</p>\r\n\r\n<ul>\r\n	<li><strong>Adults</strong>: 10-20 mg (1-2 tablet or 10-20 ml suspension), every 6-8 hours daily.</li>\r\n	<li><strong>Children</strong>: 0.2-0.4 mg/kg (2-4 ml suspension/10 kg or 0.4-0.8 ml paediatric drops/10 kg) body weight, every 6-8 hours daily.</li>\r\n</ul>\r\n\r\n<p>In acute and sub-acute conditions (mainly in acute nausea and vomiting):</p>\r\n\r\n<ul>\r\n	<li><strong>Adults</strong>: 20 mg (2 tablets or 20 ml suspension), every 6-8 hours daily</li>\r\n	<li><strong>Children</strong>: 0.2-0.4 mg/kg (2-4 ml suspension/10 kg or 0.4-0.8 ml paediatric drops/10 kg) body weight, every 6-8 hours daily. (In acute nausea and vomiting maximum period of treatment is 12 weeks).</li>\r\n</ul>\r\n\r\n<p>By rectum in suppositories:</p>\r\n\r\n<ul>\r\n	<li><strong>Adults (including elderly)</strong>: 30-60 mg every 4-8 hours.</li>\r\n	<li><strong>Children</strong>: The maximum daily dose rectally in children&#39;s is 30 mg for those weighting 10 to 25 kg. The dose may be divided throughout day if necessary.</li>\r\n	<li>The maximum period of treatment is 12 weeks.</li>\r\n</ul>', '<p>Domperidone may reduce the risk of hypoprolactemic effect of bromocriptine. The action of Domperidone on Gl function may be antagonized by antimuscarinics and opoid analgesics. Care should be exercised when domperidone is administered in combination with MAO (monoamine oxidase) inhibitors.</p>', '<p>Domperidone is contraindicated to patients having known hypersensitivity to this drug and in the case of neonates. Domperidone should not be used whenever gastrointestinal stimulation might be dangerous i.e., gastrointestinal hemorrhage, mechanical obstruction or perforation. Also contraindicated in patients with prolactin releasing pituitary tumor (prolactinoma).</p>', '<p>Domperidone may produce hyperprolactinemia (1.3%).This may result in galactorrhea, breast enlargement, and soreness and reduced libido. Dry mouth (1%), thirst, headache (1.2%), nervousness, drowsiness (0.4%), diarrhea (0.2%), skin rash and itching (0.1%) may occur during treatment with domperidone. Extra-pyramidal reactions are seen in 0.05% of patients in clinical studies.</p>', '<p>The safety of domperidone has not been proven and it is therefore not recommended during pregnancy. Animal studies have not demonstrated the teratogenic effect in the fetus. Domperidone may precipitate galactorrhea and improve post-natal lactation. It is secreted in breast milk but in very small quantities insufficient to be considered harmful.</p>', '<p>Domperidone should be used with absolute caution in the case of children because there may be an increased risk of extra-pyramidal reactions in young children because of an incompletely developed blood-brain barrier. Since domperidone is highly metabolized in liver, it should be used with caution in patient with hepatic impairment.</p>', '<p>There are no reported cases of overdose.</p>', '<p>Motility Stimulants, Motility stimulants/Dopamine antagonist, Prokinetic drugs</p>', '<p>Store below 30&deg;C, Protected from light &amp; moisture. Keep out of children&#39;s reach.</p>', NULL, '2022-02-19 06:32:31', '2022-06-07 00:25:51'),
(473, 473, '<p>Donepezil is indicated for the symptomatic treatment of mild to moderate dementia of Alzheimer&#39;s type.</p>', '<p>Donepezil Hydrochloride is a centrally acting anticholinesterase agent. It binds reversibly with acetylcholinesterase and inactivates it, thus inhibiting hydrolysis of acetylcholine. As a result the concentration of acetylcholine increases at cholinergic synapses in the brain.</p>', '<p>5 mg once daily orally at bed time. The 5 mg/day dose should be maintained for at least one month in order to allow the earliest clinical responses to treatment to be assessed and to allow steady-state concentrations of donepezil hydrochloride to be achieved. Following a one-month clinical assessment of treatment at 5 mg/day, the dose can be increased to 10 mg/day (once-a-day dosing). Since food does not affect the rate or extent of absorption of donepezil, it can be administered with or without food.</p>', '<p>Drugs with anticholinergic properties and which cross into the brain, such as atropine, benztropine produce the opposite effects of Donepezil and should be avoided during therapy with donepezil. Medication with carbamazepine, dexamethasone, phenobarbital, phenytoin may reduce the effect of donepezil whereas ketoconazole, quinidine, cimetidine may increase the effects.</p>', '<p>Donepezil is contraindicated in patients with known hypersensitivity to donepezil hydrochloride or to piperidine derivatives.</p>', '<p>Generally well tolerated but some patients may experience nausea, vomiting &amp; diarrhoea. These adverse events are of mild intensity and transient, resolving during continued treatment without the need for dose modification. Less frequent side effects are insomnia, fatigue, anorexia, muscle cramps, generalized seizure etc.</p>', '<p>There are no adequate and well controlled studies in pregnant woman. Donepezil should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether Donepezil Hydrochloride is secreted in human breast milk or not. Donepezil is not indicated in nursing mother</p>', '<p>Caution should be taken in sick sinus syndrome or other supraventricular conduction abnormalities, patients at risk of developing peptic ulcers, asthma, obstructive airway disease and during anaesthetic procedure.</p>', '<p>Symptoms of overdose includes nausea, vomiting, salivation. Over dosage with very high dose of donepezil may result in cholinergic crisis characterized by severe nausea, vomiting, salivation, bradycardia, hypotension, increasing muscle weakness, respiratory depression, collapse and convulsion. As in any case of over dose, general supportive measures should be utilized. In case of cholinergic crisis hospitalization of the patient is required.</p>', '<p>Drugs for Dementia</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', '<p><strong>Renal &amp; hepatic impairment:</strong>&nbsp;A similar dose schedule can be followed for patients with renal or mild to moderate hepatic impairment as clearance of donepezil hydrochloride is not affected by these conditions.<br />\r\n<br />\r\n<strong>Use in children:</strong>&nbsp;There are no adequate and well controlled trials in document to safety and efficacy of Donepezil hydrochloride in any illness occurring in children. Donepezil is not recommended for use in children.</p>', '2022-02-19 06:33:05', '2022-06-08 00:03:50'),
(474, 474, '<p>Dopamine is recommended for the correction of haemodynamic imbalance present in-</p>\r\n\r\n<ul>\r\n	<li>Acute hypotension or shock associated with myocardial infarction, endotoxic septicaemia, trauma and renal failure.</li>\r\n	<li>As an adjunct after open heart surgery, where there is persistent hypotension after correction of hypovolaemia.</li>\r\n	<li>In chronic cardiac decompensation as in congestive failure.</li>\r\n</ul>', '<p>Dopamine is a preparation of Dopamine hydrochloride which can stimulate &alpha;, &beta; and dopamine receptors. It is a natural catecholamine formed by the decarboxylation of 3,4-dihydroxyphenylalanine (DOPA). Dopamine is a precursor to norepinephrine in noradrenergic nerves and is also a neurotransmitter in certain areas of the central nervous system, especially in the nigrostriatal tract and in a few peripheral sympathetic nerves. It produces positive chronotropic and inotropic effects on the myocardium, resulting in increased heart rate and cardiac contractility. This is accomplished directly by exerting an agonist action on &beta;-adrenoceptors and indirectly by causing release of norepinephrine from storage sites in sympathetic nerve endings. Dopamine does not cross the blood-brain barrier and so does not activate dopamine receptors in the brain.</p>', '<p><strong>Adult dose</strong>: Where appropriate, the circulating blood volume must be restored with a suitable plasma expander or whole blood, prior to administration of dopamine. Begin infusion of dopamine hydrochloride solution at dosage of 2 to 5 micrograms/kg/min in patients who are likely to respond to a modest increment of heart force and renal perfusion.<br />\r\n<br />\r\nIn more seriously ill patients, begin infusion of dopamine hydrochloride solution at dosage of 5 micrograms/kg/min and increase gradually using 5 to 10 micrograms/kg/min increment up to 20 to 50 micrograms/kg/min as needed. If dosage in excess of 50 micrograms/kg/min are required, it is suggested that urine output should be checked frequently. In patients who do not respond to this doses, additional increments of dopamine may be given in an effort to achieve adequent blood pressure, urine flow and perfusion.<br />\r\n<br />\r\nFor patients with severe, refractory, chronic congestive heart failure doses should be started on 0.5 to 2 micrograms/kg/min, and the dose increased by 1 to 3 micrograms/kg/min as urinary output increases.<br />\r\n<br />\r\nECG, blood pressure and urine output should be monitored. Cardiac output and pulmonary wedge pressure should be monitored if possible.<br />\r\n<br />\r\n<strong>Children less than 12 years old</strong>: The safety and efficacy of dopamine in children under 12 years has not been established.<br />\r\n<br />\r\n<strong>Geriatric patients</strong>: No variation in dosage is suggested for geriatric patients. However, close monitoring is required for blood pressure, urine flow, and peripheral tissue perfusion.</p>\r\n\r\n<p>Rate of administration: After dilution dopamine hydrochloride is administered intravenously through a suitable intravenous catheter or needle. An intravenous drip chamber or other suitable metering device is essential for controlling the rate of flow in drops per minute. Each patient must be individually titrated to the desired haemodynamic and/or renal response with dopamine hydrochloride. In titrating to the desired increase in systolic blood pressure, the optimum dosage rate for renal response may be exceeded, thus necessitating a reduction in rate after the haemodynamic condition is stabilized. Administration rate greater than 50 micrograms/kg/minute have safely been used in advanced circulatory decompensation states. If unnecessary fluid expansion is of concern, adjustment of drug concentration may be preferred over increasing the flow rate of a less concentrated dilution.</p>', '<p>The action of dopamine hydrochloride is potentiated by monoamine oxidase inhibitors (MAOI&#39;s). The concurrent administration of cyclopropane or halogenated hydrocarbon anesthetics may cause ventricular arrhythmias. The cardiac effects of dopamine hydrochloride are antagonized by &beta; - adrenergic blocking agents such as Propranolol and Metoprolol. The ergot alkaloids should be avoided because of the possibility of excessive vasoconstriction. Tricyclic antidepressants and guanethidine may potentiate the pressor response to dopamine hydrochloride. Hypotension and bradycardia have been observed in patients receiving Phenytoin. Dopamine hydrochloride may increase the effect of diuretic agents. Peripheral vasoconstriction may be antagonized by &alpha; - adrenergic blocking agents, such as Phentolamine. Other vasodilators may also be useful in patients with heart failure, allowing greater inotropic and renal effects without the associated vasoconstriction. Care must be taken to avoid hypotension.</p>', '<p>Dopamine hydrochloride is contraindicated in patients with known hypersensitivity to dopamine or any of its ingredients. It should not be used in patients with phaeochromocytoma, uncorrected tachyarrhythmias, or ventricular fibrillation. Dextrose solution without electrolytes should not be administered simultaneously with blood through the same infusion set because of the possibility of pseudoagglutination of red cells.</p>', '<p>The most frequent reported adverse reactions are ectopic beats, nausea, vomiting, tachycardia, anginal pain, palpitations, dyspnoea, headache, hypotension, hypertension and vasoconstriction. Other less frequent adverse reactions are aberrant ventricular conduction, bradycardia, piloerection, mydriasis, widened QRS complex, azotaemia and elevated blood pressure. Peripheral ischemic gangrene in patients with pre-existing vascular disease. Fatal ventricular arrhythmias have been reported on rare occasions.</p>', '<p>Animal studies have revealed no evidence of teratogenic effects from dopamine hydrochloride. The drug may be used in pregnant women when in the judgment of the physician the expected benefits outweigh the potential for risk to the fetus. It is not known if dopamine hydrochloride is excreted in breast milk, nor is the effect on the infant known. It is not recommended for breast-feeding mothers unless the expected benefits outweigh any potential risks</p>', '<p>Dopamine hydrochloride should not be administered in the presence of uncorrected tachyarrhythmia or ventricular fibrillation. It is metabolized in the tissues and blood by monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT). Dopamine hydrochloride and its metabolites are almost completely excreted in the urine. Patients who have been treated with monoamine oxidase inhibitors (MAOI) prior to the administration of dopamine will require substantially reduced dosages of later. The starting dose in such patients should be reduced to at least one-tenth (1/10) of the usual dose. Excess administration of potassium-free solutions may result in significant hypokalemia. The intravenous administration of these solutions can cause fluid and/or solute overloading resulting in dilution of serum electrolyte concentration, overhydration, congested states or pulmonary oedema. Closely monitoring is advised in patients with impaired renal and hepatic function.<br />\r\n<br />\r\nHypovolaemia should be corrected where necessary prior to treatment with dopamine hydrochloride. If a disproportionate rise in diastolic blood pressure (i.e. a marked decrease in pulse pressure) is observed, the infusion rate should be decreased and the patients observed carefully for further evidence of predominant vasoconstriction activity, unless such effect is desired. Dopamine hydrochloride infusion should be withdrawn gradually, to avoid unnecessary hypotension. Patients with a history of peripheral vascular disease (e.g. atherosclerosis, arterial embolism, Raynaud&#39;s disease, cold injury, diabetic endarteritis and Buerger&#39;s disease) should be closely monitored for any changes in color or temperature of the skin in the extremities. If ischemia occurs and is thought to be the result of vasoconstriction, the benefits of continued dopamine hydrochloride infusion should be weighed against the risk of possible necrosis. These changes may be reversed by either decreasing the rate or discontinuing the infusion. Dopamine hydrochloride in 5% dextrose solution should be infused into a large vein whenever possible to prevent the possibility of infiltration of perivascular tissue adjacent to the infusion site. Extravasations may cause necrosis and sloughing of the surrounding tissue. Ischaemia can be reversed by infiltration of the affected area with 10-15ml of saline containing 5 to 10mg Phentolamine mesylate. Dopamine hydrochloride should be used with extreme caution in patients inhaling cyclopropane or halogenated hydrocarbon anaesthetics due to the arterial arrhythmogenic potential. Dextrose solutions should be used with caution in patients with known subclinical or over diabetes mellitus.</p>', '<p>In case of accidental overdosage, as evidenced by excessive blood pressure elevation, reduce the rate of administration or temporarily discontinue dopamine hydrochloride until the patients condition stabilized. Since the duration of action of dopamine hydrochloride is quite short, no additional measures are usually necessary. If these measures fail to stabilize the patient&#39;s condition, use of the short-acting &alpha;-adrenergic blocking agent such as Phentolamine should be considered.</p>', '<p>Inotropic-sympathomimetics</p>', '<p>Store below 25&deg;C and protect from light.</p>', NULL, '2022-02-19 06:33:23', '2022-06-08 00:06:16'),
(475, 475, '<p>To reduce the development of drug-resistant bacteria and maintain the effectiveness of Doripenem and other antibacterial drugs, Doripenem should be used only to treat infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting and modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.<br />\r\n<br />\r\n<strong>Complicated Intra-Abdominal Infections</strong>: Doripenem injection is indicated as a single agent for the treatment of complicated intra-abdominal infections caused by Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Bacteroides caccae, Bacteroides fragilis, Bacteroides thetaiotaomicron, Bacteroides uniformis, Bacteroides vulgatus, Streptococcus intermedius, Streptococcus constellatus and Peptostreptococcus micros.<br />\r\n<br />\r\n<strong>Complicated Urinary Tract Infections, Including Pyelonephritis</strong>: Doripenem injection is indicated as a single agent for the treatment of complicated urinary tract infections, including pyelonephritis caused by Escherichia coli including cases with concurrent bacteremia, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa and Acinetobacter baumannii.</p>', '<p>Doripenem is a synthetic broad-spectrum carbapenem &beta;-lactam antibiotic with potent in vitro antibacterial activity against aerobic and anaerobic gm+ve and gm-ve bacteria including Pseudomonas aeruginosa. It inhibits bacterial cell wall synthesis by binding to several penicillin-binding proteins, which in turn inhibits the final transpeptidase step of peptidoglycan synthesis in bacterial cell walls.</p>', '<p><strong>Intravenous-</strong></p>\r\n\r\n<ul>\r\n	<li><strong>Complicated intra-abdominal infections:</strong>&nbsp;500 mg 8 hrly infused over 1 hr for 5-14 days. May switch to an appropriate oral therapy, after at least 3 days of parenteral therapy.</li>\r\n	<li><strong>Complicated UTI, Pyelonephritis:</strong>&nbsp;500 mg 8 hrly infused over 1 hr for 10 days. May switch to an appropriate oral therapy, after at least 3 days of parenteral therapy.</li>\r\n	<li><strong>Patient with concurrent bacteraemia:</strong>&nbsp;Duration can be extended up to 14 days.</li>\r\n</ul>\r\n\r\n<p><strong>Renal impairment-</strong></p>\r\n\r\n<ul>\r\n	<li><strong>CrCI (30-50 ml/min):</strong>&nbsp;250 mg every 8 hr by IV infusion over 1 hr</li>\r\n	<li><strong>CrCI (11 -29 ml/min):</strong>&nbsp;250 mg every 12 hr by IV infusion over 1 hr</li>\r\n</ul>', '<p>Increased plasma concentration with probenecid. May decrease plasma levels of valproic acid thus, increasing the risk of seizures.</p>', NULL, '<p>Headache, nausea, diarrhoea, rash, pruritus, phlebitis, elevated hepatic enzymes, oral candidiasis, anaemia, vulvomycotic infection, thrombocytopenia, neutropenia.</p>', '<p><strong>Pregnancy&nbsp;</strong>Category B.&nbsp;Either animal-reproduction studies have not demonstrated a fetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters)</p>', '<p>Patient with known or suspected CNS disorders (e.g. brain lesions, history of seizures). Not intended for treatment of any type of pneumonia. Renal impairment. Pregnancy and lactation. Monitoring Parameters Monitor renal function and for signs of anaphylaxis during 1st dose. Consider haematologic assessment during prolonged therapy.</p>', NULL, '<p>Other beta-lactam Antibiotics</p>', '<p>Reconstituted suspension may be held for 1 hr prior to dilution in infusion bag. Following dilution of the suspension with NaCl 0.9%, stability is 8 hr at room temperature or 24 hr between 2-8&deg;C. Stability of solution when diluted with dextrose 5% injection is 4 hr at room temperature or 24 hr between 2-8&deg;C.</p>', NULL, '2022-02-19 06:33:40', '2022-06-08 00:08:09'),
(476, 476, '<p>This Eye Drops is indicated for the treatment of elevated intraocular pressure in patients with open angle glaucoma or ocular hypertension who are insufficiently responsive to topical beta blockers.</p>', '<p><strong>Dorzolamide,</strong>&nbsp;a carbonic anhydrase inhibitor, has actions similar to acetazolamide. By inhibiting carbonic anhydrase in the ciliary processes of the eye, dorzolamide decreases aqueous humor secretion. Used together, there is additional intraocular pressure reduction compared to using either component alone, but the reduction is not as much as concomitant admin of dorzolamide tid and timolol bid.<br />\r\n<br />\r\n<strong>Timolol maleate,</strong>&nbsp;a nonselective &beta;-adrenergic blocker, reduces aqueous humor formation.</p>', '<p>Instill one drop in the conjunctival sac of the affected eye(s) twice daily.</p>', '<p>Additive hypotension and bradycardia with oral calcium channel blockers, catecholamine-depleting drugs or &beta;-blockers, antiarrhythmics (e.g. amiodarone), digitalis glycosides, parasympathomimetics, narcotics and MAOIs. Additive systemic side effects with oral carbonic anhydrase or &beta;-blockers; avoid concurrent use. Additive systemic &beta;-blockade with CYP2D6 inhibitors (e.g. quinidine, SSRIs) and timolol.</p>', '<p>Contraindicated in patients who are hypersensitive to any of the components of this preparation.</p>', '<p>Mild burning, ocular hyperemia, blurred vision may occur.</p>', '<p><strong>Use in pregnancy</strong>: There are no adequate and well-controlled studies in pregnant women. This Eye Drops should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.&nbsp;<br />\r\n<br />\r\n<strong>Use in lactation</strong>: Caution should be exercised when This Eye Drops is administered to a nursing mother.</p>', '<p>For ophthalmic use only. Patients should remove their contact lenses prior to instilling this preparation and should not insert their lenses until 15 minutes after instillation of the preparation.</p>', NULL, '<p>Drugs for miotics and glaucoma</p>', '<p>Store between 15-30&deg;C. Protect from light.</p>', '<p><strong>Use in children</strong>: Safety and effectiveness in children below the age of 2 years have not been established.&nbsp;<br />\r\n<br />\r\n<strong>Use in elderly patients</strong>: No overall differences in safety and effectiveness have been observed between elderly and other adult patients.</p>', '2022-02-19 06:34:00', '2022-06-08 00:09:55'),
(477, 477, '<p>Doxepin is indicated for the treatment of insomnia characterized by difficulty with sleep maintenance. The clinical trials performed in support of efficacy were up to 3 months in duration.</p>', '<p>Doxepin binds with high affinity to the histamine H1 receptor (Ki&lt;1 nM) where it functions as an antagonist. The exact mechanism by which doxepin exerts its sleep maintenance effect is unknown but is believed due to its antagonism of the H1 receptor.</p>', '<p><strong>Dosing in Adults</strong>: The recommended dose of Doxepin for adults is 6 mg once daily. A 3 mg once daily dose may be appropriate for some patients, if clinically indicated.<br />\r\n<br />\r\n<strong>Dosing in the Elderly</strong>: The recommended starting dose of Doxepin in elderly patients (&ge;65 years old) is 3 mg once daily. The daily dose can be increased to 6 mg, if clinically indicated.<br />\r\n<br />\r\n<strong>Administration</strong>: Doxepin should be taken within 30 minutes of bedtime. To minimize the potential for next day effects, Doxepin should not be taken within 3 hours of a meal. The total Doxepin dose should not exceed 6 mg per day.<br />\r\n<br />\r\n<strong>Pediatric Use</strong>: The safety and effectiveness of Doxepin in pediatric patients have not been evaluated.</p>', '<p><strong>Cytochrome P450 Isozymes</strong>: Doxepin is primarily metabolized by hepatic cytochrome P450 isozymes CYP2C19 and CYP2D6, and to a lesser extent, by CYP1A2 and CYP2C9. Inhibitors of these isozymes may increase the exposure of doxepin. Doxepin is not an inhibitor of any CYP isozymes at therapeutically relevant concentrations. The ability of Doxepin to induce CYP isozymes is not known.<br />\r\n<br />\r\n<strong>Cimetidine</strong>: Doxepin exposure is doubled with concomitant administration of cimetidine, a nonspecific inhibitor of CYP isozymes. A maximum dose of 3 mg is recommended in adults and elderly when cimetidine is co administered with Doxepin.<br />\r\n<br />\r\n<strong>Alcohol</strong>: When taken with Doxepin, the sedative effects of alcohol may be potentiated.<br />\r\n<br />\r\n<strong>CNS Depressants and Sedating Antihistamines</strong>: When taken with Doxepin, the sedative effects of sedating antihistamines and CNS depressants may be potentiated.<br />\r\n<br />\r\n<strong>Tolazamide</strong>: A case of severe hypoglycemia has been reported in a type II diabetic patient maintained on tolazamide (1 g/day) 11 days after the addition of oral doxepin (75 mg/day).</p>', '<p><strong>Hypersensitivity</strong>: Doxepin is contraindicated in individuals who have shown hypersensitivity to doxepin HCl,<br />\r\nany of its inactive ingredients, or other dibenoxepines.<br />\r\n<br />\r\n<strong>Co-administration with Monoamine Oxidase Inhibitors (MAOIs)</strong>: Serious side effects and even death have been reported following the concomitant use of certain drugs with MAO inhibitors. Do not administer Doxepin if patient is currently on MAOIs or has used MAOIs within the past two weeks. The exact length of time may vary depending on the particular MAOI dosage and duration of treatment.<br />\r\n<br />\r\n<strong>Glaucoma and Urinary Retention</strong>: Doxepin is contraindicated in individuals with untreated narrow-angle glaucoma or severe urinary retention.</p>', '<p>The following serious adverse reactions are as follows:</p>\r\n\r\n<ul>\r\n	<li>Abnormal thinking and behavioral changes&nbsp;</li>\r\n	<li>Suicide risk and worsening of depression</li>\r\n	<li>CNS Depressant effects</li>\r\n</ul>', '<p>Pregnancy Category C. There are no adequate and well-controlled studies of Doxepin in pregnant women. Doxepin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Administration of doxepin to pregnant animals resulted in adverse effects on offspring development at doses greater than the maximum recommended human dose (MRHD) of 6 mg/day.<br />\r\n<br />\r\nDoxepin is excreted in human milk after oral administration. There has been a report of apnea and drowsiness occurring in a nursing infant whose mother was taking the higher dose of doxepin used to treat depression. Caution should be exercised when Doxepin is administered to nursing women.</p>', '<p><strong>Need to Evaluate for Comorbid Diagnoses</strong>: Because sleep disturbances may be the presenting manifestation of a physical and/or psychiatric disorder, symptomatic treatment of insomnia should be initiated only after careful evaluation of the patient. The failure of insomnia to remit after 7 to 10 days of treatment may indicate the presence of a primary psychiatric and/or medical illness that should be evaluated. Exacerbation of insomnia or the emergence of new cognitive or behavioral abnormalities may be the consequence of an unrecognized psychiatric or physical disorder. Such findings have emerged during the course of treatment with hypnotic drugs.<br />\r\n<br />\r\n<strong>Abnormal Thinking and Behavioral Change</strong>s: Complex behaviors such as &ldquo;sleep-driving&rdquo; (i.e., driving while not fully awake after ingestion of a hypnotic, with amnesia for the event) have been reported with hypnotics. These events can occur in hypnotic-naive as well as in hypnotic-experienced persons. Although behaviors such as &quot;sleep-driving&quot; may occur with hypnotics alone at therapeutic doses, the use of alcohol and other CNS depressants with hypnotics appears to increase the risk of such behaviors, as does the use of hypnotics at doses exceeding the maximum recommended dose. Due to the risk to the patient and the community, discontinuation of Doxepin should be strongly considered for patients who report a &quot;sleep-driving&quot; episode. Other complex behaviors (e.g., preparing and eating food, making phone calls, or having sex) have been reported in patients who are not fully awake after taking a hypnotic. As with &quot;sleep-driving&quot;, patients usually do not remember these events. Amnesia, anxiety and other neuro-psychiatric symptoms may occur unpredictably.<br />\r\n<br />\r\n<strong>Suicide Risk and Worsening of Depression</strong>: In primarily depressed patients, worsening of depression, including suicidal thoughts and actions (including completed suicides), has been reported in association with the use of hypnotics. Doxepin, the active ingredient in Doxepin, is an antidepressant at doses 10- to 100-fold higher than in Doxepin. Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Risk from the lower dose of doxepin in Doxepin can not be excluded. It can rarely be determined with certainty whether a particular instance of the abnormal behaviors listed above is drug induced, spontaneous in origin, or a result of an underlying psychiatric or physical disorder. Nonetheless, the emergence of any new behavioral sign or symptom of concern requires careful and immediate evaluation.</p>', NULL, '<p>Tricyclic &amp; related anti-depressant drugs</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-02-19 06:34:18', '2022-06-08 00:11:30'),
(478, 478, '<p>Doxepin cream is indicated for the short-term (upto 8 days) management of moderate pruritus in adult patients with atopic dermatitis or lichen simplex chronicus.</p>', '<p>Doxepin hydrochloride is one of a class of agents known as dibenzoxepin tricyclic antidepressant compounds. Although doxepin HCl does have H1 and H2 histamine receptor blocking actions, the exact mechanism by which doxepin exerts its antipruritic effect is unknown. It can produce drowsiness in significant numbers of patients, and this sedation may reduce awareness, including awareness of pruritic symptoms.</p>', '<p><strong>Adult and child over 12 years</strong>: apply thinly 3-4 times daily; usual max. 3 g per application; usual total max. 12 g daily; coverage should be less than 10% of body surface area.<br />\r\n<br />\r\n<strong>Use in Children</strong>: The use of Doxiderm cream in pediatric patients is not recommended. Safe conditions for use of cream in children have not been established.<br />\r\n<br />\r\n<strong>Use in Elderly Patients</strong>: Dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy.</p>', '<p>Concomitant use of tricyclic antidepressants with drugs that can inhibit cytochrome P450 2D6 like MAO inhibitors, cimetidine, alcohol may require lower doses than usually prescribed for either the tricyclic antidepressant or the other drug. MAO inhibitors should be discontinued at least two weeks prior to the cautious initiation of therapy with Doxepin cream.</p>', '<p>Patients with untreated narrow-angle glaucoma or a tendency to urinary retention because doxepin has an anticholinergic effect. Individuals who have shown previous sensitivity to any of its components</p>', '<p>Drowsiness, local burning, stinging, irritation, tingling, rash; systemic side-effects such as antimuscarinic effects, headache, fever, dizziness, gastro-intestinal disturbances has been reported.</p>', '<p>Pregnancy category B. There are no adequate and well-controlled studies in pregnant women. This drug should be used during pregnancy only if clearly needed. Doxepin is excreted in human milk after oral administration. It is possible that doxepin may also be excreted in human milk following topical application of Doxepin cream.</p>', '<p>Cautions should be exercised if there is susceptibility to angle-closure glaucoma, urinary retention, severe liver impairment, mania and also in pregnancy and breast-feeding. Drowsiness may affect performance of skilled tasks (e.g. driving) so patient should be careful.</p>', '<p>If overdosage with topical application of Doxepin cream occur, the signs and symptoms may include cardiac dysrhythmias, severe hypotension, convulsions, and CNS depression, including coma. Changes in the electrocardiogram, particularly in QRS axis or width, are clinically significant indicators of tricyclic antidepressant toxicity. Other signs of overdose may include confusion, disturbed concentration, transient visual hallucinations, dilated pupils, agitation, hyperactive reflexes, stupor, drowsiness, muscle rigidity, vomiting, hypothermia, hyperpyrexia.</p>', '<p>Local Antipruritic</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-02-19 06:34:40', '2022-06-08 00:13:17');
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
(479, 479, '<p>Doxophylline is used to treat in following indications:</p>\r\n\r\n<ul>\r\n	<li>Bronchial asthma</li>\r\n	<li>Bronchospasm</li>\r\n	<li>Chronic obstructive pulmonary disease (COPD)</li>\r\n	<li>Pulmonary disease with spastic bronchial component.</li>\r\n</ul>', '<p>Doxophylline is a novel bronchodilator. It structurally differs from Theophylline due to the presence of a dioxolane group in position 7. Doxophylline selectively inhibits phosphodiesterase 4 thereby relaxes bronchial smooth muscle. However, differently from Theophylline, Doxophylline appears to have decreased affinities toward adenosine A1 and A2 receptors, which may account for the better safety profile of the drug. Doxophylline is reported to inhibit platelet activating factor (PAF) and generation of leukotriene production.</p>', '<p><strong>Elderly</strong>: 200 mg tablet two or three times daily.<br />\r\n<br />\r\n<strong>Adults</strong>: 400 mg tablet two or three times daily or as prescribed by the physician.<br />\r\n<br />\r\nChildren:</p>\r\n\r\n<ul>\r\n	<li><strong>&gt;12 years of age</strong>: 10 ml syrup or 200 mg tablet two or three times daily.</li>\r\n	<li><strong>6-12 years of age</strong>: 6-9 mg/kg body weight two times daily, i.e. if body weight is 10 kg, 3 ml (60 mg) two times daily or as prescribed by the physician.</li>\r\n</ul>\r\n\r\n<p>If required daily dose of Doxophylline is 400 mg then Doxophylline SR tablet to be taken once daily or as prescribed by the physician</p>', '<p>Doxophylline should not be administered together with other xanthine derivatives. Toxic synergism with ephedrine has been documented for xanthines. Like other xanthines, concomitant therapy with troleandomycin, lincomycin, clindamycin, allopurinol, cimetidine, ranitidine, propranolol and anti-flu vaccine may decrease the hepatic clearance of xanthines causing an increase in blood levels. No evidence of a relationship between Doxophylline serum concentrations and toxic events have been reported.</p>', '<p>Doxophylline is contraindicated in acute myocardial infarction. It is also contraindicated in patients with hypotension, in lactating women &amp; patients who have shown hypersensitivity to its components.</p>', '<p>Doxophylline rarely causes serious side effects, however possible side effects are similar for taking excess amount of caffeine. These include: nausea, vomiting, headache, upset stomach and heartburn.</p>', '<p>Animal reproduction studies indicate that, Doxophylline does not cause fetal harm when administered to pregnant animals or can not affect reproduction capacity. However, since there is limited experience in human during pregnancy, xanthines should be given to pregnant women only if clearly needed. Doxophylline is contraindicated in nursing mothers</p>', '<p>The half-life of xanthine derivatives is influenced by a number of known variables. It may be prolonged in patients with liver disease, in patients with congestive heart failure and in those patients taking certain other drugs like erythromycin, troleandomycin, lincomycin, allopurinol, cimetidine, propanolol and anti-flu vaccine. In these cases, a lower dose of Doxophylline may be needed. Phenytoin, other anticonvulsants and smoking may cause an increase in clearance with a shorter mean half-life. In these cases higher doses of Doxophylline may be needed.</p>', '<p>In case of overdose severe cardiac arrhythmias and tonic-clonic seizure may occur. These effects may represent the first signs of intoxication. The appearance of side effects may require discontinuation of the treatment which, if necessary, at the physician&rsquo;s discretion, may be resumed at lower doses after all signs and symptoms of toxicity have subsided.<br />\r\n<br />\r\nAs there is no specific antidote, in case of overdose a symptomatic treatment of cardiovascular collapse should be instituted.</p>', '<p>Bronchodilator, Methyl xanthine derivatives</p>', '<p>Keep in a dry place away from light and heat. Keep out of the reach of children. Doxophylline should be used only on prescription of specialist physician.</p>', NULL, '2022-02-19 06:34:58', '2022-06-08 00:14:52'),
(480, 480, '<p>Doxorubicin is an anthracycline topoisomerase II inhibitor indicated for:</p>\r\n\r\n<ul>\r\n	<li><strong>Ovarian cancer</strong>: After failure of platinum-based chemotherapy.</li>\r\n	<li><strong>AIDS-related Kaposi&rsquo;s Sarcoma</strong>: After failure of prior systemic chemotherapy or intolerance to such therapy.</li>\r\n	<li><strong>Multiple Myeloma</strong>: In combination with bortezomib in patients who have not previously received bortezomib and have received at least one prior therapy.</li>\r\n</ul>', '<p>Doxorubicin is a cytotoxic anthracycline antibiotic. The cytotoxic action results from its binding to DNA and inhibition of nucleic acid synthesis. Doxorubicin has been shown to produce regression in a variety of disseminated malignancies.</p>', '<p>Administer Doxorubicin at an initial rate of 1 mg/min to minimize the risk of infusion reactions. If no infusion related reactions occur, increase rate of infusion to complete administration over 1 hour. Do not administer as bolus injection or undiluted solution.</p>\r\n\r\n<ul>\r\n	<li><strong>Ovarian cancer</strong>: 50 mg/m2 IV every 4 weeks</li>\r\n	<li><strong>AIDS-related Kaposi&rsquo;s Sarcoma</strong>: 20 mg/m2 IV every 3 weeks</li>\r\n	<li><strong>Multiple Myeloma</strong>: 30 mg/m2 IV on day 4 following bortezomib</li>\r\n</ul>', '<p>Doxorubicin interacts with a number of other drugs e.g. antibiotics (aminoglycosides), steroids, aminophylline and propranolol.</p>', '<p>Cardiac disease, neonates, pregnancy and lactation, prior irradiation to mediastinum. IM/SC admin. Severe myelosuppression due to previous treatment with antitumour agents or radiotherapy.</p>', '<p>Leucopenia, thrombocytopenia, nausea, vomiting, diarrhoea. Rarely facial flushing, rash, alopecia. Blurred vision, headache, seizures, paraesthesia, confusion, malaise, lethargy, skin pigmentation.</p>', '<p><strong>Category D</strong>: 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, children, hepatic impairment. Monitor blood counts and ECG.</p>', '<p>Acute overdosage may increase the toxic effects of mucositis, leukopenia and thrombocytopenia. Treatment includes hospitalisation of the severely myelosuppressed patient, antimicrobials, platelet transfusions and symptomatic treatment of mucositis. Use of haemopoietic growth factor (G-CSF, GM-CSF) may be considered. Cumulative dosage increases risk of cardiomyopathy and resultant congestive heart failure which may be managed with digitalis preparations, diuretics, and after load reducers such as ACE inhibitors.</p>', '<p>Cytotoxic Chemotherapy</p>', '<p>Powder for injection: Store at 15-30&deg;C.<br />\r\nSolution for injection &amp; liposomal formulations: Refrigerate at 2-8&deg;C. Do not freeze.</p>', '<p><strong>Hepatic Impairment-</strong><br />\r\n&nbsp;<br />\r\nserum-bilirubin: 12-30 mcg/ml: Half the normal dose;<br />\r\nserum-bilirubin: &gt;30 mcg/ml: Quarter of the usual dose.</p>', '2022-02-19 06:35:21', '2022-06-08 00:16:42'),
(481, 481, '<p>Doxylamine is indicated for Hypersensitivity reactions,&nbsp;Insomnia</p>', '<p>Doxylamine is an antihistamine derived from monoethanolamine possessing antimuscarinic and pronounced sedative effects</p>', '<p><strong>Hypersensitivity reactionn</strong>: 25 mg every 4-6 hr. Max: 150 mg daily.<br />\r\n<br />\r\n<strong>Insomnia</strong>: 25 mg given 30 minutes before retiring at night.<br />\r\n<br />\r\nShould be taken with food. Take with food or milk.</p>', '<p>Enhance effects of CNS depressants eg alcohol, barbiturates, hypnotics, opioid analgesics, anxiolytic sedatives and antipsychotics. Atropine, TCAs, MAOIs. Can mask signs of ototoxicity caused by aminoglycosides.</p>', '<p>Severe liver disease; avoid alcohol; premature infants or full-term neonates.</p>', '<p>Acute dystonic reactions and long-lasting impaired consciousness in child. CNS depression including slight drowsiness to deep sleep, lassitude, dizziness, incoordination. Headache, psychomotor impairment and antimuscarinic effects. Rarely rashes and hypersensitivity reactions, blood disorders, convulsions, sweating, myalgia, extrapyramidal effects, tremor, confusion, tinnitus, hypotension, hair loss.</p>', '<p><strong>Category A</strong>: Controlled studies in women fail to demonstrate a risk to the fetus in the 1st trimester (and there is no evidence of a risk in later trimesters), and the possibility of fetal harm remains remote.</p>', '<p>May impair ability to drive and operate machinery. Angle-closure galucoma, urinary retention, prostatic hypertrophy or pyloroduodenal obstruction; epilepsy; hepatic impairment. Elderly. Lactation.</p>', NULL, '<p>Anti-emetic drugs, Sedating Anti-histamine</p>', '<p>Store at 15-30&deg;C.</p>', NULL, '2022-02-19 06:36:05', '2022-06-08 00:19:16'),
(482, 482, '<p>Doxylamine is indicated for Hypersensitivity reactions,&nbsp;Insomnia</p>', '<p>Doxylamine is an antihistamine derived from monoethanolamine possessing antimuscarinic and pronounced sedative effects.</p>', '<p><strong>Hypersensitivity reactionn</strong>: 25 mg every 4-6 hr. Max: 150 mg daily.<br />\r\n<br />\r\n<strong>Insomnia</strong>: 25 mg given 30 minutes before retiring at night.<br />\r\n<br />\r\nShould be taken with food. Take with food or milk.</p>', '<p>Enhance effects of CNS depressants eg alcohol, barbiturates, hypnotics, opioid analgesics, anxiolytic sedatives and antipsychotics. Atropine, TCAs, MAOIs. Can mask signs of ototoxicity caused by aminoglycosides.</p>', '<p>Severe liver disease; avoid alcohol; premature infants or full-term neonates.</p>', '<p>Acute dystonic reactions and long-lasting impaired consciousness in child. CNS depression including slight drowsiness to deep sleep, lassitude, dizziness, incoordination. Headache, psychomotor impairment and antimuscarinic effects. Rarely rashes and hypersensitivity reactions, blood disorders, convulsions, sweating, myalgia, extrapyramidal effects, tremor, confusion, tinnitus, hypotension, hair loss.</p>', '<p><strong>Category A</strong>: Controlled studies in women fail to demonstrate a risk to the fetus in the 1st trimester (and there is no evidence of a risk in later trimesters), and the possibility of fetal harm remains remote.</p>', '<p>May impair ability to drive and operate machinery. Angle-closure galucoma, urinary retention, prostatic hypertrophy or pyloroduodenal obstruction; epilepsy; hepatic impairment. Elderly. Lactation.</p>', NULL, '<p>Anti-emetic drugs, Sedating Anti-histamine</p>', '<p>Store at 15-30&deg;C.</p>', NULL, '2022-02-19 06:36:26', '2022-06-08 00:21:11'),
(483, 483, '<p>Drospirenone is indicated for oral contraception.</p>', '<p>Drospirenone is a Progestin-only pill which is a synthetic form of progesterone. The hormonal component of Drospi inhibit ovulation by Suppressing gonadotropin release, Secondary mechanisms, which may contribute to the effectiveness of Drospi as a contraceptive, include changes in the cervical mucus (which increase the difficulty of sperm penetration) and changes in the endometrium (which reduce the likelihood of implantation). Drospirenone has antimineralocorticoid activity, counteracting oestrogen related sodium retention. Drospirenone exerts antiandrogenic activity.</p>', '<p>Drospirenone (white active and light pink inert tablets) is swallowed whole once a day. Take one tablet daily for 28 consecutive days; one white active tablet daily during the first 24 days and one light pink inert tablet daily during the 4 following days. Tablets must be taken every day at about the same time of the day so that the interval between two tablets is always 24 hours.</p>\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>', '<p>Drugs or herbal products that induce certain enzymes (for example, CYP3A4) may decrease the effectiveness of Drospirenone or increase breakthrough bleeding. Counsel patients to use a back-up or alternative method of contraception when enzyme inducers are used with Drospirenone.</p>', '<ul>\r\n	<li>Renal impairment</li>\r\n	<li>Adrenal insufficiency</li>\r\n	<li>Presence or history of progestin sensitive cancers</li>\r\n	<li>Liver tumors, benign or malignant, or hepatic impairment</li>\r\n	<li>Undiagnosed abnormal uterine bleeding</li>\r\n</ul>', '<p>The following clinically significant Side Effects are described elsewhere in other sections of the labeling:</p>\r\n\r\n<ul>\r\n	<li>Hyperkalemia</li>\r\n	<li>Bleeding Irregularities and Amenorrhea</li>\r\n	<li>Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.</li>\r\n</ul>', NULL, '<p>Before you take Drospirenone, do not take this medicine and tell your doctor if you are already taking the following medicines: efavirenz, phenytoin, barbiturates, carbamazepine, bosentan, felbamate, griseofulvin, oxcarbazepine, rifampicin, rifabutin, rufinamide, aprepitant, products containing St. John&#39;s wort. Take special care while taking Drospirenone Hyperkalemia Thromboembolic Disorders, Bone Loss, Liver Disease Ectopic Pregnancy, Risk of Hyperglycemia in Patients with Diabetes, Bleeding Irregularities, and Amenorrhea, Depression.</p>', NULL, '<p>Oral Contraceptive preparations</p>', '<p>Store below 30&deg;C and dry place. Keep away from light. Keep out of the reach of children.</p>', NULL, '2022-02-19 06:36:55', '2022-06-08 00:23:18'),
(484, 484, '<p>Spastic conditions of the gastrointestinal tract, irritable bowel syndrome-</p>\r\n\r\n<ul>\r\n	<li>Biliary colics and spastic conditions of the biliary tract: Cholecystolithiasis, cholecystitis, cholangitis.</li>\r\n	<li>Renal colics and spastic conditions of the urogenital tract: Nephrolithiasis, ureterolithiasis, pyelitis, cystitis.</li>\r\n	<li>Spastic conditions of the uterus: Dysmenorrhea, imminent abortion, uterine tetanus.</li>\r\n</ul>', '<p>Drotaverine has antispasmodic effect mediated via inhibition of phosphodiesterase-IV, specific for smooth muscle. It has a rapid and direct action on the smooth muscle. It acts to correct cyclic AMP and Ca imbalance at the spastic site, thereby relieving smooth muscle spasm and pain.</p>', '<p>Oral-</p>\r\n\r\n<ul>\r\n	<li>Adults: 1 to 2 tablets, 3 times daily</li>\r\n	<li>Children (over 6 years): 1/2 to 1 tablet, 1-2 times daily.</li>\r\n	<li>Children (1-6 years): 1/4 to 1/2 tablet, 1-2 times daily.</li>\r\n</ul>\r\n\r\n<p>Injection-</p>\r\n\r\n<ul>\r\n	<li>Adults: 1 to 2 ampoules, intramuscularly or subcutaneously, 1-3 times daily.</li>\r\n	<li>For the management of acute stone colics: 1 or 2 ampoules by slow intravenous injection.</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>', '<p>May attenuate the action of levodopa. Concurrent use of analgesics, antimuscarinics or benzodiazepines. Additive beneficial effect with concurrent use of analgesics, antimuscarinics or benzodiazepines.</p>', '<p>Drotaverine is contraindicated in patients with known hypersensitivity to the products and its constituents.</p>', '<p>The common side effects are headache, dizziness, rhinitis, sinusitis, gastrointestinal upset, nausea, pharyngitis, edema and fatigue.</p>', '<p>As with most drugs, the use of Drotaverine Hydrochloride should be avoided during pregnancy and lactation unless essential.</p>', '<p>Caution should be taken for patients suffering from liver and kidney disease.</p>', NULL, '<p>Anticholinergics</p>', NULL, NULL, '2022-02-19 06:37:25', '2022-06-08 00:25:28'),
(485, 485, '<p>Dulaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist indicated:</p>\r\n\r\n<ul>\r\n	<li>As an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.</li>\r\n	<li>To reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus who have established cardiovascular disease or multiple cardiovascular risk factors.</li>\r\n</ul>', '<p>Dulaglutide contains dulaglutide, which is a human GLP-1 receptor agonist with 90% amino acid sequence homology to endogenous human GLP-1 (7-37). Dulaglutide activates the GLP-1 receptor, a membrane-bound cell-surface receptor coupled to adenylyl cyclase in pancreatic beta cells. Dulaglutide increases intracellular cyclic AMP (cAMP) in beta cells leading to glucose-dependent insulin release. Dulaglutide&nbsp; also decreases glucagon secretion and slows gastric emptying.</p>', '<p>The recommended initiating dose of Dulaglutide is 0.75 mg once weekly. The dose may be increased to 1.5 mg once weekly for additional glycemic control. The maximum recommended dose is 1.5 mg once weekly. Administer Dulaglutide once weekly, any time of day, with or without food. Dulaglutide should be injected subcutaneously in the abdomen, thigh, or upper arm.<br />\r\n<br />\r\nIf a dose is missed, instruct patients to administer as soon as possible if there are at least 3 days (72 hours) until the next scheduled dose. If less than 3 days remain before the next scheduled dose, skip the missed dose and administer the next dose on the regularly scheduled day. In each case, patients can then resume their regular once weekly dosing schedule. The day of weekly administration can be changed if necessary as long as the last dose was administered 3 or more days before.</p>\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>', '<p>Dulaglutide slows gastric emptying and thus has the potential to reduce the rate of absorption of concomitantly administered oral medications. Caution should be exercised when oral medications are concomitantly administered with Dulaglutide. Drug levels of oral medications with a narrow therapeutic index should be adequately monitored when concomitantly administered with Dulaglutide. In clinical pharmacology studies, Dulaglutide did not affect the absorption of the tested, orally administered medications to a clinically relevant degree.</p>', '<p>Dulaglutide is contraindicated in patients with a personal or family history of medullary thyroid carcinoma or in patients with Multiple Endocrine Neoplasia syndrome type 2. Dulaglutide is contraindicated in patients with a prior serious hypersensitivity reaction to Dulaglutide or any of the product components.</p>', '<p>The most common adverse reactions, reported in &ge;5% of patients treated with Dulaglutide are: nausea, diarrhea, vomiting, abdominal pain, and decreased appetite</p>', '<p>Dulaglutide should be used during pregnancy only if the potential benefit justifies the potential risk to fetus. There are no data on the presence of dulaglutide in human milk, the effects on the breastfed infant, or the effects on milk production. The presence of dulaglutide in milk of treated lactating animals was not determined. The developmental and health benefits of breastfeeding should be considered along with the mother&rsquo;s clinical need for Dulaglutide and any potential adverse effects on the breastfed infant from Dulaglutide or from the underlying maternal condition.</p>', '<p><strong>Pancreatitis</strong>: Has been reported in clinical trials. Discontinue promptly if pancreatitis is suspected. Do not restart if pancreatitis is confirmed. Consider other antidiabetic therapies in patients with history of pancreatitis.<br />\r\n<strong>Hypoglycemia</strong>: When Dulaglutide is used with an insulin secretagogue (e.g., a sulfonylurea) or insulin, consider lowering the dose of the sulfonylurea or insulin to reduce the risk of hypoglycemia.<br />\r\n<strong>Hypersensitivity Reactions</strong>: Serious hypersensitivity reactions (e.g., anaphylactic reactions and angioedema) have occurred. Discontinue Dulaglutide and promptly seek medical advice.<br />\r\n<strong>Acute Kidney Injury</strong>: Monitor renal function in patients with renal impairment reporting severe adverse gastrointestinal reactions.<br />\r\n<strong>Severe Gastrointestinal Disease</strong>: Use may be associated with gastrointestinal adverse reactions, sometimes severe. Has not been studied in patients with severe gastrointestinal disease and is not recommended in these patients.<br />\r\n<strong>Diabetic Retinopathy Complications</strong>: Have been reported in a cardiovascular outcomes trial. Monitor patients with a history of diabetic retinopathy.</p>', '<p>Overdoses have been reported in clinical studies. Effects associated with these overdoses were primarily mild or moderate gastrointestinal events (e.g., nausea, vomiting) and non-severe hypoglycemia. In the event of overdose, appropriate supportive care (including frequent plasma glucose monitoring) should be initiated according to the patient&rsquo;s clinical signs and symptoms</p>', '<p>GLP-1 receptor agonists</p>', '<p>Store Dulaglutide in the refrigerator at 2&deg;C to 8&deg;C. Do not use Dulaglutide beyond the expiration date. If needed, each single-dose pen can be kept at room temperature, not to exceed 30&deg;C for a total of 14 days. Do not freeze Dulaglutide.</p>', '<p>Pediatric Use: Safety and effectiveness of Dulaglutide have not been established in pediatric patients. Dulaglutide is not recommended for use in pediatric patients younger than 18 years.<br />\r\n<br />\r\nHepatic Impairment: There is limited clinical experience in patients with mild, moderate, or severe hepatic impairment. Therefore, Dulaglutide should be used with caution in these patient populations.<br />\r\n<br />\r\nRenal Impairment: No dosage adjustment recommended. Monitor renal function in patients with renal impairment reporting severe adverse gastrointestinal reactions.</p>', '2022-02-19 06:37:44', '2022-06-08 00:27:30'),
(486, 486, '<p>Duloxetine is a serotonin and norepinephrine reuptake inhibitor (SNRI) indicated for-</p>\r\n\r\n<ul>\r\n	<li>Major Depressive Disorder (MDD)</li>\r\n	<li>Generalized Anxiety Disorder (GAD)</li>\r\n	<li>Diabetic Peripheral Neuropathic Pain (DPNP)</li>\r\n	<li>Fibromyalgia and</li>\r\n	<li>Chronic Musculoskeletal Pain.</li>\r\n</ul>', '<p>Duloxetine Hydrochloride is a selective serotonin and norepinephrine reuptake inhibitor (SSNRI) for oral administration. Duloxetine is a less potent inhibitor of dopamine reuptake. Duloxetine has no significant affinity for dopaminergic, adrenergic, cholinergic, histaminergic, opioid, glutamate, and GABA receptors in vitro. Duloxetine does not inhibit monoamine oxidase (MAO). Orally administered Duloxetine hydrochloride is well absorbed. Elimination of Duloxetine is mainly through hepatic metabolism.</p>', '<p>Major Depressive Disorder (MDD)-</p>\r\n\r\n<ul>\r\n	<li><strong>Starting Dose</strong>: 40 mg/day to 60 mg/day</li>\r\n	<li><strong>Target Dose</strong>: Acute: 40 mg/day (20 mg twice daily) to 60 mg/day (once daily or as 30 mg twice daily); Maintenance: 60 mg/day</li>\r\n	<li><strong>Maximum Dose</strong>: 120 mg/day</li>\r\n</ul>\r\n\r\n<p>Generalized Anxiety Disorder (GAD)-</p>\r\n\r\n<ul>\r\n	<li><strong>Starting Dose</strong>: 60 mg/day</li>\r\n	<li><strong>Target Dose</strong>: 60 mg/day (once daily)</li>\r\n	<li><strong>Maximum Dose</strong>: 120 mg/day</li>\r\n</ul>\r\n\r\n<p>Diabetic Peripheral Neuropathic Pain (DPNP)-</p>\r\n\r\n<ul>\r\n	<li><strong>Starting Dose</strong>: 60 mg/day</li>\r\n	<li><strong>Target Dose</strong>: 60 mg/day (once daily)</li>\r\n	<li><strong>Maximum Dose</strong>: 60 mg/day</li>\r\n</ul>\r\n\r\n<p>Fibromyalgia-</p>\r\n\r\n<ul>\r\n	<li><strong>Starting Dose</strong>: 30 mg/day</li>\r\n	<li><strong>Target Dose</strong>: 60 mg/day (once daily)</li>\r\n	<li><strong>Maximum Dose</strong>: 60 mg/day</li>\r\n</ul>\r\n\r\n<p>Chronic Musculoskeletal Pain-</p>\r\n\r\n<ul>\r\n	<li><strong>Starting Dose</strong>: 30 mg/day</li>\r\n	<li><strong>Target Dose</strong>: 60 mg/day (once daily)</li>\r\n	<li><strong>Maximum Dose</strong>: 60 mg/day</li>\r\n</ul>\r\n\r\n<p>Some patients may benefit from starting at 30 mg once daily. There is no evidence that doses greater than 60 mg/day confers an additional benefit, while some adverse reactions were observed to be dose-dependent. A gradual dose reduction is recommended to avoid discontinuation symptoms.</p>\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>', '<p>Both CYP1A2 and CYP2D6 isozymes are responsible for Duloxetine metabolism. When Duloxetine was co-administered with fluvoxamine, a potent CYP1A2 inhibitor, the AUC, Cmax and t of Duloxetine was increased. Other drugs that inhibit CYP1A2 metabolism include cimetidine and quinolone antimicrobials such as ciprofloxacin and enoxacin would be expected to have similar effects and these combinations should be avoided. Because CYP2D6 is involved in Duloxetine metabolism, concomitant use of Duloxetine with potent inhibitors of CYP2D6 may result in higher concentrations of Duloxetine.</p>', '<p>Duloxetine is contraindicated in patients with a known hypersensitivity to this drug or any of the inactive ingredients. Duloxetine is not approved for use in treating bipolar depression. Duloxetine should not be prescribed to patients with substantial alcohol use or evidence of chronic liver disease. In clinical trials, Duloxetine was associated with an increased risk of mydriasis; therefore, it should be used cautiously in patients with controlled narrow-angle glaucoma.</p>', '<p>The most commonly observed adverse events in Duloxetine hydrochloride treated patients were nausea, dizziness, dry mouth, constipation, decreased appetite, fatigue, somnolence, increased sweating, hyperhidrosis and asthenia. It may slightly increase blood pressure. No clinically significant differences were observed for QT, PR, and QRS intervals between Duloxetine-treated and placebo-treated patients.</p>', '<p><strong>Pregnancy</strong>: Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women; therefore, Duloxetine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.<br />\r\n<br />\r\n<strong>Labor and Delivery</strong>: The effect of Duloxetine on labor and delivery in humans is unknown. Duloxetine should be used during labor and delivery only if the potential benefit justifies the potential risk to the fetus.<br />\r\n<br />\r\n<strong>Lactation</strong>: It is unknown whether or not Duloxetine and/or it&#39;s metabolites are excreted into human milk, but nursing while on Duloxetine is not recommended</p>', '<p>All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes. Blood pressure should be measured prior to initiating treatment and periodically measured throughout treatment. Patients should be cautioned about the risk of bleeding associated with the concomitant use of Duloxetine and NSAIDs, aspirin, or other drugs that affect coagulation. Duloxetine should be used cautiously in patients with a history of mania. Duloxetine should be prescribed with care in patients with a history of a seizure disorder.</p>', '<p>There is limited clinical experience with Duloxetine overdose in humans. There is no specific antidote to Duloxetine. In case of acute overdose, treatment should consist of those general measures employed in the management of overdose with any drug. An adequate airway, oxygenation, and ventilation should be assured, and cardiac rhythm and vital signs should be monitored. Induction of emesis is not recommended. Gastric lavage with a large-bore orogastric tube with appropriate airway protection, if needed, may be indicated if performed soon after ingestion or in symptomatic patients. Activated charcoal may be useful in limiting the absorption of Duloxetine from the gastrointestinal tract.</p>', '<p>Serotonin-norepinephrine reuptake inhibitor (SNRI)</p>', '<p>Do not store above 30&deg;C. Keep away from light and out of the reach of children.</p>', '<p><strong>Use in the pediatric population</strong>: Safety and efficacy in pediatric patients have not been established</p>', '2022-02-19 06:38:38', '2022-06-08 00:30:09'),
(487, 487, '<p>Dutasteride is indicated for the treatment of symptomatic benign prostatic hyperplasia (BPH) in men with an enlarged prostate to:</p>\r\n\r\n<ul>\r\n	<li>Improve symptoms</li>\r\n	<li>Reduce the risk of acute urinary retention</li>\r\n	<li>Reduce the risk of the need for BPH-related surgery</li>\r\n</ul>', '<p>Dutasteride is a dual inhibitor of 5&alpha;-reductase. It inhibits both type 1 and type 2, 5&alpha;-reductase isoenzymes, which are responsible for the conversion of testosterone to 5&alpha;-dihydrotestosterone (DHT). DHT is the androgen primarily responsible for hyperplasia of glandular prostatic tissue.</p>', '<p>The recommended dose is Dutasteride 0.5 mg&nbsp;orally once daily. The capsules should be swallowed whole. Dutasteride may be administered with or without food.</p>\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>', '<p>Care should be taken when administering Dutasteride to patients taking potent, chronic CYP3A4 inhibitors. Dutasteride does not inhibit the in vitro metabolism of model substrates for the major human cytochrome P450 isoenzymes (CYP1A2, CYP2C9, CYP2C19, CYP2D6, and CYP3A4) at a concentration of 1,000 ng/ml, 25 times greater than steady-state serum concentrations in humans. In vitro studies demonstrate that Dutasteride does not displace Warfarin, Diazepam, or Phenytoin from plasma protein binding sites, nor do these model compounds displace Dutasteride</p>', '<p>Dutasteride is contra-indicated for use in women and children and for patients with known hypersensitivity to Dutasteride, and other 5 a-reductase inhibitors. Warnings: Exposure of women-risk to male fetus: Dutasteride is absorbed through the skin. Therefore, women who are pregnant or may be pregnant should not handle Dutasteride capsules because of the possibility of absorption of Dutasteride and the potential risk of a fetal anomaly to a male fetus. If contact is made with leaking capsules, the contact area should be washed immediately with soap and water.</p>', '<ul>\r\n	<li>Sexual problems (such as decreased sexual interest/ ability, decrease in the amount of semen/ sperm released during sex)</li>\r\n	<li>Impotence (trouble getting or keeping an erection)</li>\r\n	<li>Testicle pain or swelling</li>\r\n	<li>Increased breast size</li>\r\n	<li>Breast tenderness.</li>\r\n</ul>', '<p>Pregnancy Category X. Dutasteride is contraindicated for use in women.</p>', '<p>Lower urinary tract symptoms of BPH can be indicative of other urological diseases, including prostate cancer. Patients should be assessed to rule out other urological diseases prior to treatment with Dutasteride. Patients with a large residual urinary volume and/or severely diminished urinary flow may not be good candidates for 5 a-reductase inhibitor therapy and should be carefully monitored for obstructive uropathy. Blood Donation: Men being treated with Dutasteride should not donate blood until at least 6 months have passed following their last dose. The purpose of this deferred period is to prevent administration of Dutasteride to a pregnant female transfusion recipient.</p>', '<p>In volunteer studies, single doses of Dutasteride up to 40 mg (80 times the therapeutic dose) for 7 days have been administered without significant safety concerns. In a clinical study, daily doses of 5 mg (10 times the therapeutic dose) were administered to 60 subjects for 6 months with no additional adverse effects to those seen at therapeutic doses of 0.5 mg. There is no specific antidote for Dutasteride. Therefore, in cases of suspected overdosage symptomatic and supportive treatment should be given as appropriate, taking the long half-life of Dutasteride into consideration.</p>', '<p>BPH/ Urinary retention/ Urinary incontinence</p>', '<p>Store in a cool and dry place, protected from light</p>', '<p><strong>Pediatric use</strong>: Dutasteride is not indicated for use in the pediatric population. Safety and&nbsp;effectiveness in the pediatric population have not been established.<br />\r\n<br />\r\n<strong>Geriatric use</strong>: No overall differences in safety or efficacy were observed between elderly and&nbsp;adult subjects.<br />\r\n<br />\r\n<strong>Elderly use:</strong>&nbsp;No dosage adjustment is necessary for subjects with renal impairment or for the elderly.<br />\r\n<br />\r\n<strong>Hepatic impairment</strong>: Due to the absence of data in patients with hepatic impairment, no dosage recommendation can be made.</p>', '2022-02-19 06:38:56', '2022-06-08 00:32:45'),
(488, 488, '<p><strong>Progesterone deficiencies</strong>:</p>\r\n\r\n<ul>\r\n	<li>Treatment of threatened miscarriage</li>\r\n	<li>Treatment of habitual miscarriage</li>\r\n	<li>Treatment of dysmenorrhoea</li>\r\n	<li>Treatment of endometriosis</li>\r\n	<li>Treatment of secondary amenorrhoea</li>\r\n	<li>Treatment of irregular cycles</li>\r\n	<li>Treatment of dysfunctional uterine bleeding</li>\r\n	<li>Treatment of infertility due to luteal insufficiency</li>\r\n	<li>Luteal support as part of an Assisted Reproductive Technology (ART)</li>\r\n</ul>\r\n\r\n<p><strong>Hormone Replacement Therapy</strong>: To counteract the effects of unopposed oestrogen on the endometrium in hormone replacement therapy for women with disorders due to natural or surgical induced menopause with an intact uterus.</p>', '<p>Dydrogesterone is an orally-active progestogen which produces a complete secretory endometrium in an oestrogen-primed uterus thereby providing protection against the increased risk for endometrium hyperplasia and carcinogenesis induced by oestrogens. It is indicated in all cases of endogenous progesterone deficiency. Dydrogesterone has no oestrogenic, no androgenic, no thermogenic, no anabolic and no corticoid activity.</p>', '<p>Always take Presentation 10 mg tablet exactly as your doctor has prescribed.<br />\r\n<br />\r\n<strong>Presentationerone deficiencies</strong>:</p>\r\n\r\n<ul>\r\n	<li>Threatened miscarriage: 40 mg (four tablets) at once, then 10 mg (one tablet) every eight hours until symptoms remit.</li>\r\n	<li>Habitual miscarriage: 10 mg (one tablet) twice daily until the twentieth week of pregnancy.</li>\r\n	<li>Dysmenorrhoea: 10 mg (one tablet) twice daily from day 5 to day 25 of the menstrual cycle.</li>\r\n	<li>Endometriosis: 10 mg (one tablet) two or three times daily from day 5 to day 25 of the cycle or continuously.</li>\r\n	<li>Dysfunctional bleeding (to arrest bleeding): 10 mg (one tablet) twice daily for five to seven days. Presentation should be given with oestrogen.</li>\r\n	<li>Dysfunctional bleeding (to prevent bleeding): 10 mg (one tablet) twice daily from day 11 to day 25 of the cycle. Presentation should be given with oestrogen.</li>\r\n	<li>Amenorrhoea: An oestrogen once daily from day 1 to day 25 of the cycle, together with 10 mg Presentation twice daily from day 11 to day 25 of the cycle.</li>\r\n	<li>Irregular cycles: 10 mg (one tablet) twice daily from day 11 to day 25 of the cycle.</li>\r\n	<li>Infertility due to luteal insufficiency: 10 mg (one tablet) daily from day 14 to day 25 of the cycle. The treatment should be continued for at least 6 consecutive cycles. It is advisable to continue this treatment during the first month of any pregnancy using the doses stated with respect to habitual miscarriage.</li>\r\n	<li>Luteal support as part of an Assisted Reproductive Technology (ART) treatment: 10 mg three times daily (three tablets daily) starting at the day of oocyte retrieval and continuing for 10 weeks if pregnancy is confirmed.</li>\r\n</ul>\r\n\r\n<p><strong>Hormone Replacement Therapy</strong>: In combination with continuous oestrogentherapy, take one tablet daily for 14 consecutive days of a 28 day cycle. In combination with cyclical oestrogen therapy take one tablet daily during the last 12 to 14 days of oestrogen therapy. For doctors: If endometrial biopsies or ultrasound reveal inadequate Presentationational response, 20 mg Dydrogesterone should be prescribed. For patients: If you are not sure what type of oestrogen therapy you are on, talk to your Doctor before taking Presentation. There is no relevant use of Dydrogesterone before menarche. The safety and efficacy of Dydrogesterone in adolescents aged 12 to 18 years has not been established.</p>\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>', NULL, '<p>Known hypersensitivity to the active substance or to any of the excipients. Known or suspected progestogen dependent neoplasms (e.g. meningioma).</p>', '<p>The most commonly reported adverse drug reactions of patients treated with Dydrogesterone in clinical trials of indications without oestrogen treatment are migraines/headache, nausea, menstrual disorders and breast pain/tenderness.</p>', '<p>It is estimated that more than 10 million pregnancies have been exposed to Dydrogesterone. So far there were no indications of a harmful effect of Dydrogesterone use during pregnancy. No data exist on excretion of Dydrogesterone in mother&#39;s milk. Experience with other progestogens indicates that progestogens and the metabolites pass to mother&#39;s milk in small quantities. Whether there is a risk to the child is not known. Therefore Dydrogesterone should not be used during the lactation period.</p>', '<p>Before initiating dydrogesterone treatment for abnormal bleeding the etiology for the bleeding should be clarified. Breakthrough bleeding and spotting may occur during the first months of treatment. If breakthrough bleeding or spotting appears after some time on therapy, or continues after treatment has been discontinued, the reason should be investigated, which may include endometrial biopsy to exclude endometrial malignancy. If one of the following disorders occurs during use for the first time or gets worse, stopping the treatment should be considered.</p>\r\n\r\n<ul>\r\n	<li>Severe headache, migraine or symptoms that may indicate cerebral ischemia.</li>\r\n	<li>Marked increase in blood pressure.</li>\r\n	<li>Occurrence of venous thromboembolism (VTE)</li>\r\n</ul>\r\n\r\n<p>In cases of habitual or threatened abortion, the viability of the foetus should be ascertained. It is also necessary to monitor during treatment whether the pregnancy is still progressing and whether the embryo is still alive. Patients with a history of depression must be carefully monitored; if severe depression recurs, treatment with dydrogesterone must be stopped</p>', '<p>Dydrogesterone was well tolerated after oral dosing (maximum daily dose is 360 mg). No reports of ill effects from overdose have been recorded. If a large overdose is discovered within two or three hours and treatment seems desirable, gastric lavage is recommended. There are no specific antidotes and treatment should be symptomatic.</p>', '<p>Female Sex hormones</p>', '<p>Store at below 30&deg;C in a dry place protected from light. Keep out of reach of children.</p>', NULL, '2022-02-19 06:39:14', '2022-06-08 00:40:00'),
(489, 489, '<p>Ebastine is indicated for the symptomatic treatment of:</p>\r\n\r\n<ul>\r\n	<li>Seasonal and Perennial Allergic Rhinitis.</li>\r\n	<li>Chronic Idiopathic Urticaria.</li>\r\n</ul>', '<p>Ebastine is a long-acting and selective H1-histamine receptor antagonist. After repeated administration, inhibition of peripheral receptors remains at a constant level. Ebastine is rapidly absorbed and undergoes extensive first-pass metabolism following oral administration. Ebastine is almost totally converted to the pharmacologically active acid metabolite, carebastine.</p>', '<p>Tablet:</p>\r\n\r\n<ul>\r\n	<li><strong>Adults (more than 12 years of age)</strong>: 10 mg (one tablet) once daily.</li>\r\n	<li><strong>Children (6-12 years of age)</strong>: 5 mg (half tablet) once daily.</li>\r\n</ul>\r\n\r\n<p>Syrup:</p>\r\n\r\n<ul>\r\n	<li><strong>Children (2-5 years of age)</strong>: 2.5 ml once daily (upto 5 ml in severe cases such as Perennial Allergic Rhinitis).</li>\r\n	<li><strong>Children (6-12 years of age)</strong>: 5 ml once daily (upto 10 ml in severe cases such as Perennial Allergic Rhinitis).</li>\r\n</ul>\r\n\r\n<p>Ebastine may be taken with or without food.</p>\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>', '<p>Ebastine in combination with either ketoconazole or erythromycin increases in plasma level of ebastine and prolonged QTc interval. Ebastine does not interact with the pharmacokinetics of theophylline, warfarin, cimetidine, diazepam or alcohol. The sedation effect of alcohol and diazepam may be enhanced.</p>', '<p>Patients with a known hypersensitivity to Ebastine or any of its ingredients.</p>', '<p>The most common side-effects are headache, dry mouth and drowsiness. Less commonly reported side effects include abdominal pain, dyspepsia, nausea and insomnia.</p>', NULL, NULL, '<p>No clinically meaningful signs or symptoms were observed up to 100 mg given once daily. There is no specific antidote for Ebastine. In case of accidental overdoses, gastric lavage, monitoring of vital functions including ECG and symptomatic treatment should be carried out.</p>', '<p>Non-sedating antihistamines</p>', '<p>Store below 30&deg;C at a cool and dry place, away from light. Keep out of reach of children</p>', NULL, '2022-02-20 01:21:03', '2022-06-08 00:42:37'),
(490, 490, '<p>Econazole Nitrate is indicated for topical application-</p>\r\n\r\n<ul>\r\n	<li>In the treatment of tinea pedis, tinea cruris, and tinea corporis caused by Trichophyton rubrum, Trichophyton mentagrophytes, Trichophyton tonsurans, Microsporum canis, Microsporum audouini, Microsporum gypseum, and Epidermophyton floccosum,</li>\r\n	<li>In the treatment of cutaneous candidiasis, and in the treatment of tinea versicolor.</li>\r\n</ul>', '<p>Econazole Nitrate interferes with fungal oxidative enzymes to cause lethal accumulation of H2O2. They also reduce the formation of ergosterol, an important constituent of fungal cell wall.</p>', '<p><strong>Econazole vaginal tablet</strong>: One tablet should be inserted deep into the vagina at bed time for three consecutive nights. Treatment should be continued even if menstruation occurs. Although a three night course of treatment is often sufficient longer courses are advisable for women with recurrent vaginal infections.<br />\r\n<br />\r\n<strong>Econazole 30 gm cream</strong>: The supplied applicator should be filled with econazole cream and then inserted deep into the vagina at bedtime once or twice daily.<br />\r\n<br />\r\n<strong>Econazole 10 gm cream</strong>: Apply sparingly to the affected area once or twice daily until improvement occurs.<br />\r\n<br />\r\nSufficient Econazole cream should be applied to cover affected areas once daily in patients with tinea pedis, tinea cruris, tinea corporis, and tinea versicolor, and twice daily (morning and evening) in patients with cutaneous candidiasis. Early relief of symptoms is experienced by the majority of patients and clinical improvement may be seen fairly soon after treatment is begun; however, candidal infections and tinea cruris and corporis should be treated for two weeks and tinea pedis for one month in order to reduce the possibility of recurrence. If a patient shows no clinical improvement after the treatment period, the diagnosis should be redetermined. Patients with tinea versicolor usually exhibit clinical and mycological clearing after two weeks of treatment.</p>\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>', '<p><strong>Warfarin</strong>: Concomitant administration of econazole and warfarin has resulted in enhancement of anticoagulation effect. Most cases reported product application with use under occlusion, genital application, or application to large body surface area which may increase the systemic absorption of econzole nitrate. Monitoring of International Normalized Ratio (INR) and/or prothrombin time may be indicated especially for patients who apply econazole to large body surface areas, in the genital area, or under occlusion.<br />\r\n<br />\r\n<strong>Carcinogenicity Studies</strong>: Long-term animal studies to determine carcinogenic potential have not been performed.</p>', '<p>Econazole is contraindicated in individuals who have shown hypersensitivity to any of its ingredients.</p>', '<p>During clinical trials, approximately 3% of patients treated with econazole nitrate 1% cream reported side<br />\r\neffects thought possibly to be due to the drug, consisting mainly of burning, itching, stinging, and erythema. One case of a pruritic rash has also been reported.</p>', '<p>Intravaginal administration in humans has not shown prolonged gestation or other adverse reproductive effects attributable to econazole nitrate therapy.<br />\r\n<br />\r\nPregnancy Category C. Econazole nitrate should be used in the first trimester of pregnancy only when the physician considers it essential to the welfare of the patient. The drug should be used during the second and third trimesters of pregnancy only if clearly needed.<br />\r\n<br />\r\nIt is not known whether econazole nitrate is excreted in human milk. Caution should be exercised when econazole nitrate is administered to a nursing woman.</p>', '<p>Econazole nitrate is not for ophthalmic use.&nbsp; If a reaction suggesting sensitivity or chemical irritation should occur, use of the medication should be discontinued. For external use only. Avoid introduction of Econazole Nitrate Cream into the eyes.</p>', '<p>Overdosage of econazole nitrate in humans has not been reported to date.</p>', '<p>Drugs used in Vaginal and Vulval condition, Topical Antifungal preparations</p>', '<p>Do not use later than date of expiry. Keep all medicine out of the reach of children. To be dispensed only on the prescription of a registered physician.</p>', NULL, '2022-02-20 01:21:23', '2022-06-08 00:44:28');
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
(491, 491, '<p>Econazole Nitrate &amp; Triamcinolone Acetonide indicated for the treatment of:</p>\r\n\r\n<ul>\r\n	<li>Eczematous Mycoses</li>\r\n	<li>Psoriasis</li>\r\n	<li>Tinea Pedis (Athlete&rsquo;s foot)</li>\r\n	<li>Tinea Corporis (Ring worm)</li>\r\n	<li>Tinea Cruris (Jock itch)</li>\r\n	<li>Inflammatory Intertrigo</li>\r\n	<li>Diaper Dermatitis</li>\r\n</ul>\r\n\r\n<p>Onychomycoses- for the treatment of onychomycoses, local therapy with Econazole/Triamcinolone cream, combined with an oral antimycotic, is recommended.</p>', NULL, '<p><strong>Adults</strong>: This cream should be applied sparingly to the skin lesion no more than 2 times daily, preferably once in the morning and once in the evening. This cream should not be applied with an occlusive dressing, or to large areas of skin on the body. The duration of treatment with this cream should continue until the inflammatory symptoms subside but not longer than 2 weeks; after 2 weeks of therapy with this cream, continue therapy as needed with a preparation containing econazole or econazole nitrate alone.<br />\r\n<br />\r\n<strong>Pediatric Use</strong>: Pediatric patients may demonstrate greater susceptibility to topical corticosteroid-induced HPA axis suppression and Cushing&#39;s syndrome than mature patients because of a larger skin surface area to body weight. Caution should be exercised.</p>\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>', '<p><strong>Econazole</strong>: compound metabolized by CYP3A4/2C9 oral anticoagulants (warfarin &amp; acenocoumarol).<br />\r\n<br />\r\n<strong>Triamcinolone</strong>: lowering of plasma salicylates levels. Increased risk of Gl bleeding and ulceration with NSAIDs. Antagonised blood glucose-lowering effects of the antidiabetics. Increased risk of Hyperkalemia with amphotericin B, beta-blockers, potassium-depleting diuretics, theophylline. Increased clearance of the triamcinolone with ciclosporin, carbamazepine, phenytoin, barbiturate, rifampicin.</p>', '<p>This Cream is contraindicated-</p>\r\n\r\n<ul>\r\n	<li>In individuals who have shown hypersensitivity to any of its ingredients.</li>\r\n	<li>Like any other dermatological preparation containing corticosteroids, this Cream is contraindicated in specific skin conditions such as tuberculous, varicella, herpes simplex or other viral infections of the skin, or fresh vaccination sites.</li>\r\n	<li>Decubitus ulcers: Viral, bacterial or fungal skin infections (e.g. tuberculosis of the skin, syphilis of the skin, herpes simplex, herpes zoster, chickenpox).</li>\r\n	<li>Rosacea and rosacea-like dermatitis</li>\r\n</ul>', '<p>Rarely, transient local mild irritation, itching &amp; redness may occur immediately after application. Econazole has the minimal allergenic effect and is well tolerated, even by delicate skin. Adrenal suppression on long term continuous topical steroid therapy may occur, particularly in infants or children, or when occlusive dressings are applied. It should be noted that an infant&#39;s napkin may act as an occlusive dressing.</p>', '<p><strong>Pregnancy</strong>: Not the Econazole but the Triamcinolone Acetonide crosses the placenta and topical administration of corticosteroids during pregnancy can cause abnormalities of foetal development. The relevance of this finding to human beings has not been established. However, topical steroids in large amounts or for prolonged periods<br />\r\nshould not be used in pregnancy.<br />\r\n<br />\r\n<strong>Lactation</strong>: Negligible amount of econazole and to some extent Triamcinolone may be excreted in small amounts in breast milk. So this cream should not be prescribed to the lactating mother or if prescribed lactation should be withheld during treatment.</p>', '<ul>\r\n	<li>For external use only. This Cream is not for ophthalmic or oral use.</li>\r\n	<li>If a reaction suggesting hypersensitivity or chemical irritation should occur, use of the medication should be discontinued.</li>\r\n	<li>Corticosteroids applied to the skin can be absorbed in sufficient amounts to produce systemic effects, including adrenal suppression. Systemic absorption may be increased by various factors such as application over a large skin surface area, application to damaged skin, application under occlusive skin dressings and prolonged duration of therapy.</li>\r\n	<li>Topical corticosteroids are associated with skin thinning and atrophy, striae, telangiectasis and purpura.</li>\r\n	<li>Topical corticosteroids may lead to increased risk of dermatological superinfection or opportunistic infection.</li>\r\n</ul>\r\n\r\n<p><strong>Children</strong>: Increased caution is required when treating children. Compared to adults, the nature of a child&#39;s skin and the larger skin surface area relative to body weight may lead to an increased absorption of the corticosteroid via the child&#39;s skin. This cream should be used in children only for short periods of time (less than 2 weeks) and on small areas (less than 10% of body surface area).<br />\r\n<br />\r\nVisual disturbance may be associated with systemic and topical corticosteroid use. If a patient presents with symptoms such as blurred vision or other visual disturbances, the patient should be considered for referral to an ophthalmologist for evaluation of possible causes which may include cataract, glaucoma or rare diseases such as central serous chorioretinopathy (CSCR).</p>', '<p>This Cream is for cutaneous application only. Corticosteroids applied to the skin, including triamcinolone, can be absorbed in sufficient amounts to produce systemic effects. In the event of accidental ingestion, treat symptomatically. If this cream is accidentally applied to the eyes, wash with clean water or saline and seek medical attention if symptoms persist.</p>', '<p>Triamcinolone &amp; Combined preparations</p>', '<p>Store in a cool (below 30&deg;C) and dry place, away from light. Keep out of the reach of children</p>', NULL, '2022-02-20 01:23:44', '2022-06-08 00:49:56'),
(492, 492, '<p>Efavirenz in combination with other antiretroviral agents is indicated for the treatment of HIV-1 infection. This indication is based on analyses of plasma HIV- RNA levels and CD4 cell counts in controlled studies of up to 24 weeks in duration. At present, there are no results from controlled trials evaluating long term suppression of HIVRNA with Efavirenz.</p>', '<p>Efavirenz is a non-nucleoside reverse transcriptase inhibitor (NNRTI) with activity against HIV-1. It blocks the RNA- and DNA-dependent polymerase activities including HIV-1 replication.</p>', '<p><strong>Adults:</strong>&nbsp;The recommended dosage of Efavirenz is 600 mg orally, once daily, in combination with a protease inhibitor and/or nucleoside analogue reverse transcriptase inhibitors (NRTIs).<br />\r\n<br />\r\n<strong>Pediatric Patients:</strong>&nbsp;Following table describes the recommended dose of Efavirenz for pediatric patients 3 years of age or older and weighing between 10 and 40 kg. The recommended dosage of Efavirenz for pediatric patients weighing greater than 40 kg is 600 mg, once daily.</p>\r\n\r\n<ul>\r\n	<li>10 to &lt;15 &nbsp;kg: 200 mg</li>\r\n	<li>15 to &lt; 20 kg:&nbsp;250 mg</li>\r\n	<li>20 to &lt; 25 kg: 300 mg</li>\r\n	<li>25 to &lt; 32.5 kg:&nbsp;350 mg</li>\r\n	<li>32.5 to &lt; 40 kg: 400 mg</li>\r\n	<li>40 kg: 600 mg</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>', '<p>Additive CNS effects w/ psychoactive drugs. May alter plasma warfarin concentrations. May reduce plasma concentrations of HIV integrase inhibitors (e.g. dolutegravir), other HIV NNRTIs (e.g. etravirine), HMG-CoA reductase inhibitors (e.g. simvastatin). Plasma concentrations of efavirenz is increased and that of voriconazole is reduced when given concomitantly. Reduced plasma concentrations w/ rifampicin.</p>', '<p>Hypersensitivity. Severe hepatic impairment. Lactation. Concomitant admin with terfenadine, astemizole, cisapride, midazolam, triazolam, pimozide, bepridil, ergot alkaloids, St John&rsquo;s wort.</p>', '<p>Rashes, psychiatric or CNS disturbances, amnesia, agitation, confusion, dizziness, vertigo, headache, euphoria, insomnia or somnolence, impaired concentration, abnormal thinking or dreaming, depersonalisation, convulsions, hallucinations, nausea, vomiting, diarrhoea, pancreatitis, fatigue, hepatic failure, photoallergic dermatitis; autoimmune disorders (e.g. Graves&rsquo; disease, polymyositis, Guillain-Barre syndrome), osteonecrosis. Accumulation or redistribution of body fat (lipodystrophy) including central obesity, peripheral and facial wasting, buffalo hump, breast enlargement, cushingoid appearance. Metabolic abnormalities e.g. hypercholesterolaemia, hyperglycaemia, hypertriglyceridaemia, hyperlactataemia, insulin resistance.</p>', '<p><strong>Category D</strong>: 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).<br />\r\n<br />\r\n<strong>Lactation</strong>: Efavirenz may pass through breast milk and cause serious harm to the baby. It should not be used during lactation.</p>', '<p>Patient with history of seizures and psychiatric disorders; acute porphyria. Patients receiving voriconazole or rifampicin (weighing &ge;50 kg). Discontinue if severe rash or fever develops. Moderate hepatic and severe renal impairment. Childn. Pregnancy.</p>', '<p><strong>Symptoms:</strong>&nbsp;Increased adverse CNS effects including involuntary muscle contractions.<br />\r\n<br />\r\n<strong>Management:</strong>&nbsp;Supportive and symptomatic treatment. May administer activated charcoal.</p>', '<p>Drugs for HIV / Anti-retroviral drugs</p>', '<p>Store at 25&deg;C.</p>', '<p><strong>Paediatric use</strong>: &nbsp;Efavirenz has not been studied in pediatric patients below 3 years of age or who weigh less than 10 kg.<br />\r\n<br />\r\n<strong>Women taking hormone-based birth control:&nbsp;</strong>Women should not rely only on hormone-based birth control, such as pills, injections, or implants, because Efavirenz may make these contraceptives ineffective.</p>', '2022-02-20 01:24:04', '2022-06-08 00:52:28'),
(493, 493, '<p>Eflornithine Hydrochloride cream, 13.9% is indicated for the reduction of unwanted facial hair in women. Eflornithine Hydrochloride has only been studied on the face and adjacent involved areas under the chin of affected individuals. Usage should be limited to these areas of involvement.</p>', '<p>Eflornithine prevents hair growth by inhibiting the anagen phase of hair production. This occurs by eflornithine irreversibly binding (also called suicide inhibition) to ornithine decarboxylase (ODC) and physically preventing the natural substrate ornithine from accessing the active site.</p>', '<p><strong>Adults</strong>: Apply a thin layer of Eflornithine cream, 13.9% to affected areas of the face and adjacent involved areas under the chin and rub in thoroughly. Do not wash treated area for at least 4 hours. Use twice daily at least 8 hours apart or as directed by a physician. The patient should continue to use hair removal techniques as needed in conjunction with Eflornithine (Wonica should be applied at least 5 minutes after hair removal). Cosmetics or sunscreens may be applied over treated areas after cream has dried.&nbsp;<br />\r\n<br />\r\n<strong>Elderly</strong>: No apparent differences in safety were observed between older patients and younger patients.&nbsp;<br />\r\n<br />\r\n<strong>Children</strong>: The safety and effectiveness of this product have not been established in pediatric patients less than 12 years of age.</p>\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>', '<p>It is not known whether Eflornithine has any interaction with other topically applied drug products.</p>', '<p>Eflornithine is contraindicated in patients with a history of sensitivity to any components of the preparation.</p>', '<p>Adverse events were primarily mild in intensity and generally resolved without medical treatment or discontinuation of Eflornithine. Side effects can include acne, barbae, pseudofolliculitis, stinging skin, headache, burning skin, dry skin, erythema (redness), pruritus (itching), tingling skin, dyspepsia, skin irritation, rash, alopecia, dizziness, folliculitis, hair ingrown, facial edema, anorexia, nausea, asthenia, vertigo</p>', '<p>Pregnancy Category C.&nbsp;It is not known whether or not Eflornithine Hydrochloride is excreted in human milk. Caution should be exercised when Eflornithine is administered to a nursing woman.</p>', '<p>For external use only. Transient stinging or burning may occur when applied to abraded or broken skin.</p>', '<p>Overdosage information with Eflornithine&nbsp;is unavailable. However, if very high topical doses (e.g., multiple tubes per day) or oral ingestion has been encountered (a 30 gm tube contains 4.2 gm of Eflornithine Hydrochloride), the patient should be monitored, and appropriate supportive measures should be administered as necessary.</p>', '<p>Hair Growth Inhibitor</p>', '<p>Store at 25&deg;C, excursions permitted to 15&deg;C-30&deg;C. Do not freeze.</p>', NULL, '2022-02-20 01:24:32', '2022-06-10 00:15:12'),
(494, 494, '<p>Elagolix is indicated for the management of moderate to severe pain associated with endometriosis.</p>', '<p>Endometriosis develops when tissue that is similar to the kind that is normally located in the uterus starts to grow outside of the uterus. Such growth leads to various symptoms like pain during periods, pelvic pain between periods, and pain during sexual intercourse. The growths themselves are referred to as lesions and frequently develop on the ovaries, fallopian tubes, and other areas around the uterus, including the bowel or bladder. The growth of these lesions is dependent upon the estrogen hormone.<br />\r\n<br />\r\nElagolix is an orally-administered, nonpeptide small molecule gonadotropin-releasing hormone (GnRH) receptor antagonist that inhibits endogenous GnRH signaling by binding competitively to GnRH receptors in the pituitary gland Label. Administration of elagolix results in dose-dependent suppression of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), leading to decreased blood concentrations of the ovarian sex hormones, estradiol and progesterone.</p>', '<p>Exclude pregnancy before starting Elagolix or start Elagolix within 7 days from the onset of menses. Take Elagolix at approximately the same time each day, with or without food.<br />\r\n<br />\r\nInitiate treatment with Elagolix 150 mg once daily-</p>\r\n\r\n<ul>\r\n	<li>Maximum Treatment Duration: 24 months</li>\r\n	<li>Coexisting Condition: None</li>\r\n</ul>\r\n\r\n<p>Consider initiating treatment with Elagolix 200 mg twice daily-</p>\r\n\r\n<ul>\r\n	<li>Maximum Treatment Duration: 6 months</li>\r\n	<li>Coexisting Condition: Dyspareunia</li>\r\n</ul>\r\n\r\n<p>Initiate treatment with Elagolix 150 mg once daily. Use of 200 mg twice daily is not recommended-</p>\r\n\r\n<ul>\r\n	<li>Maximum Treatment Duration: 6 months</li>\r\n	<li>Coexisting Condition: Moderate hepatic impairment (Child-Pugh Class B)</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>', '<p>May potentiate P-gp substrates (eg. Digoxin), CYP2C19 substrates (eg. Dose limit of Omeprazole is upto 40mg daily). May antagonize CYP3A substrates. Antagonizes oral Midazolam, Rosuvastatin; consider increasing their doses. Maybe antagonized by CYP3A inducers. Reduces efcacy with estrogen-containing contraceptives.</p>', '<p>Elagolix is contraindicated in women:</p>\r\n\r\n<ul>\r\n	<li>Who are pregnant</li>\r\n	<li>Exposure to ORILISSA early in pregnancy may increase the risk of early pregnancy loss.</li>\r\n	<li>With known osteoporosis because of the risk of further bone loss</li>\r\n	<li>With severe hepatic impairment because of the risk of bone loss</li>\r\n	<li>With concomitant use of strong organic anion transporting polypeptide (OATP) 1B1 inhibitors (e.g., cyclosporine and gemfibrozil)</li>\r\n</ul>', '<p>Most common adverse reactions (&gt;5%) in clinical trials included hot flushes and night sweats, headache, nausea, insomnia, amenorrhea, anxiety, arthralgia, depression-related adverse reactions and mood changes.</p>', '<p>Exposure to Elagolix early in pregnancy may increase the risk of early pregnancy loss. Use of Elagolix is contraindicated in pregnant women. Discontinue Elagolix if pregnancy occurs during treatment. The limited human data with the use of Elagolix in pregnant women are insufficient to determine whether there is a risk for major birth defects or miscarriage. Although two cases of congenital malformations were reported in clinical trials with Elagolix, no pattern was identified and miscarriages were reported at a similar incidence across treatment groups. There is no information on the presence of elagolix or its metabolites in human milk, the effects on the breastfed child, or the effects on milk production.<br />\r\n<br />\r\nThere are no adequate animal data on the excretion of Elagolix in milk. The developmental and health benefits of breastfeeding should be considered along with the mother&rsquo;s clinical need for Elagolix and any potential adverse effects on the breastfed child from Elagolix.</p>', '<ul>\r\n	<li><strong>Bone Loss</strong>: Dose- and duration-dependent decreases in bone mineral density (BMD) that may not be completely reversible. Assess BMD in women with additional risk factors for bone loss</li>\r\n	<li><strong>Reduced Ability to Recognize Pregnancy</strong>: Elagolix may alter menstrual bleeding, which may reduce the ability to recognize pregnancy. Perform testing if pregnancy is suspected. Discontinue if pregnancy is confirmed</li>\r\n	<li><strong>Suicidal Ideation and Mood Disorders</strong>: Advise patients to seek medical attention for suicidal ideation, suicidal behavior, new onset or worsening depression, anxiety, or other mood changes</li>\r\n	<li><strong>Hepatic Transaminase Elevations</strong>: Dose-dependent elevations in serum alanine aminotransferase (ALT). Counsel patients on signs and symptoms of liver injury</li>\r\n	<li><strong>Potential for Reduced Efficacy with Estrogen-Containing Contraceptives</strong>: Use non-hormonal contraception during treatment and for one week after discontinuing Elagolix.</li>\r\n</ul>', '<p>In case of overdose, patients should be monitored for any signs or symptoms of adverse reactions and initiate appropriate symptomatic treatment, as needed.</p>\r\n\r\n<p>Therapeutic Class</p>', '<p>Gonadotropin-releasing hormone (GnRH) antagonist</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', '<ul>\r\n	<li>No dose adjustment of Elagolix is required in women with any degree of renal impairment or end-stage renal disease (including women on dialysis)</li>\r\n	<li>No dosage adjustment of Elagolix is required in women with mild hepatic impairment.</li>\r\n	<li>Safety and effectiveness of Elagolix in patients less than 18 years of age have not been established.</li>\r\n</ul>', '2022-02-20 01:24:46', '2022-06-10 00:17:13'),
(495, 495, '<p>Eltrombopag Olamine is indicated in Chronic Immune (Idiopathic) Thrombocytopenia, Chronic Hepatitis C-associated Thrombocytopenia, Severe Aplastic Anemia.</p>', '<p>Eltrombopag is an orally bioavailable, small-molecule TPO-receptor agonist that interacts with the transmembrane domain of the human TPO-receptor. Eltrombopag is a stimulator of STAT and JAK phosphorylation. Unlike recombinant TPO or romiplostim, Eltrombopag does not activate the AKT pathway in any way. It should be noted that when given to patients with aplastic anemia, other lineages besides platelet count were increased, suggesting that either eltrombopag enhanced the effect of TPO in vivo; or there is a yet uncovered mechanism of action at work.</p>', '<p>Chronic Immune (Idiopathic) Thrombocytopenia-</p>\r\n\r\n<ul>\r\n	<li><strong>Adult and Pediatric Patients 6 Years and Older with ITP</strong>: Initiate Eltrombopag at a dose of 50 mg once daily, except in patients who are of East Asian ancestry (such as Chinese, Japanese, Taiwanese or Korean) or who have mild to severe hepatic impairment (Child-Pugh Class A,B,C). For patients of East Asian ancestry with ITP, initiate Eltrombopag at a reduced dose of 25 mg once daily. For patients with ITP and mild, moderate or severe hepatic impairment (Child-Pugh Class A,B,C), initiate Eltrombopag at a reduced dose of 25 mg once daily.</li>\r\n	<li>For patients of East Asian ancestry with ITP and hepatic impairment (Child-Pugh Class A,B,C), consider initiating Eltrombopag at a reduced dose of 12.5 mg once daily. Pediatric Patients with ITP Aged 1 to 5 Years: Initiate Eltrombopag at a dose of 25 mg once daily.</li>\r\n</ul>\r\n\r\n<p><br />\r\nChronic Hepatitis C-associated Thrombocytopenia-</p>\r\n\r\n<ul>\r\n	<li><strong>Initiate Eltrombopag at a dose of 25 mg once daily. Monitoring and Dose Adjustmen</strong>t: Adjust the dose of Eltrombopag in 25-mg increments every 2 weeks as necessary to achieve the target platelet count required to initiate antiviral therapy. Monitor platelet counts every week prior to starting antiviral therapy. During antiviral therapy, adjust the dose of Eltrombopag to avoid dose reductions of Peginterferon. Monitor CBCs with differentials, including platelet counts, weekly during antiviral therapy until a stable platelet count is achieved. Monitor platelet counts monthly thereafter. Do not exceed a dose of 100 mg daily. Monitor clinical hematology and liver tests regularly throughout therapy with Eltrombopag.</li>\r\n</ul>\r\n\r\n<p><br />\r\nSevere Aplastic Anemia-</p>\r\n\r\n<ul>\r\n	<li>Initiate Eltrombopag at a dose of 50 mg once daily. For patients with severe aplastic anemia of East Asian ancestry or those with mild, moderate or severe hepatic impairment (Child-Pugh Class A,B,C), initiate Eltrombopag at a reduced dose of 25 mg once 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>', '<p>Take Eltrombopag at least 2 hours before or 4 hours after any medications or products containing polyvalent cations such as antacids, calcium-rich foods and mineral supplements.</p>', '<p>There are no contraindications for Eltrombopag</p>', '<p>The most common side effects of Eltrombopag in adults when used to treat chronic ITP are: In adult patients with ITP, the most common adverse reactions (greater than or equal to 5% and greater than placebo) were: nausea, diarrhea, upper respiratory tract infection, vomiting, increased ALT, myalgia and urinary tract infection. In pediatric patients age 1 year and older with ITP, the most common adverse reactions (greater than or equal to 10% and greater than placebo) were upper respiratory tract infection and nasopharyngitis.<br />\r\n<br />\r\nIn patients with chronic hepatitis C-associated thrombocytopenia, the most common adverse reactions (greater than or equal to 10% and greater than placebo) were: anemia, pyrexia, fatigue, headache, nausea, diarrhea, decreased appetite, influenza-like illness, asthenia, insomnia, cough, pruritus, chills, myalgia, alopecia and peripheral edema. In patients with severe aplastic anemia, the most common adverse reactions (greater than or equal to 20%) were: nausea, fatigue, cough, diarrhea and headache.</p>', '<p>Pregnancy Category C. There are no adequate and well controlled studies of Eltrombopag usein pregnancy. In animal reproduction and developmental toxicity studies, there was evidence ofembryolethality and reduced fetal weights at maternally toxic doses. Eltrombopag should beused in pregnancy only if the potential benefit to the mother justifies the potential risk to thefetus.<br />\r\n<br />\r\nNursing Mothers: It is not known whether Eltrombopag is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from Eltrombopag, a decision should be made whether to discontinue nursing or to discontinue Eltrombopag taking into account the importance of Eltrombopag to the mother.</p>', '<p><strong>Hepatotoxicity</strong>: Monitor liver function before and during therapy.<br />\r\n<br />\r\n<strong>Thrombotic or Thromboembolic Complications</strong>: Portal vein thrombosis has been reported in patients with chronic liver disease receiving Eltrombopag. Monitor platelet counts regularly.</p>', '<p>In the event of overdose, platelet counts may increase excessively and result in thrombotic/thromboembolic complications.<br />\r\n<br />\r\nIn one report, a subject who ingested 5,000 mg of Eltrombopag had a platelet count increase to a maximum of 929 x 109/L at 13 days following the ingestion. The patient also experienced rash, bradycardia, ALT/AST elevations and fatigue. The patient was treated with gastric lavage, oral Lactulose, Intravenous fluids, Omeprazole, Atropine, Furosemide, Calcium, Dexamethasone, andPlasmapheresis; however, the abnormal platelet count and liver test abnormalities persisted for 3 weeks. After 2 months follow-up, all events had resolved without sequelae.<br />\r\n<br />\r\nIn case of an overdose, consider oral administration of a metal cation-containing preparation, such as Calcium, Aluminum, or Magnesium preparations to chelate Eltrombopag and thus limit absorption. Closely monitor platelet counts. Reinitiate treatment with Eltrombopag in accordance with dosing and administration recommendations.</p>', '<p>Haemostatic drugs</p>', '<p>Store in a cool and dry place, away from light and moisture. Keep out of the reach of children.</p>', '<p><strong>Pediatric Use</strong>:The safety and efficacy of Eltrombopag in pediatric patients 1 year and older with chronic ITP were evaluated in two double-blind, placebo-controlled. The pharmacokinetics of Eltrombopag has been evaluated in 168 pediatric patients 1 year and older with ITP dosed once daily for dosing recommendations for pediatric patients 1 year and older. The safety and efficacy ofEltrombopag in pediatric patients younger than 1 year with ITP have not yet been established. The safety and efficacy of Eltrombopag in pediatric patients with thrombocytopenia associated with chronic hepatitis C and severe aplastic anemia have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Of the 106 patients in two randomized clinical trials of Eltrombopag 50 mg in chronic ITP, 22% were 65 years of age and over, while 9% were 75 years of age and over. In the two randomized clinical trials of Eltrombopag in patients with chronic hepatitis C and thrombocytopenia, 7% were 65 years of age and over, while fewer than 1% were 75 years of age and over. No overall differences in safety or effectiveness were observed between these patients and younger patients in the placebo-controlled trials, but greater sensitivity of some older individuals cannot be ruled out.<br />\r\n<br />\r\n<strong>Hepatic Impairment</strong>: Hepatic impairment influences the exposure of Eltrombopag. Reduce the initial dose of Eltrombopag in patients with chronic ITP (adult and pediatric patients 6 years and older only) or severe aplastic anemia who also have hepatic impairment (Child-Pugh Class A, B, C). No dosage adjustment is necessary for patients with chronic hepatitis C and hepatic impairment.<br />\r\n<br />\r\n<strong>Renal Impairment</strong>: No adjustment in the initial dose of Eltrombopag is needed for patients with renal impairment. Closely monitor patients with impaired renal function when administering Eltrombopag.</p>', '2022-02-20 01:25:15', '2022-06-10 00:22:15'),
(496, 496, '<p>Eluxadoline is indicated in adults for the treatment of irritable bowel syndrome with diarrhea (IBS-D).</p>', '<p>Eluxadoline is a mu-opioid receptor agonist, kappa opioid receptor agonist &amp; delta opioid receptor antagonist. Eluxadoline works directly in intestine to reduce peristalsis, also makes the nerves in intestine less sensitive to stimulation</p>', '<p>The recommended dosage in adults is 100 mg twice daily taken with food.<br />\r\n<br />\r\nThe recommended dosage is 75 mg twice daily taken with food in patients who:</p>\r\n\r\n<ul>\r\n	<li>are unable to tolerate the 100 mg dose.</li>\r\n	<li>are receiving concomitant OATP1B1 inhibitors.</li>\r\n	<li>have mild or moderate hepatic impairment.</li>\r\n</ul>\r\n\r\n<p>Discontinue Eluxadoline in patients who develop severeconstipation.<br />\r\n<br />\r\nIf a dose is missed, take the next dose at the regular time; do not take 2 doses at once</p>\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>', '<p>Oral Contraceptive, Cyclosporine, Probenecid, Rosuvastatin.</p>', '<p>Known or suspected biliary duct obstruction, sphincter of oddi disease or dysfunction &amp; pancreatitis.</p>', '<p>Most common adverse reactions are constipation, nausea and<br />\r\nabdominal pain.</p>', '<p>Pregnancy: Not established.<br />\r\nLactation: Not established.</p>', '<p>Sphincter of Oddi spasm and Pancreatitis.<br />\r\nPatients who should be monitored closely-</p>\r\n\r\n<ul>\r\n	<li>without a gallbladder</li>\r\n	<li>with new or worsening abdominal pain</li>\r\n	<li>with nausea and vomiting</li>\r\n	<li>with acute biliary pain</li>\r\n	<li>with liver or pancreatic enzyme elevation</li>\r\n</ul>', NULL, '<p>Carboxylic acids and derivatives, Prokinetic drugs</p>', '<p>Store in a cool &amp; dry place, protect from light. Keep out of the reach of children</p>', '<p><strong>Pediatric Use</strong>: Safety and effectiveness in pediatric patients have not been established.<br />\r\n<strong>Hepatic Impairment</strong>: It is contraindicated in patients with severe hepatic impairment.</p>', '2022-02-20 01:25:40', '2022-06-10 00:25:21'),
(497, 497, '<p>Relief of dry skin associated with contact dermatitis, senile pruritus, atopic dermatitis, ichthyosis &amp; related dry skin conditions.</p>', '<p>It softens and hydrates skin. It is also a mild cleanser for dry, sensitive skin. It helps reduce dryness and leaves the skin feeling soft and smooth.</p>', '<p>Parents of children with eczema should try to bathe their child in an emollient wash product once a day. Emollient creams should be used frequently; the weekly recommended amount for children is 250 g per week. On a day to day basis, it is recommended to apply an emollient cream at least 3 to 4 times a day. Add a bath emollient to the water to help prevent the skin from drying out. After bathing, apply an emollient cream to all areas of the skin to lock in the moisture Apply an emollient cream about 20 minutes before bedtime to allow it to soak in to the skin</p>\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>', '<p>There are no known drug interactions and none well documented.</p>', '<p>Patients with a history of hypersensitivity to any of the components of the preparation. Acne or greasy skin.</p>', '<p>Skin irritation in people hypersensitive to any of the ingredients.</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>This preparation is for external use only. Avoid contact with the eyes. This preparation contains cetostearyl alcohol and potassium sorbate which may cause skin irritation. Discontinue use if skin irritation occurs.</p>', NULL, '<p>Emollients &amp; combined preparations</p>', NULL, NULL, '2022-02-20 01:26:12', '2022-06-10 00:27:16'),
(498, 498, '<p>Empagliflozin is indicated in:</p>\r\n\r\n<ul>\r\n	<li>As an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.</li>\r\n	<li>To reduce the risk of cardiovascular death in adult patients with type 2 diabetes mellitus and established cardiovascular disease.</li>\r\n</ul>', '<p>Empagliflozin is a sodium glucose co-transporter-2 (SGLT-2) inhibitor. SGLT2 co-transporters are responsible for reabsorption of glucose from the glomerular filtrate in the kidney. The glucuretic effect resulting from SGLT2 inhibition reduces renal absorption and lowers the renal threshold for glucose, resulting in increased glucose excretion. Additionally, it contributes to reduced hyperglycaemia, assists weight loss, and reduces blood pressure.</p>', '<p>The recommended dose of Empagliflozin is 10 mg once daily, taken in the morning, with or without food. In patients tolerating Empagliflozin, the dose may be increased to 25 mg once daily. In patients with volume depletion, correcting this condition prior to initiation of Empagliflozin is recommended.</p>\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>', '<p><strong>Diuretics</strong>: Co-administration of Empagliflozin with diuretics resulted in increased urine volume.&nbsp;<br />\r\n<br />\r\n<strong>Insulin or Insulin Secretagogues</strong>: Co-administration of Empagliflozin with insulin or insulin secretagogues increases the risk for hypoglycemia.&nbsp;<br />\r\n<br />\r\n<strong>Positive Urine Glucose Test</strong>: Monitoring glycemic control with urine glucose tests is not recommended in patients taking SGLT2 inhibitors as SGLT2 inhibitors increase urinary glucose excretion and will lead to positive urine glucose tests. Use alternative methods to monitor glycemic control.&nbsp;<br />\r\n<br />\r\n<strong>Interference with 1,5-anhydroglucitol (1,5-AG) Assay</strong>: Monitoring glycemic control with 1,5-AG assay is not recommended as measurements of 1,5-AG are unreliable in assessing glycemic control in patients taking SGLT2 inhibitors. Use alternative methods to monitor glycemic control.</p>', '<p>Empagliflozin is contraindicated in patients with history of serious hypersensitivity reaction to Empagliflozin or any of its ingredients, severe renal impairment, end-stage renal disease, or dialysis.</p>', '<p>The most common adverse reactions associated with Empagliflozin are urinary tract infections and female genital mycotic infections. Others common side effects includes dehydration, hypotension, weakness, dizziness and increased thirstiness.</p>', '<p>There are no adequate and well-controlled studies of Empagliflozin in pregnant women. Empagliflozin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known if Empagliflozin is excreted in human milk. It is not recommended when breastfeeding.</p>', '<p>Assessment of renal function is recommended prior to initiation of Empagliflozin and periodically thereafter. Empagliflozin should not initiated in patients with an eGFR less than 45 ml/min/1.73 m2. No dose adjustment is needed in patients with an eGFR greater than or equal to 45 ml/min/1.73 m2.</p>', '<p>In the event of an overdose with Empagliflozin the usual supportive measures (e.g., remove unabsorbed material from the gastrointestinal tract, perform clinical monitoring, and institute supportive treatment) should be employed. Removal of Empagliflozin by hemodialysis has not been studied.</p>', '<p>Sodium-glucose Cotransporter-2 (SGLT2) Inhibitors</p>', '<p>Keep in a cool &amp; dry place (below 30&deg; C), protected from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-02-20 01:26:31', '2022-06-10 00:29:33'),
(499, 499, '<p>This tablet is indicated for the treatment of adults with type 2 diabetes mellitus as an adjunct to diet and exercise:</p>\r\n\r\n<ul>\r\n	<li>In patients insufficiently controlled on their maximally tolerated dose of Metformin alone</li>\r\n	<li>In combination with other medicinal products for the treatment of diabetes, in patients insufficiently controlled with Metformin and these medicinal products</li>\r\n	<li>In patients already being treated with the combination of Empagliflozin and Metformin as separate tablets</li>\r\n</ul>', '<p>Empagliflozin is an inhibitor of Sodium-Glucose Co-Transporter 2 (SGLT2). SGLT2 is the predominant transporter, responsible for reabsorption of glucose from the kidney back into the circulation. By inhibiting SGLT2, Empagliflozin reduces renal reabsorption of filtered glucose and lowers the renal threshold for glucose and thereby increases urinary glucose excretion.<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. It does not produce hypoglycemia. Metformin Hydrochloride decreases hepatic glucose production, decreases intestinal absorption of glucose and improves insulin sensitivity by an increase in peripheral glucose uptake and utilization.</p>', '<p>The dosage should be individualized based on effectiveness and tolerability. Take this combination twice daily with meals. Dose escalation should be gradual to reduce the gastrointestinal side effects due to Metformin Hydrochloride. Maximum recommended daily dose of Metformin Hydrochloride is 2000 mg and Empagliflozin is 25 mg.<br />\r\n<br />\r\nRecommended individualized starting dose:</p>\r\n\r\n<ul>\r\n	<li>In patients on Metformin Hydrochloride, switch to this combination containing Empagliflozin 5 mg with a similar total daily dose of Metformin Hydrochloride.</li>\r\n	<li>In patients on Empagliflozin, switch to this combination containing Metformin Hydrochloride 500 mg with a similar total daily dose of Empagliflozin.</li>\r\n	<li>In patients already treated with Empagliflozin and Metformin Hydrochloride separately switch to this combination containing the same total daily doses of each component.</li>\r\n	<li>In patients with volume depletion not previously treated with Empagliflozin, correct this condition before initiating this combination.</li>\r\n</ul>\r\n\r\n<p><strong>Renal impaired patient</strong>: Assess renal function before initiating this combination. In patients with an eGFR below 45 mL/min/1.73 m2&nbsp;is contraindicated.<br />\r\n<br />\r\n<strong>Pediatric patients under 18 years of age</strong>: Safety and effectiveness in pediatric patients under 18 years of age have not been established.</p>\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>', '<p><strong>Diuretics</strong>: Co-administration of Empagliflozin with diuretics resulted in increased urine volume and frequency of voids, which might enhance the potential for volume depletion.<br />\r\n<br />\r\n<strong>Insulin or Insulin Secretagogues</strong>: Co-administration of Empagliflozin with insulin or insulin secretagogues increases the risk for hypoglycemia.<br />\r\n<br />\r\n<strong>Positive Urine Glucose Test</strong>: Monitoring glycemic control with urine glucose tests is not recommended in patients taking SGLT2 inhibitors. Use alternative methods to monitor glycemic control.<br />\r\n<br />\r\n<strong>Drugs that Reduce Metformin Clearance</strong>: Drugs that reduce Metformin clearance (such as ranolazine, vandetanib, dolutegravir, and cimetidine) may increase the accumulation of Metformin.<br />\r\n<br />\r\n<strong>Carbonic Anhydrase Inhibitors</strong>: Carbonic anhydrase inhibitors may increase risk of lactic acidosis.<br />\r\n<br />\r\n<strong>Drugs Affecting Glycemic Control</strong>: Thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid produce hoperglycemia. When such drugs are administered to a patient receiving Empagliflozin and Metformin combination, the patient should be closely observed to maintain adequate glycemic control. When such drugs are withdrawn from a patient receiving Empagliflozin and Metformin combination, the patient should be observed closely for hypoglycemia.<br />\r\n<br />\r\n<strong>Alcohol</strong>: Alcohol can potentiate the effect of Metformin on lactate metabolism. Warn patients against excessive alcohol intake.</p>', '<ul>\r\n	<li>Hypersensitivity to Empagliflozin and Metformin</li>\r\n	<li>Any type of acute metabolic acidosis (such as lactic acidosis, diabetic ketoacidosis)</li>\r\n	<li>Diabetic pre-coma</li>\r\n	<li>Severe renal failure (GFR &lt;30 ml/min)</li>\r\n	<li>Acute conditions with the potential to alter renal function such as: dehydration, severe infection, shock</li>\r\n	<li>Disease which may cause tissue hypoxia (especially acute disease, or worsening of chronic disease) such as: decompensated heart failure, respiratory failure, recent myocardial infarction, shock</li>\r\n	<li>Hepatic impairment, acute alcohol intoxication, alcoholism</li>\r\n</ul>', '<p>Most common adverse reactions associated with Empagliflozin (5% or greater incidence) were urinary tract infection and female genital mycotic infections. Most common adverse reactions associated with Metformin (&gt;5%) are diarrhea, nausea/vomiting, flatulence, abdominal discomfort, indigestion, asthenia, and headache. The following important adverse reactions are given below:</p>\r\n\r\n<ul>\r\n	<li><strong>Very common</strong>: Hypoglycemia (when used with sulphonylurea or insulin), Gastrointestinal symptoms</li>\r\n	<li><strong>Common</strong>: Vaginal moniliasis, vulvovaginitis, balanitis and other genital infection. Urinary tract infection (including pyelonephritis and urosepsis), thirst, taste disturbance, pruritus (generalised), rash, Increased urination, serum lipids increased</li>\r\n	<li><strong>Uncommon</strong>: Volume depletion, urticaria, dysuria, blood creatinine increased/Glomerular filtration rate decreased, Haematocrit increased</li>\r\n	<li><strong>Rare</strong>: Diabetic ketoacidosis.</li>\r\n</ul>', '<p>Advise females of the potential risk to a fetus especially during the second and third trimesters. This is not recommended when breastfeeding.</p>', '<p><strong>Lactic Acidosis</strong>: Postmarketing cases of Metformin Hydrochloride-associated lactic acidosis. If lactic acidosis is suspected, general supportive measures should be instituted promptly in a hospital setting, along with immediate discontinuation of this combination.<br />\r\n<br />\r\n<strong>Hypotension</strong>: Before initiating this combination assess and correct volume status in patients with renal impairment, the elderly, in patients with low systolic blood pressure, and in patients on diuretics. Monitor for signs and symptoms of hypotension after initiating therapy and increase monitoring in clinical situations where volume contraction is expected.<br />\r\n<br />\r\n<strong>Ketoacidosis</strong>: Before initiating this combination assess patients who present with signs and symptoms of metabolic acidosis for ketoacidosis, regardless of blood glucose level. If suspected, discontinue this combination, evaluate and treat promptly.<br />\r\n<br />\r\n<strong>Acute kidney injury &amp; impairment in renal function</strong>: Consider temporarily discontinuing this combination in settings of reduced oral intake or fluid losses. If acute kidney injury occurs, discontinue this combination promptly and institute treatment.<br />\r\n<br />\r\n<strong>Urosepsis, Pyelonephritis, Fournier&rsquo;s gangrene &amp; Genital mycotic infections</strong>: Treatment with SGLT2 inhibitors increases the risk for urinary tract infections. Evaluate patients for signs and symptoms of urinary tract infections and treat promptly, if indicated.<br />\r\n<br />\r\n<strong>Hypoglycemia</strong>: Consider lowering the dose of insulin secretagogue or insulin to reduce the risk of hypoglycemia when initiating this combination.<br />\r\n<br />\r\n<strong>Vitamin B12 Deficiency</strong>: Metformin Hydrochloride may lower vitamin B12 levels. Monitor hematologic parameters annually.<br />\r\n<br />\r\n<strong>Increased LDL-C</strong>: Monitor and treat as appropriate.<br />\r\n<br />\r\n<strong>Macrovascular Outcomes</strong>: There have been no clinical studies establishing conclusive evidence of macrovascular risk reduction with this combination.</p>', '<p>In controlled clinical studies single doses of up to 800 mg Empagliflozin (equivalent to 32-times the highest recommended daily dose) in healthy volunteers and multiple daily doses of up to 100 mg Empagliflozin (equivalent to 4-times the highest recommended daily dose) in patients with type 2 diabetes did not show any toxicity. Hypoglycaemia has not been seen with Metformin doses of up to 85 g, although lactic acidosis has occurred in such circumstances. Lactic acidosis is a medical emergency and must be treated in hospital. In the event of an overdose, treatment should be initiated as appropriate to the patient&#39;s clinical status. The most effective method to remove lactate and Metformin is haemodialysis. The removal of Empagliflozin by haemodialysis has not been studied</p>', '<p>Combination Oral hypoglycemic preparations</p>', '<p>Keep below 30&deg;C temperature, protected from light &amp; moisture. Keep out of the reach of children</p>', NULL, '2022-02-20 01:29:51', '2022-06-10 00:32:40');
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
(500, 500, '<p>Enalapril is indicated in-</p>\r\n\r\n<ul>\r\n	<li>All grades of essential hypertension and renovascular hypertension either alone or in combination with other antihypertensive agents especially thiazide diuretics.</li>\r\n	<li>Prevention of symptomatic heart failure.</li>\r\n	<li>Treatment of congestive heart failure (adjunct), usually in combination with diuretics and digitalis.</li>\r\n	<li>Prevention of coronary ischaemic events in patients with left ventricular dysfunction.</li>\r\n</ul>\r\n\r\n<p>Enalapril is also used either alone or as an adjunct in the treatment of angina, diabetic nephropathy and Raynaud&#39;s disease.</p>', '<p>Enalapril, after hydrolysis to enalaprilate, inhibits Angiotensin Converting Enzyme (ACE). ACE is a peptidyl dipeptidase that catalyses the conversion of angiotensin I to the vasoconstrictor substance angiotensin II. Angiotensin II also stimulates aldosterone secretion by the adrenal cortex. The beneficial effects of enalapril in hypertension and heart failure appear to result primarily from suppression of the renin-angiotensin aldosterone system</p>', '<p><strong>Hypertension</strong>: Initially 5 mg once daily if used alone or 2.5 mg daily if used in addition to diuretic, in elderly patients or in patients with renal impairment. Usual maintenance dose is 10-20 mg once daily. However, in severe hypertension it may be increased to a maximum of 40 mg once daily.<br />\r\n<br />\r\n<strong>Heart failure (adjunct) and asymptomatic left ventricular dysfunction</strong>: Initially 2.5 mg under close medical supervision. Usual maintenance dose is 20 mg daily in 1-2 divided doses</p>\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>', '<p>Combination with other antihypertensive agents such as b blockers, Methyldopa, calcium antagonists and diuretics may increase the antihypertensive efficacy. Adrenergic blocking drugs should only be combined with Enalapril under careful supervision. Concomitant Propranolol may reduce the bioavailability of Enalapril, but this does not appear to be of any clinical significance. Concomitant therapy with Lithium may increase the serum Lithium concentration.</p>', '<p>Aortic stenosis or outflow tract obstruction. Renovascular disease. Severe resistant HTN. Peripheral vascular disease or generalized atherosclerosis.</p>', '<p>Dizziness and headache are more commonly reported side effects. Fatigue and asthenia were reported in 2-3% of patients. Other side effects occurred&nbsp;in less than 2% of patients and included hypotension, orthostatic hypotension, syncope, nausea, diarrhoea, muscle cramps, rash and cough.<br />\r\n<br />\r\nLess frequently renal dysfunction, renal failure and oliguria have been reported. Angioedema, hyperkalemia and hyponatremia have also been reported rarely</p>', '<p><strong>Category D</strong>: Contraindicated in pregnancy. The drug is excreted in trace amount in human milk and caution should be exercised if given to nursing mothers.</p>', '<p>Assess renal function; regular WBC counts in patient w/ collagen vascular disease eg SLE &amp; scleroderma. Patient receiving immunosuppressive therapy; those prone to salt or water depletion. Pregnancy.</p>', '<p><strong>symptoms-</strong></p>\r\n\r\n<ul>\r\n	<li>Lightheadedness, dizziness, or fainting</li>\r\n	<li>Decrease in urine output</li>\r\n	<li>Drowsiness, headache, or back pain</li>\r\n	<li>Slow or irregular heartbeat.</li>\r\n</ul>\r\n\r\n<p><strong>Management-</strong></p>\r\n\r\n<ul>\r\n	<li>Fluids through an intravenous line (IV)</li>\r\n	<li>Medications to increase blood pressure</li>\r\n	<li>Other treatments based on complications that occur</li>\r\n	<li>Closely monitoring the heart and lungs.</li>\r\n</ul>', '<p>Angiotensin-converting enzyme (ACE) inhibitors</p>', NULL, '<p><strong>Use in the elderly (over 65 years)</strong>: The starting dose should be 2.5 mg. Enaril is effective in the treatment of hypertension in the elderly. The dose should be titrated according to need for the control of blood pressure.</p>', '2022-02-20 01:30:13', '2022-06-10 00:34:25'),
(501, 501, '<p>Encephalitis Vaccine is indicated for active immunisation against Japanese encephalitis in adults, adolescents, children and infants aged 2 months and older. Encephalitis Vaccine should be considered for use in individuals at risk of exposure through travel or in the course of their occupation.</p>', '<p>The mechanism of action of Japanese encephalitis (JE) vaccines is not well understood. Studies in animals have shown that the vaccine triggers the immune system to produce antibodies against Japanese encephalitis virus that are most often protective. Challenge studies were performed in mice that were treated with human Encephalitis Vaccine antisera. These studies showed that almost all mice that had a Plaque Reduction Neutralization Test titre of at least 1:10 were protected from a lethal Japanese encephalitis virus challenge.</p>', '<p><strong>Adults (18 to &le; 65 years of age)</strong>: The primary vaccination series consists of two separate doses of 0.5 ml each, according to the following conventional schedule:</p>\r\n\r\n<ul>\r\n	<li>First dose: Day 0.</li>\r\n	<li>Second dose: 28 days after first dose.</li>\r\n</ul>\r\n\r\n<p>Rapid schedule: Persons aged 18 to &le;65 years can be vaccinated in a rapid schedule as follows:</p>\r\n\r\n<ul>\r\n	<li>First dose: Day 0.</li>\r\n	<li>Second dose: 7 days after first dose.</li>\r\n</ul>\r\n\r\n<p>With both schedules, primary immunisation should be completed at least one week prior to potential exposure to Japanese encephalitis virus (JEV). It is recommended that vaccinees who received the first dose of Encephalitis Vaccine complete the primary 2-dose vaccination course with Encephalitis Vaccine. If the primary immunization of two injections is not completed, full protection against the disease might not be achieved. There is data that a second injection given up to 11 months after the first dose results in high seroconversion rates.<br />\r\n<br />\r\nBooster dose: A booster dose (third dose) should be given within the second year (i.e. 12-24 months) after primary immunization, prior to potential re-exposure to JEV. Persons at continuous risk for acquiring Japanese encephalitis (laboratory personnel or persons residing in endemic areas) should receive a booster dose at month 12 after primary immunization. Long-term seroprotection data following a first booster dose administered 12-24 months after primary immunization suggest that a second booster should be given 10 years after the first booster dose, prior to potential exposure to JEV.<br />\r\n<br />\r\n<strong>Elderly (&gt;65 years of age)</strong>: The primary vaccination series consists of two separate doses of 0.5 ml each, according to the following conventional schedule:</p>\r\n\r\n<ul>\r\n	<li>First dose: Day 0.</li>\r\n	<li>Second dose: 28 days after first dose.</li>\r\n</ul>\r\n\r\n<p><strong>Pediatric Population</strong>:<br />\r\nChildren and adolescents from 3 years to &lt;18 years of age: The primary vaccination series consists of two separate doses of 0.5 ml according to the following schedule:</p>\r\n\r\n<ul>\r\n	<li>First dose: Day 0.</li>\r\n	<li>Second dose: 28 days after first dose.</li>\r\n</ul>\r\n\r\n<p>Children from 2 months to &lt;3 years of age: The primary vaccination series consists of two separate doses of 0.25 ml according to the following schedule:</p>\r\n\r\n<ul>\r\n	<li>First dose: Day 0.</li>\r\n	<li>Second dose: 28 days after first dose.</li>\r\n</ul>\r\n\r\n<p>The vaccine should be administered by intramuscular injection into the deltoid muscle. In infants, the anterolateral aspect of the thigh may be used as injection site. Encephalitis Vaccine should never be injected intravascularly. When Encephalitis Vaccine is administered concomitantly with injectable vaccines, they should be given with separate syringes at opposite sites. Exceptionally, Encephalitis Vaccine can also be administered subcutaneously to patients with thrombocytopenia or bleeding disorders since bleeding may occur following an intramuscular administration. Subcutaneous administration could lead to a suboptimal response to the vaccine. However, it should be noted that there are no clinical efficacy data to support administration by the subcutaneous route.</p>\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>', NULL, '<p>Hypersensitivity to the active substance or to any of the excipients or to the residues protamine sulphate, formaldehyde, bovine serum albumin, host cell DNA, sodium metabisulphite, host cell protein. Individuals who show hypersensitivity reactions after receiving the first dose of the vaccine should not be given the second dose. Administration must be postponed in persons with acute severe febrile conditions.</p>', '<p><strong>Very common</strong>: headache, muscle pain, injection site pain, injection site tenderness, tiredness.<br />\r\n<br />\r\n<strong>Common</strong>: Nausea, influenza like illness, fever, other injection site reactions (e.g. redness, hardening, swelling, itching).<br />\r\n<br />\r\n<strong>Uncommon</strong>: vomiting, skin rash, changes in the lymph-nodes, migraine (throbbing headache, often accompanied by nausea and vomiting and sensitivity to light), dizziness, vertigo (spinning sensation), diarrhoea, belly pain, excessive sweating, itching, chills, general condition of feeling unwell, musculoskeletal stiffness, joint pain, weakness, abnormal laboratory liver test results (hepatic enzymes increased).</p>', '<p><strong>Pregnancy</strong>: There are limited amount of data from the use of Encephalitis Vaccine in pregnant women. In animal studies findings of unclear clinical relevance have been identified. As a precautionary measure, the use of Encephalitis Vaccine during pregnancy should be avoided.<br />\r\n<br />\r\n<strong>Breast-feeding</strong>: It is unknown whether Encephalitis Vaccine is excreted in human milk. No effects on the breastfed newborn/infant are anticipated since the systemic exposure of the breast-feeding woman to Encephalitis Vaccine is negligible. However, in the absence of data and as a precautionary measure the use of Encephalitis Vaccine during lactation should be avoided.<br />\r\n<br />\r\n<strong>Fertility</strong>: A study in rats did not indicate vaccine-related effects on female reproduction, foetal weight, survival and development of the off-spring.</p>', NULL, NULL, '<p>Vaccines, Anti-sera &amp; Immunoglobulin</p>', '<p>Store in a refrigerator (2&deg;C-8&deg;C). Do not freeze. Store in the original package in order to protect from light.</p>', '<p><strong>Children below 2 months of age</strong>: The safety and efficacy of Encephalitis Vaccine in children younger than 2 months has not been established. No data are available.</p>', '2022-02-20 01:30:32', '2022-06-10 00:36:15'),
(502, 502, '<p>Enoxaparin is indicated in:</p>\r\n\r\n<ul>\r\n	<li>Treatment of deep vein thrombosis, with or without pulmonary embolism.</li>\r\n	<li>Treatment of unstable angina and non-Q-wave myocardial infarction, administered concurrently with aspirin.</li>\r\n	<li>Prevention of thrombus formation in the extra-corporal circulation during haemodialysis.</li>\r\n	<li>Prophylaxis of venous thromboembolic disease (prevention of blood clot formation in the veins), in particular those which may be associated with orthopedic or general surgery.</li>\r\n	<li>Prophylaxis of venous thromboembolic disease in medical patients bedridden due to acute illness, including cardiac insufficiency, respiratory failure, severe infections, rheumatic diseases.</li>\r\n</ul>', '<p>Enoxaparin Sodium is a low molecular weight heparin with a high anti-Xa activity and low anti-lla or antithrombin activity. At doses required for the various indications, Enoxaparin Sodium does not increase bleeding time. At preventive doses, Enoxaparin Sodium causes no notable modification of activated Partial Thromboplastin Time (aPTT). It neither influences platelet aggregation nor binding of fibrinogen to platelets. Enoxaparin Sodium is primarily metabolised in the liver.</p>', '<p><strong>Treatment of deep vein thrombosis, with or without pulmonary embolism</strong>: Subcutaneously 100 anti-Xa lU/kg twice daily for 10 days or Subcutaneously 150 anti-Xa lU/kq once daily for 10 days. Oral anticoagulant therapy should be initiated when appropriate and Enoxaparin Sodium treatment should be continued until a therapeutic anticoaqulant effect has been achieved.<br />\r\n<br />\r\n<strong>Treatment of unstable angina and non-Q-wave myocardial infarction, administered concurrently with aspirin</strong>: Subcutaneously 100 anti-Xa lU/kg twice daily for 2- 8 days. Should be administered concurrently with oral aspirin (100 to 325 mg once daily). Treatment with Enoxaparin Sodium in these patients should be prescribed fora minimum of 2 days and continued until clinical stabilization.<br />\r\n<br />\r\n<strong>Prevention of thrombus formation in extra corporeal circulation during hemodialysis</strong>: Recommended dose is 100 anti-Xa lU/kg. For patients with a high risk of hemorrhage, the dose should be reduced to 50 anti-Xa lU/kg for double vascular access or 75 anti-Xa lU/kg for single vascular access. During hemodialysis, Enoxaparin Sodium should be introduced into the arterial line of the circuit at the beqinninq of the dialysis session.<br />\r\n<br />\r\nProphylaxis of venous thromboembolic disease in surgical patients:</p>\r\n\r\n<ul>\r\n	<li><strong>Patients undergoing general surgery with a moderate risk of thromboembolism (e.g. abdominal surgery)</strong>: Subcutaneously 2000 anti-Xa IU (0.2 ml) or 4000 anti-Xa IU (0.4 ml) once daily for 7 to 10 days. The first injection should be given 2 hours before the surgical procedure.</li>\r\n	<li><strong>Patients undergoing orthopedic surgery with a high risk of thromboembolism</strong>: Subcutaneously 4000 anti-Xa IU (0.4 ml) once daily for 7 to 10 days. The first injection should be given 12 hours before the surgical procedure. Longer treatment duration may be appropriate in some patients like continued therapy with 4000 anti-Xa IU once daily for 3 weeks following the initial therapy has been proven to be beneficial in orthopaedic surqery.</li>\r\n</ul>\r\n\r\n<p><strong>Prophylaxis of venous thromboembolic disease in medical patients</strong>: Subcutaneously 4000 anti-Xa IU (0.4 ml) once daily for 6- 14 days.</p>\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>', '<p>It is recommended that agents which affect hemostasis should be discontinued prior to Enoxaparin Sodium therapy unless strictly indicated. These agents include medications such as: acetylsalicylic acid (and derivatives), NSAIDs (including ketorolac), ticlopidine,clopidogrel,dextran 40,glucocorticoids, thrombolytics and anticoagulants, other antiplatelet aggregation agents including glycoprotein llb/llla antagonists. If the combination is indicated, should be used with careful clinical and laboratory monitoring.</p>', '<p>Patients with known hypersensitivity to Enoxaparin Sodium, heparin or other low molecular weight heparins. Patients with active major bleeding and conditions with a high risk of uncontrolled hemorrhage including recent hemorrhagic stroke.</p>', '<p>Haemorrhage (bleeding), Thrombocytopenia, elevations of serum aminotransferase. Pain, bluish marks at injection sites to skin rash at injection sites. Cases of neuraxial hematomas with the concurrent use of Enoxaparin and spinal/epidural anesthesia or spinal puncture have resulted in varying degrees of neurologic injuries.</p>', '<p>Pregnancy category B. In humans, there is no evidence that Enoxaparin Sodium crosses the placental barrier. As there are no adequate and well-controlled studies in pregnant women, Enoxaparin Sodium should be used during pregnancy only if clearly needed. Pregnant women with mechanical prosthetic heart valves may be at a higher risk for thromboembolism.<br />\r\n<br />\r\nIt is not known whether Enoxaparin is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or discontinue Enoxaparin, taking into account the importance of Enoxaparin to the mother and the known benefits of nursing.</p>', '<p>Enoxaparin Sodium should be injected by deep subcutaneous route in prophylactic and curative treatment and by intravascular route during hemodialysis. Do not administer by the intramuscular route. Enoxaparin Sodium should be used with caution in conditions with increased potential for bleeding, such as impaired hemostasis, history of peptic ulcer, recent ischemic stroke, uncontrolled severe arterial hypertension, diabetic retinopathy and recent neuro- or ophthalmologic surgery, concomitant use of medications affecting hemostasis. It is recommended that the platelet counts be measured before the initiation of the treatment and regularly thereafter during treatment.</p>', '<p>Accidental overdosage following administration of Enoxaparin may lead to hemorrhagic complications. Injected Enoxaparin may be largely neutralized by the slow i.v. injection of protamine sulfate (1% solution) The dose of protamine sulfate should be equal to the dose of Enoxaparin injected: 1 mg protamine sulfate should be administered to neutralize 1 mg Enoxaparin.</p>', '<p>Parenteral anti-coagulants</p>', '<p>Store in a cool and dry place, protect from light and moisture. Do not store above 25&deg;C. Do not store in a refrigerator or freezer. Keep out of the reach of children</p>', '<p><strong>Dose in Elderly Patients</strong>: No dosage adjustment is necessary, unless kidney function is impaired.<br />\r\n<br />\r\n<strong>Dose in Renal Impairment</strong>: Although no dosage adjustment is recommended in patients with moderate (creatinine clearance: 30-50 ml/min) and mild (creatinine clearance: 50 80 ml/min) renal impairment, all such patients should be observed carefully for signs and symptoms of bleeding. For patients with severe (creatinine clearance &lt;30 ml/min) renal impairment, following dosage adjustments are recommended: Prophylactic dose ranges: 2000 antiXa IU once daily; Therapeutic dose ranges: 100 anti-Xa lU/kg once daily.<br />\r\n<br />\r\n<strong>Dose in Hepatic Impairment</strong>: Caution should be used in hepatically impaired patients.</p>', '2022-02-20 01:30:48', '2022-06-10 00:38:30'),
(503, 503, '<p>Adjunct to levodopa treatment in Parkinson&#39;s disease</p>', '<p>Entacapone decreases the metabolic loss of levodopa to 3-O-methyldopa (3-OMD) through inhibition of COMT enzyme leading to an increased levodopa concentration, thus, extending the duration and effect in the brain.</p>', '<p>200 mg with each levodopa/dopa decarboxylase inhibitor dose. Max: 200 mg 10 times daily (2,000 mg daily). Gradually reduce levodopa dose by approx 10-30% or increase dosing interval w/in the 1st few wk of starting treatment.<br />\r\n<br />\r\nMay be taken with or without food.</p>\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>', '<p>May interfere with metabolism of other drugs metabolised by COMT (e.g. rimiterole). May aggravate levodopa-induced orthostatic hypotension. Risk of dopaminergic effects with dopamine agonists (e.g. bromocriptine), selegiline, amantadine. May form chelates with Fe in the GI tract. Additive sedative effects with other CNS depressants.</p>', '<p>Phaeochromocytoma, history of neuroleptic malignant syndrome and/or non-traumatic rhabdomyolysis. Hepatic impairment. Concomitant use w/ non-selective MAOIs.</p>', '<p>Abdominal pain, nausea, vomiting, diarrhoea, constipation, colitis, dry mouth, dyskinesia, dizziness, nightmares, insomnia, hallucinations, confusion, fatigue, increased sweating, behavioural disturbances; urine, skin, hair, beard and nail discolourations; cholestatic hepatitis, rhabdomyolysis. Rarely, agitation, urticaria, erythematous or maculopapular rash, anorexia, wt decrease, increased liver enzymes.</p>', '<p><strong>Category C</strong>: 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>Patient with biliary obstruction, ischaemic heart disease. Avoid abrupt withdrawal. Pregnancy and lactation.</p>', '<p><strong>Symptoms:</strong>&nbsp;Decreased activity, confusion, somnolence, hypotonia, urticaria, skin discolouration.<br />\r\n<strong>Management:</strong>&nbsp;Symptomatic treatment.</p>', '<p>Antiparkinson drugs</p>', '<p>Store at 25&deg;C.</p>', NULL, '2022-02-20 01:31:05', '2022-06-10 00:40:31'),
(504, 504, '<p>Entecavir is indicated for the treatment of chronic hepatitis B virus infection in adults and pediatric patients 2 years of age and older with evidence of active viral replication and either evidence of persistent elevation in serum aminotransferases (ALT or AST) or histologically active disease.</p>', '<p>By competing with the natural substrate deoxyguanosine triphosphate, entecavir functionally inhibits all three activities of the HBV polymerase (reverse transcriptase, rt):</p>\r\n\r\n<ul>\r\n	<li>Base priming,</li>\r\n	<li>Reverse transcription of the negative strand from the pregenomic messenger RNA, and</li>\r\n	<li>Synthesis of the positive strand of HBV DNA. Upon activation by kinases, the drug can be incorporated into the DNA which has the ultimate effect of inhibiting the HBV polymerase activity.</li>\r\n</ul>', '<p>The recommended dose of Entecavir for chronic hepatitis B virus infection in nucleoside-treatment-naive adults and adolescents 16 years of age is 0.5 mg once daily. For Lamivudine-refractory or known Lamivudine or Telbivudine resistance mutations, the recommended dose of Entecavir is 1 mg once daily. For patients with decompensated liver disease (adult) the recommended dose of Entecavir is 1 mg once daily. Entecavir should be administered on an empty stomach (at least 2 hours after a meal or 2 hours before the next meal).<br />\r\n<br />\r\nMissed Dose: If it is almost time for next dose, skip the missed dose and take the next dose at the proper time. Nobody should take a double dose to make up for the missed dose.</p>\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>', '<p>Co-administration of Entecavir with Lamivudine or Adefovir dipivoxil did not result in significant drug interactions. The effects of co-administration of Entecavir with other drugs that are eliminated through renal or are known to affect renal function have not been evaluated and patients should be monitored closely for adverse events when coadministered with such drugs.</p>', '<p>Entecavir is contraindicated in patients with previously demonstrated hypersensitivity to Entecavir or any component of the product</p>', '<p>The most common adverse events are headache, fatigue, dizziness and nausea.</p>', '<p>There are no data on the effect of Entecavir on the transmission of HBV from mother to infant. Therefore, appropriate care should be taken. It is not known whether it is excreted in human milk. Mothers should be instructed not to breastfeed if they are taking Entecavir.</p>', '<p><strong>Lactic acidosis</strong>: Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases have been reported with the use of nucleoside analogues alone or in combination with antiretrovirals.<br />\r\n<br />\r\n<strong>Exacerbations of hepatitis after discontinuation of treatment</strong>: Severe acute exacerbations of hepatitis B have been reported in patients who have discontinued anti-hepatitis B therapy, including Entecavir.</p>', '<p>There is no experience of Entecavir overdosage reported in patients. Healthy subjects who received up to 20 mg daily for up to 14 days and single doses up to 40 mg had no unexpected adverse events. If overdosage occurs, the patient must be monitored for evidence of toxicity and standard supportive treatment as necessary.</p>', '<p>Hepatic viral infections (Hepatitis B)</p>', '<p>Keep in a dry place and store below 30&deg;C. Protect from light and keep out of the reach of children.</p>', '<p><strong>Pediatric</strong>: Safety and effectiveness of Entecavir in pediatric patients below the age of 2 years have not been established.<br />\r\n<br />\r\n<strong>Geriatric</strong>: Clinical studies of Entecavir did not include sufficient numbers of subjects aged 65 years and over to determine whether they respond differently from younger subjects. But care should be taken in dose selection, and it may be useful to monitor renal function.<br />\r\n<br />\r\n<strong>Dose adjustment in renal impairment</strong>: Dose adjustment is recommended for patients with CrCl &lt;50 ml/min including patients on hemodialysis or continuous ambulatory peritoneal dialysis (CAPD) as shown below:</p>\r\n\r\n<ul>\r\n	<li>CrCl &ge;50 ml/min:&nbsp;0.5 mg every 24 hours</li>\r\n	<li>CrCl&nbsp;30 to &lt;50 ml/min:&nbsp;0.5 mg every 48 hours</li>\r\n	<li>CrCl 10 to &lt;30 ml/min:&nbsp;0.5 mg every 72 hours</li>\r\n	<li>CrCl &lt;10&nbsp;ml/min or&nbsp; Hemodialysis or CAPD:&nbsp;0.5 mg every 7 days</li>\r\n</ul>', '2022-02-20 01:31:30', '2022-06-10 00:42:34'),
(505, 505, '<p>Epalrestat consequently improves peripheral neuropathy due to sorbitol accumulation. It is usually used to improve numbness, pain and abnormality of vibration sensation/heart rate variability associated with diabetic peripheral neuropathy.</p>', '<p>Epalrestat is aldose reductase inhibitor. The aldose reductase inhibitors have a distinct mechanism of action, affecting the underlying disease process in diabetic neuropathy, although the extent of the polyol pathway involvement is yet to be determined. This medicine suppresses accumulation of sorbitol in cells by inhibiting action of aldose reductase which converts glucose of sugar to sorbitol. Epalrestat may improve motor and sensory nerve conduction velocity and subjective neuropathy symptoms.</p>', '<p>In general, for adults, take 1 tablet (50 mg of the active ingredient) at a time, 3 times a day before meals. The dosage may be adjusted according to your age and symptoms.</p>\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>', '<p>There are no known drug interactions and none well documented.</p>', '<ul>\r\n	<li>If you have previously experienced any allergic reactions (itch, rash, etc.) to any medicines.</li>\r\n	<li>If you are pregnant or breastfeeding.</li>\r\n	<li>If you are taking any other medicinal products. (Some medicines may interact to enhance or diminish medicinal effects. Beware of over-the-counter medicines and dietary supplements as well as other prescription medicines.)</li>\r\n</ul>', '<p>The most commonly reported adverse reactions include abdominal pain, nausea, rash, itch, erythema and blister.</p>', '<p>Pregnancy category is not classified. FDA has not yet classified the drug into a specified pregnancy category</p>', '<p>Your urinary color may turn yellowish brown or red due to color of the component of this medicine. Do not worry about the change.</p>', NULL, '<p>Aldose reductase inhibitor</p>', '<p>Keep out of the reach of children. Store away from direct sunlight, heat and moisture.</p>', NULL, '2022-02-20 01:31:53', '2022-06-10 00:44:04'),
(506, 506, '<p>Improvement of muscular hypertonic symptoms in the following diseases Cervical syndrome, periarthritis of the shoulder, lumbago. Spastic paralysis in the following disease: Cerebrovascular disease,spastic spinal paralysis, cervical spondylosis, postoperative sequelae (including cerebrospinal tumor), sequelae to trauma (spinal trauma, head injury), amyotrophic lateral sclerosis, cerebral palsy, spinocerebellar degeneration, spinal vascular diseases and other encephalomyelopathies.</p>', '<p>Eperisone is centrally-acting skeletal muscle relaxant used to improve myotonic symptoms.</p>', '<p>For adults: Usually 3 tablets per day in three divided doses after each meal. The dosage should be adjusted depending on the patient age and severity of symptoms.</p>\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>', '<p>Avoid concomitant use with tolperisone HCl and methocarbamol.</p>', '<p>Eperisone is contraindicated in patients with a history of hypersensitivity to Eperisone Hydrochloride.</p>', '<p>The side effects of Eperisone are very rare, only a few cases have been observed. These are excessive relaxation, stomachache, nausea, vertigo, anorexia, drowsiness, skin rashes, diarrhea, vomiting, indigestion, GI disturbances, insomnia, headache, constipation, etc.</p>', '<p>Eperisone should only be used in pregnant women if the expected therapeutic benefits are evaluated to outweight the possible risks of treatment. The safety of Eperisone has not been established in pregnant women. The drug should not be used during lactation.</p>', NULL, NULL, '<p>Centrally acting Skeletal Muscle Relaxants</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-02-20 01:32:19', '2022-06-10 00:45:37'),
(507, 507, '<p>Ephedrine is indicated to reverse hypotension induced by spinal or epidural anaesthesia. It is of little value in hypotensive crisis due to shock, circulatory collapse, or haemorrhage.</p>', '<p>Ephedrine is a stimulant drug, belonging to a group of medicines known as sympathomimetics. Specifically it is both an alpha and beta adrenergic agonist. In addition, Ephedrine enhances the release of norepinephrine, a strong endogenous alpha agonist. The action of this compound is notably similar to that of the body&#39;s primary adrenergic hormone epinephrine (adrenaline), which also exhibits action toward both alpha and beta receptors. When administered, Ephedrine will notably increase the activity of the central nervous system, as well as have a stimulatory effect on other target cells.</p>', '<p>To reverse hypotension induced by spinal or epidural anaesthesia 3 to 6 mg (or at most 9 mg) Ephedrine Hydrochloride is given by slow intravenous injection and repeated every 3 to 4 minutes as required; the maximum total dose is 30 mg. Ephedrine has also been given by intramuscular or subcutaneous injection.</p>\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>', '<p>Administration of Ephedrine may cause a hypertensive crisis in patients receiving an Monoamine Oxidase Inhibitor (including an Reversible Inhibitor of Monoamine Oxidase type A). Ephedrine should be avoided or used with care in patients undergoing anaesthesia with cyclopropane, halothane, or other volatile anaesthetics. An increased risk of arrhythmias may occur if given to patients receiving cardiac glycosides, quinidine, or tricyclic antidepressants, and there is an increased risk of vasoconstrictor or pressor effects in patients receiving ergot alkaloids or oxytocin</p>', '<p>The use of Ephedrine is contraindicated in the presence of coronary thrombosis. It should be used with caution in patients with organic heart disease, cardiac decompensation, hyperthyroidism, hypertension, and angina pectoris, and in patients receiving digitalis.</p>', '<p>Adverse effects reported are nausea, vomiting, anorexia; tachycardia (sometimes bradycardia), arrhythmias, anginal pain, vasoconstriction with hypertension, vasodilation with hypotension, dizziness and flushing; dyspnoea; headache, anxiety, restlessness, confusion, psychoses, insomnia, tremor; difficulty in micturition, urine retention; sweating, hypersalivation; changes in blood-glucose concentration; very rarely angle-closure glaucoma.</p>', '<p><strong>Pregnancy</strong>: Category C. 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.<br />\r\n<br />\r\n<strong>Lactation</strong>: Ephedrine Hydrochloride is distributed into breast milk, and therefore Ephedrine Hydrochloride Injection is not recommended for use during lactation because of the risk of adverse effects in the infant.</p>', '<p>Ephedrine should be given with care to patients with hyperthyroidism, diabetes mellitus, ischemic heart disease, hypertension, renal impairment, or angle-close glaucoma. In patients with prostatic enlargement, Ephedrine may increase difficulty with micturition. Use in pregnancy and lactation: Increased fetal heart rate reported with parenteral Ephedrine. Irritability and disturbed sleep have been reported in breast-fed infants.</p>', '<p>When given in sufficiently large doses Ephedrine gives rise in most patients to certain minor reactions, such as giddiness, headache, nausea, vomiting, sweating, palpitations, difficulty in micturition, tremors, anxiety, restlessness and insomnia; some patients may exhibit these symptoms even with the usual therapeutic dosage.</p>', '<p>Other adrenoceptor stimulants, Vasoconstrictor/Venotonic</p>', '<p>Store in a cool, dry place, protected from light. Keep all medicines out of reach of children.</p>', NULL, '2022-02-20 01:32:45', '2022-06-10 00:47:21'),
(508, 508, '<p>Epinastine sterile ophthalmic solution is indicated for the treatment of signs and symptoms of allergic conditions of the anterior segment of the eye.</p>', '<p>Epinastine is a topically active antihistamine that antagonizes both histamine H1&nbsp;and H2&nbsp;receptors. Moreover, it has mast cell stabilizing activity and prevents the release of inflammatory mediators from the blood vessel. Epinastine does not penetrate the blood-brain barrier and therefore is not expected to induce side effects on the central nervous system.</p>', '<p>Instill 1 drop in the affected eye(s) twice daily.</p>\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>', NULL, '<p>Contraindicated in patients who are hypersensitive to Epinastine or to any of the components of this preparation.</p>', '<p>The most frequently reported side effects are mild burning sensation, folliculosis, hyperemia, pruritus, cold symptoms and upper respiratory infections.</p>', '<p>There are no adequate and well-controlled studies on pregnant women. Epinastine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether Epinastine is excreted in human milk. Caution should be exercised when Epinastine is administered to a nursing mother.</p>', '<p>For ophthalmic use only. Patients should be advised not to wear contact lenses if their eye is red.</p>', NULL, '<p>Ophthalmic Non-Steroid drugs</p>', '<p>Store in a cool &amp; dry place, protect from light. Do not use longer than one month after the first opening. Keep out of the reach of children.</p>', '<p><strong>Use in children</strong>: Safety and effectiveness in children below the age of 3 years have not been established.<br />\r\n<br />\r\n<strong>Use in elderly patients</strong>: No overall differences in safety and effectiveness have been observed between elderly and other adult patients.</p>', '2022-02-20 01:33:09', '2022-06-10 00:49:24'),
(509, 509, '<p>Epirubicin Injection is an anthracycline topoisomerase II inhibitor indicated as a component of adjuvant therapy in patients with evidence of axillary node tumor involvement following resection of primary breast cancer</p>', '<p>Epirubicin, an anthracycline with cytotoxic properties. It inhibits DNA and RNA synthesis by steric obstruction after intercalating between DNA base pairs that triggers DNA cleavage by by topoisomerase II. It also inhibits DNA helicase and generates cytotoxic free radicals.</p>', '<p>Acute leukaemias; Lymphoma; Multiple myeloma; Solid tumours:</p>\r\n\r\n<ul>\r\n	<li>As a single agent: 60-90 mg/m2&nbsp;3-4 wkly.</li>\r\n	<li>Max (total cumulative dose): 0.9-1 g/m2.</li>\r\n	<li>Palliative care: 12.5-25 mg/m2&nbsp;once wkly.</li>\r\n</ul>\r\n\r\n<p>Adjuvant treatment in axillary-node positive breast cancer: Recommended starting doses: 100-120 mg/m2&nbsp;as a single dose on day 1 or as 2 divided doses on days 1 and 8 of each 28-day cycle. Repeat for 6 cycles.<br />\r\n<br />\r\nIntravesical Local treatment of bladder carcinoma: As 0.1% soln: 50 mg/wk for 8 wk; reduce dose if chemical cystitis develops.<br />\r\n<br />\r\nFor carcinoma in-situ: 80 mg in 50 mL wkly.<br />\r\n<br />\r\nFor prevention of recurrence in patients who have undergone transurethral resection: 50 mg/wk for 4 wk, followed by 50 mg/mth for 11 mth; retain soln in the bladder for 1 hr during each administration.</p>\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>', '<p>Paclitaxel and other anthracyclines. Cimetidine, heparin. Antineoplastic drugs, cardiotoxic drugs, radiation, hepatoactive drugs.</p>', '<p>Cardiac impairment, severe or recent Ml; previous full cumulative doses of anthracyclines. Hypersensitivity; severe hepatic dysfunction. Not for intravesical use where invasive tumours have penetrated the bladder wall; urinary infections, bladder inflammation or catheterisation problems. Pregnancy, lactation.</p>', '<p>In early breast cancer, acute adverse events occurring in &ge;10% of patients are leucopenia, neutropenia, anemia, thrombocytopenia, amenhorrhea, lethargy, nausea/vomiting, mucositis, diarrhea, infection, conjunctivitis/keratitis, alopecia, local toxicity and rash/itch.<br />\r\n<br />\r\nLong term adverse events occurring at a frequency of 1-2% are asymptomatic drops in LVEF and CHF and secondary leukemia.</p>', '<p>Discontinue nursing prior to taking&nbsp;Epirubicin. Not known if excreted in breast milk</p>', '<p>Previous extensive radiotherapy, bone infiltration by tumour, severe renal and hepatic dysfunction. May cause tumor lysis syndrome or radiation recall. Elderly women &gt;70 yr. CV disease, hypertensive cardiomyopathy; monitor hematological and cardiac function regularly. Extravasation during IV admin may result in severe local tissue necrosis. Do not give via IM/SC routes as extravasation can lead to severe local necrosis</p>', NULL, '<p>Cytotoxic Chemotherapy</p>', NULL, NULL, '2022-02-20 01:33:37', '2022-06-10 00:51:23'),
(510, 510, '<p>Congestive heart failure after an acute myocardial infarction, Hypertension.</p>', '<p>Eplerenone selectively binds to the mineralocorticoid receptor and blocks the binding of aldosterone, a key component in the renin-angiotensin-aldosterone-system, which is involved in the regulation of BP and pathophysiology of CV disease. Aldosterone binds to mineralocorticoid receptors in both epithelial (e.g. kidney, GI tract) and nonepithelial (e.g. heart, blood vessels, brain) tissues; causing increases in BP by inducing Na reabsorption, vascular remodelling, water retention, endothelial dysfunction and possibly other mechanisms.</p>', '<p><strong>Congestive Heart Failure after an acute Myocardial Infarction:&nbsp;</strong>The recommended dose of Eplerenone is 50 mg once daily. Treatment should be initiated at 25 mg once daily and titrated to the target dose of 50 mg once daily preferably within 4 weeks as tolerated by the patient. Eplerenone may be administered with or without food.<br />\r\n<br />\r\n<strong>Hypertension:</strong>&nbsp;Eplerenone may be used alone or in combination with other antihypertensive agents. The recommended starting dose of Eplerenone is 50 mg administered once daily. For patients with an inadequate blood pressure response to 50 mg once daily the dosage of Eplerenone should be increased to 50 mg twice daily. Higher dosages of Eplerenone are not recommended either because they have no greater effect on blood pressure than 100 mg or because they are associated with an increased risk of hyperkalemia.</p>\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>', '<p>May increase risk of hyperkalaemia with ACE inhibitors and/or angiotension receptor blocker, ciclosporin, tacrolimus, trimethoprim. May reduce antihypertensive effect with NSAIDs, glucocorticoids, tetracosactide. May enhance hypotensive effect of &alpha;1-blockers (e.g. alfuzosin, prazosin), TCAs, amifostine, baclofen, neuroleptics. May increase plasma level with mild to moderate CYP3A4 inhibitors (e.g. fluconazole, erythromycin, saquinavir, amiodarone, diltiazem, verapamil).</p>', '<p>Eplerenone is contraindicated in-</p>\r\n\r\n<ul>\r\n	<li>Hyperkalaemia</li>\r\n	<li>Severe renal impairment (creatinine clearance less than 30 ml/min)</li>\r\n	<li>Severe hepatic impairment</li>\r\n	<li>Concomitant use with potent CYP3A4 inhibitors like Ketoconazole, Itraconazole, Nefazodone, Troleandomycin, Clarithromycin, Ritonavir, and Nelfinavir or other</li>\r\n	<li>Potassium-sparing diuretics are also contraindicated</li>\r\n</ul>', '<p>Headache, dizziness, diarrhea, stomach pain, nausea, cough or flu-like symptoms may occur. Symptoms of a serious allergic reaction like: rash, itching, swelling, severe dizziness, trouble breathing can occur.</p>', '<p><strong>Pregnancy</strong>: There are no adequate and well-controlled studies in pregnant women. Eplerenone should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.<br />\r\n<br />\r\n<strong>Lactation</strong>: The concentration of Eplerenone in human breast milk after oral administration is unknown. Because many drugs are excreted in human milk and because of the unknown potential for adverse effects on the nursing infant, 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>Eplerenone should be used with caution in hyperkalemia, severe kidney disease, diabetic patients with congestive heart failure after an acute myocardial infarction including those with proteinuria.</p>', '<p><strong>Symptoms:</strong>&nbsp;Hyperkalaemia, hypotension.<br />\r\n<br />\r\n<strong>Management:</strong>&nbsp;Symptomatic and supportive treatment. Admin activated charcoal. Initiate standard therapy for hyperkalaemia.</p>', '<p>Potassium-sparing diuretics, Potassium-sparing diuretics &amp; Aldosterone antagonists</p>', '<p>Store below 30&deg;C in a cool and dry place, protected from light and moisture. Keep out of children&rsquo;s reach.</p>', '<p><strong>Pediatric use:</strong>&nbsp;The safety and effectiveness of Eplerenone has not been established in pediatric patients.<br />\r\n<br />\r\n<strong>Geriatric use:</strong>&nbsp;No differences in overall incidence of effectivity or safety was observed in elderly patients.</p>', '2022-02-20 01:33:59', '2022-06-10 00:53:08');
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
(511, 511, '<p>Epoetin Beta is indicated for:</p>\r\n\r\n<ul>\r\n	<li>Treatment of symptomatic anemia associated with chronic kidney disease (CKD) in patients on dialysis.</li>\r\n	<li>Treatment of symptomatic renal anemia in patients not yet undergoing dialysis.</li>\r\n	<li>Prevention of anemia of prematurity in infants with a birth weight of 750 to 1500 g and a gestational age of less than 34 weeks.</li>\r\n	<li>Treatment of symptomatic anemia in adult patients with non-myeloid malignancies receiving chemotherapy.</li>\r\n	<li>Increasing the yield of autologous blood from patients in a pre-donation programme.</li>\r\n</ul>\r\n\r\n<p>Its use in this indication must be balanced against the reported increased risk of thromboembolic events. Treatment should only be given to patients with moderate anemia (Hb 10&ndash;13 g/dl [6.21&ndash;8.07 mmol/l], no iron deficiency) if blood conserving procedures are not available or insufficient when the scheduled major elective surgery requires a large volume of blood (4 or more units of blood for females or 5 or more units for males).</p>', '<p>Epoetin beta is identical in its amino acid and carbohydrate composition to erythropoietin that has been isolated from the urine of anemic patients. Erythropoietin is a glycoprotein that stimulates the formation of erythrocytes from its committed progenitors. It acts as a mitosis-stimulating factor and differentiation hormone. Erythropoietin is a glycoprotein that, as a growth factor, primarily stimulates the formation of erythrocytes from its committed progenitors. It acts as a mitosis-stimulating factor and differentiation hormone.</p>', '<p>Therapy with Recormon should be initiated by physicians experienced in the above- mentioned indications. As anaphylactoid reactions were observed in isolated cases, it is recommended that the first dose be administered under medical supervision. Substitution by any other biological medicinal product requires the consent of the prescribing physician.<br />\r\n<br />\r\n<strong>Lyophilisate and solvent for solution for injection</strong>: The multidose preparation can be used for several patients. To avoid the risk of cross-infection, always follow aseptic techniques and use disposable sterile syringes and needles for each administration.<br />\r\n<br />\r\n<strong>Solution for injection in pre-filled syringe</strong>: The Recormon pre-filled syringe is ready for use. Under no circumstances should more than one dose be administered per syringe; the medicinal product is for single use only.<br />\r\n<br />\r\n<strong>Treatment of patients with anemia due to chronic kidney disease</strong>: The reconstituted solution can be administered subcutaneously or intravenously. In case of intravenous administration, the solution should be injected over approx. 2 minutes, e.g. in hemodialysis patients via the arterio-venous fistula at the end of dialysis. For non-hemodialysed patients, subcutaneous administration should always be preferred in order to avoid puncture of peripheral veins. In CKD patients, the aim of treatment is to reach a target Hb level of 10&ndash;12 g/dl. An Hb level of 12 g/dl should not be exceeded. If the rise in hemoglobin is greater than 2 g/dl (1.3 mmol/l) in 4 weeks, an appropriate dose reduction should be considered. In the presence of hypertension or existing cardiovascular, cerebrovascular or peripheral vascular diseases, the weekly increase in Hb and the target Hb should be determined individually taking into account the clinical picture. Patients should be monitored closely to ensure that the lowest dose of Recormon is used to provide adequate control of the symptoms of anemia.</p>\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>', '<p>No dedicated clinical interaction studies have been performed. Clinical experience has not given evidence for potential interaction of Recormon with other medicinal products. In animal experiments epoetin did not increase the myelotoxicity of cytostatic medicinal products like etoposide, cisplatin, cyclophosphamide, and fluorouracil.</p>', '<p>Epoetin Beta is contraindicated in patients with:</p>\r\n\r\n<ul>\r\n	<li>Known hypersensitivity to the active substance or any of the excipients.</li>\r\n	<li>Poorly controlled hypertension.</li>\r\n</ul>\r\n\r\n<p>In the indication &quot;increasing the yield of autologous blood&quot;, Recormon must not be used<br />\r\nin patients who, in the month preceding treatment, have suffered a myocardial infarction<br />\r\nor stroke, patients with unstable angina pectoris, or patients who are at increased risk of<br />\r\ndeep venous thrombosis such as those with a history of venous thromboembolic disease.</p>', '<p>Rarely (&ge;1/10,000 to &le;1/1,000), skin reactions such as rash, pruritus, urticaria or injection site reactions may occur. In very rare cases (&le;1/10,000) anaphylactoid reactions have been reported. However, in controlled clinical studies no increased incidence of hypersensitivity reactions was found. In very rare cases (&le;1/10,000), particularly when starting treatment, flu-like symptoms such as fever, chills, headaches, pain in the limbs, malaise and/or bone pain have been reported. These reactions were mild or moderate in nature and subsided after a couple of hours or days.</p>', '<p><strong>Pregnancy</strong>: Animal studies do not indicate direct or indirect harmful effects with respect to pregnancy, embryonal/fetal development, parturition or postnatal development. For epoetin beta, all safety information with regard to exposure to Recormon during pregnancies has been gained from post-marketing experience. A review of the available post-marketing data does not show evidence of a causal association between harmful effects with respect to pregnancy, embryonal/fetal development or postnatal development and treatment with Recormon. However in the absence of clinical study data, caution should be exercised when prescribing to pregnant women.<br />\r\n<br />\r\n<strong>Lactation</strong>: Only limited experience in human lactation has been gained. Endogeneous erythropoietin is excreted in breast milk and readily absorbed by the neonatal gastrointestinal tract. A decision on whether to continue or discontinue breastfeeding or to continue or discontinue therapy with epoetin beta should be made taking into account the benefit of breastfeeding to the child and the benefit of epoetin beta therapy to the woman.</p>', NULL, '<p>The therapeutic range of Recormon is wide and individual response to therapy must be considered when Recormon treatment is initiated. Overdose can result in manifestations of an exaggerated pharmacodynamic effect, e.g. excessive erythropoiesis which may be associated with life-threatening complications of the cardiovascular system. In case of excessive hemoglobin levels, Recormon should be temporarily withheld. If clinically indicated, phlebotomy may be performed.</p>', '<p>Drugs for Haemolytic Hypoplastic &amp; Renal Anemia</p>', '<p>Store in a refrigerator 2&deg;C&ndash;8&deg;C. Keep the vial/cartridge/pre-filled syringe in the outer carton, in order to protect from light</p>\r\n\r\n<p>&nbsp;</p>', '<p><strong>Pediatric use</strong>: Results of pediatric clinical studies have shown that, on average, the younger the patients, the higher the Recormon doses required. Nevertheless, the recommended dosing schedule should be followed as the individual response cannot be predicted.<br />\r\n<br />\r\n<strong>Geriatric use</strong>: No dedicated studies in geriatric patients were performed. A large proportion of geriatric patients were included in clinical trials with Recormon. A need for special dose adjustments in the geriatric population was not identified.<br />\r\n<br />\r\n<strong>Hepatic Impairment</strong>: No dedicated clinical trials were conducted in patients with hepatic impairment. No special dosage Instructions are available.</p>', '2022-02-20 01:34:16', '2022-06-10 00:55:14'),
(512, 512, '<p>Eptifibatide is indicated in-</p>\r\n\r\n<ul>\r\n	<li>Patients with acute coronary syndrome (unstable angina/non-ST- segment elevation myocardial infarction), including patients who are to be managed medically and those undergoing percutaneous coronary intervention (PCI).</li>\r\n	<li>Patients undergoing PCI, including those undergoing intracoronary stenting.</li>\r\n</ul>', '<p>Eptifibatide is a cyclic heptapeptide containing six amino acids and one mercaptopropionyl (des-amino cysteinyl) residue. Integril binds to the platelet receptor glycoprotein (GP) IIb/IIIa of human platelets and reversibly inhibits platelet aggregation by preventing the binding of fibrinogen, von Willebrand factor, and other adhesive ligands to GP IIb/IIIa.</p>', '<p>Patients with ACS (Acute Coronary Syndrome):</p>\r\n\r\n<p><strong>Normal renal function</strong>: 180 &mu;g/kg IV bolus of as soon as possible following diagnosis followed by a continuous infusion of 2 &mu;g/kg/min.<br />\r\n<br />\r\n<strong>Creatinine clearance</strong>: 180 &mu;g/kg IV bolus of as soon as possible following diagnosis followed by a continuous infusion of 1 &mu;g/kg/min<strong><strong>.</strong></strong></p>\r\n\r\n<ul>\r\n	<li>Infusion should continue until hospital discharge or initiation of coronary artery bypass graft surgery (CABG), up to 72 hours.</li>\r\n	<li>If a patient is to undergo PCI, the infusion should be continued until hospital discharge or for up to 18 to 24 hours after the procedure, whichever comes first, allowing for up to 96 hours of therapy.</li>\r\n</ul>\r\n\r\n<p>Patients with PCI ( Percutaneous Coronary Intervention):</p>\r\n\r\n<p><strong>Normal renal function</strong>: 180 &mu;g/kg IV bolus immediately before PCI followed by a continuous infusion of 2 &mu;g/kg/min &amp; a second bolus of 180 &mu;g/kg (given 10 minutes after the first bolus)<br />\r\n<br />\r\n<strong>Creatinine clearance</strong>: 180 &mu;g/kg IV bolus immediately before PCI followed by a continuous infusion of 1 &mu;g/kg/min &amp; a second bolus of 180 &mu;g/kg (given 10 minutes after the first bolus)</p>\r\n\r\n<ul>\r\n	<li>Infusion should be continued until hospital discharge, or for up to 18 to 24 hours, whichever comes first. A minimum of 12 hours of infusion is recommended.</li>\r\n	<li>In patients who undergo CABG surgery, INTEGRILIN infusion should be discontinued prior to surgery.</li>\r\n</ul>\r\n\r\n<p>1. Integril solutions should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.<br />\r\n<br />\r\n2. Integril may be administered in the same IV line as alteplase, atropine, dobutamine, heparin, lidocaine, meperidine, metoprolol, midazolam, morphine, nitroglycerin, or verapamil. Integril should not be administered through the same IV line as furosemide.<br />\r\n<br />\r\n3. Integril may be administered in the same IV line with 0.9% NaCl or 0.9% NaCl/5% dextrose. With either vehicle, the infusion may also contain up to 60 mEq/L of KCl.<br />\r\n<br />\r\n4. The bolus dose(s) of Integril should be withdrawn from the 10-mL vial into a syringe. The bolus dose(s) should be administered by IV push.<br />\r\n<br />\r\n5. Immediately following the bolus dose administration, a continuous infusion of Integril should be initiated. When using an intravenous infusion pump, Integril should be administered undiluted directly from the 100 mL vial. The 100-mL vial should be spiked with a vented infusion set. Care should be taken to center the spike within the circle on the stopper top.</p>\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>', '<p>&bull; In various clinical studies, eptifibatide was used concomitantly with unfractionated heparin and aspirin. In another study, clopidogrel or ticlopidine were used routinely starting the day of PCI. Because eptifibatide inhibits platelet aggregation, caution should be employed when it is used with other drugs that affect hemostasis, including thrombolytics, oral anticoagulants, NSAIDS and dipyridamole. To avoid potentially additive pharmacologic effects, concomitant treatment with other inhibitors of platelet receptor GP IIb/IIIa should be avoided<br />\r\n<br />\r\n&bull; Enoxaparin did not alter the pharmacokinetics of Integril</p>', '<p>contraindicated in patients with:</p>\r\n\r\n<ul>\r\n	<li>A history of bleeding diathesis, or evidence of active abnormal bleeding within the previous 30 days.</li>\r\n	<li>Severe hypertension (systolic blood pressure &gt; 200 mm Hg or diastolic blood pressure &gt; 110 mm Hg) not adequately controlled on antihypertensive therapy.</li>\r\n</ul>', '<p>Bleeding is the most common adverse effect. Adverse reactions include intracranial hemorrhage &amp; stroke, thrombocytopenia, allergic reactions and hypotension.</p>', '<p><strong>Pregnancy</strong>: Category B. Animal studies revealed no evidence of harm to the fetus due to Integril. There are, however, no adequate and well-controlled studies in pregnant women with Integril.<br />\r\n<br />\r\n<strong>Lactating Mothers</strong>: It is not known whether Integril is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Integril is administered to a nursing mother.</p>', NULL, '<p>&bull; There has been only limited experience with overdosage of Integril. Symptoms of acute toxicity were loss of righting reflex, dyspnea, ptosis, and decreased muscle tone in rabbits, and petechial hemorrhages in the femoral and abdominal areas of monkeys.<br />\r\n<br />\r\n&bull; From in vitro studies, eptifibatide is not extensively bound to plasma proteins and thus may be cleared from plasma by dialysis.</p>', '<p>Anti-platelet drugs</p>', '<p>&bull; Vials should be stored refrigerated at 2-8&deg; C<br />\r\n&bull; Vials may be transferred to room temperature storage for up to 2 months.<br />\r\n&bull; Unused portion left in the vial should be discarded.<br />\r\n&bull; Vials should be protected from light until administration.</p>', '<p><strong>Use in Children</strong>: Safety and effectiveness of Integril in pediatric patients have not been studied.</p>', '2022-02-20 01:34:37', '2022-06-10 00:57:08'),
(513, 513, '<p>Erdosteine is a mucolytic drug used in the treatment of acute and chronic respiratory diseases. It also improves the symptoms associated with short episodes of chronic bronchitis.</p>', '<p>Erdosteine is a prodrug that is metabolised into&nbsp;N-thiodiglycolyl-homocysteine whereby free thiol groups are formed leading to the opening of the disulphide bonds of the bronchial mucoproteins, thus reducing the viscosity of mucus and purulent sputum. It also antagonises the local formation of free radicals and inhibits elastase enzyme activity and bacterial adhesion to epithelial cells.</p>', '<p>The usual dose of elderly patients and adults above 18 years is 1 capsule twice daily for 10 days. But study shows that in chronic cases Erdosteine can be given up to 12 months or as directed by the physician. Erdosteine capsule may be taken with or without food.</p>\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>', NULL, '<p>It is contraindicated to patients who have hypersensitivity to Erdosteine. It should not be used in patients with creatinine clearance &lt;25 ml/min, or with severe liver failure.</p>', '<p>Common side effect is epigastric pain. Other side effects include headache, cold, taste alterations, nausea, vomiting, diarrhea, angioedema and other skin allergic reactions.</p>', '<p>The use of Erdosteine in pregnant or breast-feeding women is not recommended.</p>', '<p>It should be used with caution in mild liver failure. In that case, should not exceed a dose of 300 mg per day.</p>', NULL, '<p>Cough expectorants &amp; mucolytics</p>', '<p>Keep in a dry place away from light and heat. Keep out of reach of children</p>', '<p>Renal Impairment: CrCl &lt;25 ml/min: Contraindicated.<br />\r\n<br />\r\nHepatic Impairment:</p>\r\n\r\n<ul>\r\n	<li>Mild to moderate: Max: 300 mg daily.</li>\r\n	<li>Severe: Contraindicated.</li>\r\n</ul>', '2022-02-20 01:34:58', '2022-06-10 00:59:06'),
(514, 514, '<p>Ergotamine Tartrate and caffeine are indicated as therapy to abort or prevent vascular headache; e.g., migraine, migraine variants or so-called &ldquo;histaminic cephalalgia.&rdquo;</p>', '<p>Ergotamine is an &alpha;-adrenergic blocker with a direct stimulating effect on the smooth muscle of peripheral and cranial blood vessels, it also depresses central vasomotor centers.<br />\r\n<br />\r\nCaffeine is also a cranial vasoconstrictor</p>', '<p>Usual Adult Dose for Cluster Headache:</p>\r\n\r\n<p><strong>Oral, Sublingual</strong>: 2 mg ergotamine in fixed combination with caffeine given as quickly as possible after the first symptom of headache. Additional 1 mg doses can be given every 30 minutes until the headache has been aborted or until a total dose of 6 mg has been reached or 10 mg/week.<br />\r\n<br />\r\n<strong>Rectal</strong>: 2 mg ergotamine in fixed combination with caffeine given as quickly as possible after the first symptom of headache. An additional 2 mg dose can be given 1 hour later if the first dose fails to abort the headache. The total dose should not exceed 4 mg/attack or 10 mg/week.</p>\r\n\r\n<p><br />\r\nUsual Adult Dose for Migraine:</p>\r\n\r\n<p><strong>Oral, Sublingual</strong>: 2 mg ergotamine in fixed combination with caffeine given as quickly as possible after the first symptom of headache. Additional 1 mg doses can be given every 30 minutes until the headache has been aborted or until a total dose of 6 mg has been reached or 10 mg/week.<br />\r\n<br />\r\n<strong>Rectal</strong>: 2 mg ergotamine in fixed combination with caffeine given as quickly as possible after the first symptom of headache. An additional 2 mg dose can be given 1 hour later if the first dose fails to abort the headache. The total dose should not exceed 4 mg/attack or 10 mg/week.</p>\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>', NULL, '<p>Not to be used with potent inhibitors of CYP3A4 and protease inhibitors. Hyperthyroidism, renal or hepatic impairment. Pre existing vascular disease including coronary disease, obliterative vascular disease, angina, claudication, peripheral ischaemia, Raynaud&#39;s syndrome and hypertension. Not to be used when there is sepsis. Pregnancy and lactation</p>', '<p>Increased BP, hypotension, rapid and weak pulse, palpitations, arrhythmias, precordial pain, coronary infarction, fibrotic thickening of the heart valves. Cerebral ischaemia and thrombosis, blurred vision, sleep disturbances, urinary retention, muscle cramps and joint pains.<br />\r\n<br />\r\nGI symptoms such as nausea, vomiting, constipation, abdominal pain. Dysaesthesia, paraesthesia, formication, tremor, convulsions, headache, extrapyramidal effects. Anxiety, depression, confusion, hallucinations, psychomotor impairment.</p>', '<p><strong>Pregnancy:&nbsp;</strong>Category X. This medicine should not be used during pregnancy as it may be harmful to the unborn baby.<br />\r\n<br />\r\n<strong>Lactation:</strong>&nbsp;Significant amounts of this medicine may pass into breast milk. It should not be used by breastfeeding mothers as it may be harmful to the nursing infant.</p>', '<p>Not to be taken regularly or used for migraine prophylaxis. Increased risk of arterial constriction and other symptoms of ergotism. Discontinue treatment when symptoms of arterial occlusion occur e.g. numbness and tingling of the extremities. Caution when used in patients with infective hepatitis, cardiac disease or anaemia. GI tract obstructive disease, glaucoma, prostatic hypertrophy or urinary retention may be worsened by cyclizine. May increase risk of retroperitoneal and/or pleuropulmonary fibrosis. Not recommended for use with other vasoconstrictors. Elderly.</p>', '<p>Acute overdosage:</p>\r\n\r\n<ul>\r\n	<li><strong>Symptoms</strong>: Nausea, vomiting, diarrhoea, extreme thirst, coldness, weakness, tingling and itching of the skin, rapid and weak pulse, hypotension, shock, confusion, convulsions and unconsciousness. BP may be difficult to measure; may result in fatalities. Further symptoms of peripheral vasoconstriction or CV disturbances may occur but be delayed.</li>\r\n	<li><strong>Treatment</strong>&nbsp;includes using activated charcoal to reduce absorption. General supportive measures should be instituted. IV vasodilators such as sodium nitroprusside infusion may be required to relieve vasospasm. Peritoneal dialysis and forced diuresis may be used to remove ergotamine from the body.</li>\r\n</ul>\r\n\r\n<p>Chronic overdosage:</p>\r\n\r\n<ul>\r\n	<li><strong>Symptoms</strong>: Peripheral ischaemia of the extremities, especially the feet and legs. Gangrene may develop in the toes and fingers. Anginal pain, tachycardia or bradycardia and BP fluctuations may occur. Excessive use may lead to pleural and peritoneal fibrosis. Rebound headache may occur and is a major withdrawal symptom following the development of ergotamine dependence.</li>\r\n	<li><strong>Treatment:</strong>&nbsp;IV vasodilators e.g. nitroprusside and nitroglycerin may be used to re-establish normal blood flow. Captopril may be used to reverse the effects of chronic overdosage with ergotamine.</li>\r\n</ul>', '<p>Ergot Alkaloids</p>', '<p>Store below 25&deg;C.</p>', '<p><strong>Pediatric Use</strong>: Safety and effectiveness in pediatric patients have not been established.<br />\r\n<br />\r\n<strong>Renal Dose Adjustments</strong>: Contraindicated in patients with renal dysfunction<br />\r\n<br />\r\n<strong>Liver Dose Adjustments</strong>: Contraindicated in patients with liver dysfunction</p>', '2022-02-20 01:35:28', '2022-06-10 01:02:59'),
(515, 515, '<p>Eribulin Mesylate is indicated for the treatment of patients with metastatic breast cancer who have previously received at least two chemotherapeutic regimens for the treatment of metastatic disease. Prior therapy should have included an anthracycline and a taxane in either the adjuvant or metastatic setting.</p>', '<p>Eribulin inhibits the growth phase of microtubules without affecting the shortening phase and sequesters tubulin into nonproductive aggregates. Eribulin exerts its effects via a tubulin-based antimitotic mechanism leading to G2/M cell-cycle block, disruption of mitotic spindles, and, ultimately, apoptotic cell death after prolonged mitotic blockage.</p>', '<p>The recommended dose of Eribulin Mesylate is 1.4 mg/m2&nbsp;administered intravenously over 2 to 5 minutes on Days 1 and 8 of a 21-day cycle.<br />\r\n<br />\r\nThe recommended dose of Eribulin Mesylate in patients with mild hepatic impairment (Child-Pugh A) is 1.1 mg/m2&nbsp;administered intravenously over 2 to 5 minutes on Days 1 and 8 of a 21-day cycle.<br />\r\n<br />\r\nThe recommended dose of Eribulin Mesylate in patients with moderate hepatic impairment (Child-Pugh B) is 0.7 mg/m2&nbsp;administered intravenously over 2 to 5 minutes on Days 1 and 8 of a 21-day cycle.<br />\r\n<br />\r\nThe recommended dose of Eribulin Mesylate in patients with moderate renal impairment (creatinine clearance of 30-50 mL/min) is 1.1 mg/m2&nbsp;administered intravenously over 2 to 5 minutes on Days 1 and 8 of a 21-day cycle.</p>\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>', '<p><strong>Effects of Other Drugs on Eribulin Mesylate</strong>: No drug-drug interactions are expected with CYP3A4 inhibitors or P-gp inhibitors. The effect of ketoconazole, a strong inhibitor of cytochrome P450 3A4 (CYP3A4) and a P-gp inhibitor, on the pharmacokinetics (PK) of eribulin was studied in an open-label, two-treatment, two-sequence, two-way crossover trial in 12 patients with advanced solid tumors. The mean dose-normalized AUC values were similar when eribulin was administered with or without ketoconazole (ratio of the mean AUC: 0.97; 90% CI: 0.83, 1.12).<br />\r\n<br />\r\n<strong>Effect of Eribulin Mesylate on Other Drugs</strong>: Eribulin does not inhibit CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP2E1 or CYP3A4 enzymes or induce CYP1A2, CYP2C9, CYP2C19 or CYP3A4 enzymes at relevant clinical concentrations. Eribulin is not expected to alter the plasma concentrations of drugs that are substrates of these enzymes</p>', NULL, '<p>The most common adverse reactions (incidence &ge;25%) were neutropenia, anemia, asthenia/fatigue, alopecia, peripheral neuropathy, nausea, and constipation.</p>', '<p>Pregnancy Category D. There are no adequate and well-controlled studies with Eribulin Mesylate in pregnant women. It is not known whether Eribulin Mesylate is excreted into human milk. No studies in humans or animals were conducted to determine if Eribulin Mesylate is excreted into milk. Because many drugs are excreted into human milk and because of the potential for serious adverse reactions in human milk-fed infants from Eribulin Mesylate, a decision should be made whether to discontinue nursing or to discontinue Eribulin Mesylate taking into account the importance of the drug to the mother.</p>', '<p><strong>Neutropenia</strong>: Monitor peripheral blood cell counts and adjust dose as appropriate.<br />\r\n<br />\r\n<strong>Peripheral Neuropathy</strong>: Monitor for signs of neuropathy. Manage with dose delay and adjustment.<br />\r\n<br />\r\n<strong>Use in Pregnancy</strong>: Fetal harm can occur when administered to a pregnant woman.<br />\r\n<br />\r\n<strong>QT Prolongation</strong>: Monitor for prolonged QT intervals in patients with congestive heart failure, bradyarrhythmias, drugs known to prolong the QT interval, and electrolyte abnormalities. Avoid in patients with congenital long QT syndrome.</p>', '<p>Overdosage of Eribulin has been reported at approximately 4 times the recommended dose, which resulted in Grade 3 neutropenia lasting seven days and a Grade 3 hypersensitivity reaction lasting one day. There is no known antidote for Eribulin&nbsp;overdose.</p>', '<p>Targeted Cancer Therapy</p>', '<p>Store at 25&deg;C; excursions permitted to 15&deg;-30&deg;C. Do not freeze. Store the vials in their original cartons.</p>', '<p><strong>Pediatric Use</strong>: The safety and effectiveness of Eribulin&nbsp;in pediatric patients below the age of 18 years have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Study 1 did not include sufficient numbers of subjects aged 65 years and older to determine whether they respond differently from younger subjects. Of the 827 subjects who received the recommended dose and schedule of Eribulin&nbsp;in clinical studies, 15% (121/827) were 65 and older, and 2% (17/827) patients were 75 and older. No overall differences in safety were observed between these subjects and younger subjects.<br />\r\n<br />\r\n<strong>Hepatic Impairment</strong>: A lower starting dose is recommended for patients with mild (Child-Pugh A) and moderate (Child-Pugh B) hepatic impairment. Patients with severe hepatic impairment (Child-Pugh C) were not studied.<br />\r\n<br />\r\n<strong>Renal Impairment</strong>: A lower starting dose is recommended for patients with moderate (CrCl 30-50 mL/min) renal impairment. Patients with severe (CrCl &lt; 30 mL/min) renal impairment were not studied.</p>', '2022-02-20 01:36:08', '2022-06-10 01:05:07'),
(516, 516, '<p>First-line treatment of patients with metastatic Non-Small Cell Lung cancer (NSCLC) whose tumors have Epidermal Growth Factor Receptor (EGFR) exon 19 deletions or exon 21 substitution mutations as detected.<br />\r\n<br />\r\nMaintenance treatment of patients with locally advanced or metastatic NSCLC whose disease has not progressed after four cycles of platinum based first-line chemotherapy.<br />\r\n<br />\r\nTreatment of locally advanced or metastatic NSCLC after failure of at least one prior chemotherapy regimen.<br />\r\n<br />\r\nFirst-line treatment of patients with locally advanced, unresectable or metastatic pancreatic cancer, in combination with gemcitabine.</p>', NULL, '<p><strong>NSCLC</strong>: The recommended daily dose of Erlotinib for NSCLC is 150 mg taken on an empty stomach, i.e., at least one hour before or two hours after the ingestion of food. Treatment should continue until disease progression or unacceptable toxicity occurs.<br />\r\n<br />\r\n<strong>Pancreatic Cancer</strong>: The recommended daily dose of Erlotinib for pancreatic cancer is 100 mg taken once daily in combination with gemcitabine. Take Erlotinib on an empty stomach, i.e., at least one hour before or two hours after the ingestion of food. Treatment should continue until disease progression or unacceptable toxicity occurs.<br />\r\n<br />\r\n<strong>Reduce Erlotinib by 50 mg decrements</strong>: If severe reactions occur with concomitant use of strong CYP3A4 inhibitors (such as atazanavir, Clarithromycin, Indinavir, Itraconazole, Ketoconazole, Nefazodone, Nelfinavir, Ritonavir, Saquinavir, Telithromycin, Voriconazole or grapefruit or grapefruit juice] or when using concomitantly with an inhibitor of both CYP3A4 and CYP1A2 (e.g., Ciprofloxacin).<br />\r\n<br />\r\n<strong>Increase Erlotinib by 50 mg increments as tolerated for</strong>: Concomitant use with CYP3A4 inducers, such as rifampin, rifabutin, rifapentine, phenytoin, carbamazepine, phenobarbital, or St. John&#39;s Wort. Increase doses by 50 mg increments at 2 week intervals to a maximum of 450 mg. Avoid concomitant use, if possible.<br />\r\n<br />\r\n<strong>Concurrent cigarette smoking</strong>: Increase by 50 mg increments at 2 week intervals to a maximum of 300 mg. Immediately reduce the dose of Erlotinib to the recommended dose (150 mg or 100 mg daily) upon cessation of smoking.</p>\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>', '<p><strong>Anticoagulants</strong>: Interaction with coumarin-derived anticoagulants, including warfarin, leading to increased International Normalized Ratio (INR) and bleeding adverse reactions.<br />\r\n<br />\r\n<strong>CYP3A4 inhibitors</strong>: Erlotinib is metabolized predominantly by CYP3A4. Co-treatment with the potent CYP3A4 inhibitor ketoconazole increased Erlotinib AUC by 67%. When Erlotinib was co-administered with Ciprofloxacin, an inhibitor of both CYP3A4 and CYP1A2, the Erlotinib exposure [AUC] and maximum concentration [Cmax] increased by 39% and 17%, respectively.<br />\r\n<br />\r\n<strong>CYP3A4 inducers</strong>: Pre-treatment with the CYP3A4 inducer Rifampicin for 7-11 days prior to Erlotinib decreased Erlotinib AUC by 58% to 80%. Dose modifications are recommended.<br />\r\n<br />\r\n<strong>Drugs affecting gastric pH</strong>: Co-administration of Erlotinib with omeprazole decreased Erlotinib AUC by 46% and co-administration of Erlotinib with Ranitidine 300 mg decreased Erlotinib AUC by 33%.</p>', NULL, '<p>The most common adverse reactions (20%) with Erlotinib from a pooled analysis of studies were rash, diarrhea, anorexia, fatigue, dyspnea, cough, nausea, and vomiting. The following serious adverse reactions, which may include fatalities.</p>\r\n\r\n<ul>\r\n	<li>Interstitial Lung Disease (ILD)</li>\r\n	<li>Renal Failure</li>\r\n	<li>Hepatotoxicity with or without Hepatic Impairment</li>\r\n	<li>Gastrointestinal Perforation</li>\r\n	<li>Bullous and Exfoliative Skin Disorders</li>\r\n	<li>Myocardial Infarction/Ischemia</li>\r\n	<li>Cerebrovascular Accident</li>\r\n	<li>Microangiopathic Hemolytic Anemia with Thrombocytopenia</li>\r\n	<li>Ocular Disorders</li>\r\n	<li>Hemorrhage in Patients Taking Warfarin</li>\r\n</ul>', '<p>Pregnancy category D. Based on its mechanism of action, Erlotinib can cause fetal harm when administered to a pregnant woman. It is not known whether Erlotinib is present in human milk. Because many drugs are present in human milk and because of the potential for serious adverse reactions in nursing infants from Erlotinib, 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>', '<ul>\r\n	<li>Interstitial Lung Disease (ILD): Occurs in 1.1% of patients. Withhold Erlotinib for acute onset of new or progressive unexplained pulmonary symptoms, such as dyspnea, cough and fever. Discontinue Erlotinib if ILD is diagnosed.</li>\r\n	<li>Renal Failure: Monitor renal function and electrolytes, particularly in patients at risk of dehydration. Withhold Erlotinib for severe renal toxicity.</li>\r\n	<li>Hepatotoxicity with or without hepatic impairment including hepatic failure and hepatorenal syndrome: Monitor periodic liver testing. Withhold or discontinue Erlotinib for severe or worsening liver tests.</li>\r\n	<li>Gastrointestinal perforations-discontinue Erlotinib.</li>\r\n	<li>Bullous and exfoliative skin disorders-discontinue Erlotinib.</li>\r\n	<li>Myocardial infarction (Ml)/ischemia: The risk of Ml is increased in patients with pancreatic cancer.</li>\r\n</ul>', '<p>Single oral doses of Erlotinib up to 1,000 mg in healthy subjects and weekly doses up to 1,600 mg in cancer patients have been tolerated. Repeated twice-daily doses of 200 mg single-agent Erlotinib in healthy subjects were poorly tolerated after only a few days of dosing. Based on the data from these studies, an unacceptable incidence of severe adverse reactions, such as diarrhea, rash, and liver transaminase elevation, may occur above the recommended dose. In case of suspected overdose, Erlotinib should be withheld and symptomatic treatment instituted.</p>', '<p>Targeted Cancer Therapy</p>', '<p>Store at a temperature not exceeding 30&deg;C in a dry place. Protect from light and moisture.</p>', '<p><strong>Pediatric use</strong>: The safety and effectiveness of Erlotinib in pediatric patients have not been established.<br />\r\n<br />\r\n<strong>Geriatric use</strong>: No overall differences in safety or efficacy were observed between subjects 65 years and older and those younger than 65.</p>', '2022-02-21 23:17:16', '2022-06-10 01:07:25'),
(517, 517, '<p>Ertapenem is a penem antibacterial indicated in adult patients and pediatric patients (3 months of age and older) for the treatment of the following moderate to severe infections caused by susceptible bacteria:</p>\r\n\r\n<ul>\r\n	<li>Complicated intra-abdominal infections.</li>\r\n	<li>Complicated skin and skin structure infections, including diabetic foot infections without osteomyelitis.</li>\r\n	<li>Community-acquired pneumonia.</li>\r\n	<li>Complicated urinary tract infections including pyelonephritis.</li>\r\n	<li>Acute pelvic infections including postpartum endomyometritis,</li>\r\n	<li>septic abortion and post surgical gynecologic infections.</li>\r\n	<li>Ertapenem is indicated in adults for the prophylaxis of surgical site infection following elective colorectal surgery.</li>\r\n</ul>', '<p>The bactericidal activity of ertapenem results from the inhibition of cell wall synthesis and is mediated through ertapenem binding to penicillin binding proteins (PBPs). In Escherichia coli, it has strong affinity toward PBPs 1a, 1b, 2, 3, 4 and 5 with preference for PBPs 2 and 3. Ertapenem is stable against hydrolysis by a variety of beta-lactamases, including penicillinases, and cephalosporinases and extended spectrum beta-lactamases. Ertapenem is hydrolyzed by metallo-beta-lactamases.</p>', '<p>Ertapenem should be infused over 30 minutes in both the Treatment and Prophylactic regimens. Dosing considerations should be made in adults with advanced or end-stage renal impairment and those on hemodialysis.<br />\r\n<br />\r\nTreatment regimen:</p>\r\n\r\n<ul>\r\n	<li>Adults and pediatric patients 13 years of age and older. The dosage should be 1 gram once a day intravenously or intramuscularly.</li>\r\n	<li>Patients 3 months to 12 years of age should be administered 15 mg/kg twice daily (not to exceed 1 g/day intravenously or intramuscularly.)</li>\r\n	<li>Intravenous infusion may be administered in adults and pediatrics for up to 14 days or intramuscular injection for up to 7 days.</li>\r\n</ul>\r\n\r\n<p>Prophylaxis regimen for adults:</p>\r\n\r\n<ul>\r\n	<li>1 gram single dose given 1 hour prior to elective colorectal surgery.</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>', '<ul>\r\n	<li>Co-administration with probenecid inhibits the renal excretion of ertapenem and is therefore not recommended.</li>\r\n	<li>The concomitant use of ertapenem and valproic acid/divalproex sodium is generally not recommended. Anti-bacterials other than carbapenems should be considered to treat infections in patients whose seizures are well controlled on valproic acid or divalproex sodium.</li>\r\n</ul>', '<p>Known hypersensitivity to product components or anaphylactic reactions to &beta;-lactams. Due to the use of lidocaine HCl as a diluent, Ertapenem administered intramuscularly is contraindicated in patients with a known hypersensitivity to local anesthetics of the amide-type.</p>', '<p><strong>Adults</strong>: The most common adverse reactions (&ge;5%) in patients treated with Ertapenem, including those who were switched to therapy with an oral antimicrobial, were diarrhea, nausea, headache and infused vein complication. In the prophylaxis indication, the overall adverse experience profile was generally comparable to that observed for ertapenem in other clinical trials.<br />\r\n<br />\r\n<strong>Pediatrics</strong>: Adverse reactions in this population were comparable to adults. The most common adverse reactions (&ge;5%) in pediatric patients treated with Ertapenem, including those who were switched to therapy with an oral antimicrobial, were diarrhea, vomiting and infusion site pain.</p>', '<p>Pregnancy Category B. There are, however, no adequate and well-controlled trials in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Ertapenem is excreted in human breast milk. Caution should be exercised when Ertapenem is administered to a nursing woman. Ertapenem should be administered to nursing mothers only when the expected benefit outweighs the risk.</p>', '<ul>\r\n	<li>Serious hypersensitivity (anaphylactic) reactions have been reported in patients receiving &beta;-lactams.</li>\r\n	<li>Seizures and other central nervous system adverse experiences have been reported during treatment.</li>\r\n	<li>Co-administration of Ertapenem with valproic acid or divalproex sodium reduces the serum concentration of valproic acid potentially increasing the risk of breakthrough seizures.</li>\r\n	<li>Clostridium deficits-associated diarrhea (ranging from mild diarrhea to fatal colitis): Evaluate if diarrhea occurs.</li>\r\n	<li>Caution should be taken when administering Ertapenem intramuscularly to avoid inadvertent injection into a blood vessel.</li>\r\n</ul>', '<p>No specific information is available on the treatment of overdosage with Ertapenem. Intentional overdosing of Ertapenem is unlikely. Intravenous administration of Ertapenem at a dose of 2 g over 30 min or 3 g over 1-2h in healthy adult volunteers resulted in an increased incidence of nausea. In clinical trials in adults, inadvertent administration of three 1 g doses of Ertapenem in a 24 hour period resulted in diarrhea and transient dizziness in one patient. In pediatric clinical trials, a single intravenous dose of 40 mg/kg up to a maximum of 2 g did not result in toxicity. In the event of an overdose, Ertapenem should be discontinued and general supportive treatment given until renal elimination takes place. Ertapenem can be removed by hemodialysis; the plasma clearance of the total fraction of ertapenem was increased 30% in subjects with end-stage renal disease when hemodialysis (4 hour session) was performed immediately following administration. However, no information is available on the use of hemodialysis to treat overdosage.</p>', '<p>Other beta-lactam Antibiotics</p>', '<p>Ertapenem 1 g single dose should be prepared with diluent containers containing 50 mL or 100 mL of 0.9% Sodium Chloride Injection. When prepared with this diluent, Ertapenem for Injection maintains satisfactory potency for 6 hours at room temperature (25&deg;C) or for 24 hours under refrigeration (5&deg;C) and used within 4 hours after removal from refrigeration. Solutions of Ertapenem should not be frozen.</p>', '<p><strong>Pediatric Use</strong>: Safety and effectiveness of Ertapenem in pediatric patients 3 months to 17 years of age are supported by evidence from adequate and well-controlled trials in adults, pharmacokinetic data in pediatric patients, and additional data from comparator-controlled trials in pediatric patients 3 months to 17 years of age.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: This drug is known to be substantially excreted by the kidney, and the risk of toxic reactions to this drug may be greater in patients with impaired renal function. Because elderly patients are more likely to have decreased renal function, care should be taken in dose selection, and it may be useful to monitor renal function<br />\r\n<br />\r\n<strong>Patients with Renal Impairment</strong>: Dosage adjustment is necessary in patients with creatinine clearance 30 mL/min or less.<br />\r\n<br />\r\n<strong>Patients with Hepatic Impairment</strong>: The pharmacokinetics of ertapenem in patients with hepatic impairment have not been established.</p>', '2022-02-21 23:17:33', '2022-06-10 01:09:16'),
(518, 518, '<p>For topical treatment of acne, pimples &amp; bacterial skin infections susceptible to Erythromycin.</p>', '<p>Erythromycin is a bacteriostatic macrolide antibiotic. But may be bactericidal in high concentrations. Although the mechanism by which Erythromycin acts in reducing the inflammatory lesions of acne vulgaris is unknown, it is presumably due to the antibiotic action of the drug.</p>', '<p>Apply in morning and evening to the affected areas. Before applying thoroughly wash with warm water and soap, rinse and pat dry all areas to be treated. Apply with fingertips or applicator. Wash hands after use. Spread the medication lightly rather than rubbing it in. Acne lesions on the face, neck, shoulders, chest and back may be treated in this manner. Additional containers may be used, if needed. Each container should be used once and discarded.</p>\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>', '<p>Clindamycin interacts with Erythromycin.</p>', '<p>Hypersensitivity to Erythromycin or to any of the other ingredients of the lotion.</p>', '<p>Erythema, desquamation, burning sensation, eye irritation, tenderness, dryness, oily skin etc.</p>', '<p>Safety for use during pregnancy has not been established. Use only when the potential benefits outweigh potential hazards to the fetus. Erythromycin is excreted in breast milk. Exercise caution when administering to a nursing mother.</p>', '<p>For external use only. Keep away from eyes, nose, mouth and other mucous membrane. Use of antibiotics (especially prolonged or repeated therapy) may result in bacterial or fungal overgrowth of non-susceptible organisms. Such overgrowth may lead to a secondary infection. Take appropriate measures if superinfections occur.</p>', NULL, '<p>Topical antibiotics for Acne</p>', '<p>Keep below 25&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', '<p>Safety and effectiveness in children less than 12 years have not been established.</p>', '2022-02-21 23:17:57', '2022-06-11 00:40:21'),
(519, 519, '<p>Erythromycin is highly effective in the treatment of a wide variety of clinical infections.</p>\r\n\r\n<ul>\r\n	<li><strong>Upper respiratory tract infections</strong>: Tonsilitis, Peritonsillar abscess, Pharyngitis, laryngitis, Sinusitis. Secondary infections in colds and influenza.</li>\r\n	<li><strong>Lower respiratory tract infections</strong>: Tracheitis, acute and chronic bronchitis.</li>\r\n	<li><strong>Ear infections</strong>: Otitis media, otitis externa, mastoiditis.</li>\r\n	<li><strong>Eye infections</strong>: Blepharitis, established trachoma.</li>\r\n	<li><strong>Skin and Soft tissue infections</strong>: Boils and carbuncles, impetigo, abscesses, pustular acne, paromychia, cellulitis, erysipelas.</li>\r\n	<li><strong>Gastrointestinal tract infections</strong>: Cholecystitis, staphylococcal enterocolitis.</li>\r\n	<li><strong>Prophylaxis</strong>: Pre and post-operative, trauma, burns, rheumatic fever.</li>\r\n	<li><strong>Other infections</strong>: Osteomyelitis, diptheria, scarlet fever, whooping cough.</li>\r\n</ul>', '<p>Erythromycin inhibits microsomal protein synthesis in susceptible organisms by inhibiting the translocation process. Specific binding to the 50S subunit or 70S ribosome occurs in these organisms but there is no binding to the stable 80S mammalian ribosome. Erythromycin is active against many Grampositive bacteria, some Gram-negative bacteria and against mycoplasmas and chlamydia.<br />\r\n<br />\r\n<strong>Absorption</strong>: Erythromycin base is destroyed by acid and is therefore administered in the form of stable ester. The rates of absorption of the base and esters are diminished by the presence of food. The stearate is hydrolyzed in the intestine and the free erythromycin absorbed.<br />\r\n<br />\r\n<strong>Blood concentration</strong>: After an oral dose of 500 mg. of the base of stearate, peak serum concentrations of 0.9 to 1.4 or 0.4 to 1.8 mg/ml. respectively are attained in 1 to 4 hours. Half-life: The serum half-life is 1.2 to 4 hours. In subjects with oliguria, the half-life is about 5 hours.<br />\r\n<br />\r\n<strong>Distribution</strong>: Erythromycin is widely distributed throughout body tissue and fluids with some retention in the liver and spleen, protein binding of erythromycin base is 73%. Erythromycin enters the cerebrospinal fluid when the meninges are inflamed. It also crosses the placenta and is excreted in the milk.<br />\r\n<br />\r\n<strong>Excretion</strong>: 5 to 15 % of the dose of erythromycin is excreted in the urine and large amounts of the unchanged active substance are excreted in the bile.</p>', '<p><strong>Adult and Children over 8 years</strong>: 250-500 mg every six hours for mild to moderate infections. This may be increased upto 4 gm. or more daily in severe cases.<br />\r\n<br />\r\n<strong>Elderly</strong>: No special dosage recommendation. Erythromycin may be administered if desired, three times daily or twice daily by giving one-third or half of the total daily requirement 8 hourly or 12 hourly respectively.<br />\r\n<br />\r\n<strong>Children aged 2 to 8 years</strong>: 250 mg. every six hours or 30-50 mg/kg body weight per day divided into four equal dosage.<br />\r\n<br />\r\n<strong>Infants and Children upto 2 years</strong>: 500 mg. in divided doses or 30-50 mg/kg body weight in divided doses.</p>\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>', '<p>Recent data from studies of erythromycin reveals that its use in patients who are receiving high dosage of theophylline may be associated with an increase of serum theophylline levels and potential theophylline toxicity. In such cases this dose of theophylline should be reduced.</p>', '<p>Known hypersensitivity to Erythromycin.</p>', '<p>Allergic reactions are rare and mild although anaphylaxis has occurred. Occasionally there is abdominal discomfort after oral administration, sometimes with nausea and vomiting. This discomfort usually subsides after a few days without it being necessary to reduce the dosage.</p>', '<p>Clinical and Laboratory studies have been shown no evidence in human of teratogenicity or toxicity. However, caution should be exercised when prescribing this drug to pregnant patients and lactating mothers since erythromycin crosses the placental barrier and is excreted in breast milk.</p>', '<p>Erythromycin should be given with care in patients with impaired hepatic function, as erythromycin is excreted principally in the bile.</p>', '<p>In case of overdosage, Erythromycin should be discontinued. Overdosage should be handled with the prompt elimination of unabsorbed drug and all other appropriate measures should be instituted. Erythromycin is not removed by peritoneal dialysis or haemodialysis.</p>', '<p>Anti-diarrhoeal Antimicrobial drugs, Macrolides</p>', '<p>Keep below 25&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-02-21 23:18:19', '2022-06-11 00:42:40');
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
(520, 520, '<p>Erythropoietin is indicated for the treatment of-</p>\r\n\r\n<ul>\r\n	<li>Anemia associated with Chronic Renal Failure, including patients on dialysis and patients not on dialysis.</li>\r\n	<li>Anemia in patients with non-myeloid malignancies where anemia is due to the effect of concomitantly administered chemotherapy.</li>\r\n	<li>Anemic patients (hemoglobin &gt;10 to &lt;13 g/dL) are scheduled to undergo elective, noncardiac, nonvascular surgery to reduce the need for allogeneic blood transfusions.</li>\r\n	<li>Anemia related to therapy with zidovudine in HIV-infected patients.</li>\r\n</ul>', NULL, '<p><strong>Treatment of anemia in chronic renal failure</strong>: Erythropoietin is administered to maintain hemoglobin concentration between 11 to 12 g/dl and hematocrit of 33-36 % in adults.<br />\r\n<br />\r\nStarting dose:</p>\r\n\r\n<ul>\r\n	<li>Adult: Usually 50 to 100 lU/kg three times in a week (TIW) by IV or Subcutaneous route.</li>\r\n	<li>Pediatric: 50 lU/kg TIW by IV or Subcutaneous route.</li>\r\n</ul>\r\n\r\n<p>Dose adjustment: Dose should be increased if hematocrit doses not increase by 5 to 6 points after 8 weeks therapy, and hematocrit is below suggested target range. Dose should be reduced when hematocrit approaches 36% or hematocrit increases &gt;4 points in any 2-week period.<br />\r\n<br />\r\nMaintenance dose: Maintenance dose must be individualized for each patient. In patients undergoing dialysis, the median maintenance dose is 75 lU/kg TIW, with a range from 12.5 to 525 lU/kg TIW as directed by the physician. In CRF patients not on dialysis, maintenance dose is 75 to 150 lU/kg/week.<br />\r\n<br />\r\n<strong>Treatment of Anemia in Cancer Patients on Chemotherapy</strong>:<br />\r\n<br />\r\nStarting dose:</p>\r\n\r\n<ul>\r\n	<li>Adult: 150 lU/kg TIW by Subcutaneous route or 40,000 IU Subcutaneous route weekly.</li>\r\n	<li>Pediatric: 25 to 300 lU/kg 3 to 7 times per week by Subcutaneous or IV route.</li>\r\n</ul>\r\n\r\n<p>Dose adjustment: If the response is not satisfactory, the dose should be increased to 300 lU/kg TIW. If the hematocrit exceeds 40%, the dose should be withheld until the hematocrit falls to 36%.The dose should be reduced to 25% when treatment is resumed and titrated to maintain the desired hematocrit.<br />\r\n<br />\r\nSurgery Patients: The recommended dose is 300 lU/kg/day subcutaneously for 10 days before surgery, on the day of surgery, and for 4 days after surgery. An alternate dose schedule is 600 lU/kg subcutaneously in once weekly dose (21, 14, and 7 days before surgery) plus a fourth dose on the day of surgery.<br />\r\n<br />\r\n<strong>Zidovudine-treated HIV-infected Patients</strong>:<br />\r\nStarting dose</p>\r\n\r\n<ul>\r\n	<li>Adult: 100 lU/kg as an IV or Subcutaneous injection TIW for 8 weeks.</li>\r\n	<li>Pediatric: 50 to 400 lU/kg 2 to 3 times per week by Subcutaneous or IV route.</li>\r\n</ul>\r\n\r\n<p>Dose adjustment: If the response is not satisfactory, the dose should be increased by 50-1001U/kg TIW. Response should be evaluated every 4 to 8 weeks thereafter and the dose adjusted accordingly by 50 to 100 lU/kg increments TIW.<br />\r\n<br />\r\nMaintenance dose: The dose is titrated to maintain the hematocrit between 33-36%.</p>\r\n\r\n<ul>\r\n	<li>Do not shake. It is not necessary to shake Erythropoietin. Prolonged vigorous shaking may denature any glycoprotein, rendering it biologically inactive.</li>\r\n	<li>Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration.</li>\r\n	<li>Administer as an intravenous injection over 1-2 minutes. In patients on dialysis, the injection should follow the dialysis procedure. Slow injection over 5 minutes may be beneficial to those who experience flu-like symptoms.</li>\r\n	<li>Do not administer by intravenous infusion or in conjunction with other drug solutions.</li>\r\n	<li>For the subcutaneous route, a maximum of 1 ml_ at one injection site should generally not be exceeded. In the case of larger volumes, more than one site should be chosen for the injection.</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>', NULL, '<p>Erythropoietin is contraindicated in patients with:</p>\r\n\r\n<ul>\r\n	<li>Uncontrolled hypertension</li>\r\n	<li>Known hypersensitivity to mammalian cell-derived products</li>\r\n	<li>A history of hypersensitivity to Erythropoietin or any component of the preparation.</li>\r\n</ul>', '<p>General: Headache, dizziness, fever, malaise, arthralgia and occasionally hyperkalemia. Cardiovascular: Hypertension is the most common side effect, palpitations. Gastrointestinal: Nausea, vomiting, anorexia and diarrhea may occur occasionally. Allergic reactions.</p>', '<p>Pregnancy Category C. Since there are no controlled studies of erythropoietin in pregnant women, and because animal reproduction studies are not always predictive of human responses, erythropoietin should be used during pregnancy only if clearly needed. 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 erythropoietin is administered to a nursing woman.</p>', '<p>Erythropoietin should be used with caution in those patients with controlled hypertension, ischaemic vascular disease, history of seizures, or suspected allergy to the product.<br />\r\n<br />\r\nIron evaluation: Prior to and during Erythropoietin therapy, the patient&#39;s iron stores, including transferrin saturation and serum ferritin, should be evaluated. Transferrin saturation should be at least 20%, and ferritin should be at least 100 ng/ml. Virtually all patients will require supplemental Iron to increase or maintain transferrin saturation to levels that will adequately support erythropoiesis.</p>', '<p>Doses of up to 1500 lU/kg TIW for 3 to 4 weeks have been administered to adults without any direct toxic effects. If the suggested target range is exceeded, drug therapy may be temporarily withheld until the hemoglobin returns to the suggested target range. If polycythemia is of concern, phlebotomy may be indicated to decrease the hemoglobin.</p>', '<p>Drugs for Haemolytic Hypoplastic &amp; Renal Anemia</p>', '<p>Erythropoietin should be stored at 2&deg;C to 8&deg;C. Protect from light. Do not freeze &amp; avoid shaking.</p>', NULL, '2022-02-21 23:18:55', '2022-06-11 00:44:53'),
(521, 521, '<p>Erythropoietin alfa is an erythropoiesis-stimulating agent (ESA) indicated for:<br />\r\n<br />\r\nTreatment of anemia due to:</p>\r\n\r\n<ul>\r\n	<li>Chronic Kidney Disease (CKD) in patients on dialysis and not on dialysis.</li>\r\n	<li>Zidovudine in HIV-infected patients.</li>\r\n	<li>The effects of concomitant myelosuppressive chemotherapy, and upon initiation, there is a minimum of two additional months of planned chemotherapy.</li>\r\n</ul>\r\n\r\n<p>Reduction of allogeneic RBC transfusions in patients undergoing elective, noncardiac, nonvascular surgery.<br />\r\n<br />\r\nPrevention of anemia of prematurity in infants with a birth weight of 750 to 1500 gm and gestational age of less than 34 weeks.</p>', NULL, '<p><strong>Evaluation of Iron Stores and Nutritional Factors</strong>: Evaluate the iron status in all patients before and during treatment and maintain iron repletion. Correct or exclude other causes of anemia (e.g., vitamin deficiency, metabolic or chronic inflammatory conditions, bleeding, etc.) before initiating Erythropoietin alfa.<br />\r\n<br />\r\n<strong>For all patients with CKD</strong>: When initiating or adjusting therapy, monitor hemoglobin levels at least weekly until stable, then monitor at least monthly. When adjusting therapy consider hemoglobin rate of rise, rate of decline, ESA responsiveness and hemoglobin variability. A single hemoglobin excursion may not require a dosing change.</p>\r\n\r\n<ul>\r\n	<li>Do not increase the dose more frequently than once every 4 weeks. Decreases in dose can occur more frequently. Avoid frequent dose adjustments.</li>\r\n	<li>If the hemoglobin rises rapidly (e.g., more than 1 g/dL in any 2-week period), reduce the dose of Erythropoietin alfa by 25% or more as needed to reduce rapid responses.</li>\r\n	<li>For patients who do not respond adequately, if the hemoglobin has not increased by more than 1 g/dL after 4 weeks of therapy, increase the dose by 25%.</li>\r\n	<li>For patients who do not respond adequately over a 12-week escalation period, increasing the Erythropoietin alfa dose further is unlikely to improve response and may increase risks. Use the lowest dose that will maintain a hemoglobin level sufficient to reduce the need for RBC transfusions. Evaluate other causes of anemia. Discontinue Erythropoietin alfa if responsiveness does not improve.</li>\r\n</ul>\r\n\r\n<p><strong>For patients with CKD on dialysis</strong>:</p>\r\n\r\n<ul>\r\n	<li>Initiate Erythropoietin alfa treatment when the hemoglobin level is less than 10 g/dL.</li>\r\n	<li>If the hemoglobin level approaches or exceeds 11 g/dL, reduce or interrupt the dose of Erythropoietin alfa.</li>\r\n	<li>The recommended starting dose for adult patients is 50 to 100 units/kg3 times weekly intravenously or subcutaneously. For pediatric patients, a starting dose of 50 units/kg3 times weekly intravenously or subcutaneously is recommended. The intravenous route is recommended for patients on hemodialysis.</li>\r\n</ul>\r\n\r\n<p><strong>For patients with CKD not on dialysis</strong>: Consider initiating Erythropoietin alfa treatment only when the hemoglobin level is less than 10 g/dL and the following considerations apply:</p>\r\n\r\n<ul>\r\n	<li>The rate of hemoglobin decline indicates the likelihood of requiring a RBC transfusion and,</li>\r\n	<li>Reducing the risk of alloimmunization and/or other RBC transfusion-related risks is a goal.</li>\r\n	<li>If the hemoglobin level exceeds 10 g/dL, reduce or interrupt the dose of Erythropoietin alfa, and use the lowest dose of Erythropoietin alfa sufficient to reduce the need for RBC transfusions.</li>\r\n	<li>The recommended starting dose for adult patients is 50 to 100 units/kg 3 times weekly intravenously or subcutaneously.</li>\r\n</ul>\r\n\r\n<p><strong>Zidovudine-treated HIV-infected Patients</strong>: Starting Dose: The recommended starting dose in adults is 100 units/kg as an intravenous or subcutaneous injection 3 times per week.<br />\r\n<br />\r\nDose Adjustment-</p>\r\n\r\n<ul>\r\n	<li>If hemoglobin does not increase after 8 weeks of therapy, increase Erythropoietin alfa dose by approximately 50 to 100 units/kg at 4- to 8-week intervals until hemoglobin reaches a level needed to avoid RBC transfusions or 300 units/kg.</li>\r\n	<li>Withhold Erythropoietin alfa if hemoglobin exceeds 12 g/dL. Resume therapy at a dose 25% below the previous dose when hemoglobin declines to less than 11 g/dL.</li>\r\n	<li>Discontinue Erythropoietin alfa if an increase in hemoglobin is not achieved at a dose of 300 units/kg for 8 weeks.</li>\r\n</ul>\r\n\r\n<p><strong>Patients on Cancer Chemotherapy</strong>: Initiate Erythropoietin alfa in patients on cancer chemotherapy only if the hemoglobin is less than 10 g/dL, and if there is a minimum of two additional months of planned chemotherapy. Use the lowest dose of Erythropoietin alfa necessary to avoid RBC transfusions.</p>\r\n\r\n<ul>\r\n	<li>Adults: 150 units/kg subcutaneously 3 times per week until completion of a chemotherapy course or 40,000 units subcutaneously weekly until completion of a chemotherapy course.</li>\r\n	<li>Pediatric Patients (5 to 18 years): 600 units/kg intravenously weekly until completion of a chemotherapy course.</li>\r\n	<li>Prevention of anemia of prematurity: Erythropoietin alfa is administered subcutaneously at a dose of 3x250 IU/kg b.w. per week. Treatment should start as early as possible, preferably by day 3 of life. Premature infants who have received a transfusion before starting Erythropoietin alfa treatment are not likely to benefit as much as infants who have not had a transfusion. The treatment should last for 6 weeks.</li>\r\n</ul>\r\n\r\n<p>Preparation and Administration-</p>\r\n\r\n<ul>\r\n	<li>Do not shake. Do not use Erythropoietin alfa that has been shaken or frozen.</li>\r\n	<li>Protect syringe from light.</li>\r\n	<li>Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration. Do not use any syringe exhibiting particulate matter or discoloration.</li>\r\n	<li>Discard unused portions of Erythropoietin alfa.</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>', '<p>There are no known clinically significant drug interactions but the effect of Erythropoietin alfa may be potentiated by the simultaneous therapeutic administration of a haematinic agent such as ferrous sulphate when a deficiency state exists.</p>', '<ul>\r\n	<li>Uncontrolled hypertension.</li>\r\n	<li>Serious allergic reactions to Erythropoietin alfa.</li>\r\n	<li>Patients who develop Pure Red Cell Aplasia (PRCA) following treatment with any erythropoietin should not receive Erythropoietin alfa or any other erythropoietin.</li>\r\n</ul>', '<p>Adverse reactions in 5% of Erythropoietin alfa treated patients in clinical studies were:</p>\r\n\r\n<ul>\r\n	<li>Patients with CKD: Hypertension, arthralgia, muscle spasm, pyrexia, dizziness, medical device malfunction, vascular occlusion, and upper respiratory tract infection.</li>\r\n	<li>Zidovudine-treated HIV-infected Patients: Pyrexia, cough, rash, and injection site irritation.</li>\r\n	<li>Cancer Patients on Chemotherapy: Nausea, vomiting, myalgia, arthralgia, stomatitis, cough, weight decrease, leukopenia, bone pain, rash, hyperglycemia, headache, depression, dysphagia, hypokalemia, and thrombosis.</li>\r\n	<li>Surgery Patients: Nausea, vomiting, pruritus, headache, injection site pain, chills, deep vein thrombosis, cough, and hypertension.</li>\r\n	<li>Premature infants: A fall in serum ferritin values is very common (&gt;10%)</li>\r\n</ul>', '<p>There are no adequate and well-controlled studies in pregnant women. Studies in animals have shown reproduction toxicology. Consequently:</p>\r\n\r\n<ul>\r\n	<li>In chronic renal failure patients, Erythropoietin alfa should be used in pregnancy only if the potential benefit outweighs the potential risk to the foetus.</li>\r\n	<li>In pregnant or lactating surgical patients participating in an autologous blood predonation programme, the use of Erythropoietin alfa is not recommended.</li>\r\n</ul>\r\n\r\n<p>It is not known whether exogenous Erythropoietin alfa is excreted in human milk. Erythropoietin alfa should be used with caution in nursing women. A decision on whether to continue/discontinue breast-feeding or to continue/discontinue therapy with Erythropoietin alfa should be made taking into account the benefit of breast feeding to the child and the benefit of Erythropoietin alfa therapy to the woman.</p>', NULL, '<p>The therapeutic margin of Erythropoietin alfa is very wide. Erythropoietin alfa overdosage can cause hemoglobin levels above the desired level, which should be managed with discontinuation or reduction of Erythropoietin alfa dosage and/or with phlebotomy, as clinically indicated. Cases of severe hypertension have been observed following overdose with ESAs.</p>', '<p>Drugs for Haemolytic Hypoplastic &amp; Renal Anemia</p>', '<p>Store at 2&ordm;C to 8&ordm;C. Do not freeze or shake. This temperature range should be closely maintained until administration to the patient. Store in original package in order to protect from light.</p>', NULL, '2022-02-21 23:19:08', '2022-06-11 00:47:33'),
(522, 522, '<p>Escitalopram Oxalate is indicated in the-</p>\r\n\r\n<ul>\r\n	<li>Treatment of major depressive episodes.</li>\r\n	<li>Treatment of panic disorder with or without agoraphobia.</li>\r\n	<li>Treatment of social anxiety disorder (social phobia).</li>\r\n	<li>Treatment of generalised anxiety disorder.</li>\r\n	<li>Treatment of obsessive-compulsive disorder.</li>\r\n</ul>', '<p>Escitalopram is an orally administered selective serotonin reuptake inhibitor (SSRI). Escitalopram is the pure S-enantiomer of the racemic bicyclic phthalate derivative citalopram. Escitalopram is at least 100 fold more potent than the R-enantiomer with respect to inhibition of 5-HT reuptake. Escitalopram has no or very low affinity for serotonergic or other receptors including alpha- and beta-adrenergic Dopamine, Histamine, Muscarinic and benzodiazepine receptors.</p>', '<p>Safety of daily doses above 20 mg has not been demonstrated. Escitalopram Oxalate is administered as a single daily dose and may be taken with or without food.<br />\r\n<br />\r\n<strong>Major depressive episodes</strong>: Usual dosage is 10 mg once daily. Depending on individual patient response, the dose may be increased to a maximum of 20 mg daily. Usually, 2-4 weeks are necessary to obtain an antidepressant response. After the symptoms resolve, treatment for at least 6 months is required for consolidation of the response.<br />\r\n<br />\r\n<strong>Panic disorder with or without agoraphobia</strong>: An initial dose of 5 mg is recommended for the first week before increasing the dose to 10 mg daily. The dose may be further increased, up to a maximum of 20 mg daily, dependent on individual patient response. Maximum effectiveness is reached after about 3 months. The treatment lasts several months.<br />\r\n<br />\r\n<strong>Social anxiety disorder</strong>: Usual dosage is 10 mg once daily. Usually, 2-4 weeks are necessary to obtain symptom relief. The dose may subsequently, depending on individual patient response, be decreased to 5 mg or increased to a maximum of 20 mg daily. Social anxiety disorder is a disease with a chronic course, and treatment for 12 weeks is recommended to consolidate response. Long-term treatment of responders has been studied for 6 months and can be considered on an individual basis to prevent relapse; treatment benefits should be re-evaluated at regular intervals. Social anxiety disorder is a well-defined diagnostic terminology of a specific disorder, which should not be confounded with excessive shyness. Pharmacotherapy is only indicated if the disorder interferes significantly with professional and social activities. The place of this treatment compared to cognitive behavioural therapy has not been assessed. Pharmacotherapy is part of an overall therapeutic strategy.<br />\r\n<br />\r\n<strong>Generalised anxiety disorder</strong>: Initial dosage is 10 mg once daily. Depending on the individual patient response, the dose may be increased to a maximum of 20 mg daily. Long term treatment of responders has been studied for at least 6 months in patients receiving 20 mg/day. Treatment benefits and dose should be re-evaluated at regular intervals.<br />\r\n<br />\r\n<strong>Obsessive-Compulsive Disorder</strong>: Initial dosage is 10 mg once daily. Depending on the individual patient response, the dose may be increased to a maximum of 20 mg daily. As OCD is a chronic disease, patients should be treated for a sufficient period to ensure that they are symptom-free. Treatment benefits and dose should be re-evaluated at regular intervals.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>Escitalopram should generally be administered once daily, morning or evening with or without food.</p>\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>', '<p>As SSRI or related antidepressants should not be started until 2 weeks after stopping an MAOI. Conversely, an MAOI should not. be started until at least a week after an SSRI or related antidepressant has been stopped (2 weeks in the case of paroxetine and sertraline, at least 5 weeks in the case of fluoxetine).</p>', '<p>Escitalopram is contraindicated in patients with known hypersensitivity to Escitalopram or Citalopram or any of the inactive ingredients of the drug product. Concomitant use of escitalopram in patients taking monoamine oxidase/pimozide is contraindicated.</p>', '<p>SSRIs are less sedating and have fewer antimuscarinic and cardiotoxic effects than tricyclic antidepressants. Side-effects of the SSRIs include gastrointestinal effects (dose-related and fairly common include nausea, vomiting, dyspepsia, abdominal pain, diarrhoea, constipation), anorexia with weight loss (increased appetite and weight gain also reported) and hypersensitivity reactions including rash, urticaria, angioedema, anaphylaxis, arthralgia, myalgia, and photosensitivity; other side-effects include dry mouth, nervousness, anxiety, headache, insomnia, tremor, dizziness, asthenia, hallucinations, drowsiness, convulsions, galactorrhoea, sexual dysfunction, urinary retention, sweating, hypomania or mania, movement disorders and dyskinesias, visual disturbances.</p>', '<p>When treating a pregnant woman with Escitalopram during the third trimester, the physician should carefully consider the potential risks and benefits of treatment. It is excreted in human breast milk. The decision whether to continue or discontinue either nursing or Escitalopram therapy should take into account the risk of citalopram exposure for the infant and the benefits Escitalopram treatment for the mother.</p>', '<p>SSRIs should be used with caution in patients with epilepsy (avoid if poorly controlled, discontinue if convulsions develop), concurrent electroconvulsive therapy (prolonged seizures reported with fluoxetine), history of mania, cardiac disease, diabetes mellitus, angle-closure glaucoma, concomitant use of drugs that increase risk of bleeding, history of bleeding disorders (especially gastro-lntestinal bleeding), hepatic and renal impairment.</p>', '<p><strong>Symptoms</strong>: Symptoms seen in a reported overdose of escitalopram include symptoms mainly related to the central nervous system (ranging from dizziness, tremor, and agitation to rare cases of serotonin syndrome, convulsion, and coma), the gastrointestinal system (nausea/vomiting), and the cardiovascular system (hypotension, tachycardia, QT interval, prolongation, and arrhythmia) and electrolyte/fluid balance conditions (hypokalaemia, hyponatremia).<br />\r\n<br />\r\n<strong>Management</strong>: There is no specific antidote. Establish and maintain an airway, ensure adequate oxygenation and respiratory function. Gastric lavage and the use of activated charcoal should be considered. Gastric lavage should be carried out as soon as possible after oral ingestion. Cardiac and vital signs monitoring are recommended along with general symptomatic supportive measures. ECG monitoring is advised in case of overdose, in patients with congestive heart failure/bradyarrhythmias, in patients using concomitant medications that prolong the QT-interval, or in patients with altered metabolism, e.g. liver impairment.</p>', '<p>SSRIs &amp; related anti-depressant drugs</p>', '<p>Store below 30&deg;C temperature and protect from light &amp; moisture. Keep the medicine out of the reach of children.</p>', '<p><strong>Elderly patients (&gt;65 years of age)</strong>: Initial dosage is 5 mg once daily. Depending on the individual patient response the dose may be increased to 10 mg daily. The efficacy of escitalopram in social anxiety disorder has not been studied in elderly patients.<br />\r\n<br />\r\n<strong>Children and adolescents (&lt;18 years)</strong>: Escitalopram Oxalate should not be used in the treatment of children and adolescents under the age of 18 years.<br />\r\n<br />\r\n<strong>Reduced renal function</strong>: Dosage adjustment is not necessary in patients with mild or moderate renal impairment. Caution is advised in patients with severely reduced renal function (CLCR less than 30 ml/min).<br />\r\n<br />\r\n<strong>Reduced hepatic function</strong>: An initial dose of 5 mg daily for the first two weeks of treatment is recommended in patients with mild or moderate hepatic impairment. Depending on individual patient response, the dose may be increased to 10 mg daily. Caution and extra careful dose titration is advised in patients with severely reduced hepatic function.<br />\r\n<br />\r\n<strong>Poor metabolizers of CYP2C19</strong>: For patients who are known to be poor metabolisers with respect to CYP2C19, an initial dose of 5 mg daily during the first two weeks of treatment is recommended. Depending on individual patient response, the dose may be increased to 10 mg daily. Discontinuation symptoms seen when stopping treatment. Abrupt discontinuation should be avoided.<br />\r\n<br />\r\nWhen stopping treatment with escitalopram the dose should be gradually reduced over a period of at least one to two weeks in order to reduce the risk of discontinuation symptoms. 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>', '2022-02-21 23:19:29', '2022-06-11 00:49:49'),
(523, 523, '<p>Eslicarbazepine acetate is indicated as an add-on therapy for partial seizure with or without secondary generalization.</p>', '<p>Eslicarbazepine acetate is converted into the anti-epileptic medicine Eslicarbazepine in the body. Epilepsy is caused by excessive electrical activity in the brain. For electrical impulses to travel along nerves there needs to be a rapid movement of sodium into the nerve cells. Eslicarbazepine acetate is thought to work by blocking &lsquo;voltage-gated sodium channels&rsquo;, which stops sodium entering the nerve cells. This reduces the activity of the nerve cells in the brain, reducing the intensity and the number of seizures.</p>', '<p><strong>Adult</strong>: Eslicarbazepine acetate must be added to existing anticonvulsant therapy. The recommended starting dose is 400 mg once daily which should be increased to 800 mg once daily after one or two weeks. Based on individual response the dose may be increased to 1200 mg once daily<br />\r\n<br />\r\n<strong>Elderly (over 65 years of age)</strong>: Caution should be exercised in the treatment of elderly patients as there is limited safety information on the use of Eslicarbazepine acetate in these patients.<br />\r\n<br />\r\n<strong>Paediatric</strong>: The safety and efficacy of Eslicarbazepine acetate below 18 years has not yet been established. No data are available</p>\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>', '<p><strong>Carbamazepine</strong>: Based on individual response, the dose of Eslicarbazepine acetate may need to be increased if used concomitantly with carbamazepine.<br />\r\n<br />\r\n<strong>Phenytoin</strong>: The dose of Eslicarbazepine acetate may need to be increased and the dose of phenytoin may need to be decreased.<br />\r\n<br />\r\n<strong>Oral contraceptives</strong>: Administration of Eslicarbazepine acetate 1,200 mg once daily to female subjects using a combined oral contraceptive showed an average decrease of 37% and 42% in systemic exposure to levonorgestrel and ethinyloestradiol, respectively. Therefore, women of childbearing potential must use adequate contraception during treatment with Eslicarbazepine acetate.<br />\r\n<br />\r\n<strong>Simvastatin</strong>: The dose of Simvastatin shall be increased if used with Eslicarbazepine.</p>', '<p>Hypersensitivity to the active substance, to other carboxamide derivatives (e.g. carbamazepine, oxcarbazepine) or to any of the excipients.</p>', '<p>The use of Eslicarbazepine acetate is associated with increase in the PR interval. Adverse reactions associated with PR interval prolongation (e.g. AV block, syncope, bradycardia) may occur.</p>', '<p>There are no data from the use of Eslicarbazepine acetate in pregnant women. Studies in animals have shown reproductive toxicity. If women receiving Eslicarbazepine acetate become pregnant or plan to become pregnant, the use of Exalief should be carefully re-evaluated.<br />\r\n<br />\r\nIt is unknown whether Eslicarbazepine acetate is excreted in human breast milk.</p>', '<p>Eslicarbazepine acetate has been associated with some central nervous system adverse reactions, such as dizziness and somnolence, which could increase the occurrence of accidental injury.<br />\r\n<br />\r\nEslicarbazepine acetate may decrease the effectiveness of hormonal contraceptives. Additional non-hormonal forms of contraception are recommended when using Eslicarbazepine acetate.<br />\r\n<br />\r\nAs with other anti-epileptic medicinal products, if Eslicarbazepine acetate is to be discontinued it is recommended to withdraw it gradually to minimize the potential of increased seizure frequency.<br />\r\n<br />\r\nConcomitant use of Eslicarbazepine acetate with oxcarbazepine is not recommended because this may cause overexposure to the active metabolites.<br />\r\n<br />\r\nRash developed as an adverse reaction in 1.1% of total population treated with Eslicarbazepine acetate in placebo-controlled add-on studies in epileptic patients. If signs or symptoms of hypersensitivity develop, Eslicarbazepine acetate must be discontinued. Hyponatraemia has been reported as an adverse reaction in less than 1% of patients treated with Eslicarbazepine acetate.</p>', NULL, '<p>Adjunct anti-epileptic drugs</p>', '<p>Store in a cool and dry place, protected from light and moisture. Keep the medicine out of the reach of children.</p>', '<p><strong>Patients with renal impairment</strong>: Caution should be exercised in the treatment of patients with renal impairment and the dose should be adjusted according to creatinine clearance (CLCR) as follows:</p>\r\n\r\n<ul>\r\n	<li>CLCR &gt;60 ml/min: no dose adjustment required</li>\r\n	<li>CLCR 30-60 ml/min: initial dose of 400 mg every other day for 2 weeks followed by a once daily dose of 400 mg.</li>\r\n	<li>CLCR &lt;30 ml/min: use is not recommended in patients with severe renal impairment due to insufficient data</li>\r\n</ul>\r\n\r\n<p><strong>Patients with hepatic impairment</strong>: No dose adjustment is needed in patients with mild to moderate hepatic impairment. The pharmacokinetics of Eslicarbazepine acetate has not been evaluated in patients with severe hepatic impairment and use in these patients is therefore not recommended.</p>', '2022-02-21 23:19:52', '2022-06-11 00:52:02'),
(524, 524, '<p>Esmolol Hydrochloride is a beta adrenergic blocker indicated for the short-term<br />\r\ntreatment of:</p>\r\n\r\n<ul>\r\n	<li>Control of ventricular rate in supraventricular tachycardia including atrial fibrillation and atrial flutter and control of heart rate in noncompensatory sinus tachycardia.</li>\r\n	<li>Control of perioperative tachycardia and hypertension.</li>\r\n</ul>', '<p>Esmolol Hydrochloride is a beta-1 selective (cardioselective) adrenergic receptor blocking agent with rapid onset, a very short duration of action, and no significant intrinsic sympathomimetic or membrane stabilizing activity at therapeutic dosages. Its elimination half-life after intravenous infusion is approximately 9 minutes. Esmolol Hydrochloride inhibits the beta 1 receptors located chiefly in cardiac muscle, but this preferential effect is not absolute and at higher doses it begins to inhibit beta 2 receptors located chiefly in the bronchial and vascular musculature.</p>', '<p>Administer intravenously. Titrate using ventricular rate or blood pressure at &ge;4 minute intervals. Supraventricular tachycardia (SVT) or noncompensatory sinus tachycardia-</p>\r\n\r\n<ul>\r\n	<li>Optional loading dose: 500 mcg per kg infused over one minute</li>\r\n	<li>Then 50 mcg per kg per minute for the next 4 minutes</li>\r\n	<li>Adjust dose as needed to a maximum of 200 mcg per kg per minute</li>\r\n	<li>Additional loading doses may be administered</li>\r\n</ul>\r\n\r\n<p>Perioperative tachycardia and hypertension-</p>\r\n\r\n<ul>\r\n	<li>Loading dose: 500 mcg per kg over 1 minute for gradual control (1 mg per kg over 30 seconds for immediate control).</li>\r\n	<li>Than 50 mcg per kg per minute for gradual control (150 mcg per kg per minute for immediate control) adjusted to a maximum of 200 (tachycardia) or 300 (hypertension) mcg per kg per minute.</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>', '<ul>\r\n	<li>Digitalis glycosides: Risk of bradycardia</li>\r\n	<li>Anticholinesterases: Prolongs neuromuscular blockade</li>\r\n	<li>Antihypertensive agents: Risk of rebound hypertension</li>\r\n	<li>Sympathomimetic drugs: Dose adjustment needed</li>\r\n	<li>Vasoconstrictive and positive inotropic effect substances: Avoid concomitant use</li>\r\n</ul>', '<ul>\r\n	<li>Severe sinus bradycardia</li>\r\n	<li>Heart block greater than first degree</li>\r\n	<li>Sick sinus syndrome</li>\r\n	<li>Decompensated heart failure</li>\r\n	<li>Cardiogenic shock</li>\r\n	<li>Coadministration of IV cardiodepressant calcium-channel antagonists (e.g. verapamil) in close proximity to Esmolol hydrochloride</li>\r\n	<li>Pulmonary hypertension</li>\r\n	<li>Known hypersensitivity to esmolol</li>\r\n</ul>', '<p>Most common adverse reactions (incidence&gt; 10%) are symptomatic hypotension (hyperhidrosis, dizziness) and asymptomatic hypotension.</p>', '<p>Pregnancy Category C. Esmolol hydrochloride has been shown to produce increased fetal resorptions with minimal maternal toxicity in rabbits when given in doses approximately 8 times the maximum human maintenance dose (300 mcg/kg/min). There are no adequate and well-controlled studies in pregnant women. Esmolol Hydrochloride should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from Esmolol Hydrochloride, 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>', '<ul>\r\n	<li>Risk of hypotension, bradycardia, and cardiac failure: Reduce or discontinue use</li>\r\n	<li>Risk of exacerbating reactive airway disease</li>\r\n	<li>Diabetes mellitus: Increases the effect of hypoglycemic agents and masks hypoglycemic tachycardia</li>\r\n	<li>Risk of unopposed alpha-agonism and severe hypertension in untreated pheochromocytoma</li>\r\n	<li>Risk of myocardial ischemia when abruptly discontinued in patients with coronary artery disease</li>\r\n</ul>', NULL, '<p>Anti adrenergic agent (Beta blockers)</p>', '<p>Keep below 25&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', '<p><strong>Pediatric Use</strong>: The safety and effectiveness of Esmolol Hydrochloride in pediatric patients have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Clinical studies of Esmolol Hydrochloride did not include sufficient numbers of subjects aged 65 and over to determine whether they responded differently from younger subjects.<br />\r\n<br />\r\n<strong>Hepatic Impairment</strong>: No special precautions are necessary in patients with hepatic impairment because Esmolol Hydrochloride is metabolized by red-blood cell esterases.<br />\r\n<br />\r\n<strong>Renal Impairment</strong>: No dosage adjustment is required for esmolol in patients with renal impairment receiving a maintenance infusion of esmolol 150 mcg/kg for 4 hours.</p>', '2022-02-21 23:20:16', '2022-06-11 00:54:16'),
(525, 525, '<p>Esomeprazole is indicated:</p>\r\n\r\n<ul>\r\n	<li>To relieve from chronic heartburn symptoms and other symptoms associated with GERD</li>\r\n	<li>For the healing of erosive esophagitis</li>\r\n	<li>For maintenance of healing of erosive esophagitis</li>\r\n	<li>In combination with amoxicillin and clarithromycin for eradication of Helicobacter pylori infection in patients with duodenal ulcer disease.</li>\r\n	<li>Zollinger-Ellison Syndrome</li>\r\n	<li>Acid related Dyspepsia</li>\r\n	<li>Duodenal &amp; Gastric ulcer</li>\r\n</ul>', '<p>Esomeprazole is a proton pump inhibitor that suppresses gastric acid secretion by specific inhibition of the H+/K+-ATPase in the gastric parietal cell. Esomeprazole (S-isomer of omeprazole) is the first single optical isomer of proton pump inhibitor, provides better acid control than racemic proton pump inhibitors.<br />\r\n<br />\r\n<strong>Absorption</strong>: Esomeprazole capsules contain an enteric-coated pellet formulation of esomeprazole magnesium. After oral administration peak plasma levels (Cmax) occur at approximately 1.5 hours (Tmax). The Cmax&nbsp;increases proportionally when the dose is increased, and there is a three-fold increase in the area under the plasma concentration-time curve (AUC) from 20 to 40 mg. At repeated once daily dosing, the systemic bioavailability is approximately 90% compared to 64% after a single dose. The AUC after administration of a single dose of esomeprazole is decreased by 33-53% after food intake compared to fasting conditions. Esomeprazole should be taken at least one hour before meals.<br />\r\n<br />\r\n<strong>Distribution</strong>: Esomeprazole is 97% bound to plasma proteins. Plasma protein binding is constant over the concentration range of 2 20 mmol/L. The apparent volume of distribution at steady state in healthy volunteers is approximately 16 L.<br />\r\n<br />\r\n<strong>Metabolism</strong>: Esomeprazole is extensively metabolized in the liver by the cytochrome P450 (CYP) enzyme system. The metabolites of esomeprazole lack anti-secretory activity. The major part of esomeprazole&rsquo;s metabolism is dependent upon the CYP2C19 isoenzyme, which forms the hydroxy and desmethyl metabolites. The remaining amount is dependent on CYP3A4 which forms the sulphone metabolite.<br />\r\n<br />\r\n<strong>Excretion</strong>: The plasma elimination half-life of esomeprazole is approximately 1&ndash;1.5 hours. Less than 1% of parent drug is excreted in the urine. Approximately 80% of an oral dose of esomeprazole is excreted as inactive metabolites in the urine, and the remainder is found as inactive metabolites in the faeces.<br />\r\n<br />\r\n<strong>Combination Therapy with Antimicrobials</strong>: Esomeprazole magnesium 40 mg once daily is given in combination with clarithromycin 500 mg twice daily and amoxicillin 1000 mg twice daily for 7 days. The mean steady state AUC and Cmax of Esomeprazole increased by 70% and 18%, respectively, during triple combination therapy compared to treatment with Esomeprazole alone. The pharmacokinetic parameters for clarithromycin and amoxicillin are similar during triple combination therapy and administration of each drug alone. However, the mean AUC and Cmax for 14-hydroxyclarithromycin are increased by 19% and 22%, respectively, during triple combination therapy compared to treatment with clarithromycin alone. This increase in exposure to 14-hydroxyclarithromycin is not considered to be clinically significant.</p>', '<p><strong>Healing of Erosive Esophagitis</strong>: 20 mg or 40 mg Once Daily for 4-8 Weeks. The majority of patients are healed within 4 to 8 weeks. For patients who don&#39;t heal after 4-8 weeks, an additional 4-8 weeks of treatment may be considered. Maintenance of Healing of Erosive<br />\r\n<br />\r\n<strong>Esophagitis</strong>: 20 mg Once Daily (Clinical studies did not extend 6 months).<br />\r\n<br />\r\n<strong>Symptomatic GERD</strong>: 20 mg Once Daily for 4 Weeks. If symptoms do not resolve completely after 4 weeks, an additional 4 weeks of treatment may be considered.<br />\r\n<br />\r\n<strong>Helicobacter Pylori eradication</strong>: Triple Therapy to reduce the risk of Duodenal Ulcer recurrence-Esomeprazole 40 mg Once Daily for 10 days, Amoxicillin 1000 mg Twice Daily for 10 days, Clarithromycin 500 mg Twice Daily for 10 days.<br />\r\n<br />\r\n<strong>Zollinger-Ellison Syndrome</strong>: The dose is 20-80 mg once daily. The dosage should be adjusted individually and treatment continued as long as clinically indicated.<br />\r\n<br />\r\n<strong>Acid-related Dyspepsia</strong>: 20-40 mg once daily for 2-4 weeks according to the response.<br />\r\n<br />\r\n<strong>Duodenal ulcer</strong>: 20 mg once daily for 2-4 weeks. Gastric ulcer: 20-40 mg once daily for 4-8 weeks.<br />\r\n<br />\r\n<strong>Injection</strong>: The recommended adult dose is 40 mg Esomeprazole given once daily by intravenous injection (not less than 3 minutes) or intravenous infusion (10 to 30 minutes). Esomeprazole IV injection should not be administered concomitantly with any other medications through the same intravenous site. Treatment with Esomeprazole IV injection should be discontinued as soon as the patient is able to resume treatment with Esomeprazole delayed-release capsules. Safety and effectiveness in paediatric patients have not been established.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Esomeprazole tablet or capsule</strong>: should be swallowed whole and taken one hour before a meal.<br />\r\n<br />\r\n<strong>Direction for use of Delayed-Release Oral Suspension</strong>: Whole contents of the packet should be taken into a small glass containing 15 ml. of water. The mixer should be stirred well and leave 2 to 3 minutes to thicken. Stir again and drink within 30 minutes. If any medicine remains after drinking, add more water, stir, and drink immediately. If the suspension is to be administered through a nasogastric or gastric tube, the volume of water in the syringe should be 15 ml. &amp; immediately shake the syringe and leave 2 to 3 minutes to thicken. Shake the syringe and inject it through the nasogastric or gastric tube into the stomach within 30 minutes. An appropriately sized syringe should be used. Shake and flush any remaining contents from the nasogastric or gastric tube into the stomach.<br />\r\n<br />\r\n<strong>Esomeprazole IV Injection</strong>: Esomeprazole IV should be given as a slow intravenous injection. The solution for IV injection is obtained by adding to the vial 5 ml of the solvent (WFI) provided. After reconstitution, the injection should be given slowly over a period of at least 3 minutes. The solution should be used within 12 hours of reconstitution when stored at room temperature up to 30&deg;C. No refrigeration is required. The reconstituted solution should not be used if it contains visible particulate.</p>\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>', '<p>Esomeprazole is extensively metabolized in the liver by CYP2C19 and CYP3A4. In vitro and in vivo studies have shown that Esomeprazole is not likely to inhibit CYPs 1A2, 2A6, 2C9, 2D6, 2E1 and 3A4. No clinically relevant interactions with drugs metabolized by these CYP enzymes would be expected. Drug interaction studies have shown that Esomeprazole does not have any clinically significant interactions with phenytoin, warfarin, quinidine, clarithromycin or amoxicillin.<br />\r\n<br />\r\nEsomeprazole may potentially interfere with CYP2C19, the major Esomeprazole metabolizing enzyme. Co-administration of Esomeprazole 30 mg and diazepam, a CYP2C19 substrate has resulted in a 45% decrease in clearance of diazepam. Increased plasma levels of diazepam have been observed 12 hours after dosing and onwards. Esomeprazole inhibits gastric acid secretion. Therefore, Esomeprazole may interfere with the absorption of drugs where gastric pH is an important determinant of bioavailability (e.g., ketoconazole, iron salts and digoxin).<br />\r\n<br />\r\nCo-administration of oral contraceptives, diazepam, phenytoin, or quinidine do not seem to change the pharmacokinetic profile of Esomeprazole.<br />\r\n<br />\r\nCombination Therapy with Clarithromycin: Co-administration of esomeprazole, clarithromycin, and amoxicillin has resulted in increases in the plasma levels of esomeprazole and 14-hydroxyclarithromycin.</p>', '<p>Esomeprazole is contraindicated in-patient with known hypersensitivity to any of the formulation.</p>', '<p>The most frequently occurring adverse events reported with Esomeprazole include headache, diarrhoea, nausea, flatulence, abdominal pain, constipation and dry mouth. There are no difference in types of related adverse events seen during maintenance treatment upto 12 months compared to short term treatment.</p>', '<p>There are no adequate and well-controlled studies in pregnant women. Animal studies have revealed no teratogenic effects. The excretion of esomeprazole in milk has not been studied. Breast-feeding should be therefore be discontinued if the use of esomeprazole is considered essential.</p>', '<p><strong>General</strong>: Symptomatic response to therapy with esomeprazole does not preclude the presence of gastric malignancy.<br />\r\n<br />\r\n<strong>Information for patients</strong>: Esomeprazole capsules should be taken at least one hour before meals. For patients who have difficulty swallowing capsules, one tablespoon of applesauce can be added to an empty bowl and the Esomeprazole capsules can be opened, and the pellets inside the capsule carefully emptied onto the applesauce. The pellets should be mixed with the applesauce and then swallowed immediately. The applesauce used should not be hot and should be soft enough to be swallowed without chewing. The pellets should not be chewed or crushed. The pellet/applesauce mixture should not be stored for future use. Antacids may be used while taking esomeprazole.</p>', '<p>A single oral dose of Esomeprazole at 510 mg/kg (about 103 times the human dose on a body surface area basis), has been lethal to rats. The major signs of acute toxicity are reduced motor activity, changes in respiratory frequency, tremor, ataxia, and intermittent clonic convulsions. There have been no reports of overdose with Esomeprazole. No specific antidote for Esomeprazole is known. Since Esomeprazole is extensively protein bound, it is not expected to be removed by dialysis. In the event of overdosage, treatment should be symptomatic and supportive. As with the management of any overdose, the possibility of multiple drug ingestion should be considered</p>', NULL, '<p>Store at a temperature not exceeding 30&deg;C in a dry place. Protect from light and moisture. Keep out of reach of children.</p>', '<p><strong>Paediatric Use</strong>: Safety and effectiveness in paediatric patients have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: No overall differences in safety and efficacy have been observed between the elderly and younger individuals, and other reported clinical experience has not identified differences in responses between the elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out<br />\r\n<br />\r\n<strong>Hepatic Insufficiency</strong>: No dosage adjustment is recommended for patients with mild to moderate hepatic insufficiency. However, in patients with severe hepatic insufficiency, a dose of 20 mg once daily should not be exceeded.<br />\r\n<br />\r\n<strong>Renal Insufficiency</strong>: The Pharmacokinetics of Esomeprazole in patients with renal impairment are not expected to be altered relative to healthy volunteers as less than 1% of Esomeprazole is excreted unchanged in the urine.</p>', '2022-02-21 23:20:37', '2022-06-11 00:56:39');
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
(526, 526, '<p>Esomeprazole MUPS tablet is indicated in:</p>\r\n\r\n<ul>\r\n	<li>Gastro-esophageal Reflux Disease (GERD).</li>\r\n	<li>Risk reduction in NSAID associated gastric ulcer.</li>\r\n	<li>H. pylori eradication (Triple therapy).</li>\r\n	<li>Zollinger-Ellison syndrome and idiopathic hypersecretion.</li>\r\n</ul>', '<p>Esomeprazole is a proton pump inhibitor that suppresses gastric acid secretion by specific inhibition of the H+/K+&nbsp;ATPase in the gastric parietal cell. Esomeprazole (S-isomer of omeprazole) is the first single optical isomer of proton pump inhibitor, provides better acid control than racemic proton pump inhibitors.</p>', '<p>Erosive esophagitis-</p>\r\n\r\n<ul>\r\n	<li><strong>Adult (&ge;18 years)</strong>: 40 mg once daily for 4 weeks.</li>\r\n	<li><strong>Children &amp; adolescents (12-18 years)</strong>: 40 mg once daily for 4 weeks.</li>\r\n</ul>\r\n\r\n<p>Maintenance of healing of erosive esophagitis-</p>\r\n\r\n<ul>\r\n	<li><strong>Adult (&ge;18 years)</strong>: 20 mg once daily.</li>\r\n	<li><strong>Children &amp; adolescents (12-18 years)</strong>: 20 mg once daily.</li>\r\n</ul>\r\n\r\n<p>Risk reduction in NSAID associated gastric ulcer-</p>\r\n\r\n<ul>\r\n	<li><strong>Adult (&ge;18 years)</strong>: 20 mg once daily for 4-8 weeks.</li>\r\n</ul>\r\n\r\n<p>H. pylori eradication (Esomeprazole MUPS tablet with 1000 mg Amoxicillin and 500 mg Clarithromycin)-</p>\r\n\r\n<ul>\r\n	<li><strong>Adult (&ge;18 years)</strong>: 20 mg twice daily for 7 days.</li>\r\n	<li><strong>Children &amp; adolescents (12-18 years)</strong>: 20 mg twice daily for 7 days.</li>\r\n</ul>\r\n\r\n<p>Zollinger-Ellison syndrome and idiopathic hypersecretion-</p>\r\n\r\n<ul>\r\n	<li><strong>Adult (&ge;18 years)</strong>: 40-80 mg twice daily.</li>\r\n</ul>\r\n\r\n<p><br />\r\nChildren 1-11 years:</p>\r\n\r\n<ul>\r\n	<li><strong>Erosive esophagitis</strong>: Weight &lt;20 kg: 10 mg once daily for 8 weeks. Weight &ge;20 kg: 10 mg or 20 mg once daily for 8 weeks</li>\r\n	<li><strong>Maintenance of healing of erosive esophagitis</strong>: 10 mg once daily</li>\r\n</ul>\r\n\r\n<p>Children below the age of 1 year: Esomeprazole MUPS tablet is not approved for use in children younger than 1 year.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>Esomeprazole MUPS tablets should be swallowed whole with liquid. The tablets should not be chewed or crushed. If required, the tablets can also be dispersed in half a glass of non-carbonated water (mineral water is not suitable). No other liquids should be used. Stir until the tablets disintegrate and drink the liquid with the pellets immediately or within 30 minutes. Rinse the glass with half a glass of water and drink. The pellets must not be chewed or crushed.</p>\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>', '<p>Esomeprazole is extensively metabolized in the liver by CYP2C19 and CYP3A4. In vitro and in vivo studies have shown that Esomeprazole is not likely to inhibit CYPs 1A2, 2A6, 2C9, 2D6, 2E1 and 3A4. No clinically relevant interactions with drugs metabolized by these CYP enzymes would be expected. Drug interaction studies have shown that Esomeprazole does not have any clinically significant interactions with phenytoin, warfarin, quinidine, clarithromycin or amoxicillin.<br />\r\n<br />\r\nEsomeprazole may potentially interfere with CYP2C19, the major Esomeprazole metabolizing enzyme. Co-administration of Esomeprazole 30 mg anddiazepam, a CYP2C19 substrate has resulted in a 45% decrease in clearance of diazepam. Increased plasma levels of diazepam have been observed 12 hours after dosing and onwards. Esomeprazole inhibits gastric acid secretion. Therefore, Esomeprazole may interfere with the absorption of drugs where gastric pH is an important determinant of bioavailability (e.g., ketoconazole, iron salts and digoxin).<br />\r\n<br />\r\nCo-administration of oral contraceptives, diazepam, phenytoin, or quinidine do not seem to change the pharmacokinetic profile of Esomeprazole.<br />\r\n<br />\r\nCombination Therapy with Clarithromycin: Co-administration of esomeprazole, clarithromycin, and amoxicillin has resulted in increases in the plasma levels of esomeprazole and 14-hydroxyclarithromycin.</p>', '<p>Esomeprazole is contraindicated in patient with known hypersensitivity to any of the formulation.</p>', '<p>The most frequently occurring adverse events reported with Esomeprazole include headache, diarrhoea, nausea, flatulence, abdominal pain, constipation and dry mouth. There are no difference in types of related adverse events seen during maintenance treatment upto 12 months compared to short term treatment.</p>', '<p>The manufacturer advises caution. It is not known if Esomeprazole or its metabolites appear in human breast milk.</p>', '<p>Esomeprazole should be used carefully if the patient has severe liver dysfunction and severe renal impairment. Taking a proton pump inhibitor like Esomeprazole may slightly increase the risk of hip, wrist and spine fracture, particularly when it is taken over a period of more than one year.</p>', NULL, NULL, '<p>Store in a cool &amp; dry place below 25&ordm;C, protect from light. Keep out of reach of children.</p>', NULL, '2022-02-21 23:21:00', '2022-06-11 00:59:26'),
(527, 527, '<p>This combination is indicated for the eradication of H. pylori in active chronic gastric, duodenal and gastric ulcers.</p>', '<p><strong>Esomeprazole</strong>&nbsp;exerts its stomach acid-suppressing effects by preventing the final step in gastric acid production by covalently binding to sulfhydryl groups of cysteines found on the (H+, K+)-ATPase enzyme at the secretory surface of gastric parietal cells. This effect leads to inhibition of both basal and stimulated gastric acid secretion, irrespective of the stimulus. As the binding of esomeprazole to the (H+, K+)-ATPase enzyme is irreversible and new enzyme needs to be expressed in order to resume acid secretion, esomeprazole&#39;s duration of antisecretory effect that persists longer than 24 hours<br />\r\n<br />\r\n<strong>Amoxicillin&nbsp;</strong>is similar to&nbsp;penicillin&nbsp;in its bactericidal action against susceptible bacteria during the stage of active multiplication. It acts through the inhibition of cell wall biosynthesis that leads to the death of the bacteria.<br />\r\n<br />\r\n<strong>Clarithromycin&nbsp;</strong>acts by inhibiting microsomal protein synthesis in susceptible organisms mainly by binding to the donor site on the 50S subunit of the bacterial ribosome and preventing translocation to that site.</p>', '<p>Each tablet twice daily for 7-14 days or as per the physician&rsquo;s advice</p>\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>', '<p>Esomeprazole is metabolized through the cytochrome P450 system, specially through the CYP3A isozymes. Studies have shown that Esomeprazole does not have clinically significant interactions with other drugs metabolized by the cytochrome P450 system, such as warfarin, antipyrine, indomethacin, ibuprofen, phenytoin, propranolol, prednisolone, diazepam, clarithromycin or terfenadine in healthy subject.<br />\r\n<br />\r\nClarithromycin use in patients who are receiving theophylline may be associated with an increase of serum theophylline concentrations.<br />\r\n<br />\r\nThere have been reports of interactions of clarithromycin with carbamazepine, cyclosporine, tactrolimus, hexobarbital, phenytoin, alfetanil, disopyramide, lovastatin, bromocriptine, valproate, terfenadine, cisapride, pimozide &amp; astemizole.</p>', '<p>This is contraindicated in patients with known hypersensitivity to any of its component.</p>', '<p>H. pylori eradication therapy is generally well tolerated. Adverse events reported during clinical trials were not unexpected given the component substances. Common adverse reactions included diarrhoea and nausea.</p>', '<p>This should only be given to pregnant women if its use is considered essential. The safety of this combination for use during breast feeding of infants has not been established.</p>', '<p>Serious and occasionally fatal hypersensitivity reactions have been reported in patients on Amoxicillin therapy. These reactions are more apt to occur in indivduals with a history of penicillin hypersensitivity. Clarithromycin should not used in pregnant women except in clinical circumstances where no alternative is appropriate.</p>', NULL, '<p>Anti H. pylori drugs</p>', '<p>Store in a cool (below 30 degree C) and dry place.</p>', '<p>GERIATRIC USE: Although this regimen has not been specifically studied in the elderly, dosage adjustment is not needed during therapy with individual components. It is therefore unlikely to require dosage adjustment with this combination</p>', '2022-02-21 23:21:34', '2022-06-11 01:02:24'),
(528, 528, '<p>Short term treatment of climacteric complaints after the cessation of monthly bleeding, or deficiency symptoms after oophorectomy or radiological castration for non-carcinomatous diseases, such as hot flushes, outbreaks of sweat, sleep disturbances, depressive moods, irritability, headaches, dizziness. Estradiol&nbsp;also has a favourable influence on bladder irritation (a not infrequent occurrence in the climacteric), signs of cutaneous and mucosal involution (particularly in the genital region) which normally occur with advancing age.</p>', NULL, '<p>Hormone therapy should only be continued as long as the benefit in alleviation of severe symptoms outweighs the risk. A complete medical history should be taken and a physical examination should be conducted prior to the initiation or reinstitution of HRT, should be repeated periodically. The frequency and nature of these examinations should be based on established practice guidelines, 6 monthly reviews are generally considered appropriate, and be adapted to the individual woman, but should generally include pelvic organs, including routine cervical cytology, abdomen, breasts and blood pressure. The need for continued therapy should be reconsidered at each review. Unless otherwise prescribed by the doctor, 1 tablet Estradiol is taken daily and the tablets are to be swallowed whole with some liquid. Each pack covers 30 days and treatment is continuous, which means that the next pack follows immediately without a break. It does not matter at what time of the day the patient takes her tablet, but once she has selected a particular time, she should keep it to every day. If she forgets to take a tablet at the usual time, she may take it within the following 12 to 24 hours. If the treatment is discontinued for longer, irregular bleeding may occur. Treatment may be started at any time provided that pregnancy has been excluded. High-dosed and long-term use of unopposed oestrogens during the climacteric may increase the incidence of endometrial carcinoma. Endometrial hyperplasia should be avoided in unopposed oestrogen treatment. It is therefore mandatory to add a progestogen for the last 10-14 days of each month of therapy. As a general rule, Estradiol treatment should be discontinued every 6 months in order to verify the persistence of complaints requiring treatment. It is essential to adhere to the dosage scheme prescribed by the doctor and to keep the appointments made for gynaecological check-ups.</p>\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>', '<p><strong>Interaction with laboratory tests</strong>: The use of sex steroids may influence biochemical parameters of, for example, liver, thyroid, adrenal and renal function, plasma levels of (carrier) proteins such as corticosteroid-binding globulin and lipid/lipoprotein fractions, parameters of carbohydrate metabolism, and parameters of coagulation and fibrinolysis.<br />\r\n<br />\r\n<strong>Interactions with other medicines</strong>: Long-term treatment with hepatic enzyme-inducing drugs (e.g. several anticonvulsants and antimicrobials) can increase the clearance of sex hormones and may reduce clinical efficacy. Such hepatic enzyme-inducing properties have been established for hydantoins, barbiturates, primidone, carbamazepine, and rifampicin and are also suspected for oxcarbazepine, topiramate, felbamate, griseofulvin and the herbal remedy St John&rsquo;s Wort (hypericum perforatum). Maximal enzyme induction is generally not seen before 2-3 weeks but may be sustained for at least 4 weeks after cessation of drug therapy. In rare cases, reduced oestradiol levels have been observed under the simultaneous use of certain antibiotics (e.g. penicillins and tetracycline). Substances which undergo substantial conjugation (e.g. paracetamol) may increase the bioavailability of oestradiol by competitive inhibition of the conjugation system during absorption. In individual cases, the requirement for oral antidiabetics or insulin can change as a result of the effect on glucose tolerance.</p>', '<p>HRT should not be started in the presence of any of the conditions listed below. Should any of the following conditions appear during HRT use, the product should be stopped immediately. Pregnancy and Lactation, undiagnosed vaginal bleeding, known or suspected cancer of the breast, known or suspected premalignant conditions or malignancies, if sex steroid-influenced, presence or history of liver tumours (benign or malignant), severe hepatic disease, acute arterial thromboembolism (e.g. myocardial infarction, stroke), active deep vein thrombosis, thromboembolic disorders, or a documented history of these conditions, a high risk of venous or arterial thrombosis, severe hypertriglyceridemia, Idiopathic cholestatic jaundice of pregnancy or jaundice with prior combined oral contraceptive use or combined HRT use, Otosclerosis with deterioration during pregnancy, Severe diabetes with vascular changes known hypersensitivity to any of the components of Estradiol.</p>', NULL, '<p>Pregnancy category B3. Estradiol is contraindicated during pregnancy. If pregnancy occurs during medication with Estradiol, treatment must be discontinued immediately. In animal studies, maternal administration of high doses of synthetic oestrogens produced urogenital malformations in the offspring. However, the relevance of the animal findings for the clinical use of 17b-oestradiol is uncertain. Estradiol is contraindicated during lactation</p>', '<p>The benefits and risks of HRT must be carefully weighed, including consideration of the emergence of risks as therapy continues. estrogens with or without progestogens should be prescribed at the lowest effective doses and for the shortest duration consistent with the treatment goal and risks for the individual women. If any of the conditions/risk factors mentioned below is present or deteriorates, an individual risk-benefit analysis should be done before HRT is started or continued. The potential for an increased synergistic risk of thrombosis should be considered in women who possess a combination of risk factors or exhibit a greater severity of an individual risk factor. This increase risk may be greater than a simple cumulative risk of the factor. HRT should not be prescribed in case of a negative risk benefit assessment.</p>', '<p>Acute toxicity studies indicate that even in the case of inadvertent intake of a multiple of the therapeutic dose, no acute toxicity risk is to be expected. Overdose may cause nausea and vomiting and withdrawal bleeding may occur in some women. Management of acute overdose should be supportive.</p>', '<p>Female Sex hormones</p>', '<p>Store in a cool (below 30&deg;C) and dry place, away from light &amp; children.</p>', '<p><strong>Paediatric use</strong>: Estradiol&nbsp;is not indicated for use in children and adolescents.<br />\r\n<br />\r\n<strong>Patients with hepatic impairment</strong>: Estradiol has not been studied in hepatic impaired patients. Estradiol is contraindicated in women with severe hepatic disease.</p>', '2022-02-21 23:21:51', '2022-06-11 01:04:37'),
(529, 529, '<p>Estradiol Valerate is indicated for Hormone Replacement Therapy in:</p>\r\n\r\n<ul>\r\n	<li>Ovulation Induction</li>\r\n	<li>Intrauterine Insemination</li>\r\n	<li>In vitro fertilization</li>\r\n</ul>\r\n\r\n<p>Estradiol valerate is an estrogen medication. In women, it is used in hormone therapy for menopausal symptoms.</p>', NULL, '<p>Ovulation Induction:</p>\r\n\r\n<ul>\r\n	<li><strong>Estradiol valerate</strong>: 2 mg twice daily for 5 days (from 8th day to 12th day of cycle)</li>\r\n	<li><strong>Letrozole</strong>: 2.5 mg twice daily for 5 days (from 3rd day till 7th day of cycle)</li>\r\n	<li><strong>Duration</strong>: 3 cycles</li>\r\n</ul>\r\n\r\n<p>Intrauterine Insemination:</p>\r\n\r\n<ul>\r\n	<li><strong>Estradiol Valerate</strong>: 6 or 8 mg daily in 3 or 4 divided doses (from 8th day till 12th day of cycle)</li>\r\n	<li><strong>Duration</strong>: 3 cycles</li>\r\n</ul>\r\n\r\n<p>In vitro fertilization:</p>\r\n\r\n<ul>\r\n	<li><strong>Estradiol Valerate</strong>: 6 mg in 3 divided doses daily. From 1st to 28th day of the cycle 600 mg progesterone in 3 divided doses daily from 14th to 28th day of the cycles</li>\r\n	<li><strong>Duration</strong>: 8 weeks of the cycle</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>', NULL, '<p>Substances increasing the clearance of sex hormones (diminished efficacy by enzyme-induction), e.g.: The metabolism of oestrogens may be increased by concomitant use of substances known to induce drug- metabolising enzymes, specifically cytochrome P450 enzymes, such as anticonvulsants (e.g. barbiturates, phenytoin, primidone, carbamazepine) and anti-infectives (e.g. rifampicin, rifabutin, nevirapine, efavirenz) and possibly also felbamate, griseofulvin, oxcarbazepine, topiramate and products containing the herbal remedy St. John&#39;s Wort (Hypericum perforatum). Clinically, an increased metabolism of oestrogens and progestogens may lead to decreased effect and changes in the uterine bleeding profile. Enzyme induction can already be observed after a few days of treatment. Maximal enzyme induction is generally seen within a few weeks. After cessation of drug therapy enzyme induction may be sustained for about 4 weeks.<br />\r\n<br />\r\nSubstances decreasing the clearance of sex hormones (enzyme inhibitors): Strong and moderate CYP3A4 inhibitors such as azole antifungals (e.g. fluconazole, itraconazole, ketoconazole, voriconazole), verapamil, macrolides (e.g. clarithromycin, erythromycin), diltiazem and grapefruit juice can increase plasma concentrations of the oestrogen.</p>\r\n\r\n<p>Side Effects</p>', '<p>The following diseases are reported more often in women using HRT compared to women not using HRT:</p>\r\n\r\n<ul>\r\n	<li>breast cancer</li>\r\n	<li>abnormal growth or cancer of the lining of the womb (endometrial hyperplasia or cancer)</li>\r\n	<li>ovarian cancer</li>\r\n	<li>blood clots in the veins of the legs or lungs (venous thromboembolism)</li>\r\n	<li>heart disease</li>\r\n	<li>stroke</li>\r\n	<li>probable memory loss if HRT is started over the age of 65 Other side effects that have been linked to the use of Estradiol Valerate and other oral hormone replacement therapies</li>\r\n	<li>During the first few months of treatment you may experience some vaginal bleeding at unexpected times (breakthrough bleeding and spotting). These symptoms normally lessen with continued treatment. If they don&rsquo;t, contact your doctor (see section 2 HRT and cancer/Excessive thickening of the lining of the womb (endometrial hyperplasia) and cancer of the lining of the womb (endometrial cancer)&rsquo; for more information)</li>\r\n	<li>breast pain, tenderness or enlargement, breast discharge</li>\r\n	<li>painful periods, changes in vaginal secretions, pre-menstrual symptoms, increased size of fibroids in the womb, thrush, changes to the neck of the womb</li>\r\n	<li>indigestion, a feeling of being bloated, passing wind, feeling or being sick, abdominal pain, gall bladder disease</li>\r\n	<li>skin rashes or discolouration, itching, eczema, acne, unusual hair loss or hair growth, increased skin pigment especially on the face (chloasma other conditions for more information), some rare skin problems</li>\r\n	<li>headache, migraine, dizziness, anxiety or depressive symptoms, fatigue</li>\r\n	<li>fast or irregular heartbeat (palpitations), high blood pressure, inflammation of veins usually in the legs</li>\r\n	<li>fluid retention leading to swelling of parts of the body</li>\r\n	<li>changes in body weight and sex drive, increased appetite</li>\r\n	<li>muscle cramps, leg pains</li>\r\n	<li>nose bleeds, visual disturbances (such as blurred vision), discomfort with contact lenses, allergic-type reactions, a worsening of glucose tolerance, bladder inflammation, rare disorders (porphyria, chorea).</li>\r\n</ul>', NULL, '<p><strong>Conditions that need supervision</strong>: &nbsp;If any of the following conditions are present, have occurred previously, and/or have been aggravated during pregnancy or previous hormone treatment, the patient should be closely supervised. It should be taken into account that these conditions may recur or be aggravated during treatment with It, in particular:</p>\r\n\r\n<ul>\r\n	<li>Leiomyoma (uterine fibroids) or endometriosis</li>\r\n	<li>Risk factors for, thromboembolic disorders &raquo; Risk factors for oestrogen dependent tumours, e.g. 1st degree heredity for breast cancer</li>\r\n	<li>Hypertension</li>\r\n	<li>Liver disorders (e.g. liver adenoma)</li>\r\n	<li>Diabetes mellitus with or without vascular involvement</li>\r\n	<li>Cholelithiasis</li>\r\n	<li>Migraine or (severe) headache</li>\r\n	<li>Systemic lupus erythematosus</li>\r\n	<li>A history of endometrial hyperplasia</li>\r\n	<li>Epilepsy</li>\r\n	<li>Asthma</li>\r\n	<li>Otosclerosis</li>\r\n	<li>Hereditary angioedema.</li>\r\n</ul>\r\n\r\n<p><strong>If you forget to take Estradiol Valerate</strong>: If the woman forgets to take a tablet at the usual time, she may take it within the following 12 hours. If the woman is more than 12 hours late the forgotten tablet should not be taken and the remaining tablets taken at the usual time on the right days. A missed dose may lead to breakthrough bleeding or spotting.</p>', NULL, '<p>Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones</p>', '<p>Store below 30&deg;C and dry place. Keep away from light. Keep out of the reach of children.</p>', NULL, '2022-02-21 23:22:11', '2022-06-12 00:31:41'),
(530, 530, '<p>Estriol tablet is indicatd in-</p>\r\n\r\n<ul>\r\n	<li>Atrophy of the lower urogenital tract related to oestrogen deficiency, notably for the treatment of vaginal complaints such as dyspareunia, dryness and itching, for the prevention of recurrent infections of the vagina and lower urinary tract, in the management of micturition complaints (such as frequency and dysuria) and mild urinary incontinence.</li>\r\n	<li>Pre and postoperative therapy in postmenopausal women undergoing vaginal surgery</li>\r\n	<li>Climacteric complaints such as hot flushes and night sweating</li>\r\n	<li>A diagnostic aid in case of a doubtful atrophic cervical smear</li>\r\n	<li>Infertility due to cervical hostility.</li>\r\n</ul>', '<p>Estriol induces the normalization of the vaginal epithelium and thus helps to restore the normal microflora and the physiological pH in the vagina. As a result, it increases the resistance of the vaginal epithelial cells to infection and inflammation. In comparison to other estrogens, estriol is short acting. In the years just before and after the menopause (which can be natural or surgically induced) estriol can be used in the treatment of symptoms and complaints related to estrogen deficiency. Estriol is particularly used in the treatment of urogenital symptoms.<br />\r\n<br />\r\nAfter oral administration, estriol is rapidly and almost completely absorbed from the gastrointestinal tract. Peak plasma levels of unconjugated estriol are reached within 1 hr of administration. Nearly all (90%) estriol is bound to albumin in the plasma and unlike other estrogens; estriol is hardly bound to sex hormone-binding globulin. The metabolism of estriol consists mainly of conjugation and deconjugation during enterohepatic circulation. Estriol, a metabolic end product, is mainly excreted via the urine in the conjugated form. Only a small fraction is excreted via the feces, mainly as unconjugated estriol.</p>', '<p>It is important that the total daily dose is taken at one time. It may be taken with or without food.</p>\r\n\r\n<ul>\r\n	<li><strong>Atropy of the lower urogenital tract</strong>: 4-8 mg/day for the first weeks, followed by a gradual reduction, based on relief of symptoms, until a maintenance dosage (e.g. 1-2 mg/day) is reached.</li>\r\n	<li><strong>Pre and postoperative therapy in postmenopausal women undergoing vaginal surgery</strong>: 4-8 mg/day in the 2 weeks before surgery; 1-2 mg/day in the 2 weeks after surgery.</li>\r\n	<li><strong>Climacteric complaints such as hot flushes and night sweating</strong>: 4-8 mg/day during the first weeks, followed by a gradual reduction. For maintenance therapy the lowest effective dosage should be used.</li>\r\n	<li><strong>A diagnostic aid in case of a doubtful atrophic cervical smear</strong>: 2-4 mg/day for 7 days before taking the next smear.</li>\r\n	<li><strong>Infertility due to cervical hostility</strong>: In general 1-2 mg/day on days 6-15 of the menstrual cycle. However, for some patients dosages as low as 1 mg/day are sufficient, whereas others may need up to 8 mg/day. Therefore, the dosage should be increased each month until an optimal effect on the cervical mucus is obtained.</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>', '<p>There are strong indications that estrogens, estriol included, can increase the pharmacologic effects of certain corticosteroids. If necessary, the dosage of the corticosteroid should be reduced. There are also some indications, mainly obtained with other estrogens or oral contraceptives, that concurrent use of estriol with activated charcoal, barbiturates, hydantoins and rifampicin may possibly decrease the effectiveness of estriol.</p>', '<p>Contraindicated in pregnancy, known or suspected estrogen-dependent tumours, undiagnosed vaginal bleeding, untreated endometrial hyperplasia, known or suspected breast cancer.</p>', '<p>Breast tension or pain, nausea, spotting, fluid retention and cervical hypersecretion may occasionally occur and be indicative of too high dosage. Headache, hypertension, leg cramps and vision disturbances are seldom observed. In general, most of these adverse reactions disappear after the 1 st week of treatment.<br />\r\n<br />\r\nBreast enlargement, vaginal candidiasis, change in vaginal bleeding pattern, vomiting, stomach cramps, cholestatic jaundice, chloasma or melasma, erythema multiforme, erythema nodosum, hemorrhagic eruption, mental depression, chorea, increasing or decreasing body weight, edema, changes in libido.</p>', '<p>Estriol is contraindicated during pregnancy. Use Estriol in breastfeeding women only if really needed, as estriol is excreted in the milk and it may decrease the quality and quantity of the milk production.</p>', '<p>During prolonged treatment with estrogens, periodic medical examinations are advisable. With vaginal infections, a concomitant specific treatment is recommended. In order to prevent endometrial stimulation, the daily dose should not exceed 8 mg nor should this maximum dose be used for longer than several weeks. Patients with any of the following conditions should be monitored: A history of latent or overt cardiac failure, fluid retention due to renal dysfunction, hypertension, epilepsy or migraine (or a history of these conditions), severe liver disorders, endometriosis, fibrocystic mastopathy, porphyria, hyperlipoproteinaemia, a history during pregnancy or previous use of steroids of severe pruritus, cholestatic jaundice or herpes gestationis. Estrogen is reported to increase the risk of endometrial carcinoma in postmenopausal women. Use with precaution in gallbladder disorders, hypercalcemia, additional progestin, hypercoagulability, urethral bleeding and mastodynia.</p>', '<p>Symptoms that may occur in the case of an acute overdosage are nausea, vomiting and possibly withdrawal bleeding in females. No specific antidote is known. If necessary, a symptomatic treatment should be instituted.</p>', '<p>Drugs for Infertility, Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-02-21 23:22:27', '2022-06-12 00:33:34'),
(531, 531, '<p>Estriol cream is indicated for the defficiency of estrogen. During menopause, the amount of estrogens produced by a woman&#39;s body gradually drops. Shortage of estrogens causes the vaginal wall to become thin and dry which leads to painful sexual intercourse. Estriol cream is used to relieve painful sexual intercourse. This is used in postmenopausal women with at least 12 months since their last natural period. If the ovaries are removed surgically (ovariectomy) before menopause, the decrease in estrogen production occurs very abruptly.</p>', '<p>Estriol Cream is a Hormone Replacement Therapy (HRT). It contains the female hormone estriol (an estrogen). During menopause Estriol is used in vagina which is slowly released and absorbed into the surrounding area and into the bloodstream.<br />\r\n<br />\r\nEstriol induces the normalization of the vaginal epithelium and thus helps to restore the normal microflora and the physiological pH in the vagina. As a result, it increases the resistance of the vaginal epithelial cells to infection and inflammation. In comparison to other estrogens, estriol is short acting. In the years just before and after the menopause (which can be natural or surgically induced) estriol can be used in the treatment of symptoms and complaints related to estrogen deficiency. Estriol is particularly used in the treatment of urogenital symptoms.</p>', '<p>Estriol cream should be used as per physician&#39;s advice. Each dose of cream contains 0.5 mg estriol.</p>\r\n\r\n<ul>\r\n	<li>For vulvo-vaginal complaints associated with menopause: Initially one dose of cream per day for 3 weeks. Later you may only need one dose of cream twice a week.</li>\r\n	<li>Before surgery: One dose of cream daily 2 weeks before the operation. When having a Pap smear your doctor may recommend a daily application of cream for 7 days.</li>\r\n</ul>\r\n\r\n<p>How to apply the cream:</p>\r\n\r\n<ul>\r\n	<li>Remove cap from the tube, invert it, and use the sharp point to open the tube.</li>\r\n	<li>Pull the plunger up to the ring. Now attach it to the opening of the tube.</li>\r\n	<li>Squeeze the tube slowly to fill the applicator to the ring-mark (where the plunger stops).</li>\r\n	<li>Remove the tube.</li>\r\n	<li>To apply the cream, lie down; insert the applicator deep into the vagina.</li>\r\n	<li>Slowly push the plunger all the way in until the applicator is empty</li>\r\n	<li>After use, pull the plunger out of the barrel beyond the point of resistance and wash both parts in warm, soapy water. Do not use detergents. Rinse well and dry afterwards. Do not put the applicator in hot or boiling water.</li>\r\n	<li>The applicator can be re-assembled by fully inserting the plunger into the barrel beyond the point where resistance is felt.</li>\r\n	<li>Discard the applicator once the tube is empty. Take Estriol cream before taking rest or going to sleep.If you forget a dose, use it as soon as you remember. But if you remember your missed dose at the time of your next dose, do not use an extra dose. Do not use a double dose to make up for the missed dose. This may increase the chance of you getting an unwanted side effect.</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>', '<p>Interaction is found with Anticoagulants,corticosteroid hormones, succinylcholine, theophyllines, and medicines for epilepsy, medicines for fungal or bacterial infections, viral infections, and herbal preparations containing St John&#39;s Wort. As a result irregular bleeding may occur.</p>', '<p>Do not use Estriol cream if:</p>\r\n\r\n<ul>\r\n	<li>You have or have ever had breast cancer, or if you are suspected of having it, ovarian cancer, heart attack, stroke, angina, liver disease , thrombosis, pulmonary embolism, vaginal cancer.</li>\r\n	<li>You are pregnant or think you may be pregnant</li>\r\n	<li>You have any unexplained vaginal bleeding, blood clotting disorder, endometrial hyperplasia, porphyria, and various kind of allergic reaction.</li>\r\n	<li>Jaundice, migraine pain, high blood pressure &amp; breathing problem</li>\r\n	<li>You have had an allergic reaction to estriol, or any of the other ingredients of estriol</li>\r\n</ul>', '<ul>\r\n	<li>Local irritation or itching of vagina, Swelling and increased tenderness of the breasts, Increased vaginal discharge, Nausea, Fluid retention in the tissues, usually marked by swollen ankles or feet.</li>\r\n	<li>In most patients these side effects will disappear after the first weeks of treatment. Tell your doctor if vaginal bleeding occurs or if any side effect becomes troublesome or persists.</li>\r\n	<li>Other side effects which may occur with HRT are benign and malignant hormone-dependent tumors such as endometrial cancer, heart attack and stroke, gall bladder disease, skin problems such as rashes, discoloration or red patches on the skin, various skin diseases with blisters and nodules or bleeding into the skin, venous thromboembolism or deep leg or pelvic venous thrombosis and pulmonary embolism (see Before you use Estriol Cream). Using HRT for several years slightly increases the risk of breast cancer.</li>\r\n</ul>', '<p>This medicine is contraindicated during pregnancy &amp; lactation.</p>', '<p>Patients should keep under doctor&rsquo;s observation for any Hormone Replacement Therapy (HRT). Same role is applicable for the application of Estriol cream. Doctor will give continuous advice regarding risks &amp; benefts of the drug. But in case of jaundice, sudden high blood pressure, migraine, severe headache or pregnancy, the use of Estriol cream will be stopped immediately. Children&rsquo;s are not allowed to use Estriol cream.</p>', NULL, '<p>Drugs for Infertility, Drugs for menopausal symptoms: Hormone replacement therapy, Female Sex hormones</p>', '<p>Store below 25&deg;C. Protect from light and moisture. Keep out of reach of children.</p>', NULL, '2022-02-21 23:22:49', '2022-06-12 00:35:15'),
(532, 532, '<p>Eszopiclone is indicated for the treatment of insomnia, including difficulty falling asleep and difficulty maintaining sleep through the night. Eszopiclone is the first sedative approved long-term use</p>', '<p>Eszopiclone may interact with Gama-aminobutyric acid (GABA) receptor complexes at binding domains located close to or allosterically coupled to benzodiazepine receptors.</p>', '<p>The usual dose to improve or maintain sleep in most adults is 2 or 3 mg. Persons over the age of 65 years usually are treated with 1 or 2 mg. Eszopiclone should be taken immediately before going to bed since the onset of sedation may occur as rapidly as 10 minutes. It should be taken only by individuals who intend to sleep for at least 8 hours since its effects may last up to six hours.</p>\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>', '<p>Alcohol (which causes sedation) and drugs that have sedating effects should not be used with Eszopiclone since their sedating effects, when added to those of Eszopiclone, may cause excessive sedation.</p>', '<p>Depression, Severe Chronic Obstructive Lung Disease, Severe Liver Disease, Weakened Patient, Having thoughts of Suicide.</p>', '<p>Eszopiclone is generally well tolerated. However few side effects like fatigue, anorexia, nausea, unpleasant taste in the mouth, mood problems, abdominal pain, dyspepsia, asthenia, nervousness, dizziness and confusion have been reported.</p>', '<p><strong>Pregnancy:</strong>&nbsp;Category C.&nbsp;There is no adequate and well-controlled studies in pregnant women. This drug should be used during pregnancy only if clearly needed.<br />\r\n<br />\r\n<strong>Nursing Mothers:</strong>&nbsp;It is not known whether the drug is excreted in breast milk. As many drugs are excreted in breast milk, caution should be exercised when Eszopiclone is administered to a nursing mother.</p>', '<p>Eszopiclone like all sedatives should be taken immediately before bedtime to avoid short-term memory impairment, hallucinations, impaired coordination, dizziness and lightheadedness</p>', '<p>There is limited clinical experience with the overdose of Eszopiclone. In clinical trials one case of overdose with up to 36 mg of Eszopiclone has been reported in which the subject fully recovered. Intravenous fluids should be administered as needed &amp; Flumazenil may be useful.</p>', '<p>Miscellaneous sedatives &amp; hypnotics</p>', '<p>Eszopiclone is indicated for the treatment of insomnia, including difficulty falling asleep and difficulty maintaining sleep through the night. Eszopiclone is the first sedative approved long-term use</p>', NULL, '2022-02-21 23:23:17', '2022-06-12 00:37:40');
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
(533, 533, '<p><strong><strong>Adults with Rheumatoid Arthritis (RA)</strong>: Etanercept indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in patients with moderately to severely active rheumatoid arthritis (RA). Etanercept can be initiated in combination with methotrexate (MTX) or used alone for the treatment of active rheumatoid arthritis (RA) in adults when one or more disease modifying antirheumatic drugs (DMARDs), including methotrexate (unless contraindicated), has proved inadequate.<br />\r\n<br />\r\n<strong>Pediatric patients with Juvenile Idiopathic Arthritis(JIA)</strong>: Etanercept indicated for the treatment of polyarticular-course juvenile idiopathic arthritis (JIA) in children and adolescents from the age of 2 years when the response to one or more DMARDs has proven inadequate.<br />\r\n<br />\r\n<strong>Adults with Psoriatic Arthritis (PsA)</strong>: Etanercept is indicated for reducing signs and symptoms, inhibiting the progression of structural damage of active arthritis, and improving physical function in patients with psoriatic arthritis (PsA). Etanercept can be used in combination with methotrexate (MTX) in patients who do not respond adequately to MTX alone.<br />\r\n<br />\r\n<strong>Adults with Ankylosing Spondylitis (AS)</strong>: Etanerceptis indicated for reducing signs and symptoms in patients with active ankylosing spondylitis (AS).<br />\r\n<br />\r\n<strong>Adults with Plaque Psoriasis (PsO)</strong>: Etanercept is indicated for the treatment of adult patients (18 years or older) with chronic moderate to severe plaque psoriasis (PsO) who are candidates for systemic therapy or phototherapy.<br />\r\n<br />\r\n<strong>Pediatric patients with Plaque Psoriasis (PsO)</strong>: Etanercept is indicated for the treatment of chronic severe plaque psoriasis in children and adolescents from the age of 6 years, who are inadequately controlled by or are intolerant to systemic therapies or phototherapies.</strong></p>', '<p>Etanercept is a tumor necrosis factor (TNF) blocker. This is a dimeric fusion protein consisting of the extracellular ligand-binding portion of the human 75 kilodalton (p75) tumor necrosis factor receptor (TNFR) linked to the Fc portion of human IgG1. The Fc component of etanercept contains the CH2 domain, the CH3 domain and hinge region, but not the CH1 domain of IgG1. Etanercept is produced by recombinant DNA technology in a Chinese hamster ovary (CHO) mammalian cell expression system. It consists of 934 amino acids and has an apparent molecular weight of approximately 150 kilodaltons. Etanercept is a TNF alpha inhibitor that binds specifically to tumor necrosis factor (TNF) and blocks its interaction with cell surface TNF receptors. TNF is a naturally occurring cytokine that is involved in normal inflammatory and immune responses. Elevated levels of TNF are found in the synovial fluid of RA patients. It plays an important role in the inflammatory processes of rheumatoid arthritis (RA), polyarticular-course juvenile rheumatoid arthritis (JRA) and the resulting joint pathology.</p>', '<h1>Etanercept</h1>\r\n\r\n<p><a href=\"https://medex.com.bd/attachments/buVsDUkAUWfLc9StZ8LAqj79jofDPj/etanercept-prescribing-information\" target=\"_blank\">Innovator&#39;s Monograph</a></p>\r\n\r\n<p>Indications</p>\r\n\r\n<p><strong><strong>Adults with Rheumatoid Arthritis (RA)</strong>: Etanercept indicated for reducing signs and symptoms, inducing major clinical response, inhibiting the progression of structural damage, and improving physical function in patients with moderately to severely active rheumatoid arthritis (RA). Etanercept can be initiated in combination with methotrexate (MTX) or used alone for the treatment of active rheumatoid arthritis (RA) in adults when one or more disease modifying antirheumatic drugs (DMARDs), including methotrexate (unless contraindicated), has proved inadequate.<br />\r\n<br />\r\n<strong>Pediatric patients with Juvenile Idiopathic Arthritis(JIA)</strong>: Etanercept indicated for the treatment of polyarticular-course juvenile idiopathic arthritis (JIA) in children and adolescents from the age of 2 years when the response to one or more DMARDs has proven inadequate.<br />\r\n<br />\r\n<strong>Adults with Psoriatic Arthritis (PsA)</strong>: Etanercept is indicated for reducing signs and symptoms, inhibiting the progression of structural damage of active arthritis, and improving physical function in patients with psoriatic arthritis (PsA). Etanercept can be used in combination with methotrexate (MTX) in patients who do not respond adequately to MTX alone.<br />\r\n<br />\r\n<strong>Adults with Ankylosing Spondylitis (AS)</strong>: Etanerceptis indicated for reducing signs and symptoms in patients with active ankylosing spondylitis (AS).<br />\r\n<br />\r\n<strong>Adults with Plaque Psoriasis (PsO)</strong>: Etanercept is indicated for the treatment of adult patients (18 years or older) with chronic moderate to severe plaque psoriasis (PsO) who are candidates for systemic therapy or phototherapy.<br />\r\n<br />\r\n<strong>Pediatric patients with Plaque Psoriasis (PsO)</strong>: Etanercept is indicated for the treatment of chronic severe plaque psoriasis in children and adolescents from the age of 6 years, who are inadequately controlled by or are intolerant to systemic therapies or phototherapies.</strong></p>\r\n\r\n<p><strong>Pharmacology</strong></p>\r\n\r\n<p><strong>Etanercept is a tumor necrosis factor (TNF) blocker. This is a dimeric fusion protein consisting of the extracellular ligand-binding portion of the human 75 kilodalton (p75) tumor necrosis factor receptor (TNFR) linked to the Fc portion of human IgG1. The Fc component of etanercept contains the CH2 domain, the CH3 domain and hinge region, but not the CH1 domain of IgG1. Etanercept is produced by recombinant DNA technology in a Chinese hamster ovary (CHO) mammalian cell expression system. It consists of 934 amino acids and has an apparent molecular weight of approximately 150 kilodaltons. Etanercept is a TNF alpha inhibitor that binds specifically to tumor necrosis factor (TNF) and blocks its interaction with cell surface TNF receptors. TNF is a naturally occurring cytokine that is involved in normal inflammatory and immune responses. Elevated levels of TNF are found in the synovial fluid of RA patients. It plays an important role in the inflammatory processes of rheumatoid arthritis (RA), polyarticular-course juvenile rheumatoid arthritis (JRA) and the resulting joint pathology.</strong></p>\r\n\r\n<p><strong>Dosage</strong></p>\r\n\r\n<p><strong><strong>Rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis</strong>: Patients aged 18 years or older- 50 mg Etanercept per week administered either once weekly (as one subcutaneous injection using a 50 mg syringe or as two 25 mg injections given at the same time) or 25 mg Etanercept twice weekly (72 to 96 hours apart) as a subcutaneous injection. Methotrexate, glucocorticoids, salicylates, nonsteroidal anti- inflammatory drugs (NSAIDs), or analgesics may be continued during treatment with Etanercept in adults. 25 mg once weekly gives a slower response and may be less effective.<br />\r\n<br />\r\n<strong>Plaque psoriasis</strong>: The dose of etanercept is 50 mg syringe once weekly (as one subcutaneous injection using a 50 mg syringe or as two 25 mg injections given at approximately the same time) or 25 mg twice weekly (72 to 96 hours apart) as a subcutaneous injection. Higher responses may be achieved from initial treatment with a dose of 50 mg twice weekly for up to 12 weeks, followed, if necessary, by a dose of 50 mg once weekly or 25 mg twice weekly.<br />\r\n<br />\r\nAdult patients may be treated intermittent or continuously based on physician judgment and individual patient needs. Treatment should be discontinued in patients who show no response after 12 weeks. With intermittent use, treatment cycles subsequent to the initial cycle should use a dose of 50 mg once weekly. No dose adjustment is required for elderly and or patient with renal and hepatic impairment. Patient weighs less than 62.5kg should be accurately dosed on an mg/kg basis. Patients weighing 62.5 kg or more may be fixed-dose prefilled syringe.<br />\r\n<br />\r\n<strong>Juvenile idiopathic arthritis</strong>: Children (⩾2 to &lt;18 years): 0.4mg/kg (up to maximum of 25 mg per dose) twice weekly (72 to 96 hours apart). Glucocoticoids, nonsteroidal anti-inflammatory drugs (NSAIDs), or analgesics may be continued during treatment with etanercept in children. Etanercept has not been studied in children &lt;2 years of age.<br />\r\n<br />\r\n<strong>Pediatric plaque psoriasis</strong>: Children (⩾6 to &lt;18 years): 0.8mg/kg (up to a maximum of 50 mg per dose) once weekly for up to 24 weeks. Treatment should be discontinued in patients who show no response after 12 weeks. If retreatment of etanercept is indicated, the above guidance on treatment duration should be followed. The dose should be 0.8 mg/kg (up to maximum of 50 mg per dose) once weekly.</strong></p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administer etanercept as subcutaneous injections in the thigh, abdomen or upper arm. Given each new injection at least 3 cm from a previous site. Do not use in the area where the skin is tender, bruised, red or hard. The injection should be performed under supervision of qualified healthcare professional. Before injection, single-use prefilled syringe should be allowed to reach room temperature (approximately 15-30 minutes). The needle cover should not be removed while allowing the pre-filled syringe to reach at room temperature. Before disposal of blank PFS, please activate the needle guard to avoid any chance of needle-stick injury.</strong></p>\r\n\r\n<p><strong><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;</strong></p>', NULL, '<p><strong>If any hypersensitivity to etanercept or to any component of the formulation. Incase of sepsis or risk of sepsis. Treatment with etanercept should not be initiated in patients with serious active infections, including chronic or localized infection.</strong></p>', '<p><strong>Very common</strong>: Infections (including colds, sinusitis, bronchitis, urinary tract infections and skin infections); injection site reactions (including bleeding, bruising, redness, itching, pain, and swelling). Reactions at the injection site (these do not occur as often after the first month of treatment. Some patients have developed a reaction at an injection site that was used before.<br />\r\n<br />\r\n<strong>Common</strong>: Allergic reactions; fever; itching; antibodies directed against normal tissue (autoantibody formation).<br />\r\n<br />\r\n<strong>Uncommon</strong>: Serious infections (including pneumonia, deep skin infections, joint infections, blood infection, and infections at various sites); low blood platelet count; skin cancer (excluding melanoma); localized swelling of the skin (angio edema); hives (elevated patches of red or pale skin that often itch); eye inflammation; psoriasis (new or worsening); rash; inflammation or scarring of the lungs; inflammation of the blood vessels affecting multiple organs.</p>', '<p>The safe use of etanercept during pregnancy has not been established. Use etanercept during pregnancy only if clearly needed. The safe use of etanercept during lactation has not been established. It is not known whether etanercept is excreted in human milk. Following subcutaneous administration to lactating rats, etanercept was excreted in the milk and detected in the serum of the pups. Because immunoglobulins and many medicinal products can be excreted in human milk, a decision should be made whether to discontinue nursing or to discontinue etanercept while nursing.</p>', '<p>Special warning and special precautions for use-</p>\r\n\r\n<ul>\r\n	<li>Allergic reactions</li>\r\n	<li>Infections/surgery</li>\r\n	<li>Infections/diabetes</li>\r\n	<li>Infections/monitoring</li>\r\n	<li>Tuberculosis</li>\r\n	<li>Hepatitis-B</li>\r\n	<li>Hepatitis-C</li>\r\n	<li>Blood disorders</li>\r\n	<li>Nervous system and eye disorders</li>\r\n	<li>Congestive heart failure</li>\r\n	<li>Cancer</li>\r\n	<li>Chickenpox</li>\r\n	<li>Latex</li>\r\n	<li>Alcohol abuse</li>\r\n	<li>Wegener&#39;s granulomatosis</li>\r\n	<li>Anti-diabetic medicine</li>\r\n</ul>', '<p>The maximum tolerated dose of etanercept has not been established in humans. Single intravenous doses up to 60 mg/m2&nbsp;have been administered to healthy volunteers in an endotoxemia study without evidence of dose-limiting toxicities. The highest dose level evaluated in rheumatoid arthritis patients has been an intravenous loading dose of 32 mg/m2&nbsp;followed by subcutaneous doses of 16 mg/m2&nbsp;(25 mg) administered twice weekly. No dose-limiting toxicities were observed during clinical trials of rheumatoid arthritis patients. There is no known antidote to etanercept.</p>', '<p>Immunosuppressant</p>', '<p>Etanercept should be stored in refrigerator at 2-8&deg;C. Do not freeze. Do not shake. Keep away from light. Keep out of reach of children.</p>', NULL, '2022-02-21 23:23:40', '2022-06-12 00:44:16'),
(534, 534, '<p>Ethambutol is indicated for the treatment of&nbsp;pulmonary tuberculosis. It should not be used as the sole antituberculous drug, but should be used in conjunction with at least one other antituberculous drug. Selection of the companion drug should be based on clinical experience, considerations of comparative safety, and appropriate&nbsp;in vitro&nbsp;susceptibility studies. In patients who have not received previous antituberculous therapy, ie, initial treatment, the most frequently used regimens have been the following:</p>\r\n\r\n<ul>\r\n	<li>Ethambutol plus isoniazid</li>\r\n	<li>Ethambutol plus isoniazid plus streptomycin.</li>\r\n</ul>\r\n\r\n<p>In patients who have received previous antituberculous therapy, mycobacterial resistance to other drugs used in initial therapy is frequent. Consequently, in such retreatment patients, Ethambutol should be combined with at least one of the second line drugs not previously administered to the patient and to which bacterial susceptibility has been indicated by appropriate&nbsp;in vitro&nbsp;studies. Antituberculous drugs used with Ethambutol have included cycloserine, ethionamide, pyrazinamide, viomycin and other drugs. Isoniazid, aminosalicylic acid, and streptomycin have also been used in multiple drug regimens. Alternating drug regimens have also been utilized.</p>', '<p>Ethambutol appears to inhibit the synthesis of 1 or more metabolites in susceptible bacteria resulting in impairment of cellular metabolism, arrest of multiplication, and cell death. It is active against susceptible bacteria only when they are undergoing cell division.</p>', '<p>Ethambutol should not be used alone, in initial treatment or in retreatment. Ethambutol should be administered on a once every 24-hour basis only.&nbsp;Absorption&nbsp;is not significantly altered by administration with food. Therapy, in general, should be continued until bacteriological conversion has become permanent and maximal clinical improvement has occurred.<br />\r\n<br />\r\nEthambutol is not recommended for use in pediatric patients under thirteen years of age since safe conditions for use have not been established.<br />\r\n<br />\r\n<strong>Initial Treatment</strong>:&nbsp;In patients who have not received previous antituberculous therapy, administer Ethambutol 15 mg/kg of body weight, as a single oral dose once every 24 hours. In the more recent studies, isoniazid has been administered concurrently in a single, daily, oral dose.<br />\r\n<br />\r\n<strong>Retreatment</strong>:&nbsp;In patients who have received previous antituberculous therapy, administer Ethambutol 25 mg/kg of body weight, as a single oral dose once every 24 hours. Concurrently administer at least one other antituberculous drug to which the organisms have been demonstrated to be susceptible by appropriate&nbsp;in vitro&nbsp;tests. Suitable drugs usually consist of those not previously used in the treatment of the patient. After 60 days of Ethambutol administration, decrease the dose to 15 mg/kg of body weight, and administer as a single oral dose once every 24 hours.<br />\r\n<br />\r\nDuring the period when a patient is on a daily dose of 25 mg/kg, monthly eye examinations are advised.<br />\r\n<br />\r\n<strong>Renal Impairment:</strong>&nbsp;Dose adjustment may be needed as determined by blood levels of ethambutol.</p>\r\n\r\n<p>Should be taken with food.</p>\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>', '<p>Delayed or reduced absorption with aluminium hydroxide.</p>', '<p>Ethambutol is contraindicated in patients who are known to be hypersensitive to this drug. It is also contraindicated in patients with known optic&nbsp;neuritis&nbsp;unless clinical judgment determines that it may be used. Ethambutol&nbsp;is contraindicated in patients who are unable to appreciate and report visual side effects or changes in vision</p>', '<p>Retrobulbar neuritis with reduction in visual acuity, constriction of visual field, central or peripheral scotoma and green-red colour blindness of 1 or both eyes. Reduced renal clearance of urate and may precipitate acute gout. Confusion, disorientation, hallucinations, headache, dizziness, malaise, jaundice or transient liver dysfunction, peripheral neuropathy, thrombocytopenia, pulmonary infiltrates, eosinophilia and GI disturbances (e.g. nausea, vomiting, anorexia, abdominal pain). Rarely, retinal haemorrhage, hypersensitivity reactions including rashes, pruritus, leucopenia, fever, and joint pains.</p>', '<p><strong>Category C</strong>: 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>Patient with ocular defects (e.g. cataracts, recurrent ocular inflammatory conditions, diabetic neuropathy). Renal impairment. Pregnancy and lactation.</p>', NULL, '<p>Anti-Tubercular Chemotherapeutics</p>', '<p>Store between 20-25&deg;C. Protect from light, moisture and excessive heat.</p>', NULL, '2022-02-21 23:23:54', '2022-06-12 00:46:33'),
(535, 535, '<p>They are liquids used primarily as a topical antiseptic. They also have multiple industrial and household uses. The term &quot;rubbing alcohol&quot; has become a general non-specific term for either isopropyl alcohol (isopropanol) or ethyl alcohol (ethanol) rubbing-alcohol products.</p>', '<p>Ethanol and isopropyl alcohol are both members of the alcohol family and have similar disinfectant properties. Ethanol is the type of alcohol present in alcoholic beverages. Isopropyl alcohol is also known as isopropanol, 2-propanol or rubbing alcohol. When used as disinfectants, both are typically at a concentration of 70 percent in water.</p>', '<ul>\r\n	<li>শুকেনা হােতর তালুেত ১-২ বার ক্লিন জেল প্রয়োগ করুন।</li>\r\n	<li>দুই হােতর তালু একসােথ ভােলাভােব ঘষুন।</li>\r\n	<li>আঙুেলর মােঝ ও নেখর ভেতরেও প্রয়োগ করুন এবং না শুকােনা পর্যন্ত ঘষুন।</li>\r\n	<li>কেয়ক সেকেন্ডর মধ্যেই হাত শুিকিয় জীবাণু মুক্ত হয়ে যাবে</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>', NULL, NULL, NULL, NULL, '<p>শিশুদের নাগােলর বাইের রাখুন ।</p>', NULL, '<p>Bleaching and Disinfectants</p>', '<p>আলো ও তাপ থেকে দূরে, ঘরের স্বাভাবিক তপমাত্রায় রাখুন</p>', NULL, '2022-02-21 23:24:17', '2022-06-12 00:47:56'),
(536, 536, '<p>The benefits of taking the pill include:</p>\r\n\r\n<ul>\r\n	<li>It is one of the most reliable reversible methods of contraception if used correctly</li>\r\n	<li>It does not interrupt sex</li>\r\n	<li>It usually makes period regular, lighter and less painful</li>\r\n	<li>It may help with pre-menstrual symptoms</li>\r\n</ul>', NULL, '<p><strong>Take this tablet every day for 21 days as described below</strong>: This tablet comes in strips of 21 pills, each marked with a day of the week.</p>\r\n\r\n<ul>\r\n	<li>Take your pill at the same time every day.</li>\r\n	<li>Start by taking a pill marked with the correct day of the week.</li>\r\n	<li>Follow the direction of the arrows on the strip. Take one pill each day, until you have finished all 21 pills.</li>\r\n	<li>Swallow each pill whole, with water if necessary. Do not chew the pill.</li>\r\n	<li>After you have taken all 21 pills in the strip, you have seven days when you take no pills. So, if you take the last pill of one pack on a Friday, you will take the first pill of your next pack on the Saturday of the following week.</li>\r\n</ul>\r\n\r\n<p>Within a few days of taking the last pill from the strip, you should have a withdrawal bleed like a period. This bleed may not have finished when it is time to start your next strip of pills.<br />\r\n<br />\r\nYou don&#39;t need to use extra contraception during these seven pill-free days.<br />\r\n<br />\r\nStarting this tablet:</p>\r\n\r\n<ul>\r\n	<li>As a new user icrolon or starting the pill again after a break. Either take your first pill on the first day of your next period. By starting in this way, you will have contraceptive protection with your first pill.</li>\r\n	<li>Or if your period has already begun start taking this tablet on day 5 (counting the first day of your period as day 1) whether or not your bleeding has stopped. You must also use extra contraception, such as condoms, until you have taken the first seven pills correctly.</li>\r\n</ul>\r\n\r\n<p>Changing to this pill from another contraceptive Pill-</p>\r\n\r\n<ul>\r\n	<li>If you are currently on a 21-day pill, start taking jUicrolon the next day after the end of the previous strip. You will have contraceptive protection with your first pill but you will not have a bleed until after you finish your first strip of this pill.</li>\r\n	<li>If you are currently on a 28-day pill, start taking this pill the day after your last active pill. You will have contraceptive protection with your first pill.</li>\r\n	<li>You will not have a bleed until after you finish your first strip of this pill.</li>\r\n	<li>Or if you are taking a Progestogen-only Pill (POP), start. This pill on the first day of bleeding, even if you have already taken the POP for that day. You will have contraceptive cover straight away. If you don&#39;t usually have any bleeding while you are taking a Progestogen-only Pill, you can stop taking it any day and start this pill the next day. You will need to use extra contraception, such as a condom, for seven days.</li>\r\n	<li>Changing to this pill from a Progestogen-only injection, implant of Progestogen releasing intrauterine device (IUD). Start taking this pill when your next injection is due or on the day that your implant or IUD is removed. Make sure you also use an additional contraceptive method, such as a condom, for the first 7 days that you are taking this pill.</li>\r\n</ul>\r\n\r\n<p><strong>Starting this pill after a miscarriage or abortion</strong>: If you have had a miscarriage or an abortion, your doctor may tell you to start taking this pill straight away. This means that you will have contraceptive protection with your first pill. Contraception after having a baby if you have just had a baby, ask your doctor for advice about contraception.<br />\r\n<br />\r\nIf you are not breast-feeding:</p>\r\n\r\n<ul>\r\n	<li>You can start taking this pill three weeks after the birth or more than three weeks after the birth but you need to use extra contraception, such as a condom until you have taken the first seven pills correctly.</li>\r\n	<li>If you have had sex since birth there is a chance that you could be pregnant, you should therefore use another form of contraception, such as a condom. In this case, take your first this pill on the first day of your next period.</li>\r\n</ul>\r\n\r\n<p>A missed pill:</p>\r\n\r\n<ul>\r\n	<li>If you have missed any of the pills in a strip and you do not bleed in the first pill-free break, you may be pregnant. Contact your doctor or family planning clinic or do a pregnancy test yourself.</li>\r\n	<li>If you start a new strip of pills late or make your &quot;week off&quot; longer than seven days, you may not be protected from pregnancy.</li>\r\n	<li>If you had sex in the last seven days, ask your doctor, family planning nurse or pharmacist for advice. You may need to consider emergency contraception. You should also use extra contraception, such as a condom, for seven days.</li>\r\n</ul>\r\n\r\n<p><strong>A lost pill</strong>: If you lose a pill, either take the last pill of the strip in place of the lost pill. Then take all the other pills on their proper days. Your cycle will be one day shorter than normal, but your contraceptive protection won&#39;t be affected. After your seven pill-free days you will have a new starting day, one day earlier than before.<br />\r\n<br />\r\n<strong>If you are sick or have diarrhea</strong>: If you are sick (vomit) or have very bad diarrhoea your body may not get its usual dose of hormones from that pill. If you vomit within 3 to 4 hours after taking your pill, this is like missing a pill. You must follow the advice for missed pills. If you have severe diarrhoea for more than 12 hours after taking. This pill follow the instructions for if you are more than 12 hours late, A missed pill. Talk to your doctor if your stomach upset carries on or gets worse. He or she may recommend another form of contraception.<br />\r\n<br />\r\n<strong>Missed a period- could you be pregnant</strong>: Occasionally, you may miss a withdrawal bleed. This could mean that you are pregnant, but that is very unlikely if you have taken your pills correctly. Start your next strip at the normal time. If you think that you might have put yourself at risk of pregnancy (for example, by missing pills or taking other medicines), or if you miss a second bleed, you should do a pregnancy test.<br />\r\n<br />\r\n<strong>Taking more than one pill should not cause harm</strong>: It is unlikely that taking more than one pill will do you any harm, but you may feel sick, vomit or have some vaginal bleeding. Talk to your doctor if you have any of these symptoms.<br />\r\n<br />\r\n<strong>You can delay a period</strong>: If you want to delay having a period, finish the strip of pills you are taking. Start the next strip the next day without a break. Take this strip the usual way. After the second strip, leave seven pill-free days as usual, then start your next strip of pills in the normal way. When you use the second strip, you may have some unexpected bleeding or spotting on the days that you take the pill, but don&#39;t worry.<br />\r\n<br />\r\n<strong>When you want to get pregnant</strong>: If you are planning a baby, it&rsquo;s best to use another method of contraception after stopping this pill until you have had a proper period. Your doctor or midwife relies on the date of your last natural period before you get pregnant to tell you when your baby is due. However, it will not cause you or the baby any harm if you get pregnant straight away.</p>\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>', NULL, '<p>You should not use this tablet if you have or ever had any of the conditions listed below:</p>\r\n\r\n<ul>\r\n	<li>A blood clot in a blood vessel of legs (Deep Vein Thrombosis, DVT), lungs (Pulmonary Embolus, PE) or other organs</li>\r\n	<li>A disorder affecting blood clotting- for instance, protein C deficiency, protein S deficiency, antithrombin-lll deficiency, Factor V Leiden or antiphospholipid&nbsp;antibodies</li>\r\n	<li>Need an operation or off to feet for a long time</li>\r\n	<li>A heart attack or stroke</li>\r\n	<li>Angina pectoris</li>\r\n	<li>Any of the following diseases that may increase risk of a clot in the arteries: Severe diabetes with blood vessel damage, Very high blood pressure, A very high level of fat in the blood (cholesterol or triglycerides), A condition known as hyperhomocysteinaemia</li>\r\n	<li>A type of migraine called &quot;migraine with aura&quot;</li>\r\n	<li>Severe liver disease or liver tumour</li>\r\n	<li>Cancer affected by sex hormones- such as some cancers of the breast, womb lining or ovary</li>\r\n	<li>Vaginal bleeding that has not been explained by doctor</li>\r\n	<li>Allergy (hypersensitivity) to any of the ingredients in this tablet</li>\r\n</ul>\r\n\r\n<p>If you suffer from any of these or get them for the first time while taking this tablet contact your doctor as soon as possible stop taking this tablet.</p>', '<ul>\r\n	<li>Migraine or headache (see a doctor as soon as possible if this is your first migraine or it&rsquo;s worse than usual, or if the headache is severe, unusual or long lasting)</li>\r\n	<li>Putting on weight or losing weight</li>\r\n	<li>Breast problems, such as painful or tender breasts; producing a milky fluid from the nipples</li>\r\n	<li>Depression or mood changes</li>\r\n	<li>Changes in sexual desire</li>\r\n	<li>Heart or circulation problems, such as increased blood pressure, swollen hands, ankles or feet (a sign of fluid retention)</li>\r\n	<li>Changes in vaginal secretions (Irregular vaginal bleeding)</li>\r\n	<li>Skin problems; such as, rash, bruise-like swelling to the shins (erythema nodosom)</li>\r\n	<li>Stomach problems; such as, nausea, vomiting</li>\r\n	<li>Discomfort of the eyes who wears contact lenses</li>\r\n</ul>', '<p>Do not use this tablet if you are pregnant. If you think you might be pregnant, do a pregnancy test to confirm that you are before you stop taking this tablet. This tablet is not recommended for use in breastfeeding. Ask your doctor or family planning nurse about alternative contraception.</p>', '<p>If you ever need to take another medicine at the same time as being on the pill, always tell your doctor, pharmacist or dentist that you&#39;re taking this tablet. Also check the leaflets that come with all your medicines to see if they can be taken with hormonal contraceptives.<br />\r\n<br />\r\nSome medicines can stop this tablet from working properly-for example:</p>\r\n\r\n<ul>\r\n	<li>Some medicines used to treat epilepsy (Primidone, Phenytoins, Barbiturates, Carbamazepine, Oxcarbazepine, Topiramate, Felbamate)</li>\r\n	<li>Medicine to treat tuberculosis (Rifampicin)</li>\r\n	<li>Certain HIV medicines (Ritonavir)</li>\r\n	<li>Certain antibiotics (Penicillins, Tetracyclines)</li>\r\n	<li>St. John&rsquo;s Wort (a herbal remedy)</li>\r\n	<li>Griseofulvin (an antifungal drug)</li>\r\n</ul>\r\n\r\n<p>If you do need to take one of these medicines, this tablet may not be suitable for you or you may be able to take this tablet and use extra contraception for a while. This tablet can also affect how well other medicines work. For example, Cyclosporine and Lamotrigine.<br />\r\n<br />\r\n<strong>Taking these medicines with food and drink</strong>: There are no special instructions about food and drink while on this tablet.<br />\r\n<br />\r\n<strong>Bleeding between periods should not last long</strong>: A few women have a little unexpected bleeding or spotting while they are taking this pill, especially during the first few months. Normally, this bleeding is nothing to worry about and will stop after a day or two. Keep taking this pill as usual; the problem should disappear after the first few strips. You may also have unexpected bleeding if you are not taking your pills regularly, so try to take your pill at the same time every day. Also, unexpected bleeding can sometimes be caused by other medicines. Make an appointment to see your doctor if you get breakthrough bleeding or spotting that:</p>\r\n\r\n<ul>\r\n	<li>Carries on for more than the first few months</li>\r\n	<li>Starts after you&rsquo;ve been taking this pill for a while</li>\r\n	<li>Carries on even after you&rsquo;ve stopped taking this pill</li>\r\n</ul>', NULL, '<p>Oral Contraceptive preparations</p>', '<p>Store in a cool &amp; dry place, protect from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-02-21 23:24:57', '2022-06-12 00:49:42');
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
(537, 537, '<p>This is indicated to prevent pregnancy. Oral contraceptives are a very effective method of birth control. When taken correctly (without missing tablets), the chance of becoming pregnant is very low.</p>', NULL, '<p>This pack contains 21 tablets. On the pack, each tablet is marked with the day of the week on which it is to be taken. Take your tablet at about the same time each day, with some water if necessary. Follow the direction of the arrows until all 21 tablets have been taken. During the next 7 days you take no tablets. A period should begin during these 7 days (the withdrawal bleed). Usually, it will start on day 2-3 after the last tablet. Start taking your next pack on the 8th day even if your period continues. This means that you will always start new packs on the same day of the week, and also that you have your withdrawal bleed on about the same days, each month.<br />\r\n<br />\r\nStarting your first pack of this tablet-</p>\r\n\r\n<ul>\r\n	<li><strong>When no hormonal contraceptive has been used in the past month</strong>: Start taking this tablet on the first day of your cycle, i.e. the first day of menstrual bleeding. Take a tablet marked with that day of the week. For example, if your period starts on a Friday, take a tablet marked Friday. Then follow the day&#39;s in order. You may also start on days 2-5 of your cycle, but in that case make sure you also use an additional contraceptive method (barrier method) for the first 7 days of tablet taking in the first cycle.</li>\r\n	<li><strong>When changing from another combined Pill</strong>: You can start taking this tablet the day after you take the last tablet from your present Pill pack (this means no tablet free break). If your present Pill pack also contains inactive tablets you can start this tablet on the day after taking the last active tablet (if you are not sure which this is, ask your doctor or pharmacist). You can also start later, but never later than the day following the tablet-free break of your present Pill (or the day after the last inactive tablet of your present Pill).</li>\r\n	<li><strong>When changing from a progestagen-only Pill (minipill)</strong>: You can stop taking the minipill any day and start taking this tablet the next day, at the same time. But make sure you also use an additional contraceptive method (a barrier method) for the first 7 days of tablet taking when having intercourse.</li>\r\n	<li><strong>When changing from an injectable or implant</strong>: Start using this tablet when your next injection is due or on the day that your implant is removed. But make sure you also use an additional contraceptive method (a barrier method) for the first 7 days of tablet-taking when having intercourse.</li>\r\n	<li><strong>After having a baby</strong>: If you have just had a baby, your doctor may tell you to wait until after your first normal period before you start taking this tablet. Sometimes it is possible to start sooner. Your doctor will advise you. If you are breast-feeding and want to take this tablet, you should discuss this first with your doctor.</li>\r\n	<li><strong>After a miscarriage or an abortion</strong>: Your doctor will advise you.</li>\r\n</ul>\r\n\r\n<p><strong>If too many this tablet are taken (overdose)</strong>: There have been no reports of serious harmful effects from taking too many this tablets at one time. If you have taken several tablets at a time, you may have nausea, vomiting or vaginal bleeding. If you discover that a child has taken this tablet, ask your doctor for advice.<br />\r\n<br />\r\n<strong>When you want to stop taking this tablet</strong>: You can stop taking this tablet at any time you want. If you do not want to become pregnant, ask your doctor about other methods of birth control.<br />\r\n<br />\r\nIf you stop taking this tablet because you want to get pregnant, it is generally recommended that you wait until you have had a natural period before trying to conceive. This helps you to work out when the baby will be due.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>If you forget tablets:</p>\r\n\r\n<ul>\r\n	<li>If you are less than 12 hours late in taking a tablet, the reliability of the Pill is maintained. Take the tablet as soon as you remember and take the next tablets at the usual times.</li>\r\n	<li>If you are more than 12 hours late in taking any tablet, the reliability of the Pill may be reduced. The more consecutive tablets you have missed, the higher the risk that the contraceptive efficacy is decreased. There is a particularly high risk of becoming pregnant if you miss tablets at the beginning or at the end of the pack. Therefore you should follow the rules given below.</li>\r\n</ul>\r\n\r\n<p>More than one tablet forgotten in a pack: Ask your doctor for advice.<br />\r\n<br />\r\n<strong>1 tablet missed in week 1</strong>: Take the missed tablet as soon as you remember (even if this means taking two tablets at the same time) and take the next tablets at the usual time. Use extra contraceptive precautions (barrier method) for the next 7 days. If you had sexual intercourse in the week before missing the tablets, there is a possibility of becoming pregnant. So tell your doctor immediately.<br />\r\n<br />\r\n<strong>1 tablet missed in week 2</strong>: Take the missed tablet as soon as you remember (even if this means taking two tablets at the same time) and take the next tablets at the usual time. The reliability of the Pill is maintained. You need not use extra contraceptive precautions.<br />\r\n<br />\r\n<strong>1 tablet missed in week 3</strong>: You may choose either of the following options, without the need for extra contraceptive precautions.<br />\r\n<br />\r\nTake the missed tablet as soon as you remember (even if this means taking two tablets at the same time) and take the next tablets at the usual time. Start the next pack as soon as the current pack is finished so that no gap is left between packs. You may not have a withdrawal bleed until the end of the second pack but you may have spotting or breakthrough bleeding on tablet-taking days. Or<br />\r\n<br />\r\nStop taking tablets from your current pack, have a tabletfree break of 7 days or less (also count the day you<br />\r\nmissed your tablet) and continue with the next pack. When following this method, you can always start your next pack on the same day of the week as you usually do.<br />\r\n<br />\r\nIf you have forgotten tablets in a pack and you do not have the expected period in the first normal tablet-free break, you may be pregnant. Consult your doctor before you start with the next pack.<br />\r\n<br />\r\n<strong>you vomit</strong>: If you vomit within 3 to 4 hours after taking your this tablet, the active ingredients may not have been completely absorbed. This is like missing a tablet. Therefore, follow the advice for missed tablets.<br />\r\n<br />\r\n<strong>you want to delay your period</strong>: you can delay your period if you start with your next pack of this tablet immediately after finishing your current pack. You can continue with this pack for as long as you wish, until this pack is empty. When you wish your period to begin, just stop tablet taking. While using the second pack you may have some breakthrough bleeding or spotting on tablet-taking days. Start with your next pack after the usual 7 day tablet-free break.<br />\r\n<br />\r\n<strong>you want to change the starting day of your period</strong>: If you take your tablets as directed, you will have your period on about the same day every 4 weeks. If you want to change this, just shorten, (never lengthen) the next tablet-free break. For example, if your period usually starts on a Friday and in future you want it to start on Tuesday (3 days earlier) you should now start your next pack 3 days sooner than you usually do. If you make your tablet-free break very short (e.g. 3 days or less) you may not have a bleeding during the break. You may have some breakthrough bleeding or spotting during the use of the next pack.<br />\r\n<br />\r\n<strong>You have unexpected bleeding</strong>: With all Pills, for the first few months, you can have irregular vaginal bleeding (spotting or breakthrough bleeding) between your periods. You may need to use sanitary protection, but continue to take your tablets as normal. Irregular vaginal bleeding usually stops once your body has adjusted to the pill (usually after about 3 tablet-taking cycles). If it continues, becomes heavy or starts again, tell your doctor.<br />\r\n<br />\r\n<strong>you have missed a period</strong>: If you have taken all of your tablets at the right time, and you have not vomited, or used other medicines then you are very unlikely to be pregnant. Continue to take this tablet as usual. If you miss your period twice in a row, you may be pregnant. Tell your doctor immediately. Do not start the next pack of this tablet until your doctor has checked you are not pregnant.</p>\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>', NULL, '<p>Do not use the combined Pill if you have any of the conditions listed below. If any of these apply to you, tell your doctor before starting to use this tablet. Your doctor may advise you to use a different type of Pill or an entirely different (non-hormonal) method of birth control.</p>\r\n\r\n<ul>\r\n	<li>If you have, or have ever had a disorder affecting the blood circulation. In particular, those conditions relating to thrombosis. Thrombosis is the formation of a blood clot. This may occur in the blood vessels of the legs (deep vein thrombosis), the lungs (pulmonary embolism), the heart (heart attack), the brain (stroke), or other parts of the body.</li>\r\n	<li>If you have or have ever had a condition that may be a first sign of a heart attack (such as angina pectoris or chest pain) or stroke (such as transient ischaemic attack or small reversible stroke).</li>\r\n	<li>If you have diabetes mellitus with blood vessel damage.</li>\r\n	<li>If you have jaundice (yellowing of the skin) or severe liver disease.</li>\r\n	<li>If you have or have had cancer of the breast or the genital organs.</li>\r\n	<li>If you have or have had a benign or malignant tumour in the liver.</li>\r\n	<li>If you have any unexplained vaginal bleeding.</li>\r\n	<li>If you are pregnant or think you might be pregnant.</li>\r\n	<li>If you are allergic to any of the ingredients of this tablet.</li>\r\n</ul>\r\n\r\n<p>If any of these conditions appear for the first time while using the Pill, stop taking it at once and consult your doctor. In the meantime, use non-hormonal contraceptive measures.</p>', '<p><strong>Possible side effects</strong>: The following side effects have been reported by users of the Pill, although they need not be caused by the Pill. These side effects may occur in the first few months that you are using the Pill and usually lessen with time.</p>\r\n\r\n<ul>\r\n	<li>breast tenderness, pain and secretion;</li>\r\n	<li>headache;</li>\r\n	<li>changes in sexual drive; depressive moods;</li>\r\n	<li>contact lens intolerance;</li>\r\n	<li>nausea, vomiting and feeling sick;</li>\r\n	<li>changes in vaginal secretion;</li>\r\n	<li>various skin reactions;</li>\r\n	<li>fluid retention;</li>\r\n	<li>changes in body weight;</li>\r\n	<li>hypersensitivity reactions.</li>\r\n</ul>', '<p>The Pill and Breastfeeding: This tablet&nbsp;is generally not recommended for use during breast feeding. If you wish to take the Pill while breastfeeding, please seek the advice of your doctor.<br />\r\n<br />\r\nThe Pill and Pregnancy: This tablet must not be used by women who are pregnant, or who think they may be pregnant.</p>', '<p>Before you start to use this tablet: If the combined Pill is used in the presence of any of the conditions listed below you may need to be kept under close observation. Your doctor can explain this to you. Therefore, if any of these apply to you, tell your doctor before starting to use this tablet</p>\r\n\r\n<ul>\r\n	<li>you smoke;</li>\r\n	<li>you have diabetes;</li>\r\n	<li>you are overweight;</li>\r\n	<li>you have high blood pressure;</li>\r\n	<li>you have a heart valve disorder or a certain heart rhythm disorder;</li>\r\n	<li>you have an inflammation of your veins (superficial phlebitis);</li>\r\n	<li>you have varicose veins;</li>\r\n	<li>anyone in your immediate family has had a thrombosis, a heart attack or a stroke;</li>\r\n	<li>you suffer from migraine;</li>\r\n	<li>you suffer from epilepsy;</li>\r\n	<li>you or someone in your immediate family have or had high blood levels of cholesterol or triglycerides (fatty substances);</li>\r\n	<li>anyone in your immediate family has had breast cancer;</li>\r\n	<li>you have liver or gallbladder disease;</li>\r\n	<li>you have Crohn&#39;s disease or ulcerative colitis (chronic inflammatory bowel disease);</li>\r\n	<li>you have systemic lupus eryhematosus (SLE; a disease affecting the skin all over the body);</li>\r\n	<li>you have haemolytic uraemic syndrome (HUS; a disorder of blood coagulation causing failure of the kidneys);</li>\r\n	<li>you have sickle cell disease;</li>\r\n	<li>you have or have had chloasma (yellowish-brown pigmentation patches on the skin, particularly of the face): if so, avoid too much exposure to the sun or ultraviolet radiation.</li>\r\n</ul>\r\n\r\n<p>If any of the above conditions appear for the first time, recur or worsen while using the Pill, you should contact your doctor.<br />\r\n<br />\r\n<strong>The Pill and Thrombosis</strong>: A thrombosis is the formation of a blood clot, which may block a blood vessel. A thrombosis sometimes occurs in the deep veins of the legs (deep venous thrombosis). If this blood clot breaks away from the veins where it is formed, it may reach and block the arteries of the lungs, causing a so-called &quot;Pulmonary embolism.&quot; Deep venous thrombosis is a rare occurrence. It can develop whether or not you are taking the Pill. It can also happen if you become pregnant. The risk is higher in Pill-users than in non-users, but it is not as high as the risk during pregnancy.<br />\r\n<br />\r\nBlood clots can also occur very rarely in the blood vessels of the heart (causing a heart attack) or the brain (causing a stroke). Extremely rarely blood clots can occur in the liver, gut, kidney or eye.<br />\r\n<br />\r\nVery occasionally a thrombosis may cause serious permanent disabilities or may even be fatal.<br />\r\n<br />\r\nThe risk of having a heart attack or stroke increases, as you get older. It also increases the more you smoke. When using the Pill you should stop smoking, especially if you are older than about 35 years of age.<br />\r\n<br />\r\nIf you develop high blood pressure while using the Pill, you may be told to stop using it.<br />\r\n<br />\r\nThe risk of having a deep venous thrombosis is temporarily increased as a result of an operation or immobilisation (for example, when you have your leg or legs in plaster or splints). In women who use the Pill, the risk may be yet higher. Tell your doctor you are using the Pill well in advance of any expected hospitalisation or surgery. Your doctor may tell you to stop taking the Pill several weeks before surgery or at the time of immobilisation. Your doctor will also tell you when you can start taking the Pill again after you are back on your feet. If you notice possible signs of a thrombosis, stop taking the Pill and consult your doctor immediately.<br />\r\n<br />\r\n<strong>The Pill and cancer</strong>: Breast cancer has been diagnosed, slightly more often in women who use the Pill than in women of the same age who do not use the Pill. This slight increase in the numbers of breast cancer diagnoses gradually disappears during the course of the 10 years after stopping use of the Pill. It is not known whether the difference is caused by the Pill. It may be that the women were examined more often, so that the breast cancer was noticed earlier. In rare cases benign liver tumours and even more rarely, malignant liver tumours have been reported in users of the Pill. These tumours may lead to internal bleeding. Contact your doctor immediately if you have severe pain in your stomach.<br />\r\n<br />\r\nCervical cancer has been reported to occur more often in women using the Pill for a long time. This finding may not be caused by the Pill but may be related to sexual behaviour and other factors.<br />\r\n<br />\r\n<strong>The Pill and other Medicines</strong>: Some medicines may stop the Pill from working properly. These include medicines used for the treatment of epilepsy (eg. primidone, phenytoin, barbiturates) and tuberculosis (eg. rifampicin); and antibiotics (eg. ampcillin, tetracyclines, griseofulvin) for some other infectious diseases. Always tell the doctor, who prescribes the Pill, which medicines you are already using. Also tell any other doctor or dentist who prescribes another medicine (or the dispensing pharmacist) that you use this tablet. They can tell you if you need to take additional contraceptive precautions and if so, for how long.<br />\r\n<br />\r\n<strong>The Pill and Ability to Drive</strong>: There are no observed effects.</p>', NULL, '<p>Oral Contraceptive preparations</p>', '<p>Store in a cool &amp; dry place in between 2-25&deg; C, protect from light. Keep out of the reach of children.</p>', NULL, '2022-02-21 23:25:16', '2022-06-12 00:52:04'),
(538, 538, '<p>Contraception, Oral contraceptives</p>', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '<p>Oral Contraceptive preparations</p>', NULL, NULL, '2022-02-21 23:25:53', '2022-06-12 00:52:43'),
(539, 539, '<p>This is indicated in oral contraception.</p>', '<p>This is a combined oral contraceptive tablet containing the synthetic progestogen, drospirenone and the synthetic estrogen, ethinylestradiol. The contraceptive effect of this tablet is based on the interaction of various factors, the most important of which are seen as the inhibition of ovulation and the changes in cervical secretion. When this tablet is taken according to instructions, the egg cells are prevented from maturing to the point at which they can be fertilized, the cervical mucus remains thick so as to constitute a barrier to sperm and the endometrium is rendered unreceptive to implantation. As well as protection against pregnancy, estrogen/progestogen combinations have several positive properties which, next to the negative properties, can be useful in deciding on the method of birth control. The cycle is more regular and the menstruation is often less painful and bleeding is lighter.<br />\r\n<br />\r\nDrospirenone has antimineralocorticoid activity, counteracting estrogen related sodium retention. In combination with ethinylestradiol, drospirenone displays a favourable lipid profile with an increase in high-density lipoprotein HDL. Drospirenone exerts antiandrogenic activity and does not counteract the ethinylestradiol-related sex hormone binding globulin (SHBG) increase which is useful for binding and inactivating the endogenous androgens. Drospirenone is devoid of any androgenic, estrogenic, glucocorticoid and antiglucocorticoid activity. This in combination with the antimineralocorticoid and antiandrogenic properties, gives drospirenone a biochemical and pharmacological profile closely resembling the natural hormone progesterone.</p>', '<p><strong>When and how to take the tablets</strong>: The this tablet pack contains 21 tablets. On the pack, each tablet is marked with the day of the week on which it is to be taken. Take your tablet at about the same time each day, with some water if necessary. Follow the direction of the arrows until all 21 tablets have been taken. During the next 7 days don&#39;t take any tablet. A period should begin during these 7 days (the withdrawal bleed), unusually it will start on day 2-3 after the last this tablettablet. Start taking your next pack on the 8th day even if your period continues. This means that you will always start new packs on the same day of the week and also that you have your withdrawal bleed on about the same days each month.<br />\r\n<br />\r\n<strong>Starting your first pack of this tablet</strong>: When no hormonal contraceptive has been used in the past month. Start taking this tablet on the first day of your cycle, i.e. the first day of menstrual bleeding. Take a tablet marked with that day of the week. For example, if your period starts on a Sunday, take a tablet marked Sunday. Then follow thedaysin order. You may also start on days 2-5 of your cycle, but in that case make sure you also use an additional contraceptive method (barrier method) for the first 7 days of tablet-taking in the first cycle.<br />\r\n<br />\r\n<strong>When changing form another combined Pill</strong>: You can start taking this tablet the day after you have the last tablet from your present Pill pack (this means no tablet-free break). If your present Pill pack also contains inactive tablets you can start this tablet on the day after taking the first active tablet (if you are not sure which this is, ask your doctor or pharmacist). You can also start later, but never later than the day following the tablet free break of your present Pill (or the day after the last inactive tablet of your present Pill).<br />\r\n<br />\r\n<strong>When changing from progestogen-only Pill (Mini Pill)</strong>: You can stop taking the mini pill any day and start taking this tablet the next day, at the same time. But make sure you also use an additional-contraceptive method (a barrier method) for the first 7 days of tablet-taking when having intercourse.<br />\r\n<br />\r\n<strong>When changing from an Injectable or Implant</strong>: Start using this tablet when your next injection is due or on the day that your implant is removed. But make sure you also use an additional contraceptive method (a barrier method) for the first 7 days of tablet-taking when having intercourse.<br />\r\n<br />\r\n<strong>After having a baby</strong>: If you have just had a baby, your doctor may tell you to wait until after your first normal period before you start taking this tablet. Sometimes it is possible to start sooner. Your doctor will advise you. If you are breast-feeding and want to take this tablet you should discuss this first with your doctor.<br />\r\n<br />\r\n<strong>After a miscarriage or an abortion</strong>: Your doctor will advise you.<br />\r\n<br />\r\n<strong>If too many this tablet tablets are taken (overdose)</strong>: There have been no reports of serious harmful effects from taking too many this tablet tablets at one time. If you have taken several tablets at a time, you may have nausea, vomiting or vaginal bleeding. If you discover that a child has taken this tablet ask your doctor for advice.<br />\r\n<br />\r\n<strong>When you want to stop taking this tablet</strong>: You can stop taking this tablet at any time you want. If you do not want to become pregnant, ask your doctor about other methods of birth control. If you stop taking this tablet because you want to get pregnant, it is generally recommended that you wait until you have had a natural period before trying to conceive.</p>\r\n\r\n<p>If you forget to take tablets</p>\r\n\r\n<ul>\r\n	<li>If you are less than 12 hours late in taking a tablet, the reliability of the Pill is maintained. Take the tablet as soon as you remember and take the next tablets at the usual times.</li>\r\n	<li>If you are more than 12 hours late in taking any tablet, the reliability of the Pill may be reduced. The more consecutive tablets you have missed, the higher the risk that the contraceptive efficacy is decreased. There is a particularly high risk of becoming pregnant if you miss tablets at the beginning or at the end of the pack. Therefore, you should follow the rules given below.</li>\r\n</ul>\r\n\r\n<p>More than one tablet forgotten in a pack: Ask your doctor for advice.</p>\r\n\r\n<ul>\r\n	<li><strong>1 tablet missed in week 1</strong>: Take the missed tablet as soon as your remember (even if this means taking two tablets at the same time) and take the next tablets at the usual time. Use extra contraceptive precautions (barrier method) for the next 7 days. If you had sexual intercourse in the week before missing the tablets, there is a possibility of becoming pregnant. So tell your doctor immediately.</li>\r\n	<li><strong>1 tablet missed in week 2</strong>: Take the missed tablet as soon as you remember (even if this means taking two tablets at the same time) and take the next tablets at the usual time. The reliability of the Pill is maintained. You need not use extra contraceptive precautions.</li>\r\n	<li><strong>1 tablet missed in week 3</strong>: You may choose either of the following options, without the need for extra contraceptive precautions.</li>\r\n</ul>\r\n\r\n<p>Take the missed tablet as soon as you remember (even if this means taking two tablets at the same time) and take the next tablets at the usual time. Start the next pack as soon as the current pack is finished so that no gap is left between packs. You may not have a withdrawal bleed until the end of the second pack but you may have spotting or breakthrough bleeding on tablet-taking days. Or<br />\r\n<br />\r\nStop taking tablets from your current pack, have a tablet-free break of 7 days or less (also count the day you missed your tablet) and continue with the next pack. When, following this method, you can always start your next pack on the same day of the week as you usually do.<br />\r\n<br />\r\nIf you have forgotten tablets in a pack and you do not have the expected period in the first normal tablet-free break, you may be pregnant. Consult your doctor before you start with the next pack.<br />\r\n<br />\r\n<strong>you vomit</strong>: If you vomit within 3 to 4 hours after taking your this tablet tablet, the active ingredients may not have been completely absorbed. This is like missing a tablet. Therefore, follow the advice for missed tablets.<br />\r\n<br />\r\n<strong>you want to delay your period</strong>: you can delay your period if you start with your next pack of this tablet immediately after finishing your current pack. You can continue with this pack for as long as you wish, until this pack is empty. When you wish your period to begin, just stop tablet taking. While using the second pack you may have some breakthrough bleeding or spotting on tablet-taking days. Start with your next pack after the usual 7 days tablet free break.<br />\r\n<br />\r\n<strong>you want to change the starting day of your period</strong>: If you take your tablets as directed, you will have your period on about the same day every 4 weeks. If you want to change this, just shorten, (never lengthen) the next tablet- free break. For example, if your period usually starts on a Friday and in future you want it to start on Tuesday (3 days earlier) you should now start your next pack 3 days sooner than you usually do. If you make your tablet-free break very short (e.g. 3 days or less) you may not have bleeding during the break. You may have some breakthrough bleeding or spotting during the use of the next pack.<br />\r\n<br />\r\n<strong>you have unexpected bleeding</strong>: With all Pills, for the first few months, you can have irregular vaginal bleeding (spotting or breakthrough bleeding) between your periods. You may need to use sanitary protection, but continue to take your tablets as normal. Irregular vaginal bleeding usually stops once your body has adjusted to the Pill (usually after about 3 tablet-taking cycles). If it continues, becomes heavy or starts again, tell your doctor.<br />\r\n<br />\r\n<strong>you have missed a period</strong>: If you have taken all of your tablets at the right time and you have not vomited or used other medicines then you are very unlikely to be pregnant. Continue to take this tablet as usual.<br />\r\n<br />\r\nIf you miss your period twice in row, you may be pregnant. Tell your doctor immediately. Do not start the next pack of this tablet until your doctor has checked you are not pregnant.</p>\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>&nbsp;</p>', NULL, '<p>Preparations containing estrogen/progestogen combinations should not be used in the presence of any of the conditions listed below. If any of the conditions appear for the first time during their use, the product should be stopped immediately.</p>\r\n\r\n<ul>\r\n	<li>Thrombosis (venous or arterial) present or in history (e.g. deep venous thrombosis, pulmonary embolism, myocardial infarction, cerebrovascular accident)</li>\r\n	<li>Presence or history of prodromi of a thrombosis (e.g.transient ischaemic attack, angina pectoris)</li>\r\n	<li>Presence or history of migraine with focal neurological symptoms</li>\r\n	<li>Diabetes mellitus with vascular involvement</li>\r\n	<li>Disturbed lipometabolism</li>\r\n	<li>The presence of a severe or multiple risk factor(s) for venous or arterial thrombosis may also constitute a contraindication</li>\r\n	<li>Pancreatitis or a history thereof if associated with severe hypertriglyceridemia</li>\r\n	<li>Presence or history of severe hepatic disease as long as liver function values have not returned to normal</li>\r\n	<li>Severe renal insufficiency or acute renal failure</li>\r\n	<li>Presence or history of liver tumours (benign or malignant)</li>\r\n	<li>Known or suspected malignant conditions of the genital organs or the breasts, if sex steroid-influenced</li>\r\n	<li>Undiagnosed vaginal bleeding</li>\r\n	<li>Known or suspected pregnancy</li>\r\n	<li>Hypersensitivity to any of the components of this table</li>\r\n</ul>', '<p>Like other contraceptives some undesirable effects may have seen with this tablet, these include venous and arterial thromboembolic disorders. The following undesirable effects have been reported in users of COCs and whether this association is causal has not been confirmed: Nausea, abdominal pain, Vomiting, diarrhoea, Weight increased, Fluid retention, Headache, Migraine, Depressed mood, mood altered, Breast pain, breast tenderness, Libido decreased, Breast hypertrophy, Rash, urticaria. In women with hereditary angioedema exogenous estrogens may induce or exacerbate symptoms of angioedema.</p>', '<p><strong>The Pill and Breastfeeding</strong>: This tablet is generally not recommended for use during breast feeding. If you wish to take the Pill while breastfeeding, please seek the advice of your doctor.<br />\r\n<br />\r\n<strong>The Pill and Pregnancy</strong>: This tablet must not be used by women who are pregnant or who think they may be pregnant.</p>', '<p><strong>The Pill and Breastfeeding</strong>: This tablet is generally not recommended for use during breast feeding. If you wish to take the Pill while breastfeeding, please seek the advice of your doctor.<br />\r\n<br />\r\n<strong>The Pill and Pregnancy</strong>: This tablet must not be used by women who are pregnant or who think they may be pregnant.</p>', NULL, '<p>Oral Contraceptive preparations</p>', '<p>Store below 30&deg;C. Store all drugs properly and keep them out of reach of children</p>', NULL, '2022-02-21 23:26:39', '2022-06-12 00:55:10'),
(540, 540, '<p>This tablet is indicated for:</p>\r\n\r\n<ul>\r\n	<li>As an oral contraceptive</li>\r\n	<li>Treatment of moderate acne vulgaris</li>\r\n	<li>Treatment of premenstrual dysphoric disorder (PMDD)</li>\r\n</ul>', '<p>This contains two active ingredients- Ethinylestradiol and Drospirenone. Ethinylestradiol is a synthetic version of estrogen and Drospirenone is a synthetic form of progesterone. The hormonal components of this preparation inhibit ovulation by suppressing gonadotropin release. Secondary mechanisms, which may contribute to the effectiveness of this tablet as a contraceptive, include changes in the cervical mucus (which increase the difficulty of sperm penetration) and changes in the endometrium (which reduce the likelihood of implantation).<br />\r\n<br />\r\nDrospirenone has antimineralocorticoid activity, counteracting estrogen-related sodium retention. In combination with Ethinyloestradiol, Drospirenone displays a favorable lipid profile with an increase in high-density lipoprotein HDL. Drospirenone exerts antiandrogenic activity and does not counteract the ethinyloestradiol-related sex hormone-binding globulin increase which is useful for binding and inactivating the endogenous androgens.</p>', '<p>To achieve maximum contraceptive effectiveness tablets must be taken in the order directed on the package every day at about the same time. Tablet-taking should be started with the first pink tablet of the upper row &amp; have to continue daily for 24 consecutive days. After completion of pink tablet, white tablet should be taken from 25th day to 28th day. Withdrawal bleeding usually starts on days 2-3 after starting the white tablets &amp; don&#39;t stop taking white tablets though your menstruation is already started. Each subsequent new pack is started on the day after the last white tablet of the previous pack.<br />\r\n<br />\r\n<strong>No preceding hormonal contraceptive use in the past month</strong>: Tablet taking has to start on day 1 of the woman&rsquo;s menstrual cycle. The woman should be instructed to take the first light pink active tablet from the upper row of this tablet&nbsp;according to the direction and in this case no additional methods of contraception are required. Starting on days 2-5 is allowed, but during the first cycle a barrier method is recommended in addition for the first 7 days of tablet-taking.<br />\r\n<br />\r\n<strong>Changing from another combined hormonal pill or vaginal ring or transdermal patch</strong>: In case of combined hormonal pill, woman should start with the first light pink tablet of upper row on the day after the last active tablet of her previous COC. In case of a vaginal ring or transdermal patch has been used, the woman should start using this tablet preferably on the day of removal.<br />\r\n<br />\r\n<strong>Changing from a progestogen-only-method (minipill, injection, implant) or from a progestogen-releasing intrauterine system (IUS)</strong>: The woman may switch any day from the minipill (or from an implant or the IUS on the day of its removal, from an injectable when the next injection would be due), but should in all of these cases be advised to additionally use a barrier method (like-condom) for the first 7 days of tablet-taking.<br />\r\n<br />\r\n<strong>Following first-trimester abortion</strong>: The woman may start immediately and in this case no need to take additional contraceptive method.<br />\r\n<br />\r\n<strong>Following delivery or second-trimester abortion</strong>: Women are advised to start at day 21 to 28 after delivery or second-trimester abortion. When starting later, the woman are advised to additionally use a barrier method (like-condom) for the first 7 days of tablet-taking.</p>\r\n\r\n<p><strong>Management of Missed Tablets</strong>: Missed white pills from the last row of the blister are placebo tablets and thus can be disregarded. But if you forgot to take a light pink tablet one day, take the missed tablet as soon as you remember. This may mean taking two tablets the very next day. Additionally you should use some other method of contraception (like a condom) until next 7 days. If you forget to take the tablets for two continuous days, then it is likely that you will no longer be protected against pregnancy. You should therefore discontinue taking the tablet and adopt some other temporary methods (condom/foam tablet) till your next menstruation. Discard the unfinished pack of tablets and start taking tablets from the light pink tablet of the top row of a fresh pack from the first day of next menstruation.<br />\r\n<br />\r\n<strong>If you have missed a period after taking tablet</strong>: If you have taken all of your pills at the right time and you have not vomited or used other medicines then you are very unlikely to be pregnant. Continue to take tablet as usual. If you miss your period twice in a row, you may be pregnant. Tell your doctor immediately. Do not start the next pack of this tablet&nbsp;until your doctor has checked you are not pregnant.<br />\r\n<br />\r\n<strong>How to Delay a Period</strong>: To delay period women should continue with another new pack of this tablet just after finishing the light pink active tablet of the present pack (that is no need to take white placebo tablet of present pack). The extension can be carried on for as long as wished until the end of light pink color tablet of the second pack. When women wish their period to begin, just stop tablet taking. While using the second pack woman may have some breakthrough bleeding or spotting. Start with your next pack after the usual 4 day white inactive tablet interval.<br />\r\n<br />\r\n<strong>Advice in case of Vomiting</strong>: If vomiting occurs within 3-4 hours after light pink tablet taking, absorption may not be complete. In such an event, the advice concerning management of missed tablets is applicable. The woman must take the extra active tablet (light pink color) needed from a back up pack after vomiting.</p>\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>', '<p>Interactions between ethinylestradiol and other drugs may lead to decreased or increased ethinylestradiol concentrations, respectively. Decreased ethinylestradiol serum concentrations may cause an increased incidence of breakthrough bleeding and menstrual irregularities and may possibly reduce efficacy of the oral contraceptive. Example of substances that may decrease serum ethinylestradiol concentrations include rifampicin, phenytoin, primidone, rifabutin, dexamethasone, griseofulvin, topiramate, some protease inhibitors, modafinil, ritonavir and barbiturates. Certain antibiotics including ampicillin, other penicillins and tetracyclines may reduce the efficacy of oral contraceptives. During concomitant use of this tablet &amp; other drugs that may lead to decreased ethinylestradiol serum concentrations, it is recommended that a non hormonal back-up method of contraception to be used in addition to the regular intake of this tablet.</p>', '<p>This tablet should not be used:</p>\r\n\r\n<ul>\r\n	<li>Known or suspected pregnancy</li>\r\n	<li>If you have heart disease, clotting of blood in the vein</li>\r\n	<li>If you suffer from liver disease or jaundice</li>\r\n	<li>If you suffer from high blood pressure, migraine, feel something hard in your breast, diabetes with vascular involvement, experience excessive bleeding for which no reason has yet been ascertained</li>\r\n	<li>The presence or a history of venous or arterial thromboembolic events (e.g. deep venous thrombosis, pulmonary embolism, myocardial infarction or of a cerebrovascular accident)</li>\r\n	<li>History of migraine with focal neurological symptoms</li>\r\n	<li>Pancreatitis or a history thereof if associated with severe hypertriglyceridaemia</li>\r\n	<li>Severe renal insufficiency or acute renal failure</li>\r\n	<li>Presence or history of liver tumours (benign or malignant)</li>\r\n	<li>Undiagnosed vagina! bleeding</li>\r\n	<li>Hypersensitivity to any of the components of this preparation</li>\r\n</ul>', '<p>Different types of tablet suit to different types of woman. At the initial stage some women may experience side-effects like dizziness, headache, breast pain, nausea or unscheduled uterine bleeding. These symptoms may occur in &gt;3% of users. After starting one brand of oral contraceptive tablets, if you feel any inconvenience such as migraine, changes in eyesight or speech, unusual pain or swelling in your legs, sharp chest pains or shortness of breath, rash, yellow skin or a rise in blood pressure take immediate advice from your doctor.</p>', '<p><strong>Use during pregnancy</strong>: This is contraindicated during pregnancy. Pregnancy must be excluded before starting this tablet. If pregnancy occurs during use of this tablet, the preparation must be withdrawn immediately. Women who discontinue oral contraceptives with the intent of becoming pregnant, a non-hormonal method of contraception is recommended for three months before attempting to conceive.<br />\r\n<br />\r\n<strong>Use during lactation</strong>: Lactation may be influenced by combined pill as they may reduce the quantity and change the composition of breast milk, therefore the use of estrogen containing combined pill should generally not be recommended until the nursing mother has completely weaned her child. Small amounts of the contraceptive steroids and/or their metabolites may be excreted with the milk.</p>', '<p>If any circulatory disorder (like- myocardial infarction, deep venous thrombosis, pulmonary embolism, cerebrovascular injury etc) or other risk factors(like smoking, obesity, hypertension, dyslipidemia, migraine, atrial fibrillation etc) are present, the benefits of COC use should be weighed against the possible risks for each individual woman and discussed with the woman before she decides to start using it. In the event of aggravation, exacerbation or first appearance of any of these conditions or risk factors after taking pill, the woman should contact with her physician. The physician should then decide on whether its use should be discontinued.</p>', '<p>Symptoms of oral contraceptive overdose may include nausea, vomiting, breast tenderness, dizziness, abdominal pain, drowsiness/fatigue; withdrawal bleeding may occur in females. There is no specific antidote and further treatment of overdose, if necessary, is directed to the symptoms.</p>', '<p>Oral Contraceptive preparations</p>', '<p>Do not store above 30&deg;C. Keep away from light and out of the reach of children.</p>', '<p>Pediatric Use: This is only indicated after menarche. There is no data suggesting the need for a dosage adjustment.<br />\r\n<br />\r\nUse in the Elderly: This is not indicated after menopause.</p>', '2022-02-21 23:26:54', '2022-06-12 00:57:20');
