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
(1410, 1410, '<p>Sodium Thiosulfate is indicated for sequential use with sodium nitrite for treatment of acute cyanide poisoning that is judged to be life threatening. Use with caution if the diagnosis of cyanide poisoning is uncertain.</p>', '<p>Sodium thiosulfate acts as an antidote in the treatment of cyanide poisoning. It acts as a sulphur-donating substrate for the enzyme rhodanese, thus speeding up the conversion of cyanide to thiocyanide, which is relatively non toxic. It is often used in combination with sodium nitrite but may be used alone in less severe poisoning.</p>', '<p><strong>Adult:</strong>&nbsp;To be given after 300 mg of sodium nitrite has been admin over 5-20 min: 12.5 g of sodium thiosulfate (50 ml of a 25% solution or 25 ml of a 50% solution) given over 10 min. Methaemoglobin concentration should not exceed 30-40%. If symptoms of cyanide toxicity recur, the doses of nitrite and thiosulfate may be repeated after 30 min at half the initial doses.<br />\r\n<br />\r\n<strong>Child:</strong>&nbsp;To be given after 4-10 mg/kg of sodium nitrite (max: 300 mg) has been admin: 400 mg/kg of sodium thiosulfate, as a 25 or 50% solution (max: 12.5 g). Methaemoglobin concentration should not exceed 30-40%. If symptoms of cyanide toxicity recur, the doses of nitrite and thiosulfate may be repeated after 30 min at half the initial doses.</p>', '<p>Formal drug interaction studies have not been conducted with Sodium Thiosulfate.</p>', NULL, '<p>Osmotic disturbances. Oral: catharsis (at high doses).</p>', '<p>Pregnancy Category C. There are no adequate and well controlled studies in pregnant women. Sodium Thiosulfate Injection should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether sodium thiosulfate is excreted in human milk. Because Sodium Thiosulfate Injection may be administered in life-threatening situations, breast-feeding is not a contraindication to its use. Because many drugs are excreted in human milk, caution should be exercised following Sodium Thiosulfate Injection administration to a nursing woman. There are no data to determine when breastfeeding may be safely restarted following administration of sodium thiosulfate.</p>', '<p>Sodium thiosulfate drug product may contain trace impurities of sodium sulfite. The presence of a trace amount of sulfites in this product should not deter administration of the drug for treatment of emergency situations, even if the patient is sulfite-sensitive.</p>', '<p>There is limited information about the effects of large doses of sodium thiosulfate in humans. Oral administration of 3 g sodium thiosulfate per day for 1-2 weeks in humans resulted in reductions in room air arterial oxygen saturation to as low as 75%, which was due to a rightward shift in the oxygen hemoglobin dissociation curve. The subjects returned to baseline oxygen saturations 1 week after discontinuation of sodium thiosulfate. A single intravenous administration of 20 mL of 10% sodium thiosulfate reportedly did not change oxygen saturations.</p>', '<p>Antidote preparations.</p>', '<p>Store at controlled room temperature between 20&deg;C and 25&deg;C. Protect from direct light. Do not freeze.</p>', '<p><strong>Pediatric Use</strong>: There are case reports in the medical literature of sodium nitrite in conjunction with sodium thiosulfate being administered to pediatric patients with cyanide poisoning; however, there have been no clinical studies to evaluate the safety or efficacy of sodium thiosulfate in the pediatric population.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Sodium thiosulfate is known to be substantially excreted by the kidney, and the risk of adverse 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.</p>', '2022-03-20 05:32:35', '2022-03-20 05:32:35'),
(1411, 1411, '<p>Sodium Vaiproate oral is indicated for the treatment of all types of epilepsy, e.g.</p>\r\n\r\n<ul>\r\n	<li>Partial seizures</li>\r\n	<li>Absence seizures (petit mal)</li>\r\n	<li>Generalized tonic-clonic seizures (grand mal)</li>\r\n	<li>Myoclonic seizures</li>\r\n	<li>Atonic seizures</li>\r\n	<li>Mixed seizures that include absence attack</li>\r\n	<li>Prophylaxis of febrile convulsion</li>\r\n	<li>Prophylaxis of post-traumatic epilepsy.</li>\r\n</ul>\r\n\r\n<p>It is also indicated in the treatment of bipolar disorder &amp; prophylaxis of migraine.</p>', '<p>Sodium Valproate, the active ingredient of this preparation is endowed with anti-epileptic activity against a variety of seizures. The mechanism by which Sodium Valproate exerts its anti-epileptic effects has not been established. However, it has been suggested that its activity is related to increase brain levels of gamma-aminobutyric acid (GABA).</p>', '<p>Sodium Valproate tablets may be given once or twice daily. Sodium Valproate syrup should be given in divided doses.<br />\r\n<br />\r\nEpilepsy-</p>\r\n\r\n<ul>\r\n	<li><strong>Adults</strong>: Initially 600 mg daily given in 2 divided doses, preferably after food, increasing by 200 mg/day at 3-day intervals to a maximum of 2.5 g daily in divided doses until control of seizure is achieved. Usual maintenance dose is 1-2 g daily (20-30 mg/kg daily)</li>\r\n	<li><strong>Children (up to 20 kg)</strong>: Initially 20 mg/kg daily in divided doses, may be increased provided plasma concentrations monitored (above 40 mg/kg daily also monitor clinical chemistry and hematological parameters).</li>\r\n	<li><strong>Children (over 20 kg)</strong>: Initially 400 mg daily in divided doses increased until control (usually in the range of 20-30 mg/kg daily) Maximum 35 mg/kg daily.</li>\r\n</ul>\r\n\r\n<p><strong>Febrile convulsion</strong>: 20-30 mg/kg/day in 3 divided doses.<br />\r\n<br />\r\n<strong>Bipolar disorder</strong>: Initially 20-30 mg/kg/day in 2-3 divided doses; adjust dosage in 3-5 days. Maintenance dosage is 1000-2000 mg/day.<br />\r\n<br />\r\n<strong>Prophylaxis of migraine</strong>: 300 mg twice daily, although some may require 1000 mg daily.</p>', '<p>Sodium Vaiproate appears to act as a non specific inhibitor of drug metabolism. Drugs to which it interacts most significantly are Phenobarbital, Phenytoin, Warfarin, Aspirin etc.</p>', '<p>Sodium Valproate is contraindicated to patients who have known hypersensitivity to the drug and liver dysfunction. Use of Sodium Valproate is restricted during pregnancy and in women of childbearing potential.</p>', '<p>The most common side effects are anorexia, nausea and vomiting. However, these side effects are minimized with the use of enteric coated tablets. Effects on the CNS include sedation, ataxia and tremor. These symptoms occur infrequently and usually respond to a decrease in doses. Rash, alopecia and stimulation of appetite have been observed occasionally. Sodium Vaiproate has several effects on hepatic function of which elevation of liver enzymes in plasma is observed in up to 40% of patients and often occurs asymptomatically during the first few months of therapy. Rarely a fulminate hepatitis that may be fatal may develop. Children below 2 years of age with other medical conditions and those being treated with multiple antiepileptic agents are specially prone to suffer from hepatic injury, acute pancreatitis and hyperammonemia have also been frequently associated with the use of Sodium Valproate.</p>', '<p>Sodium Vaiproate crosses the placenta and in humans, exposure to valproate in the first trimester has been associated with neural tube defects such as anencephaly and spina bifida in newborn. Pregnant women treated with Sodium Vaiproate should be offered to estimate serum a-fetoprotein. Sodium Valproate is excreted in breast miik. However, breast-feeding by a mother taking Sodium Valproate probably causes no risk to the child.</p>', '<p>Liver functions should be monitored before therapy and during first 6 months especially in patients most at risk, No undue potential for bleeding before starting and before major surgery must be ensured, Care should be taken in renal impairment, pregnancy, breast-feeding and systemic lupus erythematosus. Sodium Valproate is partially eliminated in the urine as a ketone metabolite, which may lead to a false interpretation of the urine ketone test. Sudden withdrawal of therapy should be avoided. Sodium Valproate should not be used during pregnancy and in women of childbearing potential.</p>', NULL, '<p>Primary anti-epileptic drugs.</p>', '<p>Do not store above 30&deg;C. Keep away from light and out of the reach of children.</p>', NULL, '2022-03-20 05:34:07', '2022-03-20 05:34:07'),
(1412, 1412, '<p>Sofosbuvir is a hepatitis C virus (HCV) nucleotide analog NS5B polymerase inhibitor indicated for the treatment of chronic hepatitis C (CHC) infection as a component of a combination antiviral treatment regimen.<br />\r\n<br />\r\nSofosbuvir efficacy has been established in subjects with HCV genotype 1, 2, 3 or 4 infection, including those with hepatocellular carcinoma meeting Milan criteria (awaiting liver transplantation) and those with HCV/HIV-1 co-infection.<br />\r\n<br />\r\nThe following points should be considered when initiating treatment with Sofosbuvir:</p>\r\n\r\n<ul>\r\n	<li>Monotherapy of Sofosbuvir is not recommended for treatment of CHC.</li>\r\n	<li>Treatment regimen and duration are dependent on both viral genotype and patient population.</li>\r\n	<li>Treatment response varies based on baseline host and viral factor.</li>\r\n</ul>', '<p>Sofosbuvir is nucleotide analog inhibitor, which specifically inhibits HCV NS5B (non-structural protein 5B) RNA-dependent RNA polymerase. Following intracellular metabolism to form the pharmacologically active uridine analog triphosphate (GS-461203), sofosbuvir incorporates into HCV RNA by the NS5B polymerase and acts as a chain terminator. More specifically, Sofosbuvir prevents HCV viral replication by binding to the two Mg2+ ions present in HCV NS5B polymerase&#39;s GDD active site motif and preventing further replication of HCV genetic material</p>', '<p>One 400 mg tablet taken once daily with or without food. Should be used in combination with Ribavirin or in combination with Pegylated Interferon and Ribavirin for the treatment of CHC.<br />\r\n<br />\r\nRecommended combination therapy: (HCV Mono-infected and HCV/HIV-1 Co-infected)-</p>\r\n\r\n<ul>\r\n	<li><strong>Genotype 1 or 4</strong>: Sofosbuvir + Peginterferon alfa + Ribavirin for 12 weeks</li>\r\n	<li><strong>Genotype 2</strong>: Sofosbuvir + Ribavirin for 12 weeks</li>\r\n	<li><strong>Genotype 3</strong>: Sofosbuvir + Ribavirin for 24 weeks</li>\r\n</ul>\r\n\r\n<p>Sofosbuvir in combination with Ribavirin for 24 weeks can be considered for CHC patients with genotype 1 infection who are Interferon ineligible<br />\r\n<br />\r\nShould be used in combination with Ribavirin for treatment of CHC in patients with hepatocellular carcinoma awaiting liver transplantation for up to 48 weeks or until liver transplantation whichever occurs first<br />\r\n<br />\r\nA dose recommendation cannot be made for patients with severe renal impairment or end stage renal disease</p>', '<p>Reduced therapeutic effect with drugs that are potent P-gp inducers in the intestine (eg rifampicin, St. John&#39;s wort, carbamazepine &amp; phenytoin), modafinil, phenobarb/ oxcarbazepine, rifabutin/ rifapentine. P-gp &amp;/or BCRP inhibitors. May result in serious symptomatic bradycardia when co-administered with amiodarone in combination with another direct acting antiviral.</p>', '<p>When Sofosbivur is used in combination with Ribavirin or Peginterferon alfa/ Ribavirin, the contraindications applicable to those agents are applicable to combination therapies. Sofosbuvir combination treatment with Ribavirin or Peginterferon alfa/Ribavirin is contraindicated in women who are pregnant or may become pregnant and men whose female partners are pregnant, because of the risks for birth defects and fetal death associated with Ribavirin.</p>', '<p>The most common adverse events (incidence greater than or equal to 20%, all grades) observed with Sofosbuvir in combination with Ribavirin were fatigue and headache. The most common adverse events observed with Sofosbuvir in combination with Peginterferon alfa and Ribavirin were fatigue, headache, nausea, insomnia, anemia, pruritus, asthenia, rash, decreased appetite, chills, influenza like illness, pyrexia, diarrhea, neutropenia, myalgia, irritability.</p>', '<p>Pregnancy Category B: Sofosbuvir There are no adequate and well-controlled studies with Sofosbuvir in pregnant women.<br />\r\n<br />\r\nNursing Mothers: It is not known whether Sofosbuvir and its metabolites are present in human breast milk.</p>', '<p>Bradycardia with amiodarone co-administration: Serious symptomatic bradycardia may occur in patients taking amiodarone and Sofosbuvir in combination with another direct acting antiviral (DAA), particularly in patients also receiving beta blockers, or those with underlying cardiac comorbidities and/or advanced liver disease. Co-administration of amiodarone with Sofosbuvir in combination with another DAA is not recommended. In patients without alternative, viable treatment options, cardiac monitoring is recommended.</p>', '<p>The highest dose of Sofosbuvir is a single dose of Sofosbuvir 1200 mg. No specific antidote is available for overdose treatment. Treatment of overdose with Sofosbuvir consists of general supportive measures including monitoring of vital signs as well as observation of the clinical status of the patient.</p>', '<p>Hepatic viral infections (Hepatitis C)</p>', '<p>Keep out of the reach of children. Keep in a cool &amp; dry place. Protect from light.</p>', '<p><strong>Pediatric Use</strong>: Safety and effectiveness of Sofosbuvir in children less than 18 years of age have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Sofosbuvir was administered to 90 subjects aged 65 and over. The response rates observed for subjects over 65 years of age were similar to that of younger subjects across treatment groups. No dose adjustment of Sofosbuvir is warranted in geriatric patients.</p>', '2022-03-20 05:35:45', '2022-03-20 05:35:45'),
(1413, 1413, '<p>Sofosbuvir and Velpatasvir combination is indicated for the treatment of adult patients with chronic hepatitis C virus (HCV) genotype 1, 2, 3, 4, 5 or 6 infection-</p>\r\n\r\n<ul>\r\n	<li>Without cirrhosis or with compensated cirrhosis</li>\r\n	<li>With decompensated cirrhosis for use in combination with ribavirin</li>\r\n</ul>', '<p>It is a fixed-dose combination tablet containing sofosbuvir and velpatasvir for oral administration. Sofosbuvir is a nucleotide analog HCV NS5B polymerase inhibitor and velpatasvir is an NS5A inhibitor.</p>', '<p>The recommended dosage is one tablet (400 mg of Sofosbuvir and 100 mg of Velpatasvir) taken orally once daily. Recommended treatment regimen:</p>\r\n\r\n<ul>\r\n	<li><strong>Patients without cirrhosis and patients with compensated cirrhosis (Child-Pugh A)</strong>: one tablet once daily for 12 weeks</li>\r\n	<li><strong>Patients with decompensated cirrhosis (Child-Pugh B or C)</strong>: one tablet once daily and Ribavirin for 12 weeks. The recommended dosage of Ribavirin is based on bodyweight (1000 mg/day for patients &lt; 75 kg and 1200 mg/day for &ge; 75 kg, in two divided dose/day)</li>\r\n</ul>', '<p>Drugs may decrease the concentrations of sofosbuvir and/or velpatasvir: Antacids, H2-receptor antagonists, Proton-pump inhibitors etc.<br />\r\n<br />\r\nCoadministration is not recommended with: topotecan, Carbamazepine, Phenytoin, Phenobarbital, Oxcarbazepine, Rifabutin, Rifampin, Rifapentine, efavirenz, Tipranavir, Ritonavir, Hypericum perforatum.<br />\r\n<br />\r\nCoadministration of Sofosbuvir and Velpatasvir combination, with Rosuvastatin, Atorvastatin may significantly increase the concentration of Rosuvastatin, Atorvastatin.</p>', '<p>Sofosbuvir, Velpatasvir and Ribavirin combination regimen is contraindicated in patients for whom Ribavirin is contraindicated.</p>', '<p>The most common side effects of Sofosbuvir and Velpatasvir combination include headache and tiredness. Treatment may result in slowing of the heart rate along with other symptoms when taken with amiodarone (a medicine used to treat certain heart problems).</p>', '<p>No adequate human data are available to establish whether or not Sofosbuvir and Velpatasvir combination poses a risk to pregnancy outcomes. If Sofosbuvir and Velpatasvir combination administered with Ribavirin, the combination regimen is contraindicated in pregnant women and in men whose female partner is pregnant or going to be pregnant in next six months.</p>', '<p>Serious symptomatic bradycardia may occur in patients taking amiodarone, particularly in patients also receiving beta blockers, or those with underlying cardiac comorbidities and/or advanced liver disease. Coadministration of amiodarone with Sofosbuvir and Velpatasvir combination is not recommended. In patients without alternative viable treatment options, cardiac monitoring is recommended.</p>', '<p>If overdose occurs the patient must be monitored for evidence of toxicity. Treatment of overdose includes monitoring of vital signs as well as observation of the clinical status of the patient.</p>', '<p>Hepatic viral infections (Hepatitis C)</p>', '<p>Store in a cool and dry place (preferably below 30&deg; C). Keep out of reach of children.</p>', '<p><strong>Renal impairment patient</strong>: No dosage recommendation can be given for patients with severe renal impairment (eGFR &le;30 mL/min/1.73 m2) or with ESRD, due to higher exposures of the predominant sofosbuvir metabolite.</p>', '2022-03-20 05:37:54', '2022-03-20 05:37:54'),
(1414, 1414, '<p>Symptomatic treatment of urge incontinence and/or increased urinary frequency and urgency as&nbsp;may occur in patients with overactive bladder syndrome.</p>', '<p>Solifenacin is a competitive muscarinic receptor antagonist. It has the highest affinity for M3, M1, and M2 muscarinic receptors. 80% of the muscarinic receptors in the bladder are M2, while 20% are M3. Solifenacin&#39;s antagonism of the M3 receptor prevents contraction of the detrusor muscle, while antagonism of the M2 receptor may prevent contraction of smooth muscle in the bladder.</p>', '<p><strong>The recommended dose for adults and the elderly</strong>: Solifenacin Succinate 5 mg once daily. If needed, the dose may be increased to Solifenacin Succinate 10 mg once daily.<br />\r\n<br />\r\n<strong>Use in children</strong>: Safety and effectiveness in children have not yet been established. Therefore, Solifenacin Succinate should not be used in children.</p>', '<p>Concomitant medication with other medicinal products with anticholinergic properties may result in more pronounced therapeutic effects and undesirable effects. An interval of approximately one week should be allowed after stopping treatment with Solifenacin Succinate before commencing other anticholinergic therapy. The therapeutic effect of Solifenacin may be reduced by concomitant administration of cholinergic receptor agonists. Solifenacin can reduce the effect of medicinal products that stimulate the motility of the gastrointestinal tract, such as Metoclopramide and Cisapride. In vitro studies have demonstrated that at therapeutic concentrations, Solifenacin does not inhibit CYP1A1/2, 2C9, 2C19, 2D6, or 3A4 derived from human liver microsomes. Therefore, Solifenacin is unlikely to alter the clearance of drugs metabolized by these CYP enzymes. Solifenacin is metabolized by CYP3A4. Simultaneous administration of Ketoconazole (200 mg/day), a potent CYP3A4 inhibitor, resulted in a two-fold increase of the AUC of Solifenacin, while Ketoconazole at a dose of 400 mg/day resulted in a three-fold increase of the AUC of Solifenacin. Therefore, the maximum dose of Solifenacin Succinate should be restricted to 5 mg when used simultaneously with Ketoconazole or therapeutic doses of other potent CYP3A4 inhibitors (e.g. Ritonavir, Nelfinavir, Itraconazole).<br />\r\n<br />\r\nSimultaneous treatment of Solifenacin and a potent CYP3A4 inhibitor is contra-indicated in patients with severe renal impairment or moderate hepatic impairment. The effects of enzyme induction on the pharmacokinetics of Solifenacin and its metabolites have not been studied as well as the effect of higher affinity CYP3A4 substrates on Solifenacin exposure. Since Solifenacin is metabolised by CYP3A4, pharmacokinetic interactions are possible with other CYP3A4 substrates with higher affinity (e.g. Verapamil, Diltiazem) and CYP3A4 inducers (e.g. Rifampicin, Phenytoin, Carbamazepine).<br />\r\n<br />\r\nEffect of Solifenacin on the pharmacokinetics of other medicinal products:</p>\r\n\r\n<ul>\r\n	<li><strong>Oral Contraceptives</strong>: Intake of Solifenacin showed no pharmacokinetic interaction on combined oral contraceptives (Ethinylestradiol/Levonorgestrel).</li>\r\n	<li><strong>Warfarin</strong>: Intake of Solifenacin did not alter the pharmacokinetics of R-warfarin or S-warfarin or their effect on prothrombin time.</li>\r\n	<li><strong>Digoxin</strong>: Intake of Solifenacin showed no effect on the pharmacokinetics of digoxin.</li>\r\n	<li><strong>Effects on ability to drive and use machines</strong>: Since Solifenacin, like other anticholinergics may cause blurred vision and, uncommonly, somnolence and fatigue, the ability to drive and use machines may be negatively affected.</li>\r\n</ul>', '<p>Solifenacin is contraindicated in patients with hypersensitivity to solifenacin or to any of the excipients. It is also contraindicated in myasthenia gravis, urinary retention, uncontrolled narrow angle glaucoma, severe gastro-intestinal condition (including toxic megacolon), patients undergoing haemodialysis, patients with severe hepatic impairment, patients with severe renal impairment or moderate hepatic impairment and on treatment with a strong CYP3A4 inhibitor, e.g. ketoconazole.</p>', '<p>Due to the pharmacological effect of Solifenacin, it may cause anticholinergic undesirable effects of (in general) mild or moderate severity. The frequency of anticholinergic undesirable effects is dose related. The most commonly reported adverse reactionwith Solifenacin is dry mouth. It occurred in 11% of patients treated with 5 mg once daily, in 22% of patients treated with 10 mg once daily and in 4% of placebo-treated patients. The severity of dry mouth was generally mild and only occasionally led to discontinuation of treatment. In general,medicinal product compliance was very high (approximately 99%) and approximately 90% of the patients treated with Solifenacin completed the full study period of 12 weeks treatment.</p>\r\n\r\n<ul>\r\n	<li>Gastrointestinal disorders: very common- dry mouth, common-constipation, nausea, dyspepsia, abdominal pain, uncommon- gastroesophageal reflux diseases, dry throat, rare- colonic obstruction, faecal impaction, very rare- vomiting.</li>\r\n	<li>Infections and infestations: uncommonurinary tract infection, cystitis.</li>\r\n	<li>nervous system disorders: uncommon- somnolence, dysgeusia, very rare-dizziness, headache.</li>\r\n	<li>psychiatric disorders: very rare- hallucinations.</li>\r\n	<li>eye disorders: common- blurred vision, uncommon- dry eyes.</li>\r\n	<li>General disorders and administration site conditions: uncommon- fatigue, peripheral oedema.</li>\r\n	<li>Respiratory, thoracic and mediastinal disorders: uncommon nasal dryness.</li>\r\n	<li>skin and subcutaneous tissue disorders: uncommon- dry skin, very rare- pruritus, rash, urticaria.</li>\r\n	<li>renal and urinary disorders: uncommon- difficulty in micturition, rare- urinary retention.</li>\r\n</ul>', '<p>No clinical data are available from women who became pregnant while taking Solifenacin. Animal studies do not indicate direct harmful effects on fertility, embryonal / foetal development or parturition. The potential risk for humans is unknown. Caution should be exercised when prescribing to pregnant women. No data on the excretion of Solifenacin in human milk are available. In mice, Solifenacin and/or its metabolites was excreted in milk, and caused a dose dependent failure to thrive in neonatal mice. The use of Solifenacin should therefore be avoided during breast-feeding.</p>', '<p>Other causes of frequent urination (heart failure or renal disease) should be assessed before treatment with Solifenacin Succinate. If urinary tract infection is present, an appropriate antibacterial therapy should be started. Solifenacin Succinate should be used with caution in patients with: clinically significant bladder outflow obstruction at risk of urinary retention, gastrointestinal obstructive disorders, risk of decreased gastrointestinal motility, severe renal impairment (creatinine clearance 30 ml/min), moderate hepatic impairment (Child-Pugh score of 7 to 9) and doses should not exceed 5 mg for these patients. Caution should be taken in concomitant use of a potent CYP3A4 inhibitor e.g. Ketoconazole, hiatus hernia/ gastroesophageal reflux and/or who are concurrently taking medicinal products (such as Bisphosphonates) that can cause or exacerbate oesophagitis, autonomic neuropathy. Safety and efficacy have not yet been established in patients with a neurogenic cause for detrusor overactivity. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicinal product. The maximum effect of Solifenacin Succinate can be determined after 4 weeks at the earliest.</p>', '<p>Over dosage with Solifenacin Succinate can potentially result in severe anticholinergic effects. The highest dose of Solifenacin Succinate accidentally given to a single patient was 280 mg in a 5 hour period, resulting in mental status changes not requiring hospitalization. In the event of overdose with Solifenacin Succinate, the patient should be treated with activated charcoal. Gastric lavage is useful if performed within 1 hour, but vomiting should not be induced. As for other anticholinergics, symptoms can be treated as follows:</p>\r\n\r\n<ul>\r\n	<li>Severe central anticholinergic effects such as hallucinations or pronounced excitation: treat with physostigmine or carbachol.</li>\r\n	<li>Convulsions or pronounced excitation: treat with benzodiazepines.</li>\r\n	<li>Respiratory insufficiency: treat with artificial respiration.</li>\r\n	<li>Tachycardia: treat with beta-blockers.</li>\r\n	<li>Urinary retention: treat with catheterisation.</li>\r\n	<li>Mydriasis: treat with pilocarpine eye drops and/or place patient in a dark room.</li>\r\n</ul>\r\n\r\n<p>As with other antimuscarinics, in case of overdosing, specific attention should be paid to patients with known risk for QT-prolongation (i.e. hypokalaemia, bradycardia and concurrent administration of medicinal products known to prolong QT interval) and relevant pre-existing cardiac diseases (i.e. myocardial ischaemia, arrhythmia, congestive heart failure).</p>', '<p>Anticholinergics (antimuscarinics)/ Anti-spasmodics, BPH/ Urinary retention/ Urinary incontinence.</p>', '<p>Store in a cool and dry place, protected from light.</p>', '<p><strong>Patients with renal impairment</strong>: No dose adjustment is necessary for patients with mild to moderate renal impairment (creatinine clearance &gt;30 ml/min). Patients with severe renal impairment (creatinine clearance &lt;30 ml/min) should be treated with caution and receive no more than 5 mg once daily.<br />\r\n<br />\r\n<strong>Patients with hepatic impairment</strong>: No dose adjustment is necessary for patients with mild hepatic impairment. Patients with moderate hepatic impairment (Child-Pugh score of 7 to 9) should be treated with caution and receive no more than 5 mg once daily.<br />\r\n<br />\r\n<strong>Potent inhibitors of cytochrome P450 3A4</strong>: The maximum dose of Solifenacin Succinate should be limited to 5 mg when treated simultaneously with Ketoconazole or therapeutic doses of other potent CYP3A4 inhibitors e.g. Ritonavir, Nelfinavir, Itraconazole. Solifenacin Succinate tablet should be taken orally and should be swallowed whole with liquids. It can be taken with or without food.</p>', '2022-03-20 05:39:50', '2022-03-20 05:39:50'),
(1415, 1415, '<p>Somatostatin is indicated for:</p>\r\n\r\n<ul>\r\n	<li>Severe acute haemorrhage from oesophageal varices.</li>\r\n	<li>Severe acute haemorrhage from gastric or duodenal ulcers, or accompanying acute erosive or haemorrhagic gastritis.</li>\r\n	<li>Adjuvant treatment of pancreatic, biliary and intestinal fistulae.</li>\r\n	<li>Prophylaxis and treatment of postoperative complications following pancreatic surgery.</li>\r\n</ul>', '<p>Somatostatin is a synthetic cyclic 14 amino-acid peptide, which is identical in structure and action to natural somatostatin. By intravenous infusion in humans, somatostatin causes inhibition of growth hormone, thyroid stimulating hormone, insulin and glucagon secretion as well as inhibition of gastric acid secretion. It also affects the absorption, motility, splanchnic blood flow and trophic functions of the gastro-intestinal tract. Physiologically, somatostatin is found mainly in the gastro-intestinal tract and in the hypothalamus.<br />\r\n<br />\r\nSomatostatin inhibits the release of gastrin, gastric acid, and pepsin which supports its indication in the treatment of upper gastro-intestinal haemorrhage. Furthermore, somatostatin is capable of reducing remarkably splanchnic blood flow without causing significant variations in the systemic arterial pressure, which proves to be valuable for the management of oesophageal variceal haemorrhage. Somatostatin reduces both pancreatic endocrine and exocrine secretion which makes it effective in the prophylaxis and treatment of postoperative complications of pancreatic surgery. The positive effect of somatostatin in the management of diabetic ketoacidosis can be ascribed to its suppression activity of glucagon secretion.</p>', '<p>Somatostatin is given intravenously, by slow bolus injection (3 to 5 minutes) of 250 &micro;g or by continuous infusion at a rate of 250 &micro;g/hour (equivalent of approximately 3.5 &micro;g/kg body weight/hour). The lyophilised powder should be reconstituted with the physiological sodium chloride solution immediately prior to use. For continuous infusion one 3 mg of Somatostatin ampoule should be used to prepare a 12 hours infusion. The solution may be either saline or 5 % dextrose and should be adjusted to guarantee an outflow of 250 &micro;g somatostatin/hour. The use of a perfusion syringe is recommended.<br />\r\n<br />\r\n<strong>Treatment of severe acute bleeding from the upper gastro-</strong><strong>intestinal tract, including from oesophageal varices</strong>: It is recommended to start by a slow intravenous injection of 250 &micro;g of Somatostatin as loading dose, then immediately followed by an intravenous infusion at a rate of 250 &micro;g/h. In case of interruption of more than 3 to 5 minutes between two infusions, an additional slow intravenous injection of 250 &micro;g is recommended to ensure a continuous treatment. Once the haemorrhage has stopped (usually in less than 12 to 24 hours), treatment should be continued for 48-72 hours in order to avoid rebleeding. Treatment up to 120 hours has been routinely performed in this indication.<br />\r\n<br />\r\n<strong>Adjuvant treatment in pancreatic, biliary and intestinal fistulae</strong>: A continuous infusion of Somatostatin at a rate of 250 &micro;g/h is recommended until closure of the fistulae (2-20 days). This infusion should be performed in addition to total parenteral nutrition. Once the fistula has been closed, treatment should be continued for 1 to 3 days and stopped progressively in order to avoid rebound effect. Prophylactic treatment of postoperative complications following pancreatic surgery: Somatostatin is administered at the beginning of the surgical intervention at a rate of 250 &micro;g/h and treatment is continued for 5 days.</p>', '<p>Since somatostatin lengthens the time of hexobarbital-induced sleep and potentiates the action of pentetrazol, Somatostatin should not be administered concomitantly with these drugs or with drugs exerting the same effects.</p>', '<p>Somatostatin is contra-indicated:</p>\r\n\r\n<ul>\r\n	<li>During pregnancy and the immediate post-partum period (puerperium) as well as during lactation. There is no evidence of the drug&rsquo;s safety in human pregnancy nor is there evidence from animal work that it is free from hazard.</li>\r\n	<li>In states of proven hypersensitivity to somatostatin.</li>\r\n</ul>', '<p>Nausea, vertigo, and flushing have been reported rarely. Nausea and vomiting have been reported when the infusion rate is greater than 50&nbsp;&micro;g/min.</p>', '<p>Avoid in pregnancy unless there is no safer alternative.</p>', '<p>Due to its inhibitory effect on the secretion of insulin and glucagon, the administration of Somatostatin can, at the onset of treatment, lead to a transient fall in blood glucose level. Caution is, therefore, called for in insulin-dependent diabetic patients in whom blood glucose should be measured every 3-4 hours. Simultaneous administration of insulin-requiring sugars should, if possible, be avoided. If necessary, insulin should be administered.</p>', NULL, '<p>Growth hormone antagonist</p>', '<p>Storage condition and expiry date are indicated on the box. Solutions of Somatostatin in physiological sodium chloride are stable for 24 hours.</p>', NULL, '2022-03-20 05:41:26', '2022-03-20 05:41:26'),
(1416, 1416, '<p>Treatment of growth failure in children due to pituitary growth hormone deficiency. Treatment of growth failure in girls due to gonadal dysgenesis (Turner Syndrome). Treatment of growth failure in children due to chronic renal insufficiency whose height is on or less than the twenty-fifth percentile and whose growth velocity is on or less than the twenty-fifth percentile for bone age.<br />\r\n<br />\r\nTreatment of adults with severe growth hormone deficiency as diagnosed in the insulin tolerance test for growth hormone deficiency and defined by peak growth hormone concentrations of less than 2.5 nanogram/mL.</p>', '<p>Somatropin is a synthetic human growth hormone of recombinant DNA origin. It stimulates skeletal and soft tissue growth by promoting cell division, amino acid uptake and protein synthesis. It also possesses both insulin-like and diabetogenic effects.</p>', '<p>Children with short stature homeobox-containing (SHOX) deficiency:</p>\r\n\r\n<ul>\r\n	<li><strong>Child:</strong>&nbsp;50 mcg/kg/day may be used.</li>\r\n</ul>\r\n\r\n<p>Growth retardation due to chronic renal insufficiency, Turner&#39;s syndrome:</p>\r\n\r\n<ul>\r\n	<li><strong>Child:</strong>&nbsp;45-50 mcg/kg or 1.4 mg/m2 daily.</li>\r\n</ul>\r\n\r\n<p>Growth retardation in children who were born small for gestational age, Prader-Will syndrome:</p>\r\n\r\n<ul>\r\n	<li><strong>Child:</strong>&nbsp;35 mcg/kg or 1 mg/m2 daily. Max: 2.7 mg daily.</li>\r\n</ul>\r\n\r\n<p>Growth hormone deficiency:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult:</strong>&nbsp;Initially, 6 mcg/kg daily. May increase gradually according to patient response. Max: 12.5 mcg/kg/day. Reassess 9 mth after starting treatment.</li>\r\n	<li><strong>Child:</strong>&nbsp;25-35 mcg/kg daily. Reassess 9 mth after starting treatment.</li>\r\n	<li><strong>Elderly:</strong>&nbsp;Lower doses may be required.</li>\r\n</ul>\r\n\r\n<p>Short bowel syndrome:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult:</strong>&nbsp;100 mcg/kg/day for 4 wk. Max: 8 mg/day.</li>\r\n</ul>\r\n\r\n<p>HIV-associated wasting or cachexia:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult:</strong>&nbsp;0.1 mg/kg daily at bedtime. May be taken on alternate days for patients at increased risk of adverse effects. Max: 6 mg/day.</li>\r\n</ul>', '<p>High doses of corticosteroid may inhibit growth-promoting effects of somatropin.</p>', '<p>Acute critical illness due to heart or abdominal surgery, multiple accidental trauma or respiratory failure; active neoplasms, proliferative or preproliferative diabetic retinopathy; lactation; patients with closed epiphyses. Intracranial lesions. Patients with Prader-Willi syndrome who are severely obese or have severe respiratory impairment.</p>', '<p>Hypothyroidism, peripheral oedema; headache; muscle and joint pain; benign intracranial hypertension. Loss of glycaemic control in diabetics.</p>', '<p>Pregnancy category B1. Animal reproduction studies have not been conducted with Norditropin. It is not known whether Norditropin can cause fetal harm when administered to a pregnant woman or can affect reproductive capacity. There have been no studies conducted with Norditropin in nursing mothers and it is not known whether Norditropin is excreted in breast milk.</p>', '<p>Monitor thyroid function; benign intracranial hypertension. DM; may require dose reduction in insulin. Pregnancy. Discontinue treatment if there is evidence of tumour growth. Monitoring in patients with scoliosis is recommended due to risk of progression of scoliosis.</p>', NULL, '<p>Drugs for Growth failure</p>', '<p>Store at 2-8&deg; C.</p>', NULL, '2022-03-20 05:42:49', '2022-03-20 05:42:49'),
(1417, 1417, '<p><strong>Hepatocellular Carcinoma</strong>: Sorafenib is indicated for the treatment of patients with unresectablehepatocellular carcinoma (HCC).<br />\r\n<br />\r\n<strong>Renal Cell Carcinoma</strong>: Sorafenib is indicated for the treatment of patients with advanced&nbsp;renal cell carcinoma&nbsp;(RCC).</p>', '<p>Sorafenib is a kinase inhibitor that decreases tumor cell proliferation in vitro. Sorafenib was shown to inhibit multiple intracellular (CRAF, BRAF and mutant BRAF) and cell surface kinases (KIT, FLT-3, RET, VEGFR-1, VEGFR-2, VEGFR-3, and PDGFR-&szlig;). Several of these kinases are thought to be involved in tumor cell signaling,&nbsp;angiogenesis, and&nbsp;apoptosis. Sorafenib inhibited tumor growth and angiogenesis of human&nbsp;hepatocellular carcinoma&nbsp;and&nbsp;renal cell carcinoma, and several other human tumor xenografts in&nbsp;immunocompromised&nbsp;mice.</p>', '<p><strong>Advanced renal cell carcinoma</strong>: 400 mg bid. May continue until patient is no longer responding or unacceptable toxicity occurs.<br />\r\n<br />\r\n<strong>Hepatic Impairment</strong>: No safety data is available for use in patients with Child-Pugh C hepatic impairment.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>Should be taken on an empty stomach. May be taken with a low or moderate fat meal. If the patient intends to have a high fat meal, sorafenib should be taken on an empty stomach at least 1 hr before or 2 hr after meals. Swallow whole, do not chew/crush.</p>', '<p>Inducers of isoenzyme CYP3A4 e.g. carbamazepine, dexamethasone, phenobarbital, phenytoin, rifampicin may decrease sorafenib plasma concentration. Coadmin with sorafenib may increase the plasma concentration of doxorubicin and irinotecan.</p>', '<p>Sorafenib is contraindicated in patients with known severe hypersensitivity to sorafenib or any other component of Sorafenib. Sorafenib in combination with carboplatin and paclitaxel is contraindicated in patients with squamous cell lung cancer.</p>', '<p>Rash and hand-foot skin reactions. Hypophosphataemia, hypertension, bleeding, tinnitus, depression and erectile dysfunction. Alopecia, pruritus, dry skin, erythema, acne, flushing, exfoliative dermatitis, hoarseness, GI disturbances, arthralgia, myalgia, asthenia, pain and peripheral neuropathy.</p>', '<p>Pregnancy category D&nbsp;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>Interrupt teatment if patient develops cardiac infarction, ischaemia and/or bleeding fatalities. Regular monitoring of BP, CBC and platelet is recommended. Monitor INR in patients who are on treatment with warfarin. Adequate contraception should be used during and for at least 2 wk after stopping treatment. May need to discontinue treatment if severe or persistent hypertension occurs.</p>', '<p>There is no specific treatment for Sorafenib overdose. The highest dose of Sorafenib studied clinically is 800 mg twice daily. The adverse reactions observed at this dose were primarily diarrhea and&nbsp;dermatologic. No information is available on symptoms of acute overdose in animals because of the saturation of&nbsp;absorption&nbsp;in oral acute toxicity studies conducted in animals. In cases of suspected overdose, Sorafenib should be withheld and&nbsp;supportive care&nbsp;instituted.</p>', '<p>Targeted Cancer Therapy.</p>', '<p>Store at 25&deg; C.</p>', NULL, '2022-03-20 05:44:25', '2022-03-20 05:44:25'),
(1418, 1418, '<p>Treatment of life-threatening arrhythmias including ventricular tachyarrhythmias, symptomatic non-sustained ventricular tachyarrhythmias. Prophylaxis of paroxysmal atrial tachycardia or fibrillation, paroxysmal AV re-entrant tachycardias (both nodal and involving accessory pathways), paroxysmal supraventricular tachycardia after cardiac surgery, maintenance of sinus rhythm following cardioversion of atrial fibrillation or flutter.</p>', '<p>Sotalol is a non-cardioselective beta-blocker. It increases sinus cycle length, slows heart rate, decreases AV nodal conduction and increases AV nodal refractoriness. It also prolongs AV monophasic action potentials. However, it lacks intrinsic sympathomimetic and membrane-stabilising properties.</p>', '<p>Initially 80 mg daily in 1-2 divided doses. After ECG monitoring and measurement of corrected QT interval, arrhythmias, dose is increased gradually at intervals of 2- 3 days to usual dose of 160-320 mg daily in 2 divided doses; higher doses of 480-640 mg daily for life-threatening ventricular arrhythmias under specialist supervision.<br />\r\n<br />\r\nThe dosage should be reduced in renal impairment. lf creatinine clearance is &gt;60 ml/min, recommended dose 160 mg twice daily while in those with creatinine clearance between 40 and 60 ml/ min, the dose is administered once daily. ln patients with creatnine clearance less than 40 ml/min, Sotalol is contraindicated.</p>', '<p>ln combined therapy, clonidine should not be discontinued unitil several days&nbsp;after withdrawal of Sotalol. Use with great caution with drugs that also prolong OT interval, e.g.&nbsp;disopyramide, amiodarone, Class I antiarrhythmic agents, calcium antagonists of the verapamil&nbsp;type or tricyclic antidepressants. Interactions also occur with phenothiazines, terfenadine,&nbsp;astemizole and diltiazem. Concomitant use of reserpine, guanethidine, or alpha methyldopa&nbsp;requires close monitoring for evidence of hypotension and/or marked bradycardia, syncope.&nbsp;Hypoglycemia may occur and the dosage of insulin or antidiabetic drugs may require adjustment.</p>', '<p>Sotalol should not be given to patients with sinus, bradycardia, sick sinus&nbsp;syndrome or second or third degree AV block (unless a functional pacemaker is present);&nbsp;congenital or acquired long QT syndromes, torsades de pointes, uncontrolled congestive heart&nbsp;failure, cardiogenic shock; anaesthesia that produces myocardial depression, hypotension&nbsp;(except due to arrhythmia), severe peripheral circulatory disturbances, chronic obstructive airway&nbsp;disease or bronchial asthma, renal failure (ceratinine clearance &lt;40mL/min) and previous&nbsp;evidence of hypersensitivity to Sotalol. Sotalol should not be given to patients suffering from&nbsp;diabetic keto-acidosis or metabolic acidosis, therapy with Sotalol can be recommenced or&nbsp;resumed when the metabolic condition has been corrected.</p>', '<p>The most significant adverse effects are those which are typical of its class I and class II (Cardiac action potential duration prolongation) effects.</p>', '<p>Its use throughout pregnancy should be avoided unless it is absolutely necessary as it crosses the placenta and may cause foetal bardycardia. Infants should not be fed with breast milk from mothers being treated with Sotalol.</p>', '<p>Sotalol is not for everyone with irregular heartbeats (atrial fibrillation).&nbsp;Sotalol is not indicated for those patients who have serious kidney problems or are on kidney&nbsp;dialysis, lung disease causing shortness of breath (such as asthma, chronic bronchitis or&nbsp;emphysema), symptoms of heart failure (such as shortness of breath when in exercise or&nbsp;physically active and swelling of the ankles or legs), very slow heart beat and do not have an&nbsp;implanted artificial pacemaker.</p>', '<p>Overdosage causes excessive bradycardia and hypotension; congestive heart&nbsp;failure, bronchospasm and hypoglycemia.</p>', '<p>Anti adrenergic agent (Beta blockers).</p>', '<p>Store in a cool and dry place, protected from light.</p>', NULL, '2022-03-20 05:45:56', '2022-03-20 05:45:56'),
(1419, 1419, '<p>Sparfloxacin is indicated for the treatment of the following infections due to susceptible microorganisms:</p>\r\n\r\n<ul>\r\n	<li>Upper and lower respiratory tract infections including sinusitis, acute exacerbation of chronic bronchitis, community and hospital acquired pneumonia.</li>\r\n	<li>Urinary tract infections including gonococcal and non-gonococcal urethritis, chancroid and other sexually transmitted diseases.</li>\r\n	<li>Skin and soft tissue infections.</li>\r\n	<li>Prophylactic use in different urological and ophthalmic operations.</li>\r\n</ul>', '<p>Sparfloxacin is a synthetic, broad-spectrum antibacterial agent from the difluoroquinolone family. It has been reported to be more active in vitro than ciprofloxacin against some organisms, including staphylococci and Mycobacteria, and has a much longer plasma half-life (16 hours).<br />\r\n<br />\r\nSparfloxacin inhibits the supercoiling activity of DNA gyrase which is an enzyme essential for DNA replication thus promoting the breakage of DNA structures. It has activity against S. pneumoniae, S. aureus, H. influenzae, K. pneumoniae, M. catarrhalis and Mycobacterium spp.</p>', '<p>In patients with normal renal function the recommended daily dose is two tablets of Sparfloxacin 200 mg on first day as a loading dose, thereafter take one tablet of Sparfloxacin 200 mg every 24 hours for a total of 10 days of therapy.<br />\r\n<br />\r\nThe recommended daily dose of Sparfloxacin in patients with renal impairment (Creatinine clearance &lt; 30 ml/min) is two tablets of 200 mg taken on the first day as a loading dose. Thereafter, should be taken one tablet of 200 mg every 48 hours for total of 9 days of therapy.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>Sparfloxacin can be taken with or without food.</p>', '<p>On concomitant use with Quinidine, Sotalol, Erythromycin, Astemizole, Terfenadine, vinca alkaloids there is increased risk of arrhythmia. Salts, oxides and hydroxides of Magnesium, Aluminium and Calcium decrease absorption of Sparfloxacin.</p>', '<p>Sparfloxacin is contraindicated for individuals with a history of hypersensifivity and in achilles tend in its following the use of fluoroquinolone and in pregnancy and lactation. Sparfloxacin is contraindicated in patients with known QTc prolongation or in patients being treated concomitantly with medications known to produce an increase in the QTc interval and/or torsade depointes.</p>', '<p>Most of the adverse events were mild to moderate in severity and transient in nature. The most frequently reported events among the Sparfloxacin treated patients with the recommended dosage are: diarrhea, nausea, headache, dyspepsia, dizziness, insomnia, abdominal pain and QTc interval prolongation.</p>', '<p>There are no adequate and well controlled studies in pregnant women. Sparfloxacin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.</p>', '<p>It should be used with caution in renal diseases, gastric ulcers and with concomitant use of NSAIDs. In renal failure of third degree severity (creatinine clearance &lt; 30 ml/min) dosage modification is recommended 400 mg on 1st day, 200 mg on 2nd and 3rd day followed by 200 mg every 48 hours. Because fluoroquinolones have been associated with tendon rupture, Sparfloxacin should be discontinued at the first sign of tendon pain. Exposure to UV radiation during treatment should be avoided.</p>', NULL, '<p>4-Quinolone preparations.</p>', '<p>Store at temperature below 30&deg; C.</p>', '<p><strong>Use in children:</strong>&nbsp;Safety and effectiveness have not been established in patients below the age of 18 years.</p>', '2022-03-20 05:47:35', '2022-03-20 05:47:35');
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
(1420, 1420, '<p>Spectinomycin Sterile Powder is indicated in the treatment of:</p>\r\n\r\n<ul>\r\n	<li>Acute gonorrheal urethritis and proctitis in the male</li>\r\n	<li>Acute gonorrheal cervicitis and proctitis in the female</li>\r\n	<li>Men and women with known recent exposure to gonorrhea should be treated as those known to have gonorrhea.</li>\r\n</ul>', '<p>Tinobac Sterile Powder contains Spectinomycin Hydrochloride which is an aminocyclitol antibiotic produced by a species of soil microorganism designated as Streptomyces spectabilis. Spectinomycin Hydrochloride is an inhibitor of protein synthesis in the bacterial cell; the site of action is the 30S ribosomal subunit. In vitro studies have shown Spectinomycin Hydrochloride to be active against most strains of Neisseria gonorrhoeae</p>', '<p><strong>Adults (Men and Women)</strong>: Inject 5 ml intramuscularly for a 2 gm dose.This is also the recommended dose for patients being treated after failure of previous antibiotic therapy.<br />\r\n<br />\r\nIntramuscular injections should be made deep into the upper outer quadrant of the gluteal muscle.<br />\r\n<br />\r\n<strong>Pediatric Use</strong>: Safety and effectiveness in the pediatric population have not been established.</p>', NULL, NULL, '<p>The following reactions were observed during the single dose clinical trials: soreness at the injection site, urticaria, dizziness, nausea, chills, fever and insomnia</p>', '<p>Pregnancy Category B. Since there are no controlled studies of Spectinomycin in pregnant women, and because animal reproduction studies are not always predictive of human responses, Spectinomycin 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 Spectinomycin is administered to a nursing woman.</p>', '<p>The usual precautions should be observed with atopic individuals. Prescribing Spectinomycin Sterile Powder in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.</p>', '<p>Information on overdosage in humans is not available. Hemodialysis has been reported to aid in the removal of intravenously administered Spectinomycin from the body.</p>', '<p>Macrolides</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-20 05:48:57', '2022-03-20 05:48:57'),
(1421, 1421, '<p>Spiramycin is indicated for the treatment of infections of the respiratory tract, buccal cavity, skin and soft tissues due to susceptible organisms. Neisseria gonorrhoeae: as an alternate choice of treatment for gonorrhea in patients allergic to the penicillins. Before treatment of gonorrhea, the possibility of concomitant infection due to T. pallidum should be excluded.</p>', '<p>The mechanism of action of macrolides has been a matter of controversy for some time. Spiramycin, a 16-membered macrolide, inhibits translocation by binding to bacterial 50S ribosomal subunits with an apparent 1 : 1 stoichiometry. This antibiotic is a potent inhibitor of the binding to the ribosome of both donor and acceptor substrates. The primary mechanism of action is done by stimulation of dissociation of peptidyl-tRNA from ribosomes during translocation.</p>', '<p><strong>Adult</strong>: 6 to 9 Million International Units per 24 hours, in 2 divided doses. In severe infections, the daily dosage may be increased to 12 to 15 Million International Units per day. Gonorrhea: 12 to 13.5&nbsp; Million International Units in a single dose.<br />\r\n<br />\r\n<strong>Children</strong>: The usual daily dosage is based on 150,000 l.U./kg body weight in 2 or 3 divided doses.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>Spiramycin is stable in gastric juices and absorption is not affected by food. In severe infections, the daily dosage may be increased by one half. In the treatment of beta hemolytic streptococcal infections, adequate Spiramycin dosage should be administered for 10 days.</p>', '<p>Rovamycine has been reported to inhibit the absorption of carbidopa and decrease levodopa plasma levels. When necessary, patients should be closely monitored and the levodopa dosage levels adjusted.</p>', '<p>Spiramycin is contraindicated in patients with known hypersensitivity to the drug. The levels of spiramycin attained in the cerebrospinal fluid are much lower than those in the blood and are too low to be clinically useful. Therefore Spiramycin must not be used in patients with meningitis.</p>', '<p>Side effects of include: nausea, vomiting, diarrhea, inflamed bowels, pruritus (itchy skin), tingling or numbness in the skin.</p>', '<p>Safety of this product for use during pregnancy has not been established.</p>', '<p>Administer antibiotics, including Spiramycin cautiously to any patient who has demonstrated some form of allergy, particularly to drugs. The possibility of superinfection caused by overgrowth of nonsusceptible organisms should be kept in mind during prolonged or repeated therapy. If superinfection occurs, discontinue the drug and take appropriate measures.</p>', '<p>No case of accidental overdosage has been reported. In oral doses over 4 gm per day, abdominal discomfort, nausea or diarrhea may occur. No specific treatment has been proposed. Management should be symptomatic</p>', '<p>Macrolides</p>', '<p>Store in a dry place between 15&ordm;C and 30&ordm;C.</p>', NULL, '2022-03-20 05:50:35', '2022-03-20 05:50:35'),
(1422, 1422, '<p>Spironolactone is indicated in Congestive heart failure, Hepatic cirrhosis with ascites and oedema, Nephrotic syndrome, Primary hyperaldosteronism, Essential hypertension, For the treatment of patients with hypokalemia.</p>', '<p>Spironolactone is a specific pharmacologic antagonist of aldosterone, acting primarily through competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted renal tubule. Spironolactone causes increased amounts of sodium and water to be excreted, while potassium is retained. Spironolactone acts both as a diuretic and as an antihypertensive drug by this mechanism. It may be given alone or with other diuretic agents which act more proximally in the renal tubule. Aldosterone interacts with a cytoplasmic mineralocorticoid receptor to enhance the expression of the Na+&nbsp;K+&nbsp;ATPase and the Na+&nbsp;channel involved in a Na+&nbsp;K+&nbsp;transport in the distal tubule . Spironolactone bind to this mineralcorticoid receptor, blocking the actions of aldosterone on gene expression. Aldosterone is a hormone; its primary function is to retain sodium and excrete potassium in the kidneys.</p>', '<p><strong>Edema in adults (congestive heart failure, hepatic cirrhosis, or nephrotic syndrome)</strong>: An initial daily dosage of 100 mg of Spironolactone administered in either single or divided doses is recommended, but may range from 25 to 200 mg daily. Combined therapy with other diuretics is indicated when more rapid diuresis is desired.<br />\r\n<br />\r\n<strong>Primary hyperaldosteronism</strong>: After the diagnosis of hyperaldosteronism has been established, Spironolactone may be administered in doses of 100 to 400 mg daily in preparation for surgery. For patients who are considered unsuitable for surgery, Spironolactone may be employed for long-term maintenance therapy at the lowest effective dosage determined for the individual patient.<br />\r\n<br />\r\n<strong>Essential hypertension</strong>: For adults, an initial daily dosage of 50 to 100 mg of Spironolactone administered in either single or divided doses is recommended.<br />\r\n<br />\r\n<strong>Hypokalemia</strong>: Spironolactone in a dosage ranging from 25 mg to 100 mg daily is useful in treating a diuretic-induced hypokalemia.</p>', '<p><strong>ACE inhibitors</strong>: Concomitant administration of ACE inhibitors with potassium-sparing diuretics has been associated with severe hyperkalemia.<br />\r\n<br />\r\n<strong>Alcohol, barbiturates, or narcotics</strong>: Potentiation of orthostatic hypotension may occur.<br />\r\n<br />\r\n<strong>Corticosteroids, ACTH</strong>: Intensified electrolyte depletion, particularly hypokalemia, may occur.<br />\r\n&nbsp;<br />\r\n<strong>Lithium</strong>: Lithium generally should not be given with diuretics. Diuretic agents reduce the renal clearance of lithium and add a high risk of lithium toxicity.<br />\r\n<br />\r\n<strong>Digoxin</strong>: Spironolactone has been shown to increase the half-life of digoxin.</p>', '<p>Spironolactone is contraindicated in patients with acute renal insufficiency, significant impairment of renal function, anuria, hyperkalaemia or sensitivity to Spironolactone.</p>', '<p>Gynaecomastia may develop in association with the use of Spironolactone. Other adverse reactions are: GI symptoms including cramping and diarrhoea, drowsiness, lethargy, headache, urticaria, mental confusion, impotence, irregular menses or amenorrhoea and post-menopausal bleeding.</p>', '<p><strong>Pregnancy</strong>: Spironolactone should not be used during pregnancy<br />\r\n<br />\r\n<strong>Lactation</strong>: Canrenone, an active metabolite of Spironolactone, appears in breast milk. If use of the drug is deemed essential an alternative method of infant feeding should be instituted.</p>', '<p>All patients receiving diuretic therapy should be observed for evidence of fluid or electrolyte imbalance. Hyperkalemia may occur in patients with impaired renal function or excessive potassium intake and can cause cardiac irregularities, which may be fatal.</p>', '<p>Symptoms of overdosage include drowsiness, mental confusion, dizziness, diarrhea and vomiting etc. Patients should induce vomiting or evacuate the stomach by lavage during Spironolactone overdoasge.</p>', '<p>Potassium-sparing diuretics, Potassium-sparing diuretics &amp; Aldosterone antagonists</p>', '<p>Store in a cool and dry place protected from light. Keep out of reach of children.</p>', NULL, '2022-03-20 05:52:16', '2022-03-20 05:52:16'),
(1423, 1423, '<p>Streptokinase is indicated for use in the management of acute myocardial infarction, for the lysis of intracoronary thrombi, for the improvement of ventricular function, and reduction of mortality when administered by either the intravenous or intracoronary route. Earlier administration of streptokinase is correlated with greater clinical benefit, the greatest benefit (in terms of mortality reduction) being seen when Streptase is administered within the first 4 hours after onset of symptoms. The treatment should always commence within 6 hours of the onset of pain.</p>', '<p>Streptokinase forms a complex with plasminogen which then converts plasminogen to plasmin. Plasmin breaks down clots as well as fibrinogen and other plasma proteins.</p>', '<p>Streptokinase can be reconstituted using 5 ml sodium chloride injection or 5% Dextrose Injection directing the diluent at the side of the vacuum packed vial rather than into drug powder</p>\r\n\r\n<p>Acute Myocardial Infarction:</p>\r\n\r\n<p>IV infusion:</p>\r\n\r\n<ul>\r\n	<li><strong>Vial size (IU)</strong>: 15,00,000</li>\r\n	<li><strong>Total solution volume</strong>: 45 ml</li>\r\n	<li><strong>Infusion rate</strong>: Infuse 45 ml within 60 mins</li>\r\n</ul>\r\n\r\n<p>Intracoronary infusion:</p>\r\n\r\n<ul>\r\n	<li><strong>Vial size (IU)</strong>: 2,50,000</li>\r\n	<li><strong>Total solution volume:</strong>&nbsp;125 ml</li>\r\n	<li><strong>20,000 IU bolus, Infusion rate</strong>: Loading dose of 10 ml</li>\r\n	<li><strong>2,000 IU/min. for 60 minutes, Infusion rate</strong>: 60 ml/hour</li>\r\n</ul>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>Pulmonary Embolism, Deep Vein Thrombosis, Arterial Thrombosis or Embolism:</p>\r\n\r\n<ul>\r\n	<li><strong>2,50,000 IU loading dose over 30 min, Vial size (IU)</strong>: 15,00,000, Total solution volume 90 ml, Infusion rate: Infuse 30 ml/hour for 30 min</li>\r\n	<li><strong>1,00,000 IU/hour for maintenance dose, Infusion rate</strong>: Infuse 6 ml/hour</li>\r\n</ul>', '<p>There is an increased risk of haemorrhage in patients simultaneously or previously receiving anticoagulants (such as Heparin or Coumarin derivatives) or drugs which inhibit platelet formation or function (e.g., Platelet aggregation inhibitors, Dextrans, Phenylbutazone, Dipyridamole, Non-steroidal anti-inflammatory drugs). The effect of Heparin can be neutralized rapidly by administration of Protamine Sulphate. The Thrombin time (TT) should not be more than twice the normal control value before thrombolytic therapy is started. In the case of prior treatment with coumarin derivatives, the International Normalized Ratio (INR) must be less than 1.3 before starting Streptokinase infusion.<br />\r\n<br />\r\n<strong>Combination of Streptokinase with Aspirin for treatment of Myocardial infarction</strong>: Study showed a significant benefit to patients treated with these two agents after acute myocardial infarction. Mortality (both short and longer term) was reduced in these patients to a greater extent than in those treated with either agent alone.<br />\r\n<br />\r\nUnless contraindicated, the concomitant use of Acetylsalicylic acid (ASA, Aspirin), starting prior to Streptokinase infusion and continued for one month thereafter may be instituted at the discretion of the physician. The benefit of combination therapy should therefore be weighed against the risk of increased haemorrhage.<br />\r\n<br />\r\n<strong>Anticoagulation treatment following Streptokinase</strong>: Following high dose (1.5 million IU), short term treatment with Streptokinase, for acute myocardial infarction, the use of subsequent anticoagulant treatment has not yet been shown to be of unequivocal benefit. Therefore, in this situation, the use of anticoagulants should be decided by the physician.</p>', '<p>As thrombolytic therapy increases the risk of bleeding, Streptokinase, administered either systemically or locally, is contraindicated in the following situations:<br />\r\n<br />\r\nExisting or recent haemorrhage and haemorrhagic diathesis (with the exception of consumption coagulopathy) Potential for internal bleeding (e.g., peptic ulcer, ulcerative colitis, diverticulitis or visceral tumours) All forms of reduced blood coagulability, in particular spontaneous fibrinolysis and extensive clotting disorders.<br />\r\n<br />\r\nRecent (within 2 months) cerebrovascular accident, recent (within 10 days) facial or head trauma, intracranial or intraspinal surgery, known intracranial neoplasm and all known neoplasms with risk of haemorrhage&nbsp;<br />\r\n<br />\r\nInvasive operations, e.g., recent organ biopsy, invasive diagnostic procedure, recent implantation of a vessel prosthesis, long-term traumatic closed-chest massage or other recent surgery (until the 6th to 10th post operative day, depending on the severity of surgical intervention)<br />\r\n<br />\r\nArteriovenous malformation or aneurysm: Haemorrhagic diathesis including thrombocytopenia or pronounced hepatic or renal dysfunction&nbsp;<br />\r\n<br />\r\nSevere uncontrolled hypertension (systolic BP &gt; 200 mm Hg, diastolic BP &gt; 100 mm Hg), or hypertensive retinal changes grades III/IV), hypertonic fundus&nbsp;<br />\r\n<br />\r\nSevere liver or kidney damage: Simultaneous treatment with oral anticoagulants (International Normalized Ratio (INR) &gt;1.3)&nbsp;<br />\r\n<br />\r\nEndocarditis or pericarditis (Immediately after streptococcal infections which have produced a high antiStreptokinase titre (acute rheumatic fever, acute glomerulo-nephritis, etc.). More than 5 days and less than 12 months since previous Streptokinase therapy.</p>', '<p>The following adverse reactions are based on experience from clinical trials and on post marketing experience of Streptokinase.&nbsp;<br />\r\n<br />\r\nGeneral disorders:</p>\r\n\r\n<ul>\r\n	<li><strong>Common</strong>: Headache and back pain, muscle pain (including myalgia), chills and/or fever as well as asthenia/malaise.</li>\r\n</ul>\r\n\r\n<p>Haemorrhage and bleeding:</p>\r\n\r\n<ul>\r\n	<li><strong>Common</strong>: Haemorrhages at invaded or disturbed sites, including the injection site, and ecchymoses. Gastrointestinal or genitourinary bleedings (including aggravation of menstrual bleeding), epistaxis.&nbsp;</li>\r\n	<li><strong>Uncommon</strong>: Intracranial haemorrhages with their complications and possible fatal outcome, retinal haemorrhages, severe haemorrhages (also with fatal outcome) including liver haemorrhages, retroperitoneal bleedings, splenic rupture. Blood transfusions are rarely required.</li>\r\n</ul>\r\n\r\n<p>Immune system disorders:</p>\r\n\r\n<ul>\r\n	<li><strong>Very common</strong>: Development of antistreptokinase antibodies&nbsp;</li>\r\n	<li><strong>Common</strong>: Allergic-anaphylactic reactions such as rash, flushing, itching, urticaria, angioneurotic oedema, minor breathing difficulty, periorbital swelling, bronchospasm or hypotension.</li>\r\n</ul>\r\n\r\n<p>Nervous system disorders:</p>\r\n\r\n<ul>\r\n	<li><strong>Rare</strong>: Neurologic symptoms (e.g., dizziness, confusion, paralysis, hemiparesis, agitation or convulsion) in the context of cerebral haemorrhages or cardiovascular disorders with hypoperfusion of the brain.</li>\r\n</ul>\r\n\r\n<p>Cardiac complication and vascular disorders:</p>\r\n\r\n<ul>\r\n	<li><strong>Very common</strong>: Hypotension, heart rate and rhythm disorders, angina pectoris.&nbsp;</li>\r\n	<li><strong>Common</strong>: Recurrent ischaemia, heart failure, reinfarction, cardiogenic shock, pericarditis, pulmonary oedema.&nbsp;</li>\r\n	<li><strong>Uncommon</strong>: Cardiac arrest (leading to respiratory arrest), mitral insufficiency, pericardial effusion, cardiac tamponade, myocardial rupture, pulmonary or distal embolism.</li>\r\n</ul>\r\n\r\n<p>Respiratory disorders:</p>\r\n\r\n<ul>\r\n	<li><strong>Very rare</strong>: Non-cardiogenic pulmonary oedema after intracoronary thrombolytic therapy in patients with extensive myocardial infarction.</li>\r\n</ul>\r\n\r\n<p>Gastrointestinal disorders:</p>\r\n\r\n<ul>\r\n	<li><strong>Common</strong>: Nausea, diarrhoea, epigastric pain and vomiting.</li>\r\n</ul>', '<p>Pregnancy category C. It is not known whether Streptokinase is excreted in the breast milk, nor whether it has harmful effects on the newborn. In the absence of further information, it is recommended that breast-feeding be discontinued in women who are to receive Streptokinase.</p>', '<p>Because of the increased likelihood of resistance, due to antistreptokinase antibodies, retreatment with Streptokinase or Streptokinase-containing products may not be effective if administered between five days and twelve months of prior Streptokinase administration or Streptococcal infections, such as Streptococcal pharyngitis, acute rheumatic fever or acute glomerulonephritis secondary to a Streptococcal infection.<br />\r\n<br />\r\nIn principle, no thrombolytic treatment should be commenced before the 10th postoperative day. However, in cases of pulmonary embolism, the indication for earlier treatment may be very strong and after careful consideration of all the risks, Streptokinase may be given before the tenth postoperative day. The danger of bleeding from the operative area must, of course, be taken into account.<br />\r\nThe danger of haemorrhage is increased by simultaneous or previous treatment with anticoagulants (e.g., Heparin) or substances which inhibit platelet formation or function. If the patient is under active heparinisation, it should be neutralised by the administration of protamine sulphate before the start of thrombolytic therapy.&nbsp;<br />\r\n<br />\r\n<strong>Repeated Administration</strong>: After administration of Streptokinase, the titre of antistreptokinase antibodies begins to rise after approximately one week, reaching a peak at 2 to 3 weeks and remains elevated for 8 to 12 months. Because of the increased likelihood of resistance, Streptokinase may not be effective if given during this period.</p>', '<p>If uncontrollable bleeding occurs as a result of overdosage, Streptokinase infusion should be ceased immediately. Bleeding can be reversed and blood loss managed effectively with appropriate replacement therapy. Administration of aminocaproic acid or aprotinin may be useful.</p>', '<p>Fibrinolytics (Thrombolytics)</p>', '<p>Streptokinase vial should be stored at 2 to 25&deg; C. Once reconstituted with physiological saline, the physico-chemical stability has been demonstrated for 24 hours at 2 to 8&deg; C. From a microbiological point of view and as Streptokinase 1500000 contains no preservative, the reconstituted product should be used immediately. If it is not administered immediately, storage shall not exceed 24 hours at 2 to 8&deg; C. Keep out of the reach of children.</p>', '<p><strong>Pediatric use</strong>: Safety &amp; effectiveness in children have not been established.</p>', '2022-03-20 05:54:32', '2022-03-20 05:54:32'),
(1424, 1424, '<p>Streptomycin is indicated for the treatment of individuals with moderate to severe infections caused by susceptible strains of microorganisms in the specific conditions listed below:<br />\r\n<br />\r\nMycobacterium tuberculosis: The Advisory Council for the Elimination of Tuberculosis, the American Thoracic Society, and the Center for Disease Control recommend that either streptomycin or ethambutol be added as a fourth drug in a regimen containing isoniazid (INH), rifampin and pyrazinamide for initial treatment of tuberculosis unless the likelihood of INH or rifampin resistance is very low. The need for a fourth drug should be reassessed when the results of susceptibility testing are known. In the past when the national rate of primary drug resistance to isoniazid was known to be less than 4% and was either stable or declining, therapy with two and three drug regimens was considered adequate. If community rates of INH resistance are currently less than 4%, an initial treatment regimen with less than four drugs may be considered. Streptomycin is also indicated for therapy of tuberculosis when one or more of the above drugs is contraindicated because of toxicity or intolerance. The management of tuberculosis has become more complex as a consequence of increasing rates of drug resistance and concomitant HIV infection. Additional consultation from experts in the treatment of tuberculosis may be desirable in those settings.<br />\r\n<br />\r\nNon-tuberculosis infections: The use of streptomycin should be limited to the treatment of infections caused by bacteria which have been shown to be susceptible to the antibacterial effects of streptomycin and which are not amenable to therapy with less potentially toxic agents.</p>\r\n\r\n<ul>\r\n	<li>Pasteurella pestis (plague)</li>\r\n	<li>Francisella tularensis (tularemia)</li>\r\n	<li>Brucella</li>\r\n	<li>Calymmatobacterium granulomatis (donovanosis, granuloma inguinale)</li>\r\n	<li>H. ducreyi (chancroid)</li>\r\n	<li>H. influenzae (in respiratory, endocardial, and meningeal infections - concomitantly with another antibacterial agent)</li>\r\n	<li>K. pneumoniae pneumonia (concomitantly with another antibacterial agent)</li>\r\n	<li>E.coli, Proteus, A. aerogenes, K. pneumoniae, and Enterococcus faecalis in urinary tract infections</li>\r\n	<li>Streptococcus viridans, Enterococcus faecalis (in endocardial infections - concomitantly with penicillin)</li>\r\n	<li>Gram-negative bacillary bacteremia (concomitantly with another antibacterial agent)</li>\r\n</ul>\r\n\r\n<p>To reduce the development of drug-resistant bacteria and maintain the effectiveness of streptomycin and other antibacterial drugs, streptomycin should be used only to treat or prevent 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 or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy</p>', '<p>Aminoglycosides like Streptomycin &quot;irreversibly&quot; bind to specific 30S-subunit proteins and 16S rRNA. Specifically Streptomycin binds to four nucleotides of 16S rRNA and a single amino acid of protein S12. This interferes with decoding site in the vicinity of nucleotide 1400 in 16S rRNA of 30S subunit. This region interacts with the wobble base in the anticodon of tRNA. This leads to interference with the initiation complex, misreading of mRNA so incorrect amino acids are inserted into the polypeptide leading to nonfunctional or toxic peptides and the breakup of polysomes into nonfunctional monosomes.</p>', '<p>Tularaemia:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult:</strong>&nbsp;1-2 g daily in divided doses for 7-14 days until the patient is afebrile for 5-7 days.</li>\r\n	<li><strong>Child:</strong>&nbsp;15 mg/kg bid for at least 10-14 days. Max: 2 g daily</li>\r\n</ul>\r\n\r\n<p>Bacterial endocarditis:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult:</strong>&nbsp;Streptococcal endocarditis: 1 g bid for 1 wk, then 500 mg bid for the 2nd wk. Enterococcal endocarditis: 1 g bid for 2 wk then 500 mg bid for an additional 4 wk. Doses are given in combination with penicillin.</li>\r\n	<li><strong>Child:</strong>&nbsp;Enterococcal endocarditis: 20-30 mg/kg daily in 2 divided doses, in combination w/ penicillin.</li>\r\n	<li><strong>Elderly:</strong>&nbsp;Streptococcal endocarditis: &gt;60 yr 500 mg bid for the entire 2 wk period.</li>\r\n</ul>\r\n\r\n<p>Tuberculosis:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult:</strong>&nbsp;15 mg/kg as a single dose daily. Max: 1 g daily. As part of intermittent regimen: 25-30 mg/kg 2-3 times wkly. Max: 1.5 g/dose.</li>\r\n	<li><strong>Child:</strong>&nbsp;20-40 mg/kg as a single dose daily. Max: 1 g daily. As part of intermittent regimen: 25-30 mg/kg 2-3 times wkly. Max: 1.5 g/dose.</li>\r\n	<li><strong>Elderly:</strong>&nbsp;&gt;40 yr Max: 500-750 mg daily.</li>\r\n</ul>\r\n\r\n<p>Plague:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult:</strong>&nbsp;2 g daily in 2 divided doses for a minimum of 10 days.</li>\r\n	<li><strong>Child:</strong>&nbsp;30 mg/kg daily in 2-3 divided doses. Max: 2 g daily.</li>\r\n</ul>\r\n\r\n<p>Bacteraemia, Brucellosis, Meningitis, Pneumonia, Urinary tract infections:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult:</strong>&nbsp;For concomitant use with other agents and as 2nd line agent: 1-2 g daily in divided doses 6-12 hrly. Max: 2 g daily.</li>\r\n	<li><strong>Child:</strong>&nbsp;20-40 mg/kg daily in divided doses 6-12 hrly.</li>\r\n</ul>', '<p>Additive neurotoxic and nephrotoxic effect with neomycin, kanamycin, gentamicin, cefaloridine, paronomycin, viomycin, polymyxin B, colistin, tobramycin, and ciclosporin. Enhanced ototoxic and nephrotoxic effect with ethacrynic acid, mannitol, furosemide and possibly other diuretics. May enhance the resp depressant effect of neuromuscular blockers. Increased risk of nephrotoxicity with cephalosporins. Reduced excretion with NSAIDs.</p>', '<p>Hypersensitivity to streptomycin and other aminoglycosides.</p>', '<p>Neurotoxic reactions (e.g. vestibular and cochlear function disturbance, optic nerve dysfunction, peripheral neuritis, arachnoiditis, encephalopathy); paraesthesia of face, rash, fever, angioneurotic oedema, eosinophilia; exfoliative dermatitis, azotemia, leucopenia, thrombocytopenia, pancytopenia, haemolytic anaemia, muscular weakness, amblyopia.</p>', '<p>Streptomycin can cause fetal harm when administered to a pregnant woman. Because streptomycin readily crosses the placental barrier, caution in use of the drug is important to prevent ototoxicity in the fetus. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the fetus.</p>', '<p>Patient with neuromuscular disorders (e.g. myasthenia gravis), pre-existing vertigo, or hearing loss. Renal impairment. Elderly, childn. Pregnancy and lactation.</p>', NULL, '<p>Aminoglycosides, Anti-Tubercular Antibiotics.</p>', '<p>Store between 15-30&deg;C. Protect from light.</p>', '<p><strong>Renal Impairment:</strong>&nbsp;Dosage adjustment needed.</p>', '2022-03-20 05:56:16', '2022-03-20 05:56:16'),
(1425, 1425, '<p>Strontium Ranelate is a non-hormonal medicine used to treat osteoporosis in postmenopausal women. Strontium Ranelate reduces the risk of fracture at the spine and at the hip<br />\r\n<br />\r\n<strong>About osteoporosis</strong>: Your body is constantly breaking down old bone and making new bone tissue. If you have osteoporosis, your body breaks down more bone than it forms so that gradually bone loss occurs and your bones become thinner and fragile. This is especially common in women after the menopause (change of life). Many people with osteoporosis have no symptoms and you may not even know that you have it. However, osteoporosis makes you more likely to have fractures (break bones), especially in your spine, hips and wrists.</p>', '<p>Strontium Ranelate works by reducing bone breakdown and stimulating rebuilding of bone and therefore reduces the risk of fracture. The newly formed bone is of normal quality.</p>', '<p>The recommended dose is one 2 gm sachet a day. Strontium should always be taken as per the advice of the doctor. Please check with your doctor in case of any confusion. Strontium is for oral use.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>It is recommended that you take Strontium at bedtime. You may lie down immediately after taking Strontium if you wish. Take the granules contained in the sachets as a suspension in a glass of water (see instructions below). Strontium can interact with milk and milk products, so it is important that you mix Strontium only with water to be sure it works properly<br />\r\n<br />\r\nDrink straight away. If for some reason you do not drink the medicine straight away, make sure you stir it again before drinking. You should not leave it more than 24 hours before you drink it. Your doctor may advise you to take calcium and vitamin D supplements in addition to Strontium. Do not take calcium supplements at bedtime, at the same time as Strontium. Your doctor will tell you how long you should continue to take Strontium. Osteoporosis therapy is usually required for a long period. It is important that you continue taking Strontium<br />\r\n<br />\r\nIf you forget to take Strontium:&nbsp;Do not take a double dose to make up for forgotten individual doses. Just carry on with the next dose at the normal time.</p>', '<p><strong>Taking other medicines:&nbsp;</strong>Please tell your doctor if you are taking or have recently taken any other medicines, including medicines obtained without a prescription. If you are taking medicines containing calcium, you should leave at least 2 hours before you take Strontium Ranelate . If you take antacids (medicines to relieve heartburn) you should take them at least 2 hours after Strontium Ranelate . If this is not possible, it is acceptable to take the two medicines at the same time. You should stop taking Strontium Ranelate if you have to take oral tetracyclines or quinolones (two types of antibiotics). You can take Strontium Ranelate again when you have finished taking these antibiotics. If you are unsure about this ask your doctor.<br />\r\n<br />\r\n<strong>Taking Strontium Ranelate with food and drink:&nbsp;</strong>Food, milk and milk products reduce the absorption of strontium ranelate. It is recommended that you take Strontium Ranelate in-between meals, preferably at bedtime at least two hours after food, milk or milk products or calcium supplements.</p>', '<p>Strontium Ranelate is not intended for use in children and adolescents. During treatment, if you experience an allergic reaction (such as swelling of the face, tongue or throat, difficulty in breathing or swallowing, skin rash), you must stop taking Strontium Ranelate and seek medical advice immediately. If you have stopped treatment due to hypersensitivity reactions you should not re-start therapy with Strontium Ranelate.</p>', '<p>Like all medicines, Strontium&nbsp;can cause side effects, although not everybody gets them. The most common side effects are nausea, diarrhoea, headache and skin irritation. However,these effects were mild and short-lived and usually did not cause the patients to stop taking their treatment. Other events less commonly reported included blood clots, fainting fit, memory troubles and, in rare cases, seizures. If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor.</p>', '<p><strong>Pregnancy:&nbsp;</strong>Strontium Ranelate is meant for use only in postmenopausal women. Therefore, this&nbsp;should not be taken during pregnancy. If you take it by accident during pregnancy, stop taking it straight away and talk to your doctor.<br />\r\n<br />\r\n<strong>Breast-feeding:</strong>&nbsp;Strontium Ranelate is meant for use only in postmenopausal women. Therefore, breast-feeding women should not take this medicine. If you take it by accident during breast- feeding, stop taking it straight away and talk to your doctor.</p>', '<p>Before taking Strontium Ranelate talk to your doctor:</p>\r\n\r\n<ul>\r\n	<li>if you have severe kidney disease.</li>\r\n	<li>if you are being treated or have been treated for blood clots.</li>\r\n	<li>if you are confined to bed or if you are to undergo an operation. The risk of vein thrombosis (blood clots in the leg) may be increased in the event of lengthy immobilization.</li>\r\n	<li>if you are allergic (hypersensitive) to strontium ranelate.</li>\r\n</ul>\r\n\r\n<p>Strontium Ranelate is not intended for use in children and adolescents. During treatment, if you experience an allergic reaction (such as swelling of the face, tongue or throat, difficulty in breathing or swallowing, skin rash), you must stop taking Strontium Ranelate and seek medical advice immediately. If you have stopped treatment due to hypersensitivity reactions you should not re-start therapy with Strontium Ranelate.</p>', '<p>If you take too many sachets of Strontium Ranelate, tell your doctor. They may advise you to drink milk or take antacids to reduce the absorption of the active ingredient.</p>', '<p>Inhibiting bone resorption.</p>', '<p>Keep out of the reach and sight of children. Store at a cool and dry place, away from light.</p>', NULL, '2022-03-21 03:30:34', '2022-03-21 03:30:34'),
(1426, 1426, '<p>Sucralfate is indicated in adults and adolescents over 14 years old for treatment of-</p>\r\n\r\n<ul>\r\n	<li>Duodenal ulcer</li>\r\n	<li>Gastric ulcer</li>\r\n	<li>Chronic gastritis</li>\r\n	<li>The prophylaxis of gastrointestinal hemorrhage from stress ulceration in seriously ill patients.</li>\r\n</ul>', '<p>Sucralfate is non-systemic as the drug is only minimally absorbed from the gastrointestinal tract. The minute amount which absorbed primarily excretes in the urine. Sucralfate promotes the healing of gastric and duodenal ulcers by the formation of a chemical complex that binds to the ulcer site to establish a protective barrier. Besides, Sucralfate inhibits the action of pepsin and bile.</p>', '<p>Duodenal ulcer, gastric ulcer, chronic gastritis-</p>\r\n\r\n<ul>\r\n	<li>Adults: The usual dose is Sucralfate 2 gm twice daily to be taken on rising and at bedtime or Sucralfate 1 gm four times a day to be taken 1 hour before meals and at bedtime. Maximum daily dose is 8 gm but up to twelve weeks may be necessary in resistant cases.</li>\r\n	<li>Pediatric population: The safety and efficacy of Sucralfate in children under 14 years of age has not been established.</li>\r\n	<li>Elderly: There are no special dosage requirements for elderly patients but as with all medicines the lowest effective dose should be used.</li>\r\n</ul>\r\n\r\n<p>Prophylaxis of gastrointestinal hemorrhage from stress ulceration-</p>\r\n\r\n<ul>\r\n	<li>Adults: The usual dose is Sucralfate 1 gm orally or via a nasogastric tube 4 to 6 times a day. To prevent clogging of the nasogastric tube flush with 10 ml of water following each administration. The duration of treatment for prophylaxis of stress ulceration must be individually determined. Treatment should be continued for as long as one or more of the risk factors for stress ulceration is present but normally not for more than 14 days.</li>\r\n</ul>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>Sucralfate should be taken on an empty stomach. Antacid should not be administered within 30 minutes of Sucralfate.</p>', '<p>Concomitant administration of Sucralfate may reduce the bioavailability of certain drugs including Fluoroquinolones such as Ciprofloxacin and Norfloxacin, Tetracycline, Ketoconazole, Sulpiride, Digoxin, Warfarin, Phenytoin, Theophylline, Levothyroxine, Quinidine, and H2 antagonists. The bioavailability of these agents may be restored by separating the administration of these agents from Sucralfate by two hours. This interaction appears to be non-systemic in origin presumably resulting from these agents being bound by Sucralfate in the gastrointestinal tract. Because of the potential of Sucralfate to alter the absorption of some drugs from the gastrointestinal tract, the separate administration of Sucralfate from that of other agents should be considered when alterations in bioavailability are felt to be critical for concomitantly administered drugs. Sucralfate should not be co-administered with citrate preparations. Co-administration citrate preparations with sucralfate may increase the blood concentrations of aluminium. The mechanism may be due to the chelation of aluminium which is assumed to increase its absorption. The administration of Sucralfate&nbsp;&nbsp; 1 g and enteral feeds by nasogastric tube should be separated by one hour in patients receiving Sucralfate 1 g for the prophylaxis of stress ulceration. In rare cases, bezoar formation has been reported when Sucralfate and enteral feeds have been given too closely together.</p>', '<p>Sucralfate tablet and suspension are contraindicated in patients with hypersensitivity to sucralfate.</p>', '<p>The most common adverse event was headache (3.4%) followed by nausea (2.3%), abdominal pain (2.3%), constipation (1.1%), diarrhea (1.1%), and urticaria (1.1%). The majority of patients who reported bezoars, had underlying medical conditions that may predispose to bezoar formation (such as delayed gastric emptying) or were receiving concomitant enteral tube feedings. Episodes of hyperglycemia have been reported in diabetic patient.</p>', '<p>Safety in pregnant women has not been established and Sucralfate should be used during pregnancy only if clearly needed. It is not known whether this drug is excreted in human milk. Caution should be exercised when Sucralfate is administered to breast-feeding women.</p>', '<p>Sucralfate should only be used with caution in patients with renal dysfunction, due to the possibility of increased aluminium absorption. Sucralfate is not recommended for use in individuals on dialysis. In patients with severe or chronic renal impairment, Sucralfate should be used with extreme caution and only for short-term treatment. Small amounts of aluminium are absorbed through the gastrointestinal tract and aluminium may accumulate. Aluminium osteodystrophy, osteomalacia, encephalopathy and anaemia have been reported in patients with chronic renal impairment. For patients with impairment of renal function, laboratory testing such as aluminium, phosphate, calcium and alkaline phosphatase is recommended to be periodically performed due to excretion impairment. The concomitant use of other aluminium containing medications is not recommended in view of the enhanced potential for aluminium absorption and toxicity. Bezoars have been reported after administration of sucralfate mainly to severely ill patients in intensive care units. The majority of these patients (including neonates in whom sucralfate is not recommended) had underlying conditions that may predispose to bezoar formation (such as delayed gastric emptying due to surgery, drug therapy or diseases that reduce motility) or were receiving concomitant enteral tube feeding.</p>', '<p>In a clinical trial on healthy men of overdose with Sucralfate, most cases remained asymptomatic but symptoms of abdominal pain, nausea, and vomiting were reported in a few cases. Acute oral toxicity studies in animals using doses up to 12 gm/kg body weight could not find a lethal dose. Risks associated with overdose should therefore be minimal.</p>', '<p>Chelating complex.</p>', '<p>Store in a cool and dry place, protected from light.</p>', '<p>Pediatric Population: Sucralfate is not recommended for use in children under 14 years of age due to insufficient data on safety and efficacy.<br />\r\n<br />\r\nIn elderly patients: Dose adjustments are not necessary.<br />\r\n<br />\r\nRenal Impairment: Sucralfate should be used with caution in renal insufficiency patients.<br />\r\n<br />\r\nEffects on ability to drive and use machines: Patients should not be drive if feel dizzy or drowsy.</p>', '2022-03-21 03:32:30', '2022-03-21 03:32:30'),
(1427, 1427, '<p>Sucralose is a sugar substitute, can be used as sweetener in different foods like tea, coffee, pudding, milk products, jelly, fruit juices, desserts, hot and cold beverage etc. Due to zero calorie sweetener, it is a nice preparation for the health conscious people. Sucralose can be a unique choice for the diabetic patients who have excess amount of glucose in blood. FDA has confirmed that sucralose is suitable for use by everyone, including children, pregnant women and any person who wants to reduce calorie intake.</p>', '<p>Sucralose is a Zero Calorie artificial sweetener. Sucralose is about 600 times sweeter than sugar. Sucralose Obtained from sucrose where three hydroxyl groups are replaced by three chlorine atoms. Because it is made from sugar, sucralose tastes like sugar. Tightly bound Carbon-chlorine bonds are exceptionally stable and prevent Sucralose from being metabolized for energy, making Sucralose calorie free. The chlorine atoms also provide heat stability, enabling sucralose to withstand of cooking and baking without losing sweetness. Sucralose is not broken down for energy in the body. So it has no calorie. The sucralose molecule passes through the body unchanged, is not metabolized and is eliminated after consumption. Sucralose does not cause tooth decay, has no effect on carbohydrate metabolism, no effect on fetal or neonatal development because sucralose is not actively transported across the blood-brain barrier, the placental barrier or the mammary gland. Sucralose is non-interference in the utilization and absorption of glucose, metabolism of carbohydrates and secretion of insulin. Therefore, it is a safe substance able to be ingested by diabetes patients.</p>', '<p>The acceptable daily intake of sucralose is 5-15 mg/kg body weight. Normally 1 tablet (8 mg) in a cup of tea or coffee is enough to sweeten the drink.</p>\r\n\r\n<p><br />\r\nThe acceptable daily intake (ADI) of Sucralose Sweet Drops is 5-15 mg per kg of body weight. Each drops sweetness is like one teaspoon of sugar. Normally one drop in a cup of tea or coffee is enough to sweeten the drink or as directed by the physician.</p>', '<p>There are no known drug interactions and none well documented.</p>', '<p>No known contraindication.</p>', '<p>No known side effects.</p>', '<p>FDA has not yet classified the drug into a specified pregnancy category.</p>', NULL, NULL, '<p>Oral nutritional preparations.</p>', '<p>Store at temperature not exceeding 30&deg;C. Keep in a cool and dry place, protected from light. Keep out of reach of children.</p>', NULL, '2022-03-21 03:33:58', '2022-03-21 03:33:58'),
(1428, 1428, '<p>Tea, Coffee, fruit juices, baked foods, baking mixes, non alcoholic beverages, confections and frostings, fats and oils, frozen dairy desserts and mixes, sugar substitutes, sweet sauces, toppings and syrups.</p>', '<p>Suito is non-caloric sweetener. The majority of ingested Suito is not broken down by the body and therefore it is non-caloric. Sucralose &amp; Acesulfame Potassium is 600 and 200 times as sweet as sucrose (table sugar) respectively. Sucralose is 3 times as sweet as Aspartame whereas Acesulfame Potassium is as sweet as Aspartame. Sucralose &amp; Acesulfame Potassium are blended to give a more sugar-like taste whereby each sweetener masks the others aftertaste and exhibits a synergistic effect by which the blend is sweeter than its components. Suito is stable under heat and over a broad range of pH conditions.</p>', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '<p>Oral nutritional preparations</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-21 03:35:00', '2022-03-21 03:35:00'),
(1429, 1429, '<p>Sulconazole nitrate is a broad-spectrum antifungal agent indicated for the treatment of tinea cruris and tinea corporis caused by Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum, and Microsporum canis; and for the treatment of tinea versicolor. Effectiveness has not been proven in tinea pedis (athlete&#39;s foot). Symptomatic relief usually occurs within a few days after starting Sulconazole nitrate and clinical improvement usually occurs within one week.</p>', '<p>Sulconazole nitrate is an imidazole derivative that inhibits the growth of the common pathogenic dermatophytes including Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum, and Microsporum canis. It also inhibits the organism responsible for tinea versicolor, Malassezia furfur, and certain gram positive bacteria. A maximization test with sulconazole nitrate solution showed no evidence of irritation or contact sensitization.</p>', '<p>A small amount of the solution should be gently massaged into the affected and surrounding skin areas once or twice daily. Symptomatic relief usually occurs within a few days after starting Sulconazole nitrate, and clinical improvement usually occurs within one week. To reduce the possibility of recurrence, tinea cruris, tinea corporis, and tinea versicolor should be treated for 3 weeks. If significant clinical improvement is not seen after 4 weeks of treatment, an alternate diagnosis should be considered.<br />\r\n<br />\r\n<strong>Pediatric Use</strong>: Safety and effectiveness in children have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Clinical studies of Sulconazole Nitrate, did not include sufficient numbers of patients aged 65 years and over to determine whether they respond differently than younger patients. Other reported clinical experience has not identified differences in responses between elderly and younger patients.</p>', NULL, '<p>Sulconazole nitrate is contraindicated in patients who have a history of hypersensitivity to any of the ingredients.</p>', '<p>There were no systemic effects and only infrequent cutaneous adverse reactions in 370 patients treated with sulconazole nitrate solution in controlled clinical trials. Approximately 1% of these patients reported itching and 1% burning or stinging. These complaints did not usually interfere with treatment.</p>', '<p>US FDA pregnancy category C. Animal studies have revealed evidence of embryotoxicity in rats at doses 125 times the human dose (in mg/kg); this dose given orally to rats led to prolonged gestation and dystocia, and several females died during the perinatal period (likely due to labor complications). Animal studies have failed to reveal evidence of teratogenicity in rats or rabbits at oral doses of 50 mg/kg/day. There are no controlled data in human pregnancy.<br />\r\n<br />\r\nExcreted into human milk: Unknown. Excreted into animal milk: Data not available</p>', '<p><strong>General</strong>: Sulconazole nitrate is for external use only. Avoid contact with the eyes. If irritation develops, the solution should be discontinued and appropriate therapy instituted.<br />\r\n<br />\r\n<strong>Information for Patients</strong>: Patients should be told to use Sulconazole nitrate as directed by the physician, to use it externally only, and to avoid contact with the eyes.<br />\r\n<br />\r\n<strong>Carcinogenesis, Mutagenesis, Impairment of Fertility</strong>: Long-term animal studies to determine carcinogenic potential have not been performed. In vitro studies have shown no mutagenic activity.</p>', NULL, NULL, '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-21 03:36:24', '2022-03-21 03:36:24');
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
(1430, 1430, '<p>Sulfacetamide sodium ophthalmic solution is indicated for the treatment of conjunctivitis and other superficial ocular infections due to susceptible microorganisms, and as an adjunctive in systemic sulfonamide therapy of trachoma: Escherichia coli, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus (viridans group), Haemophilus influenzae, Klebsiella species, and Enterobacter species.<br />\r\n<br />\r\nTopically applied sulfonamides do not provide adequate coverage against Neisseria species, Serratia marcescens and Pseudomonas aeruginosa. A significant percentage of staphylococcal isolates are completely resistant to sulfa drugs.</p>', '<p>The sulfonamides are bacteriostatic agents and the spectrum of activity is similar for all. Sulfonamides inhibit bacterial synthesis of dihydrofolic acid by preventing the condensation of the pteridine with aminobenzoic acid through competitive inhibition of the enzyme dihydropteroate synthetase. Resistant strains have altered dihydropteroate synthetase with reduced affinity for sulfonamides or produce increased quantities of aminobenzoic acid.<br />\r\n<br />\r\nTopically applied sulfonamides are considered active against susceptible strains of the following common bacterial eye pathogens: Escherichia coli, Staphylococcus aureus, Streptococcus pneumoniae, Streptococcus (viridans group), Haemophilus influenzae, Klebsiella species, and Enterobacter species.<br />\r\n<br />\r\nTopically applied sulfonamides do not provide adequate coverage against Neisseria species, Serratia marcescens and Pseudomonas aeruginosa. A significant percentage of staphylococcal isolates are completely resistant to sulfa drugs.</p>', '<p><strong>For conjunctivitis and other superficial ocular infections</strong>: Instill one or two drops into the conjunctival sac(s) of the affected eye(s) every two to three hours initially. Dosages may be tapered by increasing the time interval between doses as the condition responds. The usual duration of treatment is seven to ten days.<br />\r\n<br />\r\n<strong>For trachoma</strong>: Instill two drops into the conjunctival sac(s) of the affected eye(s) every two hours. Topical administration must be accompanied by systemic administration.</p>', '<p>Sulfacetamide preparations are incompatible with silver preparations.</p>', '<p>Sulfacetamide sodium ophthalmic solution is contraindicated in individuals who have a hypersensitivity to sulfonamides or to any ingredient of the preparation.</p>', '<p>Bacterial and fungal corneal ulcers have developed during treatment with sulfonamide ophthalmic preparations. The most frequently reported reactions are local irritation, stinging and burning. Less commonly reported reactions include non-specific conjunctivitis, conjunctival hyperemia, secondary infections and allergic reactions.<br />\r\n<br />\r\nFatalities have occurred, although rarely, due to severe reactions to sulfonamides including Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, agranulocytosis, aplastic anemia, and other blood dyscrasias.</p>', '<p><strong>Pregnancy</strong>&nbsp;Category C. Animal reproduction studies have not been conducted with sulfonamide ophthalmic preparations. Kernicterus may occur in the newborn as a result of treatment of a pregnant woman at term with orally administered sulfonamides. There are no adequate and well controlled studies of sulfonamide ophthalmic preparations in pregnant women and it is not known whether topically applied sulfonamides can cause fetal harm when administered to a pregnant woman. This product should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus.<br />\r\n<br />\r\n<strong>Nursing mothers</strong>: Systemically administered sulfonamides are capable of producing kernicterus in infants of lactating women. Because of the potential for the development of kernicterus in neonates, 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>Prolonged use of topical anti-bacterial agents may give rise to overgrowth of nonsusceptible organisms including fungi. Bacterial resistance to sulfonamides may also develop.<br />\r\n<br />\r\nThe effectiveness of sulfonamides may be reduced by the para-aminobenzoic acid present in purulent exudates.<br />\r\n<br />\r\nSensitization may recur when a sulfonamide is readministered irrespective of the route of administration, and cross-sensitivity between different sulfonamides may occur.<br />\r\n<br />\r\nAt the first sign of hypersensitivity, increase in purulent discharge, or aggravation of inflammation or pain, the patient should discontinue use of the medication and consult a physician</p>', NULL, '<p>Ophthalmic antibacterial drugs.</p>', '<p>Store below 25&deg; C.</p>', '<p><strong>Pediatric use</strong>: Safety and effectiveness in infants below the age of two months have not been established.</p>', '2022-03-21 03:38:06', '2022-03-21 03:38:06'),
(1431, 1431, '<p>Sulfasalazine is indicated in:</p>\r\n\r\n<ul>\r\n	<li><strong>Rheumatoid arthritis &amp; Juvenile arthritis</strong>: In the treatment of patients with rheumatoid arthritis and pediatiric patients with polyarticular-course juvenile rheumatoid arthritis, who have responded inadequately to salicylates or other non-steroidal anti-inflammatory drugs (NSAIDs).</li>\r\n	<li><strong>Ulcerative colitis and Crohn&#39;s Disease</strong>: As adjunct in the treatment of ulcerative colitis with the usual supportive and dietary measures. In the treatment of active Crohn&#39;s disease, especially in patients with colonic involvement.</li>\r\n</ul>', '<p>The mode of action of Sulfasalazine is still under investigation, but may be related to the anti inflammatory and/or immunomodulatory properties that have been observed in animal and in vitro models, to its affinity for connective tissue, and/or to the relatively high concentration it reaches in serous fluids, the liver and intestinal walls, as demonstrated in autoradiographic studies in animals. In ulcerative colitis, clinical studies utilizing rectal administration of Sulfasalazine, Sulfapyridine and 5-Aminosalyclic Acid have indicated that the major therapeutic action may reside in the 5-Aminosalyclic Acid moiety. The relative contribution of the parent drug and the major metabolites in rheumatoid arthritis is unknown.</p>', '<p>The dosage of Sulfasalazine tablets should be individually adjusted according to the patient&#39;s tolerance and response to the treatment and taken in evenly divided doses preferably after meals.<br />\r\n<br />\r\n<strong>Adult dose for crohn&rsquo;s disease</strong>: 500 mg orally 2 to 4 times a day with food.<br />\r\n<br />\r\n<strong>Pediatric use (6 years or older) for Ulcerative Colitis</strong>: The initial dose 40 to 60 mg/kg/day orally divided into 3 to 6 doses.&nbsp;<br />\r\n<br />\r\n<strong>Adult&nbsp;dose for rheumatoid arthritis</strong>: 2 g daily in two evenly divided doses. It is advisable to initiate therapy with a lower dosage e.g. 0.5 to 1.0 g daily, to reduce possible gastrointestinal intolerance. A suggested dosing schedule is given bellow:</p>\r\n\r\n<ul>\r\n	<li><strong>First week</strong>: One tablet in the&nbsp;evening</li>\r\n	<li><strong>Second&nbsp;week</strong>: One tablet&nbsp;in the morning &amp;&nbsp;One tablet&nbsp;in the evening</li>\r\n	<li><strong>Third&nbsp;week</strong>:&nbsp;One tablet&nbsp;in the morning &amp; two tablet&nbsp;in the evening</li>\r\n	<li><strong>Forth&nbsp;week</strong>: Two tablet&nbsp;in the morning &amp;&nbsp;two tablet&nbsp;in the evening</li>\r\n</ul>\r\n\r\n<p><strong>In case of rheumatoid arthritis 6 years or older</strong>: initial dose 10 mg/kg/day orally in 2 equally divided doses.<br />\r\n<br />\r\n<strong>Juvenile rheumatoid arthritis-polyarticular course</strong>: Children 6 years of age and older: 30 to 50 mg/kg/day in two evenly divided doses. Typically the maximum dose is 2 g per day.<br />\r\n<br />\r\nFor other indications:<br />\r\nInitial therapy:</p>\r\n\r\n<ul>\r\n	<li><strong>Adults</strong>: 3 to 4 g daily in divided doses with dosage intervals not exceeding eight hours. It may be advisable to initiate therapy with a lower dosage e.g. 1 to 2 g daily to reduce possible gastrointestinal intolerance.</li>\r\n	<li><strong>Children 6 years of age and older</strong>: 40 to 60 mg/kg/day in to 3 to 6 divided doses.</li>\r\n</ul>\r\n\r\n<p>Maintenance therapy:</p>\r\n\r\n<ul>\r\n	<li><strong>Adults</strong>: 2 g daily.</li>\r\n	<li><strong>Children 6 years of age and older</strong>: 30 mg/kg/day in 4 divided doses.</li>\r\n</ul>', '<p>Reduced absorption of folic acid and digoxin has been reported when those agents were administered concomitantly with sulfasalazine.</p>', '<p>Hypersensitivity to Sulfasalazine, its metabolites, sulfonamides or salicylates, patients with intestinal or urinary obstruction and porphyria.</p>', '<p>The common adverse reactions are anorexia, headache, nausea, vomiting, gastric distress, dyspepsia, abdominal pain, dizziness, apparently reversible oligospermia etc.</p>', '<p><strong>Use in pregnancy</strong>: Pregnancy category B. This drug should be used during pregnancy only if clearly needed.<br />\r\n<br />\r\n<strong>Use in lactation</strong>: Caution should be exercised when sulfasalazine is administered to a nursing mother.</p>', '<p>Hepatic/renal impairment, G6PD deficiency, allergic bronchial asthma, lactation.</p>', NULL, '<p>Drugs for Irritable Bowel Syndrome, Drugs used for Rheumatoid Arthritis, Ulcerative Colitis.</p>', '<p>Store in a cool and dry place, protected from light.</p>', NULL, '2022-03-21 03:39:45', '2022-03-21 03:39:45'),
(1432, 1432, '<p>Sulphinpyrazone is indicated for the treatment of: Chronic gouty arthritis, Intermittent gouty arthritis.</p>', '<p>Sulfinpyrazone increases urinary excretion of uric acid by competitively inhibiting tubular reabsorption of uric acid, thus lowering serum urate concentration and eventually reducing urate deposits in the tissues.</p>', '<p><strong>Initial dose</strong>: 200-400 mg daily in two divided doses, with meals or milk, gradually increasing when necessary to full maintenance dosage in one week.<br />\r\n<br />\r\n<strong>Maintenance dose</strong>: 400 mg daily, given in two divided doses, as above. This dosage may be increased to 800 mg daily, if necessary, and may sometimes be reduced to as low as 200 mg daily after the&nbsp;blood&nbsp;urate&nbsp;level has been controlled. Treatment should be continued without interruption even in the presence of&nbsp;acute&nbsp;exacerbations, which can be concomitantly treated with phenylbutazone or&nbsp;colchicine. Patients previously controlled with other uricosuric therapy may be transferred to Anturane (sulfinpyrazone) at full maintenance dosage.</p>', '<p>Decreased therapeutic effect when given with drugs that increase uric acid concentration (e.g. diuretics, pyrazinamide). May potentiate the action of coumarin anticoagulants (e.g. warfarin, acenocoumarol), hypoglycaemic agents and sulfonamides. May decrease plasma levels of theophylline. May increase plasma levels of penicillins and phenytoin. Increased risk of haemorrhage with substances affecting homeostasis (e.g. non-steroidal antirheumatic drugs). Probenecid may inhibit renal tubular secretion of sulfinpyrazone.</p>', '<p>Patients with an active peptic or symptoms of gastro-intestinal inflammation or ulceration should not receive the drug. The drug is contraindicated in patients with a history or the presence of hypersensitivity to phenylbutazone or other pyrazoles.</p>', '<p>The symptoms are upset stomach, vomiting, loss of appetite and joint pain. If you experience any of the following symptoms like difficulty in breathing, tightness in the chest, skin rash, unusual bleeding, fever, sore throat and mouth sores, call your doctor immediately.</p>', '<p>Pregnancy category C. This means that it is not known whether Sulphinpyrazone will harm an unborn baby. Don&#39;t take this&nbsp;without first talking to your doctor if you are pregnant.<br />\r\n<br />\r\nIt is also not known whether Sulphinpyrazone passess into breast milk. Do not take it without first talking to your doctor if you are breast-feeding a baby.</p>', '<p>Patients receiving Sulphinpyrazone should be kept under close medical supervision and periodic blood counts are recommended. It may be administered with care to patients with a history of healed peptic ulcer. It is suggested that Sulphinpyrazone should be used with caution in conjunction with sulfa drugs, the sulfonylurea hypoglycemic agents and insulin. Because Sulphinpyrazone is a potent uricosuric agent, it may precipitate urolithiasis and renal colic, especially in the initial stages of therapy. For this reason, an adequate fluid intake and alkalinization of the urine are recommended. Salicylates antagonize the uricosuric action of Sulphinpyrazone and for this reason, their concomitant uses are contraindicated in gouty arthritis.</p>', '<p><strong>Symptoms:&nbsp;</strong>Nausea, vomiting, diarrhea, epigastric pain, laboured respiration, convulsions and coma.<br />\r\n<br />\r\n<strong>Treatment:&nbsp;</strong>No specific antidote. Induce emesis, gastric lavage, supportive treatment (intravenous glucose infusions).</p>', '<p>Drugs used in Gout.</p>', '<p>Store between 15-30&deg; C.</p>', '<p><strong>Renal Impairment:</strong>&nbsp;Mild to moderate: Reduce dose. Severe: Contraindicated.<br />\r\n<br />\r\n<strong>Hepatic Impairment:</strong>&nbsp;Severe: Avoid.</p>', '2022-03-21 03:41:36', '2022-03-21 03:41:36'),
(1433, 1433, '<p>Sulindac is indicated for the symptomatic treatment of-</p>\r\n\r\n<ul>\r\n	<li>Rheumatoid arthritis</li>\r\n	<li>Osteoarthritis</li>\r\n	<li>Ankylosing spondylitis</li>\r\n	<li>Periarticular inflammatory disorders</li>\r\n	<li>Acute painful shoulder</li>\r\n	<li>Acute gouty arthritis</li>\r\n	<li>Diabetic neuropathy</li>\r\n	<li>Diabetic retinopathy</li>\r\n</ul>', '<p>Sulindac is a non-steroidal antirheumatic agent possessing anti-inflammatory, analgesic and anti-pyretic properties. Prostaglandin synthetase inhibition is probably the basis of the mechanism of action of non-steroidal anti-inflammatory agents. Following absorption, Sulindac undergoes two major transformations. It is oxidised to the sulphone and then reversibly reduced to the sulphide. The sulphide metabolite is the biologically active form which is an inhibitor of prostaglandin synthesis.</p>', '<p>Sulindac should be administered orally twice a day with food. The maximum dosage is 400 mg per day. Dosages above 400 mg per day are not recommended. In osteoarthritis, rheumatoid arthritis &amp; ankylosing spondylitis, the recommended starting dosage is 150 mg. In acute painful shoulder &amp; acute gouty arthritis the recommended dosage is 200 mg twice a day. The dosage may be lowered or raised depending on the response. After a satisfactory response has been achieved, the dosage may be reduced according to the response. Or, as directed by the registered physicians.</p>', '<p>Sulindac and its sulphide metabolite are highly protein bound. Patient should be monitored carefully until it is certain that no chance in their anticoagulant or hypoglycemic dosage is required. Aspirin has been shown to decrease the bioavailability of the active sulfide metabolite of sulindac. Prolonged concurrent use of Paracetamol with sulindac may increase the risk of adverse renal effects. That patient is under close medical supervision while receiving such combined therapy. Probenecid may increase the plasma concentration of sulindac and its sulfone metabolite and slightly decrease the plasma concentration of the active sulfide metabolite.</p>', '<p>Patients known to be allergic to Sulindac and those in whom acute asthmatic attacks, urticaria or rhinitis have been precipitated by Aspirin or other non-steroidal anti-inflammatory agents. Sulindac is also contraindicated in patients with a history of active gastro-intestinal bleeding or peptic ulceration. It should not be given to children, pregnant or lactating women.</p>', '<p>Gastrointestinal side effects are the most common and consist of abdominal pain, nausea and constipation. Gastrointestinal ulceration and bleeding may also occur. The most frequently reported central nervous system side effects are drowsiness, dizziness, headache and nervousness. Other adverse effects include depression, tinnitus, confusion, light-headedness, insomnia, psychiatric disturbances, syncope, convulsions, coma, peripheral neuropathy, blurred vision and other ocular effects, oedema and mass gain, hypertension, hematuria, skin rashes, pruritus, urticaria, stomatitis, alopecia and hypersensitivity reactions. A hypersensitivity syndrome consisting of fever and chills, skin rashes or other cutaneous manifestations, hepatotoxicity, renal toxicity (including renal failure), leukopenia, thrombocytopenia, eosinophilia, inflammed glands or lymph nodes, and arthralgia have been reported. Leucopenia, purpura, thrombocytopenia, aplastic anaemia, haemolytic anaemia, agranulocytosis, epitaxis, hyperglycaemia, hyperkalaemia and vaginal bleeding have been reported. There have also been reports of hepatitis and jaundice or renal failure.</p>', '<p><strong>Use in pregnancy</strong>: Sulindac should be used during the first two trimesters of pregnancy only if the potential benefit justifies the potential risk to the foetus. Use of Sulindac during the third trimester of pregnancy is not recommended.<br />\r\n<br />\r\n<strong>Use in lactation</strong>: It is not known whether Sulindac is excreted in human milk. So a decision should be made whether to discontinue nursing or discontinue the medicine taking into account the importance of the medicine to the mother.</p>', '<p>Sulindac should be administered with caution to patients with impaired renal function and bleeding disorders, epilepsy, parkinsonism or psychiatric disorders. Patient with hepatic impairment the half life of sulindac is prolonged and a reduction of daily dosage may be required. Anemia is some time seen in patients receiving NSAIDs with sulindac.</p>', '<p>Reported symptoms have generally reflected the gastro-intestinal, renal and central nervous system toxicities of Sulindac. Treatment is symptomatic and supportive.</p>', '<p>Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Drugs used in Gout, Non-steroidal Anti-inflammatory Drugs (NSAIDs)</p>', '<p>Keep below 25&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', '<p><strong>Patient with renal impairment</strong>: Sulindac should be administered with caution to patients with impaired renal function and to those with bleeding disorders, epilepsy, parkinsonism or psychiatric disorders.<br />\r\n<br />\r\n<strong>Patient with hepatic impairment</strong>: In the presence of liver function impairment the half life of Sulindac is prolonged and a reduction of daily dosage may be required.</p>', '2022-03-21 03:48:01', '2022-03-21 03:48:01'),
(1434, 1434, '<p>Treatment of all forms of malaria due to Plasmodium falciparum, Plasmodium vivax, Plasmodium malariae. The drug is also indicated for suppressive or prophylactic management, particularly in areas where resistance to chloroquine is known to exist.</p>', '<p>Sulphadoxine &amp; Pyrimethamine is an antimalarial agent embodying the concept of synergism. Individually the components of this preparation exert inferior result with higher doses in comparison with that obtained with the combination. Moreover, this preparation is effective against strains that are resistant to other antimalarial agents and the risk of resistance development is minimum with this preparation. It is extremely long acting drug, attacks the different development stages of the parasite and attains effective concentration with a single dose. The protective effect of a single dose lasts for approximately four weeks and this preparation is compatible with other antimalarial drugs and with antibiotics. It does not influence the action of antidiabetic agents.</p>', '<p>Curative treatment of malaria with a single dose-</p>\r\n\r\n<ul>\r\n	<li>Adults: 2-3 tablets</li>\r\n	<li>Children under 4 years: &frac12; tablets</li>\r\n	<li>4-8 years: 1 tablet</li>\r\n	<li>9-14 years: 2 tablets</li>\r\n</ul>\r\n\r\n<p>In severe cases, Sulphadoxine &amp; Pyrimethamine can be beneficially combined with quinine.</p>\r\n\r\n<p><br />\r\nSuppressive or prophylactic management-</p>\r\n\r\n<p>The dose given below should be taken at one time:<br />\r\n<br />\r\nFor semi-immune subjects (Dose: once every four weeks)-</p>\r\n\r\n<ul>\r\n	<li>Adults: 2-3 tablets&nbsp;</li>\r\n	<li>Children under 4 years: &frac12; tablets&nbsp;</li>\r\n	<li>4-8 years: 1 tablet&nbsp;</li>\r\n	<li>9-14 years: 2 tablets&nbsp;</li>\r\n</ul>\r\n\r\n<p>For non-immune subjects (Dose: Once every two weeks)-</p>\r\n\r\n<ul>\r\n	<li>Adults: 2 tablets</li>\r\n	<li>Children under 4 years: 1&frac12; tablets</li>\r\n	<li>4-8 years: 1 tablet</li>\r\n	<li>9-14 years: 1&frac12; tablets</li>\r\n</ul>\r\n\r\n<p>For malaria prophylaxis:&nbsp;The first dose of Sulphadoxine &amp; Pyrimethamine should be taken one or two days before departure for an endemic area in order to protect tolerance, administration should be continued in the above dosage during the stay and also for four weeks after return or as prescribed by the physician.</p>', '<p>Concurrent administration of other preparations containing folate antagonists (e.g. cotrimoxazole, methotrexate, anticonvulsants) can result in increased impairment of folic acid metabolism, which leads to haematological side effects.</p>', '<p>Prophylactic (repeated) use of Pyrimethamine + Sulphadoxine&nbsp;is contraindicated in patients with severe renal insufficiency, marked liver parenchymal damage or blood dyscrasias. Treatment must be immediately discontinued upon the appearance of any mucocutaneous signs or symptoms such as pruritus, erythema, rash, orogenital lesions or pharyngitis.</p>', '<p>Sulphadoxine &amp; Pyrimethamine at the recommended dose is well tolerated. Main side effects are given below</p>\r\n\r\n<ul>\r\n	<li><strong>Skin reactions</strong>: Drug rash, pruritus and slight hair loss have been observed.</li>\r\n	<li><strong>Gastro-intestinal reactions:</strong>&nbsp;Feeling of fullness, nausea, rarely vomiting, stomatitis.</li>\r\n	<li><strong>Haematological reactions</strong>: In rare cases, leukopenia, thrombocytopenia, and megaloblastic anemia have been observed.</li>\r\n	<li><strong>Other reactions</strong>: Fatigue, headache, fever, polyneuritis may occasionally occur.</li>\r\n</ul>', '<p>Sulphadoxine &amp; Pyrimethamine is contraindicated during pregnancy, premature and newborn infants during the first weeks of life and intolerance to sulfonamide. If pregnancy can not be excluded, possible risks should be balanced against therapeutic effect. Both Pyrimethamine and Sulphadoxine are excreted in maternal breast milk. Nursing mother should not take this preparation.</p>', '<p>Impaired renal or hepatic function, folate deficiency, severe allergy or bronchial asthma, G6PD deficiency, pregnancy. Take with plenty of water to prevent crystalluria. Avoid excessive exposure to sun. Discontinue at the first sign of rash. Discontinue if signs of folic acid deficiency develops. Regular CBC monitoring, LFT, analysis of urine for crystalluria when admin for &gt; 3 mth. Take with food to minimise Gi effects (e.g. anorexia and vomiting).</p>', NULL, '<p>Anti-malarial drugs.</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-21 03:49:59', '2022-03-21 03:49:59'),
(1435, 1435, '<p>Cotrimoxazole is bactericidal in vitro to a wide range of Gram-positive and Gram-negative organisms, including Streptococcus, Staphylococcus, Pneumococcus, Neisseria, B. catarrhalis, Escherichia coli, Klebsiella, Proteus spp., Haemophilus, Salmonella, Shigella, Vibrio cholerae, Brucella, Pneumocystis carinii, Nocardia and Bordetella. A particularly high degree of activity is exhibited against Haemophilus influenzae, E. coli and Proteus spp., making Cotrimoxazole particularly suitable for the treatment of chronic bronchitis and urinary tract infections. Cotrimoxazole exerts its bactericidal action by the sequential blockade of two bacterial enzyme systems in the biosynthesis of Folinic acid in the micro-organisms. The synergy thus produced accounts for the high degree of bactericidal activity.<br />\r\n<br />\r\nIndications are :</p>\r\n\r\n<ul>\r\n	<li>Respiratory tract infections, including acute and chronic bronchitis (treatment and prophylaxis), bronchiectasis, lung abscess, lobar and broncho-pneumonia, Pneumocystis carinii pneumonitis, sinusitis and otitis media.</li>\r\n	<li>Genito-urinary tract infections, including urethritis, acute and chronic cystitis, pyelonephritis, prostatitis and gonorrhoea.</li>\r\n	<li>Gastro-intestinal tract infections, caused by Salmonella typhi and Salmonella paratyphi, including the chronic carrier state.</li>\r\n	<li>Other infections, caused by a wide range of organisms confirmed to be susceptible to Cotrimoxazole and where the therapeutic benefits are considered to outweigh the possible occurrence of adverse events.</li>\r\n	<li>Such infections include acute and chronic osteomyelitis, acute brucellosis, skin infections including pyoderma, abscesses and wound infections, septicaemia, bacillary dysenter</li>\r\n</ul>', '<p>Cotrimoxazole having broad spectrum bactericidal activity against a wide range of gram-positive &amp; gram-negative bacteria and some protozoa. Co-trimoxazole containing Trimethoprim and Sulphamethoxazole in a 1:5 combination exerts its bactericidal action by the sequential blockade of two bacterial enzyme systems in the biosynthesis of folinic acid in the microorganism.</p>', '<p>Cotrimoxazole double strength tablet: Over 12 years</p>\r\n\r\n<ul>\r\n	<li><strong>For mild to moderate infections</strong>: 1 tablet twice daily.</li>\r\n	<li><strong>For severe infections</strong>: 1.5 tablets twice daily.</li>\r\n	<li><strong>Long term therapy (&gt;14 days)</strong>: 0.5 tablet twice daily.</li>\r\n	<li><strong>Gonorrhoea</strong>: 2 tablets every 12 hours for two days or 2.5 tablets followed by a further dose of 2.5 tablets after 8 hours.</li>\r\n</ul>\r\n\r\n<p>Cotrimoxazole tablet: over 12 years</p>\r\n\r\n<ul>\r\n	<li><strong>For mild to moderate infections</strong>: 2 tablets twice daily.</li>\r\n	<li><strong>For severe infections</strong>: 2 tablets thrice daily.</li>\r\n	<li><strong>Long term therapy</strong>: (&gt;14 days): 1 tablet twice daily.</li>\r\n</ul>\r\n\r\n<p>Cotrimoxazole suspension: Under 12 years</p>\r\n\r\n<ul>\r\n	<li><strong>6-12 years</strong>: 2 teaspoonful twice daily.</li>\r\n	<li><strong>6 month-5 years</strong>: 1 teaspoonful twice daily.</li>\r\n	<li><strong>6 weeks-6 months</strong>: 0.5 teaspoonful twice daily.</li>\r\n</ul>', NULL, '<ul>\r\n	<li>Hypersensitivity to trimethoprim or sulphonamides.</li>\r\n	<li>Patients with documented megaloblastic anaemia due to folate deficiency.</li>\r\n	<li>Patients showing marked liver parenchymal damage, blood dyscrasia, severe renal insufficiency, glucose 6-phosphate dehydrogenase deficiency.</li>\r\n</ul>', '<p>The side effects like crystalluria, allergic reactions, haemolysis, thrombocytopenia, neutropenia, agranulocytosis etc. have been reported rarely with Sulphamethoxazole-Trimethoprim combination. Other side effects are less serious in nature such as malaise, headache, nausea and vomiting. These are normally transient and do not require withdrawal of treatment.</p>', '<p>Pregnancy and during the nursing period, because sulphonamides pass the placenta and are excreted in the breast milk and may cause kernicterus.</p>', '<p>Prolonged full dose treatment with sulfamethoxazole-trimethoprim combination is associated with the risk of macrocytic anaemia due to the drug&rsquo;s interference in the conversion of Folic acid into Folinic acid. If this occurs, it can be reversed by giving Folinic acid. Care should be taken when giving this combination to diabetic patients receiving sulphonylurea drug for possible potentiation of action of sulphonylurea.</p>', NULL, '<p>Anti-diarrhoeal Antimicrobial drugs, Sulphonamides &amp; Trimethoprim.</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-21 03:51:41', '2022-03-21 03:51:41'),
(1436, 1436, '<p>Bar Cleanser for acne &amp; greasy skin. Liquid cleanser Soap-free cleanser for acne prone and oily skin conditions.</p>', '<p>Surfactants are compounds that lower the surface tension (or interfacial tension) between two liquids or between a liquid and a solid. Surfactants may act as detergents, wetting agents, emulsifiers, foaming agents, and dispersants.<br />\r\n<br />\r\nA wetting agent is a surfactant that, when dissolved in water, lowers the advancing contact angle, aids in displacing an air phase at the surface, and replaces it with a liquid phase. Examples of application of wetting to pharmacy and medicine include the displacement of air from the surface of sulfur, charcoal, and other powders for the purpose of dispersing these drugs in liquid vehicles; the displacement of air from the matrix of cotton pads and bandages so that medicinal solutions can be absorbed for application to various body areas; the displacement of dirt and debris by the use of detergents in the washing of wounds; and the application of medicinal lotions and sprays to surface of skin and mucous membranes.</p>', '<p>Use on the face or other affected areas. Wash as with an ordinary soap and massage the creamy lather into the skin. Wet skin, apply &amp; rinse off w/ water once or bid. Using warm water, gently rub the soap on the skin until a rich lather is formed. Massage briskly and rinse thoroughly.<br />\r\n<br />\r\nThis Liquid cleanser can be used both with water and without water for face. If the cleanser is used with water, apply liberal amount of cleanser to the skin. Massage gently in circular motion. Rinse with water. In case it is used without water, apply cleanser to the skin and massage gently in circular motion, remove excess with soft tissue or cotton wool.</p>', '<p>There are no known drug interactions and none well documented.</p>', '<p>Hypersensitivity..</p>', '<p>Mild irritation, skin sensitization.</p>', '<p>Pregnancy Category- Not Classified. FDA has not yet classified the drug into a specified pregnancy category.</p>', '<p>Avoid contact with eyes. Flush with water if lather enters the eyes.</p>', NULL, '<p>Benzoyl peroxide, Azelaic acid &amp; other preparations.</p>', NULL, NULL, '2022-03-21 03:53:18', '2022-03-21 03:53:18'),
(1437, 1437, '<p>Sumatriptan is indicated for acute treatment of migraine with or without aura in adults.&nbsp;<br />\r\n<br />\r\nLimitations of Use:</p>\r\n\r\n<ul>\r\n	<li>Use only if a clear diagnosis of migraine headache has been established.</li>\r\n	<li>Not indicated for the prophylactic therapy of migraine attacks.</li>\r\n	<li>Not indicated for the treatment of cluster headache.</li>\r\n</ul>', '<p>Sumatriptan Nasal Spray is an aqueous suspension of microfine Sumatriptan BP 10 mg for topical administration to the nasal mucosa by means of a metering, atomizing spray pump. Sumatriptan binds with high affinity to human cloned 5 HT1B/1D&nbsp;receptors. Sumatriptan presumably exerts its therapeutic effects in the treatment of migraine headache through agonist effects at the 5 HT1B/1D&nbsp;receptors on intracranial blood vessels and sensory nerves of the trigeminal system, which result in cranial vessel constriction and inhibition of pro-inflammatory neuropeptide release.</p>', '<p>Route of administration: Nasal</p>\r\n\r\n<ul>\r\n	<li>Single-dose of 10 mg of nasal spray.</li>\r\n	<li>The maximum dose in a 24 hour period: 30 mg; separate doses by at least one hour or as directed by the physician.</li>\r\n</ul>\r\n\r\n<p>Use in children and adolescents: Sumatriptan is not recommended for use in patients younger than 18 years of age.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>How to use the Nasal Spray-</p>\r\n\r\n<ul>\r\n	<li>Shake the bottle gently and remove the dust cover.</li>\r\n	<li>Hold the spray with your forefinger and middle finger on either side of the nozzle and your thumb underneath the bottle. Press down until a fine spray appears. If using for the first time or if you have not used it for a week or more, press the nasal applicator several times until a fine moist comes out from the container.</li>\r\n	<li>Gently blow the nose to clear the nostrils.</li>\r\n	<li>Close one nostril and carefully insert the nasal applicator into the open nostril. Tilt your head forward slightly and keep the spray upright. Breathe in through your nose and while breathing in, press the white-collar of nasal applicator firmly down once to release a spray.</li>\r\n	<li>Breathe out through your mouth.</li>\r\n	<li>Repeat the above steps in the same/ other nostril for consecutive doses.</li>\r\n</ul>\r\n\r\n<p>Cleaning: The nasal spray should be cleaned at least once a week. The procedures are as follows-</p>\r\n\r\n<ul>\r\n	<li>Remove the dust cover.</li>\r\n	<li>Gently pull off the nasal applicator.</li>\r\n	<li>Wash the applicator and dust cover in warm water.</li>\r\n	<li>Shake off the excess water and leave to dry in a normal place. Avoid to apply additional heat.</li>\r\n	<li>Gently push the applicator back on the top of the bottle and re-fix the dust cover.</li>\r\n</ul>', '<p><strong>With Medicine</strong>: Sumatriptan nasal spray is contraindicated with Ergot-Containing Drugs, Monoamine Oxidase-A Inhibitors, Other 5-HT1 Agonists and Selective Serotonin Reuptake Inhibitors/Serotonin Norepinephrine Reuptake Inhibitors.<br />\r\n<br />\r\n<strong>With food and others</strong>: No interaction with foods.</p>', '<ul>\r\n	<li>History of coronary artery disease or coronary vasospasm</li>\r\n	<li>Wolff-Parkinson-White syndrome or other cardiac accessory conduction pathway disorders</li>\r\n	<li>History of stroke, transient ischemic attack, or hemiplegic or basilar migraine</li>\r\n	<li>Peripheral vascular disease</li>\r\n	<li>Ischemic bowel disease</li>\r\n	<li>Uncontrolled hypertension</li>\r\n	<li>Recent (within 24 hours) use of another 5 HT1 agonist (e.g., another triptan) or of an ergotamine containing&nbsp;medication</li>\r\n	<li>Concurrent or recent (past 2 weeks) use of monoamine oxidase A inhibitor</li>\r\n	<li>Hypersensitivity to sumatriptan (angioedema and anaphylaxis seen)</li>\r\n	<li>Severe hepatic impairment</li>\r\n</ul>', '<p><strong>Common side effects</strong>: Unusual or unpleasant taste in the mouth; pain, burning, numbness, or tingling in the nose or throat; runny or stuffy nose after using the nasal medicine.<br />\r\n<br />\r\n<strong>Rare side effects</strong>: Anxiety, burning sensation, discomfort of the nasal cavity and throat, general feeling of illness or tiredness &amp; vision changes.</p>', '<p>There are no adequate and well-controlled studies in pregnant women and lactating mothers.</p>', '<ul>\r\n	<li>Myocardial ischemia/infarction and Prinzmetal&rsquo;s angina: Perform cardiac evaluation in patients with multiple cardiovascular risk factors</li>\r\n	<li>Arrhythmias: Discontinue Sumatriptan if occurs</li>\r\n	<li>Chest/throat/neck/jaw pain, tightness, pressure, or heaviness: Generally, not associated with Myocardial Ischemia; evaluate for coronary artery disease in patients at high risk</li>\r\n	<li>Cerebral hemorrhage, subarachnoid hemorrhage, and stroke: Discontinue Sumatriptan if occurs</li>\r\n	<li>Gastrointestinal ischemia and reactions, peripheral vasospastic reactions: Discontinue Sumatriptan if occurs</li>\r\n	<li>Medication overuse headache: Detoxification may be necessary</li>\r\n	<li>Serotonin syndrome: Discontinue Sumatriptan if occurs</li>\r\n	<li>Increase in blood pressure: Hypertensive crisis can occur</li>\r\n	<li>Hypersensitivity reactions: Angioedema and anaphylaxis can occur</li>\r\n	<li>Seizures: Use with caution in patients with epilepsy or a lowered seizure threshold</li>\r\n	<li>Local irritation: Burning and abnormal taste can occur</li>\r\n</ul>', '<p>No specific data is available on the overdose of Sumatriptan 10 mg nasal spray.</p>', '<p>5-HT Agonists.</p>', '<p>Store between 20&deg;C-25&deg;C temperature. Do not store in the refrigerator or freezer. Do not test before use.</p>', NULL, '2022-03-21 03:55:30', '2022-03-21 03:55:30'),
(1438, 1438, '<p><strong>Gastrointestinal Stromal Tumor (GIST)</strong>: Sunitinib is indicated for the treatment of gastrointestinal stromal tumor after disease progression on or intolerance to imatinib mesylate.<br />\r\n<br />\r\n<strong>Advanced Renal Cell Carcinoma (RCC)</strong>: Sunitinib is indicated for the treatment of advanced renal cell&nbsp;carcinoma.<br />\r\n<br />\r\n<strong>Advanced Pancreatic Neuroendocrine Tumors (pNET)</strong>: Sunitinib is indicated for the treatment of progressive, well-differentiated&nbsp;pancreatic neuroendocrine tumors&nbsp;in patients with&nbsp;unresectable&nbsp;locally advanced or metastatic disease.</p>', '<p>Sunitinib inhibits cellular signaling by targeting multiple receptor tyrosine kinases (RTKs).<br />\r\n<br />\r\nThese include all receptors for platelet-derived growth factor (PDGF-Rs) and vascular endothelial growth factor receptors (VEGFRs), which play a role in both tumor angiogenesis and tumor cell proliferation. The simultaneous inhibition of these targets therefore reduces tumor vascularization and triggers cancer cell apoptosis and thus results in tumor shrinkage.<br />\r\n<br />\r\nSunitinib also inhibits CD117 (c-KIT), the receptor tyrosine kinase that (when improperly activated by mutation) drives the majority of gastrointestinal stromal cell tumors. It has been recommended as a second-line therapy for patients whose tumors develop mutations in c-KIT that make them resistant to imatinib, or who the cannot tolerate the drug.<br />\r\n<br />\r\nIn addition, sunitinib binds other receptors. These include: RET, CD114, CD135. The fact that sunitinib targets many different receptors, leads to many of its side effects such as the classic hand-foot syndrome, stomatitis, and other dermatologic toxicities.</p>', '<p><strong>Recommended Dose For GIST And RCC:&nbsp;</strong>The recommended dose of Sunitinib for gastrointestinal stromal tumor (GIST) and advanced&nbsp;renal cell carcinoma&nbsp;(RCC) is one 50 mg oral dose taken once daily, on a schedule of 4 weeks on treatment followed by 2 weeks off (Schedule 4/2). Sunitinib may be taken with or without food.<br />\r\n<br />\r\n<strong>Recommended Dose For pNET</strong>: The recommended dose of Sunitinib for pancreatic neuroendocrine tumors (pNET) is 37.5 mg taken orally once daily continuously without a scheduled off-treatment period. Sunitinib may be taken with or without food.<br />\r\n<br />\r\n<strong>Dose Modification</strong>: Dose interruption and/or dose modification in 12.5 mg increments or decrements is recommended based on individual safety and tolerability. The maximum dose administered in the Phase 3 pNET study was 50 mg daily.<br />\r\n<br />\r\nStrong CYP3A4 inhibitors such as ketoconazole may increas e sunitinib plasma concentrations. Selection of an alternate concomitant medication with no or minimal enzyme inhibition potential is recommended. A dose reduction for Sunitinib to a minimum of 37.5 mg (GIST and RCC) or 25 mg (pNET) daily should be considered if Sunitinib must be co-administered with a strong CYP3A4 inhibitor<br />\r\n<br />\r\nCYP3A4 inducers such as rifampin may decreas e sunitinib plasma concentrations. Selection of an alternate concomitant medication with no or minimal enzyme induction potential is recommended. A dose increase for Sunitinib to a maximum of 87.5 mg (GIST and RCC) or 62.5 mg (pNET) daily should be considered if Sunitinib must be co-administered with a CYP3A4 inducer. If dose is increased, the patient should be monitored carefully for toxicity</p>', '<p>Increased plasma cone with strong CYP3A4 inhibitors (eg ketoconazole, ritonavir, itraconazole, erythromycin, clarithromycin, grapefruit juice). Decreased plasma cone with strong CYP3A4 inducers [eg rifampin, dexamethasone, phenytoin, carbamazepine, phenobarb, St. John&#39;s wort (Hypericum perforatum)]. Anticoagulants eg warfarin, acenocoumarol (periodically monitor platelets, prothrombin time/INR &amp; physical exam).</p>', '<p>Hypersensitivity, Renal impairment.</p>', '<p>Fatigue, GI disorders, skin discoloration, rash, palmar-plantar erythrodysesthesia, dry skin, hair color changes, mucosal inflammation, asthenia, dysguesia, anorexia, HTN, neutropenia.</p>', '<p>Pregnancy Category D. There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.</p>', NULL, '<p>Treatment of overdose with Sunitinib should consist of general supportive measures. There is no specific&nbsp;antidote&nbsp;for overdosage with Sunitinib. If indicated, elimination of unabsorbed drug should be achieved by&nbsp;emesis&nbsp;or&nbsp;gastric&nbsp;lavage. Cases of accidental overdose have been reported; these cases were associated with adverse reactions consistent with the known safety profile of Sunitinib, or without adverse reactions. A case of intentional overdose involving the ingestion of 1,500 mg of Sunitinib in an attempted suicide was reported without adverse reaction. In non-clinical studies mortality was observed following as few as 5 daily doses of 500 mg/kg (3000 mg/m&sup2;) in rats. At this dose, signs of toxicity included impaired muscle coordination, head shakes, hypoactivity, ocular discharge,&nbsp;piloerection&nbsp;and gastrointestinal distress. Mortality and similar signs of toxicity were observed at lower doses when administered for longer durations.</p>', '<p>Targeted Cancer Therapy.</p>', NULL, NULL, '2022-03-21 03:57:55', '2022-03-21 03:57:55'),
(1439, 1439, '<p>This is indicated in the following cases:</p>\r\n\r\n<ul>\r\n	<li>To develop immune system.</li>\r\n	<li>To prevent the well known deficiency diseases such as scurvey, beriberi, pellagra and others.</li>\r\n	<li>Prevent certain types of cancer by blocking the formation of cancer causing substances in the body.</li>\r\n	<li>It is also capable of combating cardiovascular and immunological disorders.</li>\r\n	<li>To prevent aging.</li>\r\n</ul>', '<p><strong>Vitamin A</strong>&nbsp;is essential for human health. Vitamin A is highly important for vision, cell development and immunity. Vitamin A&#39;s role on immunity contributes to its anti-cancer properties.<br />\r\n<br />\r\n<strong>Vitamin C</strong>&nbsp;is one of the most widely taken supplements and plays a primary role in the formation of collagen, which is important for the growth and repair of cells, gums, blood vessels, bones and teeth. Thus vitamin C helps in faster recovery after surgery or any other trauma. Vitamin C quenches free radicals in the water based cellular components and thus acts as an antioxidant.<br />\r\n<br />\r\n<strong>Vitamin E</strong>&nbsp;is a fat-soluble vitamin, which is stored in the liver, adipose tissues, heart, muscles etc. It is an active antioxidant, which prevents oxidation of fat compounds. It works in synergy with Selenium.<br />\r\n<br />\r\n<strong>Vitamin K</strong>&nbsp;is a key anti-aging vitamin and it prevents heart disease and osteoporosis.<br />\r\n<br />\r\n<strong>Zinc</strong>&nbsp;is an important mineral that can actually rejuvenate the shrinking thymus gland that involves the working of the immune system. Zinc is a co-factor in over 100 enzymes of the body.<br />\r\n<br />\r\n<strong>Selenium:</strong>&nbsp;Apart from being a co-factor in antioxidant enzymes, Selenium by itself has potent antioxidant capabilities. So, it prevents aging and hardening of tissues through oxidation. Vitamin E and Selenium are synergistic and seem to potentiate each other&#39;s antioxidant activities.<br />\r\n<br />\r\n<strong>Copper</strong>&nbsp;is an important co-factor of a number of enzymes present in our body. This enzymes act as endogenous antioxidant systems.<br />\r\n<br />\r\n<strong>Manganese</strong>, an antioxidant, is one of the minerals required to form SOD (Super Oxide Dismutase). SOD is an enzyme that protect against cell damaging free radicals.</p>', '<p>The adult dose is 1 (one) tablet daily, or as prescribed by the physician.</p>', NULL, '<p>This product is contraindicated in patients with a known hypersensitivity to any of the ingredients.</p>', '<p>Generally, this preparation is well-tolerated. Diarrhea may occasionally occur during treatment with beta carotene and the skin may assume a slightly yellow discoloration. The side-effects of vitamin A are reversible. Vitamin C and vitamin E may cause diarrhea and other gastrointestinal disturbances.</p>', '<p>This preparation is recommended in pregnancy and lactation.</p>', NULL, '<p>In case of accidental overdose, call a doctor or poison control center immediately.</p>', '<p>Anti-oxidant Multivitamin Multimineral preparations.</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-21 03:59:29', '2022-03-21 03:59:29'),
(1440, 1440, '<p>Suvorexant is indicated for the treatment of insomnia, characterized by difculties with sleep onset and/or sleep maintenance.</p>', '<p>Suvorexant is a highly selective antagonist for orexin receptors OX1R and OX2R. The mechanism by which Suvorexant exerts its therapeutic efect in insomnia is presumed to be through antagonism of orexin receptors. The orexin neuropeptide signaling system is a central promoter of wakefulness. Blocking the binding of wake-promoting neuropeptides orexin A and orexin B to receptors OX1R and OX2R is thought to suppress wake drive.</p>', '<p>Recommended dose is 10 mg, no more than once per night taken before 30 minutes of going to bed, with at least 7 hours remaining before the planned time of awakening. If the 10 mg dose is well-tolerated but not effective, the dose can be increased, not to exceed 20 mg once daily. Lowest dose effective should be used for the patient. Time to effect may be delayed if taken with or soon after a meal.</p>', '<p><strong>CNS-Active Drugs</strong>: An additive effect on psychomotor performance was observed when a single dose of 40 mg of Suvorexant was co-administered with a single dose of 0.7 g/kg alcohol. Suvorexant does not afect alcohol concentrations and alcohol does not afect Suvorexant concentrations.<br />\r\n<br />\r\n<strong>effect s of Other Drugs on Suvorexant</strong>: Strong (e.g., ketoconazole or itraconazole) and moderate (e.g., diltiazem) CYP3A inhibitors signifcantly increased Suvorexant exposure. Strong CYP3A inducers (e.g., rifampin) substantially decreases Suvorexant exposure.<br />\r\n<br />\r\n<strong>effect s of Suvorexant on Other Drugs</strong>: Suvorexant is unlikely to cause clinically signifcant inhibition of human CYP1A2, CYP2B6, CYP2C8, CYP2C9, CYP2C19 or CYP2D6. Chronic administration of Suvorexant is unlikely to induce the metabolism of drugs metabolized by major CYP isoforms.</p>', '<p>Do not use in patients with narcolepsy..</p>', '<p>Common side effects are Sleepiness during the day, Not thinking clearly, Act strangely, confused, or upset, Sleep-walking.</p>', '<p>Pregnancy Category C. There is no adequate and well-controlled studies in pregnant women. Suvorexant should be used during pregnancy only if the potential beneft justifes the potential risk to the fetus.</p>', '<p><strong>Daytime somnolence</strong>: Risk of impaired alertness and motor coordination, including impaired driving; risk increases with dose; caution patients taking 20 mg against next-day driving and other activities requiring complete mental alertness.<br />\r\n<br />\r\n<strong>Need to evaluate for co-morbid diagnoses</strong>: Reevaluate if insomnia persists after 7 to 10 days of treatment.</p>', NULL, '<p>Miscellaneous sedatives &amp; hypnotics.</p>', '<p>Store in dry and cool place, protect from light &amp; keep away from children.</p>', NULL, '2022-03-21 04:01:28', '2022-03-21 04:01:28');
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
(1441, 1441, '<p>Suxamethonium Chloride is a short-acting depolarizing neuromuscular blocking agent. It is used in anesthesia as a muscle relaxant to-</p>\r\n\r\n<ul>\r\n	<li>Facilitate endotracheal intubation</li>\r\n	<li>Aid in mechanical ventilation and</li>\r\n	<li>Assist a wide range of surgical and obstetric procedures</li>\r\n</ul>', '<p>Suxamethonium is a muscle relaxant. It acts as a depolarizing neuromuscular blocker by imitating the action of acetylcholine at the neuromuscular junction. Suxamethonium acts on muscle type nicotinic receptors. Binding of Suxamethonium to the nicotinic acetylcholine receptor results in opening of the receptor&#39;s nicotinic sodium channel; sodium moves into the cell, a disorganized depolarization of the motor-end plate occurs and calcium is released from the sarcoplasmic reticulum. This results in fasciculation. In the normal muscle, following depolarization, acetylcholine is rapidly hydrolyzed by acetylcholinesterase and the muscle cell is able to &#39;reset&#39; ready for the next signal. But Suxamethonium is degraded not by acetylcholinesterase, rather by butyrylcholinesterase, a plasma cholinesterase. This hydrolysis by butyrylcholinesterase is much slower than that of acetylcholine by acetylcholinesterase. Thus Suxamethonium has a longer duration of effect than acetylcholine and it does not allow the muscle cell to &#39;reset&#39; and keeps the &#39;new&#39; resting membrane potential below threshold. When acetylcholine binds to an already depolarized receptor it cannot cause further depolarization. Calcium is removed from the muscle cell cytosol independent of repolarization. As the calcium is taken up by the sarcoplasmic reticulum, the muscle relaxes. This explains muscle flaccidity rather than tetany following fasciculation.</p>', '<p>Suxamethonium Chloride is usually administered by bolus Intravenous or Intramuscular injection.<br />\r\n<br />\r\n<strong>Adults</strong>: The dose of Suxamethonium is dependent on body weight, the degree of muscular relaxation required, the route of administration and the response of individual patients. To achieve endotracheal intubation Suxamethonium is usually administered intravenously in a dose of 1 mg/kg. This dose will usually produce muscular relaxation in about 30-60 seconds and has a duration of action of about 2-6 minutes. Supplementary doses of Suxamethonium of 50%-100% of the initial dose administered at 5-10 minutes intervals will maintain muscle relaxation during short surgical procedures performed under general anesthesia. For prolonged surgical procedures Suxamethonium may be given by intravenous infusion as a 0.1 %-0.2% solution, diluted in 5 % glucose solution or sterile isotonic saline solution, at a rate of 2.5 to 4 mg per minute. The infusion rate should be adjusted according to the response of individual patients. The total dose of Suxamethonium given by repeated intravenous injection or continuous infusion should not be exceeded 500 mg per hour.<br />\r\n<br />\r\n<strong>Children</strong>: Infants and young children are more resistant to Suxamethonium compared with adults. The recommended intravenous dose of Suxamethonium for infants is 2 mg/kg. A dose of 1 mg/kg in older children is recommended. When Suxamethonium is given as intravenous infusion in children, the dosage is as for adults with a proportionately lower initial Infusion rate based on body weight. Suxamethonium may be given intramuscularly to infants at doses up to 4-5 mg/kg and in older children up to 4 mg/kg. These doses produce muscular relaxation within about 3 minutes. A total dose of 150 mg should not be exceeded.</p>', '<p>Certain drugs or chemicals are known to reduce normal plasma cholinesterase activity and may therefore prolong the neuromuscular blocking effects of Suxamethonium. These include: trimetaphan; specific anticholinesterase agents: neostigmine, pyridostigmine, physostigmine; cytotoxic compounds: cyclophosphamide, mechlorethamine, triethylene-melamine; psychiatric drugs: promazine and chlorpromazine, anesthetic agents and drugs: ketamine, morphine and morphine antagonists, pethidine, pancuronium.</p>', '<p>Suxamethonium has no effect on the level of consciousness and should not be administered to a patient who is notfullyanesthetized. Suxamethonium should not be administered to patients known to be hypersensitive to the drug. Suxamethonium is contraindicated in patients known to have an inherited atypical plasma cholinesterase activity. An acute transient rise in serum potassium often occurs following the administration of Suxamethonium in normal individuals (usually 0.5 mmol/Litre). But in certain pathological states it may cause excessive increase in serum potassium leading to serious cardiac arrhythmias and cardiac arrest. For this reason, use of Suxamethonium is contraindicated in patients recovering from major trauma, patients recovering from severe burns, patients with neurological deficits involving acute major muscle wasting and patients with pre-existing hyperkalemia. Suxamethonium causes a slight transient rise in intra-ocular pressure, and should therefore not be used in the presence of open eye injuries. The injection is contraindicated in new-born infants, especially in immature neonates.</p>', '<p><strong>Cardiovascular</strong>: bradycardia, tachycardia, hypertension, hypotension, arrhythmias.<br />\r\n<br />\r\n<strong>Respiratory</strong>: bronchospasm, prolonged respiratory depression and apnea.<br />\r\n<br />\r\n<strong>Musculoskeletal</strong>: muscle fasciculation, post-operative muscle pains, myoglobinemia.<br />\r\n<br />\r\n<strong>Others</strong>: hyperthermia, increased intra-ocular pressure increased intra-gastric pressure, rash, excessive salivation.</p>', '<p>Although Suxamethonium does not readily cross the placental barrier it should not be administered to pregnant women unless the potential benefit outweighs possible hazards.</p>', '<p>Suxamethonium should be administered only by or under close supervision of an anesthetist familiar with its action, characteristics and hazards, who is skilled in the management of artificial respiration and only where there are adequate facilities for immediate endotracheal intubation with administration of oxygen by intermittent positive pressure ventilation. The elderly may be more susceptible to cardiac arrhythmias, especially if digitalis-like drugs are also being taken.</p>', NULL, '<p>Depolarizing muscle relaxants.</p>', '<p>Store in a refrigerator between 2&deg;-8&deg; C. Do not freeze.</p>', NULL, '2022-03-21 04:03:10', '2022-03-21 04:03:10'),
(1442, 1442, '<p>Tacrolimus is a calcineurin-inhibitor immunosuppressant indicated for the prophylaxis of organ rejection in kidney transplant patients in combination with other immunosuppressants.</p>', '<p>Tacrolimus inhibits T-lymphocyte activation, although the exact mechanism of action is not known. Experimental evidence suggests that Tacrolimus binds to an intracellular protein, FKBP-12. A complex of Tacrolimus-FKBP-12, calcium, calmodulin, and calcineurin is then formed and the phosphatase activity of calcineurin inhibited. This effect may prevent the dephosphorylation and translocation of nuclear factor of activated T-cells (NF-AT), a nuclear component thought to initiate gene transcription for the formation of lymphokines (such as interleukin-2, gamma interferon). The net result is the inhibition of T-lymphocyte activation (i.e., immunosuppression).<br />\r\n<br />\r\nTacrolimus prolongs the survival of the host and transplanted graft in animal transplant models of liver, kidney, heart, bone marrow, small bowel and pancreas, lung and trachea, skin, cornea, and limb.<br />\r\n<br />\r\nIn animals, Tacrolimus has been demonstrated to suppress some humoral immunity and, to a greater extent, cell-mediated reactions such as allograft rejection, delayed type hypersensitivity, collagen-induced arthritis, experimental allergic encephalomyelitis, and graft versus host disease.</p>', '<p>Usual Adult Dose for Organ Transplant- Rejection Prophylaxis</p>\r\n\r\n<p>KIDNEY TRANSPLANT:</p>\r\n\r\n<ul>\r\n	<li><strong>In combination with azathioprine</strong>: Initial dose: 0.1 mg/kg orally every 12 hours. Initiate within 24 hours of surgery, but delay until renal function has recovered.</li>\r\n	<li><strong>In combination with mycophenolate mofetil (MMF)/interleukin-2 (IL-2) receptor antagonist</strong>: Initial dose: 0.05 mg/kg orally every 12 hours. Initiate within 24 hours of surgery, but delay until renal function has recovered.</li>\r\n</ul>\r\n\r\n<p>LIVER TRANSPLANT:</p>\r\n\r\n<ul>\r\n	<li><strong>Initial dose</strong>: 0.05 to 0.075 mg/kg orally every 12 hours. Initiate no sooner than 6 hours after surgery.</li>\r\n</ul>\r\n\r\n<p>HEART TRANSPLANT:</p>\r\n\r\n<ul>\r\n	<li><strong>Initial dose</strong>: 0.0375 mg/kg orally every 12 hours. Initiate no sooner than 6 hours after surgery</li>\r\n</ul>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>Usual Pediatric Dose for Organ Transplant- Rejection Reversal</p>\r\n\r\n<p>LIVER TRANSPLANT:</p>\r\n\r\n<ul>\r\n	<li><strong>Initial dose</strong>: 0.075 to 0.1 mg/kg orally every 12 hours</li>\r\n</ul>', '<p>Since Tacrolimus is metabolized mainly by CYP3A enzymes, drugs or substances known to inhibit these enzymes may increase Tacrolimus whole blood concentrations. Drugs known to induce CYP3A enzymes may decrease Tacrolimus whole blood concentrations. Dose adjustments may be needed along with frequent monitoring of Tacrolimus whole blood trough concentrations when Tacrolimus is administered with CYP3A inhibitors or inducers. In addition, patients should be monitored for adverse reactions including changes in renal function and QT prolongation.</p>', '<p>Tacrolimus capsules are contraindicated in patients with a hypersensitivity to Tacrolimus. Tacrolimus injection is contraindicated in patients with a hypersensitivity to HCO-60 (polyoxyl 60 hydrogenated castor oil). Hypersensitivity symptoms reported include dyspnea, rash, pruritus, and acute respiratory distress syndrome.</p>', NULL, '<p><strong>Pregnancy</strong>&nbsp;Category C. There are no adequate and well-controlled studies in pregnant women. Tacrolimus is transferred across the placenta. The use of Tacrolimus during pregnancy in humans has been associated with neonatal hyperkalemia and renal dysfunction. Tacrolimus given orally to pregnant rabbits at 0.5 to 4.3 times the clinical dose and pregnant rats at 0.8 to 6.9 times the clinical dose was associated with an increased incidence of fetal death&nbsp;in utero, fetal malformations (cardiovascular, skeletal, omphalocele, and gallbladder agenesis) and maternal toxicity. Tacrolimus should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the fetus.<br />\r\n<br />\r\n<strong>Nursing Mothers</strong>: Tacrolimus is excreted in human milk. As the effect of chronic exposure to Tacrolimus in healthy infants is not established, patients maintained on Tacrolimus should discontinue nursing taking into consideration importance of drug to the mother.</p>', '<p><strong>Pediatric Use</strong>: The safety and efficacy of Tacrolimus in pediatric kidney and heart transplant patients have not been established. Successful liver transplants have been performed in pediatric patients (ages up to 16 years) using Tacrolimus. Two randomized active-controlled trials of Tacrolimus in primary liver transplantation included 56 pediatric patients. Thirty-one patients were randomized to Tacrolimus-based and 25 to cyclosporine-based therapies. Additionally, a minimum of 122 pediatric patients were studied in an uncontrolled trial of Tacrolimus in living related donor liver transplantation. Pediatric patients generally required higher doses of Tacrolimus to maintain blood trough concentrations of Tacrolimus similar to adult patients.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Clinical trials of Tacrolimus did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, 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.<br />\r\n<br />\r\n<strong>Use in Renal Impairment</strong>: The pharmacokinetics of Tacrolimus in patients with renal impairment was similar to that in healthy volunteers with normal renal function. However, consideration should be given to dosing Tacrolimus at the lower end of the therapeutic dosing range in patients who have received a liver or heart transplant and have pre-existing renal impairment. Further reductions in dose below the targeted range may be required<br />\r\n<br />\r\n<strong>Use in Hepatic Impairment</strong>: The mean clearance of Tacrolimus was substantially lower in patients with severe hepatic impairment (mean Child-Pugh score: &gt;10) compared to healthy volunteers with normal hepatic function. Close monitoring of Tacrolimus trough concentrations is warranted in patients with hepatic impairment.<br />\r\n<br />\r\nThe use of Tacrolimus in liver transplant recipients experiencing post-transplant hepatic impairment may be associated with increased risk of developing renal insufficiency related to high whole-blood trough concentrations of Tacrolimus. These patients should be monitored closely and dosage adjustments should be considered. Some evidence suggests that lower doses should be used in these patients</p>', '<p>Limited overdosage experience is available. Acute overdosages of up to 30 times the intended dose have been reported. Almost all cases have been asymptomatic and all patients recovered with no sequelae. Acute overdosage was sometimes followed by adverse reactions (including tremors, abnormal renal function, hypertension, and peripheral edema); in one case of acute overdosage, transient urticaria and lethargy were observed. Based on the poor aqueous solubility and extensive erythrocyte and plasma protein binding, it is anticipated that Tacrolimus is not dialyzable to any significant extent; there is no experience with charcoal hemoperfusion. The oral use of activated charcoal has been reported in treating acute overdoses, but experience has not been sufficient to warrant recommending its use. General supportive measures and treatment of specific symptoms should be followed in all cases of overdosage.<br />\r\n<br />\r\nIn acute oral and IV toxicity studies, mortalities were seen at or above the following doses: in adult rats, 52 times the recommended human oral dose; in immature rats, 16 times the recommended oral dose; and in adult rats, 16 times the recommended human IV dose (all based on body surface area corrections).</p>', '<p>Drugs affecting the immune response.</p>', '<p>Store at 25&deg;C</p>', NULL, '2022-03-21 04:48:47', '2022-03-21 04:48:47'),
(1443, 1443, '<p>Tacrolimus ointment is indicated for short-term and intermittent long-term therapy in the treatment of patients with moderate to severe atopic dermatitis in whom the use of alternative, conventional therapies are deemed inadvisable because of potential risks, or in the treatment of patients who are not adequately responsive to or are intolerant of alternative, conventional therapies. Tacrolimus ointment is also indicated in other skin conditions such as chronic cutaneous graft-vs-host disease, hand and foot eczema, allergic contact dermatitis, vitiligo, psoriasis, lichen planus, facial lichen, vulvar lichen sclerosus, pyoderma gangrenosum, leg ulcers in rheumatoid arthritis, steroid-induced rosacea &amp; alopecia areata, annular erythema, chronic actinic dermatitis and recalcitrant facial erythema.</p>', '<p>Tacrolimus is a macroiide immunomodulator produced by fungus, Streptomyces tsukubaensis. It has been demonstrated that Tacrolimus inhibits T-lymphocyte activation by first binding to an intracellular protein, FKBP-12. A complex of Tacrolimus-FKBP-12, calcium, calmodulin, and calcineurin is then formed and the phosphatase activity of calcineurin is inhibited. This leads to a general decrease in the entire inflammatory cascade.</p>', '<p><strong>Use in adults</strong>: Apply a thin layer of Tacrolimus&nbsp;ointment onto the affected skin areas twice daily and rub in gently and completely. Treatment should be continued for one week after clearing of signs and symptoms of atopic dermatitis. The safety of Tacrolim ointment under occlusion which may promote systemic exposure has not been evaluated. Tacrolimus ointment should not be used with occlusive dressings.<br />\r\n<br />\r\n<strong>Use in Children</strong>:</p>\r\n\r\n<ul>\r\n	<li>Tacrolimus 0.03% ointment can be used in pediatric patients 2 years of age and older.</li>\r\n	<li>Tacrolimus 0.1% ointment can be used in children 16 years of age and older.</li>\r\n</ul>\r\n\r\n<p><strong>Use in Elderly Patients</strong>: Patients &gt;65 years old received Tacrolimus ointment in phase 3 studies. The adverse event profile for these patients was consistent with that for other adult patients.</p>', '<p>Formal topical drug interaction studies with Tacrolimus ointment have not been conducted. The concomitant administration of known CYP3A4 inhibitors in patients with widespread and/or erythrodermic disease should be done with caution. Some examples of such drugs are erythromycin, itraconazole, ketoconazole, fluconazole, calcium channel blockers and cimetidine.</p>', '<p>Tacrolimus ointment is contraindicated in patients with a history of hypersensitivity to Tacrolimus or any other component of the preparation.</p>', '<p>Topically applied Tacrolimus ointment have very few and rare type of side-effects including skin burning, pruritus, flu-like symptoms, allergic reactions, skin erythema, skin infections, headache, etc.</p>', '<p>Pregnancy Category C. There are no adequate and well-controlled studies of topically administered Tacrolimus in pregnant women.&nbsp;Although systemic absorption of Tacrolimus following topical applications of Tacrolimus ointment is minimal relative to systemic administration, it is known that Tacrolimus is excreted in human milk. Because of the potential for serious adverse reactions in nursing infants from Tacrolimus, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.</p>', '<p>Cautions should be exercised while treatment with Tacrolimus ointment in patients with atopic dermatitis predisposed to superficial skin infections. The safety of Tacrolimus ointment has not been established in patients with generalized erythroderma.</p>', '<p>Tacrolimus ointment is not for oral use. Accidental oral ingestion of Tacrolimus ointment may lead to adverse effects associated with systemic administration of Tacrolimus. If oral ingestion occurs, medical advice should be sought.</p>', '<p>Drugs affecting the immune response.</p>', '<p>Do not store above 30&deg;C. Keep away from light and out of the reach of children.</p>', NULL, '2022-03-21 04:50:29', '2022-03-21 04:50:29'),
(1444, 1444, '<p>Tadalafil is indicated in-</p>\r\n\r\n<ul>\r\n	<li>Erectile Dysfunction (ED)</li>\r\n	<li>Benign Prostatic Hyperplasia (BPH)</li>\r\n	<li>Both Erectile Dysfunction and signs and symptoms of Benign Prostatic Hyperplasia</li>\r\n</ul>', '<p>Tadalafil is a selective phosphodiesterase type 5 (PDE5) inhibitor. Inhibition of PDE5 increases cGMP in smooth muscle cells. cGMP causes smooth muscle relaxation and increased blood flow into the corpus cavernosum, causing penile erection. PDE5 also is present in smooth muscles of the prostate and bladder wall. Inhibiting PDE5 increases cGMP concentrations leading to relaxation of smooth muscle in the prostate and bladder. Smooth muscle relaxation may improve blood flow to the urinary tract and widen the opening of the bladder neck, resulting in improved voiding.</p>', '<p><strong>Erectile Dysfunction</strong>: For most patients the recommended starting dose is 10 mg. The dose may be increased to 20 mg or decreased to 5 mg based on requirement. The maximum dosing frequency is once daily. Tadalafil is effective for up to 36 hours.<br />\r\n<br />\r\n<strong>Benign prostatic hyperplasia</strong>: The recommended dose is 5 mg taken at the same time every day.<br />\r\n<br />\r\n<strong>Combined Erectile Dysfunction and Benign prostatic hyperplasia</strong>: The recommended dose is 5 mg at the same time every day.</p>', '<p>May interact with Nitrates for example, Isosorbide, Nitroglycerin, Alpha adrenergic blockers, Antihypertensives, Alcohol, Antacids (magnesuim hydroxide/aluminum hydroxide), Ketoconazole, Ritonavir, Erythromycin, Itraconazole, Grapefruit juice, other HIV protease inhibitors, Rifampin, Carbamazepine, Phenytoin &amp; Phenobarbital.</p>', '<ul>\r\n	<li>Use of Nitrates (for example, Nitroglycerine, Isosorbide): may increase hypotensive effects of Nitrates</li>\r\n	<li>Hypersensitivity reactions to Tadalafil</li>\r\n</ul>', '<p>Headache, Dyspepsia, Back pain, Myalgia, Nasal pharyngitis, Nasal congestion are common side effects. Change in Color Vision, Sudden vision loss, Hearing loss, Stevens-Johnson Syndrome, Exfoliative dermatitis, Angina, Stroke, Myocardial infarction, Severe hypotension, Tachycardia may also occur rarely.</p>', '<p>Tadalafil has been assigned to pregnancy category B by the USFDA. Tadalafil is only recommended for use during pregnancy when benefit outweighs risk. There are no data on the excretion of Tadalafil in human milk. Caution should be used when administering tadalafil to nursing women.</p>', '<p>Angina, renal impairment, hepatic impairment, bleeding concomitant with Nitrates, Alpha Blockers, Alcohol, CYP3A4 Inhibitors (for example, Ritonavir, Ketoconazole, Itraconazole), other PDE5 inhibitors precaution should be taken in all these conditions.</p>', NULL, '<p>Drugs for Erectile Dysfunction.</p>', '<p>Keep in a dry place, away from light and heat. Keep out of the reach of children.</p>', NULL, '2022-03-21 04:52:00', '2022-03-21 04:52:00'),
(1445, 1445, '<p>Tafluprost is indicated for reducing elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension.</p>', '<p>Tafluprost, a prostaglandin analog is a selective FP prostanoid receptor agonist which is believed to reduce intraocular pressure by increasing uveoscleral outflow of aqueous humor.</p>', '<p>Instill one drop in the affected eye(s) once daily in the evening.</p>', NULL, '<p>Tafluprost ophthalmic solution is contraindicated in patients who are hypersensitive to any component of this product.</p>', '<p>The most frequently reported treatment-related side effect is ocular hyperemia. Rare side effects observed include eye irritation and blurred vision.</p>', '<p><strong>Use in pregnancy</strong>: Pregnancy category C. There are no adequate and well-controlled studies in pregnant women. Tafluprost ophthalmic solution should be used during pregnancy unless the potential benefit justifies the potential risk to the fetus.<br />\r\n<br />\r\n<strong>Use in lactation</strong>: It is not known whether Tafluprost is excreted in human milk. Caution should be exercised while giving this ophthalmic solution to a nursing mother.</p>', '<ul>\r\n	<li>For ophthalmic use only.</li>\r\n	<li>To avoid possible contamination of the drops, do not touch the dropper tip or to any surface.</li>\r\n	<li>Should be used with caution in patients with active intraocular inflammation (e.g., iritis/uveitis).</li>\r\n	<li>If more than one topical ophthalmic drug is being used, the drugs should be administered at least five (5) minutes between applications.</li>\r\n</ul>', NULL, '<p>Drugs for miotics and glaucoma.</p>', NULL, '<p><strong>Use in children</strong>: Use in pediatric patients is not recommended.<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>', '2022-03-21 04:53:20', '2022-03-21 04:53:20'),
(1446, 1446, '<p>Tamoxifen is indicated for the treatment of breast cancer.</p>', '<p>Tamoxifen is a praparation of Tamoxifen which is a non-steroidal, triphenylene based drug and displays a complex spectrum of oestrogen antagonist and oestrogen agonist like pharmacological effects in different tissues. In breast cancer patients, at the tumour level, Tamoxifen acts primarily as an antioestrogen, preventing oestrogen binding to the oestrogen receptor. Additionally Tamoxifen has been reported to lead to maintenance of bone mineral density in post-menopausal women.</p>', '<p><strong>Adults (including elderly)</strong>: The dosage range is 20 to 40 mg daily, given either in divided doses twice daily or as a single dose once daily.</p>', '<p>When Tamoxifen is used in combination with coumarin type anticoagulants, a significant increase in anticoagulant effect may occur. Where such co administration is initiated, careful monitoring of the patient is recommended. When Tamoxifen is used in combination with cytotoxic agents, there is an increased risk of thromboembolic events.</p>', '<p>Tamoxifen must not be administered during pregnancy. Tamoxifen should not be given to patients who have experienced hypersensitivity to the product or any of its ingredients.</p>', '<p>Side effects can be classified as either due to the pharmacological action of the drug, e.g., hot flushes, vaginal bleeding, vaginal discharge, pruritus vulvae and tumour flare or as more general side effects, e.g., gastrointestinal intolerance, headache, light-headedness and occasionally fluid retention and alopecia. When such side effects are severe, it may be possible to control them by a simple reduction of dosage (within the recommended dose range) without loss of control of the disease.&nbsp;<br />\r\n<br />\r\nSkin rashes including isolated reports of erythema multiforme, Stevens Johnson syndrome and bullous pemphigoid and rare hypersensitivity reactions, including angio-oedema have been reported. A small number of patients with bony metastases have developed hypercalcaemia on initiation of therapy.<br />\r\n<br />\r\nFalls in platelet count, usually only to 80,000-90,000 per/mm3 but occasionally lower, have been reported in patients taking Tamoxifen for breast cancer.<br />\r\n<br />\r\nA number of cases of visual disturbances including infrequent reports of corneal changes and retinopathy have been described in patients receiving Tamoxifen therapy. An increased incidence of cataracts has been reported in association with the administration of the drug. Uterine fibroids and endometrial changes including hyperplasia and polyps have been reported. Cystic ovarian swellings have occasionally been observed in premenopausal women receiving Tamoxifen.<br />\r\n<br />\r\nLeucopenia has been observed following the administration of Tamoxifen, sometimes in association with anaemia and/or thrombocytopenia. Neutropenia has been reported on rare occasions; this can sometimes be severe. There is evidence of an increased incidence of thromboembolic events including deep vein thrombosis and pulmonary embolism during Tamoxifen therapy.<br />\r\n<br />\r\nTamoxifen has been associated with changes in liver enzyme levels and on rare occasions with a spectrum of more severe liver abnormalities, including fatty liver, cholestasis and hepatitis. Rarely, elevation of serum triglyceride levels, in some cases with pancreatitis, may be associated with the use of Tamoxifen.</p>', '<p><strong>Pregnancy:</strong>&nbsp;Tamoxifen must not be administered during pregnancy. There have been a small number of reports of spontaneous abortions, birth defects and foetal deaths after women have taken Tamoxifen, although no causal relationship has been established. Reproductive toxicology studies in rats, rabbits and monkeys have shown no teratogenic potential.<br />\r\n<br />\r\nWomen should be advised not to become pregnant whilst taking Tamoxifen and should use barrier or other nonhormonal contraceptive methods if sexually active. Premenopausal patients must be carefully examined before treatment to exclude pregnancy. Women should be informed of the potential risks to the foetus, if they want to become pregnant whilst taking Tamoxifen or within two months of cessation of therapy.<br />\r\n<br />\r\n<strong>Lactation:</strong>&nbsp;It is not known if Tamoxifen is excreted in human milk and therefore the drug is not recommended during lactation. The decision to discontinue Tamoxifen should take into account in case of the importance of the drug to the lactating mother.</p>', '<p>Menstruation is suppressed in a proportion of premenopausal women receiving Tamoxifen for the treatment of breast cancer. An increased incidence of endometrial cancer has seen reported in association with Tamoxifen treatment. The underlying mechanism is unknown, but may be related to the oestrogen-like effect of Tamoxifen. Any patients receiving or having previously received Tamoxifen, who report abnormal gynaecological symptoms, especially vaginal bleeding, should be promptly investigated.<br />\r\n<br />\r\nA number of second primary tumors, occurring at sites other than the endometrium and the opposite breast, have been reported in clinical trials, following the treatment of breast cancer patients with Tamoxifen. No causal link has been established and the clinical significance of these observations remains unclear.</p>', NULL, '<p>Hormonal Chemotherapy.</p>', '<p>Store between 20-25&deg; C. Protect from light.</p>', NULL, '2022-03-21 04:56:50', '2022-03-21 04:56:50'),
(1447, 1447, '<p>Tamsulosin Hydrochloride is indicated for the treatment of functional symptoms of Benign Prostatic Hyperplasia (BPH).</p>', '<p>Tamsulosin, a selective alpha1 adrenoceptor blocking agent, exhibits its selectivity for alpha1&nbsp;A adrenoceptors in human prostate. Blockade of these adrenoceptors can cause smooth muscle in the bladder neck and prostate to relax, resulting in an improvement in urine flow rate and a reduction in symptoms of BPH. Absorption of Tamsulosin hydrochloride capsule 0.4mg is essentially complete (90%) following oral administration under fasting conditions. The time to maximum concentration (Tmax) is reached by four to five hours under fasting conditions and by six to seven hours when administered with food. Tamsulosin hydrochloride is extremely bound to human plasma protein (94% to 99%). Tamsulosin hydrochloride is extensively metabolized by cytochrome P 450 enzymes in the liver and less than 10% of the dose is excreted in urine as unchanged form. Following intravenous or oral administration of an immediate-release formulation the elimination half-life of Tamsulosin hydrochloride in plasma ranges from five to seven hours. Because of the absorption rate controlled pharmacokinetics with Prostam capsules, the apparent half-life of Tamsulosin hydrochloride is approximately 9 to 13 hours in healthy volunteers and 14 to 15 hours in the target population.</p>', '<p>Tamsulosin Hydrochloride 0.4 mg (one capsule) daily, to be taken after meal at night. The dose may be increased after 2 to 4 weeks, if necessary, to Tamsulosin Hydrochloride 0.8 mg (two capsules) once daily. If Tamsulosin Hydrochloride administration is discontinued or interrupted for several days at either the 0.4 mg or 0.8 mg dose, therapy should be started again with the Tamsulosin Hydrochloride 0.4 mg (one capsule) once daily dose. The capsule should be swallowed whole with a glass of water (about 150 ml) in the standing or sitting position. The capsule should not be crunched or chewed, as this will interfere with the modified release of the active ingredient.</p>', '<p>Concurrent administration of other alfa1-adrenoceptor antagonists could lead to hypotensive effects. No interactions have been seen when Tamsulosin was given concomitantly with either atenolol, enalapril or nifedipine. Concomitant cimetidine brings about a rise and frusemide a fall in plasma levels of Tamsulosin, but as levels remain within the normal range posology need not be changed. No interactions at the level of hepatic metabolism have been seen during in vitro studies with liver microsomal fractions (representative of the cytochrome P450-linked drug-metabolizing enzyme system), involving amitriptyline, salbutamol, glibenclamide, and finasteride. Diclofenac and warfarin, however, may increase the elimination rate of Tamsulosin.</p>', '<p>Tamsulosin hydrochloride is contraindicated in patients with hypersensitivity to it; history of orthostatic hypotension; severe hepatic insufficiency.<br />\r\n<br />\r\nAs with other alpha1 blockers, a reduction in blood pressure can occur in individual cases during treatment with Tamsulosin, as a result of which, rarely, syncope can occur, at the first signs of orthostatic hypotension (dizziness, weakness) the patient should sit or lie down until the symptoms have disappeared. And they should be cautioned to avoid situations where injury could result (like driving, operating machinery or performing hazardous tasks).<br />\r\n<br />\r\nBefore therapy with Tamsulosin is initiated the patient should be examined in order to exclude the presence of other conditions which can cause the same symptoms as Benign Prostatic hyperplasia. Digital rectal examination and when the necessary determination of Prostate Specific Antigen (PSA) should be performed before treatment and at regular intervals afterwards.</p>', '<p>The following adverse reactions have been reported during the use of Tamsulosin: dizziness, abnormal ejaculation and; less frequently headache, asthenia, postural hypotension and palpitations.</p>', '<p>Use of Tamsulosin in pregnancy and lactation is not recommended.</p>', '<p>Rarely, transient postural symptoms have occurred during orthostatic provocation testing after the first dose. Use in patients with micturition syncope is not advised.<br />\r\n<br />\r\nEffects on ability to drive and use machines: No data is available on whether Tamsulosin adversely affects the ability to drive or operate machines. However, in this respect, patients should be aware of the fact that dizziness can occur.</p>', '<p>No case of acute overdosage has been reported. However, acute hypotension is likely to occur after overdosage in which case cardiovascular support should be given. Blood pressure can be restored and the heart rate brought back to normal by lying the patient down. If this does not help then volume expanders, and when necessary, vasopressors could be employed. Renal function should be monitored and general supportive measures applied. Dialysis is unlikely to be of help as Tamsulosin is very highly bound to plasma proteins. Measures, such as emesis, can be taken to impede absorption. When large quantities are involved, gastric lavage can be applied and activated charcoal and an osmotic laxative, such as sodium sulphate, can be administered.</p>', '<p>BPH/ Urinary retention/ Urinary incontinence.</p>', '<p>Store in a cool and dry place, below 30&deg;C, protected from light.</p>', NULL, '2022-03-21 04:58:25', '2022-03-21 04:58:25');
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
(1448, 1448, '<p>Tamsulosin Hydrochloride &amp; Dutasteride capsule is indicated in-</p>\r\n\r\n<ul>\r\n	<li>Treatment of moderate to severe symptoms of benign prostatic hyperplasia (BPH).</li>\r\n	<li>Reduction in the risk of acute urinary retention and surgery in patients with moderate to severe symptoms of BPH.</li>\r\n</ul>', '<p>Tamsulosin &amp; Dutasteride is a combination of two drugs with complementary mechanisms of action to improve symptoms in patients with Benign Prostatic Hyperplasia (BPH). Tamsulosin Hydrochloride, an antagonist of alpha1A-adrenoreceptors and Dutasteride, a dual 5 alpha reductase inhibitor (5ARI). Treatment of BPH with alpha1-adrenoreceptor blocking agents and 5ARIs results in an improvement in urine flow rate and a reduction in symptoms of BPH.<br />\r\n<br />\r\n<strong>Tamsulosin</strong>: An alpha1-adrenoreceptor blocking agent that affects the dynamic component of BPH by inhibiting alpha1-adrenoreceptors in the stromal prostatic smooth muscle and bladder neck. Blockade of these adrenoreceptors can cause smooth muscles in the bladder neck and prostate to relax. Specifically, Tamsulosin exhibits selectivity for both alpha&nbsp;1A&nbsp;and alpha&nbsp;1D&nbsp;receptors over the alpha1B-adrenoreceptor subtype. These three adrenoreceptor subtypes have a distinct distribution pattern in human tissue. Whereas approximately 70% of the alpha1-receptors in human prostate are of the alpha&nbsp;1A&nbsp;subtype, the human bladder contains predominantly the alpha&nbsp;1D&nbsp;subtype while blood vessels express predominantly alpha&nbsp;1B&nbsp;subtype. It is further believed that blockade of the alpha&nbsp;1D&nbsp;subtypes in the human obstructed bladder may be responsible for reducing detrusor overactivity and subsequent relief of storage symptoms.<br />\r\n<br />\r\n<strong>Dutasteride</strong>: A synthetic 4-azasteriod compound is a competitive and specific inhibitor of both Type I and Type II 5 alpha-reductase isoenzymes that affects the static component of BPH by inhibiting the conversion of Testosterone to Dihydrotestosterone (DHT) by the enzyme 5 alpha-reductase. 5 alpha-reductase exists as 2 isoforms, Type I and Type II, both of which are present in the prostate. It has been observed that compared to normal tissue, the expression of both isoenzymes are increased in BPH tissue. Dissociation from this complex has been evaluated under in vitro and in vivo conditions and is extremely slow. Dutasteride lowers DHT levels and leads to a reduction in prostatic volume, thereby treating an underlying cause of BPH. Dutasteride does not bind to the human androgen receptor.</p>', '<p><strong>Adults (including elderly)</strong>: The recommended dose is one capsule (Tamsulosin Hydrochloride 0.4 mg &amp; Dutasteride 0.5 mg) taken orally approximately 30 minutes after the same meal each day. The capsules should be swallowed whole and not chewed or opened. Where appropriate, this capsule may be used to substitute concomitant Tamsulosin Hydrochloride and Dutasteride in existing dual therapy to simplify treatment. Where clinically appropriate, direct change from Tamsulosin Hydrochloride or Dutasteride monotherapy to this capsule may be considered.<br />\r\n<br />\r\n<strong>Renal impairment</strong>: The effect of renal impairment on Tamsulosin-Dutasteride pharmacokinetics has not been studied. No adjustment in dosage is anticipated for patients with renal impairment.<br />\r\n<br />\r\n<strong>Hepatic impairment</strong>: The effect of hepatic impairment on Tamsulosin-Dutasteride pharmacokinetics has not been studied so caution should be used in patients with mild to moderate hepatic impairment. In patients with severe hepatic impairment, the use of this capsule is contra-indicated.</p>', '<p>There have been no drug interaction studies for Dutasteride-Tamsulosin combination.<br />\r\n<br />\r\n<strong>Effects of other drugs on the pharmacokinetics of Dutasteride</strong>: Use together with CYP3A4 and/or P-glycoprotein-inhibitors: Dutasteride is mainly eliminated via metabolism. In vitro studies indicate that this metabolism is catalysed by CYP3A4 and CYP3A5. No formal interaction studies have been performed with potent CYP3A4 inhibitors. However, in a population pharmacokinetic study, Dutasteride serum concentrations were on average 1.6 to 1.8 times greater, respectively, in a small number of patients treated concurrently with verapamil or diltiazem (moderate inhibitors of CYP3A4 and inhibitors of P-glycoprotein) than in other patients. Long-term combination of Dutasteride with drugs that are potent inhibitors of the enzyme CYP3A4 (e.g. ritonavir, indinavir, nefazodone, itraconazole, ketoconazole administered orally) may increase serum concentrations of Dutasteride. Further inhibition of 5-alpha reductase at increased Dutasteride exposure, is not likely. However, a reduction of the Dutasteride dosing frequency can be considered if side effects are noted. It should be noted that in the case of enzyme inhibition, the long half-life may be further prolonged and it can take more than 6 months of concurrent therapy before a new steady state is reached. Administration of 12 g cholestyramine one hour after a 5 mg single dose of Dutasteride did not affect the pharmacokinetics of Dutasteride.<br />\r\n<br />\r\n<strong>Effects of Dutasteride on the pharmacokinetics of other drugs</strong>: In a small study (N=24) of two weeks duration in healthy men, Dutasteride (0.5 mg daily) had no effect on the pharmacokinetics of Tamsulosin or terazosin. There was also no indication of a pharmacodynamic interaction in this study. Dutasteride has no effect on the pharmacokinetics of warfarin or digoxin. This indicates that Dutasteride does not inhibit/induce CYP2C9 or the transporter P-glycoprotein. In vitro interaction studies indicate that Dutasteride does not inhibit the enzymes CYP1A2, CYP2D6, CYP2C9, CYP2C19 or CYP3A4. Tamsulosin: Concomitant administration of Tamsulosin Hydrochloride with drugs which can reduce blood pressure, including anaesthetic agents, PDE5 inhibitors and other alpha-1 adrenergic blockers could lead to enhanced hypotensive effects. Tamsulosin-Dutasteride should not be used in combination with other alpha-1 adrenergic blockers. Concomitant administration of Tamsulosin Hydrochloride (0.4 mg) and cimetidine (400 mg every six hours for six days) resulted in a decrease in the clearance (26%) and an increase in the AUC (44%) of Tamsulosin Hydrochloride. Caution should be used when Tamsulosin-Dutasteride is used in combination with cimetidine. A definitive drug-drug interaction study between Tamsulosin Hydrochloride and warfarin has not been conducted. Results from limited in vitro and in vivo studies are inconclusive. Caution should be exercised with concomitant administration of warfarin and Tamsulosin Hydrochloride. No interactions have been seen when Tamsulosin Hydrochloride was given concomitantly with either atenolol, enalapril, nifedipine or theophylline. Concomitant furosemide brings about a fall in plasma levels of Tamsulosin, but as levels remain within the normal range posology need not be adjusted. In vitro neither diazepam nor propranolol, trichlormethiazide, chlormadinon, amitryptyline, diclofenac, glibenclamide and simvastatin change the free fraction of Tamsulosin in human plasma. Neither does Tamsulosin change the free fractions of diazepam, propranolol, trichlormethiazide, and chlormadinon. No interactions at the level of hepatic metabolism have been seen during in vitro studies with liver microsomal fractions, involving amitriptyline, salbutamol and glibenclamide. Diclofenac however, may increase the elimination rate of Tamsulosin.</p>', '<p>Tamsulosin-Dutasteride combination is contra-indicated in women and children and adolescents, patients with hypersensitivity to Dutasteride, other 5-alpha reductase inhibitors, Tamsulosin (including Tamsulosin- induced angio-edema), soya, peanut or any of other the excipients, patients with a history of orthostatic hypotension and patients with severe hepatic impairment.</p>', '<p>The most common adverse reactions reported in subjects receiving combination therapy were impotence, decreased libido, breast disorders (including breast enlargement and tenderness), ejaculation disorders and dizziness. The percentages of subjects with ejaculation disorders, decreased libido and impotence were higher in the combination therapy group compared with either monotherapy groups.</p>', '<p>Tamsulosin-Dutasteride combination is contra-indicated for use by women. There have been no studies to investigate the effect of Tamsulosin-Dutasteride combination on pregnancy, lactation and fertility. The following statements reflect the information available from studies with the individual components. Fertility: Dutasteride has been reported to affect semen characteristics (reduction in sperm count, semen volume, and sperm motility) in healthy men. The possibility of reduced male fertility cannot be excluded. Effects of Tamsulosin Hydrochloride on sperm counts or sperm function have not been evaluated.<br />\r\n<br />\r\n<strong>Pregnancy</strong>: As with other 5 alpha reductase inhibitors, Dutasteride inhibits the conversion of testosterone to dihydrotestosterone and may, if administered to a woman carrying a male foetus, inhibit the development of the external genitalia of the foetus. Small amounts of Dutasteride have been recovered from the semen in subjects receiving Dutasteride. It is not known whether a male foetus will be adversely affected if his mother is exposed to the semen of a patient being treated with Dutasteride. As with all 5 alpha reductase inhibitors, when the patient&rsquo;s partner is or may potentially be pregnant it is recommended that the patient avoids exposure of his partner to semen by use of a condom. Administration of Tamsulosin Hydrochloride to pregnant female rats and rabbits showed no evidence of foetal harm.<br />\r\n<br />\r\n<strong>Lactation</strong>: It is not known whether Tamsulosin or Dutasteride are excreted in human milk.</p>', '<p>Combination therapy should be prescribed after careful benefit risk assessment due to the potential increased risk of adverse events (including cardiac failure) and after consideration of alternative treatment options including monotherapies.<br />\r\n<br />\r\n<strong>Cardiac failure</strong>: In two 4-year clinical studies, the incidence of cardiac failure was higher among subjects taking the combination of Dutasteride and an alpha blocker, primarily Tamsulosin, than it was among subjects not taking the combination. In these two trials, the incidence of cardiac failure was low (1%) and variable between the studies.<br />\r\n<br />\r\n<strong>Effects on prostate specific antigen (PSA) and prostate cancer detection</strong>: Digital rectal examination, as well as other evaluations for prostate cancer or other conditions which can cause the same symptoms as BPH, must be performed on patients prior to initiating therapy with Tamsulosin-Dutasteride combination and periodically thereafter. Serum prostate-specific antigen (PSA) concentration is an important component in the detection of prostate cancer. Tamsulosin-Dutasteride combination causes a decrease in mean serum PSA levels by approximately 50%, after 6 months of treatment. Patients receiving Tamsulosin-Dutasteride combination should have a new PSA baseline established after 6 months of treatment. It is recommended to monitor PSA values regularly thereafter. Any confirmed increase from lowest PSA level while on Tamsulosin-Dutasteride combination may signal the presence of prostate cancer or noncompliance to therapy with Tamsulosin-Dutasteride combination and should be carefully evaluated, even if those values are still within the normal range for men not taking a 5 alpha-reductase inhibitor. In the interpretation of a PSA value for a patient taking Tamsulosin-Dutasteride combination, previous PSA values while on Dutasteride treatment should be sought for comparison. Treatment with Tamsulosin-Dutasteride combination does not interfere with the use of PSA as a tool to assist in the diagnosis of prostate cancer after a new baseline has been established. Total serum PSA levels return to baseline within 6 months of discontinuing treatment. The ratio of free to total PSA remains constant even under the influence of Tamsulosin-Dutasteride combination. If clinicians elect to use percent free PSA as an aid in the detection of prostate cancer in men undergoing Tamsulosin-Dutasteride combination therapy, no adjustment to its value appears necessary.<br />\r\n<br />\r\n<strong>Prostate cancer and high grade tumours</strong>: Results of one clinical study in men at increase risk of prostate cancer revealed a higher incidence of Gleason 8-10 prostate cancers in Dutasteride treated men compared to placebo. The relationship between Dutasteride and high grade prostate cancer is not clear. Men taking Tamsulosin-Dutasteride combination should be regularly evaluated for prostate cancer risk including PSA testing.<br />\r\n<br />\r\n<strong>Renal impairment</strong>: The treatment of severely renally impaired patients (creatinine clearance of less than 10 ml/min) should be approached with caution as these patients have not been studied.<br />\r\n<br />\r\n<strong>Hypotension</strong>: Orthostatic- As with other alpha-blockers, a reduction in blood pressure can occur during treatment with Tamsulosin, as a result of which, rarely, syncope can occur. Patients beginning treatment with Tamsulosin-Dutasteride combination should be cautioned to sit or lie down at the first signs of orthostatic hypotension (dizziness, weakness) until the symptoms have resolved. In order to minimize the potential for developing postural hypotension the patient should be haemodynamically stable on alpha-blocker therapy prior to initiating use of PDE5 inhibitors. Symptomatic: Caution is advised when alpha adrenergic blocking agents including Tamsulosin are coadministered with PDE5 inhibitors (e.g. sildenafil, tadalafil, vardenafil). Alpha adrenergic blockers and PDE5 inhibitors are both vasodilators that can lower blood pressure. Concomitant use of these two drug classes can potentially cause symptomatic hypotension.<br />\r\n<br />\r\n<strong>Intraoperative Floppy Iris Syndrome</strong>: Intraoperative Floppy Iris Syndrome (IFIS) has been observed during cataract surgery in some patients on or previously treated with Tamsulosin. IFIS may lead to increased procedural complications during the operation. The initiation of therapy with Tamsulosin-Dutasteride combination in patients for whom cataract surgery is scheduled is therefore not recommended. Discontinuing Tamsulosin 1-2 weeks prior to cataract surgery is anecdotally considered helpful, but the benefit and duration of stopping therapy prior to cataract surgery has not yet been established. Leaking Capsule: Dutasteride is absorbed through the skin, therefore, women, children and adolescents must avoid contact with leaking capsules. If contact is made with leaking capsules, the contact area should be washed immediately with soap and water.<br />\r\n<br />\r\n<strong>Hepatic impairment</strong>: Tamsulosin-Dutasteride combination has not been studied in patients with liver disease. Caution should be used in the administration of Tamsulosin-Dutasteride combination to patients with mild to moderate hepatic impairment.<br />\r\n<br />\r\n<strong>Breast neoplasia</strong>: Breast cancer has been reported in men taking Dutasteride in clinical trials and during the post-marketing period. Physicians should instruct their patients to promptly report any changes in their breast tissue such as lumps or nipple discharge. Currently it is not clear if there is a causal relationship between the occurrence of male breast cancer and long term use of Dutasteride.</p>', '<p>No data are available with regard to over dosage of Tamsulosin-Dutasteride combination. The following statements reflect the information available on the individual components.<br />\r\n<br />\r\n<strong>Dutasteride</strong>: In volunteer studies, single daily doses of Dutasteride up to 40 mg/day (80 times the therapeutic dose) have been administered for 7 days without significant safety concerns. In clinical studies, doses of 5 mg daily have been administered to 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 suspected over dosage symptomatic and supportive treatment should be given as appropriate.<br />\r\n<br />\r\n<strong>Tamsulosin</strong>: Acute overdose with 5 mg Tamsulosin Hydrochloride has been reported. Acute hypotension (systolic blood pressure 70 mm Hg), vomiting and diarrhoea were observed which were treated with fluid replacement and the patient could be discharged the same day. In case of acute hypotension occurring after over dosage cardiovascular support should be given. Blood pressure can be restored and heart rate brought back to normal by lying the patient down. If this does not help then volume expanders, and when necessary, vasopressors could be employed. Renal function should be monitored and general supportive measures applied. Dialysis is unlikely to be of help as Tamsulosin is very highly bound to plasma proteins. Measures, such as emesis, can be taken to impede absorption. When large quantities are involved, gastric lavage can be applied and activated charcoal and an osmotic laxative, such as sodium sulphate, can be administered.</p>', '<p>BPH/ Urinary retention/ Urinary incontinence.</p>', '<p>Store in a cool and dry place, protected from light.</p>', NULL, '2022-03-21 05:00:48', '2022-03-21 05:00:48'),
(1449, 1449, '<p>Tapentadol is indicated for the relief of moderate to severe acute pain in patients 18 years of age or older.</p>', '<p>Tapentadol is a centrally-acting synthetic analgesic. It is 18 times less potent than morphine in terms of binding to human mu-opioid receptors. It also increases norepinephrine concentrations in the brains of rats via inhibition of norepinephrine reuptake. Selective mu-opioid antagonists like naloxone can block analgesia from tapentadol. It also has not effect on the QT interval.<br />\r\n<br />\r\nTapendadol causes large increases in levels of extracellular norepinephrine (NE) due to a dual mechanism of action involving mu opioid receptor (MOR) agonism as well as noradrenaline reuptake inhibition.</p>', '<p>As with many centrally-acting analgesic medications, the dosing regimen should be individualized according to the severity of pain being treated, the previous experience with similar drugs and the ability to monitor the patient.<br />\r\n<br />\r\nThe dose is 50 mg, 75 mg, or 100 mg every 4 to 6 hours depending upon pain intensity. On the first day of dosing, the second dose may be administered as soon as one hour after the first dose, if adequate pain relief is not attained with the first dose. Subsequent dosing is 50 mg, 75 mg, or 100 mg every 4 to 6 hours and should be adjusted to maintain adequate analgesia with acceptable tolerability.<br />\r\n<br />\r\nDaily doses greater than 700 mg on the first day of therapy and 600 mg on subsequent days have not been studied and are not recommended.</p>', '<p>Increased risk of serotonin syndrome with other drugs that enhance monoaminergic neurotransmission (e.g. TCAs, triptans, SSRIs, serotonin and norepinephrine reuptake inhibitors). Enhanced sedative effect with benzodiazepines, barbiturates, antipsychotics, H1-antihistamines and other opioids. Increased potential for addiction with mixed &mu;-opioid agonists/antagonists (e.g. nalbuphine, pentazocine) or partial &mu;-opioid agonists (e.g. buprenorphine). Increased systemic exposure with strong inhibitors of UGT1A6, UGT1A9 and UGT2B7 isoenzymes. Decreased efficacy with strong enzyme inducers (e.g. rifampicin, phenobarbital).</p>', '<p>This drug is contraindicated in patients with impaired Pulmonary Function, It is also contraindicated in patients with acute or severe bronchial asthma or hypercapnia in unmonitored settings or the absence of resuscitative equipment. This drug is contraindicated in any patient who has or is suspected of having paralytic ileus.</p>', '<p>The following treatment-emergent adverse events may happen: heart rate increased, heart rate decreased, visual disturbance, abdominal discomfort, impaired gastric emptying, irritability, edema, drug withdrawal syndrome, hypersensitivity, involuntary muscle contractions, sensation of heaviness, hypoesthesia, paresthesia, disturbance in attention, sedation, dysarthria, memory impairment, ataxia, presyncope, syncope, coordination abnormal, seizure, urticaria, blood pressure decreased etc.</p>', '<p>Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. This preparation should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.<br />\r\n<br />\r\nNeonates whose mothers have been taking Tapentadol should be monitored for respiratory depression.</p>', '<p>Tapentadol should be administered with caution to patients with conditions accompanied by hypoxia, hypercapnia respiratory problems such as: asthma, chronic obstructive pulmonary disease etc. Besides this in case of patient with sleep apnea syndrome, myxedema, kyphoscoliosis, central nervous system (CNS) depression should have to be cautious prior administration of Tapentadol. Patients receiving other mu-opioid agonist analgesics, general anesthetics, phenothiazines, other tranquilizers, sedatives, hypnotics, or other CNS depressants (including alcohol) concomitantly with Tapentadol may exhibit additive CNS depression.</p>', '<p><strong>Symptoms</strong>: Vomiting, miosis, CV collapse, consciousness disorders up to coma, convulsions and resp depression up to resp arrest.<br />\r\n<br />\r\n<strong>Management</strong>: Re-establish a patent airway and institute assisted or controlled ventilation. GI decontamination with activated charcoal or by gastric lavage may be considered within 2 hr after intake. Pure opioid receptor antagonists (e.g. naloxone) may be given as antidote.</p>', '<p>Opioid analgesics</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>Pediatric use:</strong>&nbsp;The safety and effectiveness of Tapentadol in pediatric patients less than 18 years of age have not been established.<br />\r\n<br />\r\n<strong>Use in elderly patients:</strong>&nbsp;In general, recommended dosing for elderly patients with normal renal and hepatic function is the same as for younger adult patients with normal renal and hepatic function. consideration should be given to starting elderly patients with the lower range of recommended doses.<br />\r\n<br />\r\n<strong>Use in Renal Disease:</strong>&nbsp;In patients with severe renal impairment, the safety and effectiveness of Tapentadol has not been established.<br />\r\n<br />\r\n<strong>Use in Hepatic Disease</strong>: Tapentadol should be used with caution in patients with moderate hepatic impairment. Tapentadol has not been studied in patients with severe hepatic impairment.</p>', '2022-03-21 05:02:33', '2022-03-21 05:02:33'),
(1450, 1450, '<p>Tazarotene is used to treat plaque psoriasis of the skin. It also works to treat acne on the face.</p>', '<p>Tazarotene is a retinoid prodrug which is converted to its active form, the cognate carboxylic acid of tazarotene, by rapid deesterification in animals and man. In cell culture and in vitro models of skin, tazarotene suppresses expression of MRP8, a marker of inflammation present in the epidermis of psoriasis patients at high levels. In human keratinocyte cultures, it inhibits cornified envelope formation, whose build-up is an element of the psoriatic scale.</p>', '<p><strong>For psoriasis</strong>: Tazarotene cream should be applied once per day, in the evening, to psoriatic lesions, using enough (2 mg/cm2) to cover only the lesion with a thin film. If a bath or shower is taken prior to application, the skin should be dried before applying the cream. If emollients are used, they should be applied at least one hour before application of Tazarotene cream.<br />\r\n<br />\r\n<strong>For acne</strong>: Cleanse the face gently. After the skin is dry, apply a thin layer (2mg/cm2) of Tazarotene cream 0.1% once per day, in the evening, to the skin areas where acne lesions appear. Use enough to cover the entire affected area.</p>', '<p>Concomitant dermatologic medications and cosmetics that have a strong drying effect should be avoided. It is also advisable to &quot;rest&quot; a patient&rsquo;s skin until the effects of such preparations subside before use of Tazarotene cream is begun. Topical steroid may be hazardous in psoriasis; careful patient supervision is important. Consider if infection spreads. Do not use near a naked flame.</p>', '<p>Retinoids may cause fetal harm when administered to a pregnant woman. Tazarotene cream is contraindicated in women who are or may become pregnant. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, treatment should be discontinued and the patient should be apprised of the potential hazard to the fetus. Women of childbearing potential should be warned to the potential risk and use adequate birth-control measures when Tazarotene cream is used.</p>', '<p>The most frequent adverse events reported with Tazarotene cream were limited to the skin. Those occurring in 10 to 23% of patients, in descending order, included pruritus, erythema and burning. For acne treatment, in 10 to 30% patients, it is reported desquamation, dry skin, face pain, irritation and stinging sensation.</p>', '<p><strong>Pregnancy</strong>: Tazarotene is not recommended during pregnancy. It has been shown to cause serious birth defects and problems in animals. Be sure you have discussed this&nbsp;with your doctor.<br />\r\n<br />\r\n<strong>Nursing Mothers</strong>: It is not known whether tazarotene passes into breast milk. However, Tazarotene is not recommended during breast-feeding because it may cause unwanted effects in nursing babies.</p>', '<p>Tazarotene cream should be applied only to the affected areas. For external use only. Avoid contact with eyes, eyelids and mouth. If contact with eyes occurs, rinse thoroughly with water. Retinoids should not be used on eczematous skin, as they may cause severe irritation. Patients must be warned to use sunscreens and protective clothing when using Tazarotene cream. Some individuals may experience excessive pruritus, burning, skin redness or peeling. If these effects occur, the medication should either be discontinued until the integrity of the skin is restored, or the dosing should be reduced.</p>', '<p>Excessive topical use cause marked redness, peeling or discomfort. Accidental oral ingestion produces similar adverse effects as those associated with excessive oral intake of Vitamin A or other retinoids. Monitor and take supportive measures as necessary.</p>', '<p>Topical retinoid and related preparations.</p>', '<p>Store at 25&deg; C.</p>', '<p><strong>Pediatric Use</strong>: Studies of this medicine have been done only in adult patients, and there is no specific information comparing&nbsp;use&nbsp;of Tazarotene in children up to 12 years of age (gel) and up to 18 years of age (cream) with use in other age groups.<br />\r\n<br />\r\n<strong>Elderly Use (Over 65 year)</strong>: There is no specific information comparing the use of Tazarotene in the elderly with use in other age groups.</p>', '2022-03-21 05:04:19', '2022-03-21 05:04:19'),
(1451, 1451, '<p>This is indicated in bad breath, prevents common cold and flu, kills virus, bacteria &amp; fungus from oral cavity, gum protection, plaque control, enamel protection &amp; to maintain oral hygiene.</p>', NULL, '<p>1-2 sprays into the mouth in the morning and evening. To be dispensed only by or on the prescription of a registered physician.</p>', NULL, '<p>Hypersensitivity of any other ingredient of this preparation.</p>', NULL, NULL, NULL, NULL, '<p>Oral preparations</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-21 05:05:22', '2022-03-21 05:05:22'),
(1452, 1452, '<p>ইহা নিম্নোক্ত উপসর্গে নির্দেশিত-</p>\r\n\r\n<ul>\r\n	<li>চোখের সুরক্ষায়</li>\r\n	<li>চোখ দিয়ে করোনা সংক্রামন প্রতরোধে</li>\r\n	<li>হাত জীবাণুমুক্ত করতে</li>\r\n	<li>চোখের পাতা ও ভ্রূ-এর খুশকী দূরীকরণে</li>\r\n	<li>চোখের শুস্কভাব দূর করতে</li>\r\n	<li>বলিরেখা প্রতিরোধে</li>\r\n	<li>কসমেটিকস পরিস্কার করতে।&nbsp;</li>\r\n</ul>', '<p>সানগ্লাস বা গগলস ব্যবহারের পাশাপাশি রোগজীবানু প্রতিরোধী Tea tree oil ও Geothermal water সমৃদ্ধ Shampoo দিয়ে প্রতিদিন দুইবার করে চোখ পরিস্কার করলে চোখ দিয়ে করোনা ভাইরাসে সংক্রামিত হওয়ার সুযোগ কমে যায় এবং চোখের স্বাস্থ্যও সুরক্ষিত থাকে।</p>', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '<p>Other preparations</p>', '<p>Keep out of reach of children, Store in a dry place, below 25&deg;C temperature and protected from light</p>', NULL, '2022-03-21 05:07:45', '2022-03-21 05:07:45'),
(1453, 1453, '<p>This shampoo is indicated in-</p>\r\n\r\n<ul>\r\n	<li>Dandruff</li>\r\n	<li>Pityriasis versicolor</li>\r\n	<li>Seborrhoeic dermatitis</li>\r\n	<li>Wide spread of bodily fungal acne &amp; bacterial disease.</li>\r\n</ul>', '<p><strong>Tea Tree Oil</strong>: Tea tree oil comes from the leaves of&nbsp;Melaleuca alternifolia, a small tree native to Queensland and New South Wales, Australia. Tea tree oil contains a number of compounds, including terpinen-4-ol that have been shown to kill certain bacteria, viruses and fungi.<br />\r\n<br />\r\n<strong>Geothermal Water</strong>: It is natural hot water and has skin healing benefits.</p>', '<p>Seborrheic Dermatitis: Apply in the hair thrice in a weekend wash properly after 5 minutes.<br />\r\n<br />\r\nBodily Fungal Infection (Eczema, Acne, Bedsores, aging): Apply in infected or lesion area once daily and wash after 5 minutes.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<ul>\r\n	<li>Use a small amount of water to wet the scalp</li>\r\n	<li>Apply the shampoo &amp; massage gently until it forms a lather</li>\r\n	<li>Leave the shampoo on the scalp for 5 minutes</li>\r\n	<li>Rinse the shampoo with sufficient amount of water</li>\r\n</ul>', '<p>Topical treatment with Tea Tree Oil (TTO) enriched with geothermal water is generally well tolerated. As with other shampoos, a local burning sensation, itching or contact dermatitis (due to irritation or allergy) may occur on exposed areas. Oily and dry hair have been reported rarely with the use of Tea Tree Oil (TTO) enriched with geothermal water.</p>', NULL, NULL, '<p>Since Tea Tree Oil (TTO) enriched with geothermal water shampoo is not absorbed through the skin after topical application, pregnancy and lactation are not a contraindication for the use of Tea Tree Oil (TTO) enriched with geothermal water shampoo.</p>', NULL, NULL, '<p>Miscellaneous topical agents.</p>', '<p>Keep out of reach of children, Store in a dry place, below 25&deg;C temperature and protected from light.</p>', NULL, '2022-03-21 05:09:08', '2022-03-21 05:09:08'),
(1454, 1454, '<p>This gel is indicated in-</p>\r\n\r\n<ul>\r\n	<li>Deeply clean acne-prone skin</li>\r\n	<li>Excessive sebum control</li>\r\n	<li>Acne Vulgaris</li>\r\n	<li>Dark Spot</li>\r\n</ul>', NULL, '<p>Twice a day in the morning and evening.</p>', NULL, '<p>Contraindicated in any other ingredient of this preparations.</p>', NULL, NULL, NULL, NULL, '<p>Miscellaneous topical agents.</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-21 05:11:11', '2022-03-21 05:11:11'),
(1455, 1455, '<p>Tedizolid is an oxazolidinone-class antibacterial drug indicated in adults for the treatment of acute bacterial skin and skin structure infections (ABSSSI) caused by designated susceptible bacteria.<br />\r\n<br />\r\nTo reduce the development of drug-resistant bacteria and maintain the effectiveness of Tedizolid and other antibacterial drugs, Tedizolid should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria.</p>', '<p>After conversion to its active form by phosphatases, tedizolid exerts its antibacterial activity through inhibition of protein synthesis by binding to the 50S ribosomal subunit of susceptible Gram-positive bacteria. Cross-resistance between other non-oxazolidinone antibacterial drugs is unlikely as it inhibits bacterial protein synthesis through a different mechanism.</p>', '<p>Acute Bacterial Skin and Skin Structure Infection (ABSSSI):</p>\r\n\r\n<ul>\r\n	<li><strong>Intravenous</strong>: 200 mg Once daily 1 hour (Infusion Time) for&nbsp;6 days</li>\r\n	<li><strong>Oral</strong>: 200 mg Once daily for&nbsp;6 days</li>\r\n</ul>\r\n\r\n<p>No dose adjustment is necessary when changing from intravenous to oral Tedizolid. If patients miss a dose, they should take it as soon as possible anytime up to 8 hours prior to their next scheduled dose. If less than 8 hours remain before the next dose, wait until their next scheduled dose.</p>', '<p>Tedizolid (when administered orally) can increase the plasma concentrations of orally administered Breast Cancer Resistance Protein BCRP substrates. Monitor for adverse reactions related to the concomitant BCRP substrates if coadministration cannot be avoided.</p>', '<p>None</p>', '<p>The most common adverse reactions (&gt;2%) are nausea, headache, diarrhea, vomiting, and dizziness.</p>', '<p><strong>Pregnancy</strong>&nbsp;category C. There are no adequate and well-controlled studies of Tedizolid in pregnant women. Tedizolid should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.<br />\r\n<br />\r\n<strong>Nursing Mothers</strong>: Tedizolid is excreted in the breast milk of rats. It is not known whether tedizolid is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Tedizolid is administered to a nursing woman.</p>', '<p><strong>Patients with neutropenia</strong>: The safety and efficacy of Tedizolid in patients with neutropenia (neutrophil counts &lt;1000 cells/mm3) have not been adequately evaluated. In an animal model of infection, the antibacterial activity of Tedizolid was reduced in the absence of granulocytes. Consider alternative therapies in neutropenic patients.<br />\r\n<br />\r\n<strong>Clostridium difficile-associated diarrhea</strong>: Evaluate if diarrhea occurs.</p>', '<p>In the event of overdosage, Tedizolid should be discontinued and general supportive treatment given. Hemodialysis does not result in meaningful removal of tedizolid from systemic circulation.</p>', '<p>Other antibiotic.</p>', '<p>Tablets and injection should be stored at 20&deg;C to 25&deg;C.</p>', '<p><strong>Pediatric Use</strong>: Safety and effectiveness in pediatric patients below the age of 18 have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Clinical studies of Tedizolid did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. No overall differences in pharmacokinetics were observed between elderly subjects and younger subjects.</p>', '2022-03-21 05:13:17', '2022-03-21 05:13:17'),
(1456, 1456, '<p>Tegaserod is indicated for the symptomatic treatment of irritable bowel syndrome with constipation (IBS-C) in patients whose main symptoms are constipation and abdominal pain or discomfort. The maximum duration of treatment is 12 weeks and treatment should be discontinued if there has been no response after 4 weeks.</p>', '<p>Tegaserod is a serotonin type-4 (5HT4) receptor partial agonist. Tegaserod&nbsp;binds with high affinity at human 5HT4 receptors, present on caudate membranes, whereas it has no appreciable affinity for human recombinant 5HT3 receptors or human recombinant dopamine D2 receptors. In vitro and animal study has revealed that Tegaserod can trigger the peristaltic reflex via 5HT4 receptor activation and thereby enhance basal motor activity and normalize impaired GI motility.</p>', '<p><strong>General recommended dosage for adult:</strong>&nbsp;Tegaserod 6 mg twice daily taken orally with a glass of water 30 minutes before meal. The maximum duration of treatment is 12 weeks and treatment should be discontinued after 4 weeks if no response has occurred.<br />\r\n<br />\r\n<strong>Use in elderly</strong>: Dose adjustment is not necessary when administering Tegaserod to patients over 65 years old.<br />\r\n<br />\r\n<strong>Use in children</strong>: There is no clinical trial in document to safety and efficacy of tegaserod in children. Therefore, it is not recommended for use in children.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>Administration</p>\r\n\r\n<p>Patient should be advised to take Tegaserod (6 mg twice daily) 30 minutes before meal.<br />\r\n<br />\r\nPatient should also be made aware of the possible occurrence of diarrhea during therapy. In most cases, the diarrhea occurred early, is transient, is most often observed as a single episode during the 12 week treatment period, and resolved with continued therapy.<br />\r\n<br />\r\nPatients should be instructed to consult their physician if they experience new or worsening abdominal pain not typical of their IBS symptoms.</p>', '<p>No clinically relevant drug-drug interactions have been observed with dextromethorphan, theophylline, digoxin, oral contraceptives, and warfarin.</p>', '<p>Tegaserod is not recommended in patients with severe renal or hepatic impairment. It is also contraindicated in patients with hypersensitivity to tegaserod or any excipient of this formulation.</p>', '<p>Abdominal pain, diarrhea, nausea, flatulence, headache, fatigue, back pain etc.</p>', '<p><strong>Pregnancy</strong>: In view of limited experience in human, use of Tegaserod during pregnancy is not recommended.<br />\r\n<br />\r\n<strong>Nursing mothers</strong>: Tegaserod should not be prescribed to nursing mothers.</p>', '<p>Diarrhea was reported in some of the patients receiving Tegaserod in the Phase III clinical studies. Caution is required in patients in whom increased diarrhea could have negative effects. Patients who are currently experiencing or frequently experience diarrhea should not initiate therapy with Tegaserod</p>', '<p>Signs and symptoms of overdosage may include diarrhoea, headache, abdominal pain and orthostatic hypotension. As in any case of over dose, general supportive measures should be utilized.</p>', '<p>Drugs for Irritable Bowel Syndrome</p>', '<p>Store at a cool and dry place, protected from light and moisture.</p>', '<p><strong>Renal impairment</strong>: No dosage adjustment is required in patients with mild to moderate renal impairment. Tegaserod is not recommended in patients with severe renal impairment.<br />\r\n<br />\r\n<strong>Hepatic impairment:</strong>&nbsp;No dosage adjustment is required in patients with mild to moderate hepatic impairment, however, caution is recommended when using Tegaserod in this patient population. It has not been studied in patients with severe hepatic impairment, and therefore, it is not recommended in this group.</p>', '2022-03-21 05:16:22', '2022-03-21 05:16:22'),
(1457, 1457, '<p>Teicoplanin injection is indicated for the treatment of serious infections due to staphylococci or streptococci. Following infections are treated more satisfactorily-</p>\r\n\r\n<ul>\r\n	<li>Prevention of infection (usually after surgery)</li>\r\n	<li>Oesteomyelitis</li>\r\n	<li>Septic arthritis</li>\r\n	<li>Septicaemia</li>\r\n	<li>Inflammation of the lining of the heart cavity and heart valves due to endocarditis</li>\r\n	<li>Treatment of serious staphylococcal bacterial infections</li>\r\n	<li>Non-cardiac bacteremia</li>\r\n	<li>Dialysis associated peritonitis</li>\r\n	<li>Severe infections-RTI, UTI, SSTI etc.</li>\r\n</ul>', '<p>Teicoplanin is a glycopeptide antibiotic that has shown in vitro bactericidal activity against both anaerobic and aerobic gram-positive organisms. Teicoplanin inhibits the growth of susceptible organisms by interfering with cell-wall biosynthesis at a site different from that affected by beta-lactams. It is active against staphylococci (including those resistant to methicillin and other beta-lactam antibiotics), streptococci, enterococci, Listeria monocytogenes, micrococci, group JK corynebacteria and gram-positive anaerobes including Clostridium difficile and peptococci.</p>', '<p>Adult or elderly patients with normal renal function:<br />\r\n<br />\r\n<strong>Intravenously</strong>: Intravenous injection may be administered by rapid injection over 3-5 minutes, or slowly over a 30 minutes infusion by diluting with 0.9% Sodium Chloride or Hartmanns Solution or 5% Dextrose etc.<br />\r\n<br />\r\n<strong>Intramascularly</strong>: An intramuscular injection of Teicoplanin should not exceed 3 ml at a single site.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>3 ml water for injection should be added slowly down the side wall of the vial of Teicoplanin&nbsp;200 mg or 400 mg. The vial should be rolled gently between the palms until the powder is completely dissolved. During the rolling, we have to be cautious about the solution that it does not become foamy. The solution must not be shaken. If foam formed then it should be allowed to stand for 15 minutes for the foam to be subsided. The entire contents from the vial should be withdrawn slowly into a syringe.</p>', '<p>Teicoplanin should be administered with caution in patients receiving concurrent nephrotoxic or ototoxic drugs such as Aminoglycosides, Amphotericin B, Cyclosporine and Frusemide.</p>', '<p>Teicoplanin is contraindicated in patients who have exhibited&nbsp;previous&nbsp;hypersensitivity to Teicoplanin.</p>', '<p>Teicoplanin is generally well tolerated. Serious side-effects are rare. Side-effects are gastrointestinal like nausea, vomiting, diarrhea, CNS associated with urticaria, rash, anaphylactic shock as well as hearing problems like vertigo, tinnitus and vestibular disorder may occur.</p>', '<p>There are no adequate and well-controlled studies in pregnant women about administration of Teicoplanin; this drug should be used during pregnancy only if clearly needed. Information about the excretion of Teicoplanin in milk is not known.</p>', '<p>Teicoplanin should be administered with caution in patients with renal insufficiency, patients who require concurrent use of drugs which have ototoxic and/or nephrotoxic properties.</p>', NULL, '<p>Glycopeptide</p>', NULL, '<p><strong>Patients with renal impairment</strong>: For patients with impaired renal function, reduction of dosage is not required until the fourth day of Teicoplanin treatment. From the fourth day of treatment-<br />\r\n<br />\r\n<strong>In mild renal insufficiency</strong>: Teicoplanin dose should be halved either by administering the initial unit dose every two days, or by administering half of this dose once a day when creatinine clearance is 40-60 ml/min.<br />\r\n<br />\r\n<strong>In severe renal insufficiency</strong>: Teicoplanin dose should be 1/3 of the normal either by administering the initial unit dose every third day or by administering 1/3 of this dose once a day when creatinine clearance is less than 40 ml/min and in haemodialysed patients. Teicoplanin is not removed by dialysis.</p>', '2022-03-21 05:18:12', '2022-03-21 05:18:12');
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
(1458, 1458, '<p><strong>Chronic Hepatitis B</strong>: Telbivudine is indicated for the treatment of chronic hepatitis B in adult patients with evidence of viral replication and either evidence of persistent elevations in serum aminotransferases (ALT or AST) or histologically active disease. The following points should be considered when initiating therapy with Telbivudine:<br />\r\n&nbsp;</p>\r\n\r\n<ul>\r\n	<li>This indication is based on virologic, serologic,&nbsp;biochemical&nbsp;and histologic responses in nucleoside treatment na&iuml;ve adult patients with HBeAg positive and HBeAg negative chronic hepatitis B with compensated liver disease&nbsp;</li>\r\n	<li>For HBeAg-positive patients, Telbivudine should only be initiated in patients with HBV DNA less than 9 log10&nbsp;copies per mL and ALT greater than or equal to 2x Upper Limit of Normal (ULN) prior to treatment.</li>\r\n	<li>For HBeAg-negative patients, Telbivudine should only be initiated in patients with HBV DNA less than 7 log10&nbsp;copies per mL prior to treatment.</li>\r\n	<li>On-treatment response should guide continued therapy&nbsp;</li>\r\n	<li>Telbivudine has not been evaluated in patients co-infected with&nbsp;HIV, HCV or&nbsp;HDV.</li>\r\n	<li>Telbivudine has not been evaluated in&nbsp;liver transplant&nbsp;recipients or in patients with decompensated liver disease.</li>\r\n	<li>Telbivudine has not been studied in well-controlled trials for the treatment of patients with established nucleoside analog reverse transcriptase inhibitor-resistant hepatitis B virus infection, but is expected to be cross-resistant to lamivudine.</li>\r\n	<li>The safety and efficacy of Telbivudine have not been evaluated in Black/African American or Hispanic patients</li>\r\n</ul>', '<p>Telbivudine is a synthetic thymidine nucleoside analogue with activity against hepatitis B virus (HBV). Telbivudine is the unmodified &beta;&ndash;L enantiomer of the naturally occurring nucleoside, thymidine. It undergoes phosphorylation via interaction with cellular kinases to form the active metabolite, telbivudine 5&#39;-triphosphate.<br />\r\n<br />\r\nTelbivudine 5&#39;&ndash;triphosphate inhibits HBV DNA polymerase (reverse transcriptase) by competing with the natural substrate, thymidine 5&#39;&ndash;triphosphate. This leads to the chain termination of DNA synthesis, thereby inhibiting viral replication. Incorporation of telbivudine 5&#39;&ndash;triphosphate into viral DNA also causes DNA chain termination, resulting in inhibition of HBV replication. Telbivudine inhibits anticompliment or second-strand DNA.</p>', '<p><strong>Adults and Adolescents (16 years of age and older)</strong>: Due to higher rates of resistance that may develop with longer term treatment among patients with incomplete viral suppression, treatment should only be initiated, if pre-treatment HBV DNA and ALT measurements are known, in the following patient populations-<br />\r\n<br />\r\nFor HBeAg-positive patients, HBV DNA should be less than 9 log10&nbsp;copies per mL and ALT should be greater than or equal to 2x ULN prior to treatment with Telbivudine.<br />\r\n<br />\r\nFor HBeAg-negative patients, HBV DNA should be less than 7 log10&nbsp;copies per mL prior to treatment with Telbivudine.<br />\r\n<br />\r\nHBV DNA levels should be monitored at 24 weeks of treatment to assure complete viral suppression (HBV DNA less than 300 copies per mL). Alternate therapy should be initiated for patients who have detectable HBV DNA after 24 weeks of treatment. Optimal therapy should be guided by further resistance testing.<br />\r\n<br />\r\n<strong>The recommended dose of Telbivudine for the treatment of chronic hepatitis B:</strong>&nbsp;600 mg once daily, taken orally, with or without food. Telbivudine Oral Solution (30 mL) may be considered for patients who have difficulty with swallowing tablets.</p>', '<p>Altered plasma concentration with drugs that affect renal function (e.g. aminoglycosides, loop diuretics, platinum compounds, vancomycin, amphotericin B). May increase risk of myopathy with other drugs associated with myopathy (e.g. azole antifungals, ciclosporin, corticosteroids, erythromycin, fibrates, HMG-CoA reductase inhibitors, penicillamine, zidovudine).</p>', '<p>Hypersensitivity. Combination of Telbivudine with pegylated interferon alfa-2a is contraindicated because of increased risk of&nbsp;peripheral neuropathy.</p>', '<p>Cough, dizziness, fatigue, GI effects (e.g. abdominal pain, diarrhoea, nausea, vomiting, dyspepsia), rash, arthralgia, myalgia, myopathy, malaise, back pain, nasopharyngitis, headache, flu or flu-like symptoms, insomnia; increased serum amylase, lipase, creatine phosphokinase, alanine aminotransferase levels; peripheral neuropathy, rhabdomyolysis.</p>', '<p>Pregnancy Category B. Telbivudine is not&nbsp;teratogenic&nbsp;and has shown no adverse effects in developing embryos and fetuses in preclinical studies. Studies in pregnant rats and rabbits showed that telbivudine crosses the placenta. Developmental toxicity studies revealed no evidence of harm to the fetus in rats and rabbits at doses up to 1000 mg per kg per day, providing exposure levels 6- and 37-times higher, respectively, than those observed with the 600 mg per day dose in humans.<br />\r\n<br />\r\nThere are no adequate and well-controlled trials of Tyzeka in pregnant women. Because animal reproductive toxicity studies are not always predictive of human response, Tyzeka should be used during pregnancy only if potential benefits outweigh the risks.</p>', '<p>Severe acute exacerbations of hepatitis B. Monitor hepatic function in discontinued therapy. Lactic acidosis, severe hepatomegaly with steatosis, myopathy, rhabdomyolysis, uncomplicated myalgia. Discontinue if myopathy is diagnosed. Increased risk of peripheral neuropathy when combined with pegylated interferon &alpha;-2a. Decompensated cirrhosis, renal impairment or on hemodialysis; liver transplant recipients or under immunosuppressant therapy. May impair the ability to drive or operate machinery. Pregnancy. Childn &lt;16 yr. Elderly.</p>', NULL, '<p>Hepatic viral infections (Hepatitis B).</p>', '<p>Store Telbivudine Tablets and Oral Solution in the original bottle at room temperature (15&deg; to 30&deg;C).</p>', NULL, '2022-03-21 05:19:51', '2022-03-21 05:19:51'),
(1459, 1459, '<p>Telmisartan is indicated in-<br />\r\n<br />\r\n<strong>Hypertension</strong>: Treatment of essential hypertension in adults.<br />\r\n<strong>Cardiovascular prevention</strong>: Reduction of cardiovascular morbidity in adults with:</p>\r\n\r\n<ul>\r\n	<li>Atherothrombotic cardiovascular disease (history of coronary heart disease, stroke, or peripheral arterial disease) or</li>\r\n	<li>Type 2 diabetes mellitus with documented target organ damage.</li>\r\n</ul>', '<p>Telmisartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the AT1 receptor in many tissues, such as vascular smooth muscle and the adrenal gland. Its action is therefore independent of the pathways for angiotensin II synthesis. Telmisartan has much greater affinity (&gt;3,000 fold) for the AT1 receptor than for the AT2 receptor. Because telmisartan does not inhibit ACE (kininase II), it does not affect the response to bradykinin. Telmisartan does not bind to or block other hormone receptors or ion channels known to be important in cardiovascular regulation.</p>', '<p>Dosage must be individualized. The usual starting dose of Telmisartan tablets is 40 mg once a day. Blood pressure response is dose-related over the range of 20 to 80 mg. Most of the antihypertensive effect is apparent within 2 weeks and maximal reduction is generally attained after 4 weeks. When additional blood pressure reduction beyond that achieved with 80 mg Telmisartan is required, may switch to the combination. No initial dosage adjustment is necessary for elderly patients or patients with renal impairment, including those on hemodialysis. Patients on dialysis may develop orthostatic hypotension; their blood pressure should be closely monitored. Telmisartan tablets may be administered with other antihypertensive agents. Telmisartan tablets may be administered with or without food. Initial therapy with Telmisartan is not recommended in patients &ge;75 years old or with hepatic impairment.</p>', '<ul>\r\n	<li>NSAIDS: Increased risk of renal impairment and loss of antihypertensive effect.</li>\r\n	<li>Co-administration with aliskiren with Telmisartan: in patients with diabetes should be avoided.</li>\r\n</ul>', '<p>Known hypersensitivity to this product or any of its components.</p>', '<p><strong>In hypertensive patients</strong>: The most common side effects of Telmisartan tablets include sinus pain and congestion (sinusitis), back pain, diarrhea etc.<br />\r\n<br />\r\n<strong>For patients of cardiovascular risk reduction</strong>: The most common side effects of Telmisartan tablets in CV risk reduction include intermittent claudication and skin ulcer.</p>', '<p>Pregnancy Category C (first trimester) and D (second and third trimester). Because of the potential for adverse effects on the nursing infant, decide whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.</p>', '<ul>\r\n	<li>Avoid fetal or neonatal exposure.</li>\r\n	<li>Hypotension.</li>\r\n	<li>Monitor carefully in patients with impaired hepatic or renal function.</li>\r\n	<li>Avoid concomitant use of an ACE inhibitor and angiotensin receptor blocker.</li>\r\n</ul>', '<p>The most likely manifestation of overdosage with Telmisartan tablets would be hypotension, dizziness and tachycardia; bradycardia, increase in serum creatinine and acute renal failure could occur from parasympathetic (vagal) stimulation.</p>', '<p>Angiotensin-ll receptor blocker.</p>', '<p>Do not store above 30&deg;C. Protect from light and high humidity. Keep out of the reach of children.</p>', '<p><strong>Pediatric use</strong>: The safety and effectiveness of Telmisartan in pediatric patients have not been established.<br />\r\n<br />\r\n<strong>Geriatric use</strong>: No overall differences in effectiveness and safety were observed in these patients compared to younger patients.<br />\r\n<br />\r\n<strong>Hepatic impairment</strong>: Monitor carefully and up titrate slowly in patients with biliary obstructive disorders or hepatic insufficiency.</p>', '2022-03-21 05:21:43', '2022-03-21 05:21:43'),
(1460, 1460, '<p>Telmisartan and Hydrochlorothiazide is indicated for the treatment of hypertension, to lower blood pressure. This combination can be used alone or with other antihypertensive agents. Lowering blood pressure reduces the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarctions.</p>', '<p><strong>Telmisartan</strong>: Angiotensin II is formed from angiotensin I in a reaction catalyzed by angiotensin-converting enzyme (ACE, kininase II). Angiotensin II is the principal&nbsp;pressor&nbsp;agent of the renin-angiotensin system, with effects that include&nbsp;vasoconstriction, stimulation of synthesis and release of&nbsp;aldosterone, cardiac stimulation, and renal reabsorption of sodium. Telmisartan blocks the vasoconstrictor and aldosteronesecreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the AT1 receptor in many tissues, such as&nbsp;vascular&nbsp;smooth muscle&nbsp;and the&nbsp;adrenal gland. Its action is therefore independent of the pathways for angiotensin II synthesis.<br />\r\n<br />\r\nThere is also an AT2 receptor found in many tissues, but AT2 is not known to be associated with cardiovascular homeostasis. Telmisartan has much greater affinity (&gt;3,000-fold) for the AT1 receptor than for the AT2 receptor.<br />\r\n<br />\r\nTelmisartan does not inhibit ACE (kininase II) nor does it bind to or block other hormone receptors or ion channels known to be important in cardiovascular regulation.<br />\r\n<br />\r\nBlockade of the angiotensin II receptor inhibits the negative regulatory feedback of angiotensin II on renin secretion, but the resulting increased plasma renin activity and angiotensin II circulating levels do not overcome the effect of telmisartan on blood pressure.<br />\r\n<br />\r\n<strong>Hydrochlorothiazide</strong>: Hydrochlorothiazide is a thiazide diuretic. Thiazides affect the renal tubular mechanisms of&nbsp;electrolyte&nbsp;reabsorption, directly increasing excretion of sodium salt and chloride in approximately equivalent amounts. Indirectly, the diuretic action of hydrochlorothiazide reduces plasma volume, with consequent increases in plasma renin activity, increases in aldosterone secretion, increases in urinary&nbsp;potassium&nbsp;loss, and decreases in serum potassium. The renin-aldosterone link is mediated by angiotensin II, so coadministration of an ARB tends to reverse the potassium loss associated with these&nbsp;diuretics. The mechanism of the antihypertensive effect of thiazides is not fully understood.</p>', '<p>Initiate a patient whose blood pressure is not adequately controlled with-</p>\r\n\r\n<ul>\r\n	<li><strong>Telmisartan monotherapy 80 mg</strong>: Telmisartan and Hydrochlorothiazide 80 mg/12.5 mg once daily. Dose can be titrated up to 160 mg/25 mg after 2 to 4 weeks, if necessary.</li>\r\n	<li><strong>Hydrochlorothiazide 25 mg once daily, or is controlled but who experiences hypokalemia with this regimen</strong>: Telmisartan and Hydrochlorothiazide 80 mg/12.5 mg once daily. Dose can be titrated up to 160 mg/25 mg after 2 to 4 weeks, if necessary.</li>\r\n</ul>\r\n\r\n<p>Telmisartan and Hydrochlorothiazide may be administered with other antihypertensive drugs.</p>', '<p>Caution should be exercised before taking this drug if you are taking aliskiren, digoxin, lithium, other medicines for high blood pressure, NSAIDs (such as aspirin, ibuprofen, naproxen, others), corticosteroids (such as prednisone, hydrocortisone, others), angiotensin-converting enzyme (ACE) blockers (such as benazepril, enalapril, lisinopril) angiotensin II receptor blockers (such as losartan, olmesartan, valsartan). This product may interfere with certain laboratory tests (including parathyroid test, protein-bound iodide test), possibly causing false test results.</p>', '<p>This is contraindicated in patients with known hypersensitivity (e.g., anaphylaxis or angioedema) to Telmisartan, Hydrochlorothiazide or any other component of this product. Do not co-administer Aliskiren with this tablet in patients with Diabetes.</p>', '<p>Common side effects include dizziness, drowsiness, tired feeling, flushing (warmth, redness, or tingly feeling), back pain, nausea, diarrhea, stomach pain. Other adverse events include allergy, fever, leg pain, chest pain, insomnia, somnolence, and dry mouth, elevations of liver enzymes or serum bilirubin, leg cramps, myalgia, dermatitis. Other adverse events that have been reported includes weakness, gastric irritation, photosensitivity, urticaria, muscle spasm, restlessness.</p>', '<p>Pregnancy Category D. Use of drugs that act on the renin-angiotensin&nbsp;system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and&nbsp;neonatal&nbsp;morbidity and death. Resulting&nbsp;oligohydramnios&nbsp;can be associated with fetal lung&nbsp;hypoplasia&nbsp;and skeletal deformations. Potential neonatal adverse effects include skull hypoplasia, anuria,&nbsp;hypotension, renal failure, and death. When pregnancy is detected, discontinue Telmisartan and hydrochlorothiazide as soon as possible.<br />\r\n<br />\r\nNursing Mothers: It is not known whether telmisartan is excreted in human milk, but telmisartan was shown to be present in the milk of lactating rats. Thiazides appear in human milk. Because of the potential for adverse effects on the nursing infant, decide whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.</p>', '<p>Before using this medication, tell your doctor about your medical history, especially of kidney disease, liver disease, bile duct blockage, loss of too much body water and/or minerals (dehydration), untreated mineral imbalance (such as low or high potassium), gout, lupus. If you have diabetes, this medication may affect your blood sugar. Check your blood sugar regularly as directed by your doctor. This product may affect your body potassium levels. Before using potassium supplements or salt substitutes that contain potassium, consult your doctor. This drug may make you dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Report prolonged diarrhea or vomiting to your doctor. Be sure to drink enough fluids to prevent dehydration unless your doctor directs you otherwise.</p>', '<p>The most likely manifestations of overdosage are hypertension, dizziness, tachycardia, bradycardia, hypokalemia, hypochloremia, hyponatremia and dehydration etc. Telmisartan is not removed by hemodialysis and the degree to which hydrochlorothiazide is removed by hemodialysis has not been established.</p>', '<p>Combined antihypertensive preparations.</p>', '<p>Keep out of the reach of children. Keep in a cool and dry place. Protect from light.</p>', '<p><strong>Pediatric Use</strong>: Safety and effectiveness of Telmisartan and Hydrochlorothiazide in pediatric patients have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: In general, 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 diseases or other drug therapy.<br />\r\n<br />\r\n<strong>Use in Patients with Hepatic Impairment</strong>: Patients with biliary obstructive disorders or hepatic insufficiency should initiate treatment under close medical supervision.<br />\r\n<br />\r\n<strong>Use in Patients with Renal Impairment</strong>: Safety and effectiveness of Telmisartan and Hydrochlorothiazide in patients with severe renal impairment (Cr.Cl. &lt;30 ml/min) have not been established. In patients with severe renal impairment, Telmisartan and Hydrochlorothiazide tablets are not recommended. No dose adjustment is required in patients with mild (Cr.Cl. 60 to 90 ml/min) or moderate (Cr.Cl. 30 to 60 ml/min) renal impairment.</p>', '2022-03-21 05:23:35', '2022-03-21 05:23:35'),
(1461, 1461, '<p>Temazepam is indicated for the short-term treatment of insomnia (generally 7 to 10 days). For patients with short-term insomnia, instructions in the prescription should indicate that Temazepam should be used for short periods of time (7 to 10 days). The clinical trials performed in support of efficacy were 2 weeks in duration with the final formal assessment of sleep latency performed at the end of treatment.</p>', '<p>Gamma-Aminobutyric acid (GABA) is considered the principal inhibitory neurotransmitter in the human body. When GABA binds to GABA(a) receptors found in neuron synapses, chloride ions are conducted across neuron cell membranes via an ion channel in the receptors. With enough chloride ions conducted, the local, associated neuron membrane potentials are hyperpolarized - making it more difficult or less likely for action potentials to fire, ultimately resulting in less excitation of the neurons.<br />\r\n<br />\r\nSubsequently, benzodiazepines like temazepam can bind to benzodiazepine receptors that are components of various varieties of GABA(a) receptors. This binding acts to enhance the effects of GABA by increasing GABA affinity for the GABA(a) receptor, which ultimately enhances GABA ligand binding at the receptors. This enhanced ligand binding of the inhibitory neurotransmitter GABA to the receptors increases the aforementioned chloride ion conduction (perhaps reportedly via an increase in the frequency of the chloride channel opening), resulting in a hyperpolarized cell membrane that prevents further excitation of the associated neuron cells. Combined with the notion that such benzodiazepine receptor associated GABA(a) receptors exist both peripherally and in the CNS, this activity consequently facilitates various effects like sedation, hypnosis, skeletal muscle relaxation, anticonvulsant activity, and anxiolytic action</p>', '<p>While the recommended usual adult dose is 15 mg before retiring, 7.5 mg may be sufficient for some patients, and others may need 30 mg. In&nbsp;transient insomnia, a 7.5 mg dose may be sufficient to improve sleep latency. In elderly or debilitated patients, it is recommended that&nbsp;therapy&nbsp;be initiated with 7.5 mg until individual responses are determined.<br />\r\n<br />\r\nPediatric Use: Safety and effectiveness in pediatric patients have not been established.</p>', NULL, '<p>Benzodiazepines may cause fetal harm when administered to a&nbsp;pregnant&nbsp;woman. An increased risk of congenital malformations associated with the use of diazepam and chlordiazepoxide during the first&nbsp;trimester&nbsp;of&nbsp;pregnancy&nbsp;has been suggested in several studies. Transplacental distribution has resulted in&nbsp;neonatal&nbsp;CNS depression following the ingestion of&nbsp;therapeutic&nbsp;doses of a benzodiazepine hypnotic during the last weeks of pregnancy.<br />\r\n<br />\r\nReproduction&nbsp;studies in animals with temazepam were performed in rats and rabbits. In a&nbsp;perinatal-postnatal study in rats, oral doses of 60 mg/kg/day resulted in increasing nursling&nbsp;mortality. Teratology studies in rats demonstrated increased fetal resorptions at doses of 30 and 120 mg/kg in one study and increased occurrence of rudimentary ribs, which are considered&nbsp;skeletal&nbsp;variants, in a second study at doses of 240 mg/kg or higher. In rabbits, occasional abnormalities such as exencephaly and fusion or asymmetry of ribs were reported without dose relationship. Although these abnormalities were not found in the concurrent control group, they have been reported to occur randomly in historical controls. At doses of 40 mg/kg or higher, there was an increased&nbsp;incidence&nbsp;of the 13th&nbsp;rib&nbsp;variant when compared to the incidence in concurrent and historical controls.<br />\r\n<br />\r\nTemazepam is contraindicated in women who are or may become pregnant. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to the&nbsp;fetus. Patients should be instructed to discontinue the drug prior to becoming pregnant. The possibility that a woman of childbearing potential may be pregnant at the time of institution of&nbsp;therapy&nbsp;should be considered.</p>', '<p>The most common side effects of temazepam are:</p>\r\n\r\n<ul>\r\n	<li>drowsiness</li>\r\n	<li>headache</li>\r\n	<li>tiredness</li>\r\n	<li>nervousness</li>\r\n	<li>dizziness</li>\r\n	<li>nausea</li>\r\n</ul>', '<p>Pregnancy Category X. 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 temazepam is administered to a nursing woman.</p>', '<p>Since the risk of the development of oversedation, dizziness, confusion, and/or ataxia increases substantially with larger doses of benzodiazepines in elderly and debilitated patients, 7.5 mg of temazepam is recommended as the initial dosage for such patients. Temazepam should be administered with caution in severely depressed patients or those in whom there is any evidence of latent depression; it should be recognized that suicidal tendencies may be present and protective measures may be necessary. The usual precautions should be observed in patients with impaired renal or hepatic function and in patients with chronic pulmonary insufficiency. If temazepam is to be combined with other drugs having known hypnotic properties or CNS-depressant effects, consideration should be given to potential additive effects. The possibility of a synergistic effect exists with the co-administration of temazepam and diphenhydramine. One case of stillbirth at term has been reported 8 hours after a pregnant patient received temazepam and diphenhydramine. A cause and effect relationship has not yet been determined.</p>', NULL, '<p>Benzodiazepine antagonist, Benzodiazepine hypnotics, Benzodiazepine sedatives.</p>', '<p>Store temazepam at room temperature, 20&deg; to 25&deg;C. Keep temazepam and all medicines out of reach of children.</p>', NULL, '2022-03-21 05:25:02', '2022-03-21 05:25:02'),
(1462, 1462, '<p><strong>Newly Diagnosed Glioblastoma Multiforme</strong>: Temozolomide is indicated for the treatment of adult patients with newly diagnosed glioblastoma multiforme concomitantly with&nbsp;radiotherapy&nbsp;and then as maintenance treatment.<br />\r\n<br />\r\n<strong>Refractory Anaplastic Astrocytoma</strong>: Temozolomide is indicated for the treatment of adult patients with refractory anaplastic astrocytoma, i.e., patients who have experienced disease progression on a drug regimen containing nitrosourea and procarbazine.</p>', '<p>Temozolomide, a triazene, is an inactive prodrug. It is chemically hydrolysed to 3-methyl-(triazen-1-yl) imidazole-4-carboxamide (MTIC), the active metabolite of dacarbazine. The cytotoxicity of MTIC is believed to be due alkylation of DNA, mainly at the O6&nbsp;and N7&nbsp;positions of guanine.</p>', '<p><strong>Newly diagnosed glioblastoma multiforme</strong>: 75 mg/m&lt;sup&gt;2&lt;/sup&gt; for 42 days concomitant with focal radiotherapy followed by initial maintenance dose of 150 mg/m&lt;sup&gt;2&lt;/sup&gt; once daily for Days 1-5 of a 28-day cycle of Temozolomide for 6 cycles<br />\r\n<br />\r\n<strong>Refractory Anaplastic Astrocytoma</strong>: Initial dose 150 mg/m&lt;sup&gt;2&lt;/sup&gt; once daily for 5 consecutive days per 28-day treatment cycle.&nbsp;<br />\r\n<br />\r\nThe recommended dose for Temozolomide as an intravenous infusion over 90 minutes is the same as the dose for the oral capsule formulation. Bioequivalence has been established only when Temozolomide for Injection was given over 90 minutes</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>Should be taken on an empty stomach. Take at least 1 hr before meals.</p>', '<p>Reduced effectiveness of vaccines and generalised infection may occur in patients immunised with live vaccines. Decreased temozolomide clearance with valproic acid.</p>', '<p>Hypersensitivity to dacarbazine. Severe myelosupression. Pregnancy.</p>', '<p>Nausea, vomiting, taste perversion, constipation, diarrhoea, abdominal pain, stomatitis, anorexia, headache, fatigue, convulsions, dizziness, memory impairment, impaired concentration, tremors, blurred vision, hearing impairment, speech disorder, rash, infection, oral candidiasis, dyspnoea, coughing, neutropenia, thrombocytopenia, leucopenia, anaemia, hyperglycemia, decreased wt, insomnia, anxiety, alopecia, muscle weakness, urinary incontinence, increased alanine aminotransferase. Rarely, myelodysplastic syndrome and secondary malignancies.</p>', '<p>Pregnancy Category D. There is positive evidence of human foetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).<br />\r\n<br />\r\n<strong>Nursing Mothers</strong>: It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants and tumorigenicity shown for temozolomide in animal studies, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of Temozolomide&nbsp;to the mother.</p>', '<p>Severe hepatic and renal impairment. Elderly &gt;70 yr, children. Women of child bearing potential should avoid becoming pregnant during therapy. Males should be advised not to father a child up to 6 mth after treatment and to consider cryoconservation of sperms due to possibility of irreversible infertility. Unknown if distributed into breastmilk, discontinue nursing due to potential risk. May impair ability to drive or operate machinery. Swallow capsules whole with a full glass of water on an empty stomach or at bedtime. Do not take a 2nd dose if capsules are vomited. Monitor CBC wkly during concomitant therapy and on day 22 of each 28 day treatment cycle, followed by wkly blood count until recovery. Hepatitis screening and prophylactic therapy with antiviral agents as clinically indicated to be considered. Prophylaxis for Pneumocystis jiroveci (or Pneumocystis carinii) pneumonia (PCP) needed for all patients receiving concomitant temozolomide and radiation therapy for the 42-day regimen; if patients experience lymphocytopenia during the concomitant phase of therapy, PCP prophylaxis should be continued until recovery from lymphocytopenia. Monitor closely for PCP development in all patients. Anti-emetic prophylaxis recommended.</p>', '<p>Doses of 500, 750, 1000, and 1250 mg/m2&nbsp;(total dose per cycle over 5 days) have been evaluated clinically in patients. Dose-limiting toxicity was hematologic and was reported with any dose but is expected to be more severe at higher doses. An overdose of 2000 mg per day for 5 days was taken by one patient and the adverse reactions reported were&nbsp;pancytopenia, pyrexia, multi-organ failure, and death. There are reports of patients who have taken more than 5 days of treatment (up to 64 days), with adverse reactions reported including&nbsp;bone marrow&nbsp;suppression, which in some cases was severe and prolonged, and infections and resulted in death. In the event of an overdose, hematologic evaluation is needed. Supportive measures should be provided as necessary.</p>', '<p>Cytotoxic Chemotherapy.</p>', '<p>Store at 15-30&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>Geriatric Use</strong>: Clinical studies of temozolomide did not include sufficient numbers of subjects aged 65 and over to determine whether they responded differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.<br />\r\n<br />\r\n<strong>Renal Impairment</strong>: Caution should be exercised when temozolomide is administered to patients with severe renal impairment<br />\r\n<br />\r\n<strong>Hepatic Impairment</strong>: Caution should be exercised when temozolomide is administered to patients with severe hepatic impairment</p>', '2022-03-21 05:32:24', '2022-03-21 05:32:24'),
(1463, 1463, '<p>Tenecteplase is indicated for use in the reduction of mortality associated with acute myocardial infarction (AMI). Treatment should be initiated as soon as possible after the onset of acute myocardial infarction symptoms.</p>', '<p>Tenecteplase is a modified form of human tissue plasminogen activator (tPA) that binds to fibrin and converts plasminogen to plasmin. In the presence of fibrin, in vitro studies demonstrate that Tenecteplase conversion of plasminogen to plasmin is increased relative to its conversion in the absence of fibrin. This fibrin specificity decreases systemic activation of plasminogen and the resulting degradation of circulating fibrinogen as compared to a molecule lacking this property. Following administration of 30, 40, or 50 mg of Tenecteplase, there are decreases in circulating fibrinogen (4%-15%) and plasminogen (11%-24%). The clinical significance of fibrinspecificity on safety (e.g., bleeding) or efficacy has not been established. Biological potency is determined by an in vitro clot lysis assay and is expressed in Tenecteplase-specific units. The specific activity of Tenecteplase has been defined as 200 units/mg.</p>', '<p>Tenecteplase is for intravenous administration only. The recommended total dose should not exceed 50 mg and is based upon patient weight. A single bolus dose should be administered over 5 seconds based on patient weight. Treatment should be initiated as soon as possible after the onset of AMI symptoms.</p>\r\n\r\n<ul>\r\n	<li>Patient Weight &lt;60 kg: 30 mg Tenecteplase&nbsp;</li>\r\n	<li>Patient Weight &ge;60 to &lt;70 kg: 35 mg Tenecteplase&nbsp;</li>\r\n	<li>Patient Weight &ge;70 to &lt;80 kg: 40 mg Tenecteplase&nbsp;</li>\r\n	<li>Patient Weight &ge;80 to &lt;90 kg: 45 mg Tenecteplase&nbsp;</li>\r\n	<li>Patient Weight &ge;90 kg: 50 mg Tenecteplase</li>\r\n</ul>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<ol>\r\n	<li>The product should be visually inspected prior to administration for particulate matter and discoloration. Tenecteplase may be administered as reconstituted at 5 mg/mL.</li>\r\n	<li>Precipitation may occur when Tenecteplase is administered in an IV line containing dextrose. Dextrose-containing lines should be flushed with a saline-containing solution prior to and following single bolus administration of Tenecteplase.</li>\r\n	<li>Reconstituted Tenecteplase should be administered as a single IV bolus over 5 seconds.</li>\r\n	<li>Because Tenecteplase contains no antibacterial preservatives, it should be reconstituted immediately before use. If the reconstituted Tenecteplase is not used immediately, refrigerate the Tenecteplase vial at 2-8&deg;C and use within 8 hours.</li>\r\n	<li>Although the supplied syringe is compatible with a conventional needle, this syringe is designed to be used with needleless IV systems. From the information below, follow the instructions applicable to the IV system in use.</li>\r\n</ol>', '<p>Formal interaction studies of Tenectaplase with other drugs have not been performed. Patients studied in clinical trials of Tenecteplase were routinely treated with heparin and aspirin. Anticoagulants (such as heparin and vitamin K antagonists) and drugs that alter platelet function. (such as acetylsalicylic acid, dipyridamole, and GP IIb/IIIa inhibitors) may increase the risk of bleeding if administered prior to, during, or after Tenectaplase therapy.</p>', '<p>Tenecteplase therapy in patients with acute myocardial infarction is contraindicated in the following situations because of an increased risk of bleeding:</p>\r\n\r\n<ul>\r\n	<li>Active internal bleeding</li>\r\n	<li>History of cerebrovascular accident</li>\r\n	<li>Intracranial or intraspinal surgery or trauma within 2 months</li>\r\n	<li>Intracranial neoplasm, arteriovenous malformation, or aneurysm</li>\r\n	<li>Known bleeding diathesis</li>\r\n	<li>Severe uncontrolled hypertension</li>\r\n</ul>', '<p>The most frequent adverse reaction associated with Tenecteplase is bleeding. Should serious bleeding occur, concomitant heparin and antiplatelet therapy should be discontinued. Death or permanent disability can occur in patients who experience stroke or serious bleeding episodes. For Tenecteplase-treated patients in ASSENT-2, the incidence of intracranial hemorrhage was 0.9% and any stroke was 1.8%. The incidence of all strokes, including intracranial bleeding, increases with increasing age.</p>', '<p><strong>Pregnancy</strong>: Tenectaplase has been shown to elicit maternal and embryo toxicity in rabbits given multiple IV administrations. In rabbits administered 0.5, 1.5, and 5.0 mg/kg/day during organogenesis, vaginal hemorrhage resulted in maternal deaths. Subsequent embryonic deaths were secondary to maternal hemorrhage and no fetal anomalies were observed. Tenectaplase does not elicit maternal and embryo toxicity in rabbits following a single IV administration. Thus, in developmental toxicity studies conducted in rabbits, the no observable effect level (NOEL) of a single IV administration of Tenectaplase on maternal or developmental toxicity (5 mg/kg) was approximately 7 times human exposure (based on AUC) at the dose for AMI. There are no adequate and well controlled studies in pregnant women. Tenectaplase should be given to pregnant women only if the potential benefits justify the potential risk to the fetus.<br />\r\n<br />\r\n<strong>Nursing Mothers</strong>: It is not known if Tenectaplase is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Tenectaplase is administered to a nursing woman.</p>', '<p><strong>General</strong>: Standard management of myocardial infarction should be implemented concomitantly with Tenecteplase treatment. Arterial and venous punctures should be minimized. Noncompressible arterial puncture must be avoided and internal jugular and subclavian venous punctures should be avoided to minimize bleeding from the noncompressible sites. In the event of serious bleeding, heparin and antiplatelet agents should be discontinued immediately. Heparin effects can be reversed by protamine.<br />\r\n<br />\r\n<strong>Readministration</strong>: Readministration of plasminogen activators, including Tenecteplase, to patients who have received prior plasminogen activator therapy has not been systematically studied. Three of 487 patients tested for antibody formation to Tenecteplase had a positive antibody titer at 30 days. The data reflect the percentage of patients whose test results were considered positive for antibodies to Tenecteplase in a radioimmunoprecipitation assay, and are highly dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody positivity in an assay may be influenced by several factors including sample handling, concomitant medications, and underlying disease. For these reasons, comparison of the incidence of antibodies to Tenecteplase with the incidence of antibodies to other products may be misleading. Although sustained antibody formation in patients receiving one dose of Tenecteplase has not been documented, readministration should be undertaken with caution.<br />\r\n<br />\r\n<strong>Hypersensitivity</strong>: Hypersensitivity, including urticarial / anaphylactic reactions, have been reported after administration of Tenecteplase (e.g., anaphylaxis, angioedema, laryngeal edema, rash, and urticaria). Monitor patients treated with Tenecteplase during and for several hours after infusion. If symptoms of hypersensitivity occur, appropriate therapy should be initiated.</p>', NULL, '<p>Fibrinolytics (Thrombolytics)</p>', '<p>Store lyophilized Tenecteplase at controlled room temperature not to exceed 30&deg;C or under refrigeration 2-8&deg;C. Do not use beyond the expiration date stamped on the vial.</p>', '<p>Pediatric Use: The safety and effectiveness of Tenecteplase in pediatric patients have not been established.<br />\r\n<br />\r\nIn elderly patients: The benefits of Tenecteplase on mortality should be carefully weighed against the risk of increased adverse events, including bleeding.</p>', '2022-03-21 05:34:19', '2022-03-21 05:34:19'),
(1464, 1464, '<p>Tenofovir Alafenamide is a hepatitis B virus (HBV) nucleoside analog reverse transcriptase inhibitor and is indicated for the treatment of chronic hepatitis B virus infection in adults with compensated liver disease.</p>', '<p>Tenofovir alafenamide is a phosphonamidate&nbsp;prodrug&nbsp;of tenofovir (2&#39;-deoxyadenosine monophosphate analog). Tenofovir alafenamide as a lipophilic cell-permeant compound enters primary hepatocytes by passive diffusion and by the hepatic uptake transporters OATP1B1 and OATP1B3. Tenofovir alafenamide is then converted to tenofovir through hydrolysis primarily by carboxylesterase 1 (CES1) in primary hepatocytes. Intracellular tenofovir is subsequently phosphorylated by cellular kinases to the pharmacologically active metabolite tenofovir diphosphate. Tenofovir diphosphate inhibits&nbsp;HBV&nbsp;replication through incorporation into viral DNA by the HBV reverse transcriptase, which results in DNA chain-termination.<br />\r\n<br />\r\nTenofovir diphosphate is a weak inhibitor of mammalian DNA polymerases that include&nbsp;mitochondrial DNA polymerase &gamma; and there is no evidence of toxicity to&nbsp;mitochondria&nbsp;in cell culture.</p>', '<p><strong>Testing Prior To Initiation Of Tenofovir Alafenamide</strong>: Prior to initiation of Tenofovir Alafenamide, patients should be tested for&nbsp;HIV-1 infection. Tenofovir Alafenamide alone should not be used in patients with HIV infection<br />\r\n<br />\r\nIt is recommended that serum creatinine, serum phosphorous, estimated creatinine clearance, urine glucose, and urine protein be assessed before initiating Tenofovir Alafenamide and during therapy in all patients as clinically appropriate<br />\r\n<br />\r\n<strong>Recommended Dosage In Adults</strong>: The recommended dosage of Tenofovir Alafenamide is 25 mg (one tablet) taken orally once daily with food</p>', '<p>Tenofovir is a substrate of P-glycoprotein (P-gp) and BCRP. Drugs that strongly affect P-gp and BCRP activity may lead to changes in Tenofovir absorption. Consult the full prescribing information prior to and during treatment for potential drug drug interactions.</p>', '<p>None</p>', '<p>The following adverse reactions are discussed in other sections of the labeling:</p>\r\n\r\n<ul>\r\n	<li>Lactic Acidosis/Severe&nbsp;Hepatomegaly&nbsp;with Steatosis&nbsp;</li>\r\n	<li>Severe Acute Exacerbation of&nbsp;Hepatitis B</li>\r\n	<li>New Onset or Worsening of Renal Impairment</li>\r\n</ul>\r\n\r\n<p>The most common side effects are headache, stomach pain, tiredness, cough, nausea, back pain</p>', '<p>Before you take Tenofovir Alafenamide, tell your healthcare provider about all of your medical conditions, including if you are pregnant or plan to become pregnant. It is not known if Tenofovir Alafenamide will harm your unborn baby. Tell your healthcare provider if you become pregnant during treatment with Tenofovir Alafenamide.&nbsp;<br />\r\n<br />\r\nPregnancy Registry:&nbsp;There is a pregnancy registry for women who take antiviral medicines during pregnancy. The purpose of this registry is to collect information about the health of you and your baby. Talk with your healthcare provider about how you can take part in this registry.</p>', NULL, '<p>If overdose occurs, monitor patient for evidence of toxicity. Treatment of overdosage with Tenofovir Alafenamide consists of general supportive measures including monitoring of vital signs as well as observation of the clinical status of the patient. Tenofovir is efficiently removed by&nbsp;hemodialysiswith an extraction coefficient of approximately 54%.</p>', '<p>Hepatic viral infections (Hepatitis B).</p>', '<p>Store below 86&deg;F (30&deg;C). Keep in its original container. Keep the container tightly closed.</p>', '<p><strong>Pediatric Use</strong>: Safety and effectiveness of Tenofovir Alafenamide in pediatric patients less than 18 years of age have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Clinical trials of Tenofovir Alafenamide did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.<br />\r\n<br />\r\n<strong>Renal Impairment</strong>: No dosage adjustment of Tenofovir Alafenamide is required in patients with mild, moderate, or severe renal impairment. Tenofovir Alafenamide is not recommended in patients with end stage renal disease (estimated creatinine clearance below 15 mL per minute)&nbsp;<br />\r\n<br />\r\n<strong>Hepatic Impairment</strong>: No dosage adjustment of Tenofovir Alafenamide is required in patients with mild hepatic impairment (Child-Pugh A). The safety and efficacy of Tenofovir Alafenamide in patients with decompensated cirrhosis (Child-Pugh B or C) have not been established; therefore Tenofovir Alafenamide is not recommended in patients with decompensated (Child-Pugh B or C) hepatic impairment</p>', '2022-03-21 05:36:04', '2022-03-21 05:36:04'),
(1465, 1465, '<p>This is indicated for the treatment of:</p>\r\n\r\n<ul>\r\n	<li>Chronic hepatitis B virus infection in adults</li>\r\n	<li>HIV infected adults in combination with other anti retroviral agents</li>\r\n</ul>', '<p>Tenofovir Disoproxil Fumarate, an acyclic nucleotide analogue of adenosine monophosphate, is a pro-drug of Tenofovir. It shows activity against hepatitis B virus polymerase and HIV reverse transcriptase after phosphorylation to the active diphosphate form. Tenofovir diphosphate inhibits viral polymerase (reverse transcriptase) by directly competing with the natural substrate deoxyribonucleotide and by causing DNA chain termination after its incorporation into viral DNA.</p>', '<p>The recommended dose of Tenofovir in chronic hepatitis B virus infection in adults 18 years of age and older with adequate renal function is 300 mg once daily with or without food.</p>', '<p>Co-administration of Tenofovir with anti-retroviral, entecavir, lamivudine, methadone, oral contraceptives, ribavirin and tacrolimus did not result in significant drug interactions. The effects of co-administration of Tenofovir with other drugs that are renally eliminated or are known to affect renal function have not been evaluated.</p>', '<p>Tenofovir is contraindicated in patients with known hypersensitivity to Tenofovir or any component of the product.</p>', '<p>The most common side effects are nausea, vomiting, diarrhea and flatulence.</p>', '<p><strong>Pregnancy:</strong>&nbsp;Pregnancy category B. It should be used during pregnancy only if clearly needed.<br />\r\n<br />\r\n<strong>Lactation:</strong>&nbsp;It is not known whether it is excreted in human milk. Mothers should be instructed not to breast feed if they are taking Tenofovir.</p>', '<p><strong>Co-administration with other drugs:</strong>&nbsp;Tenofovir should not be administered concurrently with Emtricitabine &amp; Tenofovir combination or Adefovir Dipivoxil.<br />\r\n<br />\r\n<strong>Lactic Acidosis &amp; Severe Hepatomegaly with Steatosis:</strong>&nbsp;Though the risk of occurrence of lactic acidosis is low for Tenofovir, treatment should be suspended in any patient who develops lactic acidosis or hepatotoxicity.<br />\r\n<br />\r\n<strong>Exacerbation of hepatitis after discontinuation of treatment:</strong>&nbsp;Discontinuation of Tenofovir<br />\r\ntherapy may be associated with severe acute exacerbation of hepatitis.</p>', '<p>There is no experience of Tenofovir overdose reported in patients.</p>', '<p>Drugs for HIV / Anti-retroviral drugs, Hepatic viral infections (Hepatitis B).</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>Pediatric use:</strong>&nbsp;Safety and effectiveness of Tenofovir in pediatric patients below the age of 18 years have not been established.<br />\r\n<br />\r\n<strong>Geriatrics use</strong>: Clinical studies of Tenofovir 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>Renal Impairment</strong>: Haemodialysis patients: 300 mg once every 7 days or after a cumulative total of 12 hr of dialysis.</p>\r\n\r\n<ul>\r\n	<li><strong>CrCl (10-29 mL/min)</strong>: 300 mg 72-96 hrly.</li>\r\n	<li><strong>CrCl (30-49 mL/min)</strong>: 300 mg 48 hrly.</li>\r\n</ul>\r\n\r\n<p><strong>Hepatic impairment</strong>: No dose adjustment is required in patients with hepatic impairment.</p>', '2022-03-21 05:37:43', '2022-03-21 05:37:43');
INSERT INTO `generic_details` (`id`, `generic_id`, `indications`, `pharmacology`, `dosage_and_administration`, `interaction`, `contraindications`, `side_effects`, `pregnancy_and_lactation`, `precautions_and_warnings`, `overdose_effects`, `therapeutic_class`, `storage_conditions`, `use_in_special_populations`, `created_at`, `updated_at`) VALUES
(1466, 1466, '<p>Tenoxicam is indicated for the symptomatic treatment of the following painful inflammatory and degenerative disorders of the musculoskeletal system:</p>\r\n\r\n<ul>\r\n	<li>Rheumatoid arthritis.</li>\r\n	<li>Osteoarthritis.</li>\r\n	<li>Arthrosis.</li>\r\n	<li>Ankylosing spondylitis.</li>\r\n	<li>Extra-articular disorders, e.g. tendinitis, bursitis, periarthritis of the shoulders (shoulder-hand syndrome) or hips, strains, and sprains.</li>\r\n	<li>Acute gout.</li>\r\n</ul>', '<p>Tenoxicam is a non-steroidal anti-inflammatory drug (NSAID) with anti-inflammatory, analgesic and antipyretic properties and it also inhibits platelet aggregation. Tenoxicam inhibits prostaglandin biosynthesis. In-vitro tests of leukocyte peroxidase suggest that tenoxicam may act as a scavenger for active oxygen at the site of inflammation. Tenoxicam is a potent in-vitro inhibitor of human metalloproteinases (stromelysin and collagenase), which induce cartilage breakdown. These pharmacological effects explain, at least in part, the therapeutic benefit of Tenoxicam in the treatment of painful inflammatory and degenerative disorders of the musculoskeletal system. Tenoxicam showed no mutagenic, carcinogenic or teratogenic effects in animals. As with other prostaglandin inhibitors, renal and gastrointestinal effects, increased incidence of dystocia and delayed parturition were observed in animal safety studies.</p>', '<p><strong>Standard dosage</strong>: For all indications except acute gout, a daily dosage of 20 mg should be given at the same time of day.<br />\r\n<br />\r\n<strong>In acute attacks of gout</strong>: The recommended dose for acute attacks of gout is 40 mg once daily for two days followed by 20 mg once daily for a further five days.<br />\r\n<br />\r\n<strong>In the treatment of chronic disorders</strong>: The therapeutic effect of tenoxicam is evident early in treatment but there is a progressive increase in response over time. In chronic disorders, daily doses higher than 20 mg should be avoided since this would increase the frequency and intensity of unwanted reactions without significantly increasing efficacy. For patients needing long-term treatment, a reduction to a daily oral dose of 10 mg may be tried for maintenance.<br />\r\n<br />\r\n<strong>Special dosage instructions</strong>: In principle, the above dosage recommendations also apply to elderly patients and to patients suffering from kidney or liver disease. Because of lack of clinical experience, no dosage recommendations have so far been established for children and adolescents.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>The tablets should be taken with a glass of water. It is preferable to take this medicine during or immediately after a meal.</p>', '<p>As in the case of other NSAIDs, salicylate displaces tenoxicam from protein-binding sites and increases clearance and volume of distribution of tenoxicam. Concurrent treatment with salicylate or other NSAIDs should be avoided because of increased risk of gastrointestinal undesirable reactions. The co-administration of some NSAIDs and methotrexate has been associated with reduced renal tubular secretion of methotrexate, higher plasma concentrations of methotrexate, and severe methotrexate toxicity. Therefore, caution should be exercised when Tenoxicam is administered concurrently with methotrexate. No clinically relevant interaction was found in the small number of patients receiving concomitant treatment with gold, penicillamine or probenecid. As Tenoxicam may decrease the renal clearance of lithium, their concomitant administration may lead to increased plasma levels and toxicity of lithium. The plasma levels of lithium should be closely monitored. As with NSAIDs in general, Tenoxicam should not be administered concurrently with K-sparing diuretics. There is a known interaction between these two classes of compounds, which may cause hyperkalemia and renal failure. No clinically significant interaction between Tenoxicam and furosemide was noted, but Tenoxicam attenuates the blood pressure-lowering effect of hydrochlorothiazide. As known from other NSAIDs, Tenoxicam might attenuate the antihypertensive effects of alpha-adrenergic blockers and ACE-inhibitors. No interactions have been reported between NSAIDs and centrally-acting alpha agonists or calcium channel blockers. There was no clinically relevant interaction when Tenoxicam was administered together with atenolol. During clinical trials no interaction was reported for patients treated concomitantly with digitalis products. Thus concurrent dosing of Tenoxicam and digoxin appears to be without major risk. No interaction has been found with concomitantly administered antacids, cimetidine, warfarin and phenprocoumon at the recommended dosages. The clinical effect of oral antidiabetic drugs (glibornuride, glibenclamide, tolbutamide) was likewise not modified by Tenoxicam. Nevertheless, careful monitoring is recommended when patients concomitantly receive anticoagulants or oral antidiabetic drugs. No clinically relevant interaction has been found between Tenoxicam and low molecular weight heparin.</p>', '<p>Tenoxicam must not be administered to patients:</p>\r\n\r\n<ul>\r\n	<li>known to be hypersensitive to the drug;</li>\r\n	<li>in whom salicylates or other non-steroidal anti-inflammatory drugs (NSAIDs) induce symptoms of asthma, rhinitis, or urticaria;</li>\r\n	<li>suffering or having suffered from the disease of the upper gastrointestinal tract, such as gastritis, gastric and duodenal ulcer.</li>\r\n</ul>', '<p>Based on clinical trials including large numbers of patients, Tenoxicam proved to be well tolerated in the recommended dose. Usually, the undesirable effects reported were mild and transient. In a small proportion of patients, the interruption of treatment due to undesirable effects was necessary. Local tolerance of Tenoxicam given parenterally was good. The following undesirable effects have been reported:<br />\r\n<br />\r\nFrequency is greater than 1%-</p>\r\n\r\n<ul>\r\n	<li>Gastrointestinal tract: gastric, epigastric and abdominal discomfort, dyspepsia, heartburn, nausea.</li>\r\n	<li>Central nervous system: dizziness, headache.</li>\r\n</ul>\r\n\r\n<p>Frequency less than 1%-</p>\r\n\r\n<ul>\r\n	<li>Gastrointestinal tract: constipation, diarrhea, stomatitis, gastritis, vomiting, ulcers, Gl-bleeding including hematemesis and melena.</li>\r\n	<li>Central nervous system: fatigue, sleep disturbances, appetite loss, dry mouth, vertigo.</li>\r\n	<li>Skin: itching (also in the anal region after rectal administration), erythema, exanthema, rash, urticaria.</li>\r\n	<li>Urinary tract and kidneys: increase in BUN or creatinine, edema.</li>\r\n	<li>Liver and biliary tract: increased liver enzyme activity.</li>\r\n	<li>Cardiovascular system: palpitations.</li>\r\n</ul>\r\n\r\n<p>Isolated cases (frequency less than 0.01%)-</p>\r\n\r\n<ul>\r\n	<li>Gastrointestinal tract: Gl-perforation.</li>\r\n	<li>Central nervous system: visual disturbances.</li>\r\n	<li>Skin: Stevens-Johnson and Lyell&#39;s syndrome, photosensitivity reaction, vasculitis.</li>\r\n	<li>Blood: anemia, agranulocytosis, leukopenia, thrombocytopenia.</li>\r\n	<li>Hypersensitivity reactions: dyspnea, asthma, anaphylaxis, angioedema.</li>\r\n	<li>Cardiovascular system: elevated blood pressure, mainly in patients treated with cardiovascular drugs.</li>\r\n	<li>Liver/Biliary tract: hepatitis.</li>\r\n</ul>', '<p>NSAIDs have an inhibitory effect on prostaglandin synthesis and, when given during late pregnancy, may cause the closure of the fetal ductus arteriosus, prolong labor and delay parturition. Treatment during the third trimester of pregnancy should be avoided. Based on findings from single-dose administration, a very small amount (approximately 0.2%) of tenoxicam passes into breast milk. There is no evidence of adverse reactions in breast-fed infants of mothers taking Tenoxicam. Nevertheless, infants should be weaned or the drug discontinued.</p>', '<p>NSAIDs inhibit renal prostaglandin synthesis and consequently may have an undesirable effect on renal hemodynamics and on salt and water balance. It is necessary to adequately monitor the patient with a special emphasis on cardiac and renal function (BUN, creatinine, development of edema, weight gain, etc.) when giving Tenoxicam to patients with conditions that could increase their risk of developing renal failure, such as pre-existing renal disease, impaired renal function in diabetics, hepatic cirrhosis, congestive heart failure, volume depletion or concomitant treatment with potentially nephrotoxic drugs, diuretics and corticosteroids. Tenoxicam inhibits platelet aggregation and may affect hemostasis. Tenoxicam has no significant influence on blood coagulation factors, coagulation time, prothrombin time or activated thromboplastin time. Patients having coagulation disorders or receiving drug therapy that interferes with hemostasis should, however, be carefully observed when Tenoxicam is administered. Any patient being treated with Tenoxicam who presents with symptoms of gastrointestinal disease should be closely monitored. If peptic ulceration or gastrointestinal bleeding occurs, Tenoxicam should be immediately withdrawn. If severe skin reactions (e.g. Lyell&#39;s or Stevens-Johnson syndrome) occur, the treatment should be discontinued immediately. Adverse eye findings have been reported with Tenoxicam. Thus ophthalmic evaluation is recommended for patients who develop visual disturbances. Because of the high plasma protein binding of tenoxicam, caution is required when plasma albumin levels are markedly reduced. In common with anti-inflammatory drugs, Tenoxicam may mask the usual signs of infection. Tenoxicam Tablets should not be given to patients who either dislike or do not tolerate milk products.</p>', '<p>Although there is no experience of acute overdosage with Tenoxicam, it may be expected that the signs and symptoms mentioned under Undesirable effects would be more pronounced. Overdose should be countered by conventional measures to reduce absorption (e.g. gastrolavage and charcoal) and speed up elimination (e.g. cholestyramine).</p>', '<p>Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs).</p>', '<p>Do not store above 30&deg;C, protect from light &amp; moisture. Keep out of the reach of children.</p>', '<p>Use in Children &amp; adolescent: Tenoxicam is not recommended for use in patients under 16 years of age, as the dose and indications in this population have not been established.<br />\r\n<br />\r\nEffects on ability to drive and use machines: Patients experiencing adverse events that might affect driving or using machines, such as vertigo, dizziness or visual disturbances should refrain from driving a car or using machines.</p>', '2022-03-21 05:39:55', '2022-03-21 05:39:55'),
(1467, 1467, '<p>Terazosin Hydrochloride is indicated in-</p>\r\n\r\n<ul>\r\n	<li>Single therapy is used to relieve from signs and symptoms of benign prostatic hyperplasia (BPH).</li>\r\n	<li>For the treatment of hypertension.</li>\r\n</ul>', '<p>Terazosin is selective for alpha-1-adrenoceptors but not their individual subtypes. Inhibition of these alpha-1-adrenoceptors results in relaxation of smooth muscle in blood vessels and the prostate, lowering blood pressure and improving urinary flow. Smooth muscle cells accounts for roughly 40% of the volume of the prostate and so their relaxation reduces pressure on the urethra.<br />\r\n<br />\r\nIt has also been shown that catecholamines induce factors responsible for mitogenesis and alpha-1-adrenergic receptor blockers inhibit this effect. A final long term mechanism of terazosin and other alpha-1-adrenergic receptor blockers is the induction of apoptosis of prostate cells. Treatment with terazosin enhances the expression of transforming growth factor beta-1 (TGF-beta1), which upregulates p27kip1, and the caspase cascade.</p>', '<p>Benign Prostatic Hyperplasia-</p>\r\n\r\n<ul>\r\n	<li><strong>Initial dose</strong>: 1 mg at bedtime is starting dose of all patients and this dose should not be exceeded.</li>\r\n	<li><strong>Subsequent dose</strong>: The dose slowly increases to achieve the desired response. The usual recommended dose range is 5-10 mg administered once a day.</li>\r\n</ul>\r\n\r\n<p>Hypertension-</p>\r\n\r\n<ul>\r\n	<li><strong>Initial dose</strong>: 1 mg at bedtime is starting dose of all patients and this dose should not be exceeded.</li>\r\n	<li><strong>Subsequent dose</strong>: The dose slowly increases to achieve the desired response. The usual recommended dose range is 2-10 mg administered once a day.</li>\r\n</ul>', '<ul>\r\n	<li>In patients receiving Terazosin plus ACE inhibitors or diuretics the proportion reporting dizziness or related side effects was greater than in the total population of Terazosin treated patients from clinical trials.</li>\r\n	<li>Terazosin has been given without interaction with analgesics/anti-inflammatory, cardiac glycosides, hypoglycemic, antiarrhythmic, anxiolytics/sedatives, antibacterial, hormones/steroids and drugs used for gout.</li>\r\n</ul>', '<p>Terazosin is contraindicated in patients known to be hypersensitive to Terazosin or its analogues.</p>', '<p>Postural hypotension is more commonly reported side effect. Dizziness, lack of energy, peripheral oedema; urinary frequency and priapism reported.</p>', '<p>The safety of Terazosin during pregnancy has not been established. So Terazosin is not recommended during pregnancy unless the potential benefit justifies the potential risk to mother and fetus. It is not known whether Terazosin is excreted in breast milk. As many drugs are excreted in breast milk, caution should be exercised when Terazosin is administered to a nursing mother.</p>', '<ul>\r\n	<li>First dose may cause hypotension (within 30-90 minutes). Therefore should be taken on retiring to bed.</li>\r\n	<li>Caution should be observed when Terazosin is administered with other antihypertensive agents, avoid the possibility of significant hypotension. When adding Terazosin to a diuretic or other antihypertensive agent, dosage reduction and retitration may be necessary.</li>\r\n	<li>The patients should be cautioned to avoid situation such as driving and hazardous tasks where injury could result due to syncope after initiation of Terazosin therapy.</li>\r\n</ul>', '<p>Acute overdose may lead to acute hypotension, cardiovascular support is of first importance. Restoration of blood pressure and normalization of heart rate may be accomplished by keeping the patient in a supine position. At the same time expansion of plasma volume and noradrenergic vasopressor may also be needed.</p>', '<p>Alpha adrenoceptor blocking drugs, BPH/ Urinary retention/ Urinary incontinence.</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-21 05:41:35', '2022-03-21 05:41:35'),
(1468, 1468, '<p><strong>Terbinafine tablet</strong>: This tablet is indicated for the treatment of onychomycosis of the toenail or fingernail due to dermatophytes (tinea unguium).<br />\r\n<br />\r\n<strong>Terbinafine granules</strong>: This is indicated in Tinea Capitis.<br />\r\n<br />\r\n<strong>Terbinafine cream</strong>: Fungal infection of the skin caused by Trichophyton (e.g. T. rubrum, T. mentagrophytes, T. verrucosum, T. violaceum), Microsporum canis and Epidermophyton floccosum. Yeast infections of the skin, principally those caused by the genus Candida (e.g. C. albicans). Pityriasis (tinea) versicolor due to Pityrosporum orbiculare (also known as Malassezia furfur).</p>', '<p>Terbinafine, an Allylamine antifungal, inhibits biosynthesis of Ergosterol (an essential component of fungai cell membrane) via inhibition of Squalene Epoxidase enzyme. This results in fungal cell death primarily due to the increased membrane permeability mediated by the accumulation of high concentrations of Squalene but not due to Ergosterol deficiency. Depending on the concentration of the drug and the fungal species test in vitro, Terbinafine hydrochloride may be fungicidal. However, the clinical significance of in vitro data is unknown. Terbinafine has been shown to be active against most strains of the following microorganisms both in vitro and in clinical infections: Tricophyton Mentagrophyte, Trichophyton Rubrum.</p>', '<p><strong>Terbinafine tablet</strong>:</p>\r\n\r\n<ul>\r\n	<li>For the treatment of finger nail onychomycosis: Terbinafine 250 mg (one tablet), once daily for 6 weeks.</li>\r\n	<li>For the treatment of toenail onychomycosis: Terbinafine 250 mg (one tablet), once daily for 12 weeks.</li>\r\n	<li>The optimal clinical effect is seen some months after mycological cure and cessation of treatment. This is related to the period required for outgrowth of healthy nail.</li>\r\n</ul>\r\n\r\n<p><strong>Terbinafine granules</strong>:</p>\r\n\r\n<ul>\r\n	<li>Body Weight: &lt;25 kg: 125 mg/day up to 6 weeks</li>\r\n	<li>Body Weight: 25-35 kg: 187.5 mg/day up to 6 weeks</li>\r\n	<li>Body Weight: &gt;35 kg: 250 mg/day up to 6 weeks</li>\r\n</ul>\r\n\r\n<p><strong>Terbinafine cream</strong>: Terbinafine cream can be applied once or twice daily. Cleanse and dry the affected areas thoroughly before application of the terbinafine cream. Apply the cream to the affected skin and the surrounding area in a thin layer and rub in lightly. In the case of intertriginous infections (submammary, interdigital, intergluteal, inguinal) the application may be covered with a gauze strip, especially at night. The likely durations of treatment are as follows:</p>\r\n\r\n<ul>\r\n	<li>Tinea corporis, cruris: 1 to 2 weeks</li>\r\n	<li>Tinea pedis: 1 week</li>\r\n	<li>Cutaneous candidiasis: 2 weeks</li>\r\n	<li>Pityriasis versicolor: 2 weeks</li>\r\n</ul>\r\n\r\n<p>Relief of the clinical symptoms usually occurs within a few days. Irregular use or premature discontinuation of treatment carries the risk of recurrence. If there are no signs of improvement after two weeks, the diagnosis should be verified.</p>', '<p>In vivo studies have shown that terbinafine is an inhibitor of the CYP450 2D6 isozyme. Drugs predominantly metabolized by the CYP450 2D6 isozyme include the following drug classes: tricyclic antidepressants, selective serotonin reuptake inhibitors, beta-blockers, antiarrhythmics class 1C (e.g., flecainide and propafenone) and monoamine oxidase inhibitors Type B. Co-administration of terbinafine should be done with careful monitoring and may require a reduction in dose of the 2D6-metabolized drug.</p>', '<p>Terbinafine tablet and cream are contra-indicated in individuals with hypersensitive to terbinafine.</p>', '<p>The adverse events reported encompass gastrointestinal symptoms (including diarrhea, dyspepsia and abdominal pain), liver test abnormalities, rashes, urticaria, pruritus, and taste disturbances. In general, the adverse events were mild, transient, and did not lead to discontinuation. Adverse events, based on worldwide experience with terbinafine use, include: idiosyncratic and symptomatic hepatic injury and more rarely, cases of liver failure, some leading to death or liver transplant, serious skin reactions, severe neutropenia, thrombocytopenia, angioedema and allergic reactions (including anaphylaxis). Other adverse reactions that have been reported include malaise, fatigue, vomiting, arthralgia, myalgia, and hair loss.</p>', '<p><strong>Terbinafine tablet</strong>: There are no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, and because treatment of onychomycosis can be postponed until after pregnancy is completed, it is recommended that terbinafine not be initiated during pregnancy. After oral administration, terbinafine is present in the breast milk of nursing mothers. Treatment with terbinafine is not recommended in nursing mothers.<br />\r\n<br />\r\n<strong>Terbinafine cream</strong>: Foetal toxicity and fertility studies in animals suggest no adverse effects. There is no clinical experience with terbinafine in pregnant women; therefore, unless the potential benefits outweigh any potential risk, terbinafine should not be administered. Terbinafine is excreted in breast milk and therefore mothers should not receive terbinafine treatment whilst breast-feeding.</p>', '<p><strong>Warnings</strong>-</p>\r\n\r\n<ul>\r\n	<li>Terbinafine tablets: Rare cases of liver failure, some leading to death or liver transplant, have occurred with the use of terbinafine tablets for the treatment of onychomycosis in individuals with and without preexisting liver disease. In the majority of liver cases reported in association with terbinafine use, the patients had serious underlying systemic conditions and an uncertain causal association with terbinafine. The severity of hepatic events and/or their outcome may be worse in patients with active or chronic liver disease. Treatment with terbinafine tablets should be discontinued if there is biochemical or clinical evidence of liver injury. There have been isolated reports of serious skin reaction (e.g., Stevens-Johnson Syndrome and toxic epidermal necrolysis). If progressive skin rash occurs, treatment with terbinafine should be discontinued.</li>\r\n	<li>Terbinafine cream: Terbinafine cream is for external use only. Contact with the eyes should be avoided.</li>\r\n</ul>\r\n\r\n<p><strong>Precautions</strong>: Terbinafine are not recommended for patients with chronic or active liver disease. Before prescribing Terbinafine, pre-existing liver disease should be assessed. Hepatotoxicity may occur in patients with and without pre-existing liver disease. Pretreatment serum transaminase (ALT and AST) teste are advised for all patients before taking terbinafine tablets.</p>', '<p>Clinical experience regarding overdose with terbinafine tablets is limited. Doses up to 5 gm (20 times the therapeutic daily dose) have been taken without inducing serious adverse reactions. The symptoms of overdose included nausea, vomiting, abdominal pain, dizziness, rash, frequent urination, and headache.</p>', '<p>Drugs for subcutaneous and mycoses, Topical Antifungal preparations.</p>', '<p>Store in a cool and dry place, below 30&deg;C, protect from light.</p>', '<p><strong>Pediatric use</strong>: The safety and efficacy of terbinafine have not been established in pediatric patients.<br />\r\n<br />\r\n<strong>Use in the elderly</strong>: There is no evidence to suggest that elderly patients require different dosages or experience side-effects different to those of younger patients.</p>', '2022-03-21 05:43:23', '2022-03-21 05:43:23'),
(1469, 1469, '<p>Terbutaline sulfate is indicated for the prevention and reversal of bronchospasm in patients 12 years of age and older with asthma and reversible bronchospasm associated with bronchitis and emphysema.</p>', '<p>Terbutaline is a relatively selective &beta;2-adrenergic bronchodilator that has little or no effect on alpha-adrenergic receptors. The drug has exerts a preferential effect on &beta;2-adrenergic receptors but stimulates beta-adrenergic receptors less selectively than relatively selective &beta;2-agonists. Terbutaline appears to have a greater stimulating effect on beta-receptors of the bronchial, vascular, and uterine smooth muscles (&beta;2 receptors) than on the beta-receptors of the heart (&beta;1 receptors). This drug relaxes smooth muscle and inhibits uterine contractions, but may also cause some cardiostimulatory effects and CNS stimulation.<br />\r\n<br />\r\nThe pharmacologic effects of terbutaline are at least in part attributable to stimulation through beta-adrenergic receptors of intracellular adenyl cyclase, the enzyme that catalyzes the conversion of adenosine triphosphate (ATP) to cyclic- 3&#39;,5&#39;- adenosine monophosphate (c-AMP). Increased c-AMP levels are associated with relaxation of bronchial smooth muscle and inhibition of release of mediators of immediate hypersensitivity from cells, especially from mast cells.</p>', '<p><strong>Use in bronchospasm</strong>: Terbutaline tablets and syrup have a duration of action of 7 to 8 hours. The minimum recommended dosage interval is therefore 7 hours.<br />\r\n<br />\r\nAdults/Elderly:</p>\r\n\r\n<ul>\r\n	<li><strong>Tablets</strong>:&nbsp;During the first 1-2 weeks 2.5 mg (1 tablet) 3 times in a 24 hour period is recommended. The dose may then be increased to 5 mg (2 tablets) 3 times in 24 hours to achieve adequate bronchodilation.</li>\r\n	<li><strong>Syrup</strong>:&nbsp;The starting dose should be 2&times;5 ml spoonfuls (3 mg) 3 times in 24 hours. The dose may then be increased to 3&times;5 ml spoonfuls (4.5 mg) 3 times in 24 hours if necessary.</li>\r\n</ul>\r\n\r\n<p>Children:&nbsp;</p>\r\n\r\n<ul>\r\n	<li><strong>Tablets</strong>: 7-15 years, the starting dose should normally be 2.5 mg (1 tablet) 2 times in 24 hours. However, in some patients, the dose may need to be increased to 2.5 mg (1 tablet) 3 times in 24 hours.</li>\r\n	<li><strong>Syrup</strong>:&nbsp;0.25 ml (0.075 mg)/kg body weight 3 times in a 24 hour period.</li>\r\n</ul>', '<p>&beta;-blocking agents, especially the non-selective ones such as propranolol may partially or totally inhibit the effect of &beta;-stimulants. Therefore Terbutaline preparations and non-selective &beta;-blockers should not normally be administered concurrently. Terbutaline should be used with caution in patients receiving other sympathomimetics.</p>', '<p>Patients with known hypersensitivity to Terbutaline.</p>', '<p>The frequency of side-effects is low at the recommended doses. Side-effects which have been recorded such as tremor, headache, tonic cramp and palpitations are all characteristic of sympathomimetic amines. A few patients feel tense; this is also due to the effects on skeletal muscle and not to direct CNS stimulation. Whenever these side-effects have occurred the majority have usually been spontaneously reversible within the first week of treatment. Urticaria and exanthema may occur. In children sleep disturbances and disturbances of behavioural effects have been observed. Potentially serious hypokalaemia may result from &beta;2-agonist therapy.</p>', '<p>Although no teratogenic effects have been observed in animals or in patients, Terbutaline should only be administered with caution during the first trimester of pregnancy. Terbutaline is secreted via breast milk, but effect on the infant is unlikely at therapeutic doses.</p>', '<p>Care should be taken with patients suffering from myocardial insufficiency or thyrotoxicosis. Due to the hyperglycaemic effects of &beta;2-stimulants, additional blood glucose measurements are initially recommended when Terbutaline therapy is commenced in diabetic patients. If a previously effective dosage regimen no longer gives the same symptomatic relief the patient should seek further medical advice, for reassessment of asthma therapy, as soon as possible. Potentially serious hypokalaemia may result from &beta;2-agonist therapy. Particular caution is advised in severe asthma as this effect may be potentiated by concomitant treatment with xanthine derivatives, steroids, diuretics and by hypoxia. It is recommended that serum potassium levels are monitored in such situations. Due to the positive inotropic effect of &beta;2-agonists, these drugs should not be used in patients with hypertophic cardiomyopathy.</p>', '<p><strong>Possible symptoms</strong>: Headache, anxiety, tremor, tonic cramp, palpitations,&nbsp;arrhythmia. A fall in blood pressure sometimes occurs.<br />\r\n<br />\r\nTreatment:</p>\r\n\r\n<ul>\r\n	<li><strong>Mild and moderate cases</strong>: Reduce the dose.</li>\r\n	<li><strong>Severe cases</strong>: Gastric lavage, administration of activated charcoal.</li>\r\n</ul>', '<p>Short-acting selective &amp; &beta;2-adrenoceptor stimulants.</p>', '<p>Store in a cool and dry place, protected from light.</p>', NULL, '2022-03-21 05:45:04', '2022-03-21 05:45:04'),
(1470, 1470, '<p>Terconazole Vaginal Cream and Vaginal Suppositories are indicated for the&nbsp;local treatment&nbsp;of vulvovaginal candidiasis (moniliasis). As these products are effective only for vulvovaginitis caused by the genus Candida, the diagnosis should be confirmed by KOH smears and/or cultures.</p>', '<p>Terconazole disrupts ergosterol synthesis by binding to fungal cytochrome P450. It is active in vitro against Candida spp. and other fungi. It has some antibacterial activity in vitro but not against usual vag flora e.g, lactobacilli.</p>', '<p><strong>Terconazole Vaginal Cream 0.4%</strong>: One full applicator (5 g) of 7 Vaginal Cream (20 mg terconazole) should be administered intravaginally once daily at bedtime for seven consecutive days.<br />\r\n<br />\r\n<strong>Terconazole Vaginal Cream 0.8%</strong>: One full applicator (5 g) of Vaginal Cream (40 mg terconazole) should be administered intravaginally once daily at bedtime for three consecutive days.<br />\r\n<br />\r\n<strong>Terconazole Vaginal Suppositories 80 mg</strong>: One Vaginal Suppository (80 mg terconazole) should be administered intravaginally once daily at bedtime for three consecutive days.<br />\r\n<br />\r\nBefore prescribing another course of therapy, the diagnosis should be reconfirmed by smears and/or cultures and other pathogens commonly associated with vulvovaginitis ruled out. The therapeutic effect of these products is not affected by menstruation.</p>', '<p>May decrease absorption of ciprofloxacin, ciclosporin, mycophenolate, tacrolimus and levothyroxine. Sevelamer should be given 3 hr before or 1 hr after taking other drugs to minimise potential pharmacokinetic interaction.</p>', '<p>Patients known to be hypersensitive to terconazole or to any of the components of the cream or suppositories.</p>', '<p>Vulvovaginal burning, vulvar itching, dysmenorrhoea, genital, body and abdominal pain. Flu-like syndrome with headache, fever, chills and hypotension with doses &gt;80 mg.</p>', '<p><strong>Pregnancy</strong>&nbsp;Category C. There was no evidence of teratogenicity when terconazole was administered orally up to 40 mg/kg/day (25x the recommended intravaginal human dose of the suppository formulation, 50x the recommended intravaginal human dose of the 0.8% vaginal cream formulation, and 100x the intravaginal human dose of the 0.4% vaginal cream formulation) in rats, or 20 mg/kg/day in rabbits, or subcutaneously up to 20 mg/kg/day in rats.<br />\r\n<br />\r\n<strong>Nursing Mothers</strong>: It is not known whether this drug is excreted in human milk. Animal studies have shown that rat offspring exposed via the milk of treated (40 mg/kg/orally) dams showed decreased survival during the first few post-partum days, but overall pup weight and weight gain were comparable to or greater than controls throughout lactation. Because many drugs are excreted in human milk, and because of the potential for&nbsp;adverse reaction&nbsp;in nursing infants from terconazole, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.</p>', '<p>Discontinue use and do not retreat with terconazole if sensitization, irritation, fever, chills or flu-like symptoms are reported during use. The base contained in the suppository formulation may interact with certain rubber or latex products, such as those used in vaginal contraceptive diaphragms; therefore concurrent use is not recommended.</p>', '<p>Overdose of terconazole in humans has not been reported to date. In the rat, the oral LD 50 values were found to be 1741 and 849 mg/kg for the male and female, respectively. The oral LD 50 values for the male and female dog were&nbsp;@&nbsp;1280 and &ge; 640 mg/kg, respectively.</p>', '<p>Drugs used in Vaginal and Vulval condition.</p>', '<p>Store at Controlled Room Temperature 15&ndash;30&deg;C</p>', '<p><strong>Pediatric Use</strong>: Safety and efficacy in children have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Clinical studies of terconazole did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients.</p>', '2022-03-21 05:46:49', '2022-03-21 05:46:49'),
(1471, 1471, '<p>Terfenadine is indicated for the treatment of allergic rhinitis, hay fever, and allergic skin disorders.</p>', '<p>Terfenadine competes with histamine for binding at H1-receptor sites in the GI tract, uterus, large blood vessels, and bronchial muscle. This reversible binding of terfenadine to H1-receptors suppresses the formation of edema, flare, and pruritus resulting from histaminic activity. As the drug does not readily cross the blood-brain barrier, CNS depression is minimal.</p>', '<p><strong>Adult (&gt;12 year and &gt;50 kg)</strong>: 60-120 mg in the morning or 60 mg bid. Max: 120 mg daily.<br />\r\n<br />\r\n<strong>Renal Impairment</strong>: CrCl &lt;40: Half the usual daily dose</p>', '<p>Increased risk of ventricular arrhythmia with triazole and imidazole antifungals, macrolide antibacterials, streptogramin antibacterials, SSRI, HIV-protease inhibitors and non-nucleoside reverse transcriptase inhibitors, arrhythmogenic drugs, diuretics, astemizole and zileutron.</p>', '<p>Porphyria.</p>', '<p>Anxiety, palpitations, insomnia, mild GI distubances, erythema multiforme and galactorrhoea.</p>', '<p>Pregnancy 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.</p>', '<p>Child and elderly. Avoid in patients with cardiac or significant hepatic disease, electrolyte imbalance, or known or suspected prolongation of the QT interval. Lactation, pregnancy.</p>', NULL, '<p>Non-sedating antihistamines.</p>', NULL, NULL, '2022-03-21 05:48:17', '2022-03-21 05:48:17'),
(1472, 1472, '<p>Teriparatide is a parathyroid hormone analog, (PTH 1-34), indicated for:</p>\r\n\r\n<ul>\r\n	<li>Treatment of postmenopausal women with osteoporosis at high risk for fracture.</li>\r\n	<li>Increase of bone mass in men with primary or hypogonadal osteoporosis at high risk for fracture.</li>\r\n	<li>Treatment of men and women with osteoporosis associated with sustained systemic glucocorticoid therapy at high risk for fracture.</li>\r\n</ul>', '<p>Endogenous 84-amino acid parathyroid hormone (PTH) is the primary regulator of calcium and phosphate metabolism in bone and kidney. Physiological actions of PTH include regulation of bone metabolism, renal tubular reabsorption of calcium and phosphate, and intestinal calcium absorption. The biological actions of PTH and teriparatide are mediated through binding to specific high-affinity cell-surface receptors. Teriparatide and the 34 N-terminal amino acids of PTH bind to these receptors with the same affinity and have the same physiological actions on bone and kidney. Teriparatide is not expected to accumulate in bone or other tissues. The skeletal effects of teriparatide depend upon the pattern of systemic exposure. Once-daily administration of teriparatide stimulates new bone formation on trabecular and cortical (periosteal and/or endosteal) bone surfaces by preferential stimulation of osteoblastic activity over osteoclastic activity. In monkey studies, teriparatide improved trabecular microarchitecture and increased bone mass and strength by stimulating new bone formation in both cancellous and cortical bone. In humans, the anabolic effects of teriparatide manifest as an increase in skeletal mass, an increase in markers of bone formation and resorption, and an increase in bone strength. By contrast, continuous excess of endogenous PTH, as occurs in hyperparathyroidism, may be detrimental to the skeleton because bone resorption may be stimulated more than bone formation.</p>', '<ul>\r\n	<li>Treatment of Postmenopausal Women with Osteoporosis at High Risk for Fracture: The recommended dose is 20 mcg subcutaneously once a day.</li>\r\n	<li>Increase of Bone Mass in Men with Primary or Hypogonadal Osteoporosis at High Risk for Fracture: The recommended dose is 20 mcg subcutaneously once a day.</li>\r\n	<li>Treatment of Men and Women with Glucocorticoid-Induced Osteoporosis at High Risk for Fracture: The recommended dose is 20 mcg subcutaneously once a day.</li>\r\n</ul>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<ul>\r\n</ul>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>Teriparatide should be administered as a subcutaneous injection into the thigh or abdominal wall. There are no data available on the safety or efficacy of intravenous or intramuscular injection of Teriparatide.</p>\r\n\r\n<ul>\r\n	<li>Teriparatide should be administered initially under circumstances in which the patient can sit or lie down if symptoms of orthostatic hypotension occur</li>\r\n	<li>Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Teriparatide is a clear and colorless liquid. Do not use if solid particles appear or if the solution is cloudy or colored.</li>\r\n	<li>Patients and caregivers who administer Teriparatide should receive appropriate training and instruction on the proper use of the Teriparatide delivery device from a qualified health professional</li>\r\n</ul>', '<p>Digoxin: A single Teriparatide dose did not alter the effect of digoxin on the systolic time interval (from electrocardiographic Q-wave onset to aortic valve closure, a measure of digoxin&rsquo;s calcium-mediated cardiac effect). However, because Teriparatide may transiently increase serum calcium, Teriparatide should be used with caution in patients taking digoxin<br />\r\n<br />\r\nHydrochlorothiazide: The coadministration of hydrochlorothiazide 25 mg with teriparatide did not affect the serum calcium response to teriparatide 40 mcg. The effect of coadministration of a higher dose of hydrochlorothiazide with teriparatide on serum calcium levels has not been studied<br />\r\n<br />\r\nFurosemide: Coadministration of intravenous furosemide (20 to 100 mg) with teriparatide 40 mcg in healthy people and patients with mild, moderate, or severe renal impairment (CrCl 13 to 72 mL/min) resulted in small increases in the serum calcium (2%) and 24-hour urine calcium (37%) responses to teriparatide that did not appear to be clinically important</p>', '<p>Do not use Teriparatide in patients with hypersensitivity to teriparatide or to any of its excipients. Reactions have included angioedema and anaphylaxis.</p>', '<p>Most common adverse reactions include: arthralgia, pain, and nausea.</p>', '<p>There are no available data on Teriparatide use in pregnant women to evaluate for drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. Consider discontinuing Teriparatide when pregnancy is recognized. It is not known whether teriparatide is excreted in human milk, affects human milk production, or has effects on the breastfed infant.</p>', '<ul>\r\n	<li>Patients with Paget&rsquo;s disease of bone, pediatric and young adult patients with open epiphyses, and patients with prior external beam or implant radiation involving the skeleton: Should not be treated with Teriparatide</li>\r\n	<li>Treatment duration: Use of Teriparatide for more than 2 years during a patient&rsquo;s lifetime is not recommended.</li>\r\n	<li>Patients with bone metastases, history of skeletal malignancies, metabolic bone diseases other than osteoporosis, or hypercalcemic disorders: Should not be treated with Teriparatide</li>\r\n	<li>Laboratory alterations: Teriparatide may increase serum calcium, urinary calcium, and serum uric acid</li>\r\n	<li>Urolithiasis: Use with caution in patients with active or recent urolithiasis because of risk of exacerbation</li>\r\n	<li>Orthostatic hypotension: Transient orthostatic hypotension may occur with initial doses of Teriparatide.</li>\r\n</ul>', NULL, '<p>Thyroid drugs &amp; hormone.</p>', '<p>The Teriparatide delivery device should be stored under refrigeration at 2 to 8&deg;C at all times. Do not freeze. Do not use Teriparatide if it has been frozen.</p>', '<ul>\r\n	<li>Pediatric Use: The safety and efficacy of Teriparatide have not been established in any pediatric population.</li>\r\n	<li>Hepatic Impairment: No studies have been performed in patients with hepatic impairment.</li>\r\n</ul>', '2022-03-21 05:50:24', '2022-03-21 05:50:24'),
(1473, 1473, '<p>For use in the short term management of bleeding oesophageal varices. &quot;Emergency treatment of type 1 hepatorenal syndrome, as defined by IAC (International Ascites Club) criteria&quot;.</p>', NULL, '<p><strong>Short term management of bleeding oesophageal varices</strong>: Initially an i.v. injection of 2 mg (2x8.5 ml) terlipressin acetate is given every 4 hours. The treatment should be maintained until bleeding has been controlled for 24 hours, but up to a maximum of 48 hours. After the initial dose, the dose can be adjusted to 1 mg (8.5 ml) terlipressin acetate i.v. every 4 hours in patients with body weight &lt;50 kg or if adverse effects<br />\r\noccur.<br />\r\n<br />\r\n<strong>In type 1 hepatorenal syndrome</strong>: An i.v. injection 3 to 4 mg (3x8.5ml to 4x8.5ml) terlipressin acetate every 24 hours as 3 or 4 administrations. In the absence of any reduction of the serum creatinine after 3 days of treatment, cessation of Terlipressin Acetate treatment is advised. In other cases, Terlipressin Acetate treatment is to be pursued until the obtaining either of a serum creatinine less than 130 &micro;mol/litre or of a drop of at least 30% in the serum creatinine with respect to the value measured at the time of diagnosis of hepatorenal syndrome. The standard average duration of treatment is 10 days.</p>', '<p>The hypotensive effect of non-selective beta-blockers on the portal vein is increased with terlipressin. Concomitant treatment with medicinal products with a known bradycardiac effect (e.g. propofol, sufentanil) may lower the heart rate and cardiac output. These effects are due to reflexofenic inhibition of the cardiac activity via the vagus nerve due to elevated blood pressure. Terlipressin can trigger &quot;torsade de pointes&quot;. Therefore, extreme caution should be exercised in the use of terlipressin in patients with concomitant medications that can prolong the QT interval, such as class IA and III antiarrhythmics, erythromycin, certain antihistamines and tricyclic antidepressants or medications that may cause hypokalaemia or hypomagnesemia (e.g. some diuretics).</p>', '<p>Hypersensitivity to the active substance or to any of the excipients of this preparation. Contraindicated in pregnancy.</p>', '<p>The most frequently reported undesired effects in clinical trials are paleness, increased blood pressure, abdominal pain, nausea, diarrhoea, and headache.</p>', '<p>Treatment with Terlipressin Acetate during pregnancy is contraindicated. Terlipressin Acetate has been shown to cause uterine contractions and increased intrauterine pressure in early pregnancy and may decrease the uterine blood flow. Terlipressin Acetate may have harmful effects on pregnancy and foetus. Spontaneous abortion and malformation of the foetus have been shown in rabbits after treatment with Terlipressin Acetate.<br />\r\n<br />\r\nIt is not known whether Terlipressin Acetate is excreted in human breast milk. The excretion of Terlipressin Acetate in milk has not been studied in animals. A risk to the suckling child cannot be excluded. A decision on whether to continue/discontinue breast-feeding or to continue/discontinue therapy with Terlipressin Acetate should be made taking into account the benefit of breast-feeding to the child and the benefit of Terlipressin Acetate therapy to the woman.</p>', '<p><strong>Cardiac, pulmonary and vascular disease</strong>: During treatment regular monitoring and control of blood pressure, ECG, heart rate, serum levels of sodium and potassium, as well as fluid balance are required. Caution should be exercised in treating patients with hypertension, recognised heart disease, renal dysfunction, cerebral or peripheral vascular disease, asthma or respiratory failure.<br />\r\n<br />\r\n<strong>Septic shock</strong>: In patients with septic shock with a low cardiac output terlipressin should not be used.<br />\r\n<br />\r\n<strong>Injection site reaction</strong>: To avoid local necrosis at the injection site, the injection must be administered intravenously.<br />\r\n<br />\r\n<strong>Torsade de pointes</strong>: During clinical trials and post-marketing experience, several cases of QT interval prolongation and ventricular arrhythmias including &ldquo;Torsade de pointes&rdquo; have been reported. In most cases, patients had predisposing factors such as basal prolongation of the QT interval, electrolyte abnormalities (hypokalemia, hypomagnesemia) or medications with concomitant effect on QT prolongation. Therefore, extreme caution should be exercised in the use of terlipressin in patients with a history of QT interval prolongation, electrolyte abnormalities, or concomitant medications that can prolong the QT interval.<br />\r\n<br />\r\nPrior to use of terlipressin for hepatorenal syndrome, it must be ascertained that the patient has an acute functional renal failure and this functional renal failure does not respond to a suitable plasma expansion therapy.<br />\r\n<br />\r\n<strong>Paediatric population and elderly patients</strong>: Particular caution should be exercised in the treatment of children and elderly patients, as experience is limited in these groups. There is no data available regarding dosage recommendation in these special patient categories.<br />\r\n<br />\r\nExcipients: This medicinal product contains 1.33 mmol (30.7 mg) of sodium per ampoule, equivalent to 1.5% of the WHO recommended maximum daily intake of 2 g sodium for an adult.</p>', '<p>The recommended dose in the specific patient population should not be exceeded as the risk of severe circulatory adverse effects is dose-dependent. Elevated blood pressure in patients with recognised hypertension can be controlled with 150 mcg clonidine i.v. Bradycardia requiring treatment should be treated with atropine.</p>', '<p>Other preparations.</p>', '<p>Store in a refrigerator (2-8&deg;C). Keep the ampoules in the outer carton in order to protect from light.</p>', '<p>Elderly patients: There is no data available regarding dosage recommendation in the elderly.<br />\r\n<br />\r\nPaediatric population: There is no data available regarding dosage recommendation in the paediatric population.</p>', '2022-03-21 05:53:15', '2022-03-21 05:53:15');
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
(1474, 1474, '<p><strong>Males</strong>: Testosterone is indicated for Testosterone replacement therapy for primary and secondary hypogonadal disorders, which include:</p>\r\n\r\n<ul>\r\n	<li>After castration</li>\r\n	<li>Eunuchoidism</li>\r\n	<li>Hypopituitarism</li>\r\n	<li>Endocrine impotence</li>\r\n	<li>Certain types of infertility due to spermatogenic disorders</li>\r\n	<li>Male climacteric symptoms as decreased libido and decreased feeling of general wellbeing and fitness</li>\r\n	<li>Osteoporosis caused by androgen deficiency</li>\r\n</ul>\r\n\r\n<p><strong>Female to male transsexuals</strong>: Testosterone is indicated for masculinization.</p>', '<p>Testosterone is the principal endogenous hormone essential for normal growth and development of the male sex organs and male secondary sex characteristics. During adult life testosterone is essential for the functioning of the testes and accessory structures and for the maintenance of libido, sense of well-being, erectile potency, prostate and seminal vesicle function.<br />\r\n<br />\r\nTreatment of hypogonadal men with Testanon results in a clinically significant rise of plasma concentrations of testosterone, dihydrotestosterone and androstenedione, as well as a decrease of SHBG (sex hormone binding globulin). In males with primary (hypergonadotropic) hypogonadism treatment with Testosterone Decanoate results in a normalization of gonadotropin levels. Treatment of female-to-male transsexuals with Testosterone Decanoate results in a clinically significant rise of plasma testosterone levels, a decrease of LH and FSH levels and a decrease in SHBG level.</p>', '<p>In general, the dose should be adjusted according to the response of the individual patient.<br />\r\n<br />\r\n<strong>Adults</strong>: Usually, one injection of 1 ml per three weeks is adequate. Testosterone should be administered by deep intramuscular injection.<br />\r\n<br />\r\n<strong>Children</strong>: Safety and efficacy have not been adequately determined in children and adolescents.<br />\r\n<br />\r\nTestosterone contains benzyl alcohol and should not be given to children under 3 years of age.</p>', '<p>Enzyme inducing agents may exert increasing or decreasing effects on Testosterone levels. Therefore, adjustment of dose or intervals between injections may be required.</p>', '<p>Testosterone is contraindicated in case of known hypersensitivity to Testosterone or any of its components. It is also contraindicated in patient with known and suspected prostatic carcinoma or breast carcinoma in male.</p>', '<p>The most common side effects of Testosterone therapy are precocious sexual development, increased frequency of erections, phallic enlargement and premature epiphyseal closure, priapism, oligospermia, decreased ejaculatory volume and fluid &amp; sodium retention.</p>', '<p><strong>Pregnancy</strong>: There are no adequate data for the use of Testosterone in pregnant women. In view of the risk of virilization of the foetus, Testosterone should not be used during pregnancy. Treatment with Testosterone should be discontinued when pregnancy occurs.<br />\r\n<br />\r\n<strong>Lactation</strong>: There are no adequate data for the use of Testosterone during lactation. Therefore, Testosterone should not be used during lactation.</p>', '<p>Androgens should be used with caution in pre (pubertal) boys to avoid premature epiphyseal closure or precocious sexual development. Skeletal maturation should be monitored regularly. Patients with latent or overt cardiac failure, renal dysfunction, hypertension, epilepsy or migraine (or a history of these conditions) should be kept under close medical supervision, since aggravation or recurrence may occasionally be induced. Androgens should be used with caution in men suffering from benign prostatic hyperplasia. The use of steroids may influence the results of certain laboratory tests. The misuse of androgens to enhance ability in sports carries serious health risks and is to be discouraged.</p>', '<p>The acute intramuscular toxicity of Testosterone is very low. Priapism in men is a symptom of chronic over dosage. If this occurs, treatment should be interrupted and after disappearance of the symptom, be resumed at a lower dosage.</p>', '<p>Male Sex hormones (Androgens).</p>', '<p>Store in a cool (between 8&ordm; C to 30&ordm; C) and dry place protected from light. Keep out of the reach of children.</p>', NULL, '2022-03-21 05:55:11', '2022-03-21 05:55:11'),
(1475, 1475, '<p>The active substance of this preparation is turned into testosterone by your body. Testosterone is the natural male hormone, necessary for the normal growth, development and function of the male sex organs and for secondary male sex characteristics. Preparations containing Testosterone are usually prescribed to replace the hormone if the body is unable to produce enough on its own. Testosterone are soft oval glossy capsules, transparent, orange-red colour, with an oily fill.</p>', '<p>Testosterone plays a key role in male sexual differentiation and is involved in regulation of hematopoiesis, body composition, and bone metabolism. As a result, testosterone replacement therapy in males with hypogonadism can result in improved sexual function, increased lean body mass, bone density, erythropoiesis, prostate size, and changes in lipid profiles.<br />\r\n<br />\r\nTestosterone is produced by Leydig cells and exerts it&#39;s effects by binding to androgen receptors throughout the body. Testosterone affects the voice, genitalia, mood, and influences muscle growth and protein expression. Accordingly, males with low levels of testosterone often experience decreased libido, fatigue, mood changes and dysphoria. Exogenous sources of testosterone are designed to mimic the effects of endogenous testosterone.</p>', '<p>Usually, the dosage is 3-4 capsules daily during the first 2-3 weeks, followed by a gradual decrease to 1-3 capsules daily. You must take Testosterone with a meal. Swallow the capsules whole without chewing, using some water or other fluid. Take half of the daily dose in the morning and the other half in the evening. If the daily dose is an uneven number of capsules, take the larger number in the morning. If you have the impression that the effect of Testosterone is too strong or too weak, inform your doctor immediately.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>If you forget to take Testosterone, do not take a double dose to make up for the forgotten individual dose. When treatment with Testosterone is stopped, complaints as those before treatment may re-occur within a few weeks.</p>', '<p>Food allows Testosterone Undecanoate to be taken up by your body. Therefore, Testosterone must be taken with a meal. Other medicines may influence the effects of Testosterone or Testosterone may affect other medicines. You must tell your doctor or pharmacist if you are using (or intend to use) rifampicin (an antibiotic) or medicines for epilepsy or sleeplessness.</p>', '<p>Do not take Testosterone</p>\r\n\r\n<ul>\r\n	<li>If you have a tumour of the prostate or the breast.</li>\r\n	<li>If you are hypersensitive (allergic) to Testosterone Undecanoate or any of the other ingredients of Testosterone.</li>\r\n</ul>', '<p>In general:</p>\r\n\r\n<ul>\r\n	<li>increased sexual desire</li>\r\n	<li>fluid retention in the tissues, usually marked by swelling of ankles or feet</li>\r\n</ul>\r\n\r\n<p>In men:</p>\r\n\r\n<ul>\r\n	<li>prolonged abnormal, painful erection of the penis</li>\r\n	<li>disturbed formation of sperm</li>\r\n	<li>decreased amount of sperm with seminal discharge</li>\r\n</ul>\r\n\r\n<p>In elderly men:</p>\r\n\r\n<ul>\r\n	<li>problems with passing urine</li>\r\n</ul>\r\n\r\n<p>In young boys:</p>\r\n\r\n<ul>\r\n	<li>early sexual development</li>\r\n	<li>erections occurring more often than normal</li>\r\n	<li>enlarged penis</li>\r\n	<li>disturbed growth</li>\r\n</ul>\r\n\r\n<p>Tell your doctor as soon as possible if any side-effect becomes troublesome or continues.</p>', NULL, '<p>Extra supervision by a doctor is necessary in the treatment of young boys, since Testosterone suppletion may cause early sexual development and disturb growth. Extra supervision by a doctor is also necessary in the treatment of elderly men, since male hormones may increase the size of the prostate gland. Medical checks may also be necessary for some other conditions.<br />\r\n<br />\r\nTherefore, tell your doctor if you have or have ever had:</p>\r\n\r\n<ul>\r\n	<li>heart disease</li>\r\n	<li>kidney disease</li>\r\n	<li>high blood pressure</li>\r\n	<li>epilepsy</li>\r\n	<li>migraine headaches</li>\r\n	<li>prostatic complaints, such as problems with passing urine.</li>\r\n</ul>', '<p>If you have taken several capsules at once, there is no need for great concern. However, you should consult your doctor. The oily substance in the capsule may cause diarrhoea.</p>', '<p>Male Sex hormones (Androgens).</p>', '<p>Keep Testosterone out of reach and sight of children. Store at 8&deg;C-30&deg;C. Store in the original package in order to protect from light. Do not use Testosterone after the expiry date stated on the package, sachet and blister.</p>', NULL, '2022-03-21 05:57:15', '2022-03-21 05:57:15'),
(1476, 1476, '<p>To provide temporary passive immunity in the prevention and treatment of tetanus.</p>', '<p>This is a sterile clear, faintly yellow or brown liquid of tetanus antitoxin (equine) for human use. It is a preparation containing antitoxic globulins that have the power of specifically neutralizing the toxin formed by Clostridium tetani. It is obtained by fractionation from the serum of horses that have been hyperimmunized against tetanus toxin.</p>', '<p><strong>Prophylaxis of tetanus</strong>: Tetanus Antitoxin (equine) should not be used in the routine treatment of traumatic wounds. It is given prophylactically to persons at the risk of tetanus infection by infected wounds or severe wounds. For prophylaxis after injury, non-immune or partially immune persons may be given 3,000 to 5,000 units of tetanus antitoxin subcutaneously or intramuscularly. If 24 hours have passed since the wound occurred, the dose is 3,000 III. In crush wounds or wounds contaminated with soil or other foreign bodies, the dose is 10,000 to 20,000 III. For persons below 30 kg the dosage is 1,500 IU. Active immunization with Adsorbed Tetanus vaccine should be given simultaneously with the use of this preparation or a booster injection of Adsorbed Tetanus vaccine should be given if the patient has previously been immunized.<br />\r\n<br />\r\n<strong>Treatment</strong>: Therapy should be given as soon as possible after the appearance of symptoms of the disease. Therapeutic dose not less than 3000 IU. Depending on the severity, the dose may vary from 50,000 to 100,000 IU of tetanus antitoxin for hospitalized patients given partially by intravenous route and the rest of the dose intramuscularly.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>The solution should be shaken well before use. Please do not shake vigorously. The solution should be inspected visually for particulate matter and discoloration prior to administration. If either of these conditions exists, the solution should not be administered. The solution should be used as supplied; no dilution is necessary. Once the vial is opened, the preperation must be used immediately.<br />\r\n<br />\r\nCo-administration: Immunosuppressive therapy should be interrupted when immunization is required because of a tetanus-prone wound.</p>', NULL, '<p>Injection of the antitoxin to persons with a history of allergic reactions to equine protein and to allergic individuals is contraindicated.</p>', '<p>Hypersensitive reactions may occur after the injection of any serum of animal origin. In rare cases hypotension, dyspnoea, urticaria may occur. It should be treated with adrenalin, possibly in association with antihistamine and corticosteroid therapy. Serum sickness may occur 7 to 10 days after injection of serum of animal origin; symptoms include fever, vomiting, diarrhoea, bronchospasm and urticaria.</p>', '<p>Tetanus antitoxin (equine) must not be administered during pregnancy.</p>', '<p>If there is no history of previous serum injection or allergic reaction, the dose of serum may be given intramuscularly. If the patient is subject to allergic diseases, a trial dose of 0,2 ml (diluted 1:10 if preferred) of the serum should be given subcutaneously; if no general reaction develops during an interval of 30 minutes, the main dose may be given intramuscularly. The patient must be kept under observation for at least 30 minutes after the injection and adrenaline kept in readiness for emergency use. In all urgent cases, the intravenous route is indicated, but should never be used unless a preliminary intramuscular injection, given at least 30 minutes beforehand, has been tolerated. For intravenous use, the serum should be at room temperature, the injection should be given very slowly, and the patient should be recumbent during the injection, and for at least an hour afterwards.</p>', '<p>Not applicable..</p>', '<p>Vaccines, Anti-sera &amp; Immunoglobulin.</p>', '<p>Keep out of the reach and sight of children. Store at +2&deg;C to +8&deg;C. Transportation should also be at +2&deg;C to +8 &deg;C. Do not freeze. Discard solution if frozen. Protect from light.</p>', NULL, '2022-03-21 05:59:14', '2022-03-21 05:59:14'),
(1477, 1477, '<p>Tetrabenazine is indicated for the treatment of&nbsp;chorea&nbsp;associated with&nbsp;Huntington&#39;s disease.</p>', '<p>Prolongation of the QTc interval has been observed at doses of 50 mg. In rats, it has been observed that tetrabenazine or its metabolites bind to melanin-containing tissues such as the eyes and skin. After a single oral dose of radiolabeled tetrabenazine, radioactivity was still detected in eye and fur at 21 days post dosing.<br />\r\n<br />\r\nTetrabenazine is a reversible human vesicular monoamine transporter type 2 inhibitor (Ki = 100 nM). It acts within the basal ganglia and promotes depletion of monoamine neurotransmitters serotonin, norepinephrine, and dopamine from stores. It also decreases uptake into synaptic vesicles. Dopamine is required for fine motor movement, so the inhibition of its transmission is efficacious for hyperkinetic movement. Tetrabenazine exhibits weak in vitro binding affinity at the dopamine D2 receptor (Ki = 2100 nM).</p>', '<p>General Dosing Considerations:</p>\r\n\r\n<p>The chronic daily dose of Tetrabenazine used to treat chorea associated with Huntington&#39;s disease (HD) is determined individually for each patient. When first prescribed, Tetrabenazine therapy should be titrated slowly over several weeks to identify a dose of XENAXINE that reduces chorea and is tolerated. Tetrabenazine can be administered without regard to food.<br />\r\n&nbsp;</p>\r\n\r\n<p>Individualization Of Dose:</p>\r\n\r\n<p><strong>Dosing Recommendations Up to 50 mg per day</strong>: The starting dose should be 12.5 mg per day given once in the morning. After one week, the dose should be increased to 25 mg per day given as 12.5 mg twice a day. Tetrabenazine should be titrated up slowly at weekly intervals by 12.5 mg daily, to allow the identification of a tolerated dose that reduces chorea. If a dose of 37.5 to 50 mg per day is needed, it should be given in a three times a day regimen. The maximum recommended single dose is 25 mg. If adverse reactions such as&nbsp;akathisia, restlessness,&nbsp;parkinsonism, depression, insomnia, anxiety or sedation occur, titration should be stopped and the dose should be reduced. If the adverse reaction does not resolve, consideration should be given to withdrawing Tetrabenazine treatment or initiating other specific treatment (e.g.,&nbsp;antidepressants).<br />\r\n<br />\r\n<strong>Dosing Recommendations Above 50 mg per day</strong>: Patients who require doses of Tetrabenazine greater than 50 mg per day should be first tested and genotyped to determine if they are poor metabolizers (PMs) or extensive metabolizers (EMs) by their ability to express the drug metabolizing enzyme, CYP2D6. The dose of Tetrabenazine should then be individualized accordingly to their status as PMs or EMs<br />\r\n&nbsp;</p>\r\n\r\n<p>Extensive and Intermediate CYP2D6 Metabolizers:</p>\r\n\r\n<p>Genotyped patients who are identified as extensive (EMs) or intermediate metabolizers (IMs) of CYP2D6, who need doses of Tetrabenazine above 50 mg per day, should be titrated up slowly at weekly intervals by 12.5 mg daily, to allow the identification of a tolerated dose that reduces chorea. Doses above 50 mg per day should be given in a three times a day regimen. The maximum recommended daily dose is 100 mg and the maximum recommended single dose is 37.5 mg. If adverse reactions such as akathisia, parkinsonism, depression, insomnia, anxiety or sedation occur, titration should be stopped and the dose should be reduced. If the adverse reaction does not resolve, consideration should be given to withdrawing Tetrabenazine treatment or initiating other specific treatment (e.g., antidepressants)</p>', '<p>Tetrabenazine should not be given with or within 14 days of discontinuation of MAOI therapy. Blocks action of reserpine. Decreases effects of levodopa and worsen parkinsonism. Increased risk of extrapyramidal side effects when given with amantadine, metoclopramide, antipsychotics.</p>', '<p>Tetrabenazine is contraindicated in patients:</p>\r\n\r\n<ul>\r\n	<li>Who are actively suicidal, or in patients with untreated or inadequately treated depression&nbsp;</li>\r\n	<li>With hepatic impairment&nbsp;</li>\r\n	<li>Taking monoamine oxidase inhibitors (MAOIs). XENAZINE should not be used in combination with an&nbsp;MAOI, or within a minimum of 14 days of discontinuing therapy with an MAOI&nbsp;</li>\r\n</ul>', '<p>The following serious adverse reactions are Depression, Suicidality Akathisia, restlessness, and agitation, Parkinsonism, Dysphagia, Sedation and&nbsp;somnolence.</p>', '<p><strong>Pregnancy</strong>&nbsp;Category C. There are no adequate and well-controlled studies in pregnant women. Tetrabenazine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.<br />\r\n<br />\r\n<strong>Nursing Mothers</strong>: It is not known whether Tetrabenazine or its metabolites are excreted in human milk. Since many drugs are excreted into human milk and because of the potential for serious adverse reactions in nursing infants from Tetrabenazine, a decision should be made whether to discontinue nursing or to discontinue Tetrabenazine, taking into account the importance of the drug to the mother.</p>', '<p>May exacerbate symptoms of parkinsonism. Caution to be exercised when driving or performing skilled tasks. Pregnancy.</p>', '<p>Three episodes of overdose occurred in the open-label trials performed in support of registration. Eight cases of overdose with Tetrabenazine have been reported in the literature. The dose of Tetrabenazine in these patients ranged from 100 mg to 1g. Adverse reactions associated with Tetrabenazine overdose include acute&nbsp;dystonia, oculogyric crisis,&nbsp;nausea and vomiting, sweating, sedation, hypotension, confusion, diarrhea, hallucinations,&nbsp;rubor, and&nbsp;tremor.<br />\r\n<br />\r\nTreatment should consist of those general measures employed in the management of overdosage with any CNS-active drug. General supportive and symptomatic measures are recommended. Cardiac rhythm and vital signs should be monitored. In managing overdosage, the possibility of multiple drug involvement should always be considered. The physician should consider contacting a poison control center on the treatment of any overdose.</p>', '<p>Atypical neuroleptic drugs.</p>', NULL, '<p><strong>Pediatric Use</strong>: The safety and efficacy of Tetrabenazine in pediatric patients have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: The pharmacokinetics of Tetrabenazine and its primary metabolites have not been formally studied in geriatric subjects.<br />\r\n<br />\r\n<strong>Hepatic Impairment</strong>: Because the safety and efficacy of the increased exposure to Tetrabenazine and other circulating metabolites are unknown, it is not possible to adjust the dosage of Tetrabenazine in hepatic impairment to ensure safe use. The use of Tetrabenazine in patients with hepatic impairment is contraindicated.</p>', '2022-03-21 06:01:08', '2022-03-21 06:01:08'),
(1478, 1478, '<p>Tetracycline ointment is indicated as followings-</p>\r\n\r\n<ul>\r\n	<li>Treatment of bacterial conjunctivitis</li>\r\n	<li>Treatment of trachoma (by preference use oral azithromycin for this indication)</li>\r\n	<li>Prevention of chlamydial and gonococcal neonatal conjunctivitis</li>\r\n</ul>', '<p>Tetracycline exhibits its bacteriostatic action by reversibly binding to the 30S subunits of the ribosome, thus preventing protein synthesis and arresting cell growth. It has a broad spectrum of antimicrobial activity including Chlamydiaceae, Mycoplasma spp., Rickettsia spp., spirochaetes, many aerobic and anaerobic gm+ve and gm-ve pathogenic bacteria and some protozoa.</p>', '<p>Wash the eyes with boiled and cooled water before each application. Use sterile sodium chloride 0.9% for newborns. Apply tetracycline 1% into the conjunctival sac of both eyes:</p>\r\n\r\n<ul>\r\n	<li><strong>Conjunctivitis</strong>: one application 2 times daily for 7 days</li>\r\n	<li><strong>Trachoma</strong>: one application 2 times daily&nbsp;for 6 weeks</li>\r\n	<li><strong>Prevention of neonatal conjunctivitis</strong>: one single application immediately after birth</li>\r\n</ul>', '<p>Impaired absorption with antacids containing divalent and trivalent cations (e.g. Al, Ca, Mg), Fe, Zn and Na bicarbonate preparations, kaolin-pectin, bismuth subsalicylate, sucralfate, strontium ranelate, colestipol and colestyramine. May interfere with the bactericidal action of penicillin. May potentiate the effect of anticoagulants. May decrease efficacy of oral contraceptives. Nephrotoxic effects may be exacerbated by diuretics or other nephrotoxic drugs. May increase the hypoglycaemic effect of insulin and sulfonylureas in patients with DM. May increase toxic effects of ergot alkaloids and methotrexate.</p>', '<p>Do not use in patients with hypersensitivity to tetracyclines. May cause allergic reactions; stop treatment in the event of a serious reaction.</p>', '<p>Burning, irritation, visual disturbances, superinfections, photosensitivity, hypersensitivity.</p>', '<p>Pregnancy Category- D. There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.</p>', '<p>Hepatic impairment. Avoid exposure to sunlight. Periodic evaluation of renal, hepatic and haematological system during prolonged therapy.</p>', NULL, '<p>Ophthalmic antibacterial drugs.</p>', '<p>Store below 25&deg;C.&nbsp;Keep out of the reach of children. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. Do not keep outdated medicine or medicine no longer needed.</p>', NULL, '2022-03-21 06:03:00', '2022-03-21 06:03:00'),
(1479, 1479, '<p>Tetracycline is the drug of choice in the following infections :</p>\r\n\r\n<ul>\r\n	<li>Ricketsial infection (Rocky Mountain spotted fever, endemic and scrub typhus fever and human ehrlichiosis).</li>\r\n	<li>Mycoplasma pneumoniae infections in adults. Outbreaks of pneumonia caused by this organism are common in barracks and institutions. Most cases occur in children and young adults. Maculopapular rashes, haemolytic anaemia and meningo-encephalitis occur rarely.</li>\r\n	<li>Chlamydial Infections: Chlamydia psittaci: This organism is the cause of psittacosis (ornithosis), a systemic illness contracted from infected birds. The pneumonia associated with it may be extensive, and severe systemic upset and death are common.Headache is a prominent early symptom.</li>\r\n	<li>Non-gonococcal or non specific urethritis: Inflammation of the urethra not resulting from gonococcal, chlamydial, or other specific infectious agents.</li>\r\n	<li>Lyme disease</li>\r\n	<li>Brucellosis</li>\r\n	<li>Miscellaneous infections, including granuloma inguinale, cholera, glanders, relapsing fever and V. vulnifians.</li>\r\n</ul>\r\n\r\n<p>Other common uses of tetracycline include the following:</p>\r\n\r\n<ul>\r\n	<li>Urinary Tract Infections with susceptible organisms (including the acute urethral syndrome in women).</li>\r\n	<li>Bronchitis in patients with known underlying chronic lung diseases.</li>\r\n	<li>Pelvic inflammatory disease and other sexually transmitted diseases (STDs) regimen.</li>\r\n	<li>Travelers diarrhoea.</li>\r\n	<li>Acne vulgaris</li>\r\n	<li>Prostatitis.</li>\r\n	<li>As an alternative agent in the penicillin allergic patient with syphilis.</li>\r\n	<li>Anaerobic infections with susceptible organisms.</li>\r\n</ul>', '<p>Tetracycline has its main mechanism of action on protein synthesis, and an energy-dependent active transport system pumps the drug through the inner cytoplasmic membrane of bacteria. Once inside the bacterial cell, Tetracycline binds specifically to the 30s ribosomes and inhibit bacterial protein synthesis.<br />\r\n<br />\r\nMany Gram positive aerobic Cocci are susceptible, but many strains of staphylococci, streptococci and even some pneumococci are resistant to Tetracycline. Thus, tetracycline is not the drug of choice in infections due to gram positive aerobes.<br />\r\n<br />\r\nPseudomonas and many Enterobacteriaceae are resistant. Urinary concentrations are adequate for some community - acquired E. coli and consequently, Tetracycline is still used in uncomplicated initial UTIs. Tetracycline is also active against and is the drug of choice for Brucella species, Calymmatobacterium granulomatis, Vibrio cholerae and V. vulnificus.<br />\r\n<br />\r\nTetracycline is also active against anaerobic species of bacteria and since concentrations of the drug are quite high in the gastrointestinal contents, the enteric flora are usually altered by the drug.<br />\r\n<br />\r\nTetracycline&nbsp;is incompletely absorbed from the gastro-intestinal tract, about 60 to 80% of a dose of tetracycline usually being available. It is widely distributed through the body tissues and fluids.<br />\r\n<br />\r\nTetracycline has a half-life of about 12 hours. It is excreted in the urine and in the faeces.</p>', '<p>The usual adult oral dosage of Tetracycline is 1-2 g daily given in 2-4 divided doses. The usual oral dosage of Tetracycline for children older than 8 years of age in 25-50 mg/kg daily given in 2-4 divided doses. Alternatively some clinicians recommended that children should receive 0.6-1.2 g/m2 daily.<br />\r\n<br />\r\nTetracycline should be taken preferably one hour before or 2 hours after meals.<br />\r\n<br />\r\nSome specific indications along with some information on dosage is given below:<br />\r\n<br />\r\n<strong>Acne vulgaris</strong>: 250 mg four times daily or 500 mg 12 hourly for 1 week; 125-250 mg for several weeks or months.&nbsp;Duration of therapy is determined by individual progress<br />\r\n<br />\r\n<strong>Acute&nbsp;staphylococcal infections</strong>: 1-2 g daily in divided&nbsp;doses for 10-14 days<br />\r\n<br />\r\n<strong>Acute streptococcal infections</strong>:&nbsp;1-2 g daily in divided doses for 10 days.&nbsp;Prolonged therapy is needed to avoid risk of rheumatic fever or glomerulonephritis<br />\r\n<br />\r\n<strong>Amoebiasis</strong>:&nbsp;1 g daily in four divided doses or 500 mg 12 hourly for 7 days.&nbsp;Given in association with amoebicidal agents<br />\r\n<br />\r\n<strong>Brucellosis</strong>: 500 mg four times daily plus 1 g streptomycin twice daily for 1 week ; then 500 mg four times daily (no streptomycin) for 1 week.&nbsp;Prolonged therapy is necessary to avoid relapse<br />\r\n<br />\r\n<strong>Subacute bacterial endocarditis</strong>:&nbsp;1-2 g daily in divided doses for 6 weeks.&nbsp;Usually given in combination with a bactericidal agent<br />\r\n<br />\r\n<strong>Syphilis</strong>:&nbsp;Total 30-40 g given in divided doses over 10-15 days.&nbsp;Serology and spinal fluid examination should follow the administration of tetracycline</p>', '<p>Impaired absorption with antacids containing divalent and trivalent cations (e.g. Al, Ca, Mg), Fe, Zn and Na bicarbonate preparations, kaolin-pectin, bismuth subsalicylate, sucralfate, strontium ranelate, colestipol and colestyramine. May interfere with the bactericidal action of penicillin. May potentiate the effect of anticoagulants. May decrease efficacy of oral contraceptives. Nephrotoxic effects may be exacerbated by diuretics or other nephrotoxic drugs. May increase the hypoglycaemic effect of insulin and sulfonylureas in patients with DM. May increase toxic effects of ergot alkaloids and methotrexate.</p>', '<p>Tetracycline Hydrochloride is contraindicated in patients hypersensitive to any of the member of tetracycline groups, since cross-sensitivity may occur Tetracycline Hydrochloride should be avoided in patients with systemic lupus erythematosus. Tetracycline Hydrochloride is considered to be contraindicated in renal impairment, particularly if severe ; if it must be given, doses should be reduced.</p>', '<p><strong>Teeth and bone</strong>: Tetracycline can cause depression of bone growth, permanent graybrown discoloration of the teeth and enamel hypoplasia when given during tooth development (i.e. during the later half of pregnancy, during infancy and in childhood).<br />\r\n<br />\r\nHypersensitivity reactions such as anaphylaxis, urticaria and rashes are uncommon. Photosensitivity reactions consisting of a red rash on areas exposed to intense sunlight can occur with Tetracycline.<br />\r\n<br />\r\n<strong>Gastrointestinal effects</strong>: Epigastric distress and nausea are commonly seen after oral administration, and these symptoms are somewhat dose related. Vomiting can occur.<br />\r\n<br />\r\n<strong>Accentuated prerenal azotemia</strong>: Tetracycline appears to aggravate pre-existing renal failure by inhibiting protein synthesis, which increases the azotemia from amino acid metabolism.<br />\r\n<br />\r\nSuperinfections with oral and anogenital candidiasis are relatively common in patients taking Tetracycline.<br />\r\n<br />\r\n<strong>Esophageal ulcerations</strong>: In most cases, the patients were taking the capsules with little or no fluid before going to bed. To help minimize this, oral doses should be given with adequate amounts of fluid.</p>', '<p>Tetracycline should not be used during pregnancy because of the risk of hypertoxicity in the mother as well as the effects on the developing foetus. Use in pregnancy potentially during breast-feeding and in children up to the age of 8, or some authorise say 12 years, may result in impaired bone growth and permanent discoloration of the child&#39;s teeth.</p>', '<p>Care should be taken if Tetracycline Hydrochloride is given to patients with impaired liver function and high doses should be avoided. Potentiality hepatotoxic drugs (including erythromycin, chloramphenicol, isoniazide and sulphonamides) should not be given concomitantly.</p>', NULL, '<p>Tetracycline group of drugs.</p>', '<p>Store between 20-25&deg; C.</p>', NULL, '2022-03-21 06:04:52', '2022-03-21 06:04:52'),
(1480, 1480, '<p>First aid to help prevent skin infection in minor cuts, scrapes, and burns.</p>', '<p>Tetracycline passively diffuses through porin channels in the bacterial membrane and reversibly binds to the 30S ribosomal subunit, preventing binding of tRNA to the mRNA-ribosome complex, and thus interfering with protein synthesis.</p>', '<p>Clean the affected area. Apply a small amount of this product (an amount equal to the surface area of the tip of a finger) on the area 1 to 3 times daily. May be covered with a sterile bandage.</p>', '<p>Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription medicine.</p>', '<p>Do not use</p>\r\n\r\n<ul>\r\n	<li>in eyes</li>\r\n	<li>over large areas of the body</li>\r\n	<li>longer than 1 week unless directed by doctor</li>\r\n</ul>', '<p>Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.</p>', '<p><strong>Pregnancy</strong>: Studies have not been done in humans. In studies in rats and rabbits, chlortetracycline and tetracycline topical preparations have not been shown to cause birth defects or other problems. However, studies in rabbits have shown meclocycline to cause a slight delay in bone formation.<br />\r\n<br />\r\n<strong>Breast feeding</strong>: It is not known whether tetracycline topical preparations pass into breast milk. Although most medicines pass into breast milk in small amounts, many of them may be used safely while breast-feeding. Mothers who are using any of these medicines and who wish to breast-feed should discuss this with their doctor.</p>', '<p>May be harmful is swallowed. Do not use if allergic to any ingredient listed on this label.</p>', NULL, '<p>Topical Antibiotic preparations.</p>', '<p>Keep our of reach of children. If swallowed, get medical help or contact a Poison control Center right away. Keep product refrigerated to preserve its effectiveness and color.</p>', '<p><strong>Pediatric</strong>: Tetracycline topical solution has been tested on a limited number of children 11 years of age or older and has not been shown to cause different side effects or problems in children than it does in adults. Although there is no specific information about the use of topical chlortetracycline or topical meclocycline in children, they are not expected to cause different side effects or problems in children than they do in adults.<br />\r\n<br />\r\n<strong>Geriatric</strong>: Many medicines have not been tested in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information about the use of topical tetracyclines in the elderly.</p>', '2022-03-21 06:06:34', '2022-03-21 06:06:34'),
(1481, 1481, '<p><strong>Multiple Myeloma</strong>: Thalidomide in combination with&nbsp;dexamethasone&nbsp;is indicated for the treatment of patients with newly diagnosed&nbsp;multiple myeloma&nbsp;(MM).<br />\r\n<br />\r\n<strong>Erythema Nodosum Leprosum</strong>: Thalidomide is indicated for the acute treatment of the cutaneous manifestations of moderate to severe&nbsp;erythema&nbsp;nodosum leprosum (ENL). Thalidomide is not indicated as monotherapy for such ENL treatment in the presence of moderate to severe neuritis. Thalidomide is also indicated as&nbsp;maintenance therapy&nbsp;for prevention and suppression of the cutaneous manifestations of ENL recurrence</p>', '<p>Thalidomide is a synthetic glutamic acid derivative immunomodulator with anti-inflammatory, antiangiogenetic, sedative and hypnotic activity.<br />\r\n<br />\r\nIn patients with erythema nodosum leprosum (ENL) the mechanism of action is not fully understood. Available data from in vitro studies and preliminary clinical trials suggest that the immunologic effects of this compound can vary substantially under different conditions, but may be related to suppression of excessive tumor necrosis factor-alpha (TNF-a) production and down-modulation of selected cell surface adhesion molecules involved in leukocyte migration. For example, administration of thalidomide has been reported to decrease circulating levels of TNF-a in patients with ENL, however, it has also been shown to increase plasma TNF-a levels in HIV-seropositive patients. As a cancer treatment, the drug may act as a VEGF inhibitor.</p>', '<p><strong>Multiple Myeloma</strong>: Thalidomide is administered in combination with dexamethasone in 28-day treatment cycles. The dose of Thalidomide is 200 mg administered orally once daily with water, preferably at bedtime and at least 1 hour after the evening meal. The dose of dexamethasone is 40 mg daily administered orally on days 1-4, 9-12, and 17-20 every 28 days.<br />\r\n<br />\r\nPatients who develop adverse reactions such as constipation,&nbsp;somnolence, or&nbsp;peripheral neuropathy&nbsp;may benefit by either temporarily discontinuing the drug or continuing at a lower dose. With the&nbsp;abatement&nbsp;of these adverse reactions, the drug may be started at a lower dose or at the previous dose based on clinical judgment.<br />\r\n<br />\r\n<strong>Erythema Nodosum Leprosum</strong>: For an episode of cutaneous ENL, Thalidomide dosing should be initiated at 100 to 300 mg/day, administered once daily with water, preferably at bedtime and at least 1 hour after the evening meal. Patients weighing less than 50 kilograms should be started at the low end of the dose range.<br />\r\n<br />\r\nIn patients with a severe cutaneous ENL reaction, or in those who have previously required higher doses to control the reaction, Thalidomide dosing may be initiated at higher doses up to 400 mg/day once daily at bedtime or in divided doses with water, at least 1 hour after meals.<br />\r\n<br />\r\nIn patients with moderate to severe neuritis associated with a severe ENL reaction, corticosteroids may be started concomitantly with Thalidomide.&nbsp;Steroid&nbsp;usage can be tapered and discontinued when the neuritis has ameliorated.<br />\r\n<br />\r\nDosing with Thalidomide should usually continue until signs and symptoms of active reaction have subsided, usually a period of at least 2 weeks. Patients may then be tapered off medication in 50 mg decrements every 2 to 4 weeks.<br />\r\n<br />\r\nPatients who have a documented history of requiring prolonged maintenance treatment to prevent the recurrence of cutaneous ENL or who flare during tapering should be maintained on the minimum dose necessary to control the reaction. Tapering off medication should be attempted every 3 to 6 months, in decrements of 50 mg every 2 to 4 weeks.</p>', '<p>Thalidomide enhances sedative activity of barbiturates, alcohol, chlorpromazine and reserpine. Avoid use of other drugs that have the potential to cause peripheral neuropathy. Increased risk of thromboembolic events with darbepoetin-alfa and doxorubicin.</p>', '<p>Pregnancy and lactation.</p>', '<p>Severe and irreversible peripheral neuropathy, constipation, dizziness, orthostatic hypotension, drowsiness, somnolence, bradycardia, increase of viral load in HIV-infected patients, hypersensitivity reaction.</p>', '<p>Pregnancy Category X. Studies in animals or human beings have demonstrated foetal abnormalities or there is evidence of foetal risk based on human experience or both, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit. The drug is contraindicated in women who are or may become pregnant.</p>', '<p>All females of childbearing potential must use 2 reliable forms of contraception simultaneously 4 wk before starting therapy, during and 4 wk after therapy is discontinued. Therapy to be stopped immediately if pregnancy occurs. Male: Use of barrier methods of contraception if partner is of child-bearing potential. Do not donate blood or sperm during therapy. Patient should not drive or operate machinery. Discontinue therapy if any skin rash develops. Do not resume therapy if the rash is exfoliative, purpuric, or bullous, or if Stevens-Johnson syndrome or toxic epidermal necrolysis suspected.</p>', NULL, '<p>Anti-Leprotic drugs, Immunosuppressant.</p>', NULL, NULL, '2022-03-21 06:08:14', '2022-03-21 06:08:14'),
(1482, 1482, '<p>Theophylline is indicated for the-</p>\r\n\r\n<ul>\r\n	<li>Control of acute asthma.</li>\r\n	<li>Management of chronic asthma (For both Symptomatic and prophylactic treatment).</li>\r\n	<li>For controlling nocturnal asthma and early morning wheezing.</li>\r\n	<li>Management of chronic obstructive lung disease (Chronic bronchitis and emphysema) and acute exacerbation of chronic obstructive lung disease.</li>\r\n	<li>Control of apnea of pre-maturity.</li>\r\n</ul>', '<p>Theophylline is a bronchodilator, structurally classified as a Methylxanthine. Theophylline has two distinct actions in the airways of patients with reversible obstruction; smooth muscle relaxation and suppression of the response of the airways to stimuli. Theophylline also increases the force of contraction of diaphragmatic muscles. The half-life of Theophylline is influenced by a number of known variables. In adult nonsmokers with uncomplicated asthma the half-life ranges from 3 to 9 hours</p>', '<p>The dose of theophylline must be individualized on the basis of peak serum theophylline concentration measurements in order to achieve a dose that will provide maximum potential benefit with minimal risk of adverse effects. Most of the sustained release preparations may be administered every 12 hours in adults while administration every 8 hours may be necessary in some children with markedly rapid hepatic<br />\r\nmetabolism of theophylline. The recommended maintenance dose within accepted therapeutic range is as follows :</p>\r\n\r\n<ul>\r\n	<li>16 years or older: 10 mg/Kg/day (Do not exceed 900 mg/day)</li>\r\n	<li>12 years-15 years: 13 mg/Kg/day</li>\r\n	<li>9-11 years: 16 mg/Kg/day</li>\r\n	<li>1 year-8 years: 24-24 mg/Kg/day</li>\r\n	<li>6 months-1 year: 12-18 mg/Kg/day</li>\r\n	<li>1-6 months: 10 mg/Kg/day.</li>\r\n</ul>', '<p>Theophylline should not be used concurrently with other preparations containing xanthine derivatives. The clearance of theophylline is increased by barbiturates, carbamazepine, lithium, phenytoin, rifampicin and sulphinpyrazone and it may therefore be necessary to increase dosage. On the other hand, the clearance of the drug is reduced by allopurinol, cimetidine, ciprofloxacin, corticosteroids, erythromycin, frusemide, isoprenaline, oral contraceptive and thiabendazole and a reduced dosage may therefore be needed to avoid side effects. Theophylline can potentiate hypokalemia resulting from beta-2-agonist therapy, steroids, diuretics and hypoxia, so serum potassium levels should be monitored in such instances.</p>', '<p>Theophylline is contraindicated in patients with hypersensitivity to Theophylline or any other component of the product.</p>', '<p>Generally side effects are rare at normal dosage. It may include gastrointestinal discomfort, headache, nausea, insomnia and hypotension. CNS stimulation and diuresis may also occur, especially in children.</p>', '<p>It is not known whether Theophylline can cause foetal harm when administered to pregnant woman. Xanthines should be given to a pregnant woman only if clearly needed. Theophylline is excreted into breast milk and may cause irritability or other signs of mild toxicity in nursing human infants. Serious adverse effects in the infant are unlikely unless the mother has toxic serum Theophylline concentrations.</p>', '<p>Careful consideration is needed for various interacting drugs and physiologic conditions that can alter Theophylline clearance. Dosage adjustment is required prior to initiation of Theophylline therapy, prior to increases in Theophylline dose, and during follow up. The dose of Theophylline selected for initiation of therapy should be low and, if tolerated, increased slowly over a period of time.</p>', NULL, '<p>Bronchodilator, Theophylline &amp; related drugs.</p>', '<p>Keep all medicines out of reach of children. Store in a cool and dry place, protected from light.</p>', '<p><strong>Pediatrics use</strong>: The clearance of Theophylline is very low in neonates. Careful attention to dosage selection and monitoring of serum Theophylline concentrations are required in pediatric patients.</p>', '2022-03-21 06:15:16', '2022-03-21 06:15:16'),
(1483, 1483, '<p>Thiamine is specifically used in the treatment of the various manifestations of thiamine deficiency such as Beriberi and Wernick&#39;s encephalopathy, neuritis associated with pregnancy and pellagra. Supplementary Thiamine may be indicated prophylactically in conditions where there is low dietary intake or impaired gastro intestinal absorption of thiamine (e.g. alcohol) or where requirements are increased (pregnancy, carbohydrate rich diet).</p>', '<p>Thiamine, in the form of thiamine pyrophosphate, is the coenzyme for decarboxylation of &alpha;-ketoglutaric acid. Thiamine deficiency affects the peripheral nervous system, the gastrointestinal tract, and the cardiovascular system. This vitamin is necessary for the optimal growth of infants and children. Thiamine is not stored in the body, and is regularly lost from tissues during short periods of deficiency. In order to maintain normal health, an adequate amount of thiamine is required every day. Deficiency of thiamine leads to fatigue, anorexia, gastrointestinal disturbance, tachycardia, irritability and neurological symptoms. Beriberi, a disease due to vitamin B1 deficiency, is common in alcoholics, in pregnant women receiving an inadequate diet, and in people with malabsorption syndrome, prolonged diarrhoea and hepatic disease.<br />\r\n<br />\r\nThiamine is well absorbed from the gastrointestinal tract and widely distributed throughout the body. Thiamine is rapidly absorbed from the upper small intestine. Thiamine is not stored in the body to any appreciable extent. Excess ingested thiamine appears in urine as intact thiamine or as pyrimidine, which arises from degradation of the thiamine molecule. The plasma half life of thiamine is 24 hours.</p>', '<p><strong>Prophylaxis</strong>: 3 to 10 mg daily.<br />\r\n<strong>Mild chronic deficiency</strong>: 10 to 25 mg daily.<br />\r\n<strong>Severe deficiency</strong>: 200 to 300 mg daily.</p>', '<p>No hazardous drug interactions have been reported. Vitamin B1 acts synergistically with other vitamins of the B-complex group and its potential for causing adverse effects is considerably reduced.</p>', '<p>There is no absolute contraindication but the risk of anaphylaxis is increased by repeated parenteral administration.&nbsp;Mild allergic phenomena, such as sneezing or mild asthma are warning signs that further may give rise to anaphylactic shock. To avoid this possibility it is advisable to start a second course of injection with a dose considerably lower than that previously used. Because of the above, vitamin B1 injection should not be given intravenously except in the case of comatose patients. Once thiamine deficiency is corrected there is no need for parenteral administration or for the administration of amounts in excess of daily requirement.</p>', '<p>Vitamin B1 does not have adverse effects when given orally, but in a few fatal cases anaphylactic reactions have occurred after intravenous administration of large doses (400 mg) in sensitive patients, especially children, and in one case following an intramuscular dose of 125 mg. The risk of such reactions increases with repeated administration of the drug by parenteral route. Transient mild soreness may occur at the site of intramuscular administration.</p>', '<p>The drug may be given safely to neonates, children, pregnant and lactating women and elderly patients.</p>', NULL, NULL, '<p>Vitamin-B preparations.</p>', '<p>Thiamine injection should be protected from light and moisture.</p>', NULL, '2022-03-21 06:16:38', '2022-03-21 06:16:38');
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
(1484, 1484, '<p>Thiopental Sodium for Injection is indicated-&nbsp;</p>\r\n\r\n<ul>\r\n	<li>As the sole anesthetic agent for brief (15 minutes) procedures,</li>\r\n	<li>For induction of anesthesia prior to administration of other anesthetic agents,</li>\r\n	<li>To supplement regional anesthesia,</li>\r\n	<li>To provide hypnosis during balanced anesthesia with other agents for analgesia or muscle relaxation,</li>\r\n	<li>For the control of convulsive states during or following inhalation anesthesia, local anesthesia, or other causes,</li>\r\n	<li>In neurosurgical patients with increased intracranial pressure, if adequate ventilation is provided, and</li>\r\n	<li>For narcoanalysis and narcosynthesis in psychiatric disorders.</li>\r\n</ul>', '<p>Thiopental, a barbiturate, is used for the induction of anesthesia prior to the use of other general anesthetic agents and for induction of anesthesia for short surgical, diagnostic, or therapeutic procedures associated with minimal painful stimuli. Thiopental is an ultrashort-acting depressant of the central nervous system which induces hypnosis and anesthesia, but not analgesia. It produces hypnosis within 30 to 40 seconds of intravenous injection. Recovery after a small dose is rapid, with some somnolence and retrograde amnesia. Repeated intravenous doses lead to prolonged anesthesia because fatty tissues act as a reservoir; they accumulate Pentothal in concentrations 6 to 12 times greater than the plasma concentration, and then release the drug slowly to cause prolonged anesthesia<br />\r\n<br />\r\nThiopental binds at a distinct binding site associated with a Cl-&nbsp;ionopore at the GABAA&nbsp;receptor, increasing the duration of time for which the Cl-&nbsp;ionopore is open. The post-synaptic inhibitory effect of GABA in the thalamus is, therefore, prolonged.</p>', '<p>Thiopental Injection is administered intravenously normally as a 2.5% w/v solution. On occasions it may be administered as a 5% w/v solution (500 mg in 10 ml). The intravenous injection preparation should be used after reconstitution of the sterile powder with Water for Injections, usually to produce a 2.5% w/v solution.<br />\r\n<br />\r\n<strong>Premedication</strong>: Premedication usually consists of atropine or scopolamine to suppress vagal reflexes and inhibit secretions. In addition, a barbiturate or an opiate is often given. Ideally, the peak effect of these medications should be reached shortly before the time of induction.<br />\r\n<br />\r\n<strong>Test dose</strong>: It is advisable to inject a small &quot;test&quot; dose of 25 mg to 75 mg of Thiopental Sodium for Injection to assess tolerance or unusual sensitivity to Thiopental Sodium for Injection, and pausing to observe patient reaction for at least 60 seconds. If unexpectedly deep anesthesia develops or if respiratory depression occurs, consider these possibilities: (1) the patient may be unusually sensitive to Thiopental Sodium for Injection, (2) the solution may be more concentrated than had been assumed, or (3) the patient may have received too much.<br />\r\n<br />\r\n<strong>Use in anaesthesia</strong>: Normal dosage for the induction of anesthesia is 100 mg to 150 mg injected over 10 to 15 seconds. If necessary, a repeat dose of 100 mg to 150 mg may be given after one minute. No fixed dosage recommendations for the intravenous injection can be given, since the dosage will need to be carefully adjusted according to the patient&#39;s response. Factors such as age, sex, and weight of the patient should be taken into consideration. Thiopental Sodium reaches effective concentrations in the brain within 30 seconds and anesthesia is normally produced within one minute of an intravenous dose.</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>: 100 mg to 150 mg intravenously over 10 to 15 seconds, normally as a 2.5% w/v solution. A repeat dose of 100 mg to 150 mg may be given after one minute. The intravenous injection should be given slowly and the amount given titrated against the patient&#39;s response to minimize the risk of respiratory depression or the possibility of over dosage. The average dose for an adult of 70 kg is roughly 200 mg to 300 mg (8 mls to 12 mls of a 2.5% w/v solution) with a maximum of 500 mg.</li>\r\n	<li><strong>Children</strong>: 2 mg/kg to 7 mg/kg bodyweight, intravenously over 10 to 15 seconds, normally as a 2.5% w/v solution. A repeat dose of 2 mg/kg to 7 mg/kg may be given after one minute. The dose is 2 mg/kg to 7 mg/kg based on the patient&#39;s response. The dose for children should not exceed 7 mg/kg.</li>\r\n	<li><strong>Elderly</strong>: Smaller adult doses are advisable.</li>\r\n</ul>\r\n\r\n<p><strong>Use in convulsive states</strong>: 75 mg to 125 mg (3 mls to 5 mls of a 2.5% w/v solution) should be given as soon as possible after the convulsion begins. Further doses may be required to control convulsion following the use of a local anesthetic. Other regimens, such as the use of intravenous or rectal diazepam, may be used to control convulsive states.</p>', '<p>Possible increase in difficulty in producing anaesthesia in patients taking alcohol or CNS depressants. Additive action with other CNS depressants including sedatives, hypnotics, nitrous oxide or alcohol. Increased hypotension and excitatory effects with phenothiazine antipsychotics. Increased hypnotic effect with antipsychotic. Decreased requirement of thiopental sodium with metoclopramide, sulfisoxazole, aspirin, meprobamate, probenecid and other highly protein bound drugs.</p>', '<p>Absolute Contraindication:</p>\r\n\r\n<ul>\r\n	<li>Absence of suitable veins for intravenous administration</li>\r\n	<li>Hypersensitivity (allergy) to barbiturates</li>\r\n	<li>Variegate porphyria (South African) or acute intermittent porphyria</li>\r\n	<li>Status asthmaticus</li>\r\n</ul>\r\n\r\n<p>Relative Contraindication:</p>\r\n\r\n<ul>\r\n	<li>Severe cardiovascular disease</li>\r\n	<li>Hypotension or shock</li>\r\n	<li>Conditions in which the hypnotic effect may be prolonged or potentiated, eg, excessive premedication, Addison&#39;s disease, hepatic or renal dysfunction, myxedema, increased blood urea, severe anemia, asthma, myasthenia gravis</li>\r\n</ul>', '<p>Hypersensitivity reactions have been reported. Other adverse reactions to thiopental sodium include the followings: respiratory depression, myocardial depression, cardiac arrhythmias, prolonged somnolence and recovery, hypotension, tachycardia, sneezing, coughing, bronchospasm, laryngospasm and shivering. Anaphylactic reactions have been reported. Symptoms, e.g., urticaria, bronchospasm, vasodilation and edema.</p>', '<p>Pregnancy Category C. Animal reproduction studies have not been conducted with Thiopental. It is also not known whether Thiopental can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Thiopental should be given to a pregnant woman only if clearly needed. Thiopental sodium readily crosses the placental barrier and small amounts may appear in the milk of nursing mothers following administration of large doses.</p>', '<p>A person competent in anesthesia management should be in constant attendance and adequate facilities for support of respiration and circulation should be available when Thiopental Sodium for injection is being used. Thiopental Sodium for Injection should be administered with caution to patients with preexisting hypotension or in conditions where the hypnotic effect may be prolonged or intensified, such as in the presence of liver disease and renal disease.<br />\r\n<br />\r\nThis product may be habit forming. Keep resuscitative and endotracheal intubation equipment and oxygen readily available. Maintain patency of the airway at all times. Only persons qualified in the use of anesthetics should administer this drug. Avoid extravasations or intra-arterial injection.</p>', '<p>Overdosage may occur from too rapid or repeated administration. Too rapid injection may be followed by an alarming fall in blood pressure even to shock levels. Apnoea, occasional laryngospasm, coughing and other respiratory difficulties with excessive or too rapid injections may occur. In the event of suspected or apparent overdosage, the agent should be discontinued.</p>', '<p>General (Intravenous) anesthetics.</p>', '<p>Store at controlled room temperature of 15&deg;&nbsp;C to 30&deg;&nbsp;C. Solutions should be freshly prepared and used immediately. Any portion of the contents remaining should be discarded.</p>', NULL, '2022-03-21 20:07:46', '2022-03-21 20:07:46'),
(1485, 1485, '<p>Thioridazine is indicated for the management of schizophrenic patients who fail to respond adequately to treatment with other antipsychotic&nbsp;drugs. Due to the risk of significant, potentially life-threatening, proarrhythmic effects with thioridazine treatment, thioridazine should be used only in patients who have failed to respond adequately to treatment with appropriate courses of other antipsychotic drugs, either because of insufficient effectiveness or the inability to achieve an&nbsp;effective dose&nbsp;due to intolerable adverse effects from those drugs. Consequently, before initiating treatment with thioridazine, it is strongly recommended that a patient be given at least 2 trials, each with a different antipsychotic drug product, at an adequate dose, and for an adequate duration.<br />\r\n<br />\r\nHowever, the prescriber should be aware that thioridazine has not been systematically evaluated in controlled trials in treatment refractory&nbsp;schizophrenic patients and its efficacy in such patients is unknown.</p>', '<p>Thioridazine is a piperidine phenothiazine which blocks postsynaptic mesolimbic dopaminergic receptors in the brain. It exhibits a strong &alpha;-adrenergic blocking effect and depresses the release of hypothalamic and hypophyseal hormones.</p>', '<p>Since thioridazine is associated with a dose-related prolongation of the QTc interval, which is a potentially life-threatening event, its use should be reserved for schizophrenic patients who fail to respond adequately to treatment with other antipsychotic drugs. Dosage must be individualized and the smallest effective dosage should be determined for each patient&nbsp;<br />\r\n<br />\r\n<strong>Adults</strong>: The usual starting dose for adult schizophrenic patients is 50 to 100 mg three times a day, with a gradual increment to a maximum of 800 mg daily if necessary. Once effective control of symptoms has been achieved, the dosage may be reduced gradually to determine the minimum maintenance dose. The total daily dosage ranges from 200 to 800 mg, divided into two to four doses.<br />\r\n<br />\r\n<strong>Pediatric</strong>: For pediatric patients with schizophrenia who are unresponsive to other agents, the recommended initial dose is 0.5 mg/kg/day given in divided doses. Dosage may be increased gradually until optimum&nbsp;therapeutic&nbsp;effect is obtained or the maximum dose of 3 mg/kg/day has been reached.</p>', '<p>May potentiate the effects of CNS depressants (e.g. anaesth, barbiturates, narcotics, opiates, other psychoactive drugs).</p>', '<p>Patients with reduced levels of CYP2D6 isoenzyme, congenital long QT syndrome or history of cardiac arrhythmias; severe CNS depression or comatose states of any cause; hypertensive or hypotensive heart disease of extreme degree. Concomitant use with drugs that prolong QTc interval, CYP2D6 isoenzyme inhibitors and drugs which reduce thioridazine clearance by other mechanisms.</p>', '<p>Tardive dyskinesia; leucopenia, neutropenia, agranulocytosis; drowsiness, pseudoparkinsonism and other extrapyramidal symptoms; dry mouth, blurred vision, constipation, nausea, vomiting, diarrhoea, nasal stuffiness, pallor; galactorrhoea, breast engorgement, amenorrhoea, inhibition of ejaculation, peripheral oedema; dermatitis, skin eruptions. Rarely, nocturnal confusion, hyperactivity, lethargy, psychotic reactions, restlessness, headache, photosensitivity, parotid swelling.</p>', '<p>Pregnancy 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.</p>', '<p>Patient with severe CV disease, narrow-angle glaucoma, Parkinson&#39;s disease, seizure disorder. Avoid abrupt withdrawal. Hepatic and renal impairment. Elderly with dementia-related psychosis. Pregnancy and lactation.</p>', '<p>Symptoms: Cardiotoxicity (e.g. prolongation of QT interval and QRS complex).<br />\r\n<br />\r\nManagement: Symptomatic and supportive treatment with CV (e.g. ECG) monitoring. Establish a patent airway and ensure adequate oxygenation and ventilation. Employ gastric lavage and administer repeated doses of activated charcoal. May include ventricular pacing, defibrillation, admin of IV Mg sulfate, lidocaine, phenytoin or isoproterenol, correction of electrolyte abnormalities and/or acid-base balance to manage arrhythmias. Administer lidocaine with caution as it may increase the risk of developing seizures.</p>', '<p>Phenothiazine drugs, Phenothiazine related drugs.</p>', '<p>Store between 15-30&deg; C. Protect from light.</p>', '<p>Renal Impairment: Lower initial doses and more gradual dosage increase.<br />\r\nHepatic Impairment: Lower initial doses and more gradual dosage increase.</p>', '2022-03-21 20:09:38', '2022-03-21 20:09:38'),
(1486, 1486, '<p>Thiotepa is indicated, in combination with other chemotherapy medicinal products:</p>\r\n\r\n<ul>\r\n	<li>With or without total body irradiation (TBI), as conditioning treatment prior to allogeneic or autologous haematopoietic progenitor cell transplantation (HPCT) in haematological diseases in adult and paediatric patients;</li>\r\n	<li>When high dose chemotherapy with HPCT support is appropriate for the treatment of solid tumours in adult and paediatric patients.</li>\r\n</ul>', '<p>Thiotepa is a polyfunctional cytotoxic agent related chemically and pharmacologically to the nitrogen mustard. The radiomimetic action of thiotepa is believed to occur through the release of ethylene imine radicals that, as in the case of irradiation therapy, disrupt the bonds of DNA, e.g. by alkylation of guanine at the N-7, breaking the linkage between the purine base and the sugar and liberating alkylated guanine.</p>', '<p>Adults-<br />\r\n<br />\r\nAutologous HPCT:</p>\r\n\r\n<ul>\r\n	<li><strong>Haematological diseases</strong>: The recommended dose in haematological diseases ranges from 125 mg/m2/day (3.38 mg/kg/day) to 300 mg/m2/day (8.10 mg/kg/day) as a single daily infusion, administered from2up to 4 consecutive days before autologous HPCT depending on the combination with other chemotherapeutic medicinal products, without exceeding the total maximum cumulative dose of 900 mg/m2(24.32 mg/kg), during the time of the entire conditioning treatment.</li>\r\n	<li><strong>Lymphoma</strong>: The recommended dose ranges from 125 mg/m2/day (3.38 mg/kg/day) to 300 mg/m2/day (8.10 mg/kg/day) as a single daily infusion, administered from2up to 4 consecutive days before autologous HPCT depending on the combination with other chemotherapeutic medicinal products, without exceeding the total maximum cumulative dose of 900 mg/m2(24.32 mg/kg), during the time of the entire conditioning treatment.</li>\r\n	<li><strong>Central nervous system lymphoma</strong>: The recommended dose is 185 mg/m2/day (5 mg/kg/day) as a single daily infusion, administered for 2 consecutive days before autologous HPCT, without exceeding the total maximum cumulative dose of 370 mg/m2(10 mg/kg), during the time of the entire conditioning treatment.</li>\r\n	<li><strong>Multiple myeloma</strong>: The recommended dose ranges from 150 mg/m2/day (4.05 mg/kg/day) to 250 mg/m2/day (6.76 mg/kg/day) as a single daily infusion, administered for 3 consecutive days before autologous HPCT depending on the combination with other chemotherapeutic medicinal products, without exceeding the total maximum cumulative dose of 750 mg/m2(20.27 mg/kg), during the time of the entire conditioning treatment.</li>\r\n</ul>\r\n\r\n<p><strong>Solid tumours</strong>: The recommended dose in solid tumours ranges from 120 mg/m2/day (3.24 mg/kg/day) to 250 mg/m2/day (6.76 mg/kg/day) divided in one or two daily infusions, administered from2up to 5 consecutive days before autologous HPCT depending on the combination with other chemotherapeutic medicinal products, without exceeding the total maximum cumulative dose of 800 mg/m2(21.62 mg/kg), during the time of the entire conditioning treatment.</p>\r\n\r\n<ul>\r\n	<li><strong>Breast cancer</strong>: The recommended dose ranges from 120 mg/m2/day (3.24 mg/kg/day) to 250 mg/m2/day (6.76 mg/kg/day) as a single daily infusion, administered from 3 up to 5 consecutive days before autologous HPCT depending on the combination with other chemotherapeutic medicinal products, without exceeding the total maximum cumulative dose of 800 mg/m2(21.62 mg/kg), during the time of the entire conditioning treatment.</li>\r\n	<li><strong>CNS tumours</strong>: The recommended dose ranges from 125 mg/m2/day (3.38 mg/kg/day) to 250 mg/m2/day (6.76 mg/kg/day) divided in one or two daily infusions, administered from 3 up to 4 consecutive days before autologous HPCT depending on the combination with other chemotherapeutic medicinal products, without exceeding the total maximum cumulative dose of 750 mg/m2(20.27 mg/kg), during the time of the entire conditioning treatment.</li>\r\n	<li><strong>Ovarian cancer</strong>: The recommended dose is 250 mg/m2/day (6.76 mg/kg/day) as a single daily infusion, administered in 2 consecutive days before autologous HPCT, without exceeding the total maximum cumulative dose of 500 mg/m2(13.51 mg/kg), during the time of the entire conditioning treatment.</li>\r\n	<li><strong>Germ cell tumours</strong>: The recommended dose ranges from 150 mg/m2/day (4.05 mg/kg/day) to 250 mg/m2/day (6.76 mg/kg/day) as a single daily infusion, administered for 3 consecutive days before autologous HPCT depending on the combination with other chemotherapeutic medicinal products, without exceeding the total maximum cumulative dose of 750 mg/m2(20.27 mg/kg), during the time of the entire conditioning treatment.</li>\r\n</ul>\r\n\r\n<p>Allogeneic HPCT:</p>\r\n\r\n<ul>\r\n	<li><strong>Haematological diseases</strong>: The recommended dose in haematological diseases ranges from 185 mg/m2/day (5 mg/kg/day) to 481 mg/m2/day (13 mg/kg/day) divided in one or two daily infusions, administered from 1 up to 3 consecutive days before allogeneic HPCT depending on the combination with other chemotherapeutic medicinal products, without exceeding the total maximum cumulative dose of 555 mg/m2(15 mg/kg), during the time of the entire conditioning treatment.</li>\r\n	<li><strong>Lymphoma</strong>: The recommended dose in lymphoma is 370 mg/m2/day (10 mg/kg/day) divided in two daily infusions before allogeneic HPCT, without exceeding the total maximum cumulative dose of 370 mg/m2(10 mg/kg), during the time of the entire conditioning treatment.</li>\r\n	<li><strong>Multiple myeloma</strong>: The recommended dose is 185 mg/m2/day (5 mg/kg/day) as a single daily infusion before allogeneic HPCT, without exceeding the total maximum cumulative dose of 185 mg/m2(5 mg/kg), during the time of the entire conditioning treatment.</li>\r\n	<li><strong>Leukaemia</strong>: The recommended dose ranges from 185 mg/m2/day (5 mg/kg/day) to 481 mg/m2/day (13 mg/kg/day) divided in one or two daily infusions, administered from 1 up to 2 consecutive days before allogeneic HPCT depending on the combination with other chemotherapeutic medicinal products, without exceeding the total maximum cumulative dose of 555 mg/m2(15 mg/kg), during the time of the entire conditioning treatment.</li>\r\n	<li><strong>Thalassemia</strong>: The recommended dose is 370 mg/m2/day (10 mg/kg/day) divided in two daily infusions, administered before allogeneic HPCT, without exceeding the total maximum cumulative dose of 370 mg/m2(10 mg/kg), during the time of the entire conditioning treatment.</li>\r\n</ul>', '<p>Live virus and bacterial vaccines must not be administered to a patient receiving an immunosuppressive chemotherapeutic agent and at least three months must elapse between discontinuation of therapy and vaccination.<br />\r\n<br />\r\nThiotepa appears to be metabolised via CYP2B6 and CYP3A4. Co-administration with inhibitors of CYP2B6 (for example clopidogrel and ticlopidine) or CYP3A4 (for example azole antifungals, macrolides like erythromycin, clarithromycin, telithromycin, and protease inhibitors) may increase the plasma concentrations of thiotepa and potentially decrease the concentrations of the active metabolite TEPA. Co-administration of inducers of cytochrome P450 (such as rifampicin, carbamazepine, phenobarbital) may increase the metabolism of thiotepa leading to increased plasma concentrations of the active metabolite. Therefore, during the concomitant use of thiotepa and these medicinal products, patients should be carefully monitored clinically.<br />\r\n<br />\r\nThiotepa is a weak inhibitor for CYP2B6, and may thereby potentially increase plasma concentrations of substances metabolised via CYP2B6, such as ifosfamide, tamoxifen, bupropion, efavirenz and cyclophosphamide. CYP2B6 catalyzes the metabolic conversion of cyclophosphamide to its active form 4-hydroxycyclophosphamide (4-OHCP) and co-administration of thiotepa may therefore lead to decreased concentrations of the active 4 OHCP. Therefore, a clinical monitoring should be exercised during the concomitant use of thiotepa and these medicinal products.</p>', '<p>Hypersensitivity to the active substance. Pregnancy and lactation. Concomitant use with yellow fever vaccine and with live virus and bacterial vaccines.</p>', NULL, '<p>There are no data on the use of thiotepa during pregnancy. In pre-clinical studies thiotepa, as most alkylating agents, has been shown to cause embryofoetal lethality and teratogenicity. Therefore, thiotepa is contraindicated during pregnancy. It is unknown whether thiotepa is excreted in human milk. Due to its pharmacological properties and its potential toxicity for breast-fed newborns/infants, breastfeeding is contraindicated during treatment with thiotepa.</p>', '<p>The consequence of treatment with thiotepa at the recommended dose and schedule is profound myelosuppression, occurring in all patients. Severe granulocytopenia, thrombocytopenia, anaemia or any combination thereof may develop. Frequent complete blood counts, including differential white blood cell counts, and platelet counts need to be performed during the treatment and until recovery is achieved. Platelet and red blood cell support, as well as the use of growth factors such as Granulocyte- colony stimulating factor (G-CSF), should be employed as medically indicated. Daily white blood cell counts and platelet counts are recommended during therapy with thiotepa and after transplant for at least 30 days.</p>', '<p>There is no experience with overdoses of thiotepa. The most important adverse reactions expected in case of overdose is myeloablation and pancytopenia. There is no known antidote for thiotepa. The haematological status needs to be closely monitored and vigorous supportive measures instituted as medically indicated.</p>', '<p>Haematopoietic Agents</p>', '<p>Store and transport refrigerated (2&deg;C-8&deg;C). Do not freeze.</p>', '<p><strong>Renal impairment</strong>: Studies in renally impaired patients have not been conducted. As thiotepa and its metabolites are poorly excreted in the urine, dose modification is not recommended in patients with mild or moderate renal insufficiency. However, caution is recommended.<br />\r\n<br />\r\n<strong>Hepatic impairment</strong>: Thiotepa has not been studied in patients with hepatic impairment. Since thiotepa is mainly metabolized through the liver, caution needs to be exercised when thiotepa is used in patients with pre-existing impairment of liver function, especially in those with severe hepatic impairment. Dose modification is not recommended for transient alterations of hepatic parameters.<br />\r\n<br />\r\n<strong>Elderly</strong>: The administration of thiotepa has not been specifically investigated in elderly patients. However, in clinical studies, a proportion of patients over the age of 65 received the same cumulative dose as the other patients. No dose adjustment was deemed necessary.</p>', '2022-03-21 20:11:42', '2022-03-21 20:11:42'),
(1487, 1487, '<p>Active protection for high-risk moments. Intimate hygiene wash with Thymus vulgaris extracts for a natural antibacterial and antifungal action.<br />\r\n<br />\r\nWho should use it?</p>\r\n\r\n<ul>\r\n	<li>Women having periods</li>\r\n	<li>Expectant Mothers</li>\r\n	<li>New Mothers</li>\r\n	<li>In situations where there is a risk of infections (swimming-pools, gyms, beaches and surgical procedures)</li>\r\n</ul>', '<p>It ensures the natural antibacterial and antifungal action of Thymus vulgaris, a plant extracts with marked selective antibacterial properties. Its pH 3.5 is the way to restore the acid environment that might have been altered in the vagina and protect the good vaginal flora.</p>', NULL, NULL, '<p>Hypersensitivity to the active substance or to any of the excipients.</p>', NULL, NULL, NULL, NULL, '<p>Miscellaneous topical agents</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-21 20:13:31', '2022-03-21 20:13:31'),
(1488, 1488, '<p>Treatment of symptoms resulting from the natural or surgical menopause in post menopausal women. Prevention of osteoporosis in women who have gone through the menopause and are at high risk of fractures, but cannot take other medicines used to prevent osteoporosis.</p>', '<p>Tibolone is a synthetic steroid that has estrogenic, androgenic and progestagenic properties. After oral administration, Tibolone is rapidly metabolized into three compounds which contribute to the pharmacological effects of Tibolone. Two of these metabolites (the 3&alpha;&minus;OH and 3&beta;&minus;OH metabolite) have predominantly estrogenic activity; a third metabolite (&delta;4-isomer of Tibolone) and the parent compound have predominantly progestagenic and androgenic activities. Tibolone substitutes for the loss of estrogen production in postmenopausal women and alleviates menopausal symptoms. It prevents bone loss following menopause or ovariectomy. It has estrogenic effects on the vagina, on bone and on the thermoregulatory centers in the brain (hot flushes). It improves vaginal dryness and vaginal atrophy. Tibolone has also effects on mood and libido.</p>', '<p>The dose is one Tibolone tablet per day (2.5 mg daily). The tablet should be swallowed with some water or other drink, preferably at the same time in each day. Improvement of symptoms generally occurs within a few weeks, but optimal results are obtained when therapy is continued for at least 3 months.<br />\r\n<br />\r\n<strong>Starting Tibolone Tablet</strong>: Women experiencing a natural menopause should commence treatment with Tibolone tablet at least 12 months after their last natural bleed. In case of a surgical menopause, treatment with Tibolone tablet may commence immediately.<br />\r\n<br />\r\n<strong>Switching from a sequential or continuous combined HRT (Hormone Replacement Therapy) preparation</strong>: If changing from a sequential HRT preparation, treatment with Tibolone should start the day following completion of the prior regimen. If changing from a continuous-combined HRT preparation, treatment can start at any time.<br />\r\n<br />\r\n<strong>Missed dose</strong>: A missed dose should be taken as soon as remembered, unless it is more than 12 hours overdue. In the later case, the missed dose should be skipped and the next dose should be taken at the normal time. Missing a dose may increase the likelihood of breakthrough bleeding and spotting</p>', '<p>No examples of interactions between Tibolone and other medicines have been reported in clinical practice. However, the following potential interactions should be considered on a theoretical basis: Enzyme-inducing compounds such as barbiturates, carbamazepine, hydantoins, and rifampicin may enhance the metabolism of Tibolone and thus decrease its therapeutic effect. Since Tibolone may increase blood or fibrinolytic activity (lower fibrinogen levels; higher AT III, plasminogen, and fibrinolytic activity values), it may enhance the effect of anticoagulants.</p>', '<p>Contraindicated in pregnancy and lactation, known or suspected hormone-dependent tumours, cardiovascular or cerebrovascular disorders, active deep vein thrombosis, thromboembolic disorders, vaginal bleeding of unknown etiology and severe liver disorders.</p>', '<p>Occasionally, vaginal bleeding or spotting may occur, mainly during the first months of treatment. Other adverse effects are headache and migraine, oedema, dizziness, pruritus, increase in body weight, nausea, abdominal pain, rash, and depression.</p>', '<p>Tibolone tablet is contraindicated during pregnancy. If pregnancy occurs during medication with this tablet, treatment should be withdrawn immediately. For this tablet no clinical data on exposed pregnancies are available. Tibolone tablet is contraindicated in lactating women.</p>', '<p>In patients with renal dysfunction, history of liver disease, epilepsy, migraine, hypercholesterolemia, impaired carbohydrate metabolism, diabetes mellitus and cholestatic jaundice.</p>', '<p>The acute toxicity of Tibolone in animals is very low. Therefore, toxic symptoms are not expected to occur if several tablets are taken simultaneously. In cases of acute overdose - nausea, vomiting, and withdrawal bleeding in females may develop. Symptomatic treatment can be given if necessary.</p>', '<p>Drugs for menopausal symptoms: Hormone replacement therapy.</p>', '<p>Keep in a cool &amp; dry place. Protect from light. Keep out of the reach of children.</p>', NULL, '2022-03-21 20:15:09', '2022-03-21 20:15:09'),
(1489, 1489, '<p>Ticagrelor is indicated for the prevention of atherothrombotic events in adult patients with Acute Coronary Syndromes (unstable angina, non ST elevation Myocardial Infarction [NSTEMI] or ST elevation Myocardial Infarction [STEMI]); including patients managed medically, and those who are managed with percutaneous coronary intervention (PCI) or coronary artery by-pass grafting (CABG).</p>', '<p>Ticagrelor is a selective adenosine diphosphate (ADP) receptor antagonist acting on the P2Y12 ADP-receptor that can prevent ADP-mediated platelet activation and aggregation. Ticagrelor reversibly interacts with the platelet P2Y12 ADP-receptor.Ticagrelor does not interact with the ADP binding site itself, but interacts with platelet P2Y12 ADP-receptor to prevent signal transduction.Thus it prevents platelet activation &amp; aggregation.</p>', '<p>Ticagrelor treatment should be initiated with a single 180 mg loading dose (two tablets of 90 mg) and then continued at 90 mg twice daily. Patients taking Ticagrelor should also take aspirin daily, unless specifically contraindicated. Following an initial dose of aspirin (usually 325 mg), Ticagrelor should be used with a maintenance dose of aspirin of 75-100 mg. Maintenance dose of Aspirin above 100 mg decreased the efficacy of Ticagrelor. So, maintenance dose of aspirin above 100 mg should be avoided.<br />\r\n<br />\r\nA patient who misses a dose of Ticagrelor should take only one 90 mg tablet (the next dose) at its scheduled time. Patients treated with Clopidogrel can be directly switched to Ticagrelor if needed. Switching from prasugrel to ticagrelor has not been investigated.<br />\r\n<br />\r\nTreatment is recommended for up to 12 months unless discontinuation of Ticagrelor is clinically indicated. Ticagrelor can be administered with or without food.</p>', '<p><strong>CYP3A inhibitors</strong>: Avoid use of strong inhibitors of CYP3A (e.g., ketoconazole, itraconazole, voriconazole, clarithromycin, nefazodone, ritonavir, saquinavir, nelfinavir, indinavir, atazanavir and telithromycin).<br />\r\n<br />\r\n<strong>CYP3A inducers</strong>: Avoid use with potent inducers of CYP3A (e.g., rifampin, dexamethasone, phenytoin,carbamazepine and phenobarbital).<br />\r\n<br />\r\n<strong>Aspirin</strong>: Use of Ticagrelor with aspirin maintenance doses above 100 mg reduced the effectiveness ofTicagrelor.<br />\r\n<br />\r\n<strong>Simvastatin, Lovastatin</strong>: Ticagrelor will result in higher serum concentrations of simvastatin and lovastatin because these drugs are metabolized by CYP3A4. Avoid simvastatin and lovastatin doses greater than 40 mg.<br />\r\n<br />\r\n<strong>Digoxin</strong>: Because of inhibition of the P-glycoprotein transporter, monitor digoxin levels with initiation of or any change in ticagrelor therapy.<br />\r\n<br />\r\n<strong>Other Concomitant Therapy</strong>: Ticagrelor can be administered with unfractionated or low-molecular-weight heparin, GPIIb/llla inhibitors, proton pump inhibitors, beta-blockers, angiotensin converting enzyme inhibitors, and angiotensin receptor blockers.</p>', '<p>Ticagrelor is contraindicated in case of-</p>\r\n\r\n<ul>\r\n	<li>Hypersensitivity to Ticagrelor or to any of the excipients</li>\r\n	<li>Active pathological bleeding (peptic ulcer)</li>\r\n	<li>History of intracranial haemorrhage</li>\r\n	<li>Moderate to severe hepatic impairment</li>\r\n	<li>Co-administration of Ticagrelor with strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin, nefazodone, ritonavir, and atazanavir)</li>\r\n</ul>', '<p>Dyspnea,bleeding,headache,cough,dizziness,nausea,atrial fibrillation, hypertension, non-cardiac chest pain, diarrhea, back pain, hypotension, fatigue, chest pain.</p>', '<p><strong>Pregnancy</strong>&nbsp;category C. There are no or limited amount of data from the use of Ticagrelor in pregnant women.Ticagrelor is not recommended during pregnancy.<br />\r\n<br />\r\n<strong>Nursing mothers</strong>: Available pharmacodynamic/toxicological data in animals have shown excretion of Ticagrelor and its active metabolites in milk. A risk to newborns/infants cannot be excluded. A decision must be made whether to discontinue breastfeeding or to discontinue/abstain from ticagrelor therapy taking into account the benefit of breastfeeding for the child and the benefit of therapy for the women.</p>', '<p>General Risk of Bleeding: Drugs that inhibit platelet function including Ticagrelor increase the risk of bleeding.<br />\r\n<br />\r\nConcomitant Aspirin Maintenance Dose: Use of Ticagrelor with maintenance doses of aspirin above 100 mg decreased the effectiveness of Ticagrelor. Therefore, after the initial loading dose of aspirin (usually 325 mg), use Ticagrelor with a maintenance dose of aspirin of 75-100 mg.<br />\r\n<br />\r\nModerate Hepatic Impairment: Ticagrelor has not been studied in patients with moderate hepatic impairment.<br />\r\n<br />\r\nDiscontinuation of Ticagrelor: Discontinuation of Ticagrelor will increase the risk of myocardial infarction, stent thrombosis, and death.</p>', '<p>There is currently no known antidote to reverse the effects ofTicagrelor and it is not expected to be dialysable.Treatment of overdose should follow local standard medical practice.The expected effect of excessive ticagrelor dosing is prolonged duration of bleeding risk associated with platelet inhibition. If bleeding occurs appropriate supportive measures should be taken.</p>', '<p>Anti-platelet drugs</p>', '<p>Protect from light &amp; moisture. Store below 25&deg; C. Keep out of reach of children.</p>', '<p><strong>Pediatric Use</strong>: The safety and effectiveness of Ticagrelor in pediatric patients have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: No overall differences in safety or effectiveness were observed in geriatric patients.<br />\r\n<br />\r\n<strong>Hepatic Impairment</strong>: Ticagrelor has not been studied in the patients with moderate or severe hepatic impairment. Ticagrelor is metabolized by the liver and impaired hepatic function can increase risks for bleeding and other adverse events. Hence,<br />\r\n<br />\r\n<strong>Renal Impairment</strong>: No dosage adjustment is needed in patients with renal impairment. Patients receiving dialysis have not been studied.</p>', '2022-03-21 20:17:02', '2022-03-21 20:17:02'),
(1490, 1490, '<p>Ticlopidine is indicated to reduce the risk of thrombotic stroke (fatal or nonfatal) in patients who have experienced stroke precursors, and in patients who have had a completed thrombotic stroke. Because Ticlopidine&nbsp;is associated with a risk of life-threatening blood dyscrasias including&nbsp;thrombotic thrombocytopenic purpura&nbsp;(TTP), neutropenia/ agranulocytosis and&nbsp;aplastic anemia. Ticlopidine should be reserved for patients who are intolerant or allergic to&nbsp;aspirin&nbsp;therapy&nbsp;or who have failed aspirin therapy.<br />\r\n<br />\r\nTiclopidine is also indicated as an adjunctive therapy with aspirin to reduce the incidence of subacute stent&nbsp;thrombosis&nbsp;in patients undergoing successful coronary stent&nbsp;implantation</p>', '<p>When taken orally, Ticlopidine hydrochloride causes a time- and dose-dependent inhibition of both&nbsp;platelet aggregation and release of&nbsp;platelet&nbsp;granule constituents, as well as a prolongation of bleeding time. The intact drug has no significant&nbsp;in vitro&nbsp;activity at the concentrations attained&nbsp;in vivo; and, although&nbsp;analysis&nbsp;of&nbsp;urine&nbsp;and&nbsp;plasma&nbsp;indicates at least 20 metabolites, no metabolite which accounts for the activity of ticlopidine has been isolated.<br />\r\n<br />\r\nTiclopidine hydrochloride, after oral ingestion, interferes with platelet&nbsp;membrane&nbsp;function by inhibiting ADP-induced platelet-fibrinogen binding and subsequent platelet-platelet interactions. The effect on platelet function is irreversible for the life of the platelet, as shown both by persistent inhibition of&nbsp;fibrinogen&nbsp;binding after washing platelets ex vivo and by inhibition of platelet aggregation after resuspension of platelets in buffered medium.</p>', '<p><strong>Stroke</strong>:&nbsp;The recommended dose of Ticlopidine is 250 mg bid taken with food. Other doses have not been studied in controlled trials for these indications.<br />\r\n<br />\r\n<strong>Coronary Artery Stenting</strong>:&nbsp;The recommended dose of Ticlopidine is 250 mg bid taken with food together with antiplatelet doses of aspirin for up to 30 days of therapy following successful stent implantation.</p>', '<p>Reduced clearance with cimetidine; corticosteroid may antagonise effects on bleeding time. Avoid concurrent use with clopidogrel.</p>', '<p>The use of Ticlopidine is contraindicated in the following conditions:</p>\r\n\r\n<ul>\r\n	<li>Hypersensitivity to the drug</li>\r\n	<li>Presence of&nbsp;hematopoietic&nbsp;disorders such as&nbsp;neutropenia&nbsp;and thrombocytopenia or a past history of either&nbsp;TTP&nbsp;or&nbsp;aplastic anemia</li>\r\n	<li>Presence of a hemostatic disorder or active pathological bleeding (such as bleeding&nbsp;peptic ulcer&nbsp;or&nbsp;intracranial&nbsp;bleeding)</li>\r\n	<li>Patients with severe&nbsp;liver&nbsp;impairment</li>\r\n</ul>', '<p>Diarrhoea, nausea, dyspepsia, bleeding, pupura, skin rash, increase in serum cholesterol concentration, elevation of LFTs, hepatitis, cholestatic jaundice.</p>', '<p><strong>Pregnancy</strong>&nbsp;Category B. Teratology studies have been conducted in mice (doses up to 200 mg/kg/day), rats (doses up to 400 mg/kg/day) and rabbits (doses up to 200 mg/kg/day). Doses of 400 mg/kg in rats, 200 mg/kg/day in mice and 100 mg/kg in rabbits produced&nbsp;maternal&nbsp;toxicity, as well as fetal toxicity, but there was no evidence of a teratogenic potential of ticlopidine. There are, however, no adequate and well-controlled studies in&nbsp;pregnant&nbsp;women. Because animal&nbsp;reproduction&nbsp;studies are not always predictive of a human response, this drug should be used during pregnancy only if clearly needed.<br />\r\n<br />\r\n<strong>Nursing Mothers</strong>:&nbsp;Studies in rats have shown ticlopidine is excreted in the milk. 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 ticlopidine, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.</p>', '<p>Patients with increased risk of bleeding from trauma, surgery or pathological disorder. Moderate to severe renal impairment. May need to stop therapy 10-14 days before elective surgery. Full blood counts should be performed prior to therapy and every 2 wk during the first 3 mth of treatment. Pregnancy.</p>', '<p>One case of deliberate overdosage with Ticlopidine has been reported by a foreign postmarketing surveillance program. A 38-year-old male took a single 6000-mg dose of Ticlopidine (equivalent to 24 standard 250-mg tablets). The only abnormalities reported were increased bleeding time and increased&nbsp;SGPT. No special&nbsp;therapy&nbsp;was instituted and the patient recovered without&nbsp;sequelae.<br />\r\n<br />\r\nSingle oral doses of ticlopidine at 1600 mg/kg and 500 mg/kg were&nbsp;lethal&nbsp;to rats and mice, respectively. Symptoms of&nbsp;acute&nbsp;toxicity&nbsp;were GI&nbsp;hemorrhage, convulsions, hypothermia, dyspnea, loss of equilibrium and&nbsp;abnormal&nbsp;gait.</p>', '<p>Anti-platelet drugs, Fibrinolytics (Thrombolytics)</p>', '<p>Store at 15&deg; to 30&deg; C</p>', '<p><strong>Pediatric Use</strong>:&nbsp;Safety and effectiveness in pediatric patients have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>:&nbsp;Clearance of ticlopidine is somewhat lower in elderly patients and trough levels are increased. The major clinical trials with Ticlopidine in stroke patients were conducted in an elderly population with an average age of 64 years. Of the total number of patients in the therapeutic trials, 45% of patients were over 65 years old and 12% were over 75 years old. No overall differences in effectiveness or safety were observed between these patients and younger patients, 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>Renal Impairment</strong>: Dose reduction or discontinuance if haemorrhagic or haematopoietic complications occur.<br />\r\n<br />\r\n<strong>Hepatic Impairment</strong>: Severe: contraindicated.</p>', '2022-03-21 20:21:18', '2022-03-21 20:21:18'),
(1491, 1491, '<p>Tiemonium Methylsulphate is an antispasmodic drug that reduces muscles spasm of the intestine, biliary system, bladder and uterus. It is used in symptomatic treatment of pain related to functional disorders of the digestive tract and biliary system. It is also indicated for the treatment of spasm and pain in urological and gynaecological diseases.</p>', '<p>Tiemonium Methylsulphate a competitive antagonist of Acetylcholine, Histamine and strengthens of calcium bond with membrane phospholipids and proteins. Thus inhibits intracellular contractile protein of visceral cell which causes inhibition of visceral spasm and pain.</p>', '<p>Tablet/Syrup-</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>: usual dose is 2-6 tablets or 3-9 teaspoonfuls syrup daily in divided doses.</li>\r\n	<li><strong>Children</strong>: 3 ml/kg or 6 mg/kg body weight daily in divided doses.</li>\r\n</ul>\r\n\r\n<p><strong>Injection</strong>: 1 Tiemonium Methylsulphate Injection 3 times daily, through Intravenous route slowly or Intramuscular route.<br />\r\n<br />\r\n<strong>Suppository</strong>: 20 mg Tiemonium Methylsulphate suppository two or three times daily, through rectal route.</p>', '<p>Tiemonium methylsulphate tablet should not be used with other drugs without prior consult of a registered physician to avoid possible drug interaction.</p>', '<p>It should not be used in urethroprostatic disorder involving a risk of urine retension. It is contraindicated in patient with having risk of angle closure glaucoma.</p>', '<p>Tiemonium Methylsulphate may have the risk of hypotension &amp; tachycardia in certain individuals.</p>', '<p>The results of animal studies of Tiemonium Methylsulphate did not reveal any teratogenic effects; no deformities have been reported up till now with normal use. In absence of sufficient data, prudence should be the rule for nursing mothers although no problems have been reported with normal use.</p>', '<p>Caution should be taken during treatment of patients with disorders of the prostate. Caution should also be taken in case of chronic bronchitis, coronary insufficiency, ambient hyperthermia, renal &amp; hepatic insufficiency. The risks of visual disturbances can make it dangerous to drive or use machines.</p>', '<p>There is not available data regarding the overdose of Tiemonium methylsulphate tablet.</p>', '<p>Anticholinergics.</p>', '<p>Keep in a dry place, away from light and heat. Keep out of the reach of children.</p>', '<p><strong>Paediatric use:</strong>&nbsp;safety and effectiveness of Tiemonium methylsulphate in paediatric patients have not been established.<br />\r\n<br />\r\n<strong>Geriatric use:</strong>&nbsp;Efficacy and safety were maintained with increasing age.</p>', '2022-03-21 20:23:22', '2022-03-21 20:23:22');
