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
(725, 725, '<p>Ibandronic acid is indicated for the treatment of postmenopausal osteoporosis, to reduce the risk of fractures.<br />\r\n<br />\r\nTreatment of Osteoporosis: Osteoporosis may be confirmed by the finding of low bone mass (T-score &lt;-2.0 SD) and the presence or history of osteoporotic fracture, or a low bone mass (T-score &lt;-2.5 SD) in the absence of documented pre-existing osteoporotic fracture.</p>', '<p>The pharmacodynamic action of ibandronic acid is inhibition of bone resorption. In vivo, ibandronic acid prevents experimentally induced bone destruction caused by cessation of gonadal function, retinoids, tumors or tumor extracts. In young (fast growing) rats, the endogenous bone resorption is also inhibited, leading to increased bone mass compared with untreated animals. Animal models confirm that ibandronic acid is a highly potent inhibitor of osteoclastic activity. In growing rats, there was no evidence of impaired mineralization even at doses greater than 5,000 times the dose required for osteoporosis treatment. The high potency and therapeutic margin of ibandronic acid allows for more flexible dosing regimens and intermittent treatment with long drug-free intervals at comparatively low doses.<br />\r\n<br />\r\nIbandronic acid is a highly potent bisphosphonate belonging to the nitrogen-containing group of bisphosphonates, which act on bone tissue and specifically inhibit osteoclast activity, It does not interfere with osteoclast recruitment. The selective action of ibandronic acid on bone tissue is based on the high affinity of this compound for hydroxyapatite, which represents the mineral matrix of the bone. Ibandronic acid reduces bone resorption, with no direct effect on bone formation. In postmenopausal women, it reduces the elevated rate of bone turnover towards premenopausal levels, leading to a progressive net gain in bone mass. Daily or intermittent administration of ibandronic acid results in reduced bone resorption as reflected in reduced levels of serum and urinary biochemical markers of bone turnover, increased BMD and a decreased incidence of fractures.</p>', '<p>The recommended dose of Ibandronic acid for treatment is one 150 mg film-coated tablet once a month. The tablet should preferably be taken on the same date each month. Ibandronic acid should be taken 60 minutes before the first food or drink (other than water) of the day or any other oral medication or supplementation (including calcium):</p>\r\n\r\n<ul>\r\n	<li>Tablets should be swallowed whole with a full glass of plain water (180 to 240 ml) while the patient is sitting or standing in an upright position. Patients should not lie down for 60 minutes after taking Ibandronic acid.</li>\r\n	<li>Plain water is the only drink that should be taken with Ibandronic acid. Please note that some mineral waters may have a higher concentration of calcium and therefore should not be used.</li>\r\n	<li>Patients should not chew or suck the tablet because of a potential for oropharyngeal ulceration. Patients should receive supplemental calcium or vitamin D if dietary intake is inadequate. In case a once-monthly dose is missed, patients should be instructed to take one Ibandronic Acid 150 mg tablet the morning after the tablet is remembered unless the time to the next scheduled dose is within 7 days. Patients should then return to taking their dose once a month on their originally scheduled date. If the next scheduled dose is within 7 days, patients should wait until their next dose and then continue taking one tablet once a month as originally scheduled. Patients should not take two 150 mg tablets within the same week.</li>\r\n</ul>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>', '<p>It is likely that calcium supplements, antacids and some oral medications containing multivalent cations (such as aluminium, magnesium, iron) are likely to interfere with the absorption of Ibandronic Acid. Therefore, patients must wait 60 minutes after taking Ibandronic Acid before taking other oral medications. Pharmacokinetic interaction studies in postmenopausal women have demonstrated the absence of any interaction potential with tamoxifen or hormone replacement therapy (estrogen). No interaction was observed when co-administered with melphalan/prednisolone in patients with multiple myeloma. In healthy male volunteers and postmenopausal women, i.v. ranitidine caused an increase in ibandronic acid bioavailability of about 20 %, probably as a result of reduced gastric acidity. However, since this increase is within the normal range of the bioavailability of ibandronic acid, no dosage adjustment is required when Ibandronic Acid is administered with H2-antagonists or other drugs which increase gastric pH.<br />\r\n<br />\r\nIn relation to disposition, no drug interactions of clinical significance are considered likely, since ibandronic acid does not inhibit the major human hepatic P450 isoenzymes and has been shown not to induce the hepatic cytochrome P450 system in rats. Furthermore, plasma protein binding is low at therapeutic concentrations and ibandronic acid is therefore unlikely to displace other drugs. Ibandronic acid is eliminated by renal excretion only and does not undergo any biotransformation. The secretory pathway appears not to include known acidic or basic transport systems involved in the excretion of other drugs. In a one-year study in postmenopausal women with osteoporosis (BM16549). the incidence of upper gastrointestinal events in patients concomitantly taking aspirin or NSAIDs was similar in patients taking Ibandronic Acid 2.5 mg daily or 150mg once monthly. Of over 1500 patients enrolled in study BM 16549 comparing monthly with daily dosing regimens of ibandronic acid, 14% of patients used histamine (H2) blockers or proton pump inhibitors. Among these patients, the incidence of upper gastrointestinal events in the patients treated with Ibandronic Acid 150 mg once monthly was similar to that in patients treated with Ibandronic Acid 2.5 mg daily.</p>', '<p>Ibandronic Acid is contraindicated in patients with known hypersensitivity to ibandronic acid or to any of the excipients. Ibandronic Acid is contraindicated in patients with uncorrected hypocalcemia. As with all bisphosphonates indicated in the treatment of osteoporosis, pre-existing hypocalcemia needs to be corrected before initiating therapy with Ibandronic Acid. As with several bisphosphonates, Ibandronic Acid is contraindicated in patients with abnormalities of the esophagus which delay esophageal emptying such as stricture or achalasia. Ibandronic Acid is contraindicated in patients who are unable to stand or sit upright for at least 60 minutes.</p>', '<p>The main side effects of ibandronic acid are dyspepsia, nausea, diarrhea, abdominal pain, muscle aches, headaches, dizziness.</p>', '<p><strong>Pregnancy</strong>: Ibandronic Acid should not be used during pregnancy. There was no evidence for a direct fetal toxic or teratogenic effect of ibandronic acid in daily orally treated rats and rabbits and there were no adverse effects on the development in F1 offspring in rats. Adverse effects of ibandronic acid in reproductive toxicity studies in the rat were those observed with bisphosphonates as a class. They include a decreased number of implantation sites, interference with natural delivery (dystocia), and an increase in visceral variations (renal pelvis ureter syndrome). Specific studies for the monthly regimen have not been performed. There is no clinical experience with Ibandronic Acid in pregnant women.<br />\r\n<br />\r\n<strong>Nursing Mothers</strong>: Ibandronic Acid should not be used during lactation. In lactating rats treated with 0.08 mg/kg/day IV. ibandronic acid, the highest concentration of ibandronic acid in breast milk was 8.1 ng/ml and was seen in the first 2 hours after i.v. administration. After 24 hours, the concentration in milk and plasma was similar, and corresponded to about 5 % of the concentration measured after 2 hours.</p>', '<p>Hypocalcemia and other disturbances of bone and mineral metabolism should be effectively treated before starting Ibandronic Acid therapy. Adequate intake of calcium and vitamin D is important in all patients. Orally administered bisphosphonates may cause local irritation of the upper gastrointestinal mucosa. Because of these possible irritant effects and a potential for worsening of the underlying disease, caution should be used when Ibandronic Acid is given to patients with active upper gastrointestinal problems (e.g. known Barrett&rsquo;s esophagus, dysphagia, other esophageal diseases, gastritis, duodenitis or ulcers). Adverse experiences such as esophagitis, esophageal ulcers and esophageal erosions, in some cases severe and requiring hospitalization, rarely with bleeding or followed by esophageal stricture or perforation, have been reported in patients receiving treatment with oral bisphosphonates. The risk of severe esophageal adverse experiences appears to be greater in patients who do not comply with the dosing instruction and/or who continue to take oral bisphosphonates after developing symptoms suggestive of esophageal irritation. Patients should pay particular attention and be able to comply with the dosing instructions.<br />\r\n<br />\r\nPhysicians should be alert to any signs or symptoms signaling a possible esophageal reaction and patients should be instructed to discontinue Ibandronic Acid and seek medical attention if they develop dysphagia, odynophagia, retrosternal pain or new or worsening heartburn. While no increased risk was observed in controlled clinical trials there have been post-marketing reports of gastric and duodenal ulcers with oral bisphosphonate use, some severe and with complications. Since NSAIDs and bisphosphonates are both associated with gastrointestinal irritation, caution should be taken during concomitant medication with Ibandronic Acid. Osteonecrosis of the jaw (ONJ) has been reported in patients treated with bisphosphonates. Most cases have been in cancer patients undergoing dental procedures, but some have occurred in patients with postmenopausal osteoporosis or other diagnoses. Known risk factors for osteonecrosis of the jaw include a diagnosis of cancer, concomitant therapies (e.g., chemotherapy, radiotherapy, corticosteroids), and co-morbid disorders (e.g., anemia, coagulopathy, infection, pre-existing dental disease). Most reported cases have been in patients treated with bisphosphonates intravenously but some have been in patients treated orally. For patients who develop osteonecrosis of the jaw while on bisphosphonate therapy, dental surgery may exacerbate the condition. For patients requiring dental procedures, there are no data available to suggest whether discontinuation of bisphosphonate treatment reduces the risk of ONJ. Clinical judgment of the treating physician should guide the management plan of each patient based on individual benefit-risk assessment.</p>', '<p>No specific information is available on the treatment of overdosage with ibandronic acid. However, oral overdosage may result in upper gastrointestinal adverse events, such as upset stomach, heartburn, esophagitis, gastritis, or ulcer. Milk or antacids should be given to bind ibandronic acid. Owing to the risk of esophageal irritation, vomiting should not be induced and the patient should remain fully upright.</p>', '<p>Bisphosphonate preparations</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', '<p><strong>Patients with renal impairment</strong>: No dosage adjustment is necessary for patients with mild or moderate renal impairment where creatinine clearance is &ge;30 ml/min. Below 30 ml/min creatinine clearance, the decision to administer Ibandronic Acid should be based on an individual risk-benefit assessment.<br />\r\n<br />\r\n<strong>Patients with hepatic impairment</strong>: No dosage adjustment is necessary.<br />\r\n&nbsp;</p>\r\n\r\n<p><strong>Elderly</strong>: No dosage adjustment is necessary.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Children</strong>: Safety and efficacy have not been established in patients less than 18 years old.</p>', '2022-02-27 19:02:04', '2022-06-17 00:38:37'),
(726, 726, '<p>This Kit is indicated for the treatment and prevention of osteoporosis in women (especially after menopause) &amp; men. It increases bone mineral density (BMD) and reduces the incidence of vertebral fractures.</p>', NULL, '<p>One tablet of Ibandronic Acid 150 mg once monthly of the same date of each month is recommended. To maximize the clinical benefit of Ibandronic Acid, two tablets of Calcium Orotate per day are usually recommended in divided dosage.<br />\r\n<br />\r\nTo maximize absorption and clinical benefit, Ibandronic Acid tablet of this&nbsp;Kit should be taken at least 60 minutes before the first food or drink (other than water) of the day or before taking any oral medication or supplementation, including calcium, antacids, or vitamins.<br />\r\n<br />\r\nTo facilitate delivery to the stomach and thus reduce the potential for esophageal irritation, Ibandronic Acid tablet should be swallowed whole with a full glass of plain water (250 ml) while the patient is standing or sitting in an upright position. Patients should not lie down for 60 minutes after taking Ibandronic Acid tablet.<br />\r\n<br />\r\nIbandronic Acid 150 mg tablet of this Kit should be taken on the same date of each month (i.e., the patients Ibandronic Acid day)<br />\r\n<br />\r\nIf the once monthly dose is missed, and the patients next scheduled Ibandronic Acid day is more than 7 days away, the patient should be instructed to take one Ibandronic Acid 150 mg tablet in the morning following the date that it is remembered. The patient should then return to taking one Ibandronic Acid 150 mg tablet every month in the morning of their chosen day, according to their original schedule.<br />\r\n<br />\r\nIf the once monthly dose is missed, and the patients next scheduled Ibandronic Acid day is only 1 to 7 days away, the patient must wait until the subsequent month&rsquo;s scheduled Ibandronic Acid day to take their tablet. The patient should then return to taking one Ibandronic Acid 150 mg tablet every month in the morning of their chosen day according to their original schedule.<br />\r\n<br />\r\nThe Patient must not take two Ibandronic Acid 150 mg tablets within the same week.<br />\r\n<br />\r\nStart taking Calcium Orotate tablets from the next day of Ibandronic Acid day (from day-2 and onwards).</p>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>', '<p><strong>Ibandronic Acid</strong>: Products containing calcium and other multivalent cautions (such as aluminium, magnesium, iron) are likely to interfere with absorption of Ibandronic Acid. Ibandronic Acid should be taken at least 60 minutes before any oral medications. Aspirin, NSAIDs, and bisphosphonates are all associated with gasrointestinal irritation, caution should be exercised in the concomitant use of aspirin of NSNADs with Ibandronic Acid.<br />\r\n<br />\r\n<strong>Calcium Orotate</strong>: Calcium can decrease the absorption of the other drugs such as bisphosphonates (e.g., alendronate/risedronate), quinolone antibiotics (e.g., ciprofloxacin, levofloxacin), and tetracycline antibiotic (e.g., doxycycline, levofloxacin).</p>', '<p><strong>Ibandronic Acid</strong>: Abnormalities of the esophagus, hypocalcemia, known hypersensitivity to Ibandronic Acid or any of its components.<br />\r\n<br />\r\n<strong>Calcium Orotate</strong>: Incomplete bowel movements, Kidney stone, Kidney disease and lung disease.</p>', '<p><strong>Ibandronic Acid</strong>: Common side effects include Hypertension, Dyspepsia, Nausea, Diarrhea, Abdominal Pain, Arthralgia, Back Pain, Localized Osteoarthritis, Myalgia, Muscle Cramp, Influenza, Nasopharyngitis, Bonchitis, Urinary Tract Infection, Upper Respiratory Tract Infection, Headache, Dizziness, Skin Rash, Insomnia etc.<br />\r\n<br />\r\n<strong>Calcium Orotate</strong>: Bloating and swelling in the abdomen are common side effects of Calcium Orotate, loss of appetite, upset stomach, constipation, nausea, vomiting, unusual weight loss, mood changes, bone/muscle pain, headache, increased thirst/urination, weakness, unusual tiredness, formation of kidney stones may occur infrequently.</p>', '<p>There are no adequate and well-controlled studies in pregnant women for this kit. This kit should be used during pregnancy only if the potential benefit justifies the potential risk to the mother and fetus. It is not known whether this kit is excreted in human milk. Caution should be exercised when this kit is administered to a nursing woman.</p>', '<p>Ibandronic Acid:</p>\r\n\r\n<ul>\r\n	<li>Ibandronic Acid of this Kit may cause local irritation of the upper gastrointestinal mucosa.</li>\r\n	<li>Adequate intake of Calcium is important in all patient hypocalcaemia</li>\r\n	<li>Severe and occasionally incapacitating bone joint, and/or muscle pain has been reported in patients taking Ibandronic Acid.</li>\r\n	<li>Ibandronic Acid is not recommended for use in patients with severe renal impairment (Creatinine clearance of &lt;30 ml/min).</li>\r\n</ul>\r\n\r\n<p>Calcium Orotate: Before taking Calcium Orotate, precaution is needed if the patient is allergic to Calcium Orotate. Any Calcium supplement taken without food may increase the risk of kidney stones. Therefore, it is advisable that Calcium Orotate be taken with food.</p>', NULL, '<p>Minerals in bone formation, Specific mineral preparations</p>', '<p>Store in a cool &amp; dry place, protected from light. Keep all medicines out of reach of children.</p>', '<p><strong>Pediatric Use</strong>: Safety and effectiveness in pediatric patients have not been established.<br />\r\n<br />\r\n<strong>Renal and hepatic impaired patient</strong>: No dose adjustment is necessary for patients with mild or moderate renal impairment where creatinine clearance is equal to or greater than 30 ml/min. No dose adjustment is required for patients with hepatic impairment.</p>', '2022-02-27 19:03:14', '2022-06-17 00:42:00'),
(727, 727, '<p>This kit is indicated for the treatment and prevention of Osteoporosis. It increases Bone Mineral Density (BMD) and reduces the incidence of vertebral fractures.</p>', '<p>Ibandronic Acid (Ibandronate Sodium Monohydrate) is a nitrogen- containing bisphosphonate that inhibits osteoclast-mediated bone resorption. The action of Ibandronate on bone tissue is based on its affinity for hydroxyapatite, which is part of the mineral matrix of bone. Ibandronate inhibits osteoclast activity and reduces bone resorption and turnover. In postmenopausal women, it reduces the elevated rate of bone turnover, leading to, on average, a net gain in bone mass.<br />\r\n<br />\r\nThe combination of Coral Calcium and Colecalciferol is composed of Calcium Carbonate with small amounts of Magnesium and other Trace minerals. Coral Calcium ensures better absorption than Calcium of other Calcium Carbonate origin due to its chemical structure that is very similar to the composition of human bone Calcium Carbonate. Vitamin-D aids in the absorption of Calcium from GI tract and helps to maintain Calcium balance in the body.</p>', '<p>One tablet of Ibandronic Acid 150 mg once monthly on the same date of each month is recommended. To maximize clinical benefit of Ibandronic acid, two tablets of Calcium 500 mg and Vitamin D3 200 IU per day are usually recommended in divided dosage or as directed by the physician.<br />\r\n<br />\r\n<strong>Day 1</strong>: Take the Ibandronic Acid tablet on an empty stomach at least 60 minutes before the first food or drink (other than water) of the day or before taking any oral medication or supplementation including Calcium, Antacid and/or Vitamins</p>\r\n\r\n<ul>\r\n	<li>Swallow tablet whole with a glass of plain water while standing or sitting in an upright position</li>\r\n	<li>Avoid lying down for 60 minutes</li>\r\n	<li>Do not chew or suck the tablet</li>\r\n</ul>\r\n\r\n<p><strong>Day 2-31</strong>: One tablet of Calcium and Vitamin D should be taken at the morning and at the evening after meal</p>\r\n\r\n<ul>\r\n	<li>Tablets should be taken in order as directed on the blister strip for ease of dose tracking.</li>\r\n</ul>\r\n\r\n<p><strong>Pediatric patient</strong>: Safety and effectiveness in pediatric patients have not been established.</p>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>', '<p><strong>Ibandronic Acid</strong>: Products containing calcium and other multivalent cations (such as aluminum, magnesium, iron), including milk, food, and antacids are likely to interfere with absorption of Ibandronate. It is also found to interact with H2 blockers such as Ranitidine in several clinical trials..<br />\r\n<br />\r\n<strong>Calcium (Coral) and Vitamin-D</strong>: Oral Calcium can reduce the absorption of tetracycline &amp; fluoride preparations and minimum 3 hours&rsquo; time should be allowed between ingestion of these medications. Thiazide diuretics reduce the renal excretion of Calcium. Phenytoin, barbiturates, glucocorticoids may induce metabolism of Vitamin D. Concomitant intake of certain foods like spinach, cereals, milk and its derivatives may reduce the intestinal uptake of Calcium.</p>', '<p>Ibandronic Acid is contraindicated in conditions like: abnormalities of the esophagus which delay esophageal emptying such as stricture or achalasia. Inability to stand or sit upright for at least 60 minutes, Hypocalcemia, known hypersensitivity to Ibandronic Acid.<br />\r\n<br />\r\nCalcium &amp; Vitamin D3: Hypersensitivity to any of the component of this preparation. It is also contraindicated in case of hypercalcemia, hyperparathyroidism, hypercalciuria, nephrolithiasis, severe renal insufficiencies, concomitant Digoxin therapy (requires careful monitoring of serum calcium level), renal calculi and Zollinger Ellison syndrome.</p>', '<p>Ibandronic Acid: Common side effects include Hypertension, Dyspepsia, Nausea, Diarrhea, Abdominal Pain, Arthralgia, Back Pain, Localized Osteoarthritis, Myalgia, Muscle Cramp, Influenza, Nasopharyngitis, Bronchitis, Urinary Tract Infection, Upper Respiratory Tract Infection, Headache, Dizziness, Skin rash, Insomnia etc.<br />\r\n<br />\r\nCalcium &amp; Vitamin D3: Most common side effects are flatulence, diarrhea, constipation, upper GI discomfort etc. Hypercalciuria and hypercalcemia due to prolong use has rarely been reported.</p>', '<p>Pregnancy category C. There are no adequate and well-controlled studies in pregnant women. This kit should be used during pregnancy only if the potential benefit justifies the potential risk to the mother and fetus.<br />\r\n<br />\r\nNursing mother: It is not known whether this kit is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when this kit is administered to a nursing woman.</p>', '<p>Ibandronic Acid:</p>\r\n\r\n<ul>\r\n	<li><strong>Upper Gastrointestinal Adverse Reactions</strong>: Ibandronic acid like other bisphosphonates administered orally may cause local irritation of the upper gastrointestinal mucosa. Because of these possible irritant effects, caution should be used when Ibandronic acid is given to patients with active upper gastrointestinal problems (such as known Barrett&rsquo;s esophagus, dysphagia, other esophageal diseases, gastritis, duodenitis or ulcers).</li>\r\n	<li><strong>Hypocalcaemia and Mineral Metabolism</strong>: Treat hypocalcemia and other disturbances of bone and mineral metabolism before starting therapy.</li>\r\n	<li><strong>Musculoskeletal Pain</strong>: Severe and occasionally incapacitating bone, joint, and/or muscle pain has been reported in patients taking Ibandronic acid and other bisphosphonates.</li>\r\n	<li><strong>Jaw Osteonecrosis</strong>: Osteonecrosis, primarily in the jaw, has been reported in patients treated with bisphosphonates. Most cases have been in cancer patients undergoing dental procedures, but some have occurred in patients with postmenopausal osteoporosis or other diagnoses.</li>\r\n</ul>\r\n\r\n<p>Calcium and Vitamin-D: In mild hypercalciuria reduction of dose is sufficient to return to normal serum Calcium concentration. Plasma and serum Calcium level should be monitored in mild to moderate renal impairment patients and also in case of long term use. Patients with renal stone or with such previous history should be recommended to increase their fluid intake.</p>', '<p>No specific information is available on the treatment of over dosage of Ibandronic acid. However, based on knowledge of this class of compounds, oral over dosage may result in hypocalcemia, hypophosphatemia, and upper gastrointestinal adverse events.</p>', '<p>Bisphosphonate preparations</p>', '<p>Do not store above 30&deg;C. Keep away from light and out of the reach of children.</p>', NULL, '2022-02-27 19:03:59', '2022-06-17 00:44:00'),
(728, 728, '<p><strong>Mantle Cell Lymphoma</strong>: Ibrutinib is indicated for the treatment of patients with Mantle Cell Lymphoma (MCL) who have received at least one prior therapy.<br />\r\n<br />\r\n<strong>Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma</strong>: Ibrutinib is indicated for the treatment of patients with chronic lymphocytic leukemia. Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma with 17p deletion Ibrutinib is indicated for the treatment of patients with chronic lymphocytic leukemia.<br />\r\n<br />\r\n<strong>Waldenstrom Macroglobulinemia (WM)</strong>: Ibrutinib is indicated for the treatment of patients with Waldenstrom Macroglobulinemia (WM).<br />\r\n<br />\r\n<strong>Marginal Zone Lymphoma</strong>: Ibrutinib is indicated for the&nbsp; reatment of patients with marginal zone lymphoma (MZL) who require systemic therapy and have received at least one prior anti-CD 20-based therapy.</p>', '<p>Ibrutinib is a small-molecule inhibitor of BTK. Ibrutinib forms a covalent bond with a cysteine residue in the BTK active site, leading to inhibition of BTK enzymatic activity. BTK is a signaling molecule of the B-cell antigen receptor (BCR) and cytokine receptor pathways. BTK&rsquo;s role in signaling through the B-cell surface receptors results in activation of pathways necessary for B-cell trafficking, chemotaxis, and adhesion. Nonclinical studies show that ibrutinib inhibits malignant B-cell proliferation and survival in vivo as well as cell migration and substrate adhesion in vitro.</p>', '<p><strong>Mantle Cell Lymphoma and Marginal Zone Lymphoma</strong>: The recommended dose of Ibrutinib for MCL and MZL is 560 mg (four 140 mg capsules) orally once daily until disease progression or unacceptable toxicity.<br />\r\n<br />\r\n<strong>Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma and Waldenstrom Macroglobulinemia (WM)</strong>: The recommended dose of Ibrutinib for CLL/SLL and WM is 420 mg (three 140 mg capsules) orally once daily until disease progression or unacceptable toxicity. The recommended dose of Ibrutinib for CLL/SLL when used in combination with bendamustine and rituximab (administered every 28 days for up to 6 cycles) is 420 mg (three 140 mg capsules) orally once daily until disease progression or unacceptable toxicity.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>Administer Ibrutinib orally once daily at approximately the same time each day.<br />\r\nSwallow the capsules whole with water. Do not open, break, or chew the capsules.</p>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>', '<p><strong>CYP3A Inhibitors</strong>: Co-administration with strong and moderate CYP3A inhibitors should be avoided. If a moderate CYP3A inhibitor must be used, Ibrutinib dose should be reduced&nbsp;<br />\r\n<br />\r\n<strong>CYP3A Inducers</strong>: Co-administration with strong CYP3A inducers should be avoided</p>', '<p>Hypersensitivity to the active substance or to any of the excipients.</p>', '<p>The following adverse reactions are discussed in more detail in other sections of the labeling: Hemorrhage, Infections, Cytopenias, Atrial Fibrillation, Hypertension, Second Primary Malignancies and Tumor Lysis Syndrome. Additional Important Adverse Reactions: Diarrhea, Visual Disturbance.</p>', '<p><strong>Pregnancy</strong>: Ibrutinib, a kinase inhibitor, can cause fetal harm based on findings from animal studies. In animal reproduction studies, administration of Ibrutinib to pregnant rats and rabbits during the period of organogenesis at exposures up to 2-20 times the clinical doses of 420-560 mg daily produced embryofetal toxicity including malformations. If Ibrutinib is used during pregnancy or if the patient becomes pregnant while taking Ibrutinib, the patient should be apprised of the potential hazard to the fetus. The estimated background risk of major birth defects and miscarriage for the indicated population is unknown.<br />\r\n<br />\r\n<strong>Lactation</strong>: There is no information regarding the presence of Ibrutinib or its metabolites in human milk, the effects on the breast fed infant, or the effects on milk production.</p>', NULL, '<p>There is no specific experience in the management of Ibrutinib over dose in patients. One healthy subject experienced reversible Grade 4 hepatic enzyme increases (AST and ALT) after a dose of 1680 mg. Closely monitor patients who ingest more than the recommended dosage and provide appropriate supportive treatment.</p>', '<p>Targeted Cancer Therapy</p>', '<p>Store in a dry place below 30&deg;C, protect from light. Keep out of the reach of children.</p>', '<p><strong>Pediatric Use</strong>: The safety and effectiveness of Ibrutinib in pediatric patients has not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Of the 905 patients in clinical studies of Ibrutinib, 62% were &ge; 65 years of age, while 21% were &ge;75 years of age. No overall differences in effectiveness were observed between younger and older patients. Anemia (all grades) and Grade 3 or higher pneumonia occurred more frequently among older patients treated with Ibrutinib.<br />\r\n<br />\r\n<strong>Hepatic Impairment</strong>: Ibrutinib is metabolized in the liver. In a hepatic impairment study, data showed an increase in Ibrutinib exposure. The safety of Ibrutinib has not been evaluated in cancer patients with mild to severe hepatic impairment by Child-Pugh criteria. Monitor patients for signs of Ibrutinib toxicity and follow dose modification guidance as needed. It is not recommended to administer Ibrutinib to patients with moderate or severe hepatic impairment.</p>', '2022-02-27 19:06:40', '2022-06-17 00:46:19'),
(729, 729, '<p>Ibuprofen is indicated in the following indications-</p>\r\n\r\n<ul>\r\n	<li>Rheumatoid arthritis</li>\r\n	<li>Osteoarthritis</li>\r\n	<li>Gouty arthritis</li>\r\n	<li>Juvenile polyarthritis</li>\r\n	<li>Ankylosing spondylitis</li>\r\n	<li>Synovitis</li>\r\n	<li>Low back pain</li>\r\n	<li>Dysmenorrhoea</li>\r\n	<li>Fever</li>\r\n	<li>Migraine</li>\r\n	<li>Soft tissue injuries</li>\r\n	<li>Pain &amp; Inflammation in dental and musculoskeletal origin</li>\r\n</ul>', '<p>Ibuprofen has a high level of anti-inflammatory, anti-pyretic, and analgesic activity. The analgesic effects of Ibuprofen are due to both a peripheral and a central effect. Ibuprofen is a potent inhibitor of the enzyme cyclooxygenase, which thus results in a marked reduction in prostaglandin synthesis. Ibuprofen also inhibits the synthesis of some lipo-oxygenase products. Ibuprofen thus quickly relieves pain and stiffness, reduces swelling, and improves the movement of different joints of arthritis sufferers.</p>', '<p><strong>Adults</strong>: The dose is initially, 400 mg 3 times daily. A dose of 2400 mg daily should not be exceeded.<br />\r\n<br />\r\n<strong>Children</strong>:</p>\r\n\r\n<ul>\r\n	<li>3-6 months (body-weight over 5 kg): &frac12;&nbsp;tsp (2.5 ml) 3 times daily; max. 30 mg/kg daily in 3-4 divided doses.</li>\r\n	<li>6 months-1 year: &frac12; tsp (2.5 ml) 3-4 times daily; max. 30 mg/kg daily in 3-4 divided doses.</li>\r\n	<li>1-4 years: 1 tsp (5 ml) 3 times daily; max. 30 mg/kg daily in 3-4 divided doses.</li>\r\n	<li>4-7 years: 1&frac12; tsp (7.5 ml) 3 times daily; max. 30 mg/kg daily in 3-4 divided doses.</li>\r\n	<li>7-10 years: 2 tsp (10 ml) 3 times daily; upto 30 mg/kg (max. 2.4 gm) daily in 3-4 divided doses.</li>\r\n	<li>10-12 years: 3 tsp (15 ml) 3 times daily; upto 30 mg/kg (max. 2.4 gm) daily in 3-4 divided doses.</li>\r\n</ul>\r\n\r\n<p><strong>children weighing less than 5 kg</strong>: Not recommended for children weighing less than 5 kg.<br />\r\n<br />\r\n<strong>In juvenile rheumatoid arthritis</strong>: up to 30-40 mg/kg of body weight daily in 3-4 divided doses may be taken or as directed by the physician.</p>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>', NULL, '<p>Ibuprofen is contraindicated in patients who have shown the previous hypersensitivity to Ibuprofen, and in patients with severe or active peptic ulceration.</p>', '<p>Upset stomach, vomiting, heartburn, nausea may occur.</p>', '<p>Adverse effects of Ibuprofen on the developing fetus cannot be fully excluded. Ibuprofen should not be used during pregnancy and for nursing mothers unless the potential benefits to the mothers outweigh the potential risks.</p>', '<p>Ibuprofen should be used with caution and the lowest effective doses should be given if there is a history of gastrointestinal hemorrhage or ulcer. Patients on long-term therapy with Ibuprofen require ocular monitoring at regular intervals, as changes in ocular function have been reported. Patients with systemic lupus erythematosus are more likely than others to develop hypersensitivity to Ibuprofen. Ibuprofen should be prescribed with caution in patients with asthma and in patients with a history of hypersensitivity to other nonsteroidal anti-inflammatory agents.</p>', NULL, '<p>Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)</p>', '<p>Keep all medicines out of reach of children. Store in a cool and dry place, protected from light.</p>', NULL, '2022-02-27 19:07:02', '2022-06-17 00:48:12'),
(730, 730, '<p>Idoxuridine Eye drops is used for Skin infection, Eyes infection, Infection of reproduction organs, Herpes simplex infections of skin, External reproductive organs infection, External eyes area infection and other conditions. Idoxuridine Eye drops may also be used for purposes not listed in this medication guide.</p>', '<p>Herpes simplex virus utilizes thymidine in the synthesis of deoxyribonucleic acid (DNA), a metabolite necessary for reproduction. Idoxuridine is identical in chemical structure to thymidine except that the 5-methyl group is replaced by iodine. When idoxuridine is substituted for thymidine in DNA, the cell is unable to utilize the DNA and reproduction ceases.</p>', '<p><strong>Herpes simplex keratitis</strong>: As 0.1% solution: Instill 1 drop in the affected eye(s) every hour. Taper to every 2 hr or 4 times daily. Continue treatment for at least 7 days.</p>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>', '<p>Corticosteroids may accelerate spread of viral infection.</p>', '<p>Contraindicated in hypersensitivity to any ingredient of this preparation.</p>', '<p>Common side effects are eye irritation or pain, redness, itching, swelling of the eye, increased sensitivity to light and glare</p>', '<p>Idoxuridine should be administered with caution in pregnancy or in women of childbearing potential. Idoxuridine has been reported to cross the placental barrier and to produce fetal malformations in rabbits when administered topically to the eyes of pregnant females in doses similar to those used clinically.</p>', '<p>For topical use only. Do not exceed the frequency or duration of recommended dosage. The incidence of some adverse reactions increases with prolonged use. Idoxuridine is not effective in corneal inflammations following herpes simplex keratitis in which the virus is not present. Some strains of herpes simplex appear resistant to the action of Idoxuridine.</p>', NULL, '<p>Ophthalmic Anti-viral Products</p>', '<p>Store medicines at room temperature, away from heat and direct light. Do not freeze medicines unless required by package insert. Keep medicines away from children.</p>', NULL, '2022-02-27 19:07:35', '2022-06-17 00:49:58'),
(731, 731, '<p>Ifosfamide is indicated for use in combination with certain other approved antineoplastic agents for third-line&nbsp;chemotherapy&nbsp;of germ cell testicular cancer. It should be used in combination with Mesna for prophylaxis of hemorrhagic cystitis.</p>', '<p>Ifosfamide is converted to its active metabolites via hepatic microsomal enzymes. These active metabolites act as alkylating agents, disrupting DNA and protein synthesis of the target cells. It is routinely given with mesna to reduce urothelial toxicity.</p>', '<p><strong>Lymphoma, Sarcoma, Solid tumours</strong>: Different licensed dosage regimens are available.</p>\r\n\r\n<ul>\r\n	<li><strong>Regimen 1</strong>: 8-12 gm/m2&nbsp;divided over 3-5 days, repeat course every 2-4 wk.</li>\r\n	<li><strong>Regimen 2</strong>: 6 gm/m2&nbsp;divided over 5 days, repeat course every 3 wk.</li>\r\n	<li><strong>Regimen 3</strong>: 5-6 gm/m2&nbsp;(max: 10 gm), give as a single 24-hr infusion, repeat course every 3-4 wkly.</li>\r\n</ul>\r\n\r\n<p><strong>Germ cell testicular carcinoma</strong>: 1.2 gm/m2/day for 5 days via slow infusion over at least 30 minutes, repeat treatment every 3 wk or after recovery from haematological toxicity. To be given with mesna and adequate hydration of at least 2 L of oral or IV fluid per day.</p>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>', '<p>Causes enhanced toxicity with allopurinol, cisplatin. Ifosfamide enhances the anticoagulant effect of warfarin. CYP2A6 inducers (e.g. amobarbital, pentobarbital, phenobarbital, rifampin and secobarbital) may reduce serum levels of ifosfamide while the inhibitors (e.g. isoniazid, methoxsalen and miconazole) may increase its serum levels. CYP3A4 inducers (e.g. aminoglutethimide, carbamazepine, nafcillin, nevirapine, phenobarbital, phenytoin, and rifamycins) may reduce serum levels of ifosfamide while the inhibitors (e.g. azole antifungals, clarithromycin, diclofenac, doxycycline, erythromycin, imatinib, isoniazid) may increase its serum levels.</p>', '<p>Hypersensitivity; severe bone-marrow depression. Pregnancy, lactation.</p>', '<p>Confusion, alopoecia, nausea, vomiting, phloebitis, somnolence, depression, hallucinations. Wound healing may be impaired during ifosfamide use.<br />\r\n<br />\r\n<strong>Potentially Fatal:</strong>&nbsp;Severe myelosuppression, haemorrhagic cystitis, nephrotoxicity, cardiotoxicity, coma.</p>', '<p><strong>Category D:</strong>&nbsp;There is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).</p>', '<p>Hepatic or renal dysfunction, compromised bone marrow reserve. Use with mesna and ensure high oral/IV fluid intake to reduce urotoxic effects.</p>', NULL, '<p>Cytotoxic Chemotherapy</p>', '<p>Store at 20-25&deg; C.</p>', '<p>Renal Impairment: CrCl&nbsp;&lt;10: Administer 75% of dose.</p>', '2022-02-27 19:07:55', '2022-06-17 00:52:47'),
(732, 732, '<p>Iloperidone is indicated for the treatment of schizophrenia in adults.<br />\r\n<br />\r\nWhen deciding among the alternative treatments available for this condition, the prescriber should consider the finding that iloperidone is associated with prolongation of the QTc interval. Prolongation of the QTc interval is associated in some other drugs with the ability to cause torsade de pointestype arrhythmia, a potentially fatal polymorphic ventricular tachycardia&nbsp;which can result in sudden death. In many cases this would lead to the conclusion that other drugs should be tried first. Whether iloperidone will cause torsade de pointes or increase the rate of sudden death is not yet known.<br />\r\n<br />\r\nPatients must be titrated to an&nbsp;effective dose&nbsp;of iloperidone. Thus, control of symptoms may be delayed during the first 1 to 2 weeks of treatment compared to some other antipsychotic&nbsp;drugs that do not require a similar titration. Prescribers should be mindful of this delay when selecting an antipsychotic drug for the treatment of schizophrenia</p>', '<p>Iloperidone shows high affinity and maximal receptor occupancy for dopamine D2 receptors in the caudate nucleus and putamen of the brains of schizophrenic patients. The improvement in cognition is attributed to iloperidone&#39;s high affinity for &alpha; adrenergic receptors. Iloperidone also binds with high affinity to serotonin 5-HT2a and dopamine 3 receptors. Iloperidone binds with moderate affinity to dopamine D4, serotonin 5-HT6 and 5-HT7, and norepinephrine NE&alpha;1 receptors. Furthermore, iloperidone binds with weak affinity to serotonin 5-HT1A, dopamine D1, and histamine H1 receptors.</p>', '<p><strong>Initial dose</strong>: 1 mg orally twice a day<br />\r\n<strong>Titration</strong>: Increase in increments of not more than 2 mg twice daily as tolerated.<br />\r\n<strong>Target dose</strong>: 6 to 12 mg twice a day<br />\r\n<strong>Maximum dose</strong>: 24 mg/day<br />\r\n<br />\r\nThis drug must be titrated slowly to avoid orthostatic hypotension; because of the need to titrate slowly, control of symptoms may be delayed during the first 1 to 2 weeks of treatment.</p>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>', '<p>There are no known drug interactions and none well documented.</p>', '<p>Hypersensitivity.</p>', '<p>Dizziness (20%), Dry mouth (15%), Nausea (10%), Somnolence (10%), Tachycardia, Diarrhea, Ejaculation failure, Myalgia, Nasal congestion, Orthostatic hypotension, Palpitations, Urinary incontinence, Weight gain</p>', '<p><strong>Pregnancy</strong>&nbsp;Category-C. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks<br />\r\n<br />\r\n<strong>Lactation</strong>:&nbsp;Not known if excreted in breast milk, do not nurse.</p>', '<p>This drug is not approved for the treatment of patients with dementia-related psychosis. Prolongs QT interval; caution with other drugs/conditions that increase QTc. Risk of neuroleptic malignant syndrome and extrapyramidal symptoms. May cause anticholinergic side effects (eg., confusion, agitation). Blood dyscrasias (leukopenia, neutropenia, agranulocytosis) may occur. Orthostatic hypotension may occur.</p>', NULL, '<p>Piperidinyl-benzisoxazole derivative</p>', NULL, '<p>Renal Dose Adjustments: No adjustment recommended.<br />\r\n<br />\r\nLiver Dose Adjustments-</p>\r\n\r\n<ul>\r\n	<li><strong>Mild hepatic impairment</strong>: No adjustment recommended.</li>\r\n	<li><strong>Moderate hepatic impairment</strong>: Use with caution.</li>\r\n	<li><strong>Severe hepatic impairment</strong>: Not recommended.</li>\r\n</ul>', '2022-02-27 19:08:19', '2022-06-17 00:54:49');
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
(733, 733, '<ul>\r\n	<li>Newly diagnosed adult and pediatric patients with Philadelphia chromosome positive chronic myeloid leukemia (Ph+CML) in chronic phase.</li>\r\n	<li>Patients with Philadelphia chromosome positive chronic myeloid leukemia in blast crisis, accelerated phase, or in chronic phase after failure of interferon-alpha therapy.</li>\r\n	<li>Adult patients with relapsed or refractory Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL).</li>\r\n	<li>Pediatric patients with newly diagnosed Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL) in combination with chemotherapy</li>\r\n	<li>Adult patients with myelodysplastic/myeloproliferative diseases associated with platelet-derived growth factor receptor (PDGFR) gene re-arrangements.</li>\r\n	<li>Adult patients with aggressive systemic mastocytosis without the D816V c-Kit mutation or with c-Kit mutational status unknown.</li>\r\n	<li>Adult patients with hypereosinophilic syndrome and/or chronic eosinophilic leukemia who have the FIP1L1-PDGFR a fusion kinase (mutational analysis or fluorescence in situ hybridization [FISH] demonstration of CHIC2 allele deletion) and for patients with HES and/or CEL who are FIP1L1-PDGFRa fusion kinase negative or unknown.</li>\r\n	<li>Adult patients with unresectable, recurrent and/or metastatic dermatofibrosarcoma protuberans.</li>\r\n	<li>Patients with Kit (CD117) positive unresectable and/or metastatic malignant gastrointestinal stromal tumors.</li>\r\n	<li>Adjuvant treatment of adult patients following complete gross resection of Kit (CD117) positive GIST.</li>\r\n</ul>', '<p>Imatinib is a small molecule protein-tyrosine kinase inhibitor that potently inhibits the activity of the Bcr-Abl tyrosine kinase (TK), as well as several receptor TKs: Kit, the receptor for stem cell factor (SCF) coded for by the c-Kit proto-oncogene, the discoidin domain receptors (DDR1 and DDR2), the colony stimulating factor receptor (CSF-1R) and the platelet-derived growth factor receptors alpha and beta (PDGFR-alpha and PDGFR beta). Imatinib can also inhibit cellular events mediated by activation of these receptor kinases.<br />\r\n<br />\r\n<strong>Absorption and Distribution</strong>: Imatinib is well absorbed after oral administration with Cmax achieved within 2 4 hours post-dose. Mean absolute bioavailability is 98%. Mean Imatinib AUC increases proportionally with increasing doses ranging from 25 mg to 1,000 mg. There is no significant change in the pharmacokinetics of Imatinib on repeated dosing, and accumulation is 1.5- to 2.5- fold at a steady state when Imatinib is dosed once daily. At clinically relevant concentrations of Imatinib, binding to plasma proteins in in vitro experiments is approximately 95%, mostly to albumin and 1-acid glycoprotein.<br />\r\n<br />\r\n<strong>Metabolism</strong>: CYP3A4 is the major enzyme responsible for metabolism of Imatinib. Other cytochrome P450 enzymes, such as CYP1A2, CYP2D6, CYP2C9, and CYP2C19, play a minor role in its metabolism. The main circulating active metabolite in humans is the N-demethylated piperazine derivative, formed predominantly by CYP3A4. It shows in vitro potency similar to the parent Imatinib. The plasma AUC for this metabolite is about 15% of the AUC for Imatinib. The plasma protein binding of N-demethylated metabolite CGP74588 is similar to that of the parent compound.<br />\r\n<br />\r\n<strong>Excretion</strong>: Imatinib elimination is predominately in the feces, mostly as metabolites. Based on the recovery of compound(s) after an oral 14C-labeled dose of Imatinib, approximately 81% of the dose was eliminated within 7 days, in feces (68% of dose) and urine (13% of dose). Unchanged Imatinib accounted for 25% of the dose (5% urine, 20% feces), the remainder being metabolites. Following oral administration in healthy volunteers, the elimination half-lives of Imatinib and its major active metabolite, the N-demethyl derivative (CGP74588), are approximately 18 and 40 hours, respectively.</p>', '<p>Adults with Ph+ CML CP: 400 mg/day<br />\r\nAdults with Ph+ CML AP or BC: 600 mg/day<br />\r\nPediatrics with Ph+ CML CP: 340 mg/m2/day<br />\r\nAdults with Ph+ ALL: 600 mg/day<br />\r\nPediatrics with Ph+ ALL: 340 mg/m2/day<br />\r\nAdults with MDS/MPD: 400 mg/day<br />\r\nAdults with ASM: 100 mg/day or 400 mg/day<br />\r\nAdults with HES/CEL: 100 mg/day or 400 mg/day<br />\r\nAdults with DFSP: 800 mg/day<br />\r\nAdults with metastatic and/or unresectable GIST: 400 mg/day<br />\r\nAdjuvant treatment of adults with GIST: 400 mg/day<br />\r\nPatients with mild to moderate hepatic impairment: 400 mg/day<br />\r\nPatients with severe hepatic impairment: 300 mg/day<br />\r\n<br />\r\nAll doses of Imatinib should be taken with a meal and a large glass of water. Doses of 400 mg or 600 mg should be administered once daily, whereas a dose of 800 mg should be administered as 400 mg twice a day. Imatinib can be dissolved in water or apple juice for patients having difficulty swallowing. Daily dosing of 800 mg and above should be accomplished using the 400-mg tablet to reduce exposure to iron.</p>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>', '<p><strong>Agents Inducing CYP3A Metabolism</strong>: Concomitant administration of Imatinib and strong CYP3A4 inducers may reduce total exposure of imatinib; consider alternative agents.<br />\r\n<br />\r\n<strong>Agents Inhibiting CYP3A Metabolism</strong>: Concomitant administration of Imatinib and strong CYP3A4 inhibitors may result in a significant imatinib exposure increase. Grapefruit juice may also increase plasma concentrations of imatinib; avoid grapefruit juice).<br />\r\n<br />\r\n<strong>Interactions with Drugs Metabolized by CYP3A4</strong>: Imatinib will increase plasma concentration of CYP3A4 metabolized drugs (e.g., triazolo-benzodiazepines, dihydropyridine calcium channel blockers, certain HMG-CoA reductase inhibitors, etc.). Use caution when administering Imatinib with CYP3A4 substrates that have a narrow therapeutic window. Because warfarin is metabolized by CYP2C9 and CYP3A4, use low-molecular weight or standard heparin instead of warfarin in patients who require anticoagulation.<br />\r\n<br />\r\n<strong>Interactions with Drugs Metabolized by CYP2D6</strong>: Use caution when administering Imatinib with CYP2D6 substrates that have a narrow therapeutic window.</p>', NULL, '<p>The following serious adverse reactions are described elsewhere in the labeling:</p>\r\n\r\n<ul>\r\n	<li>Fluid Retention and Edema</li>\r\n	<li>Hematologic Toxicity</li>\r\n	<li>Congestive Heart Failure and Left Ventricular Dysfunction</li>\r\n	<li>Hepatotoxicity</li>\r\n	<li>Hemorrhage</li>\r\n	<li>Gastrointestinal Disorders</li>\r\n	<li>Hypereosinophilic Cardiac Toxicity</li>\r\n	<li>Dermatologic Toxicities</li>\r\n	<li>Hypothyroidism</li>\r\n	<li>Growth Retardation in Children and Adolescents</li>\r\n	<li>Tumor Lysis Syndrome</li>\r\n	<li>Impairments Related to Driving and Using Machinery</li>\r\n	<li>Renal Toxicity</li>\r\n</ul>', '<p>Women of childbearing potential: Women of childbearing potential must be advised to use effective contraception during treatment and for at least 15 days after stopping treatment with Imatinib.<br />\r\n<br />\r\n<strong>Pregnancy</strong>: There are limited data on the use of imatinib in pregnant women. There have been post-marketing reports of spontaneous abortions and infant congenital anomalies from women who have taken Imatinib. Studies in animals have however shown reproductive toxicity and the potential risk for the foetus is unknown. Imatinib should not be used during pregnancy unless clearly necessary. If it is used during pregnancy, the patient must be informed of the potential risk to the foetus.<br />\r\n<br />\r\n<strong>Breast-feeding</strong>: There is limited information on imatinib distribution on human milk. Studies in two breast feeding women revealed that both imatinib and its active metabolite can be distributed into human milk. The milk plasma ratio studied in a single patient was determined to be 0.5 for imatinib and 0.9 for the metabolite, suggesting greater distribution of the metabolite into the milk. Considering the combined concentration of imatinib and the metabolite and the maximum daily milk intake by infants, the total exposure would be expected to be low (-10% of a therapeutic dose). However, since the effects of low-dose exposure of the infant to imatinib are unknown, women should not breast-feed during treatment and for at least 15 days after stopping treatment with Imatinib.<br />\r\n<br />\r\n<strong>Fertility</strong>: In non-clinical studies, the fertility of male and female rats was not affected, although effects on reproductive parameters were observed. Studies on patients receiving Imatinib and its effect on fertility and gametogenesis have not been performed. Patients concerned about their fertility on Imatinib treatment should consult with their physician.</p>', '<ul>\r\n	<li>Edema and severe fluid retention have occurred. Weigh patients regularly and manage unexpected rapid weight gain by drug interruption and diuretics.</li>\r\n	<li>Cytopenias, particularly anemia, neutropenia, and thrombocytopenia, have occurred. Manage with dose reduction, dose interruption, or discontinuation of treatment. Perform complete blood counts weekly for the first month, biweekly for the second month, and periodically thereafter.</li>\r\n	<li>Severe congestive heart failure and left ventricular dysfunction have been reported, particularly in patients with comorbidities and risk factors. Monitor and treat patients with cardiac disease or risk factors for cardiac failure.</li>\r\n	<li>Severe hepatotoxicity, including fatalities may occur. Assess liver function before initiation of treatment and monthly thereafter or as clinically indicated. Monitor liver function when combined with chemotherapy known to be associated with liver dysfunction.</li>\r\n	<li>Grade 3/4 hemorrhage has been reported in clinical studies in patients with newly diagnosed CML and with GIST. Gl tumor sites may be the source of Gl bleeds in GIST. Gastrointestinal (Gl) perforations, some fatal, have been reported.</li>\r\n	<li>Cardiogenic shock/left ventricular dysfunction has been associated with the initiation of Imatinib in patients with conditions associated with high eosinophil levels (e.g., HES, MDS/MPD, and ASM).</li>\r\n	<li>Bullous dermatologic reactions (e.g., erythema multiforme and Stevens-Johnson syndrome) have been reported with the use of Imatinib.</li>\r\n	<li>Hypothyroidism has been reported in thyroidectomy ZyvaxatX patients undergoing levothyroxine replacement. Closely monitor TSH levels in such patients.</li>\r\n	<li>Fetal harm can occur when administered to a pregnant woman. Apprise women of the potential harm to the fetus, and to avoid pregnancy when taking Imatinib.</li>\r\n	<li>Growth retardation occurring in children and pre-adolescents receiving Imatinib has been reported. Close monitoring of growth in children under Imatinib treatment is recommended.</li>\r\n	<li>Tumor Lysis Syndrome. Close monitoring is recommended.</li>\r\n	<li>Reports of motor vehicle accidents have been received in patients receiving Imatinib. Caution patients about driving a car or operating machinery.</li>\r\n	<li>Renal Toxicity. A decline in renal function may occur in patients receiving Imatinib. Evaluate renal function at baseline and during therapy, with attention to risk factors for renal dysfunction</li>\r\n</ul>', '<p>Experience with doses higher than the recommended therapeutic dose is limited. In the event of overdose the patient should be observed and an appropriate symptomatic treatment given. Generally, the reported outcome in these cases was &quot;improved&quot; or &quot;recovered&quot;. Events that have been reported at different dose ranges are as follows:<br />\r\n<br />\r\n<strong>Adult Population</strong>:</p>\r\n\r\n<ul>\r\n	<li>1200 to 1600 mg (duration varying between 1 to 10 days): Nausea, vomiting, diarrhoea, rash, erythema, oedema, swelling, fatigue, muscle spasms, thrombocytopenia, pancytopenia, abdominal pain, headache, decreased appetite.</li>\r\n	<li>1800 to 3200 mg (as high as 3200 mg daily for 6 days): Weakness, myalgia, increased creatine phosphokinase,</li>\r\n	<li>increased bilirubin, gastrointestinal pain.</li>\r\n	<li>6400 mg (single dose): One case reported in the literature of one patient who experienced nausea, vomiting, abdominal pain, pyrexia, facial swelling, decreased neutrophil count, and increased transaminases.</li>\r\n	<li>8 to 10 g (single dose): Vomiting and gastrointestinal pain have been reported.</li>\r\n</ul>\r\n\r\n<p><strong>Paediatric population</strong>: One 3-year-old male exposed to a single dose of 400 mg experienced vomiting, diarrhoea and anorexia and another 3-year-old male exposed to a single dose of 980 mg experienced decreased white blood cell count and diarrhoea. In the event of overdose, the patient should be observed and appropriate supportive treatment given.</p>', '<p>Targeted Cancer Therapy, Tyrosine Kinase Inhibitor</p>', '<p>Store below 30&deg;C, in a cool and dry place. Keep away from light. Keep out of the reach of children.</p>', NULL, '2022-02-27 19:08:40', '2022-06-17 00:57:14'),
(734, 734, '<p>The activity of Cilastatin &amp; Imipenem against an unusually broad spectrum of pathogens makes it particularly useful in the treatment of polymicrobic mixed aerobic/anaerobic infections as well as initial therapy prior to the identification of the causative organisms. Cilastatin &amp; Imipenem is indicated for the treatment of the following infections due to susceptible organisms:</p>\r\n\r\n<ul>\r\n	<li>Intra-abdominal infections</li>\r\n	<li>Lower respiratory tract infections</li>\r\n	<li>Gynaecological infections</li>\r\n	<li>Septicaemia</li>\r\n	<li>Genitourinary tract infections</li>\r\n	<li>Bone and joint infections</li>\r\n	<li>Skin and soft tissue infections</li>\r\n	<li>Endocardit</li>\r\n</ul>', '<p><strong>Imipenem</strong>&nbsp;acts as an antimicrobial through the inhibition of cell wall synthesis of various gram-positive and gram-negative bacteria. This inhibition of cell wall synthesis in gram-negative bateria is attained by binding to pencillin binding proteins (PBPs). In E. coli and selected strains of P. aeruginosa, imipenem has shown to have the highest affinity to PBP-2, PBP-1a, and PBP-1b. This preferential binding to PBP-2 and PBP-1b results in the direct conversion of the individual cell to a spheroblast, which leads to rapid cell lysis and death without filament formation.<br />\r\n<br />\r\n<strong>Cilastatin</strong>&nbsp;is a specific and reversible renal dehydropeptidase-I inhibitor. Since the antibiotic, imipenem, is hydrolyzed by dehydropeptidase-I, which resides in the brush border of the renal tubule, cilastatin is administered with imipenem to block the metabolism and thus the inactivation of imipenem so that antibacterial levels of imipenem can be attained in the urine. The drug also prevents the metabolism of leukotriene D4 to leukotriene E4 through the inhibition of leukotriene D4 dipeptidase.</p>', '<p>The total daily dosage of Imipenem should be based on the type or severity of infection and given in equally divided doses based on consideration of degree of susceptibility of the pathogens, renal function and body-weight.<br />\r\n<br />\r\n<strong>Imipenem &amp; Cilastatin IV</strong>: Up to 500 mg dose should be given over 20 to 30 minutes; &gt; 500 mg dose should be infused over 40 to 60 minutes. In patients who develop nausea during the infusion, the rate of infusion may be slowed.<br />\r\n<br />\r\n<strong>Adult</strong>:&nbsp;Normal daily dose is 1-2 g administered in 3-4 divided doses. For the treatment of moderate infection, a 1 g b.i.d. dosage regimen may also be used. In infections due to less susceptible organisms, the daily dosage may be increased to a maximum of 4 g/day or 50 mg/kg/day, whichever is lower.</p>\r\n\r\n<ul>\r\n	<li><strong>Mild infection</strong>: 250 mg 6 hourly (1 gm/day)</li>\r\n	<li><strong>Moderate infection</strong>: 500 mg 8 hourly or 1 gm 12 hourly (1.5-2 gm/day)</li>\r\n	<li><strong>Severe infection with fully susceptible microorganism</strong>: 500 mg 6 hourly (2gm/day)</li>\r\n	<li><strong>Severe infection with less susceptible organisms (primarily some strains of P. aeruginosa)</strong>: 1 gm 3-4 times daily (3-4 gm/day)</li>\r\n</ul>\r\n\r\n<p>Paediatric Dosing Schedule:</p>\r\n\r\n<ul>\r\n	<li><strong>&ge; 3 months of age</strong>: the recommended dose for non-CNS infections is 15-25 mg/kg/dose administered every six hours. The maximum daily dose for treatment of infections with fully susceptible organisms is 2.0 g per day, and of infections with moderately susceptible organisms is 4.0 g/day. Higher doses (up to 90 mg/kg/day in older children) have been used in patients with cystic fibrosis.</li>\r\n	<li><strong>&le;3 months of age</strong>: Following dosage schedule is recommended for non-CNS infections:</li>\r\n	<li><strong>&lt;1 week of age</strong>: 25 mg/kg every 12 hrs</li>\r\n	<li><strong>1-4 weeks of age</strong>: 25 mg/kg every 8 hrs</li>\r\n	<li><strong>4 weeks-3 months of age</strong>: 25 mg/kg every 6 hrs.</li>\r\n</ul>\r\n\r\n<p>Imipenem is not recommended for the therapy of meningitis. If meningitis is suspected, an appropriate antibiotic should be used. Imipenem and cilastatin for injection is not recommended in pediatric patients &lt;30 kg with impaired renal function, as no data are available.</p>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>', '<p>Concurrent admin with probenecid may increase the half-life of cilastatin. Increased risk of generalised seizures when used concurrently with ganciclovir.</p>', '<p>Contraindicated in patients who have demonstrated hypersensitivity to this product.</p>', '<p>Most common side effects with imipenem are nausea and vomiting. Other side effects reported with this drug are diarrhea, rash, thrombophlebitis, thrombocytosis, neutro-penia, eosinophilia and derangements of liver and renal functions. Use of imipenem is not recommended for patient with history of anaphylactic reaction with penicillin.</p>', '<p><strong>Pregnancy:&nbsp;</strong>Category C. There are no adequate and well controlled studies in pregnant women. Cispenam should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.<br />\r\n<br />\r\n<strong>Lactation:</strong>&nbsp;Imipenem has been detected in human milk. If the use of Cispenam is deemed essential, the patient should stop nursing.</p>', NULL, '<p>In the case of overdosage, discontinue Imipenem/Cilastatin, treat symptomatically, and institute supportive measures as required. Imipenem/Cilastatin Sodium is hemodialyzable.</p>', '<p>Other beta-lactam Antibiotics</p>', NULL, '<p>Dosage adjustment in renal impairment:</p>\r\n\r\n<ul>\r\n	<li><strong>CrCl &gt;71</strong>: No changes.</li>\r\n	<li><strong>CrCl 41-70</strong>: Max 37.5 mg/kg/day or 3 g/day. (Range: 9.4 - 37.5 mg/kg/day) divided q6-8h.</li>\r\n	<li><strong>CrCl 21-40</strong>: Max 25 mg/kg/day or 2 g/day. (Range: 6.25 - 25 mg/kg/day) divided q6-12h.</li>\r\n	<li><strong>CrCl 6-20</strong>: Max 12.5 mg/kg/day (max dose 1 g/day). Range: 6.25 - 12.5 mg/kg/day) divided q12h. (Usual: 250mg q12h)</li>\r\n	<li><strong>Dialysis Hemodialysis</strong>: 125 - 500 mg q12h. (Max 12.5 mg/kg/day). Give dose after dialysis.</li>\r\n	<li><strong>Peritonial Dialysis</strong>: 125 - 250 mg q12h</li>\r\n</ul>', '2022-02-27 19:09:04', '2022-06-17 00:59:17'),
(735, 735, '<p>Imipramine Hydrochloride is indicated in-</p>\r\n\r\n<ul>\r\n	<li>Depressive illness</li>\r\n	<li>Nocturnal enuresis in children</li>\r\n</ul>', '<p>Imipramine works by inhibiting the neuronal reuptake of the neurotransmitters norepinephrine and serotonin. It binds the sodium-dependent serotonin transporter and sodium-dependent norepinephrine transporter reducing the reuptake of norepinephrine and serotonin by neurons. Depression has been linked to a lack of stimulation of the post-synaptic neuron by norepinephrine and serotonin. Slowing the reuptake of these neurotransmitters increases their concentration in the synaptic cleft, producing knock-on effects in protein kinase signaling which is thought to contribute to changes in neurotransmission and brain physiology which relieves symptoms of depression.</p>', '<p>Depression:</p>\r\n\r\n<ul>\r\n	<li>Initially up to 75 mg daily in divided doses increased gradually to 150-200 mg (up to 300 mg in hospital patients)</li>\r\n	<li>Up to 150 mg may be given as a single dose at bedtime</li>\r\n	<li>Elderly initially 10 mg daily, increased gradually to 30-50 mg daily</li>\r\n	<li>Child not recommended for depression</li>\r\n</ul>\r\n\r\n<p>Nocturnal enuresis:</p>\r\n\r\n<ul>\r\n	<li>Child 7-8 years: 25 mg</li>\r\n	<li>8-11 years: 25-50 mg</li>\r\n	<li>Over 11 years: 50-75 mg at bedtime; max</li>\r\n</ul>\r\n\r\n<p>Period of treatment (including gradual withdrawal): 3 months-full physical examinations before the further course.</p>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>', '<p>Methylphenidate may increase the effects of imipramine. This is usually avoided by reducing the dosage of imipramine. Imipramine may increase the depressant action of alcohol. Dangerously high blood pressure has resulted from the combination of imipramine, and members of monoamine oxidase (MAO) inhibitors. Because of this, imipramine should never be taken in combination with MAO inhibitors. Patients taking any MAO inhibitors, for example phenelzine sulfate or tranylcypromine sulfate, should stop the MAO inhibitor then wait at least 14 days before starting imipramine or any other tricyclic antidepressant. The same holds true when discontinuing imipramine and starting an MAO inhibitor. The anticholinergic (drying out) effects of imipramine are additive with other anticholinergic drugs such as benztropine, biperiden, trihexyphenidyl, and antihistamines.</p>', '<p>Imipramine should not be given in conjunction with, or within 14 days of treatment with a MAO inhibitor. The combined&nbsp;therapy of this type could lead to the appearance of serious interactions such as hypertensive crises, hyperactivity, hyperpyrexia, spasticity, severe convulsions or coma and death may occur. Imipramine is contraindicated in patients with existing severe hepatic or renal damage, and those with a history of blood dyscrasias. Imipramine is contraindicated in patients who have shown hypersensitivity to the drug or hypersensitivity to tricyclic antidepressants belonging to the dibenzazepine group. Imipramine is contraindicated for use during the acute recovery phase following myocardial infarction. It should not be used in patients with convulsive disorders or glaucoma.</p>', '<p>The most frequent of side effects are dry mouth, constipation, urinary retention, increased heart rate, sedation, irritability, dizziness, and decreased coordination. Dry mouth, if severe to the point of causing difficulty speaking or swallowing, may be managed by dosage reduction or temporary discontinuation of the drug. Imipramine usage has been linked to both increases and decreases in blood pressure and heart rate. Heart attacks, congestive heart failure, and strokes have been reported. Confusion, disorientation, delusions, insomnia, and anxiety have also been reported as side effects in a small percentage of people taking imipramine. Problems associated with the skin (loss of sensation, numbness and tingling, rashes, spots, itching and puffiness), seizures, and ringing in the ears have also been reported. Nausea, vomiting, loss of appetite, diarrhea, and abdominal cramping are all side effects associated with imipramine usage in a small number of people.</p>', '<p>Pregnancy category D. Limited data suggest that imipramine is likely to be excreted in human breast milk. Known risk of damage to fetus.</p>', '<p>Imipramine should be used cautiously and with close physician supervision in people, especially the elderly, who have benign prostatic hypertrophy, urinary retention, and glaucoma, especially angle-closure glaucoma. The sedative effect is increased when imipramine is taken with other central nervous system depressants, such as alcoholic beverages, sleeping medications, other sedatives, or antihistamines. Imipramine may increase heart rate and stress on the heart. It may be dangerous for people with cardiovascular disease, especially those who have recently had a heart attack, to take this drug or other antidepressants in the same pharmacological class. Older people and persons with a history of heart disease may develop heart arrhythmias, heart conduction abnormalities, congestive heart failure, heart attack, abnormally rapid heart rates and strokes. Until a therapeutic dosage has been determined, people starting imipramine should be closely watched for signs of suicide. The risk of suicide is increased when imipramine is taken in overdose or combined with alcohol. Manic episodes and the emergence of symptoms of pre-existing psychotic states have been reported when imipramine therapy is started.</p>', '<p>Children have been reported to be more sensitive than adults to an acute overdosage of imipramine. An acute overdose in infants or young children must be considered serious and potentially fatal.</p>', '<p>Tricyclic &amp; related anti-depressant drugs, Tricyclic Anti-depressant</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-02-27 19:49:09', '2022-06-21 00:49:10'),
(736, 736, '<p>Imiquimod cream is indicated for the topical treatment of-</p>\r\n\r\n<ul>\r\n	<li>External genital and perianal warts in adults.</li>\r\n	<li>Small superficial basal cell carcinomas in adults.</li>\r\n	<li>Clinically typical, nonhyperkeratotic, nonhypertrophic actinic keratoses on the face or scalp in immunocompetent adult patients when size or number of lesions limit the efficacy and/or acceptability of cryotherapy and other topical treatment options are contraindicated or less appropriate.</li>\r\n</ul>', '<p>Imiquimod is a toll-like receptor-7 agonist enhancing both the innate and acquired immune response. It activates the production of numerous compounds, including IFN-&alpha;, IL-1, -6, -8, -10, -12, and TNF-&alpha;, stimulates natural killer cells and the proliferation of B-cells. It also activates Langerhans cells and promotes their migration to the regional lymph nodes. Imiquimod stimulates TH-1 cells to produce IFN-g, which in turn can activate cytotoxic T lymphocytes. These cells provide long-term immune memory, which can offer future protection against the previously encountered virus or tumor.</p>', '<p><strong>External genital warts in adults</strong>: Imiquimod cream should be applied 3 times per week (example: Monday, Wednesday, and Friday; or Tuesday, Thursday, and Saturday) prior to normal sleeping hours, and should remain on the skin for 6 to 10 hours. Imiquimod cream treatment should continue until the clearance of visible genital or perianal warts or for a maximum of 16 weeks per episode of warts.<br />\r\n<br />\r\nImiquimod cream should be applied in a thin layer and rubbed on the clean wart area until the cream vanishes. Only apply to affected areas and avoid any application on internal surfaces. Imiquimod cream should be applied prior to normal sleeping hours. During the 6 to 10 hour treatment period, showering or bathing should be avoided. After this period it is essential that Imiquimod cream is removed with mild soap and water. Application of an excess of cream or prolonged contact with the skin may result in a severe application site reaction. A single use sachet is sufficient to cover a wart area of 20 cm2 (approx. 3 inches2). Sachets should not be re-used once opened. Hands should be washed carefully before and after application of cream. Uncircumcised males treating warts under the foreskin should retract the foreskin and wash the area daily.<br />\r\n<br />\r\n<strong>Superficial basal cell carcinoma in adults</strong>: Apply Imiquimod cream for 6 weeks, 5 times per week (example: Monday to Friday) prior to normal sleeping hours, and leave on the skin for approximately 8 hours. Before applying Imiquimod cream, patients should wash the treatment area with mild soap and water and dry thoroughly. Sufficient cream should be applied to cover the treatment area, including one centimetre of skin surrounding the tumour. The cream should be rubbed into the treatment area until the cream vanishes. The cream should be applied prior to normal sleeping hours and remain on the skin for approximately 8 hours. During this period, showering and bathing should be avoided. After this period it is essential that Imiquimod cream is removed with mild soap and water. Sachets should not be re-used once opened. Hands should be washed carefully before and after application of cream. Response of the treated tumour to Imiquimod cream should be assessed 12 weeks after the end of treatment. If the treated tumour shows an incomplete response, a different therapy should be used. A rest period of several days may be taken if the local skin reaction to Imiquimod cream causes excessive discomfort to the patient, or if infection is observed at the treatment site. In this latter case, appropriate other measures should be taken.<br />\r\n<br />\r\n<strong>Actinic keratosis in adults</strong>: Treatment should be initiated and monitored by a physician. Imiquimod cream should be applied 3 times per week (example: Monday, Wednesday and Friday) for four weeks prior to normal sleeping hours, and left on the skin for approximately 8 hours. Sufficient cream should be applied to cover the treatment area. After a 4-week treatment-free period, clearance of Actinic Keratosis should be assessed. If any lesions persist, treatment should be repeated for another four weeks. An interruption of dosing should be considered if intense local inflammatory reactions occur or if infection is observed at the treatment site. In this latter case, appropriate other measures should be taken. Each treatment period should not be extended beyond 4 weeks due to missed doses or rest periods. If the treated area does not show complete clearance at a follow-up examination about 8 weeks after the last 4-weeks course of treatment, an additional 4-weeks course of Imiquimod treatment may be considered. A different therapy is recommended if the treated lesion(s) shows insufficient response to Imiquimod. Actinic keratosis lesions that have cleared after one or two courses of treatment and subsequently recur can be re-treated with one or two further courses of Imiquimod cream following an at least 12 weeks treatment pause. Before applying Imiquimod cream, patients should wash the treatment area with mild soap and water and dry thoroughly. Sufficient cream should be applied to cover the treatment area, including one centimetre of skin surrounding the tumour. The cream should be rubbed into the treatment area until the cream vanishes. The cream should be applied prior to normal sleeping hours and remain on the skin for approximately 8 hours. During this period, showering and bathing should be avoided. After this period it is essential that Imiquimod cream is removed with mild soap and water. Sachets should not be re-used once opened. Hands should be washed carefully before and after application of cream.<br />\r\n<br />\r\n<strong>Information applicable to all indications</strong>: If a dose is missed, the patient should apply the cream as soon as he/she remember and then he/she should continue with the regular schedule. However the cream should not be applied more than once a day.</p>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>', '<p>No interaction studies have been performed. This includes studies with immunosuppressive drugs. Interactions with systemic drugs would be limited by the minimal percutaneous absorption of Imiquimod cream. Due to its immunostimulating properties, Imiquimod cream should be used with caution in patients who are receiving immunosuppressive medication.</p>', '<p>Imiquimod cream is contraindicated in patients with hypersensitivity to imiquimod or cream excipients.</p>', '<p>Reported side effects are pustules, genital candidiasis, vaginitis, bacterial infection, fungal infection, upper respiratory tract infection, vulvitis, rhinitis, influenza, lymphadenopathy, anorexia, insomnia, depression, irritability, headache, paraesthesia, dizziness, migraine, somnolence, conjunctival irritation, eyelid oedema, tinnitus, flushing, pharyngitis, nasal congestion, pharyngo laryngeal pain, nausea, abdominal pain, diarrhoea, vomitting, rectal disorder, rectal tenesmus, dry mouth, pruritus, folliculitis, rash erythematous, eczema, rash, increased sweating, urticaria, erythema, face oedema, skin ulcer, myalgia, arthralgia, back pain, pain in extremity, dysuria, genital pain in male, penile disorder, dyspareunia, erectile dysfunction, uterovaginal prolapse, vaginal pain, vaginitis atrophic, vulval disorder, and general disorders and administration site disorders such as pruritus, pain, burning, irritation, erythema, reaction, bleeding, papules, rash, inflammation asthenia, malaise, rigors, lethargy, discomfort, fatigue, discharge, oedema, scar, ulcer, vesicle, warmth, pyrexia etc. Reports have been received of localised hypopigmentation and hyperpigmentation following Imiquimod cream use. Clinical studies investigating the use of Imiquimod for the treatment of actinic keratosis have detected a 0.4% frequency of alopecia at the treatment site or surrounding area. Reductions in haemoglobin, white blood cell count, absolute neutrophils and platelets have been observed in clinical trials.</p>', '<p>Use in Pregnancy B1. No human study is available. Imiquimod cream should only be used during pregnancy, if the potential benefit justifies the potential risk of fetus. No human study is available. Imiquimod&nbsp;cream should only be used during lactation if the potential benefit justifies the potential risk to the new-born baby.</p>', '<p>Hypersensitivity to the active substance or to any of the excipients.</p>', '<p>When applied topically, systemic overdosage with Imiquimod cream is unlikely due to minimal percutaneous absorption. Persistent dermal overdosing of Imiquimod cream could result in severe local skin reactions. Following accidental ingestion, nausea, emesis, headache, myalgia and fever could occur after a single dose of 200 mg Imiquimod which corresponds to the content of approximately 16 sachets. The most clinically serious adverse event reported following multiple oral doses of &ge; 200 mg was hypotension which resolved following oral or intravenous fluid administration.</p>', '<p>Immunosuppressant, Miscellaneous topical agents</p>', '<p>Store in a cool &amp; dry place, protected from light. Store at 4&deg;-25&deg;C.</p>', '<p><strong>Use in Children</strong>: Imiquimod cream is not recommended below the age of 12 years.<br />\r\n<strong>Use in Elderly</strong>: Imiquimod cream is recommended in elderly patient.<br />\r\n<strong>Effect on ability to drive and use machineries</strong>: Imiquimod cream is unlikely to produce any effect.</p>', '2022-02-27 19:49:28', '2022-06-21 00:51:47'),
(737, 737, '<p>Prophylaxis of influenza (flu), especially in those who run an increased risk of associated complications. The use of Inactivated Influenza Vaccine should be based on official recommendations.</p>', NULL, '<p><strong>Dosage</strong>:</p>\r\n\r\n<ul>\r\n	<li>Adults and children over 36 months of age: 0.5ml</li>\r\n	<li>Children from 6 to 35 months of age: clinical data are limited. Doses of 0.25 ml or 0.5 ml have been used.</li>\r\n</ul>\r\n\r\n<p><strong>Administrations</strong>: For children who have not previously been vaccinated, a second dose should be given after an interval of at least 4 weeks. If half a dose (0.25 ml) is to be administered, discard half the contained volume (up to the mark indicated on the syringe barrel), before injection. Immunisation should be carried out by intramuscular or deep subcutaneous injection. The vaccine should be allowed to reach room temperature before use. Shake before use. Seroprotection is generally obtained within 2 to 3 weeks. The duration of postvaccinal immunity to homologous strains or to strains closely related to the vaccine strains varies but is usually 6-12 months.</p>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>', '<p>Inactivated Influenza Vaccine may be given at the same time as other vaccines. Immunisation should be carried out on separate limbs. It should be noted that the adverse reactions may be intensified. The immunological response may be diminished if the patient is undergoing immunosuppressant treatment. Following influenza vaccination, false positive results in serology tests using the ELISA method (blood test) to detect antibodies against HIV1, Hepatitis C and especially HTLV1 have been observed. The Western Blot technique disproves the false-positive ELISA results. The transient false positive reactions could be due to the IgM response by the vaccine.</p>', '<p>Hypersensitivity to the active substances, to any of the excipients and to residues, e.g. eggs, chicken proteins, such as ovalbumin. The vaccine may contain residues of the following substances, e.g. kanamycin and neomycin sulphate, formaldehyde, cetyltrimethylammonium bromide (CTAB) and polysorbate 80. Immunisation shall be postponed in patients with febrile illness or acute infection.</p>', NULL, '<p>The limited data from vaccinations in pregnant women do not indicate that adverse foetal and maternal outcomes were attributable to the vaccine. The use of this vaccine may be considered from the second trimester of pregnancy. For pregnant women with medical conditions that increase their risk of complications from influenza, administration of the vaccine is recommended, irrespective of their stage of pregnancy. Inactivated Influenza Vaccine may be used during lactation.</p>', '<p>Antibody response in patients with endogenous (due to illness) or iatrogenic (due to medicine) immunosuppression (poor immune response) may be insufficient. As with all injectable vaccines, appropriate medical treatment and supervision should always be readily available in case of a rare anaphylactic event following the administration of the vaccine. Inactivated Influenza Vaccine&nbsp;should under no circumstances be administered intravascularly.</p>', NULL, '<p>Vaccines, Anti-sera &amp; Immunoglobulin</p>', '<p>Inactivated Influenza Vaccine must be stored in a refrigerator (2&deg;C-8&deg;C). Do not freeze. Keep the syringe in the outer carton in order to protect from light. Any unused product or waste material should be disposed of in accordance with local requirements.</p>', NULL, '2022-02-27 19:49:53', '2022-06-21 00:54:22'),
(738, 738, '<p>Prophylaxis of influenza (flu), especially in those who run an increased risk of associated complications. The use of Inactivated Influenza Vaccine should be based on official recommendations.</p>', NULL, '<p><strong>Dosage</strong>:</p>\r\n\r\n<ul>\r\n	<li>Adults and children over 36 months of age: 0.5ml</li>\r\n	<li>Children from 6 to 35 months of age: clinical data are limited. Doses of 0.25 ml or 0.5 ml have been used.</li>\r\n</ul>\r\n\r\n<p><strong>Administrations</strong>: For children who have not previously been vaccinated, a second dose should be given after an interval of at least 4 weeks. If half a dose (0.25 ml) is to be administered, discard half the contained volume (up to the mark indicated on the syringe barrel), before injection. Immunisation should be carried out by intramuscular or deep subcutaneous injection. The vaccine should be allowed to reach room temperature before use. Shake before use. Seroprotection is generally obtained within 2 to 3 weeks. The duration of postvaccinal immunity to homologous strains or to strains closely related to the vaccine strains varies but is usually 6-12 months.</p>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>', '<p>Inactivated Influenza Vaccine may be given at the same time as other vaccines. Immunisation should be carried out on separate limbs. It should be noted that the adverse reactions may be intensified. The immunological response may be diminished if the patient is undergoing immunosuppressant treatment. Following influenza vaccination, false positive results in serology tests using the ELISA method (blood test) to detect antibodies against HIV1, Hepatitis C and especially HTLV1 have been observed. The Western Blot technique disproves the false-positive ELISA results. The transient false positive reactions could be due to the IgM response by the vaccine.</p>', '<p>Hypersensitivity to the active substances, to any of the excipients and to residues, e.g. eggs, chicken proteins, such as ovalbumin. The vaccine may contain residues of the following substances, e.g. kanamycin and neomycin sulphate, formaldehyde, cetyltrimethylammonium bromide (CTAB) and polysorbate 80. Immunisation shall be postponed in patients with febrile illness or acute infection.</p>', NULL, '<p>The limited data from vaccinations in pregnant women do not indicate that adverse foetal and maternal outcomes were attributable to the vaccine. The use of this vaccine may be considered from the second trimester of pregnancy. For pregnant women with medical conditions that increase their risk of complications from influenza, administration of the vaccine is recommended, irrespective of their stage of pregnancy. Inactivated Influenza Vaccine may be used during lactation.</p>', '<p>Antibody response in patients with endogenous (due to illness) or iatrogenic (due to medicine) immunosuppression (poor immune response) may be insufficient. As with all injectable vaccines, appropriate medical treatment and supervision should always be readily available in case of a rare anaphylactic event following the administration of the vaccine. Inactivated Influenza Vaccine&nbsp;should under no circumstances be administered intravascularly.</p>', NULL, '<p>Vaccines, Anti-sera &amp; Immunoglobulin</p>', '<p>Inactivated Influenza Vaccine must be stored in a refrigerator (2&deg;C-8&deg;C). Do not freeze. Keep the syringe in the outer carton in order to protect from light. Any unused product or waste material should be disposed of in accordance with local requirements.</p>', NULL, '2022-02-27 19:50:31', '2022-06-21 00:58:23'),
(739, 739, '<p><strong>Primary active immunization</strong>: Poliomyelitis vaccine is indicated for active immunization of infants, children and adults for the prevention of poliomyelitis caused by poliovirus types 1, 2 and 3. It is recommended that all infants, unimmunized children and adolescents not previously immunized be vaccinated routinely against paralytic poliomyelitis.<br />\r\n<br />\r\n<strong>Immune deficiency and altered immune status</strong>: Patients with immuno-deficiencies status are at a greater risk of developing paralysis when exposed to poliovirus. Oral polio vaccine is contraindicated in such a patient.<br />\r\n<br />\r\nAltered immune states due to disease and compromised immune system due to treatment with corticosteroids should be immunized with IPV according to the dosage schedule. Patients with altered immune status may or may not develop protective immune response after administration of IPV.</p>', '<p>Inactivated poliovirus vaccine induces the production of neutralizing antibodies against each type of virus. Administration of the second dose results in rapid increase of antibody levels indicating existance of immunological memory. IPV is able to induce secretory antibody (IgA) produced in the pharynx and gut and reduces pharyngeal excretion of poliovirus.</p>', '<p>Primary dose schedule of polio vaccine (IPV) along with OPV:</p>\r\n\r\n<ul>\r\n	<li>At birth- OPV;</li>\r\n	<li>At 6th week- IPV+OPV;</li>\r\n	<li>At 10th week- IPV+OPV;</li>\r\n	<li>At 14th week- IPV+OPV;</li>\r\n	<li>At 15-18th months- IPV+OPV;</li>\r\n	<li>At 4-5 years- OPV.</li>\r\n</ul>\r\n\r\n<p>Polio vaccine (IPV) alone:</p>\r\n\r\n<ul>\r\n	<li>1st dose- at 2 months</li>\r\n	<li>2nd dose- at 4 months</li>\r\n	<li>3rd dose- at 6-18 months</li>\r\n	<li>Booster dose- at 4-6 years.</li>\r\n</ul>\r\n\r\n<p>After preparation of the injection site, immediately administer 0.5 ml of polio vaccine intramuscularly. For patients with thrombocytopenia or bleeding disorders, the injection should be given subcutaneously. Lateral aspect of the mid thigh is the preferred site in infants and small children. In&nbsp;older children and adults, it should be administered in deltoid area. Shake well before use. Do not administer vaccine intravenously.</p>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>', NULL, '<p>Polio vaccine should not be administered to subjects with known hypersensitivity to any component of the vaccine, or to subjects that have shown any signs of hypersensitivity after previous administration of IPV vaccine. Vaccination of persons with an acute, febrile illness should be deferred until recovery.</p>', '<p>Following vaccine administration, a mild erythematous reaction and induration has been observed at the site of injection, in rare cases. In a few instances, the erythema may be accompanied by moderate fever.</p>', '<p>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>', NULL, NULL, '<p>Vaccines, Anti-sera &amp; Immunoglobulin</p>', '<p>Keep refrigerated (between +2&deg;C and +8&deg;C). Protect from light. Do not freeze.<br />\r\nShelf-Life:&nbsp;36 months.</p>', NULL, '2022-02-27 19:50:56', '2022-06-21 01:00:43');
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
(740, 740, '<p>Indacaterol &amp; Glycopyrronium combination is indicated for the long-term, maintenance treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD).</p>', '<p>Indacaterol Maleate is a selective &beta;2-adrenergic agonist. Its chemical name is (R)-5-[2-(5,6-Diethylindan-2-ylamino)-1-hydroxyethyl]-8 hydroxy-1H-quinolin-2-one maleate. Indacaterol Maleate has a molecular weight of 508.56 and its empirical formula is C24H28N2O3.C4H4O4. Indacaterol Maleate is a white to very slightly grayish or very slightly yellowish powder. Indacaterol Maleate is freely soluble in N methylpyrrolidone and dimethylformamide, slightly soluble in methanol, ethanol, propylene glycol and polyethylene glycol 400, very slightly soluble in water, isopropyl alcohol and practically insoluble in 0.9% sodium chloride in water, ethyl acetate and n-octanol. Glycopyrronium is a long-acting, specific antimuscarinic agent, in clinical medicine often called an anticholinergic. It has a similar affinity to the subtypes of muscarinic receptors M1 to M5. In the airways, inhibition of M3-receptors at the smooth muscle results in relaxation. The high potency and slow receptor dissociation found its clinical correlate in significant and long-acting bronchodilation in patients with COPD.</p>', '<p><strong>Indacaterol 110 &micro;g and Glycopyrronium 50 &micro;g</strong>: The recommended dosage of Indacaterol &amp; Glycopyrronium combination DPI is inhalation of the contents of one capsule once daily with the ConviHaler device.<br />\r\n<br />\r\n<strong>Indacaterol 27.5 &micro;g &amp; Glycopyrronium 15.6 &micro;g</strong>: The recommended dosage of Indacaterol &amp; Glycopyrronium combination DPI is inhalation of the contents of one capsule twice daily with the ConviHaler device.</p>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>', '<p>Adrenergic drugs, xanthine derivatives, steroids, or diuretics, non-potassium sparing diuretics, monoamine oxidase inhibitors, tricyclic antidepressants, QTc prolonging drugs, beta-blockers, inhibitors of cytochrome P450 3A4 and P-gp efflux transporter may interact with Indacaterol.</p>', NULL, '<p>Inhaled medicines may cause inhalation-induced bronchospasm, dehydration, dry mouth, constipation dizziness, insomnia, skin and subcutaneous tissue disorders &amp; immune system disorders.</p>', '<p>There is a limited amount of data from the use of Indacaterol and Glycopyrronium combination in pregnant women. Animal studies do not indicate direct or indirect harmful effects with respect to reproductive toxicity at clinically relevant doses. Indacaterol and Glycopyrronium combination should not be used in pregnant or nursing women unless the expected benefit outweighs any possible risk to the unborn child or the infant.</p>', '<p>Indacaterol and Glycopyrronium combination is as a twice daily maintenance bronchodilator should not be used for the initial treatment of acute episodes of bronchospasm, i.e. rescue therapy. Immediate hypersensitivity reactions may occur after administration of Indacaterol and Glycopyrronium combination inhalation powder. As with other anticholinergic drugs, Glycopyrronium should be used with caution in patients with narrow-angle glaucoma, prostatic hyperplasia or bladder-neck obstruction.</p>', '<p>An overdose of indacaterol is likely to lead to exaggerated effects typical of beta2-adrenergic stimulants, i.e. tachycardia, tremor, palpitations, headache, nausea, vomiting, drowsiness, ventricular arrhythmias, metabolic acidosis, hypokalaemia and hyperglycaemia. High doses of Glycopyrronium may lead to anticholinergic signs and symptoms.</p>', '<p>Combined bronchodilators</p>', '<p>Do not store above 30&deg;C. Keep away from light and out of the reach of children. Protect from freezing. Insert the ConviCap in the ConviHaler just prior to use to protect from deterioration by moisture.</p>', NULL, '2022-02-27 19:51:33', '2022-06-21 01:02:57'),
(741, 741, '<p>Indacaterol is indicated for the treatment of airflow obstruction in patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema.</p>', NULL, '<p>Indacaterol capsules must not be swallowed as the intended effects on the lungs will not be obtained. The contents of Indacaterol capsules are only for oral inhalation and should only be used with the&nbsp;device.<br />\r\n<br />\r\nThe recommended dosage of Indacaterol is the once-daily inhalation of the contents of one 75 mcg, 150 mcg, 300 mcg Indacaterol capsule using the device.<br />\r\n<br />\r\nIndacaterol should be administered once daily every day at the same time of the day by the orally inhaled route only. If a dose is missed, the next dose should be taken as soon as it is remembered. Do not use Indacaterol more than one time every 24 hours.<br />\r\n<br />\r\nNo dosage adjustment is required for geriatric patients, patients with mild and moderate hepatic impairment, or renally impaired patients. No data are available for subjects with severe hepatic impairment. Indacaterol&nbsp;is not indicated for use in the pediatric population. Safety and efficacy have not been established.</p>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>', '<p>Indacaterol shows interaction with Adrenergic Drugs, Xanthine Derivatives, Steroids, or Diuretics. Concomitant treatment with xanthine derivatives, steroids, or diuretics may potentiate any hypokalemic effect of Indacaterol. The ECG changes or hypokalemia that may result from the administration of non-potassium sparing diuretics (such as loop or thiazide diuretics) can be acutely worsened by &beta;2-agonists. Indacaterol, as with other &beta;2-agonists, should be administered with extreme caution to patients being treated with monoamine oxidase inhibitors, tricyclic antidepressants, or other drugs known to prolong the QTc interval. &beta;-adrenergic receptor antagonists (beta-blockers) and Indacaterol may interfere with the effect of each other when administered concurrently.</p>', '<p>All LABA are contraindicated in patients with asthma without use of a long-term asthma control medication. Indacaterol powder is not indicated for the treatment of asthma. Indacaterol is contraindicated in patients with a history of hypersensitivity to Indacaterol or to any of the ingredients.</p>', '<p>The most commonly reported adverse effects were cough, nasopharyngitis, headache, nausea, oropharyngeal pain. Some other also reported of hypersensitivity reactions, paradoxical bronchospasm, tachycardia, pruritis and dizziness.</p>', '<p>Pregnancy Category C. There are no adequate and well-controlled studies with Indacaterol powder in pregnant women. Indacaterol powder should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known that the active component of Indacaterol powder, Indacaterol is excreted in human milk. Because many drugs are excreted in human milk and because Indacaterol has been detected in the milk of lactating rats, caution should be exercised when Indacaterol powder is administered to nursing women.</p>', '<p>Rarely, serious (sometimes fatal) breathing problems have happened to people with asthma using a long-acting inhaled beta agonist (salmeterol). Since Indacaterol&nbsp;is similar to salmeterol, it might cause these serious&nbsp;breathing problems. Indacaterol&nbsp;has not been shown to be safe or effective to treat asthma and is not approved for this use.</p>', '<p>The expected signs and symptoms associated with over dosage of Indacaterol powder are those of excessive beta-adrenergic stimulation and occurrence or exaggeration of any of the signs and symptoms, e.g., angina, hypertension or hypotension, tachycardia, with rates up to 200 bpm, arrhythmias, nervousness, headache, tremor, dry mouth, palpitation, muscle cramps, nausea, dizziness, fatigue, malaise, hypokalemia, hyperglycemia, metabolic acidosis and insomnia. As with all inhaled sympathomimetic medications, cardiac arrest and even death may be associated with an over dose of Indacaterol powder.</p>', '<p>Long-acting selective &beta;-adrenoceptor stimulants</p>', '<p>Indacaterol capsules must always be stored in the blister, and only removed immediately before use. Keep in a cool &amp; dry place. Keep out of the reach of children.</p>', NULL, '2022-02-27 19:51:55', '2022-06-21 01:05:07'),
(742, 742, '<p>Indapamide is indicated in the treatment of essential hypertension . It is effective in treating hypertension in patients with renal function impairment, although its diuretic effect is reduced. Indapamide is also indicated for the treatment of salt and fluid retention associated with congestive heart failure.</p>', '<p>Indapamide is a diuretic antihypertensive. It appears to cause vasodilation, probably by inhibiting the passage of calcium and other ions (sodium, potassium) across membranes. It has an extra-renal antihypertensive action resulting in a decrease in vascular hyperreactivity and a reduction in total peripheral and arteriolar resistance.</p>', '<p>One tablet daily preferably in the morning. In more sever case Indapamide can be combine with other categories of anti-hypertensive agent. The safety and effectiveness in pediatric patients have not been established</p>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>', '<p><strong>Other antihypertensive:</strong>&nbsp;Indapamide may add to or potentiate the action of other antihypertensive drugs.<br />\r\n<br />\r\n<strong>Norepinephrine:</strong>&nbsp;Indapamide like thiazides, may decrease arterial responsiveness to norepinephrine.<br />\r\n<br />\r\n<strong>Lithium:</strong>&nbsp;In general, diuretics should not be given concomitantly with lithium because they reduce its renal clearance and add a high risk of lithium toxicity.</p>', '<p>This drug must not be taken in the following conditions:</p>\r\n\r\n<ul>\r\n	<li>Hypersensitivity to sulfonamides</li>\r\n	<li>Severe renal failure</li>\r\n	<li>Hepatic encephalopathy or severe hepatic failure</li>\r\n	<li>Hypokalaemia</li>\r\n</ul>', '<p>Side effects of Indapamide include headache, anorexia, gastric irritation,nausea, vomiting, constipation, diarrhoea etc.</p>', '<p>There are no adequate and well-controlled studies in pregnant women and so Indapamide is not recommended. Mothers taking Indapamide should not breast feed.</p>', '<p>Monitoring of potassium and uric acid serum levels is recommended, especially in subjects with a predisposition or sensitivity to hypokalemia and in patients with gout. Although no allergic manifestations have been reported during clinical trials, patients with a history of allergy to sulfonamide derivatives should be closely monitored.</p>', '<p><strong>Symptoms:</strong>&nbsp;These could include: allergies, skin rashes, epigastric pain, nausea, photosensitivity, dizziness, weakness and paraesthesia.<br />\r\n<br />\r\n<strong>Treatment:</strong>&nbsp;Treatment is supportive and symptomatic, directed at correcting the electrolyte abnormalities.</p>', '<p>Thiazide diuretics &amp; related drugs</p>', '<p>Store in a cool and dry place. Protect from light and moisture.</p>', NULL, '2022-02-27 19:52:11', '2022-06-21 01:07:19'),
(743, 743, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '2022-02-27 19:52:35', '2022-02-27 19:52:35'),
(744, 744, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '2022-02-27 19:53:03', '2022-02-27 19:53:03'),
(745, 745, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '2022-02-27 19:59:37', '2022-02-27 19:59:37'),
(746, 746, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '2022-02-27 19:59:51', '2022-02-27 19:59:51'),
(747, 747, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '2022-02-27 20:00:15', '2022-02-27 20:00:15'),
(748, 748, '<p>Inositol Nicotinate has a fairly broad range of therapeutic applications. The most well researched conditions include the hyperlipidemias, Raynaud&#39;s disease and intermittent claudication. Promising applications, which bear further investigation, include its use for stasis ulcers, dysmenorrhea, dermatitis herpetiformis, alcoholism, diabetes, cancer prevention and hypertension.</p>', '<p>Inositol Niacinate is a vasodilator and lipid-lowering agent. It improves circulation by releasing histamine, which causes the blood vessels to dilate and breaks up a protein needed for the clotting of blood. It also prevents the formation of lipids in the body, which helps to lower cholesterol and triglyceride levels.</p>', '<p>Recommended dosage for lipid-lowering and improving conditions related to peripheral vascular insufficiency ranges from 1500 mg to 4000 mg daily, in divided dosages of two to three times daily.</p>', NULL, '<p>Inositol nicotinate is contraindicated to children, early stage of stroke &amp; people who have recently had a heart attack. It should not be used if anyone is allergic to one or any of its ingredients</p>', '<p>The most common side effects are headache, rash, paraesthesia, dizziness, nausea and vomiting, flushing, excessive fluid retention in the body tissues, postural hypotension, fainting</p>', '<p><strong>Pregnancy:</strong>&nbsp;There is no information available about the safety of this medicine during pregnancy, therefore it is not recommended for use during pregnancy, unless considered essential by your doctor. Seek medical advice from your doctor.<br />\r\n<br />\r\n<strong>Lactation:</strong>&nbsp;There is no information available regarding the safety of this medicine during breastfeeding</p>', '<p>Cautions should be exercised in patients with angina not well controlled by medical treatment and decreased blood supply through the vessels of the brain (cerebrovascular insufficiency).</p>', '<p>Both acute and chronic toxicities have been reported from the use of highdose niacin. Reactions to niacin range from acute symptoms of flushing, pruritis, and GI complaints to chronic symptoms of hepatotoxicity, hyperuricemia, and impaired glucose tolerance. On the other hand, no adverse effects have been reported from the use of inositol hexaniacinate in dosages as high as four grams daily</p>', '<p>Nicotinic acid group, Oral nutritional preparations</p>', '<p>Should be stored in cool and dry place.</p>', NULL, '2022-03-02 01:35:32', '2022-03-02 01:35:32'),
(749, 749, '<p>Each ml suspension contains 100 IU (equivalent to 3.50 mg) Insulin Aspart (rDNA) BP as 30% soluble Insulin Aspart and 70% protamine-crystallised Insulin Aspart.</p>\r\n\r\n<p>Insulin Aspart is a rapid acting human insulin analog indicated to improve glycemic control in adults and children with diabetes mellitus.</p>\r\n\r\n<p>Insulin aspart protamine and insulin aspart is a sterile suspension of human insulin analog containing 30% soluble insulin aspart and 70% protamine-crystallised insulin aspart. It is a blood glucose lowering agent with an earlier onset and an intermediate duration of action. Insulin Aspart is homologous with regular human insulin with the exception of a single substitution of the amino acid proline by aspartic acid in position B28, and is produced by recombinant DNA technology.</p>', '<p>The primary activity of Insulin Aspart is the regulation of glucose metabolism. Insulin Aspart bind to the insulin receptors on muscle and fat cells and lower blood glucose by facilitating the cellular uptake of glucose and simultaneously inhibiting the output of glucose from the liver.</p>', '<p>Dosage of Insulin Aspart is individual and determined by the physician in accordance with the needs of the patient. In patients with type 2 diabetes, Insulin Aspart can be given in mono therapy or in combination with oral antidiabetic drugs when the blood glucose is inadequately controlled with those oral antidiabetic drugs alone. For patients with type 2 diabetes, the recommended starting dose of Insulin Aspart is 6 IU at breakfast and 6 IU at dinner (evening meal). Insulin Aspart can also be initiated once daily with 12 IU at dinner (evening meal). When using Insulin Aspart once daily, it is generally recommended to move to twice-daily when reaching 30 units by splitting the dose into equal breakfast and dinner doses. If twice daily dosing with Insulin Aspart results in recurrent daytime hypoglycaemic episodes, the morning dose can be split into morning and lunchtime doses (thrice daily dosing).<br />\r\n<br />\r\nThe dose should not be increased if hypoglycemia occurred within three days. Dose adjustments can be made once a week until target HbA1c is reached. In patients with type 1 diabetes the individual insulin requirement is usually between 0.5 and 1.0 IU/kg/day. Insulin Aspart may fully or partially meet this requirement. When transferring a patient from biphasic human insulin to Insulin Aspart, start with the same dose and regimen. Then titrate according to individual needs (according to the titration guidelines in table above). Insulin Aspart can be used in elderly patients; however there is limited experience with the use of Insulin Aspart in combination with OADs in patients older than 75 years.</p>\r\n\r\n<p>Administer 5-10 min before meal</p>', '<p>A number of drugs affect glucose metabolism and may require dose adjustment. The following substances may reduce the Insulin as well as Insulin Aspart requirements: Oral anti-diabetic products, angiotensin converting enzyme (ACE) inhibitors, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, propoxyphene, pentoxifylline, salicylates and sulfonamide antibiotics. The following substances may increase the Insulin as well as Insulin Aspart requirements: Thiazides, glucocorticoids, thyroid hormones, beta-sympathomimetics, growth hormone and danazol. Beta-blockers, clonidine, lithium salts, and alcohol may either potentiate or weaken the blood glucose lowering effect of insulin.</p>', '<p>Insulin Insulin Aspart is contraindicated-</p>\r\n\r\n<ul>\r\n	<li>during episodes of hypoglycemia</li>\r\n	<li>in patients with hypersensitivity to Insulin Aspart or one of its excipients</li>\r\n</ul>', '<p>Side effects of Insulin Aspart are hypoglycemia, allergic reactions, injection site reaction, lipodystrophy, pruritus and rash.</p>', '<p>Pregnancy category B. There are no restrictions on treatment with Insulin Aspart during lactation. Insulin treatment of the nursing mother should not affect the baby. However, dosage may need to be adjusted.</p>', '<p><strong>Dose adjustment and monitoring</strong>: Blood glucose should be monitored in all patients treated with insulin. Insulin regimens should be modified cautiously and only under medical supervision.</p>', '<p>A specific overdose for insulin cannot be defined, however, hypoglycaemia may develop over sequential stages if too high doses relative to the patient&rsquo;s requirement are administered. Mild hypoglycaemic episodes can be treated by oral administration of glucose or sugary products. Severe hypoglycaemic episodes, where the patient has become unconscious, can be treated by glucagon (0.5 to 1 mg) given intramuscularly or subcutaneously. Glucose must also be given intravenously if the patient does not respond to glucagon within 10 to 15 minutes. Upon regaining consciousness administration of oral carbohydrate is recommended for the patient in order to prevent relapse.</p>', '<p>Rapid Acting Insulin</p>', '<p>Store at 2&deg;C to 8&deg;C in a refrigerator. Do not freeze. Protect from light.</p>', '<p>Renal Impairment: Decreased dose may be necessary.<br />\r\nHepatic Impairment: Decreased dose may be necessary.</p>', '2022-03-02 01:49:24', '2022-03-02 01:49:24'),
(750, 750, '<p>Insulin Degludec is indicated for once-daily treatment of adults with diabetes mellitus to improve glycemic control.&nbsp;Insulin Degludec is not recommended for the treatment of diabetic ketoacidosis.</p>', '<p>The primary activity of insulin, including Insulin Degludec, is regulation of glucose metabolism. Insulin and its analogues lower blood glucose by stimulating peripheral glucose uptake, especially by skeletal muscle and fat, and by inhibiting hepatic glucose production. Insulin also inhibits lipolysis and proteolysis, and enhances protein synthesis. Insulin Degludec forms multihexamers when injected into the subcutaneous tissue resulting in a subcutaneous insulin degludec depot. The protracted time action profile of Insulin Degludec is predominantly due to delayed absorption of insulin degludec from the subcutaneous tissue to the systemic circulation and to a lesser extent due to binding of insulin degludec to circulating albumin.</p>', '<p>Insulin Degludec is ultra long-acting basal insulin for once-daily at any time of the day, preferably at the same time every day.<br />\r\n<br />\r\n<strong>Patients with type 2 diabetes mellitus</strong>: The recommended daily starting dose is 10 units followed by individual dosage adjustments.<br />\r\n<br />\r\n<strong>Patients with type 1 diabetes mellitus</strong>: Insulin Degludec is to be used once-daily with meal-time insulin and requires subsequent individual dosage adjustments.<br />\r\n<br />\r\nIn patients with type 2 diabetes mellitus,&nbsp;Insulin Degludec can be administered alone or in any combination with oral anti-diabetic medicinal products, GLP-1 receptor agonists and bolus insulin. In type 1 diabetes mellitus, Insulin Degludec must be combined with short-/rapid-acting insulin to cover mealtime insulin requirements. On occasions when administration at the same time of the day is not possible, Insulin Degludec allows for flexibility in the timing of insulin administration. A minimum of 8 hours between injections should always be ensured. Patients who forget a dose, are advised to take it upon discovery and then resume their usual once-daily dosing schedule.</p>', '<p>Decreased hypoglycaemic effect with corticosteroids, danazol, diazoxide, diuretics, glucagon, isoniazid, phenothiazine derivatives, somatropin, sympathomimetic agents, thyroid hormones, oestrogens, progestins (e.g. in oral contraceptives), protease inhibitors and atypical antipsychotic (e.g. olanzapine and clozapine). Increased hypoglycaemic effect with oral antidiabetic agents, ACE inhibitors, disopyramide, fibrates, fluoxetine, MAOIs, pentoxifylline, propoxyphene, salicylates and sulfonamide antibiotics. Decreased insulin resistance with octreotide and lanreotide. Increased risk of wt gain and peripheral oedema with pioglitazone, rosiglitazone. Decreased effect of sermorelin.</p>', '<p>Hypersensitivity to the active substance or to any of the excipients. Hypoglycaemia, Hyperglycaemia, Eye disorder.</p>', '<p>Nasopharyngitis, Severe hypoglycemic episode, Upper respiratory tract infection, Headache, Diarrhea, Sinusitis, Gastroenteritis, Injection site reactions, Peripheral edema.</p>', '<p><strong>Pregnant Women</strong>: There is no clinical experience from well-controlled studies with Insulin degludec in pregnant women. Animal reproduction studies have not revealed any differences between insulin degludec and human insulin regarding embryotoxicity and teratogenicity. Animal reproduction studies are not always predictive of human response; therefore, Insulin degludec should not be used during pregnancy unless the potential benefits to the mother justify the potential risks to the fetus<br />\r\n<br />\r\n<strong>Nursing Women</strong>: There is no clinical experience from well controlled studies with Insulin degludec during breast-feeding. It is unknown whether insulin degludec is excreted in human milk. In rats, insulin degludec was secreted in milk; the concentration in milk was lower than in plasma.</p>', '<p>Insulin Degludecs must not be injected into a vein (intravenously) or a muscle (intramuscularly) and must not be used in infusion pumps.<br />\r\n<br />\r\nThere is no experience with Insulin Degludec in children and adolescents under 18 years of age.</p>', NULL, '<p>Long Acting Insulin</p>', NULL, '<p><strong>Geriatrics (&ge; 65 years of age)</strong>: No overall clinical differences in safety or effectiveness have been observed between elderly and adult patients.<br />\r\n<br />\r\n<strong>Pediatrics (&lt; 18 years of age)</strong>: Insulin Degludec&nbsp;is not indicated for use in the pediatric population.</p>', '2022-03-06 16:13:59', '2022-03-06 16:13:59'),
(751, 751, '<p>Insulin degludec (a long-acting human insulin analog) and insulin aspart (a rapid-acting human insulin analog) indicated to improve glycemic control in patients 1 year of age and older with diabetes mellitus</p>', '<p>Insulin degludec and insulin aspart binds specifically to the human insulin receptor and results in the same pharmacological effects as human insulin.<br />\r\n<br />\r\nThe blood glucose-lowering effect of insulin is due to the facilitated uptake of glucose following the binding of insulin to receptors on muscle and fat cells and to the simultaneous inhibition of glucose output from the liver.</p>', '<p>This is a soluble insulin product consisting of the basal insulin degludec and the rapid-acting prandial insulin aspart.<br />\r\n<br />\r\nThis is to be dosed in accordance with the individual patient&#39;s needs. Dose-adjustments are recommended to be primarily based on fasting plasma glucose measurements.<br />\r\n<br />\r\n<strong>Patients with type 2 diabetes mellitus</strong>: The recommended total daily starting dose is 10 units with meal(s) followed by individual dosage adjustments.<br />\r\n<br />\r\n<strong>Patients with type 1 diabetes mellitus</strong>: The recommended starting dose is 60-70% of the total daily insulin requirements. This is to be used once-daily at meal-time in combination.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>This can be administered once- or twice-daily with the main meal(s). When needed, the patient can change the time of administration as long as this insulin is dosed with the largest meal when taken once daily.<br />\r\n<br />\r\nIn patients with type 2 diabetes mellitus this insulin can be administered alone, in combination with oral anti-diabetic medicinal products, and in combination with bolus insulin.<br />\r\n<br />\r\nIn type 1 diabetes mellitus, this insulin is combined with short-/rapid-acting insulin at the remaining meals.</p>\r\n\r\n<p>&nbsp;</p>', '<p>There are no known drug interactions and none well documented.</p>', '<p>Hypersensitivity to the active substances or to any of the excipients.</p>', '<p>Hypoglycemia, allergic reactions, injection site reactions, lipodystrophy, pruritus, rash, edema and weight gain</p>', '<p>Pregnancy Category C. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks<br />\r\n<br />\r\nThere are no data on the presence of insulin degludec in human milk, the effects on the breastfed infant, or the effect on milk production. Insulin degludec is present in rat milk. One small published study reported that exogenous nsulin, including insulin aspart, was present in human milk. However, there is insufficient information to determine the effects of insulin aspart on the breastfed infant and no available information on the effects of insulin aspart on milk production.</p>', '<p>Hypoglycaemia:&nbsp;Omission of a meal or unplanned strenuous physical exercise may lead to hypoglycaemia. Hypoglycaemia may occur if the insulin dose is too high in relation to the insulin requirement. Concomitant illness, especially infections and fever, usually increases the patient&#39;s insulin requirement. Concomitant diseases in the kidney, liver or diseases affecting the adrenal, pituitary or thyroid gland may require changes in the insulin dose.<br />\r\n<br />\r\nHyperglycaemia:&nbsp;Administration of rapid-acting insulin is recommended in situations with severe hyperglycaemia. Inadequate dosing and/or discontinuation of treatment in patients requiring insulin may lead to hyperglycaemia and potentially to diabetic ketoacidosis. Furthermore, concomitant illness, especially infections, may lead to hyperglycaemia and thereby cause an increased insulin requirement.<br />\r\n<br />\r\nEye disorder:&nbsp;Intensification of insulin therapy with abrupt improvement in glycaemic control may be associated with temporary worsening of diabetic retinopathy, while long-term improved glycaemic control decreases the risk of progression of diabetic retinopathy.<br />\r\n<br />\r\nAvoidance of accidental mix-ups:&nbsp;Patients must be instructed to always check the insulin label before each injection to avoid accidental mix-ups between this and other insulin products.<br />\r\n<br />\r\nOlder patients (&gt; 65 years old): Insulin Degludec &amp; Insulin Aspart Premixed&nbsp;can be used in older patients. Glucose-monitoring is to be intensified and the insulin dose adjusted on an individual basis.<br />\r\n<br />\r\nPaediatric population:&nbsp;This Insulin has been administered to children and adolescents up to 18 years of age for the investigation of pharmacokinetic properties. Safety and efficacy have not been investigated in children and adolescents.</p>', '<p>Combination Insulin</p>', NULL, NULL, '<p>Renal and hepatic impairment: This insulin can be used in renal and hepatic impaired patients. Glucose-monitoring is to be intensified and the insulin dose adjusted on an individual basis.</p>', '2022-03-06 16:20:34', '2022-03-06 16:20:34'),
(752, 752, '<p>Insulin Detemir is a long-acting human insulin analog indicated to improve glycemic control in adults and children with diabetes mellitus.<br />\r\n<br />\r\nImportant Limitations of Use: Not recommended for treating diabetic ketoacidosis. Use intravenous, rapid acting or short-acting insulin instead.</p>', '<p>The primary activity of insulin detemir is the regulation of glucose metabolism. Insulins, including insulin detemir, exert their specific action through binding to insulin receptors. Receptor-bound insulin lowers blood glucose by facilitating cellular uptake of glucose into skeletal muscle and adipose tissue and by inhibiting the output of glucose from the liver. Insulin inhibits lipolysis in the adipocyte, inhibits proteolysis, and enhances protein synthesis.</p>', '<p><strong>Adult</strong>: In insulin-naive patients with type 2 DM who are not well controlled on oral antidiabetic drugs: Initial: 0.1 -0.2 unit/kg once daily in the evening or 10 unit 1-2 times/day, adjust subsequently based on glycaemic control.<br />\r\n<br />\r\n<strong>In patients on basal insulin only</strong>: May substitute with insulin detemir on a unit-for-unit basis based on the current basal insulin dosage, adjust subsequently to achieve glycaemic targets.</p>', '<p>Possible absence of hypoglycaemic warning symptoms with beta-blockers. Increased blood sugar with thiazide diuretics, corticosteriods, chlorpromazine, tibolone, isoniazid, niacin, some calcium-channel blockers such as diltiazem or nifedipine, diazoxide, lithium and thyroid hormones. Increased risk of hypoglycemia with disopyramide, larges doses of aspirin, gatifloxacin, MAOIs, mebanazine, nandrolone, pegvisomant, testosterone. Decreased insulin resistance with octreotide and lanreotide. Increased risk of wt gain and peripheral oedema with pioglitazone, rosiglitazone. Decreased effect of sermorelin.</p>', '<p>Insulin Detemir is contraindicated in patients with hypersensitivity to Insulin Detemir or any of its excipients. Reactions have included anaphylaxis</p>', '<p>Hypoglycaemia, lipodystrophy, pruritus, rash, wt gain, sodium retention and oedema. Inj site reactions e.g. pain, itching, hives, swelling and inflammation. Influenza-like symptoms, Pallor, Palpitation, Tachycardia, Mental confusion, Weakness, Blurred vision, Itching, Hunger, Nausea.</p>', '<p>Pregnancy Category B.&nbsp;Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.<br />\r\n<br />\r\nNursing Mothers: It is unknown whether Insulin detemir is excreted in human milk. Because many drugs, including human insulin, are excreted in human milk, use caution when administering Insulin detemir to a nursing woman. Women with diabetes who are lactating may require adjustments of their insulin doses.</p>', '<p>Renal or hepatic impairment. Regular monitoring of blood glucose and HbA1c. Continuous rotation of the inj site within a given area to reduce inj site reactions. Pregnancy, lactation</p>', '<p>An excess of insulin relative to food intake, energy expenditure, or both may lead to severe and sometimes prolonged and life-threatening hypoglycemia. Mild episodes of hypoglycemia usually can be treated with oral glucose. Adjustments in drug dosage, meal patterns, or exercise may be needed. More severe episodes with coma, seizure, or neurologic impairment may be treated with intramuscular/subcutaneous glucagon or concentrated intravenous glucose. After apparent clinical recovery from hypoglycemia, continued observation and additional carbohydrate intake may be necessary to avoid recurrence of hypoglycemia</p>', '<p>Long Acting Insulin</p>', '<p>Unused (unopened) Insulin Detemir should be stored in the refrigerator between 2&deg; and 8&deg;C. Do not store in the freezer or directly adjacent to the refrigerator cooling element. Do not freeze. Do not use Insulin Detemir if it has been frozen. Unused (unopened) Insulin Detemir can be kept until the expiration date printed on the label if it is stored in a refrigerator. Keep unused Insulin Detemir in the carton so that it stays clean and protected from light.<br />\r\n<br />\r\nIf refrigeration is not possible, unused (unopened) Insulin Detemir can be kept unrefrigerated at room temperature, below 30&deg;C as long as it is kept as cool as possible and away from direct heat and light. Unrefrigerated Insulin Detemir should be discarded 42 days after it is first kept out of the refrigerator, even if the FlexPen or vial still contains insulin.</p>', '<p><strong>Pediatric Use</strong>: The pharmacokinetics, safety and effectiveness of subcutaneous injections of Insulin Detemir have been established in pediatric patients (age 6 to 17 years) with type 1 diabetes. Insulin Detemir has not been studied in pediatric patients younger than 6 years of age with type 1 diabetes. Insulin Detemir has not been studied in pediatric patients with type 2 diabetes. The dose recommendation when converting to Insulin Detemir is the same as that described for adults. As in adults, the dosage of Insulin Detemir must be individualized in pediatric patients based on metabolic needs and frequent monitoring of blood glucose.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: In controlled clinical trials comparing Insulin Detemir to NPH insulin or insulin glargine, 64 of 1624 patients (3.9%) in the type 1 diabetes trials and 309 of 1082 patients (28.6%) in the type 2 diabetes trials were&ge;65 years of age. A total of 52 (7 type 1 and 45 type 2) patients (1.9%) were &ge;75 years of age. Nooverall differences in safety or effectiveness were observed between these patients and younger patients, but small sample sizes, particularly for patients &ge;65 years of age in the type 1 diabetes trials and for patients &ge;75 years of age in all trials limits conclusions. Greater sensitivity of some older individuals cannot be ruled out. In elderly patients with diabetes, the initial dosing, dose increments, and maintenance dosage should be conservative to avoid hypoglycemia. Hypoglycemia may be difficult to recognize in the elderly.</p>', '2022-03-06 16:24:37', '2022-03-06 16:24:37'),
(753, 753, '<p>Insulin Glargine is indicated to improve glycemic control in adults and children with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus.</p>', '<p>Insulin Glargine is a sterile solution of insulin glargine for use as a subcutaneous injection. Insulin glargine is a recombinant human insulin analogue that is a long-acting (up to 24-hour duration of action), parenteral blood glucose lowering agent. Insulin Glargine is produced by recombinant DNA technology. Primary function of insulin glargine is regulation of glucose metabolism. Insulin and its analogues lower blood glucose by stimulation peripheral glucose uptake, primarily by skeletal muscle and fat, and by inhibiting hepatic glucose production. Insulin inhibits lipolysis and proteolysis and enhances protein synthesis.</p>', '<p>Insulin Glargine exhibits a relatively constant glucose-lowering profile over 24 hours that permits once-daily dosing. Potency of insulin glargine is approximately the same as human insulin.<br />\r\n<br />\r\nInsulin Glargine is recommended for once daily subcutaneous administration &amp; may be administered at any time during the day. However, once started should be administered at the same time every day. The dose of Insulin Glargine must be individualized based on clinical response. Blood glucose monitoring is essential in all patients with diabetes. In patients with type 1 diabetes, Insulin Glargine must be used in regimens with short-acting insulin. Insulin Glargine is not recommended for intravenous administration. Intravenous administration of the usual subcutaneous dose could result in severe hypoglycemia.<br />\r\n<br />\r\nInitiation of Insulin Glargine therapy:</p>\r\n\r\n<ul>\r\n	<li>The recommended starting dose of Insulin Glargine in patients with type 1 diabetes should be approximately one-third of the total daily insulin requirements. Short-acting, premeal insulin should be used to satisfy the remainder of the daily insulin requirements.</li>\r\n	<li>The recommended starting dose of Insulin Glargine in patients with type 2 diabetes who are not currently treated with insulin is 10 units (or 0.2 Units/kg) once daily, which should subsequently be adjusted to the patient&#39;s needs.</li>\r\n</ul>\r\n\r\n<p><strong>Converting to Insulin Glargine from other insulin therapies:&nbsp;</strong>If changing from a treatment regimen with an intermediate-or long-acting insulin to a regimen with Insulin Glargine , the amount and timing of shorter-acting insulins and doses of any oral anti-diabetic drugs may need to be adjusted.</p>\r\n\r\n<ul>\r\n	<li>If transferring patients from once-daily NPH insulin to once-daily Insulin Glargine , the recommended initial Insulin Glargine dose is the same as the dose of NPH that is being discontinued.</li>\r\n	<li>If transferring patients from twice-daily NPH insulin to once-daily Insulin Glargine , the recommended initial Insulin Glargine dose is 80% of the total NPH dose that is being discontinued.</li>\r\n</ul>\r\n\r\n<p>Insulin Glargine should be injected subcutaneously once daily at any time of day, but at the same time everyday.<br />\r\n<br />\r\nCartridge:</p>\r\n\r\n<ul>\r\n	<li>Insert the Insulin Glargine cartridge into the pen correctly and equip the needle. Gently turn the pen upside down for 8-10 times until the insulin in the cartridge becomes uniformly mixed.</li>\r\n	<li>Adjust the dosage button to get correct dose. After removal of the needle cap and discharge air bubbles in the cartridge, it is ready to be injected. In order to avoid cross contamination, do not let the needle touch anything during the process of preparation.</li>\r\n</ul>\r\n\r\n<p>Vial:</p>\r\n\r\n<ul>\r\n	<li>Firstly, clean your hands. Shake or rotate the vial gently to mix the solution uniformly and check if the insulin has the normal appearance.</li>\r\n	<li>If using a new Insulin Glargine bottle then flip off the plastic protective cap and wipe the rubber stopper with an alcohol swab.</li>\r\n	<li>Draw air into your syringe equal to the amount of Insulin Glargine needed. Puncture the needle into the vial and inject the air.</li>\r\n	<li>Turn the bottle and syringe upside down. Withdraw correct dose of Insulin Glargine into the syringe. Before pulling out the needle, check if there are any bubbles remain in the syringe.</li>\r\n	<li>If so, put the syringe upright and tap the syringe to discharge the air bubbles.</li>\r\n</ul>\r\n\r\n<p><strong>Injection Site</strong>: Choose the area where skin is less tight, such as the upper arm, thigh, buttock and abdomen, etc. To avoid tissue damage, choose a site for each injection that is at least 1 cm from the previous injection site.<br />\r\n<br />\r\n<strong>Injection Method</strong>: Cleanse the skin with alcohol where the injection is to be made. Put the needle in such a position as to form 45&deg; angle with the skin. Puncture the needle into skin and inject insulin. Then pull the needle out and apply gentle pressure over the injected site for several seconds. Do not rub the injection site.</p>', '<p>A number of drugs affect glucose metabolism and may require dose adjustment.<br />\r\n<br />\r\n<strong>The following substances may reduce the Insulin as well as Insulin glargine requirements</strong>: Oral anti-diabetic products, angiotensin converting enzyme (ACE) inhibitors, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, propoxyphene, pentoxifylline, salicylates and sulfonamide antibiotics.<br />\r\n<br />\r\n<strong>The following substances may increase the Insulin as well as Insulin glargine requirements</strong>: Thiazides, glucocorticoids, thyroid hormones, beta-sympathomimetics, growth hormone and danazol. Beta-blockers, clonidine, lithium salts, and alcohol may either potentiate or weaken the blood-glucose-lowering effect of insulin.</p>', '<p>Insulin glargine is contraindicated in patients with hypersensitivity to insulin glargine or any of its excipients.</p>', '<p>Side effects of Insulin glargine are hypoglycemia, allergic reactions, injection site reaction, lipodystrophy, pruritus, and rash.</p>', '<p>Pregnancy category C. Insulin glargine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.<br />\r\n<br />\r\nLactation: It is unknown whether insulin glargine is excreted in human milk. Because many drugs, including human insulin, are excreted in human milk, caution should be exercised when Insulin glargine is administered to a nursing woman. Lactating women may require adjustments in insulin dose &amp; diet.</p>', '<p><strong>Dose adjustment and monitoring</strong>: Blood glucose should be monitored in all patients treated with insulin. Insulin regimens should be modified cautiously and only under medical supervision.<br />\r\n<br />\r\n<strong>Administration</strong>: Insulin glargine must not be diluted or mixed with any other insulin or solution. It should not be administered subcutaneously via an insulin pump or intravenously because severe hypoglycemia can occur.<br />\r\n<br />\r\n<strong>Renal or hepatic impairment</strong>: Reduction in the Insulin glarginedose may require in these cases.</p>', '<p>Insulin glargine overdose may result in hypoglycemia. Mild episodes of hypoglycemia can usually be treated with oral carbohydrates. Severe hypoglycemia may be treated with parenteral glucose or injections of glucagon. Adjustments in drug dosage, meal patterns, or exercise may be needed.</p>', '<p>Long Acting Insulin</p>', '<p>Store at 2&deg; C to 8&deg; C in a refrigerator. Do not freeze. In case of insulin for recent use need not to be refrigerated, try to keep it in a cool place and keep away from heat and light. The insulin in use can be kept under the room temperature for a month.</p>', '<p>Use in Renal/ Hepatic impairment: Reduction in the insulin glargine doses may be required in these cases.</p>', '2022-03-06 16:28:40', '2022-03-06 16:28:40');
INSERT INTO `generic_details` (`id`, `generic_id`, `indications`, `pharmacology`, `dosage_and_administration`, `interaction`, `contraindications`, `side_effects`, `pregnancy_and_lactation`, `precautions_and_warnings`, `overdose_effects`, `therapeutic_class`, `storage_conditions`, `use_in_special_populations`, `created_at`, `updated_at`) VALUES
(754, 754, '<p>Insulin Glulisine is indicated to improve glycemic control in adults and children with diabetes mellitus.</p>', '<p>Regulation of glucose metabolism is the primary activity of insulins and insulin analogs, including insulin glulisine. Insulins lower blood glucose by stimulating peripheral glucose uptake by skeletal muscle and fat, and by inhibiting hepatic glucose production. Insulins inhibit lipolysis and proteolysis, and enhance protein synthesis. The glucose lowering activities of Insulin Glulisine and of regular human insulin are equipotent when administered by the intravenous route. After subcutaneous administration, the effect of Insulin Glulisine is more rapid in onset and of shorter duration compared to regular human insulin.</p>', '<p>Insulin Glulisine is a recombinant insulin analog that is equipotent to human insulin (i.e. one unit of Insulin Glulisine has the same glucose lowering effect as one unit of regular human insulin) when given intravenously. When given subcutaneously, Insulin Glulisine has a more rapid onset of action and a shorter duration of action than regular human insulin.<br />\r\n<br />\r\nThe dosage of Insulin Glulisine must be individualized. Blood glucose monitoring is essential in all patients receiving insulin therapy. The total daily insulin requirement may vary and is usually between 0.5 to 1 Unit/kg/day. Insulin requirements may be altered during stress, major illness, or with changes in exercise, meal patterns, or coadministered drugs.</p>\r\n\r\n<p><strong>Subcutaneous administration</strong>: Insulin Glulisine should be given within 15 minutes before a meal or within 20 minutes after starting a meal. Insulin Glulisine given by subcutaneous injection should generally be used in regimens with an intermediate or long acting insulin. Insulin Glulisine should be administered by subcutaneous injection in the abdominal wall, thigh, or upper arm. Injection sites should be rotated within the same region (abdomen, thigh or upper arm) from one injection to the next to reduce the risk of lipodystrophy<br />\r\n<br />\r\n<strong>Continuous subcutaneous infusion (insulin pump)</strong>: Insulin Glulisine may be administered by continuous subcutaneous infusion in the abdominal wall. Do not use diluted or mixed insulins in external insulin pumps. Infusion sites should be rotated within the same region to reduce the risk of lipodystrophy. The initial programming of the external insulin infusion pump should be based on the total daily insulin dose of the previous regimen.<br />\r\n<br />\r\n<strong>Intravenous administration</strong>: Insulin Glulisine can be administered intravenously under medical supervision for glycemic control with close monitoring of blood glucose and serum potassium to avoid hypoglycemia and hypokalemia. For intravenous use, Insulin Glulisine should be used at concentrations of 0.05 Units/mL to 1 Unit/mL insulin glulisine in infusion systems using polyvinyl chloride (PVC) bags. Insulin Glulisine has been shown to be stable only in normal saline solution (0.9% sodium chloride). Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. Do not administer insulin mixtures intravenously.</p>', '<p>Possible absence of hypoglycaemic warning symptoms with beta-blockers. Decreased hypoglycaemic effect with corticosteroids, danazol, diazoxide, diuretics, glucagon, isoniazid, phenothiazine derivatives, somatropin, sympathomimetic agents, thyroid hormones, oestrogens, progestins (e.g. in oral contraceptives), protease inhibitors and atypical antipsychotics (e.g. olanzapine and clozapine). Increased hypoglycaemic effect with oral antidiabetic agents, ACE inhibitors, disopyramide, fibrates, fluoxetine, MAOIs, pentoxifylline, propoxyphene, salicylates and sulfonamide antibiotics. Decreased insulin resistance with octreotide and lanreotide. Increased risk of wt gain and peripheral oedema with pioglitazone, rosiglitazone. Decreased effect of sermorelin.</p>', '<p>Insulin Glulisine is contraindicated during episodes of hypoglycemia, in patients who are hypersensitive to Insulin Glulisine or to any of its excipients.<br />\r\n<br />\r\nWhen used in patients with known hypersensitivity to Insulin Glulisine or its excipients, patients may develop localized or generalized hypersensitivity reactions</p>', '<p>Some times severe, life-threatening allergic reactions can happen with insulin. If you think you are having a severe allergic reaction, get medical help right away. Signs of insulin allergy include:</p>\r\n\r\n<ul>\r\n	<li>rash all over your body</li>\r\n	<li>shortness of breath</li>\r\n	<li>wheezing (trouble breathing)</li>\r\n	<li>fast pulse</li>\r\n	<li>sweating</li>\r\n	<li>low blood pressure</li>\r\n</ul>', '<p>Pregnancy Category C. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks<br />\r\n<br />\r\nNursing mothers: It is unknown whether insulin glulisine is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Insulin Glulisine is administered to a nursing woman. Use of Insulin Glulisine is compatible with breast feeding, but women with diabetes who are lactating may require adjustments of their insulin doses.</p>', '<p>Renal or hepatic impairment. Regular monitoring of blood glucose and HbA1c. Rotate Inj sites to reduce lipodystrophy . Pregnancy, lactation.</p>', '<p>Excess insulin may cause hypoglycemia and, particularly when given intravenously, hypokalemia. Mild episodes of hypoglycemia usually can be treated with oral glucose. Adjustments in drug dosage, meal patterns, or exercise may be needed. More severe episodes of hypoglycemia with coma, seizure, or neurologic impairment may be treated with intramuscular/subcutaneous glucagon or concentrated intravenous glucose. Sustained carbohydrate intake and observation may be necessary because hypoglycemia may recur after apparent clinical recovery. Hypokalemia must be corrected appropriately.</p>', '<p>Rapid Acting Insulin</p>', '<p>Unopened Insulin Glulisine vials and cartridge systems should be stored in a refrigerator 2&deg;C-8&deg;C. Protect from light. Insulin Glulisine should not be stored in the freezer and it should not be allowed to freeze. Discard if it has been frozen. Unopened vials/cartridge systems not stored in a refrigerator must be used within 28 days.<br />\r\n<br />\r\nOpened vials, whether or not refrigerated, must be used within 28 days. If refrigeration is not possible, the open vial in use can be kept unrefrigerated for up to 28 days away from direct heat and light, as long as the temperature is not greater than 25&deg;C.</p>', '<p><strong>Pediatric use</strong>: The safety and effectiveness of subcutaneous injections of Insulin Glulisine have been established in pediatric patients (age 4 to 17 years) with type 1 diabetes. Insulin Glulisine has not been studied in pediatric patients with type 1 diabetes younger than 4 years of age and in pediatric patients with type 2 diabetes. As in adults, the dosage of Insulin Glulisine must be individualized in pediatric patients based on metabolic needs and frequent monitoring of blood glucose<br />\r\n<br />\r\n<strong>Geriatric use</strong>: In clinical trials (n=2408), Insulin Glulisine was administered to 147 patients &ge;65 years of age and 27 patients &ge;75 years of age. The majority of this small subset of elderly patients had type 2 diabetes. The change in HbA1c values and hypoglycemia frequencies did not differ by age. Nevertheless, caution should be exercised when Insulin Glulisine is administered to geriatric patients.<br />\r\n<br />\r\n<strong>Renal impairment</strong>: Dose reduction may be needed<br />\r\n<br />\r\n<strong>Hepatic impairment</strong>: Dose reduction may be needed</p>', '2022-03-06 16:32:19', '2022-03-06 16:32:19'),
(755, 755, '<p>Treatment of all patients with type 1 diabetes. Treatment of patients with type 2 diabetes who are not adequately controlled by diet and/ or oral hypoglycemic agents. For the initial stabilization of diabetes in patients with diabetic ketoacidosis, hyperosmolar non-ketotic syndrome and during periods of stress such as severe infections and major surgery in diabetic patients. Treatment of gestational diabetes.</p>', '<p>The blood glucose lowering effect of insulin is due to the facilitated uptake of glucose following binding of insulin to receptors on muscle and fat cells and to the simultaneous inhibition of glucose output from the liver. Insulatard is a long-acting insulin. Onset of action is within 1&frac12; hours, reaches a maximum effect within 4-12 hours and the entire time of duration is approximately 24 hours.<br />\r\n<br />\r\nInsulin in the blood stream has a half-life of a few minutes. Consequently, the time-action profile of an insulin preparation is determined solely by its absorption characteristics. This process is influenced by several factors (e.g. insulin dosage, injection route and site, thickness of subcutaneous fat, type of diabetes). The pharmacokinetics of insulins is therefore affected by significant intra- and inter-individual variation</p>', '<p>Always use your insulin and adjust your dose exactly as your doctor has told you. Check with your doctor, pharmacist or nurse if you are not sure. Eat a meal or snack containing carbohydrates within 30 minutes of the injection to avoid low blood sugar. Do not change your insulin unless your doctor tells you to. If your doctor has switched you from one type or brand of insulin to another, your dose may have to be adjusted by your doctor.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>For subcutaneous use. Insulatard is usually administered subcutaneously in the thigh. If convenient, the abdominal wall, the gluteal region or the deltoid region may also be used. Subcutaneous injection into the thigh results in a slower and less variable absorption compared to the other injection sites. Injection into a lifted skin fold minimises the risk of unintended intramuscular injection.<br />\r\n<br />\r\nKeep the needle under the skin for at least 6 seconds to make sure the entire dose is injected. Injection sites should be rotated within an anatomic region in order to avoid lipodystrophy. Insulin suspensions are never to be administered intravenously. Insulatard is accompanied by a package leaflet with detailed instruction for use to be followed. The vials are for use with insulin syringes with corresponding unit scale. When two types of insulin are mixed, draw the amount of fast-acting insulin first, followed by the amount of long-acting insulin.</p>', NULL, NULL, '<p>Low blood sugar (hypoglycaemia) is a very common side effect. It may affect more than 1 in 10 people.<br />\r\n<br />\r\nSigns of low blood sugar: Cold sweat; cool pale skin; headache; rapid heartbeat; feeling sick; feeling very hungry; temporary changes in vision; drowsiness; unusual tiredness and weakness; nervousness or tremor; feeling anxious; feeling confused; difficulty in concentrating.</p>', '<p>If you are pregnant, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine. This insulin can be used during pregnancy. Your insulin dose may need to be changed during pregnancy and after delivery. Careful control of your diabetes, particularly prevention of hypoglycaemia, is important for the health of your baby. There are no restrictions on treatment with this insulin during breast-feeding.</p>', '<ul>\r\n	<li>If you have trouble with your kidneys or liver, or with your adrenal, pituitary or thyroid glands.</li>\r\n	<li>If you exercise more than usual or if you want to change your usual diet, as this may affect your blood sugar level.</li>\r\n	<li>If you are ill, carry on taking your insulin and consult your doctor.</li>\r\n	<li>If you are going abroad, travelling over time zones may affect your insulin needs and the timing hereof.</li>\r\n</ul>', NULL, '<p>Rapid Acting Insulin</p>', '<p>Store in a refrigerator at 2&deg;C-8&deg;C. Keep away from the cooling element. Do not freeze.</p>', '<p>Use in children and adolescents: Can be used in children and adolescents.<br />\r\n<br />\r\nUse in special patient groups: If you have reduced kidney or liver function, or if you are above 65 years of age, you need to check your blood sugar more regularly and discuss changes in your insulin dose with your doctor.</p>', '2022-03-06 16:48:25', '2022-03-06 16:48:25'),
(756, 756, '<p>Treatment of all patients with type 1 diabetes. Treatment of patients with type 2 diabetes who are not adequately controlled by diet and/ or oral hypoglycemic agents. For the initial stabilization of diabetes in patients with diabetic ketoacidosis, hyperosmolar non-ketotic syndrome and during periods of stress such as severe infections and major surgery in diabetic patients. Treatment of gestational diabetes.</p>', '<p>The blood glucose lowering effect of insulin is due to the facilitated uptake of glucose following binding of insulin to receptors on muscle and fat cells and to the simultaneous inhibition of glucose output from the liver. Insulatard is a long-acting insulin. Onset of action is within 1&frac12; hours, reaches a maximum effect within 4-12 hours and the entire time of duration is approximately 24 hours.<br />\r\n<br />\r\nInsulin in the blood stream has a half-life of a few minutes. Consequently, the time-action profile of an insulin preparation is determined solely by its absorption characteristics. This process is influenced by several factors (e.g. insulin dosage, injection route and site, thickness of subcutaneous fat, type of diabetes). The pharmacokinetics of insulins is therefore affected by significant intra- and inter-individual variation</p>', '<p>Dosage is individual and determined in accordance with the needs of the patient. The individual insulin requirement is usually between 0.3 and 1.0 IU/kg day. The daily insulin requirement may be higher in patients with insulin resistance (e.g. during puberty or due to obesity) and lower in patients with residual, endogenous insulin production.<br />\r\n<br />\r\nThe physician determines one or several daily injections are necessary. Insulatard may be used alone or mixed with fast-acting insulin. In intensive insulin therapy the suspension may be used as basal insulin (evening and/or morning injection) with fast-acting insulin given at meals. In patients with diabetes mellitus optimised glycaemic control delays the onset of late diabetic complications. Close blood glucose monitoring is recommended.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>For subcutaneous use. Insulatard is usually administered subcutaneously in the thigh. If convenient, the abdominal wall, the gluteal region or the deltoid region may also be used. Subcutaneous injection into the thigh results in a slower and less variable absorption compared to the other injection sites. Injection into a lifted skin fold minimises the risk of unintended intramuscular injection.<br />\r\n<br />\r\nKeep the needle under the skin for at least 6 seconds to make sure the entire dose is injected. Injection sites should be rotated within an anatomic region in order to avoid lipodystrophy. Insulin suspensions are never to be administered intravenously. Insulatard is accompanied by a package leaflet with detailed instruction for use to be followed. The vials are for use with insulin syringes with corresponding unit scale. When two types of insulin are mixed, draw the amount of fast-acting insulin first, followed by the amount of long-acting insulin</p>', '<p>A number of medicinal products are known to interact with the glucose metabolism. Physicians must therefore take possible interactions into account and should always ask their patients about any medicinal products they take.<br />\r\n<br />\r\nThe following substances may reduce insulin requirement: Oral hypoglycaemic agents (OHA), monoamine oxidase inhibitors (MAOI), non-selective beta-blocking agents, angiotensin converting enzyme (ACE) inhibitors, salicylates and alcohol.<br />\r\n<br />\r\nThe following substances may increase insulin requirement: Thiazides, glucocorticoids, thyroid hormones and beta-sympathomimetics, growth hormone and danazol. Beta-blocking agents may mask the symptoms of hypoglycaemia and delay recovery from hypoglycaemia. Octreotide/lanreotide may both decrease and increase insulin requirement. Alcohol may intensify and prolong the hypoglycaemic effect of insulin.</p>', '<p>Hypoglycaemia, Hypersensitivity to human insulin or to any of the excipients</p>', '<p>Hypoglycemia is the most common adverse effect during insulin treatment and symptoms of hypoglycemia may occur suddenly. Few cases of the allergic reaction such as red and swollen or itching are reported. It usually disappears in a few days. In some instances, the allergy may be caused by other reasons rather than insulin, such as disinfectant and poor injection technique.</p>', '<p>There are no restrictions on treatment of diabetes with insulin during pregnancy, as insulin does not pass the placental barrier.</p>', '<p>Inadequate dosage or discontinuation of treatment, especially in type 1 diabetes, may lead to hyperglycaemia. Usually the first symptoms of hyperglycaemia set in gradually, over a period of hours or days. They include thirst, increased frequency of urination, nausea, vomiting, drowsiness, flushed dry skin, dry mouth, loss of appetite as well as acetone odour of breath In type 1 diabetes, untreated hyperglycaemic events eventually lead to diabetic ketoacidosis, which is potentially lethal. Hypoglycaemia may occur if the insulin dose is too high in relation to the insulin requirement<br />\r\n<br />\r\nOmission of a meal or unplanned, strenuous physical exercise may lead to hypoglycaemia. Patients whose blood glucose control is greatly improved e.g. by intensified insulin therapy, may experience a change in their usual warning symptoms of hypoglycaemia and should be advised accordingly Usual warning symptoms may disappear in patients with longstanding diabetes.</p>', '<p>A specific overdose of insulin cannot be defined. However, hypoglycaemia may develop over sequential stages</p>', '<p>Long Acting Insulin</p>', '<p>Store in a refrigerator (2&deg;C-8&deg;C). Do not freeze. Keep the container cartridge or vial in the outer carton in order to protect from light.<br />\r\n<br />\r\nDuring use: do not refrigerate. Do not store vials above 25&deg;C and cartridges above 30&deg;C. Protect from excessive heat and sunlight.</p>', NULL, '2022-03-07 05:21:06', '2022-03-07 05:21:06'),
(757, 757, '<p>Treatment of all patients with type 1 diabetes. Treatment of patients with type 2 diabetes who are not adequately controlled by diet and/ or oral hypoglycemic agents.<br />\r\n<br />\r\nFor the initial stabilization of diabetes in patients with diabetic ketoacidosis, hyperosmolar non-ketotic syndrome and during periods of stress such as severe infections and major surgery in diabetic patients. Treatment of gestational diabetes.</p>', '<p>Insulin Human (rDNA) is human insulin made by recombinant DNA technology. It has the same structure and function as natural insulin. Insulin regulates the glucose metabolism and stimulates the ingestion and utilization of glucose by liver, muscle and fat tissue. It also lowers blood glucose by accelerating glycogenesis and inhibiting gluconeogenesis.<br />\r\n<br />\r\nInsulin Human (rDNA) 30/70 &amp; Insulin Human (rDNA) 50/50 start action within 30 minutes after injection, reach peak level within 2-8 hours and last about 24 hours.</p>', '<p>The average range of total daily insulin requirement for maintenance therapy in type 1 diabetic patients lies between 0.5 and 1.0 IU/kg. In pre-pubertal children it usually varies from 0.7 to 1.0 IU/kg, whereas in insulin resistant cases, e.g. during puberty or due to obesity, the daily insulin requirement may be substantially higher. Initial dosages for type 2 diabetic patients are often lower, e.g. 0.3 to 0.6 IU/kg/day.<br />\r\n<br />\r\nThe dosage form, the dosage and the administration time of the insulin are different due to the individual differences of each patient. In addition, the dosage is also affected by food, working style and exercising intensity. Therefore, patients should use the insulin under doctor&#39;s instruction.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>An injection should be followed by a meal or snack containing carbohydrates within 30 minutes. Injection is administered subcutaneously in the upper arm, thigh, buttock or abdominal wall. A subcutaneous injection into the abdominal wall results in a faster absorption than from other injection sites. Insulin Human (rDNA) 30/70 &amp; Insulin Human (rDNA) 50/50 are never to be administered intravenously.<br />\r\n<br />\r\nPreparation before use:</p>\r\n\r\n<ul>\r\n	<li>Clean your hands.</li>\r\n	<li>Shake or rotate the vial gently to mix the solution uniformly and check if the insulin has the normal appearance.</li>\r\n	<li>In case of using a new vial, flip off the plastic protective cap and wipe the rubber plug with an alcohol swab.</li>\r\n	<li>Draw air into your syringe equal to the amount of insulin needed.</li>\r\n	<li>Puncture the needle into the vial and inject the air.</li>\r\n	<li>Turn the bottle and syringe upside down and withdraw correct dose of insulin into the syringe.</li>\r\n	<li>Before pulling out the needle, check if there are any bubbles remain in the syringe. If so, put the syringe upright and tap the syringe to discharge the air bubbles.</li>\r\n</ul>\r\n\r\n<p>Injection site:</p>\r\n\r\n<ul>\r\n	<li>Choose the area where skin is less tight, such as the upper arm, thigh, buttock or abdomen.</li>\r\n	<li>To avoid tissue damage, choose a site for each injection that is at least 1 cm from the previous injection site.</li>\r\n</ul>\r\n\r\n<p>Injection method:</p>\r\n\r\n<ul>\r\n	<li>Cleanse the skin with alcohol where the injection is to be made.</li>\r\n	<li>Put the needle in such a position as to form 45&deg; angle with the skin.</li>\r\n	<li>Puncture the needle into skin and inject insulin.</li>\r\n	<li>Keep the needle under the skin for at least 6 seconds to make sure the entire dose is injected.</li>\r\n	<li>Pull the needle out and apply gentle pressure over the injected site for several seconds.</li>\r\n	<li>Do not rub the injection site.</li>\r\n</ul>', '<p>When using oral contraceptive drug, adrenal cortical hormone, thyroid hormone, etc., the drugs that can result in the rise of blood glucose; you might need to increase the amount of Insulin. When using drugs with hypoglycemic activities, salicylate, sulfanilamide and other anti-depressants, which will result in the decrease of blood glucose, the dosage of insulin should be reduced.</p>', '<p>Hypoglycemia or the patients who have allergic reaction to insulin or any of the excipients.</p>', '<p>Hypoglycemia is the most common adverse effect during insulin treatment and symptoms of hypoglycemia may occur suddenly. Few cases of the allergic reaction such as red and swollen or itching are reported. It usually disappears in a few days. In some instances, the allergy may be caused by other reasons rather than insulin, such as disinfectant and poor injection technique.</p>', '<p>There are no restrictions on treatment of diabetes with insulin during pregnancy, as insulin does not pass the placental barrier. Insulin treatment of the nursing mother presents no risk to the baby.</p>', '<p>Inadequate dosing or discontinuation especially in type 1 diabetes, may lead to hyperglycemia. Hypoglycemia may occur if the insulin dose is too high in relation to the insulin requirement. Omission of a meal or unplanned, strenuous physical exercise may lead to hypoglycemia.</p>', '<p>Excessive use of insulin may lead to hypoglycemia during the treatment. Slight to moderate hypoglycemia may suddenly occur. It is important to get immediate treatment when hypoglycemia occurs. If you have frequent hypoglycemia, you should consult your doctor to discuss possible changes in therapy, diet plans, and/or exercise programs to help you avoid hypoglycemia.</p>', '<p>Medium Acting Insulin</p>', '<p>Store at 2&deg;C - 8&deg;C in a refrigerator. Do not freeze. In case of insulin for recent use need not be refrigerated, try to keep it in a cool place and keep away from heat and light. The insulin in use can be kept under the room temperature for a month.</p>', NULL, '2022-03-07 05:24:50', '2022-03-07 05:24:50'),
(758, 758, '<p>Insulin Lispro is an insulin analogue that is indicated in the treatment of patients with diabetes mellitus for the control of hyperglycemia. Insulin Lispro has a more rapid onset and a shorter duration of action than human regular insulin. Therefore, in patients with type 1 diabetes, Insulin Lispro should be used in regimens that include a longer-acting insulin. However, in patients with type 2 diabetes, Insulin Lispro may be used without a longer-acting insulin when used in combination therapy with sulfonylurea agents.</p>', '<p>Insulin Lispro (insulin lispro, rDNA origin) is a human insulin analogue that is a rapid-acting, parenteral blood glucose-lowering agent. Chemically, it is Lys(B28), Pro(B29) human insulin analogue, created when the amino acids at positions 28 and 29 on the insulin B -chain are reversed. Insulin Lispro is synthesized in a special non-pathogenic laboratory strain of Escherichia coli bacteria that has been genetically altered by the addition of the gene for insulin lispro. The blood glucose lowering effect of insulin lispro is due to the facilitated uptake of glucose following binding of insulin to receptors on muscle and fat cells and to the simultaneous inhibition of glucose output from the liver.</p>', '<p><strong>Adult</strong>: SC Dosing regimen should be individualised and adjusted based on patient&#39;s glycaemic response. Usual range is 0.5-1 unit/kg/day.<br />\r\n<br />\r\n<strong>Type 1 diabetes mellitus:&nbsp;</strong>Approximately one third of the total daily insulin requirements SC; rapid-acting or short-acting, premeal insulin should be used to satisfy the remainder of the daily insulin requirements<br />\r\n<br />\r\n<strong>Usual daily maintenance range</strong>: 0.5-1 unit/kg/day in divided doses; nonobese may require 0.4-0.6 unit/kg/day; obese may require 0.8-1.2 units/kg/day<br />\r\n<br />\r\n<strong>Type 2 diabetes mellitus:&nbsp;</strong>If inadequately controlled with oral medication: 10 units/day SC (or 0.1 -0.2 unit/kg/day) of intermediate- or long-acting insulin given at bedtime generally recommended; as an alternative, rapid-acting formulations, such as insulin lispro, given before meals have also been used; dose must be adjusted carefully.</p>', '<p>Insulin requirements may be increased by medications with hyperglycemic activity such as corticosteroids, isoniazid, certain lipid-lowering drugs (e.g., niacin), estrogens, oral contraceptives, phenothiazines, and thyroid replacement therapy. Insulin requirements may be decreased in the presence of drugs that increase insulin sensitivity or have hypoglycemic activity, such as oral antidiabetic agents, salicylates, sulfa antibiotics, certain antidepressants (monoamine oxidase inhibitors), angiotensin-converting-enzyme inhibitors, Angiotensin II receptor blocking agents, beta-adrenergic blockers, inhibitors of pancreatic function (e.g., octreotide), and alcohol. Beta-adrenergic blockers may mask the symptoms of hypoglycemia in some patients.</p>', '<p>Insulin Lispro is contraindicated by patients hypersensitivity to insulin lispro or the other excipients.</p>', '<p>Clinical studies comparing Insulin Lispro with Regular human insulin did not demonstrate a difference in frequency of adverse events between the two treatments. Adverse events commonly associated with human insulin therapy include the following: Body as a Whole: allergic reactions. Skin and Appendages: injection site reaction, lipodystrophy, pruritus, rash. Other: hypoglycemia.</p>', '<p>Pregnancy Category B. All pregnancies have a background risk of birth defects, loss, or other adverse outcome regardless of drug exposure. This background risk is increased in pregnancies complicated by hyperglycemia and may be decreased with good metabolic control. It is essential for patients with diabetes or history of gestational diabetes to maintain good metabolic control before conception and throughout pregnancy. In patients with diabetes or gestational diabetes insulin requirements may decrease during the first trimester, generally increase during the second and third trimesters, and rapidly decline after delivery. Careful monitoring of glucose control is essential in these patients. Therefore, female patients should be advised to tell their physicians if they intend to become, or if they become pregnant while taking Insulin Lispro.<br />\r\n<br />\r\nNursing Mothers: It is unknown whether insulin lispro is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when insulin lispro is administered to a nursing woman. Use of insulin lispro is compatible with breastfeeding, but women with diabetes who are lactating may require adjustments of their insulin doses.</p>', '<p>Renal or hepatic impairment; pregnancy, lactation; transferring from other insulin. Monitor serum glucose, potassium, electrolytes, HbA1c and lipid profile. Concomitant illness esp infections.</p>', '<p>Excess insulin administration may cause hypoglycemia and hypokalemia. Mild episodes of hypoglycemia usually can be treated with oral glucose. Adjustments in drug dosage, meal patterns, or exercise may be needed. More severe episodes with coma, seizure, or neurologic impairment may be treated with intramuscular/subcutaneous glucagon or concentrated intravenous glucose. Sustained carbohydrate intake and observation may be necessary because hypoglycemia may recur after apparent clinical recovery. Hypokalemia must be corrected appropriately.</p>', '<p>Rapid Acting Insulin</p>', '<p>Store at 2&deg;C - 8&deg;C in a refrigerator. Do not freeze. In case of insulin for recent use need not be refrigerated, try to keep it in a cool place and keep away from heat and light. The insulin in use can be kept under the room temperature for a month.</p>', '<p><strong>Pediatric Use</strong>: Insulin Lispro is approved for use in children for subcutaneous daily injections. Only the U-100 formulation of Insulin Lispro is approved for use in children by continuous subcutaneous infusion in insulin pumps. Insulin Lispro has not been studied in pediatric patients younger than 3 years of age. Insulin Lispro has not been studied in pediatric patients with type 2 diabetes. As in adults, the dosage of Insulin Lispro must be individualized in pediatric patients based on metabolic needs and results of frequent monitoring of blood glucose.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Of the total number of subjects (n=2834) in eight clinical studies of Insulin Lispro, twelve percent (n=338) were 65 years of age or over. The majority of these had type 2 diabetes. HbA1c values and hypoglycemia rates did not differ by age. Pharmacokinetic/pharmacodynamic studies to assess the effect of age on the onset of Insulin Lispro action have not been performed.<br />\r\n<br />\r\n<strong>Renal Impairment</strong>: Patients with renal impairment may be at increased risk of hypoglycemia and may require more frequent Insulin Lispro dose adjustment and more frequent blood glucose monitoring.<br />\r\n<br />\r\n<strong>Hepatic Impairment</strong>: Patients with hepatic impairment may be at increased risk of hypoglycemia and may require more frequent Insulin Lispro dose adjustment and more frequent blood glucose monitoring</p>', '2022-03-07 05:27:43', '2022-03-07 05:27:43'),
(759, 759, '<p>A mixture of 75% insulin lispro protamine suspension and 25% insulin lispro injection, (rDNA origin), is indicated in the treatment of patients with diabetes mellitus for the control of hyperglycemia.<br />\r\n<br />\r\nA mixture of 50% insulin lispro protamine suspension and 50% insulin lispro injection, (rDNA origin), is also indicated in the treatment of patients with diabetes mellitus for the control of hyperglycemia.</p>', '<p>Insulin lispro is a short-acting biosynthetic human insulin analogue. Insulin lispro protamine is an intermediate-acting glucose-lowering agent; it is a suspension of crystals produced from combining insulin lispro and protamine sulfate under appropriate conditions for crystal formation. They are used together for the regulation of glucose metabolism.</p>', '<p>Combination rapid-onset (faster than regular insulin) and intermediate-acting insulins in fixed dose. Dose regimen varies among patients depending on metabolic needs; typical daily insulin requirements range between 0.5-1 unit/kg</p>', '<p>Effects may be increased by: oral antidiabetic agents, ACE inhibitors, disopyramide, fibrates, fluoxetine, MAOIs, propoxyphene, salicylates, somatostatin analog (e.g., octreotide), sulfonamide antibiotics. Effects may be decreased by: corticosteroids, niacin, danazol, diuretics, sympathomimetic agents, isoniazid, phenothiazine derivatives, somatropin, thyroid hormones, oral contraceptives, lithium. Signs of hypoglycaemia may be masked by beta-blockers, clonidine.</p>', '<p>Insulin Lispro Protamine &amp; Insulin Lispro is contraindicated during episodes of hypoglycemia and in patients sensitive to insulin lispro or any of the excipients contained in the formulation</p>', '<p>Hypoglycaemia; hypokalemia, oedema; pruritus; pulpitation, nausea, rash; hypersensitivity reactions; lipoatropy or lipohypertrophy with SC Inj.</p>', '<p>Pregnancy Category B. Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women OR Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in any trimester.<br />\r\n<br />\r\nLactation: Unknown whether distributed in breast milk; compatible with breast feeding, but lactating women may require dosage adjustment; caution advised</p>', '<p>Renal or hepatic impairment; pregnancy, lactation; transferring from other insulin. Monitor serum glucose, potassium, electrolytes, HbA1c and lipid profile. Concomitant illness esp infections.</p>', '<p>Store at 2-8&deg; C in a refrigerator. Do not freeze. In case of insulin for recent use need not be refrigerated, try to keep it in a cool place and keep away from heat and light. The insulin in use can be kept under the room temperature for a month.</p>', '<p>Combination Insulin</p>', '<p>Store at 2-8&deg; C in a refrigerator. Do not freeze. In case of insulin for recent use need not be refrigerated, try to keep it in a cool place and keep away from heat and light. The insulin in use can be kept under the room temperature for a month.</p>', NULL, '2022-03-07 05:38:00', '2022-03-07 05:38:00'),
(760, 760, '<p>Interferon alfa-2a is indicated for the treatment of chronic hepatitis C and hairy cell leukemia in patients 18 years of age or older. In addition, it is indicated for&nbsp;chronic phase,&nbsp;Philadelphia chromosome&nbsp;(Ph) positive chronic myelogenous leukemia (CML) patients who are minimally pretreated (within 1 year of diagnosis).<br />\r\n<br />\r\n<strong>For Patients With Chronic Hepatitis C</strong>: Interferon alfa-2a is indicated for use in patients with chronic hepatitis C diagnosed by HCV antibody and/or a history of exposure to hepatitis C who have compensated&nbsp;liver disease&nbsp;and are 18 years of age or older. A&nbsp;liver biopsyand a serum test for the presence of antibody to HCV should be performed to establish the diagnosis of chronic hepatitis C. Other causes of hepatitis, including&nbsp;hepatitis B, should be excluded prior to therapy with Interferon alfa-2a .</p>', '<p>Interferon alfa-2a has antiviral, antitumour and immunomodulatory activity. It inhibits replication of a wide range of RNA and DNA viruses. It also exerts antiproliferative effects on normal and malignant cells. Interferon alfa-2a suppresses antibody formation through an effect on B-lymphocytes and inhibits onset of delayed hypersensitivity.</p>', '<p><strong>Renal cell carcinoma:</strong>&nbsp;In an escalating dose of 3 million unit 3 times/week for 1 week, then 9 million unit 3 times/week for 1 week, then 18 million unit 3 times/week thereafter for 3-12 month.<br />\r\n<br />\r\n<strong>Chronic hepatitis B:</strong>&nbsp;2.5-5 million unit/m2&nbsp;3 times/week for 4-6 month. Chronic hepatitis C with&nbsp;ribavirin: 3-4.5 million unit 3 times/week for 6 month. Monotherapy: 3 million unit 3 times/ week for 12 month. Hairy cell leukaemia 3 million unit/day for 16-24 week. Maintenance: 3 million unit 3 times/week, up to 24 week.<br />\r\n<br />\r\n<strong>AIDS related Kaposi&#39;s sarcoma:</strong>&nbsp;In an escalating dose of 3 million unit/day for 3 days, 9 million unit/day for 3 days, 18 million unit/day for 3 days, and 36 million unit/day (if tolerated) on days 10-84. thereafter max tolerated dose (up to 36 million u) 3 times/week.<br />\r\n<br />\r\n<strong>Chronic myeloid leukaemia:</strong>&nbsp;In an escalating dose of 3 million unit/day for 3 days, 6 million unit/day for 3 days, and 9 million unit/day thereafter. For responders after 12 week: Continue treatment until haematological response is complete or up to 18 month. Follicular lymphoma As adjunct to chemotherapy: 6 million unit/m2/day on days 22-26 of each 28-day cycle.<br />\r\n<br />\r\n<strong>Cutaneous T-cell lymphoma:</strong>&nbsp;In an escalating dose of 3 million unit/day for 3 days, then 9 million unit/day for 3 days, and then 18 million unit/day to complete 12 week of treatment. Thereafter, max tolerated dose (up to 18 million unit) 3 times/week for at least 12 month in responders.</p>', '<p>Reduces clearance of theophylline. Enhanced myelosuppression with other myelosuppressive drugs (e.g. zidovudine). Drugs metabolised by CYP450 pathway (monitor for changes in pharmacologic or adverse effects of concomitant drug). Increased risk of toxicity of centrally acting drugs. Increased risk of renal failure with interleukin-2.</p>', '<p>Interferon Alfa-2a is contraindicated in</p>\r\n\r\n<ul>\r\n	<li>patients with a history of hypersensitivity to recombinant interferon alfa-2a or any component of the preparation.</li>\r\n	<li>patients with severe pre-existing cardiac disease or with any history of cardiac illness. No direct cardiotoxic effect has been demonstrated, but it is likely that acute, self-limiting toxicities (e.g. fever, chills) frequently associated with administration of Interferon Alfa-2a may exacerbate pre-existing cardiac conditions.</li>\r\n	<li>severe renal, hepatic or myeloid dysfunction.</li>\r\n	<li>seizure disorders and/or compromised central nervous system function.</li>\r\n	<li>chronic hepatitis with advanced, decompensated hepatic disease.</li>\r\n	<li>chronic hepatitis patients who are being or have recently been treated with immunosuppressive agents, excluding short-term &quot;steroid withdrawal&quot;.</li>\r\n	<li>CML patients with an HLA-identical relative who are potential candidates for allogeneic bone marrow transplantation in the immediate future.</li>\r\n	<li>neonates, children up to 3 years, and premature infants. Interferon Alfa-2a solution for injection contains benzyl alcohol. There have been reports of permanent neuropsychiatric deficits and multiple system organ failure associated with benzyl alcohol.</li>\r\n</ul>', '<p>Depressive illness, suicidal behaviour, irritability, insomnia, anxiety. Flu-like symptoms. Headache, dizziness, paraesthesia, confusion, impaired concentration, alteration in taste or smell. Gl disturbances. Dryness of oropharynx, epistaxis, rhinitis, arrhythmia, sinusitis. Inj site reaction, alopecia, rash, dry skin or pruritus. Conjunctivitis, menstrual irregularity, visual disturbances. Coughing, dyspnoea. Myalgia, joint or bone pain, arthritis or polyarthritis. Bone marrow depression.</p>', '<p><strong>Pregnancy Category</strong>: Interferon Alfa-2a should be administered only if the benefit to the woman justifies the potential risk to the foetus. Although animal tests do not indicate that Roferon-A is a teratogen, harm to the foetus from use during pregnancy cannot be excluded. When doses greatly in excess of the recommended clinical dose were administered to pregnant rhesus monkeys in the early to mid foetal period, an abortifacient effect was observed.<br />\r\n<br />\r\n<strong>Nursing mothers</strong>: It is not known whether Interferon Alfa-2a is secreted in human milk. A decision must be taken whether to suspend breast-feeding or to discontinue the medicine, taking into account the importance of the medicine to the mother.</p>', '<p>History of depression (monitor for signs). Perform regular neuropsychiatric monitoring. Seizure disorders and/or compromised CNS function. Preexisting or any history of cardiac disease. Monitor CBC prior to and during therapy. Myelosuppression or concurrent use of myelosuppressive drugs. Hypothyroidism, hyperthyroidism, DM. Perform ophthalmological exam on patients with preexisting ophthalmologic disorders (e.g. diabetic or hypertensive retinopathy). Monitor patients with impaired renal function.</p>', NULL, '<p>Immunological Chemotherapy</p>', NULL, NULL, '2022-03-07 05:41:33', '2022-03-07 05:41:33'),
(761, 761, '<p>This&nbsp;is a source of calories and essential fatty acids for patients requiring parenteral nutrition for extended periods of time (usually for &gt;5 days). It is a source of essential fatty acids when a deficiency occurs. Part of the intravenous diet in all parenteral nutrition indications including:<br />\r\n<br />\r\nPreoperative and postoperative nutritional disturbances where an improved nitrogen balance is required;<br />\r\n<br />\r\nNutritional disorders or disturbances of nitrogen balance due to inadequate or failing intestinal absorption caused by tumours in the gastrointestinal tract, acute or chronic intestinal diseases (peritonitis, ulcerative colitis, terminal ileitis);<br />\r\n<br />\r\nBurns, to reduce the frequently excessive nitrogen losses; Prolonged unconsciousness, eg. following cranial trauma or poisoning in cases where enteral feeding is inappropriate or impossible;<br />\r\n<br />\r\nImpaired renal function where a concentrated source of energy may be indicated to reduce protein breakdown;<br />\r\n<br />\r\nCachexia and Patients with essential fatty acid deficiency who cannot maintain or restore a normal essential fatty acid pattern by oral intake.</p>', '<p>This&nbsp;is a preparation of 10% refined soyabean oil intended to be used as an intravenous nutrient. This prevents Essential Fatty Acid Deficiency (EFAD) and corrects the clinical manifestations of EFAD. However, for patients requiring complete parenteral nutrition, complementary vitamin supplements are required. This are prepared from either soyabean or safflower oil and provide a mixture of neutral triglycerides, predominantly unsaturated fatty acids. The major components of fatty acids are linoleic, oleic, palmitic acids. In addition, This contains 1.2% egg yolk phospholipids as an emulsifier and glycerol to adjust tonicity. IV Fat emulsions are isotonic and may be given by central or peripheral venous route. This is formulated as a concentrated source of energy to be used together with carbohydrates and amino acids in parenteral nutrition, it is isotonic, and provides a source of basal phosphate requirements and a source of vitamin E.</p>', '<p>Total Parenteral nutrition: As a part of TPN, administer IV via a peripheral vein or by central venous catheter. Fat emulsion should comprise no more than 60% of the patient&#39;s total caloric intake, with carbohydrates and amino acids comprising the remaining 40% or more of caloric intake. Adult: Initial infusion rate is 1 ml/min for the first 15 to 30 mins. If no adverse reactions occur, the infusion rate can be increased to 2 ml/min. Infuse only 500 ml the first day and increase dose the following day. Do not exceed a daily dosage of 2.5 g/kg. Children: Initial infusion rate is 0.1 ml/min for the first 10 to 15 mins. If no adverse reactions occur, the infusion rate can be increased to 1 g/kg in 4 hours. Do not exceed a daily dosage of 3 g/kg. Infants: Starts at 0.5 g/kg/24 hours and may be increased in relation to the infant&#39;s ability to eliminate fat. The maximum recommended dosage is 3 g/kg/24 hours. Fatty acid deficiency: To correct EFAD, supply 8% to 10% of the caloric intake by IV fat emulsion to provide an adequate amount of linoleic acid. Do not store partially used bags for later use. Do not use filters. Do not use any bag in which there appears to be separation of the emulsion.</p>', '<p>Some drugs, like insulin, may interfere with the body&#39;s lipase system. This kind of interaction seems, however, to be of only limited clinical importance. Heparin in clinical doses causes a transient increase in lipolysis in plasma, resulting in a transient decrease in triglyceride clearance due to depletion of lipoprotein lipase.</p>', '<p>This is contraindicated in conditions with severely disordered fat metabolism, such as in severe liver damage and acute shock. Hypersensitivity to egg-, soya- or peanut protein or to any of active substances or excipients.</p>', '<p>This&nbsp;IV infusion may cause a rise in body temperature (incidence &lt;3%) and, less frequently, shivering, chills and nausea/vomiting (incidence &lt;1%). Reports of other adverse events in conjunction with 10% fat emulsion infusion are extremely rare, less than one report of certain events per one million infusions. Hypersensitivity reactions (anaphylactic reaction, skin rash, urticaria), respiratory symptoms (tachypnoea) and circulatory effects (hypertension, hypotension) have been described. Thrombosis, haemolysis, reticulocytosis, abdominal pain, tiredness, priapism and neurological adverse reactions including headaches, flushing, dyspnoea, slight pressure over the eyes and dizziness have been reported.</p>', '<p>No data found</p>', '<p>This injection contains soya oil and egg lecithin which may rarely cause allergic reactions. Cross allergic reaction has been observed between soya-bean and peanut. Fat metabolism may be disturbed in conditions such as renal insufficiency, uncompensated diabetes, pancreatitis, certain forms of liver insufficiency, metabolic disorders and sepsis. This injection should be administered with caution as a strong correlation exists between C-reactive protein and the agglutination of This injection in seriously ill patients. This injection should be given with caution to neonates and premature infants with hyperbilirubinaemia and in cases with suspected pulmonary hypertension. In low birthweight infants, the risk of lipid infusions may outweigh potential benefits due to further diminution of defences against infection. In infants, metabolism of lipids in peripheral tissues may be diminished by infection and heparin administration. In neonates receiving long term parenteral nutrition, particularly premature neonates, platelet count, liver function tests and serum triglyceride concentration should be monitored. Use in Pregnancy &amp; Lactation: Absolute safety of the foetus and the nursing infant has not been established. Therefore, This injectionTM should be administered with caution during pregnancy and lactation.</p>', '<p>Impaired capacity to eliminate this&nbsp;may lead to fat overload syndrome as a result of overdosage. It may also occur at recommended rates of infusion in association with a sudden change in the clinical condition such as renal function impairment or infection. Fat overload syndrome is characterised by bone marrow depression, anaemia, thrombocytopenia, hepatosplenomegaly, splenomegaly, hyperlipaemia, fever, fat infiltration, focal seizures and shock. All symptoms are usually reversible if the infusion of this&nbsp;is discontinued.</p>', '<p>Parenteral nutritional preparations</p>', '<p>Store at room temperature (not exceeding 25&deg; C). Protect from freezing and light. Emulsion which has been frozen should be discarded. Any remaining emulsion from an opened bag must be discarded. Do not use if the emulsion is discolored. This&nbsp;contains no preservatives.</p>', NULL, '2022-03-07 05:44:22', '2022-03-07 05:44:22');
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
(762, 762, '<p>Iodixanol injection is a radiographic contrast agent indicated for the following:</p>\r\n\r\n<p>Intra-arterial Procedures:</p>\r\n\r\n<p>Adults and pediatric patients 12 years of age and over:</p>\r\n\r\n<ul>\r\n	<li>Intra-arterial digital subtraction angiography (270 and 320 mg Iodine/mL).</li>\r\n	<li>Angiocardiography (left ventriculography and selective coronary arteriography), peripheral arteriography, visceral arteriography, and cerebral arteriography (320 mg Iodine/mL).</li>\r\n</ul>\r\n\r\n<p>Pediatric patients less than 12 years of age:</p>\r\n\r\n<ul>\r\n	<li>Angiocardiography, cerebral arteriography, and visceral arteriography (320 mg Iodine/mL).</li>\r\n</ul>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>Intravenous Procedures:</p>\r\n\r\n<p>Adults and pediatric patients 12 years of age and over:</p>\r\n\r\n<ul>\r\n	<li>Computed tomography (CT) imaging head and body and excretory urography (270 and 320 mg Iodine/mL).</li>\r\n	<li>CT imaging peripheral venography (270 mg Iodine/mL).</li>\r\n	<li>Coronary computed tomography angiography (CCTA) to assist diagnostic evaluation of patients with suspected coronary artery disease (320 mg Iodine/mL).</li>\r\n</ul>\r\n\r\n<p>Pediatric patients less than 12 years of age:</p>\r\n\r\n<ul>\r\n	<li>CT imaging of the head and body and excretory urography (270 mg Iodine/mL).</li>\r\n</ul>', '<p>Intravascular injection of iodixanol opacifies vessels in the path of flow of the contrast agent, permitting visualization of internal structures. In imaging of the body, iodinated contrast agents diffuse from the vascular into the extravascular space. In a normal brain with an intact blood-brain barrier, contrast does not diffuse into the extravascular space. In patients with a disrupted bloodbrain barrier, contrast agent accumulates in the interstitial space in the region of disruption.</p>', '<p>Individualize the combination of volume and concentration of&nbsp;Iodixanol&nbsp;Injection considering age, body weight, size of the vessel, rate of blood flow within the vessel, and other applicable factors. For the adult patients, the maximum recommended total dose of iodine is 80 grams. Patients should be adequately hydrated prior to and following the intravascular administration of iodinated contrast agents.</p>', NULL, '<p>Not indicated for intrathecal use</p>', '<p>Most common adverse reactions (incidence greater than 0.5%) in adult patients after Iodixanol&nbsp;injection: Discomfort, warmth, pain<br />\r\n<br />\r\n<strong>Cardiovascular</strong>: angina. Gastrointestinal: diarrhea, nausea, vomiting.<br />\r\n<br />\r\n<strong>Nervous System</strong>: agitation, anxiety, insomnia, nervousness, dizziness, headache, migraine, unusual skin sensations, sensory disturbance, fainting, sensation of spinning.<br />\r\n<br />\r\n<strong>Skin</strong>: itchy rash, severe itching, hives.<br />\r\n<br />\r\n<strong>Special Senses</strong>: Smell, taste, and vision alteration. Pediatric patients experienced similar adverse reactions.</p>', '<p><strong>Pregnancy</strong>:There are no data with iodixanol use in pregnant women to inform any drug-associated risks.<br />\r\n<br />\r\n<strong>Lactation</strong>: A lactating woman may pump and discard breast milk for 10 hours after Iodixanol&nbsp;administration</p>', '<p><strong>Hypersensitivity Reactions</strong>: life-threatening or fatal reactions can occur. Always have emergency equipment and trained personnel available.<br />\r\n<br />\r\n<strong>Contrast Induced Acute Kidney Injury</strong>: Acute injury including renal failure can occur. Minimize dose and maintain adequate hydration to minimize risk.<br />\r\n<br />\r\n<strong>Cardiovascular reactions</strong>: hemodynamic disturbances including shock and cardiac arrest may occur during or after administration.</p>', '<p>The adverse effects of overdosage of any contrast agent may be life-threatening and affect mainly the pulmonary and cardiovascular systems. Treatment of an overdosage is directed toward the support of all vital functions and prompt institution of symptomatic therapy. Iodixanol Injection does not bind to plasma or serum protein and can be dialyzed.</p>', '<p>Contrast medium for diagnostic procedures</p>', '<p>Iodixanol injection is a radiographic contrast agent indicated for the following:</p>\r\n\r\n<p>Intra-arterial Procedures:</p>\r\n\r\n<p>Adults and pediatric patients 12 years of age and over:</p>\r\n\r\n<ul>\r\n	<li>Intra-arterial digital subtraction angiography (270 and 320 mg Iodine/mL).</li>\r\n	<li>Angiocardiography (left ventriculography and selective coronary arteriography), peripheral arteriography, visceral arteriography, and cerebral arteriography (320 mg Iodine/mL).</li>\r\n</ul>\r\n\r\n<p>Pediatric patients less than 12 years of age:</p>\r\n\r\n<ul>\r\n	<li>Angiocardiography, cerebral arteriography, and visceral arteriography (320 mg Iodine/mL).</li>\r\n</ul>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p>Intravenous Procedures:</p>\r\n\r\n<p>Adults and pediatric patients 12 years of age and over:</p>\r\n\r\n<ul>\r\n	<li>Computed tomography (CT) imaging head and body and excretory urography (270 and 320 mg Iodine/mL).</li>\r\n	<li>CT imaging peripheral venography (270 mg Iodine/mL).</li>\r\n	<li>Coronary computed tomography angiography (CCTA) to assist diagnostic evaluation of patients with suspected coronary artery disease (320 mg Iodine/mL).</li>\r\n</ul>\r\n\r\n<p>Pediatric patients less than 12 years of age:</p>\r\n\r\n<ul>\r\n	<li>CT imaging of the head and body and excretory urography (270 mg Iodine/mL).</li>\r\n</ul>', '<p><strong>Geriatrics</strong>: Exercise caution in dose selection for elderly patients<br />\r\n<br />\r\n<strong>Pediatric Use</strong>: The safety and efficacy of Iodixanol have been established in pediatric patients down to birth for angiocardiography, cerebral arteriography, visceral arteriography, CT imaging of the head and body, and excretory urography. The safety and efficacy of Iodixanol have also been established in pediatric patients 12 years and older for intra-arterial digital subtraction angiography, peripheral arteriography, CT imaging peripheral venography and CCTA.</p>', '2022-03-07 05:48:48', '2022-03-07 05:53:27'),
(763, 763, '<p>Iohexol is an X-ray contrast medium for use in adults and children for cardioangiography, arteriography, urography, phlebography and CT-enhancement. Lumbar, thoracic, cervical myelography and computed tomography of the basal cisterns, following subarachnoid injection. It is also indicated for arthrography, endoscopic retrograde pancreatography (ERP), endoscopic retrograde cholangiopancreatography (ERCP), herniography, hysterosalpingography, sialography and studies of the gastrointestinal tract when the use of barium sulphate is unsatisfactory, undesirable or contraindicated.<br />\r\n<br />\r\nThe dosage varies depending on the type of examination, age, weight, cardiac output and general condition of the patient and the technique used. Usually the same iodine concentration and volume is used as with other iodinated X-ray contrast media in current use. Adequate hydration should be assured before and after administration as for other contrast media.</p>', '<p>Iohexol provides opacification of blood vessels and permits radiographic visualisation until sufficient haemodilution occurs or sufficient contrast medium has left the site of injection. Being a non-ionic compound, Iohexol yields solutions of lower osmolality than the conventional ionic contrast media. Intravenous or intra-arterial injection of Iohexol causes less pain and sensation of heat than conventional ionic media with similar iodine content. Iohexol solutions cause less cardiac and vascular disturbances on intravascular injection. The transit time of Iohexol through the coronary vascular system is slightly increased compared with conventional ionic contrast media, probably due to the increased viscosity of Iohexol at comparable iodine concentrations. The period of maximal opacification of the renal vessels may begin as early as 30 seconds after IV injection. Urograms become apparent in about 1 to 3 minutes with optimal contrast occurring between 5 to 15 minutes. In nephropathic conditions, particularly when excretory capacity has been altered, the rate of excretion may vary unpredictably, and opacification may be delayed after injection. Severe renal impairment may result in a lack of diagnostic opacification of the collecting system. The initial concentration and volume of the medium, in conjunction with appropriate patient manipulation and the volume of CSF into which the medium is placed, will determine the extent of diagnostic contrast that can be achieved. Following subarachnoid injection, Iohexol will continue to provide good diagnostic contrast by conventional radiography for at least 30 minutes. Slow diffusion of Iohexol takes place throughout the CSF as well as transfer into the circulation. At approximately 1 hour, contrast of diagnostic quality will not usually be available for conventional myelography. However, sufficient contrast for CT myelography will be available for several hours. If CT myelography is to follow, it should be deferred for several hours to allow the degree of contrast to decrease. Following lumbar subarachnoid placement, irrespective of the position in which the patient is later maintained, slow upward diffusion of Iohexol takes place throughout the CSF. CSF contrast enhancement for CT scanning may be expected in the thoracic region in about 1 hour, in the cervical region in about 2 hours and in the basal cisterns in 3 to 4 hours after administration into the lumbar subarachnoid space.</p>', '<p>Injection As iohexol soln containing 6-350 mg iodine/mL: Dose and strength used depends on the procedure and route of administration.</p>\r\n\r\n<p>Injection-</p>\r\n\r\n<p>Angiocardiography:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>:&nbsp;Ventriculography: 350 mg iodine/ml: 30-60 ml, usual: 40 ml, may be repeated as necessary. If with selective coronary arteriography: max 250 ml. Selective coronary arteriography: 350 mg iodine/ml: 3-14 ml per inj, usual: 5 ml. Aortic root and arch study when used alone: 350 mg iodine/ml: 20-75 ml, usual 50 ml. Multiple procedures: 350 mg iodine/ml: max 250 ml.</li>\r\n	<li><strong>Child</strong>:&nbsp;Ventriculography: 350 mg iodine/ml: 1-1.5 ml/kg, usual: 1.25 ml/kg; 300 mg iodine/ml: 1.5-2 ml/kg, usual 1.75 ml/kg. Max: 5 ml/kg; 350 mg iodine/ml: 250 ml; 300 mg iodine/ml: 291 ml. Pulmonary angiography: 350 mg iodine/ml: 1 ml/kg. Multiple procedures: Max: 5 ml/kg; 350 mg iodine/ml: 250 ml; 300 mg iodine/ml: 291 ml.</li>\r\n</ul>\r\n\r\n<p>Aortography and selective visceral arteriography</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>:&nbsp;Use 300 or 350 mg iodine/ml solution, single inj. Aorta: 50-80 ml; major branches: 30-60 ml; renal arteries: 5-15 ml. Repeat as necessary. Max: 300 mg iodine/ml: 291 ml; 350 mg iodine/ml: 250 ml.</li>\r\n	<li><strong>Child</strong>:&nbsp;Use 350 mg iodine/ml solution: 1 ml/kg, single dose. Max: 5 ml/kg up to 250 ml.</li>\r\n</ul>\r\n\r\n<p>Voiding cystourethrography:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>:&nbsp;Use diluted solutions using sterile water for inj to concentrations of 50-100 mg iodine/ml. Usual volume: 50 mg iodine/ml solution: 50-600 ml; 100 mg iodine/ml: 50-300 ml.</li>\r\n	<li><strong>Child</strong>:&nbsp;Children: Use diluted solutions using sterile water for inj to concentrations of 50-100 mg iodine/ml: 50-300 ml.</li>\r\n</ul>\r\n\r\n<p>Hysterosalpingography:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>:&nbsp;240 mg iodine/ml: 15-20 ml; 300 mg iodine/ml: 15-20 ml.</li>\r\n</ul>\r\n\r\n<p>Arthrography:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>:&nbsp;Knee: 240 mg iodine/ml: 5-15 ml; 300 mg iodine/ml: 5-15 ml; 350 mg iodine/ml: 5-10 ml. Shoulder: 240 mg iodine/ml: 3 ml; 300 mg iodine/ml: 10 ml. Temporomandibular: 300 mg iodine/ml: 0.5-1 ml. Lower volumes are recommended for double-contrast examinations; higher volumes are recommended fro single-contrast examinations.</li>\r\n</ul>\r\n\r\n<p>Herniography:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>:&nbsp;240 mg iodine/ml: 50 ml.</li>\r\n</ul>\r\n\r\n<p>Excretory urography:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>:&nbsp;Use 300 or 350 mg iodine/ml solution: 200-350 mg iodine/kg.</li>\r\n	<li>Child:&nbsp;Use 300 mg iodine/ml solution: 0.5-3 ml/kg,&nbsp;<strong>usual</strong>: 1-1.5 ml/kg; max: 3 ml/kg.</li>\r\n</ul>\r\n\r\n<p>Endoscopic retrograde cholangiopancreatography (ERCP), Endoscopic retrograde pancreatography (ERP):</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>:&nbsp;Use 240 mg iodine/ml: 10-50 ml.</li>\r\n</ul>\r\n\r\n<p><br />\r\nIntra-arterial-</p>\r\n\r\n<p>Peripheral arteriography:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>:&nbsp;Aortofemoral runoffs: 350 mg iodine/ml: 20-70 ml; 300 mg iodine/ml: 30-90 ml. Selective arteriograms (femoral/iliac): 350 mg iodine/ml: 10-30 ml; 300 mg iodine/ml: 10-60 ml. Venography (per leg): 240 mg iodine/ml: 20-150 ml; 300 mg iodine/ml: 40-100 ml.</li>\r\n</ul>\r\n\r\n<p>Cerebral arteriography:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>:&nbsp;Use 300 mg iodine/ml solution: Common carotid artery: 6-12 ml; internal carotid artery: 8-10 ml; external carotid artery: 6-9 ml; vertebral artery: 6-10 ml.</li>\r\n</ul>\r\n\r\n<p>Digital subtraction angiography:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>:&nbsp;Use 140 mg iodine/ml solution: Aorta: 20-45 ml at 8-20 ml/sec; carotid: 5-10 ml at 3-6 ml/sec; femoral: 9-20 ml at 3-6 ml/sec; vertebral: 4-10 ml at 2-8 ml/sec; renal: 6-12 ml at 3-6 ml/sec; other branches of the aorta (includes subclavian, axillary, innominate and iliac): 8-25 ml at 3-10 ml/sec.</li>\r\n</ul>\r\n\r\n<p><br />\r\nIntrathecal-</p>\r\n\r\n<p>Contrast-enhanced computerized tomography:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>:&nbsp;Lumbar (via lumbar inj): 180 mg iodine/ml: 10-17 ml; 240 mg iodine/ml: 7-12.5 ml. Thoracic (via lumbar or cervical inj): 240 mg iodine/ml: 6-12.5 ml; 300 mg iodine/ml: 6-10 ml. Cervical (via lumbar inj): 240 mg iodine/ml: 6-12.5 ml; 300 mg iodine/ml solution: 6-10 ml. Cervical (via C1-2 inj): 180 mg iodine/ml: 7-10 ml; 240 mg iodine/ml: 6-12.5 ml; 300 mg iodine/ml: 4-10 ml. Total columnar (via lumbar inj): 240 mg iodine/ml: 6-12.5 ml; 300 mg iodine/ml: 6-10 ml.</li>\r\n	<li><strong>Child</strong>:&nbsp;Use 180 mg iodine/ml solution. 0-&lt;3 mth: 240 ml; 3-&lt;36 mth: 4-8 ml; 3-&lt;7 yr: 5-10 ml; 7-&lt;13 yr: 5-12 ml; 13-18 yr: 6-15 ml.</li>\r\n</ul>\r\n\r\n<p><br />\r\nIntravenous-</p>\r\n\r\n<p>Contrast-enhanced computerized tomography of the abdomen:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>:&nbsp;In conjunction with dilute oral admin, use 300 mg iodine/ml solution: 100-150 ml. The oral dose is administered 20-40 min prior to IV dose and image acquisition.</li>\r\n	<li><strong>Child</strong>:&nbsp;In conjunction with dilute oral admin, use 240 or 300 mg iodine/ml solution: 1-2 ml/kg; max 3 ml/kg. The oral dose is administered 30-60 min prior to IV dose and image acquisition.</li>\r\n</ul>\r\n\r\n<p>Digital subtraction angiography:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>:&nbsp;350 mg iodine/ml: 30-50 ml, as a bolus at 7.5-30 ml/second using a pressure injector, usually for 3 or more inj; max: 250 ml.</li>\r\n</ul>\r\n\r\n<p>Contrast-enhanced computerized tomography:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>:&nbsp;Head imaging by inj: 300 mg iodine/ml: 70-150 ml; 350 mg iodine/ml: 80 ml. Head imaging by infusion: 240 mg iodine/ml: 120-250 ml. Body imaging by inj: 300 mg iodine/ml: 50-200 ml; 350 mg iodine/ml: 60-100 ml.</li>\r\n	<li><strong>Child</strong>:&nbsp;Head imaging: 240 or 300 mg iodine/ml: 1-2 ml/kg. Max: 28 g iodine with 240 mg iodine/ml solution or 35 g iodine with 300 mg iodine/ml solution.</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>Dose and strength used depends on the procedure and route of administration.</p>', '<p>Use of contrast media may result in a transient impairment of renal function and this may precipitate lactic acidosis in diabetics who are taking metformin (see Warnings and Precautions). Patients treated with interleukin-2 less than two weeks previously have been associated with an increased risk for delayed reactions (flu-like symptoms or skin reactions). All iodinated contrast media may interfere with tests on thyroid function, thus the iodine binding capacity of the thyroid may be reduced for up to several weeks. High concentrations of contrast media in serum and urine can interfere with laboratory tests for bilirubin, proteins or inorganic substances (e.g. iron, copper, calcium and phosphate). These substances should therefore not be assayed on the day of examination.</p>', '<p>Manifest thyrotoxicosis. History of serious reaction to Iohexol.</p>', '<p>Flushing or a sensation of heat; pain, extravasation, thrombophlebitis at the inj site; nausea, vomiting, headache, and dizziness; urticaria, pruritus, pallor, sweating, metallic taste, weakness, coughing, rhinitis, sneezing, lachrymation, visual disturbances; hypotension, tachycardia, bradycardia, transient ECG abnormalities, haemodynamic disturbances; dyspnoea, bronchospasm, angioedema, severe urticaria; convulsions, paraesthesia, paralysis; acute renal failure; thromboembolism, disseminated intravascular coagulation, thrombocytopenia; hyperthyroidism, thyroid storm thyrotoxicosis.</p>', '<p><strong>Use in Pregnancy</strong>: The safety of Iohexol for use in human pregnancy has not been established. An evaluation of experimental animal studies does not indicate direct or indirect harmful effects with respect to reproduction, development of the embryo or foetus, the course of gestation and peri- and postnatal development. Since whenever possible, radiation exposure should be avoided during pregnancy, the benefits of an X-ray examination, with or without contrast media, should be carefully weighed against the possible risk. Iohexol should not be used in pregnancy unless the benefit outweighs the risk and it is considered essential by the physician.<br />\r\n<br />\r\n<strong>Use during Lactation</strong>: Breast feeding may be continued normally when iodinated contrast media are given to the mother.</p>', '<p>A positive history of allergy, asthma, or untoward reactions to iodinated contrast media indicates a need for special caution. Premedication with corticosteroids or histamine H1 and H2 antagonists might be considered in these cases. The risk of serious reactions in connection with use of Iohexol is regarded as minor. However, iodinated contrast media may provoke anaphylactoid reactions or other manifestations of hypersensitivity. A course of action should therefore be planned in advance, with necessary drugs and equipment available for immediate treatment, should a serious reaction occur. It is advisable always to use an indwelling cannula or catheter for quick intravenous access throughout the entire X-ray procedure. Non-ionic contrast media have less effect on the coagulation system in vitro, compared to ionic contrast media. When performing vascular catheterisation procedures one should pay meticulous attention to the angiographic technique and flush the catheter frequently (e.g.: with heparinised saline) so as to minimise the risk of procedure-related thrombosis and embolism. Adequate hydration should be assured before and after contrast media administration. This applies especially to patients with multiple myeloma, diabetes mellitus, renal dysfunction, as well as to infants, small children and elderly patients. Young infants (age &lt; 1 year) and especially neonates are susceptible to electrolyte disturbance and haemodynamic alterations. Care should also be taken in patients with serious cardiac disease and pulmonary hypertension as they may develop haemodynamic changes or arrhythmias. Patients with acute cerebral pathology, tumours or a history of epilepsy are predisposed for seizures and merit particular care. Also alcoholics and drug addicts have an increased risk for seizures and neurological reactions. A few patients have experienced a temporary hearing loss or even deafness after myelography, which is believed to be due to a drop in spinal fluid pressure by the lumbar puncture per se. To prevent acute renal failure following contrast media administration, special care should be exercised in patients with pre-existing renal impairment and diabetes mellitus as they are at risk. Patients with paraproteinemias (myelomatosis and Waldenstr&ouml;m&#39;s macroglobulinemia) are also at risk</p>', '<p>Preclinical data indicate a high safety margin for Iohexol and no fixed upper dose level has been established for routine intravascular use. Symptomatic overdosing is unlikely in patients with normal renal function unless the patient has received an excess of 2000 mg I/kg body-weight over a limited period of time. The duration of the procedure is important for the renal tolerability of high doses of contrast media (t&frac12; ~ 2 hours). Accidental overdosing is most likely following complex angiographic procedures in children, particularly when multiple injections of contrast medium with high-concentration are given. In cases of overdose, any resulting water or electrolyte imbalance must be corrected. Renal function should be monitored for the next 3 days. If needed, haemodialysis may be used for clearance of excessive contrast medium. There is no specific antidote.</p>', '<p>Contrast medium for diagnostic procedures</p>', '<p>Store at room temperature below 30&deg; C and protect from light and secondary X-rays. The product in glass vials and bottles may be stored at 37&deg; C for up to 3 months prior to use.Do not freeze.</p>', NULL, '2022-03-07 05:56:30', '2022-03-07 05:56:30'),
(764, 764, '<p><strong>Neuroradiology:</strong>&nbsp;Lumber myelography, thoraco-cervical myelography<br />\r\n<br />\r\n<strong>Angiography:</strong>&nbsp;Cerebral angiography, selective coronary angiography, left ventriculography, aortography, angiocadiography, selective visceral arteriography, peripheral arteriography, digital subtraction angiography, venography, urography<br />\r\n<br />\r\n<strong>Other diagnostic procedures:</strong>&nbsp;Contrast enhancement in CT scanning, arthrography, fistulography.</p>', '<p>Iopamidol, an organic Iodine compound and used as a non-ionic water soluble radiographic contrast medium. Iopamidol blocks X-rays as they pass through the body, thereby allowing body structures not containing Iodine to be visualized. The degree of opacity produced by Iopamidol is directly proportional to the total amount of the iodinated contrast agent in the path of the X-rays. The visualization of body structures is dependent upon the distribution and elimination of Iopamidol.</p>', '<p>Adult dosage:</p>\r\n\r\n<ul>\r\n	<li><strong>Neurology</strong>:&nbsp;Lumber myelography: Iopamidol 370, 6-13 ml,</li>\r\n	<li><strong>Thoraco-cervical myelography</strong>: Iopamidol 370, 6-13 ml.</li>\r\n	<li><strong>Urography</strong>: Iopamidol 370, 40-80 ml IV up to 1.5 ml/kg in severe renal disease.</li>\r\n</ul>\r\n\r\n<p>Children:</p>\r\n\r\n<ul>\r\n	<li><strong>Usual Dose</strong>: 1-2.5 ml/kg</li>\r\n	<li><strong>Other Diagnostic Procedure</strong>: Contrast enhancement in CT scanning: Iopamidol 370, 0.5-2.0 ml/kg</li>\r\n</ul>\r\n\r\n<p><strong>Angiography</strong>: Cerebral angiography: Iopamidol 370, 6-13 ml<br />\r\n<br />\r\n<strong>Selective coronary arteriography</strong>: Iopamidol 370, 4-8 ml/artery<br />\r\n<br />\r\n<strong>Peripheral arteriography</strong>: Iopamidol 370, 20-50 ml<br />\r\n<br />\r\n<strong>Venography</strong>: Iopamidol 370, 24-60 ml<br />\r\n<br />\r\n<strong>Angiocardiography</strong>: Iopamidol 370, 30-80 ml<br />\r\n<br />\r\n<strong>Left ventriculography</strong>: Iopamidol 370, 30-80 ml<br />\r\n<br />\r\n<strong>Percutaneous transfemoral or renal arteriography</strong>: Iopamidol 370, 30 ml<br />\r\n<br />\r\n<strong>Selective renal arteriography</strong>: Iopamidol 370, 5-10 ml<br />\r\n<br />\r\n<strong>Hepatic angiography</strong>: Iopamidol 370, 70 ml<br />\r\n<br />\r\n<strong>Coeliac angiography</strong>: Iopamidol 370, 40-70 ml<br />\r\n<br />\r\n<strong>Superior mesenteric angiography</strong>: Iopamidol 370, 25-50 ml<br />\r\n<br />\r\n<strong>Inferior mesenteric angiography</strong>: Iopamidol 370, 5-30 ml<br />\r\n<br />\r\n<strong>Digital subtraction angiography</strong>: 30-50 ml (10-20 ml/sec) of Iopamidol 370, IV 25 ml (left ventricle), 2-5 ml (coronary arteries) ,15 ml/sec. of Iopamidol 370 i.a for cardiac imaging</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p><strong>NEURORADIOLOGY-</strong><br />\r\n<br />\r\n<strong>Lumber myelography:</strong>&nbsp;A slow sub-arachnoid injection is made through a fine lumber puncture needle into one of the lower interspinous spaces (L3-L4 or L4-L5). Optimum contrast appears immediately after injections and films should be obtained promptly.<br />\r\n<strong>Thoraco-cervical myelography:</strong>&nbsp;Following a slow sub-arachnoid injection the patient should be turned on his/her side and tilted 10o-20o head down under fluoroscopic control. In this manner it is possible to control movement of the contrast medium column into the dorsal region.<br />\r\nIf the cervical region is to be examined, the contrast medium should be run into the cervical region first, before the examination of the dorsal areas where it is progressively diluted. Iopamidol 300/370 may also be injected sub-occipitally or by lateral puncture technique .Care should be taken to ensure that the contrast medium does not move intracranially. It is generally recommended that in intrathecal use the patient should remain with a raised bed head and be kept well hydrated; following hydration it is preferable that the patient be allowed to be ambulatory .<br />\r\n<br />\r\n<strong>ANGIOGRAPHY-</strong><br />\r\n<br />\r\n<strong>Cerebral angiography:</strong>&nbsp;Any current technique is suitable for radiological visualization of the cerebral vasculature with Iopamidol 370/300 injection. Carotid and vertebral angiography, performed by catheterization or percutaneous injection techniques, require rapid injection which, if necessary, may be repeated.<br />\r\n<strong>Peripheral arteriography and venography</strong>: Percutaneous injection into the appropriate blood vessel is used for visualization of peripheral arteries and veins.<br />\r\n<strong>Angiocardiography, left ventriculography, selective coronary arteriography</strong>: Iopamidol 370/300 injection may be administered by rapid injection through a catheter into a suitable peripheral artery or vein. It can also be introduced under pressure through a cardiac catheter in to any of the heart chambers, or injected into large vessel for immediate visualization. The contrast medium may also be administered during selective catheterization of the coronary arteries.<br />\r\n<strong>Aortography:</strong>&nbsp;The contrast medium may be introduced directly or by intra-arterial injection for visualization of the aorta and its main branches.<br />\r\nSelective visceral angiography: Visualization can be achieved by selective catheterization and injection into the hepatic, coeliac or mesenteric arteries.<br />\r\n<strong>Digital subtraction angiography:</strong>&nbsp;For cardiac imaging the contrast medium may be administered intra-arterially by selective catheterization to provide substrated images. Iopamidol 370/300 injected intravenously either centrally or peripherally is also recommended for use this modality.<br />\r\n<br />\r\n<strong>UROGRAPHY-</strong><br />\r\n<br />\r\nThe contrast medium injected intravenously and rapidly eliminated through the kidneys. In patients with severe renal failure, high dose urography should be used.<br />\r\n<br />\r\n<strong>OTHER DIAGNOSTIC PROCEDURES-</strong><br />\r\n<br />\r\n<strong>Arthrography:</strong>&nbsp;Visualization of joint cavities and articular surfaces can be achieved either single or double contrast examination.<br />\r\n<strong>Contrast enhancement in CT scanning</strong>: Contrast enhancement for brain scans can be achieved between one and three minutes after i.v. injection. Iopamidol 370/300 are also be used for total body scanning examinations after i.v.administration as a bolus, as a drip infusion or by combination of the two methods.</p>', '<p>Iopamidol may interfere with thyroid function. Biguanide compete for excretion in the kidneys with contrast media and this could lead to reduction in kidney function. Patient taking Metformin or other Biguanides should therefore not take any doses of Metformin for 48 hours before or 48 hours after the X-ray examination.</p>', '<p>There are no definite or absolute contraindications to the use of Amidol, with the possible exception of waldenstrom&#39;s macroglobulinemia, multiple myeloma and severe liver and kidney disease.</p>', '<p>Common side effects are arrhythmias, arterial spasm, flushing, vasodilatation, angina, cardiopulmonary arrest; dizziness, confusion, paraesthesia, visual disturbances, seizure, paralysis, coma, temporary amnesia; inj site pain, pallor, periorbital and facial oedema; coughing, sneezing, rhinitis, asthma, apnoea, laryngeal oedema, chest tightness; watery itchy eyes, lachrymation, conjunctivitis; muscle spasm, involuntary leg movement; tremors, malaise; severe retching and choking, abdominal pain; urogenital pain, haematuria.</p>', '<p>Iopamidol injection should be administered in pregnancy only if the procedure is considered essential by the physician.</p>', '<p>May inhibit blood coagulation. Multiple myeloma or other paraproteinaemia. Sickle-cell disease. Known or suspected phaeochromocytoma (monitor closely). Hyperthyroidism. Ensure adequate hydration. History of a previous sensitivity to a contrast medium, sensitivity to iodine, bronchial asthma, hay fever and food allergy. Monitor patients with CHF. Avoid angiography in patients with homocystinuria. Severe arterial or venous disease. Severe renal impairment, combined renal and hepatic disease or anuria, especially when large doses are used. Pregnancy and lactation.</p>', '<p>Treatments of an overdose is directed toward the support of all vital functions and prompt institution of symptomatic therapy.</p>', '<p>Contrast medium for diagnostic procedures</p>', '<p>Store at 20-25&deg; C</p>', NULL, '2022-03-07 05:59:15', '2022-03-07 05:59:15'),
(765, 765, '<p>Ipratropium inhaler is indicated for-</p>\r\n\r\n<ul>\r\n	<li>As bronchodilator in treatment of chronic reversible airway obstruction as in asthma and Chronic Obstructive Pulmonary Disease (COPD) including chronic bronchitis and emphysema.</li>\r\n	<li>Treatment of acute reversible airways obstruction.</li>\r\n</ul>', '<p>Ipratropium bromide causes bronchodilation by blocking the action of acetylcholine at parasympathetic site in bronchial smooth muscle. It also inhibits serous and seromucous gland secretions by nasal application.</p>', '<p>Adults: The usual dose is 1-2 puffs (20 &micro;g/puff) three or four times daily. Single-dose up to 80 &micro;g (4 puffs) may be required to obtain maximum benefit during early treatment. Patients may take additional inhalations as required: however, the total number of inhalations should not exceed 12 puffs in 24 hours.<br />\r\n<br />\r\nChildren:</p>\r\n\r\n<ul>\r\n	<li>6-12 years: Usually 1-2 puffs two to three times daily.</li>\r\n	<li>Bellow 6 years: The usual dose is 1 puff (20 &micro;g) three times daily.</li>\r\n</ul>\r\n\r\n<p>In order to ensure that the inhaler is used correctly, the administration should be supervised by an adult.<br />\r\n<br />\r\nNo specific information on the use of the product in the elderly is available. Clinical trials have included patients over 65 years and no adverse reactions specific to this age group have been reported.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>Using an Inhaler seems simple, but most patients do not know how to use it in the right way. If the Inhaler is used in the wrong way, less medicine can reach the lungs. Correct and regular use of the Inhaler will prevent or lessen the severity of asthma attacks.<br />\r\n<br />\r\nFollowing simple steps can help to use Inhaler effectively (According to &quot;<strong>National Asthma Guidelines for Medical Practitioners</strong>&quot; published by Asthma Association):</p>\r\n\r\n<ul>\r\n	<li>Take off the cap.</li>\r\n	<li>Shake the inhaler (at least six times) vigorously before each use.</li>\r\n	<li>If the inhaler is new or if it has not been used for a week or more, shake it well and release one puff into the air to make sure that it works.</li>\r\n	<li>Breathe out as full as comfortably possible &amp; hold the inhaler upright.</li>\r\n	<li>Place the actuator into mouth between the teeth and close lips around the mouthpiece.</li>\r\n	<li>While breathing deeply and slowly through the mouth, press down firmly add fully on the canister to release medicine.</li>\r\n	<li>Remove the inhaler from mouth. Continue holding breath for at least for 10 seconds or as long as it is comfortable.</li>\r\n	<li>If doctor has prescribed more than one inhalation per treatment, wait 1 minute between puffs (inhalations). Shake the inhaler well and repeat steps 4 to 7.</li>\r\n	<li>After use, replace the cap on the mouthpiece. After each treatment, rinse mouth with water.</li>\r\n	<li>Check your technique in front of a mirror from time to time, if you see a white mist during the inhalation, you may not have closed your lips properly around mouthpiece, or you may not be breathing in as you press the can. This indicates failure of technique. If this happens, repeat the procedure from step 4 carefully.</li>\r\n</ul>\r\n\r\n<p><strong>Instructions for Cleaning Inhaler</strong>: Clean your Inhaler at least once a week. Remove canister and rinse the plastic actuator and cap in warm water but do not put the metal canister into water. Dry the actuator and cap thoroughly and gently replace the metal canister into the actuator with a twisting motion. Put the cap on the mouthpiece.</p>', '<p>Ipratropium bromide has been used concomitantly with other drugs, including sympathomimetic bronchodilators, methylxanthines, steroids and cromolyn sodium, commonly used in treatment of COPD, without any adverse drug reactions, there are no studies fully evaluating the interaction effects of lpratropium bromide and these drugs in respect to effectiveness.</p>', '<p>Known hypersensitivity to ipratropium bromide, Atropine or its derivative. Also contraindicated in patients with a history of hypersensitivity to soya lecithin or related food products such as soyabean, lecithin and peanut.</p>', '<p>Idiosyncratic reactions to lpratropium bromide are rare. Severe adverse effects due to inhibition of muscarinic receptors and ganglion blockade are theoretically possible but unlikely with the metered-dose aerosol. Regular use of ipratropium can lead to a dry mouth through inhibition of salivary flow.<br />\r\n<br />\r\nOther most common adverse reactions reported are - dryness of the oropharynx (5%); cough, exacerbation of symptoms, &amp; imitation from aerosol (3%); headache (2%); nausea, dizziness, blurred vision/difficulty in accommodation &amp; drying of secretions (1%).<br />\r\n<br />\r\nLess frequently reported adverse reactions include tachycardia, nervousness, paresthesias, drowsiness, co-ordination difficulty, itching, flushing, alopecia, constipation, tremor &amp; mucosal ulceration. Case of precipitation or worsening of narrow-angle glaucoma, acute eye pain &amp; hypotension also have been reported. Allergic-type reactions such as skin rash, angio-oedema of tongue, lips &amp; face, urticaria (including giant urticaria), laryngospasm and anaphylactic reaction have been also reported; with positive rechallenge in some cases.<br />\r\n<br />\r\nIpratropium bromide dose not produce adverse effects on mucociliary clearance, in contrast to atropine and other muscarinic antagonists. There is no evidence that in the therapeutic does range ipratropium bromide has any adverse effect on bronchial secretion.</p>', '<p>The safety of Ipratropium Bromide during human pregnancy has not been established. The benefits of using Ipratropium Bromide during a confirmed or suspected pregnancy must be weighed against possible hazards to the unborn child. It is not known whether Ipratropium Bromide is excreted into breast milk.</p>', '<p>Patients should be advised that temporary blurring of vision, precipitation or worsening of narrow angle glaucoma or eye pain may result if the aerosol is sprayed into the eyes. If recommended dosage does not provide relief or symptoms become worse, patients should seek immediate medical attention. While taking ipratropium bromide inhalation aerosol, other inhaled drugs should not be used unless prescribed.<br />\r\n<br />\r\nlpratropium bromide inhalation aerosol is not indicated for the initial treatment of acute episodes of bronchospasm where rapid response is required. Drugs with faster onset may be preferable as initial therapy in this situation. Immediate hypersensitivity reactions may occur after administration of ipratropium bromide, as demonstrated by rare cases of urticaria, angio-oedema, rash, bronchospasm and oropharyngeal oedema.</p>', '<p>Acute overdosage by inhalation is unlikely since ipratropium bromide is not well absorbed systematically after administration as aerosol. Inhaled dosage of 5 mg of ipratropium bromide produce an increase in heart rate and palpitation. Single doses of ipratropium bromide 30 mg by mouth caused anticholinergic side effects but which were not considered severe enough to require specific reversal.</p>', '<p>Anticholinergic bronchodilators</p>', '<p>The inhaler should be stored in a dry and cool place. Protected from direct sunlight and heat. Keep away from eyes. Keep out of reach of children. The canister should not be broken, punctured or burnt, even when apparently empty.</p>', NULL, '2022-03-07 06:23:39', '2022-03-07 06:23:39'),
(766, 766, '<p>Ipratropium bromide nasal spray is indicated for the treatment and management of perennial rhinitis, allergic rhinitis and vasomotor rhinitis when characterized by watery rhinorrhoea. Ipratropium bromide nasal spray is also indicated for the symptomatic relief of rhinorrhoea associated with the common cold. Ipratropium bromide nasal spray does not relieve nasal congestion, sneezing, or postnasal drip associated with allergic or non-allergic perennial rhinitis.</p>', '<p>Ipratropium bromide is an anticholinergic agent that inhibits vagally mediated reflexes by antagonizing the action of acetylcholine at the cholinergic receptor. In humans, Ipratropium bromide has antisecretory properties and when applied locally, inhibits secretions from the serous and seromucous glands lining the nasal mucosa. Ipratropium bromide is a quaternary amine that minimally crosses the nasal and gastrointestinal membrane and the blood-brain barrier, resulting in a reduction of the systemic anticholinergic effects (e.g. neuroleptic, ophthalmic, cardiovascular, and gastrointestinal effects) that are seen with tertiary anticholinergic amines.</p>', '<p><strong>For the treatment and management of perennial rhinitis, allergic rhinitis and vasomotor rhinitis when characterized by watery rhinorrhoea</strong>: 2 sprays into each nostril 2-4 times daily in adults and children age 5 years and older.<br />\r\n<br />\r\n<strong>For the symptomatic relief of rhinorrhoea associated with the common cold</strong>: The recommended dose is 2 sprays in to each nostril 2-4 times daily in adults and children age 5 years and older.<br />\r\n<br />\r\nThe safety and effectiveness of Ipratropium bromide nasal spray in pediatric patients under 5 years of age have not been established. The safety and effectiveness of Ipratropium bromide nasal spray beyond 3 weeks in patients with allergic rhinitis and 4 days in patients with the common cold have not been established.<br />\r\n<br />\r\nInitial pump priming requires seven sprays of the pump. If used regularly as recommended, no further priming is required. If not used more than 24 hours, the pump will require 2 sprays, or if not used for more than seven days, the pump will require 7 sprays.</p>', '<p>No controlled clinical trials were conducted to investigate drug drug interactions. Ipratropium bromide nasal spray is minimally absorbed into the systemic circulation; nonetheless, there is some potential for additive interaction with other concomitantly administered anti-cholinergic medications, including Ipratropium bromide containing aerosols for oral inhalation.</p>', '<p>Known hypersensitivity to atropine or its derivatives, or to any of the ingredients of Ipratropium bromide nasal spray (sodium chloride, benzalkonium chloride, disodium edetate dihydrate). Immediate hypersensitivity reactions may occur after administration of Ipratropium bromide, as demonstrated by rare cases of urticaria, angioedema, rash, bronchospasm, and oropharyngeal edema.</p>', '<p>The most frequent local undesirable effects of Ipratropium bromide nasal spray are nasal reactions including epistaxis, dryness of the nose and nasal irritation. Headache, nausea and local irritation (e.g. burning sensation) may occur as non specific reactions in association with use of Ipratropium bromide nasal spray. Potential systemic anticholinergic effects are dry mouth and dry throat. Ocular side effects, increase of heart rate and palpitations, urinary retention and gastrointestinal motility disturbances have been reported in isolated patients in association with use of Ipratropium bromide either intranasally or after oral inhalation. Allergic type reactions such as skin rash, angio-oedema of tongue, lips and face, urticaria, laryngospasm and anaphylactic reactions may occur.</p>', '<p>The safety of Ipratropium bromide nasal spray during pregnancy has not been established. The benefits of using this spray during a confirmed or suspected pregnancy must be weighed against possible hazards to the unborn child. Preclinical studies showed no embryotoxic or teratogenic effects following inhalation at doses considerably higher than those recommended in man<br />\r\n<br />\r\nIt is not known whether Ipratropium bromide is excreted into human milk. Although lipid-insoluble quaternary cations pass into breast milk, the minimal systemic absorption makes it unlikely that Ipratropium bromide would reach the infant in an amount sufficient to cause a clinical effect. However, because many drugs are excreted into human milk, caution should be exercised when Ipratropium bromide nasal spray is administered to a nursing mother.</p>', '<p>Ipratropium bromide nasal spray should be used with caution in patients predisposed to narrow-angle glaucoma, or with prostatic hyperplasia or bladder neck obstruction. Patients with cystic fibrosis may be more prone to gastrointestinal motility disturbances.</p>', NULL, '<p>Anticholinergic bronchodilators</p>', '<p>Store in a safe place out of the reach of children. Store below 30&deg;C. Avoid freezing. Do not spray in the eyes.</p>', '<p><strong>Use in children</strong>: The safety and effectiveness of Ipratropium bromide nasal spray in patients under 5 years of age have not been established.</p>', '2022-03-07 06:25:51', '2022-03-07 06:25:51'),
(767, 767, '<p>Ipratropium Nebuliser Solution is indicated as a bronchodilator for maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease, including chronic bronchitis and emphysema.</p>', '<p>Ipratropium Bromide is a quaternary ammonium compound with anticholinergic properties. It appears to inhibit vagal reflexes by antagonising the action of acetylcholine (the transmitter agent released from the vagus nerve). Anticholinergics prevent the increase in intracellular concentration of cyclic guanosine monophosphate (cyclic GMP) caused by interaction of acetylcholine with the muscarinic receptor on bronchial smooth muscle.</p>', '<p><strong>Children over 3 years</strong>: The usual dose is 0.4-2.0 ml Ipratropium Bromide Solution (100-500 micrograms) up to three times daily.&nbsp;<br />\r\n<br />\r\n<strong>Adults (including elderly and adolescents) over 12 years of age</strong>: The usual dose is 0.4-2.0 ml Ipratropium Bromide Solution (100-500 micrograms) up to four times daily.</p>', NULL, NULL, '<p>Allergic-type reactions such as skin rash, angio-oedema of the tongue, lips and face, urticaria (including giant urticaria), laryngospasm and anaphylactic reactions have been reported, with positive rechallenge in some cases.</p>', '<p>The safety of Ipratropium Bromide during human pregnancy has not been established. The benefits of using Ipratropium Bromide during a confirmed or suspected pregnancy must be weighed against possible hazards to the unborn child. It is not known whether Ipratropium Bromide is excreted into breast milk.</p>', '<p>Ipratropium Bromide should be used with caution in patients predisposed to narrow-angle glaucoma, or with prostatic hyperplasia or bladder-neck obstruction.</p>', NULL, '<p>Anticholinergic bronchodilators</p>', '<p>Should be stored in cool and dry place</p>', NULL, '2022-03-07 06:27:51', '2022-03-07 06:27:51');
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
(768, 768, '<p>Treatment of essential hypertension. Treatment of renal disease in patients with hypertension and type 2 diabetes mellitus as part of an antihypertensive drug regimen.</p>', '<p>Irbesartan is an angiotensin II receptor antagonist. It blocks the vasoconstricting and aldosterone-secreting effects of angiotensin II by binding to AT1 receptors.</p>', '<p><strong>Adult:</strong>&nbsp;The usual recommended initial and maintenance dose is Irbesartan 150 mg once daily, with&nbsp;or without food. Irbesartan at a dose of 150 mg once daily generally provides a better 24 hour&nbsp;blood pressure control than 75 mg. However, initiation of therapy with Irbesartan 75 mg could&nbsp;be considered, particularly in haemodialysed patients and in the elderly over 75 years.&nbsp;In patients insufficiently controlled with Irbesartan 150 mg once daily, the dose of Irbesartan&nbsp;can be increased to Irbesartan 300 mg, or other anti-hypertensive agents can be added. In particular, the addition of a diuretic such as hydrochlorothiazide has been shown to have an&nbsp;additive effect with Irbesartan.&nbsp;In hypertensive type 2 diabetic patients, therapy should be initiated at Irbesartan 150 mg&nbsp;once daily and titrated up to Irbesartan 300 mg once daily as the preferred maintenance dose&nbsp;for treatment of renal disease.&nbsp;The demonstration of renal benefit of Irbesartan in hypertensive type 2 diabetic patients is based&nbsp;on studies where Irbesartan was used in addition to other antihypertensive agents, as needed, to&nbsp;reach target blood pressure.&nbsp;<br />\r\n<br />\r\n<strong>Elderly:</strong>&nbsp;although consideration should be given to initiating therapy with Irbesartan 75 mg in patients over 75 years of age, dosage adjustment is not usually necessary for the elderly<br />\r\n<br />\r\n<strong>Paediatric:</strong>&nbsp;Irbesartan is not recommended for use in children and adolescents due to&nbsp;insufficient data on safety and efficacy.</p>', '<p><strong>Diuretics and other antihypertensive&nbsp;agents</strong>: prior treatment with high dose diuretics may result in volume depletion and&nbsp;a risk of hypotension when initiating therapy with Irbesartan.<br />\r\n<br />\r\n<strong>Potassium&nbsp;supplements and potassium-sparing diuretics</strong>: based on experience with the use of&nbsp;other drugs that affect the renin-angiotensin system, concomitant use of potassiumsparing&nbsp;diuretics, potassium supplements, salt substitutes containing potassium or&nbsp;other drugs that may increase serum potassium levels (e.g. heparin) may lead to&nbsp;increases in serum potassium and is, therefore, not recommended.<br />\r\n<br />\r\n<strong>Lithium</strong>:&nbsp;reversible increases in serum lithium concentrations and toxicity have been reported&nbsp;during concomitant administration of lithium with angiotensin converting enzyme&nbsp;inhibitors. Similar effects have been very rarely reported with irbesartan so far.&nbsp;Therefore, this combination is not recommended. If the combination proves&nbsp;necessary, careful monitoring of serum lithium levels is recommended.<br />\r\n<br />\r\n<strong>Non-steroidal&nbsp;anti-inflammatory drugs</strong>: When angiotensin II antagonists are administered&nbsp;simultaneously with non-steroidal anti- inflammatory drugs (i.e. selective COX-2&nbsp;inhibitors, acetylsalicylic acid &gt; 3 g/day and non-selective NSAIDs), attenuation of&nbsp;the antihypertensive effect may occur. Additional information on irbesartan&nbsp;interactions: In clinical studies, the pharmacokinetic of irbesartan is not affected by&nbsp;hydrochlorothiazide. Irbesartan is mainly metabolised by CYP2C9 and to a lesser&nbsp;extent by glucuronidation. No significant pharmacokinetic or pharmacodynamic&nbsp;interactions were observed when irbesartan was coadministered with warfarin, a&nbsp;drug metabolised by CYP2C9. The effects of CYP2C9 inducers such as rifampicin&nbsp;on the pharmacokinetic of irbesartan have not been evaluated. The pharmacokinetic&nbsp;of digoxin was not altered by coadministration of irbesartan.</p>', '<p>Concomitant use with aliskiren in patients with diabetes and renal impairment (GFR &lt;60 ml/min). Pregnancy.</p>', '<p>Diarrhoea, fatigue, dyspepsia or heartburn, dizziness, orthostatic hypotension, nausea, vomiting, musculoskeletal pain, thrombocytopaenia, hyperkalaemia, elevated serum creatinine.</p>', '<p><strong>Pregnancy</strong>: Irbesartan is contraindicated in the second and third trimesters of&nbsp;pregnancy. In the second and third trimesters, substances that act directly on the&nbsp;renin-angiotensin-system can cause foetal or neonatal renal failure, foetal skull&nbsp;hypoplasia and even foetal death. As precautionary measure, irbesartan should&nbsp;preferably not be used during first trimester of pregnancy. A switch to a suitable alternative treatment should be carried out in advance of a planned pregnancy. If&nbsp;pregnancy is diagnosed, irbesartan should be discontinued as soon as possible, skull&nbsp;and renal function should be checked with echography if, inadvertently, the&nbsp;treatment was taken for a long period.<br />\r\n<br />\r\n<strong>Lactation</strong>: Irbesartan is contraindicated during lactation. It is not known whether&nbsp;irbesartan is excreted in human milk. Irbesartan is excreted in the milk of lactating&nbsp;rats. Precautions: Intravascular volume depletion: symptomatic hypotension,&nbsp;especially after the first dose, may occur in patients who are volume and/or sodium&nbsp;depleted by vigorous diuretic therapy, dietary salt restriction, diarrhoea or vomiting. Such conditions should be corrected before the administration of Irbesartan.</p>', '<p>Patients with unilateral or bilateral renal artery stenosis, depletion of intravascular volume, aortic or mitral stenosis, or obstructive hypertrophic cardiomyopathy. Renal impairment. Lactation.</p>', '<p>Experience in adults exposed to doses of up to 900 mg/day for 8 weeks revealed no&nbsp;toxicity. The most likely manifestations of overdosage are expected to be&nbsp;hypotension and tachycardia; bradycardia might also occur from overdose. No&nbsp;specific information is available on the treatment of overdosage with Irbesartan. The&nbsp;patient should be closely monitored, and the treatment should be symptomatic and&nbsp;supportive. Suggested measures include induction of emesis and/or gastric lavage.&nbsp;Activated charcoal may be useful in the treatment of overdosage. Irbesartan is not&nbsp;removed by haemodialysis.</p>', '<p>Angiotensin-ll receptor blocker</p>', '<p>Store in a cool and dry place, protected from light.</p>', '<p><strong>Renal impairment</strong>: no dosage adjustment is necessary in patients with impaired renal function. A&nbsp;lower starting dose of Irbesartan 75 mg should be considered for patients undergoing&nbsp;haemodialysis.&nbsp;Intravascular volume depletion: volume and/or sodium depletion should be corrected prior to&nbsp;administration of Irbesartan.&nbsp;<br />\r\n<br />\r\n<strong>Hepatic impairment</strong>: no dosage adjustment is necessary in patients with mild to moderate&nbsp;hepatic impairment. There is no clinical experience in patients with severe hepatic impairment.<br />\r\n<br />\r\n<strong>Hypertensive patients with&nbsp;type 2 diabetes and renal disease</strong>: the effects of irbesartan both on renal and&nbsp;cardiovascular events were not uniform across all subgroups, in an analysis carried&nbsp;out in the study with patients with advanced renal disease. In particular, they&nbsp;appeared less favourable in women and non-white subjects.<br />\r\n<br />\r\n<strong>Hyperkalaemia</strong>: as with&nbsp;other drugs that affect the renin-angiotensin-aldosterone system, hyperkalaemia may&nbsp;occur during the treatment with Irbesartan, especially in the presence of renal&nbsp;impairment, overt proteinuria due to diabetic renal disease, and/or heart failure.&nbsp;Close monitoring of serum potassium in patients at risk is recommended.<br />\r\n<br />\r\n<strong>Aortic and&nbsp;mitral valve stenosis, obstructive hypertrophic cardiomyopathy</strong>: as with other&nbsp;vasodilators, special caution is indicated in patients suffering from aortic or mitral&nbsp;stenosis, or obstructive hypertrophic cardiomyopathy.<br />\r\n<br />\r\n<strong>Primary aldosteronism</strong>:&nbsp;patients with primary aldosteronism generally will not respond to anti-hypertensive&nbsp;drugs acting through inhibition of the renin-angiotensin system. Therefore, the use&nbsp;of Irbesartan is not recommended.<br />\r\n<br />\r\n<strong>General</strong>: in patients whose vascular tone and&nbsp;renal function depend predominantly on the activity of the renin-angiotensinaldosterone&nbsp;system (e.g. patients with severe congestive heart failure or underlying&nbsp;renal disease, including renal artery stenosis), treatment with angiotensin converting&nbsp;enzyme inhibitors or angiotensin-II receptor antagonists that affect this system has&nbsp;been associated with acute hypotension, azotaemia, oliguria, or rarely acute renal&nbsp;failure. As with any anti-hypertensive agent, excessive blood pressure decrease in&nbsp;patients with ischaemic cardiopathy or ischaemic cardiovascular disease could result&nbsp;in a myocardial infarction or stroke.</p>', '2022-03-07 06:30:25', '2022-03-07 06:30:25'),
(769, 769, '<p>Irbesartan &amp; Hydrochlorothiazide tablet are indicated for the treatment of hypertension. This tablet may be used in patients whose blood pressure is not adequately controlled on monotherapy. This tablet may also be used as initial therapy in patients who are likely to need multiple drugs to achieve their blood pressure goals. The choice of Irbesartan &amp; Hydrochlorothiazide tablets as initial therapy for hypertension should be based on an assessment of potential benefits and risks.<br />\r\n<br />\r\nPatients with stage 2 (moderate or severe) hypertension are at relatively high risk for cardiovascular events (such as strokes, heart attacks, and heart failure), kidney failure, and vision problems, so prompt treatment is clinically relevant. The decision to use a combination as initial therapy should be individualized and may be shaped by considerations such as the baseline blood pressure, the target goal, and the incremental likelihood of achieving goal with a combination compared with monotherapy.</p>', '<p><strong>Irbesartan</strong>: Angiotensin II is a potent vasoconstrictor formed from angiotensin I in a reaction catalyzed by angiotensin-converting enzyme (ACE, kininase II). Angiotensin II is the principal pressor agent of the RAS and also stimulates aldosterone synthesis and secretion by adrenal cortex, cardiac contraction, renal resorption of sodium, activity of the sympathetic nervous system, and smooth muscle cell growth. Irbesartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II by selectively binding to the AT1&nbsp;angiotensin II receptor. There is also an AT2&nbsp;receptor in many tissues, but it is not involved in cardiovascular homeostasis.<br />\r\n<br />\r\nIrbesartan is a specific competitive antagonist of AT1&nbsp;receptors with a much greater affinity (more than 8500-fold) for the AT1&nbsp;receptor than for the AT2&nbsp;receptor, and no agonist activity.<br />\r\n<br />\r\nBlockade of the AT1&nbsp;receptor removes the negative feedback of angiotensin II on renin secretion, but the resulting increased plasma renin activity and circulating angiotensin II do not overcome the effects of irbesartan on blood pressure.<br />\r\n<br />\r\nIrbesartan does not inhibit ACE or renin or affect other hormone receptors or ion channels known to be involved in the cardiovascular regulation of blood pressure and sodium homeostasis. Because irbesartan does not inhibit ACE, it does not affect the response to bradykinin; whether this has clinical relevance is not known.<br />\r\n<br />\r\n<strong>Hydrochlorothiazide</strong>: Hydrochlorothiazide is a thiazide diuretic. Thiazides affect the renal tubular mechanisms of electrolyte reabsorption, directly increasing excretion of sodium 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 potassium loss, and decreases in serum potassium. The renin-aldosterone link is mediated by angiotensin II, so coadministration of an angiotensin II receptor antagonist tends to reverse the potassium loss associated with these diuretics.</p>', '<p><strong>Initial therapy</strong>: Irbesartan 150 mg &amp; Hydrochlorothiazide 12.5 mg orally once a day; may increase after 1 to 2 weeks.<br />\r\n<br />\r\n<strong>Add-on/Replacement therapy</strong>: Irbesartan 150 to 300 mg &amp; Hydrochlorothiazide 12.5 to 25 mg orally once a day<br />\r\n<br />\r\n<strong>Maximum dose</strong>: Irbesartan 300 mg &amp; Hydrochlorothiazide 25 mg orally once a day</p>', '<p>Other antihypertensives, lithium, K-sparing diuretics, K supplements, salt substitutes containing K. CNS depressants, antidiabetics, cholestyramine &amp; colestipol resins, corticosteroids, ACTH, digitalis glycosides, antiarrhythmics, NSAIDs, tubocurarine, antigout medications, Ca salts. Alcohol; diazoxide, atropine, beperiden, amantadine, cyclophosphamide, methotrexate.</p>', '<p>Irbesartan and Hydrochlorothiazide tablets are contraindicated in patients who are hypersensitive to any component of this product. Because of the hydrochlorothiazide component, this product is contraindicated in patients with anuria or hypersensitivity to other sulfonamide-derived drugs. Do not coadminister aliskiren with Irbesartan and Hydrochlorothiazide tablets in patients with diabetes</p>', '<p><strong>Irbesartan:&nbsp;</strong>Hyperkalemia (19%), Chest pain (2%), Tachycardia (1%), Abnormal urination (2%), Musculoskeletal pain (6%), Flu-like syndrome (3%), Edema (3%), Tachycardia (1%), Chest pain (2%), Creatinine increased (1%), Increased BUN (2%), Dizziness (10%), URI (9%), Orthostatic hypotension (5%), Fatigue (4%), Diarrhea (3%), Dyspepsia (2%)<br />\r\n<br />\r\n<strong>Hydrochlorothiazide:&nbsp;</strong>Anorexia, Epigastric distress, Hypotension, Orthostatic hypotension, Photosensitivity, Anaphylaxis, Anemia, Confusion, Erythema multiforme, Stevens-Johnson syndrome, Exfoliative dermatitis including toxic epidermal necrolysis, Dizziness, Hypokalemia and/or hypomagnesemia, Hyperuricemia, Headache</p>', '<p><strong>Pregnancy</strong>&nbsp;Category D. Use of drugs that act&nbsp;on the renin-angiotensin system during the second and third trimesters of pregnancy reduces fetal renal function and increases fetal and neonatal morbidity and death. Resulting oligohydramnios can be associated with fetal lung hypoplasia and skeletal deformations. Potential neonatal adverse effects include skull hypoplasia, anuria, hypotension, renal failure, and death. When pregnancy is detected, discontinue Irbesartan and Hydrochlorothiazide as soon as possible.<br />\r\n<br />\r\nThiazides cross the placenta, and use of thiazides during pregnancy is associated with a risk of fetal or neonatal jaundice, thrombocytopenia, and possibly other adverse reactions that have occurred in adults.<br />\r\n<br />\r\n<strong>Nursing Mothers</strong>: It is not known whether irbesartan is excreted in human milk, but irbesartan or some metabolite of irbesartan is secreted at low concentration in the milk of lactating rats.<br />\r\n<br />\r\nThiazides appear in human milk. Because of the potential for adverse effects on the nursing infant, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.</p>', '<p><strong>Child</strong>: Do not nurse<br />\r\n<strong>Lactation</strong>: Discontinue drug or do not nurse</p>', '<p><strong>Irbesartan</strong>: No data are available in regard to overdosage in humans. However, daily doses of 900 mg for 8 weeks were well tolerated. The most likely manifestations of overdosage are expected to be hypotension and tachycardia; bradycardia might also occur from overdose. Irbesartan is not removed by hemodialysis.<br />\r\n<br />\r\nTo obtain up-to-date information about the treatment of overdosage, a good resource is a certified regional Poison Control Center. Telephone numbers of certified Poison Control Centers are listed in the&nbsp;Physicians&rsquo; Desk Reference&nbsp;(PDR). In managing overdose, consider the possibilities of multiple-drug interactions, drug-drug interactions, and unusual drug kinetics in the patient.<br />\r\n<br />\r\nLaboratory determinations of serum levels of irbesartan are not widely available, and such determinations have, in any event, no established role in the management of irbesartan overdose.<br />\r\n<br />\r\nAcute oral toxicity studies with irbesartan in mice and rats indicated acute lethal doses were in excess of 2000 mg/kg, about 25- and 50-fold the MRHD (300 mg) on a mg/m2&nbsp;basis, respectively.<br />\r\n<br />\r\n<strong>Hydrochlorothiazide</strong>: The most common signs and symptoms of overdose observed in humans are those caused by electrolyte depletion (hypokalemia, hypochloremia, hyponatremia) and dehydration resulting from excessive diuresis. If digitalis has also been administered, hypokalemia may accentuate cardiac arrhythmias. The degree to which hydrochlorothiazide is removed by hemodialysis has not been established. The oral LD50&nbsp;of hydrochlorothiazide is greater than 10 g/kg in both mice and rats.</p>', '<p>Combined antihypertensive preparations</p>', '<p>Should be stored in cool and dry place</p>', NULL, '2022-03-07 06:32:48', '2022-03-07 06:32:48'),
(770, 770, '<p>Irinotecan Injection is indicated as a component of first-line therapy in combination with 5-fluorouracil (5-FU) and&nbsp;leucovorin&nbsp;(LV) for patients with metastatic carcinoma of the colon or rectum.<br />\r\n<br />\r\nIrinotecan is indicated for patients with metastatic carcinoma of the colon or rectum whose disease has recurred or progressed following initial fluorouracil-based therapy.</p>', '<p>Irinotecan inhibits the action of topoisomerase I. Irinotecan prevents religation of the DNA strand by binding to topoisomerase I-DNA complex. The formation of this ternary complex interferes with the moving replication fork, which induces replication arrest and lethal double-stranded breaks in DNA. As a result, DNA damage is not efficiently repaired and apoptosis (programmed cell death) occurs.</p>', '<p>Administer as a 90-minute intravenous infusion followed by LV and 5-FU. A reduction in the starting dose by one dose level may be considered for patients with any of the following conditions: prior pelvic/abdominal radiotherapy, performance status of 2, or increased bilirubin levels.<br />\r\n<br />\r\n<strong>Refractory colorectal malignancies</strong>: 125 mg/m2&nbsp;once wkly for 4 wk, followed by a 2 wk rest period.<br />\r\n<br />\r\n<strong>Metastatic colorectal cancer</strong>: As 1st &nbsp;line treatment: 125 mg/m2&nbsp;on days 1,8,15 and 22 of a 6-wk cycle.</p>', '<p>Diuretics increase risks of dehydration secondary to vomiting/diarrhoea; prophylactic dexamethasone as an antiemetic may enhance lymphocytopenia; prochlorperazine may increase incidence of akathisia; antineoplastic agents (myelosuppression and diarrhoea). St John&#39;s wort, ketoconazole may reduce irinotecan exposure.</p>', '<p>Patients with a known hypersensitivity to the drug or its excitements.</p>', '<p>Anemia, Leukopenia, Neutropenia,Thrombocytopenia, Elevated bilirubin, Diarrhea, Nausea, Asthenia, Abdominal pain, Vomiting , Alopecia, Fever, Constipation, Anorexia, Mucositis, Pain, Dyspnea, Cough, Dizziness, Infection, Rash, Abdominal fullness, AST increased , Dyspepsia, Edema, Ascites/jaundice, Vasodilation, Thromboembolism, Hypotension, Neutropenic fever, Headache, Insomnia, Orthostatic hypotension</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>Early diarrhea is usually transient and infrequently severe. It may be accompanied by cholinergic symptoms of rhinitis, increased salivation, miosis, lacrimation, diaphoresis, flushing, and intestinal hyperperistalsis that can cause abdominal cramping. Bradycardia may also occur.<br />\r\n<br />\r\nLate diarrhea can be life threatening since it may be prolonged and may lead to dehydration, electrolyte imbalance, or sepsis.Late diarrhea can be complicated by colitis, ulceration, bleeding, ileus, obstruction, and infection. Cases of megacolon and intestinal perforation have been reported.</p>', NULL, '<p>Cytotoxic Chemotherapy</p>', '<p>Store at controlled room temperature 15&deg; to 30&deg;C. Protect from light. Keep the vial in the carton until the time of use.</p>', NULL, '2022-03-07 06:35:13', '2022-03-07 06:35:13'),
(771, 771, '<p>Anemia is one of the leading causes of malnutrition among children under five years of age. In Bangladesh, more than 50% of under five children have been suffering from iron deficiency anemia (IDA). This powder is effective for treatment and prevention of anemia. It is a tasteless and odorless micronutrient powder.<br />\r\n<br />\r\nThis preparation is used for-</p>\r\n\r\n<ul>\r\n	<li>Prevents and treats micronutrient deficiencies and improves overall nutrition status of children (6-24 months).</li>\r\n	<li>Increases brain development and physical growth.</li>\r\n	<li>Increases attention to and improves concentration in different activities such as education, games &amp; sports, etc.</li>\r\n	<li>Enhances learning ability and memory functions.</li>\r\n	<li>Increases resistance to diseases and reduces infections.</li>\r\n	<li>Increases appetite.</li>\r\n</ul>', NULL, '<p>This is most suited to children from the age of 6-23 months. As recommended by WHO, this preparation is very effective in addressing iron and micronutrient deficiency anemia among under five children.<br />\r\n<br />\r\nThe dose is-</p>\r\n\r\n<ul>\r\n	<li>Feed this to children by mixing with semi-solid or soft food (rice, hotchpotch, suji etc).</li>\r\n	<li>When child becomes hungry, mix one sachet of this preparation with a small quantity of child&rsquo;s main meal of the day and feed it in full within half-an hour.</li>\r\n	<li>Feed one sachet of this preparation to a child daily to be continued for 2 months, then 4 months interval and continue for another 2 months. Following same process, feed this preparation to children up to 59 months of age.</li>\r\n</ul>', NULL, '<p>This is prohibited for children affected thalassemia, sickle cell anemia, and HIV/AIDS.</p>', '<p>Apparently this has no side effect but due to the presence of iron in this preparation, stool of a child could be hard or soft and it&rsquo;s color may also be blackish and after few days it would become normal.</p>', NULL, '<ul>\r\n	<li>This is not applicable for children who are hospitalized or affected by acute malnutrition. In case of recovery and if the child begins to take food normally and then this could be fed again.</li>\r\n	<li>This preparation should not be mixed with too hot, liquid or hard food.</li>\r\n	<li>Do not feed This preparation to your child while it (sachet) is torn, abandoned or it&rsquo;s shelf life expired.</li>\r\n</ul>', NULL, '<p>Iron, Vitamin &amp; Mineral Combined preparation</p>', '<p>This should be stored in a dry place protected from light where temperature might be below 30&deg;C.</p>', NULL, '2022-03-07 06:40:20', '2022-03-07 06:40:20'),
(772, 772, '<p>This is indicated for the treatment and prophylaxis of Iron, Folic acid, Vitamin B complex and Vitamin C deficiency, or to meet extra need of these vitamins and minerals especially in pregnancy or when planning for pregnancy.</p>', '<p><strong>Iron</strong>&nbsp;is an essential mineral,&nbsp;with several&nbsp;important roles in the body. For example, it helps to make red blood cells, which carry oxygen around the body. A lack of iron can lead to iron deficiency anaemia. Liver is a good source of iron, don&#39;t eat it if you are pregnant. This is because it is also rich in vitamin A which, in large amounts, can harm your unborn baby.<br />\r\n<br />\r\n<strong>Folic acid</strong>&nbsp;is essential for the production of certain coenzymes in many metabolic systems such as purine and pyrimidine synthesis. It is also essential in the synthesis and maintenance of nucleoprotein in erythropoesis. It also promotes WBC and platelet production in folate-deficiency anaemia.<br />\r\n<br />\r\n<strong>Vitamin C</strong>&nbsp;is necessary for collagen formation and tissue repair; plays a role in oxidation/reduction reactions as well as other metabolic pathways including synthesis of catecholamines, carnitine, and steroids; also plays a role in conversion of folic acid to folinic acid.<br />\r\n<br />\r\n<strong>Vitamin B complex:</strong>&nbsp;The building blocks for good health come from a variety of foods, even if they are from the same family of nutrients. Such is the case with vitamin B, a key player in maintaining cell health and keeping you energized.<br />\r\n<br />\r\nNot all types of vitamin B do the same thing. Additionally, the different types of vitamin B all come from different types of foods.<br />\r\n<br />\r\nVitamin B deficiencies can lead to health problems. Sometimes a doctor will prescribe a supplement when they think you&rsquo;re not getting enough.</p>', '<p>Recommended adult dose is one capsule daily. In more severe deficiency states, 2 capsules a day may be required or as directed by the physician.</p>', '<p>Care should be taken when given to patients with Iron storage or Iron absorption disease. Iron form chelates with antacids and Tetracycline and absorption of all these may be impaired if taken concurrently.</p>', '<p>This product is contraindicated in patients with a known hypersensitivity to any of the ingredients. Iron therapy is contraindicated in haemachromatosis and haemosiderosis, and in patients receiving repeated blood transfusion or with anaemia not due to by iron deficiency. It should be given cautiously to patients taking Levodopa as one of the ingredients&nbsp;(Pyridoxine) reduces the effect of Levodopa.</p>', '<p>Generally well tolerated. However, a few allergic reactions may be seen.</p>', '<p>It is recommended during pregnancy and lactation.</p>', '<p>Care should be taken in patients who may develop iron overload, such as those with hemochromatosis, haemolytic anaemia or red cell aplasia. Iron chelates with tetracycline and absorption may be impaired.</p>', '<p>Accidental overdose of iron containing products is a leading cause of fatal poisoning in children fewer than 6. Avoid higher doses if you have liver disease or hemochromatosis; excess can cause bloody diarrhea, vomiting, acidosis, darkened stools, abdominal pain. Symptoms may clear in a few hours. Riboflavin is reported to be completely safe and no toxic symptoms have been reported so far. Higher doses of Nicotinamide may cause vomiting, diarrhea. Sensory neuropathy was observed in individuals consuming more than 200 mg Pyridoxine for very long periods. No cases of Folic acid overdosages have been reported. Acute ingestion of Ascorbic acid, even of massive doses, is unlikely to cause significant effects.</p>', '<p>Iron &amp; Vitamin Combined preparations</p>', '<p>Store in a dry place below 25&deg; C. Protect from light.</p>', NULL, '2022-03-07 06:42:52', '2022-03-07 06:42:52'),
(773, 773, '<h1>This&nbsp;is indicated for the treatment and prophylaxis of Zinc, Iron, Folic Acid, B-vitamins and Vitamin-C deficiency especially during pregnancy and lactation.</h1>', '<p><strong>Zinc sulfate</strong>&nbsp;precipitates protein and this is responsible for the astringent and weak antiseptic activity of Zn sulfate. It also produces mild vasodilation. Zinc sulfate can also be used orally or systemically as a zinc supplement. 220 mg of zinc sulfate (heptahydrate) contains 50 mg of elemental zinc.<br />\r\n<br />\r\n<strong>Iron</strong>&nbsp;is an essential mineral, with several important roles in the body. For example, it helps to make red blood cells, which carry oxygen around the body. A lack of iron can lead to iron deficiency anaemia. Liver is a good source of iron, don&#39;t eat it if you are pregnant. This is because it is also rich in vitamin A which, in large amounts, can harm your unborn baby.<br />\r\n<br />\r\n<strong>Folic acid</strong>&nbsp;is essential for the production of certain coenzymes in many metabolic systems such as purine and pyrimidine synthesis. It is also essential in the synthesis and maintenance of nucleoprotein in erythropoesis. It also promotes WBC and platelet production in folate-deficiency anaemia.<br />\r\n<br />\r\n<strong>Nicotinamide</strong>&nbsp;is a vitamin B3 derivative. It is incorporated into coenzymes nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP), which are involved in multiple cellular metabolic pathways.<br />\r\n<br />\r\n<strong>Vitamin C</strong>&nbsp;is necessary for collagen formation and tissue repair; plays a role in oxidation/reduction reactions as well as other metabolic pathways including synthesis of catecholamines, carnitine, and steroids; also plays a role in conversion of folic acid to folinic acid.<br />\r\n<br />\r\n<strong>Vitamin B complex</strong>: The building blocks for good health come from a variety of foods, even if they are from the same family of nutrients. Such is the case with vitamin B, a key player in maintaining cell health and keeping you energized.<br />\r\n<br />\r\nNot all types of vitamin B do the same thing. Additionally, the different types of vitamin B all come from different types of foods.<br />\r\n<br />\r\nVitamin B deficiencies can lead to health problems. Sometimes a doctor will prescribe a supplement when they think you&rsquo;re not getting enough.</p>', '<p>One capsule daily. In more severe cases, 2 capsules a day may be required or as directed by the physician.</p>', NULL, '<p>This product is contraindicated in patients with a known hypersensitivity to any of the ingredients.</p>', '<p>Generally well tolerated. However, a few allergic reactions may be seen.</p>', '<p>Recommended.</p>', '<p>Care should be taken in patients who may develop iron overload, such as those with haemochromatosis, haemolytic anaemia or red cell aplasia. Iron chelates with tetracycline and absorption may be impaired.</p>', '<p><strong>Accidental overdose of iron containing products</strong>&nbsp;is a leading cause of fatal poisoning in children below 6 years. Avoid higher doses if you have liver disease or haemochromatosis; excess can cause bloody diarrhea, vomiting, acidosis, darkened stools, abdominal pain. Symptoms may clear in a few hours.<br />\r\n<br />\r\n<strong>Riboflavin</strong>&nbsp;is reported to be completely safe and no toxic symptoms have been reported so far. Higher doses of Nicotinamide may cause vomiting, diarrhea. Sensory neuropathy was observed in individuals consuming more than 200 mg Pyridoxine for very long periods. No case of Folic acid overdodage has been reported.<br />\r\n<br />\r\n<strong>Acute ingestion of Ascorbic acid</strong>, even of massive doses, is unlikely to cause significant effects.<br />\r\n<br />\r\n<strong>Zinc</strong>&nbsp;toxicity has been seen in both acute and chronic forms. Ingestion of 150 to 450 mg of zinc per day have been associated with low copper status, altered iron function, reduced immune function, and reduced levels of high-density lipoproteins. So, Zinc at its RDA dosages dose not cause any significant effect.</p>', '<p>Iron &amp; Vitamin Combined preparations</p>', '<p>Store in a dry place below 25 &deg;C. Protect from light.</p>', NULL, '2022-03-07 06:46:03', '2022-03-07 06:46:03'),
(774, 774, '<p>This is indicated in the prevention and treatment of Iron, Folic Acid and Zinc deficiencies.</p>', NULL, '<p>One tablet daily or two tablets may be required a day in severe cases or as directed by the physician.</p>', NULL, NULL, NULL, NULL, NULL, NULL, '<p>Iron, Vitamin &amp; Mineral Combined preparation</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-07 06:47:44', '2022-03-07 06:47:44'),
(775, 775, '<p>Iron Polymaltose Complex is indicated for the-</p>\r\n\r\n<ul>\r\n	<li>Treatment of latent iron deficiency and iron deficiency anaemia including macrocytic anaemia,nutritional anaemia of infants, anaemia due to excessive haemorrhage and anaemia associated with infections and malignant disease.</li>\r\n	<li>Prevention and treatment of iron deficiency anaemia before, during and after pregnancy and during lactation.</li>\r\n	<li>For prophylactic therapy of iron deficiency to cover the recommended daily dietary allowances (RDA).</li>\r\n</ul>', '<p>Iron Polymaltose Complex is a polysaccharide-iron complex, which is a novel iron preparation used in the treatment of iron deficiency anaemia. Iron, an essential constituent of the body, is necessary for haemoglobin formation and for the oxidative process of living tissue. This preparation contains non-ionic ferric iron and polymaltose in a stable complex. This facilitates a controlled absorption of the ferric iron when it comes in contact with the mucosal cell surface. Being non-ionic, it does not release any free radicals and thus takes care of all the toxic effects found due to the release of free radicals by the traditional ionized iron salt preparations. It does not interact with the food components and other medications and so, unlike ferrous salts, there is no decrease in bioavailability of Iron Polymaltose Complex. This makes sure that with the consumption of this complex, iron gets utilized at a faster rate in the haemoglobin and myoglobin synthesis.</p>', '<p>Dosage and duration of therapy are dependent upon the extent of iron deficiency and should be taken as directed by the physician.</p>\r\n\r\n<ul>\r\n	<li>Adults: 10 ml once or twice daily</li>\r\n	<li>Children (6-12 years): 10 ml daily</li>\r\n	<li>Children (2-6 years): 5 ml daily</li>\r\n	<li>Premature infants &amp; Infants: 3.33 mg of elemental iron/kg body weight.</li>\r\n</ul>', '<p>Generally no interactions have been observed. Since, the iron is complex bound, ionic interactions with foodstuff components (phytates, oxalates, tannin, etc.) and concomitantly administered medicaments (tetracycline, antacids) are unlikely to occur.</p>', '<ul>\r\n	<li>In conditions where there is a risk of iron overload e.g.&nbsp;haemochromatosis, thalassemia or<br />\r\n	haemosiderosis.</li>\r\n	<li>In case of hypersensitivity to iron or any other ingredients of the syrup.</li>\r\n</ul>', '<p>This preparation is well tolerated. However, a few side effects of oral iron preparations, including nausea, vomiting, constipation or diarrhoea may occur.</p>', '<p>Administration of drugs during first trimester of pregnancy requires careful assessment of potential risk versus benefits to be gained and should not be administered unless clearly indicated. For the remainder of the pregnancy, iron therapy may be indicated but only on advice of a physician. Iron is excreted in breast milk but not in clinically significant concentrations.</p>', '<p>Initially epigastric pain, diarrhea and vomiting; and may include metabolic acidosis, convulsions, and coma after apparent recovery. Speed is essential for effective treatment which is dependent upon removing excess iron from the alimentary tract prior to absorption. Initially an emetic should be given, followed by gastric lavage with 1% sodium bicarbonate, and oral administration of desferrioxamine to complex with residue.</p>', '<p>In case of overdosage, initially epigastric pain, diarrhoea and vomiting can occur and may include metabolic acidosis, convulsions and coma after apparent recovery. Should seek emergency medical attention in case of overdose. Initially an emetic should be given and then gastric lavage and general supportive measures should be employed.</p>', '<p>Oral Iron preparations</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-07 19:13:43', '2022-03-07 19:13:43'),
(776, 776, '<p>This is indicated for the treatment and prophylaxis of Zinc, Iron, Folic Acid, B-vitamins deficiency, especially during pregnancy and lactation.</p>', '<p>This is a special preparation of Iron Polymaltose Complex, Folic Acid, Zinc, and B vitamins. Iron Polymaltose Complex is a water soluble, macromolecular complex of poly nuclear iron (III) hydroxide and partially hydrolysed dextrin (Polymaltose). It does not interact with the food components and other medications and so there is no decrease in bioavailability of Iron Polymaltose Complex. This makes sure that with the consumption of this complex, iron gets utilized at a faster rate in the haemoglobin synthesis. Folic acid prevents neural tube defects. Zinc is essential for many metabolic processes, blood formation, wound healing and for immune system. Thiamine is essential for the functioning of the nervous and digestive systems. Riboflavin is important for digestion, immune system support and energy production. Pyridoxin is important for brain development, production of red blood cells, metabolism of proteins and to reduce morning sickness. Nicotinamide is important for energy, blood pressure and circulation.</p>', '<p>One capsule daily. In more severe cases, 2 capsules a day may be required or as directed by the physician.</p>', '<p>No drug interactions have been reported.</p>', '<p>This product is contraindicated in patients with a known hypersensitivity to any of the ingredients.</p>', '<p>Generally well tolerated. However, a few allergic reactions may be seen.</p>', '<p>Recommended during pregnancy &amp; lactation.</p>', '<p>Care should be taken in patients who may develop iron overloads, such as those with haemochromatosis, haemolytic anaemia or red cell aplasia. Iron chelates with tetracycline and absorption may be impaired.</p>', '<p>Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children below 6 years. Avoid higher doses if you have liver disease or hemochromatosis; excess can cause bloody diarrhea, vomiting, acidosis, darkened stools, abdominal pain. Symptoms may clear in a few hours. Riboflavin is reported to be completely safe and no toxic symptoms have been reported so far. Higher doses of Nicotinamide may cause vomiting, diarrhea. Sensory neuropathy was observed in individuals consuming more than 200 mg Pyridoxine for very long periods. No case of Folic acid overdose has been reported. Zinc toxicity has been seen in both acute and chronic forms. Ingestion of 150 to 450 mg of zinc per day has been associated with low copper status, altered iron function, reduced immune function, and reduced levels of high-density lipoproteins. So, Zinc at its RDA dosage does not cause any significant effect.</p>', '<p>Iron &amp; Vitamin Combined preparations</p>', '<p>Do not store above 30&deg;C. Keep away from light and out of the reach of children.</p>', NULL, '2022-03-07 19:16:06', '2022-03-07 19:16:06'),
(777, 777, '<p>This tablet is indicated for the treatment and prevention of Iron, Folic Acid and Zinc deficiencies.</p>', '<p>This tablet is the preparation of Iron, Folic Acid and Zinc. In this preparation, Iron is present as Iron (III) Hydroxide Polymaltose Complex, a noble Iron preparation. It contains non-ionic Ferric Iron and Polymaltose in a stable complex. This complex facilitates a controlled absorption of the Iron when it comes in contact with the mucosal cell surface. Due to non-ionic nature, Iron (III) Hydroxide Polymaltose Complex is more stable than conventional Iron form. Folic Acid helps in the proper development of the fetus. Zinc keeps enzymes working and helps to metabolize proteins.</p>', '<p>One tablet daily. Two tablets may be required a day in severe cases or as directed by the physician.</p>', '<p>Since Iron is complex bound, ionic interaction with foodstuff components (phytates, oxalates, tannin etc.) and concomitant administration of medicaments (tetracyclines, antacids) are unlikely to occur.</p>', '<p>This tablet is contraindicated in patients with a known hypersensitivity to any of the ingredients of this product.</p>', '<p>This tablet is generally well tolerated. However, a few side effects of oral Iron preparations, including nausea, vomiting, constipation or diarrhoea may occur rarely.</p>', '<p>Use of any drug during the first trimester of pregnancy should be avoided if possible. Thus administration of Iron in the first trimester requires definite evidence of Iron deficiency.</p>', '<p>As with all Iron preparations, dark coloration of the stool may occur which is without clinical significance.</p>', '<p>No intoxication or Iron overloaded has been reported in case of overdose.</p>', '<p>Iron, Vitamin &amp; Mineral Combined preparation</p>', '<p>Keep in a cool &amp; dry place away from light and moisture. Keep out of the reach of children.</p>', NULL, '2022-03-07 19:18:16', '2022-03-07 19:18:16'),
(778, 778, '<p>This syrup is indicated for the treatment and prevention of Iron, Vitamin B complex and Zinc deficiencies, specially during pregnancy and lactation.</p>', '<p>This syrup is the preparation of Iron, Vitamin B complex and Zinc. In this preparation, Iron is present as Iron (III) Hydroxide Polymaltose Complex. Iron (III) Hydroxide Polymaltose Complex facilitates a controlled absorption of the iron when it comes in contact with the mucosal cell surface. Due to non-ionic nature, this Iron (III) Hydroxide Polymaltose Complex is more stable than conventional Iron form.</p>', '<p><strong>Adults</strong>: 5 ml-10 ml (1-2 teaspoonful) 3 times daily or as recommended by the physician.<br />\r\n<br />\r\n<strong>Children</strong>: 5 ml (1 teaspoonful) 3 times daily or as recommended by the physician.<br />\r\n<br />\r\n<strong>Infants</strong>: 0.33 ml/kg body weight daily or as recommended by the physician.</p>', '<p>Since Iron is complex bound, ionic interaction with foodstuff components (phytates, oxalates, tannin etc.) and concomitant administrations of medicaments (tetracyclines, antacids) are unlikely to occur.</p>', '<p>It is contraindicated in patients with a known hypersensitivity to any of the ingredients of this product.</p>', '<p>This syrup is generally well tolerated. However, a few side effects of oral Iron preparations, including nausea, vomiting, constipation or diarrhoea may occur.</p>', '<p>Recommended in pregnancy &amp; lactation</p>', '<p>Caution should be taken in the conditions where there is a risk of Iron overload, such as hemochromatosis, thalassemia, hemosiderosis or hemolytic anemia.</p>', '<p>In case of overdose, epigastric pain, diarrhoea, vomiting, metabolic acidosis and convulsion may occur. Should seek emergency medical attention in case of overdose. Initially an emetic should be given and then gastric lavage &amp; general supportive measures should be employed.</p>', '<p>Iron &amp; Vitamin Combined preparations</p>', '<p>Keep in a dry place away from light and heat. Keep out of the reach of children.</p>', '<p>Recommended in children</p>', '2022-03-07 19:20:37', '2022-03-07 19:20:37');
INSERT INTO `generic_details` (`id`, `generic_id`, `indications`, `pharmacology`, `dosage_and_administration`, `interaction`, `contraindications`, `side_effects`, `pregnancy_and_lactation`, `precautions_and_warnings`, `overdose_effects`, `therapeutic_class`, `storage_conditions`, `use_in_special_populations`, `created_at`, `updated_at`) VALUES
(779, 779, '<p>This&nbsp;is indicated for the treatment of Iron deficiency in the following indications:</p>\r\n\r\n<ul>\r\n	<li>Where there is a clinical need for a rapid Iron supply</li>\r\n	<li>In patients who can not tolerate oral Iron therapy or who are non-compliant</li>\r\n	<li>In active inflammatory bowel disease where oral Iron preparations are ineffective</li>\r\n	<li>Non-dialysis dependent-chronic kidney disease (NDD-CKD) patients receiving an erythropoietin</li>\r\n	<li>Non-dialysis dependent-chronic kidney disease (NDD-CKD) patients not receiving an erythropoietin</li>\r\n	<li>Hemodialysis dependent-chronic kidney disease (HDD-CKD) patients receiving an erythropoietin</li>\r\n	<li>Peritoneal dialysis dependent-chronic kidney disease (PDD-CKD) patients receiving an erythropoietin</li>\r\n	<li>It is also indicated in the treatment of Iron deficiency anaemia in patients undergoing surgical procedures, patients donating blood, postpartum patients.</li>\r\n</ul>', '<p>The therapeutic class of Iron Sucrose is haematinic. Iron Sucrose Injection USP is a brown, sterile, aqueous, complex of Polynuclear Iron (III) Hydroxide in Sucrose for Intravenous use. The drug product contains approximately 30% Sucrose w/v (300 mg/ml) and has a pH of 10.5-11.1. Following intravenous administration, Iron Sucrose Injection is dissociated into Iron and Sucrose by the reticuloendothelial system, and Iron is transferred from the blood to a pool of Iron in the liver and bone marrow. Ferritin, an Iron storage protein, binds and sequesters Iron in a nontoxic form, from which Iron is easily available. Iron binds to plasma transferrin, which carries Iron within the plasma and the extracellular fluid to supply the tissues. The transferrin receptor, located in the cell, and the transferrin-receptor complex is returned to the cell membrane. Transferrin without Iron (apotransferrin) is then released to the plasma. The intracellular Iron becomes (mostly) haemoglobin in circulating red blood cells (RBCs). Transferrin synthesis is increased and ferritin production reduced in Iron deficiency. The converse is true when Iron is plentiful. Its elimination halflife is 6 h, total clearance is 1.2 L/h, non-steady state apparent volume of distribution is 10.0 L and steady state apparent volume of distribution is 7.9 L. In Iron Sucrose, its Iron component appears to distribute mainly in blood and to some extent in extravascular fluid. A significant amount of the administered Iron distributes in the liver, spleen and bone marrow and that the bone marrow is an Iron trapping compartment and not a reversible volume distribution. The sucrose component is eliminated mainly through urinary excretion.</p>', '<p><strong>Adults and Elderly</strong>: 5-10 ml Iron Sucrose Injection (100-200 mg Iron) once to three times a week depending on the hemoglobin level.<br />\r\n<br />\r\n<strong>Children</strong>: There is limited data on children under study conditions. If there is a clinical need, it is recommended not to exceed 0.15 ml Iron Sucrose Injection (3 mg Iron) per kg body weight once to three times per week depending on the haemoglobin level.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p><strong>Intravenous injection</strong>: Iron Sucrose Injection can also be administered undiluted by slow intravenous injection at the (normal) recommended rate of 1 ml Iron Sucrose Injection (20 mg Iron) per minute [5 ml Iron Sucrose Injection (100 mg Iron) in 2 to 5 minutes]. A maximum of 10 ml Iron Sucrose Injection (200 mg Iron) can be injected per injection. Before administration of the therapeutic dose in a new patient, a test dose of 1 ml Iron Sucrose Injection (20 mg Iron) in adults and in children with a body weight greater than 14 kg and half the daily dose (1.5 mg Iron/kg) in children with a body weight less than 14 kg should be injected over 1 to 2 minutes. If no adverse reactions occur within a waiting period of 15 minutes, the remaining portion of the injection can be administered at recommended speed. After an injection the arm of the patient should be extended.<br />\r\n<br />\r\n<strong>Infusion</strong>: Iron Sucrose Injection should preferably be administered by drip infusion (in order to reduce the risk of hypotensive episodes and paravenous injection) in a dilution of 1 ml Iron Sucrose Injection (20 mg Iron) in max. 20 ml 0.9% w/v Sodium Chloride [5 ml (100 mg Iron) in max. 100 ml 0.9% w/v NaCI etc. up to 25 ml (500 mg Iron) in max. 500 ml 0.9% w/v NaCI]. Dilution must take place immediately prior to infusion and the solution should be administered as follows: 100 mg Iron in at least 15 minutes; 200 mg Iron in at least 30 minutes; 400 mg Iron In at least 1.5 hours, and 500 mg Iron in at least 3.5 hours. Further of the maximum tolerated single dose of 7 mg Iron/kg body weight, an Infusion time of at least 3.5 hours has to be respected, independently of the total dose.<br />\r\n<br />\r\nBefore administration of the therapeutic dose in a new patient the first 20 mg Iron in adults and in children with a body weight greater than 14 kg and half the daily dose (1.5 mg lron/kg) in children with a body weight less than 14 kg should be infused over 15 minutes as a test dose. If no adverse reactions occur, the remaining portion of the infusion can be administered at recommended speed.</p>', '<p>Drug-drug interactions involving Iron Sucrose have not been studied. Iron Sucrose Injection should not be administered concomitantly with oral iron preparations since the absorption of oral Iron is reduced. Even oral Iron therapy should not be given until 5 days after last injection.</p>', '<p>The use of Iron Sucrose is contraindicated in patients with evidence of Iron overload, in patients with known hypersensitivity to Iron Sucrose or any of its inactive components, and in patients with anaemia not caused by Iron deficiency. It is also contraindicated in patients with history of allergic disorders including asthma, eczema and anaphylaxis, liver disease and infections.</p>', '<ul>\r\n	<li>Adverse reactions, whether or not related to Iron Sucrose injection are as follows: hypotension, cramps/leg cramps, nausea, headache, vomiting, and diarrhea. Some of these symptoms may be seen in patients with chronic renal failure or on hemodialysis not receiving intravenous iron.&nbsp;</li>\r\n	<li>Body as a Whole: headache, fever, pain, asthenia, unwell, malaise, accidental injury. Cardiovascular Disorders</li>\r\n	<li>General: hypotension, chest pain, hypertension, hypervolemia.</li>\r\n	<li>Gastrointestinal Disorders: nausea, vomiting, abdominal pain, elevated liver enzymes.</li>\r\n	<li>Central and Peripheral Nervous System: dizziness.</li>\r\n	<li>Musculoskeletal System: cramps/leg cramps, musculoskeletal pain.</li>\r\n	<li>Respiratory System: dyspnea pneumonia, cough.</li>\r\n	<li>Skin and appendages: pruritus, application site reaction.</li>\r\n	<li>Hypersensitivity reactions: In safety studies, several patients experienced mild or moderate hypersensitivity reactions presenting with wheezing, dyspnea, hypotension, rashes, or pruritus. Anaphylactoid reactions including patients who experienced serious or life-threatening reactions (anaphylactic shock, loss of consciousness or collapse, bronchospasm with dyspnea, or convulsion) associated with Iron Sucrose administration can occur. So, patients should be given a small test dose initially.</li>\r\n</ul>', '<p>Pregnancy Category-B. No adequate and well controlled studies in pregnant women. This drug 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 Iron Sucrose is administered to a nursing woman.</p>', '<p><strong>General</strong>: Because body Iron excretion is limited and excess tissue Iron can be hazardous, caution should be exercised to withhold Iron administration in the presence of evidence of tissue Iron overload. Patients receiving Iron Sucrose require periodic monitoring of hematologic and haematinic parameters (hemoglobin, hematocrit, serum ferritin and transferrin saturation). Iron therapy should be withheld in patients with evidence of Iron overload. Transferrin saturation values increase rapidly after IV administration of Iron Sucrose; thus, serum Iron values may be reliably obtained 48 hours after IV dosing.<br />\r\n<br />\r\n<strong>Hypersensitivity Reactions</strong>: Serious hypersensitivity reactions have been rarely reported in patients receiving Iron Sucrose. Several cases of mild or moderate hypersensitivity reactions were observed in these studies.<br />\r\n<br />\r\n<strong>Hypotension</strong>: Hypotension has been reported frequently in hemodialysis patients receiving intravenous Iron. Hypotension following administration of Iron Sucrose may be related to rate of administration and total dose administered. Caution should be taken to administer Iron Sucrose according to recommended guidelines.</p>', '<p>Dosages of Iron Sucrose Injection in excess of Iron needs may lead to accumulation of Iron in storage sites leading to hemosiderosis. Periodic monitoring of Iron parameters such as serum ferritin and transferrin saturation may assist in recognizing Iron accumulation. Iron Sucrose should not be administered to patients with Iron overload and should be discontinued when serum ferritin levels equal or exceed established guidelines. Particular caution should be exercised to avoid Iron overload where anaemia unresponsive to treatment has been incorrectly diagnosed as Iron deficiency anaemia. Symptoms associated with overdosage or infusing Iron Sucrose too rapidly included hypotension, headache, vomiting, nausea, dizziness, joint aches, paresthesia, abdominal and muscle pain, edema. and cardiovascular collapse. Most symptoms have been successfully treated with IV fluids, hydrocortisone, and/or antihistamines. Infusing the solution as recommended or at a slower rate may also alleviate symptoms.</p>', '<p>Parenteral Iron Preparations</p>', '<p>Store in a cool (15&deg;C- 30&deg;C) &amp; dry place, protected from light. Keep out of the reach of children. Do not freeze.</p>', '<p><strong>Pediatric Use</strong>: Safety and effectiveness of Iron Sucrose in pediatric patients have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: No overall differences in safety were observed between the elder subjects and younger subjects, 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>Injection into dialyser</strong>: Iron Sucrose Injection may be administered directly into the venous limb of the dialyser under the same conditions as for intravenous injection.<br />\r\n<br />\r\n<strong>Hemodialysis Dependent-Chronic Kidney Disease Patients (HDD-CKD)</strong>: Iron Sucrose Injection may be administered undiluted as a 100 mg slow intravenous injection over 2 to 5 minutes or as an infusion of 100 mg, diluted in a maximum of 100 ml of 0.9% NaCI over a period of at least 15 minutes per consecutive hemodialysis session for a total cumulative dose of 1,000 mg.<br />\r\n<br />\r\n<strong>Non-Dialysis Dependent-Chronic Kidney Disease Patient (NDD-CKD)</strong>: Iron Sucrose Injection is administered as a total cumulative dose 1000 mg over a 14 day period as a 200 mg slow IV injection undiluted over 2 to 5 minutes on 5 different occasions within the 14 day period.</p>', '2022-03-07 19:23:19', '2022-03-07 19:23:19'),
(780, 780, '<p>Eye Relief removes loose foreign material, air pollutants (smog or pollen), chlorinated water for washing the eye to relieve irritation, stinging, discomfort, itching, burning</p>', '<p>Eye Relief, eye irrigating solution for eye wash can be used for daily or emergency eye cleansing. Boric Acid has mild antibiotic properties against fungal or bacterial infection. Boric Acid is used in eye wash to cleanse or irrigate the eyes. Boric Acid provides soothing relief from eye irritation, and helps remove pollutants from the eye such as smog, chlorine, or other chemicals</p>', '<p>Instill in the affected eyes as needed or prescribed by the physician.<br />\r\n<br />\r\nUsing without Eye Cup</p>\r\n\r\n<ul>\r\n	<li>Flush the affected eye(s) as needed</li>\r\n	<li>Control the rate of flow of solution by pressure on the bottle</li>\r\n	<li>Do not touch dropper tip to eye</li>\r\n</ul>\r\n\r\n<p>Using with Eye Cup</p>\r\n\r\n<ul>\r\n	<li>Fill the cup upto the 5 ml round mark with Eye Relief eye wash solution and apply the cup to the affected eye(s), pressing tightly to prevent leakage</li>\r\n	<li>Tilt the head backward. Open eyelids wide and rotate eyeball to wash the eye throughly</li>\r\n	<li>Rinse cup with clean water after each use</li>\r\n	<li>Close the cap after use</li>\r\n</ul>', NULL, '<p>No data available.</p>', NULL, NULL, '<ul>\r\n	<li>Do not use if you have open wounds in or near the eyes, and get medical help right away</li>\r\n	<li>Do not use if solution changes color or becomes cloudy</li>\r\n	<li>Remove contact lenses before using</li>\r\n	<li>Do not touch tip of container to any surface to avoid contamination</li>\r\n	<li>Replace cap after use</li>\r\n	<li>Stop use and ask a doctor if you experience eye pain, changes in vision, continued redness or irritation of the eye</li>\r\n	<li>Condition worsens or persists</li>\r\n	<li>If swallowed, get medical help or contact a Poison Control Center right away.</li>\r\n</ul>', NULL, '<p>Other ophthalmic preparations</p>', '<p>Store at 15&deg;C to 30&deg;C in a dry place protected from light. It is desirable that the contents should not be used more than one month after first opening of the bottle. Keep out of reach of children.</p>', NULL, '2022-03-07 19:26:03', '2022-03-07 19:26:03'),
(781, 781, '<p>Isoflurane may be used for induction and maintenance of general anesthesia. Adequate data have not been developed to establish its application in obstetrical anesthesia.</p>', '<p>Isoflurane may be used for induction and maintenance of general anesthesia. Adequate data have not been developed to establish its application in obstetrical anesthesia.<br />\r\n<br />\r\nInduction of and recovery from Isoflurane anesthesia are rapid. Isoflurane has a mild pungency, which limits the rate of induction, although excessive salivation or tracheobronchial secretions do not appear to be stimulated. Pharyngeal and laryngeal reflexes are readily obtunded. The level of anesthesia may be changed rapidly with Isoflurane. Isoflurane is a profound respiratory depressant. Respiration must be monitored closely and supported when necessary. As anesthetic dose is increased, tidal volume decreases and respiratory rate is unchanged. This depression is partially reversed by surgical stimulation, even at deeper levels of anesthesia. Isoflurane evokes a sigh response reminiscent of that seen with diethyl ether and enflurane, although the frequency is less than with enflurane.<br />\r\n<br />\r\nBlood pressure&nbsp;decreases with induction of anesthesia but returns toward normal with surgical stimulation. Progressive increases in depth of anesthesia produce corresponding decreases in blood pressure. Nitrous oxide diminishes the inspiratory concentration of Isoflurane required to reach a desired level of anesthesia and may reduce the arterial hypotension seen with Isoflurane alone. Heart rhythm is remarkably stable. With controlled ventilation and normal PaCO2, cardiac output is maintained despite increasing depth of anesthesia, primarily through an increase in heart rate, which compensates for a reduction in stroke volume. The hypercapnia, which attends spontaneous ventilation during Isoflurane anesthesia further increases heart rate and raises cardiac output above awake levels. Isoflurane does not sensitize the myocardium to exogenously administered epinephrine in the dog. Limited data indicate that subcutaneous injection of 0.25 mg of epinephrine (50 mL of 1:200,000 solution) does not produce an increase in&nbsp;ventricular arrhythmias&nbsp;in patients anesthetized with Isoflurane.<br />\r\n<br />\r\nMuscle relaxation is often adequate for intra-abdominal operations at normal levels of anesthesia. Complete muscle paralysis can be attained with small doses of muscle relaxants. All commonly used muscle relaxants are markedly potentiated with Isoflurane, the effect being most profound with the nondepolarizing type. Neostigmine reverses the effect of nondepolarizing muscle relaxants in the presence of Isoflurane. All commonly used muscle relaxants are compatible with Isoflurane.<br />\r\n<br />\r\nIsoflurane can produce coronary vasodilation at the arteriolar level in selected animal models; the drug is probably also a coronary dilator in humans. Isoflurane, like some other coronary arteriolar dilators, has been shown to divert blood from collateral dependent myocardium to normally perfused areas in an animal model (&ldquo;coronary steal&rdquo;). Clinical studies to date evaluating myocardial ischemia, infarction and death as outcome parameters have not established that the coronary arteriolar dilation property of Isoflurane is associated with coronary steal or myocardial ischemia in patients with coronary artery disease.</p>', '<p><strong>Premedication</strong>: Premedication should be selected according to the need of the individual patient, taking into account that secretions are weakly stimulated by Isoflurane, and the heart rate tends to be increased. The use of anticholinergic drugs is a matter of choice.<br />\r\n<br />\r\n<strong>Inspired Concentration</strong>: The concentration of Isoflurane being delivered from a vaporizer during anesthesia should be known. This may be accomplished by using:<br />\r\n<br />\r\nVaporizers calibrated specifically for Isoflurane;<br />\r\nVaporizers from which delivered flows can be calculated, such as vaporizers delivering a saturated vapor, which is then diluted. The delivered concentration from such a vaporizer may be calculated using the formula:&nbsp;<strong>% Isoflurane = 100 PvFv/FT&nbsp;(PA&nbsp;- PV)</strong><br />\r\n<br />\r\nWhere:</p>\r\n\r\n<ul>\r\n	<li>PA= Pressure of atmosphere</li>\r\n	<li>PV= Vapor pressure of Isoflurane</li>\r\n	<li>FV= Flow of gas through vaporizer (mL/min)</li>\r\n	<li>FT= Total gas flow (mL/min)</li>\r\n</ul>\r\n\r\n<p>Isoflurane contains no stabilizer. Nothing in the agent alters calibration or operation of these vaporizers.<br />\r\n<br />\r\n<strong>Induction</strong>: Induction with Isoflurane in oxygen or in combination with oxygen-nitrous oxide mixtures may produce coughing, breath holding, or laryngospasm. These difficulties may be avoided by the use of a hypnotic dose of an ultra-short-acting barbiturate. Inspired concentrations of 1.5 to 3.0% Isoflurane usually produce surgical anesthesia in 7 to 10 minutes.<br />\r\n<br />\r\n<strong>Maintenance</strong>: Surgical levels of anesthesia may be sustained with a 1.0 to 2.5% concentration when nitrous oxide is used concomitantly. An additional 0.5 to 1.0% may be required when Isoflurane is given using oxygen alone. If added relaxation is required, supplemental doses of muscle relaxants may be used.<br />\r\n<br />\r\nThe level of blood pressure during maintenance is an inverse function of Isoflurane concentration in the absence of other complicating problems. Excessive decreases may be due to depth of anesthesia and in such instances may be corrected by lightening anesthesia.</p>', '<p>Enhances effects of neuromuscular blockers. May sensitise the myocardium to adrenaline and other sympathomimetics. Enhances hypotensive effects of ACE inhibitors, TCAs, MAOIs, antihypertensives, antipsychotics or beta-blockers. May have synergistic effects with CNS depressants.</p>', '<p>Known or suspected susceptibility to malignant hyperthermia. Porphyria.</p>', '<p>Nausea, Vomiting, Shivering, Dose-dependent hypotension, Arrhythmias, Malignant hyperthermia (rare), Elevations in white blood count, May decrease creatinine and increase BUN, Ileus, severe (fatal), Hepatic dysfunction (postoperative period),Respiratory depression may occur</p>', '<p><strong>Pregnancy</strong>&nbsp;Category C. Isoflurane has been shown to have a possible anesthetic-related fetotoxic effect in mice when given in doses 6 times the human dose. There are no adequate and well-controlled studies in pregnant women. Isoflurane 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 this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Isoflurane is administered to a nursing woman.</p>', '<p><strong>Pregnancy</strong>&nbsp;Category C. Isoflurane has been shown to have a possible anesthetic-related fetotoxic effect in mice when given in doses 6 times the human dose. There are no adequate and well-controlled studies in pregnant women. Isoflurane 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 this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Isoflurane is administered to a nursing woman.</p>', '<p>Store at room temperature 15&deg;-30&deg;C.&nbsp;Isoflurane contains no additives and has been demonstrated to be stable at room temperature for periods in excess of five years.</p>', '<p>General (Inhalation) anesthetics</p>', NULL, NULL, '2022-03-07 20:01:17', '2022-03-07 20:01:17'),
(782, 782, '<p>Isoniazid is indicated for the treatment of all forms of tuberculosis in which organisms are susceptible.</p>', '<p>Isoniazid inhibits the synthesis of mycoloic acids in susceptible bacteria which results in loss of acid-fastness and disruption of bacterial cell wall. At therapeutic levels, it is bacteriocidal against actively growing intracellular and extracellular Mycobacterium tuberculosis organisms.</p>', '<p><strong>Adult</strong>:&nbsp;</p>\r\n\r\n<ul>\r\n	<li><strong>Active tuberculosis</strong>: 5 mg/kg/day. Max: 300 mg/day or 15 mg/kg up to 900 mg/day, 2 or 3 times wkly.</li>\r\n	<li><strong>Latent tuberculosis</strong>: 300 mg/day for 6 mth. Nontuberculous mycobacterial infections 5 mg/kg/day for at least 12 mth of culture-negative sputum. Max: 300 mg/day.</li>\r\n</ul>\r\n\r\n<p><strong>Child</strong>:<strong>&nbsp;</strong>10-15 mg/kg/day, max 300 mg/day q 12-24 hourly<br />\r\n<br />\r\nWith directly observed biweekly therapy, dosage is 20-30 mg/kg, max 900 mg/dose twice weekly</p>', '<p>Inhibit the hepatic metabolism of antiepileptics (e.g. carbamazepine, ethosuximide, primidone, phenytoin), benzodiazepines (e.g. diazepam, triazolam), chlorzoxazone, theophylline, disulfiram, sometimes leading to increased toxicity. Increased metabolism of enflurane, resulting in potentially nephrotoxic levels of fluoride. Increased concentrations and enhanced effects or toxicity of clofazimine, cycloserine and warfarin. Reduced absorption with Al-containing antacids. Increased risk of peripheral neuropathy with zalcitabine and stavudine.</p>', '<p>Acute liver disease or history of hepatic damage during INH therapy; hypersensitivity.</p>', '<p>Peripheral neuropathy (dose-related incidence, 10-20% incidence with 10 mg/kg/d), Loss of appetite, Nausea, Vomiting, Stomach pain, Weakness 1-10%, Dizziness, Slurred speech, Lethargy, Progressive liver damage (increases with age; 2.3% in pts &gt; 50 yo), Hyperreflexia, Agranulocytosis, Anemia, Megaloblastic anemia, Thrombocytopenia, Systemic lupus erythematosus, Seizure.</p>', '<p><strong>Pregnancy</strong>&nbsp;Category C. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks<br />\r\n<br />\r\n<strong>Lactation</strong>: distributed into milk but safe for nursing infants.</p>', '<p>Renal or hepatic impairment; convulsive disorders; history of psychosis; patients at risk of neuropathy or pyridoxine deficiency eg, diabetic, alcoholic, malnourished, uraemic, infected with HIV. Careful monitoring of hepatic function is necessary for black and Hispanic women. Check hepatic function before and during treatment. Pregnancy and lactation.</p>', NULL, '<p>Anti-Tubercular Chemotherapeutics.</p>', NULL, NULL, '2022-03-07 20:04:54', '2022-03-07 20:04:54'),
(783, 783, '<p>This preparation may be employed to advantage in the treatment of a wide range of gastrointestinal disorders, including such conditions as peptic ulcer, gastritis, hyperchlorhydria, functional diarrhea, irritable or spastic colon, pyloroduodenal irritability, pylorospasm, acute nonspecific gastroenteritis, biliary dyskinesia and chronic cholelithiasis, duodenitis, gastrointestinal spasm; it may also be used to treat genitourinary spasm. This preparation is particularly indicated where anxiety, tension, worry, or other emotional factors are thought to be wholly or partially responsible for the digestive dysfunction.</p>', '<p>Trifluoperazine inhibits dopamine D2 receptors in the brain. It has weak anticholinergic and sedative effects but strong extrapyramidal and antiemetic effects. It controls severely disturbed, agitated or violent behaviour but may also be used for nonpsychotic anxiety.</p>', '<p>Since both components of this preparation are inherently long-acting, a single tablet twice daily (every 12 hours) can provide continuous 24-hour control of symptoms of ulcer and other gastrointestinal disorders.<br />\r\n<br />\r\nIn addition to the convenience of twice-daily dosage, this tablet can provide significant therapeutic advantages: continuous reduction of gastric secretion; continuous inhibition of spasm and motility; continuous relief of anxiety and tension; continuous control of nausea and vomiting.</p>', '<p>Increased CNS depression with CNS depressants such as opiates or other analgesics, barbiturates or other sedatives, general anaesthetics, or alcohol. Increased risk of side effects with drugs with antimuscarinic properties e.g. TCA, antiparkinsonian drugs. Antagonised effects of dopaminergic drugs such as levodopa. Increased risk of hypotension with antihypertensives, trazodone. Reverses antihypertensive effect of guanethidine. Increased risk of severe extrapyramidal side-effects or severe neurotoxicity with lithium. Possible decrease in absorption with antacids.</p>', '<p>Because of the antiemetic action of the trifluoperazine component, this should not be used where nausea and vomiting are believed to be evidence of intestinal obstruction or brain tumor.</p>', '<p>The usual anticholinergic side effects are dry mouth, blurred vision, urinary hesitancy and retention, and constipation&ndash;have been encountered with this tablet.</p>', '<p>Use during pregnancy should be restricted to those cases where the potential benefit to the mother outweighs the potential risk to the fetus. Adequate human data on use during lactation and adequate animal reproduction studies are not available.</p>', '<p>Use with caution in elderly patients, in patients with cardiac impairment, hyperthyroidism, or hiatal hernia associated with reflux esophagitis (anticholinergic drugs may aggravate this condition).</p>', NULL, '<p>Anticholinergics (antimuscarinics)/ Anti-spasmodics, Phenothiazine related drugs</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-07 20:07:00', '2022-03-07 20:07:00'),
(784, 784, '<p>For the disinfection of clean and intact skin. For pre-operative surgical hand disinfection, hand disinfection on the ward prior to aseptic procedures or after handling contaminated materials. For disinfection of the patients&#39; skin prior to surgery or other invasive procedures</p>', '<p>Isopropyl Alcohol is an isomer of propyl alcohol with antibacterial properties. Although the exact mechanism of isopropanol&#39;s disinfecting action is not known, it might kill cells by denaturing cell proteins and DNA, interfering with cellular metabolism, and dissolving cell lipo-protein membranes. Isopropanol is used in soaps and lotions as an antiseptic. 70 % isopropyl alcohol solution kills microorganisms by dissolving plasma membrane of the cell wall.</p>', '<p>Squeeze thumbnail size amount in your palm then briskly rub hands together until dry. Use as often as required.</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>To completely remove germs from hands wash your hand with this Anti-Germ Hand Wash for 20 seconds using the below WHO recommended 7 steps:</p>\r\n\r\n<ul>\r\n	<li>Step 1: Wet Hands. Wet your hands and apply enough liquid soap to create a good lather.</li>\r\n	<li>Step 2: Rub Palms Together.</li>\r\n	<li>Step 3: Rub the Back of Hands.</li>\r\n	<li>Step 4: Interlink Your Fingers.</li>\r\n	<li>Step 5: Cup Your Fingers.</li>\r\n	<li>Step 6: Clean the Thumbs.</li>\r\n	<li>Step 7: Rub Palms with Your Fingers.</li>\r\n</ul>', NULL, NULL, NULL, NULL, '<ul>\r\n	<li>Highly Flammable. Keep away from fire or flame</li>\r\n	<li>For external use only</li>\r\n	<li>Avoid eyes. In case of contact with eye, flush with water</li>\r\n	<li>Discontinue use if skin irritation occurs</li>\r\n	<li>Keep out of reach of children</li>\r\n</ul>', NULL, '<p>Other antibacterial preparation</p>', '<p>Isopropyl alcohol should be stored in a tightly closed container in a cool &amp; dry place, protected from light, well-ventilated area. Due to the chemical&#39;s extreme flammability, it must be kept away from all possible ignition sources, including heat, sparks, and flames. Keep out of reach of children.</p>', NULL, '2022-03-07 20:12:45', '2022-03-07 20:12:45'),
(785, 785, '<p>This hand sanitizer is generally used to decrease infectious agents on the hands and is the most commonly used disinfectant in pharmaceutical industries. The important thing is that only 70% solution of isopropyl alcohol acts as a disinfectant killing all surface microorganisms. It is used to disinfect hands and equipment surface in pharmaceuticals.</p>', '<p>Isopropyl Alcohol is an isomer of propyl alcohol with antibacterial properties. Although the exact mechanism of isopropanol&#39;s disinfecting action is not known, it might kill cells by denaturing cell proteins and DNA, interfering with cellular metabolism, and dissolving cell lipo-protein membranes. Isopropanol is used in soaps and lotions as an antiseptic. 70 % isopropyl alcohol solution kills microorganisms by dissolving plasma membrane of the cell wall.<br />\r\n<br />\r\nGlycerol: used as humectant, but other emollients may be used for skin care, provided that they are cheap, widely available and miscible in water and alcohol and do not add to toxicity, or promote allergy.<br />\r\n<br />\r\nHydrogen peroxide: used to inactivate contaminating bacterial spores in the solution and is not an active substance for hand antisepsis.</p>', '<p>Alcohol-based hand sanitizer is more convenient compared to hand washing with soap and water in most situations in the healthcare setting. It is generally more effective at killing microorganisms and better tolerated than soap and water. Alcohol-based hand sanitizer is recommended only if soap and water are not available. Using guideline is given bellow-</p>\r\n\r\n<ol>\r\n	<li>Apply product to the palm of one hand.</li>\r\n	<li>Rub hands together.</li>\r\n	<li>Rub the product over all surfaces of hands and fingers until hands are dry.</li>\r\n</ol>', NULL, '<p>Isopropyl Alcohol is contraindicated in patients with known Hypersensitivity.</p>', '<p>Inhaling large amounts of isopropyl alcohol can cause nausea, vomiting, irritation of the nose and mucous membranes, throat irritations, and even difficulty with breathing as coughing can occur making it difficult for you to catch your breath. Isopropyl alcohol may cause burning, stinging, or a cold feeling where the medicine is applied.</p>', NULL, '<p>Isopropyl Alcohol is highly flammable in the presence of heat, sparks, or an open flame. When handling isopropyl alcohol in a work environment (to best to avoid any contact with skin) protective clothing should be always be worn, including safety gloves and goggles. Isopropyl alcohol should be kept away from heat, sparks, flames and other sources of ignition, as well as strong oxidizers, acetaldehyde, chlorine, ethylene oxide, acids, and isocyanates. A flammable safety cabinet is the best storage option.</p>', NULL, '<p>Bleaching and Disinfectants</p>', '<p>Isopropyl alcohol should be stored in a tightly closed container in a cool &amp; dry place, protected from light, well-ventilated area. Due to the chemical&#39;s extreme flammability, it must be kept away from all possible ignition sources, including heat, sparks, and flames. Keep out of reach of children.</p>', NULL, '2022-03-07 20:15:33', '2022-03-07 20:15:33'),
(786, 786, '<p>Isosorbide Mononitrate is indicated for the prevention and treatment of angina pectoris due to coronary artery disease. The onset of action of oral isosorbide mononitrate is not sufficiently rapid for this product to be useful in aborting an acute anginal episode.</p>', '<p>Isosorbide mononitrate is the major active metabolite of isosorbide dinitrate (ISDN), and most of the clinical activity of the dinitrate is attributable to the mononitrate. The principal pharmacological action of isosorbide mononitrate is relaxation of vascular smooth muscle and consequent dilatation of peripheral arteries and veins, especially the latter. Dilation of the veins promotes peripheral pooling of blood and decreases venous return to the heart, thereby reducing left ventricular end-diastolic pressure and&nbsp; pulmonary capillary wedge pressure (preload). Arteriolar relaxation reduces systemic vascular resistance, systolic arterial pressure, and mean arterial pressure (afterload). Dilatation of the coronary arteries also occurs. The relative importance of preload reduction, afterload reduction and coronary dilatation remains undefined.</p>', '<p><strong>Tablet</strong>: The usual oral dose is 1 tablet (20 mg) 2 times daily, first dose in the morning and another 7 hours apart. Although maintenance doses ranging from 20 mg to 120 mg (1-6 tablets), a dose of 10 mg (1/2 tablet) is suitable when lower dosage is used at the starting of treatment or as directed by a registered physician.<br />\r\n<br />\r\n<strong>Sustained Release Capsule</strong>: The usual oral dose is 1 capsule (50 mg) daily or as directed by the registered physician.</p>', '<ul>\r\n	<li>Concomitant use of Isosorbide Mononitrate with phosphodiesterase inhibitors in any form is contraindicated.</li>\r\n	<li>Concomitant use of Isosorbide Mononitrate with riociguat, a soluble guanylate cyclase stimulator, is contraindicated.</li>\r\n	<li>The vasodilating effects of isosorbide mononitrate may be additive with those of other vasodilators. Alcohol, in particular, has been found to exhibit additive effects of this variety.</li>\r\n	<li>Marked symptomatic orthostatic hypotension has been reported when calcium channel blockers and organic nitrates were used in combination. Dose adjustments of either class of agents may be necessary.</li>\r\n</ul>', '<p>Isosorbide mononitrate is contraindicated in patients who are allergic to it. Do not use Isosorbide Mononitrate in patients who are taking certain drugs for erectile dysfunction (phosphodiesterase inhibitors), such as sildenafil, tadalafil, or vardenafil. Concomitant use can cause severe hypotension, syncope, or myocardial ischemia. Do not use Isosorbide Mononitrate in patients who are taking the soluble guanylate cyclase stimulator riociguat. Concomitant use can cause hypotension.</p>', '<p>Headache, feelings of dizziness, hypotension may occur sometimes.</p>', '<p>Pregnancy Category B: Reproduction studies performed in rats and rabbits at doses of up to 540 and 810 mg/kg/day, respectively, have revealed no evidence of harm to the fetus due to isosorbide mononitrate. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, Isosorbide Mononitrate should be used during pregnancy only if clearly needed.<br />\r\n<br />\r\nNursing Mothers: It is not known whether isosorbide mononitrate is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when isosorbide mononitrate is administered to a nursing woman.</p>', '<p>Severe hypotension, particularly with upright posture, may occur with even small doses of isosorbide mononitrate. This drug should therefore be used with caution in patients who may be volume depleted or who, for whatever reason, are already hypotensive. Hypotension induced by isosorbide mononitrate may be accompanied by paradoxical bradycardia and increased angina pectoris.<br />\r\n<br />\r\nNitrate therapy may aggravate the angina caused by hypertrophic cardiomyopathy. In industrial workers who have had long-term exposure to unknown (presumably high) doses of organic nitrates, tolerance clearly occurs. Chest pain, acute myocardial infarction, and even sudden death have occurred during temporary withdrawal of nitrates from these workers, demonstrating the existence of true physical dependence. The importance of these observations to the routine, clinical use of oral isosorbide mononitrate is not known.<br />\r\n<br />\r\nPatients should be told that the antianginal efficacy of Isosorbide Mononitrate tablets can be maintained by carefully following the prescribed schedule of dosing (two doses taken seven hours apart). For most patients, this can be accomplished by taking the first dose on awakening and the second dose 7 hours later.<br />\r\n<br />\r\nAs with other nitrates, daily headaches sometimes accompany treatment with isosorbide mononitrate. In patients who get these headaches, the headaches are a marker of the activity of the drug. Patients should resist the temptation to avoid headaches by altering the schedule of their treatment with isosorbide mononitrate, since loss of headache may be associated with simultaneous loss of antianginal efficacy. Aspirin and/or acetaminophen, on the other hand, often successfully relieve isosorbide mononitrate-induced headaches with no deleterious effect on isosorbide mononitrate&rsquo;s antianginal efficacy.<br />\r\n<br />\r\nTreatment with isosorbide mononitrate may be associated with light-headedness on standing, especially just after rising from a recumbent or seated position. This effect may be more frequent in patients who have also consumed alcohol.</p>', '<p><strong>Symptoms</strong>: Most common symptoms are hypotension, throbbing headache, tachycardia, and flushing. Methemoglobinemia may occur with massive doses.<br />\r\n<br />\r\n<strong>Treatment</strong>: Treatment consists of placing patients in recumbent position and administering fluids; alpha-adrenergic vasopressors may be required. Methemoglobinemia should be treated with methyline blue at a dose of 1-2 mg/kg IV slowly.</p>', '<p>Nitrates: Coronary vasodilators.</p>', '<p>Store at 20&deg;-30&deg;C.</p>', NULL, '2022-03-07 20:18:04', '2022-03-07 20:18:04');
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
(787, 787, '<p>Isotretinoin is indicated in severe forms of acne (such as nodular or conglobate acne or acne at risk of permanent scarring) resistant to adequate courses of standard therapy with systemic antibacterials and topical therapy.</p>', '<p>Isotretinoin produces its effects through altering progress through the cell cycle, cell differentiation, survival, and apoptosis. These actions reduce sebum production, preventing the blockage of pores, and growth of acne causing bacteria. Isotretinoin and 4-oxo-isotretinoin both significantly reduce the production of sebum. Isotretinoin has little to no affinity for retinol binding proteins (RBPs) and retinoic acid nuclear receptors (RARs). Tretinoin and 4-oxo-tretinion bind to the RAR-&gamma; receptor, which is suspected to be part of the action of acne treatment by isotretinoin. Isotretinoin induces apoptosis in sebocytes, leading to a decrease in sebum production. Isotretinoin also reduces the formation of comedones by reducing hyperkeratinization through an unknown mechanism. Isotretinoin does not directly kill bacteria but it does reduce the size of sebum ducts and makes the microenvironment less hospitable to acne causing bacteria. It may also increase immune mechanisms and alter chemotaxis of monocytes to reduce inflammation.</p>', '<p>The capsules should be taken with food once or twice daily. Isotretinoin should only be prescribed by or under the supervision of physicians with expertise in the use of systemic retinoids for the treatment of severe acne and a full understanding of the risks of Isotretinoin therapy and monitoring requirements.<br />\r\n<br />\r\n<strong>Adults including adolescents and the elderly</strong>: Isotretinoin therapy should be started at a dose of 0.5 mg/kg daily. The therapeutic response to Isotretinoin and some of the adverse effects are dose-related and vary between patients. This necessitates individual dosage adjustment during therapy. For most patients, the dose ranges from 0.5-1.0 mg/kg per day. Long-term remission and relapse rates are more closely related to the total dose administered than to either duration of treatment or daily dose. It has been shown that no substantial additional benefit is to be expected beyond a cumulative treatment dose of 120-150 mg/kg. The duration of treatment will depend on the individual daily dose. A treatment course of 16-24 weeks is normally sufficient to achieve remission. In the majority of patients, complete clearing of the acne is obtained with a single treatment course. In the event of a definite relapse a further course of Isotretinoin therapy may be considered using the same daily dose and cumulative treatment dose. As further improvement of the acne can be observed up to 8 weeks after discontinuation of treatment, a further course of treatment should not be considered until at least this period has elapsed.<br />\r\n<br />\r\n<strong>Patients with severe renal insufficiency</strong>: In patients with severe renal insufficiency treatment should be started at a lower dose (e.g. 10 mg/day). The dose should then be increased up to 1 mg/kg/day or until the patient is receiving the maximum tolerated dose.<br />\r\n<br />\r\n<strong>Children</strong>: Isotretinoin is not indicated for the treatment of prepubertal acne and is not recommended in patients less than 12 years of age due to a lack of data on efficacy and safety.<br />\r\n<br />\r\n<strong>Patients with intolerance</strong>: In patients who show severe intolerance to the recommended dose, treatment may be continued at a lower dose with the consequences of a longer therapy duration and a higher risk of relapse. In order to achieve the maximum possible efficacy in these patients the dose should normally be continued at the highest tolerated dose.</p>', '<p>Additive adverse effects with vit A or its derivatives. Decreased efficacy of microdosed progesterone (use 2 forms of contraception).Increased risk of local irritation with topical keratolytic or exfoliative anti-acne agents. Oxidising agents (e.g. benzoyl peroxide) may reduce the efficacy of topical isotretinoin.</p>', '<p>Isotretinoin is contraindicated in women who are pregnant or breastfeeding. Isotretinoin is contraindicated in women of childbearing potential unless all of the conditions of the Pregnancy Prevention Programme are met. Isotretinoin is also contraindicated in patients with hypersensitivity to Isotretinoin or to any of the excipients. Isotretinoin is also contraindicated in patients with hepatic insufficiency, with excessively elevated blood lipid values, with hypervitaminosis A, receiving concomitant treatment with tetracyclines.<br />\r\n<br />\r\nThis medicinal product is contraindicated in women of childbearing potential unless all of the following conditions of the Pregnancy Prevention Programme are met: She has severe acne (such as nodular or conglobate acne or acne at risk of permanent scarring) resistant to adequate courses of standard therapy with systemic anti-bacterials and topical therapy. She understands the teratogenic risk. She understands the need for rigorous follow-up, on a monthly basis. She understands and accepts the need for effective contraception, without interruption, 1 month before starting treatment, throughout the duration of treatment and 1 month after the end of treatment. At least one and preferably two complementary forms of contraception including a barrier method should be used. Even if she has amenorrhea she must follow all of the advice on effective contraception. She should be capable of complying with effective contraceptive measures. She is informed and understands the potential consequences of pregnancy and the need to rapidly consult if there is a risk of pregnancy. She understands the need and accepts to undergo pregnancy testing before, during and 5 weeks after the end of treatment. She has acknowledged that she has understood the hazards and necessary precautions associated with the use of Isotretinoin. These conditions also concern women who are not currently sexually active unless the prescriber considers that there are compelling reasons to indicate that there is no risk of pregnancy. The prescriber must ensure that the patient complies with the conditions for pregnancy prevention as listed above, including confirmation that she has an adequate level of understanding. The patient has acknowledged the aforementioned conditions. The patient has used at least one and preferably two methods of effective contraception including a barrier method for at least 1 month prior to starting treatment and is continuing to use effective contraception throughout the treatment period and for at least 1 month after cessation of treatment. Negative pregnancy test results have been obtained before, during and 5 weeks after the end of treatment. The dates and results of pregnancy tests should be documented.</p>', '<p>Some of the side effects associated with the use of Isotretinoin are dose-related. The side effects are generally reversible after altering the dose or discontinuation of treatment, however some may persist after treatment has stopped. The following symptoms are the most commonly reported undesirable effects with Isotretinoin: dryness of the skin, dryness of the mucosae e.g. of the lips (cheilitis), the nasal mucosa (epistaxis) and the eyes (conjunctivitis).<br />\r\n<br />\r\nThe incidence of the adverse events was calculated from pooled clinical trial data involving 824 patients and from post-marketing data. Frequency categories are defined as Very common (&sup3;1/10), Common (&sup3;1/100 to &lt;1/10), Uncommon (&sup3;1/1,000 to &lt;1/100), Rare (&sup3;1/10,000 to &lt;1/1,000), Very rare (&sup3;1/10,000 to &lt;1/1,000) and not known (cannot be estimated from the available data. Infections: Very Rare: Gram positive (mucocutaneous) bacterial infection Blood and lymphatic system disorders: Very common: Anaemia, red blood cell sedimentation rate increased, thrombocytopenia, thrombocytosis; Common: Neutropenia; Very Rare: Lymphadenopathy Immune system disorders: Rare: Allergic skin reaction, anaphylactic reactions, hypersensitivity Metabolism and nutrition disorders: Very Rare: Diabetes mellitus, hyperuricaemia Psychiatric disorders: Rare: Depression, depression aggravated, aggressive tendencies, anxiety, mood alterations. Very Rare: Abnormal behaviour, psychotic disorder, suicidal ideation suicide attempt, suicide Nervous system disorders: Common: Headache; Very Rare: Benign intracranial hypertension, convulsions, drowsiness, dizziness Eye disorders: Very Common: Blepharitis, conjunctivitis, dry eye, eye irritation; Very Rare: Blurred vision, cataract, colour blindness (colour vision deficiencies), contact lens intolerance, corneal opacity, decreased night vision, keratitis, papilloedema (as sign of benign intracranial hypertension), photophobia, visual disturbances. Ear and labyrinth disorders: Very Rare: Hearing impaired Vascular disorders: Very Rare: Vasculitis (for example Wegener&#39;s granulomatosis, allergic vasculitis) Respiratory, thoracic and mediastinal disorders: Common: Epistaxis, nasal dryness, nasopharyngitis, Very Rare: Bronchospasm (particularly in patients with asthma), hoarseness Gastrointestinal disorders: Very Rare: Colitis, ileitis, dry throat, gastrointestinal haemorrhage, haemorrhagic diarrhoea and inflammatory bowel disease, nausea, pancreatitis Hepatobiliary disorders: Very Common: Transaminase increased; Very rare: Hepatitis Skin and subcutaneous tissues disorders: Very Common: Pruritus, rash erythematous, dermatitis, cheilitis, dry skin, localised exfoliation, skin fragility (risk of frictional trauma), Rare: Alopecia, Very Rare: Acne fulminans, acne aggravated (acne flare), erythema (facial), exanthema, hair disorders, hirsutism, nail dystrophy, paronychia, photosensitivity reaction, pyogenic granuloma, skin hyperpigmentation, sweating increased. Musculo-skeletal and connective tissue disorders: Very Common: Arthralgia, myalgia, back pain (particularly in children and adolescent patients), Very Rare: Arthritis, calcinosis (calcification of ligaments and tendons), epiphyses premature fusion, exostosis, (hyperostosis), reduced bone density, tendonitis. Renal and urinary disorders: Very Rare: Glomerulonephritis. General disorders and administration site conditions: Very Rare: Granulation tissue (increased formation of), malaise. Overdose Isotretinoin is a derivative of vitamin A. Although the acute toxicity of Isotretinoin is low, signs of hypervitaminosis A could appear in cases of accidental overdose. Manifestations of acute vitamin A toxicity include severe headache, nausea or vomiting, drowsiness, irritability and pruritus. Signs and symptoms of accidental or deliberate overdosage with Isotretinoin would probably be similar. These symptoms would be expected to be reversible and to subside without the need for treatment. Pharmaceutical precautions Store in a cool and dry place protected from light.</p>', '<p>Pregnancy is an absolute contraindication to treatment with Isotretinoin. If pregnancy does occur in spite of these precautions during treatment with Isotretinoin or in the month following, there is a great risk of very severe and serious malformation of the foetus. The foetal malformations associated with exposure to Isotretinoin include central nervous system abnormalities (hydrocephalus, cerebellar malformation/abnormalities, microcephaly), facial dysmorphia, cleft palate, external ear abnormalities (absence of external ear, small or absent external auditory canals), eye abnormalities (microphthalmia), cardiovascular abnormalities (conotruncal malformations such as tetralogy of Fallot, transposition of great vessels, septal defects), thymus gland abnormality and parathyroid gland abnormalities. There is also an increased incidence of spontaneous abortion. If pregnancy occurs in a woman treated with Isotretinoin, treatment must be stopped and the patient should be referred to a physician specialised or experienced in teratology for evaluation and advice. Isotretinoin is highly lipophilic, therefore the passage of Isotretinoin into human milk is very likely. Due to the potential for adverse effects in the child exposed via mothers&rsquo; milk, the use of Isotretinoin is contraindicated in nursing mothers.</p>', '<p><strong>Contraception</strong>: Female patients must be provided with comprehensive information on pregnancy prevention and should be referred for contraceptive advice if they are not using effective contraception. As a minimum requirement, female patients at potential risk of pregnancy must use at least one effective method of contraception. Preferably the patient should use two complementary forms of contraception including a barrier method. Contraception should be continued for at least 1 month after stopping treatment with Isotretinoin, even in patients with amenorrhea.<br />\r\n<br />\r\n<strong>Pregnancy testing</strong>: According to local practice, medically supervised pregnancy tests with a minimum sensitivity of 25mIU/mL are recommended to be performed in the first 3 days of the menstrual cycle, as follows.<br />\r\n<br />\r\n<strong>Prior to starting therapy</strong>: In order to exclude the possibility of pregnancy prior to starting contraception, it is recommended that an initial medically supervised pregnancy test should be performed and its date and result recorded. In patients without regular menses, the timing of this pregnancy test should reflect the sexual activity of the patient and should be undertaken approximately 3 weeks after the patient last had unprotected sexual intercourse. The prescriber should educate the patient about contraception. A medically supervised pregnancy test should also be performed during the consultation when Isotretinoin is prescribed or in the 3 days prior to the visit to the prescriber, and should have been delayed until the patient had been using effective contraception for at least 1 month. This test should ensure the patient is not pregnant when she starts treatment with Isotretinoin.<br />\r\n<br />\r\n<strong>Follow-up visits</strong>: Follow-up visits should be arranged at 28 day intervals. The need for repeated medically supervised pregnancy tests every month should be determined according to local practice including consideration of the patient&rsquo;s sexual activity and recent menstrual history (abnormal menses, missed periods or amenorrhea). Where indicated, follow-up pregnancy tests should be performed on the day of the prescribing visit or in the 3 days prior to the visit to the prescriber.<br />\r\n<br />\r\n<strong>End of treatment</strong>: Five weeks after stopping treatment, women should undergo a final pregnancy test to exclude pregnancy.<br />\r\n<br />\r\n<strong>Prescribing and dispensing restrictions</strong>: Prescriptions of Isotretinoin for women of childbearing potential should be limited to 30 days of treatment and continuation of treatment requires a new prescription. Ideally, pregnancy testing, issuing a prescription and dispensing of Isotretinoin should occur on the same day. Dispensing of Isotretinoin should occur within a maximum of 7 days of the prescription.<br />\r\n<br />\r\n<strong>Male patients</strong>: The available data suggest that the level of maternal exposure from the semen of the patients receiving Isotretinoin, is not of a sufficient magnitude to be associated with the teratogenic effects of Isotretinoin. Male patients should be reminded that they must not share their medication with anyone, particularly not females.<br />\r\n<br />\r\n<strong>Additional precautions</strong>: Patients should be instructed never to give this medicinal product to another person, and to return any unused capsules to their pharmacist at the end of treatment. Patients should not donate blood during therapy and for 1 month following discontinuation of Isotretinoin because of the potential risk to the foetus of a pregnant transfusion recipient.<br />\r\n<br />\r\n<strong>Psychiatric disorders</strong>: Depression, depression aggravated, anxiety, aggressive tendencies, mood alterations, psychotic symptoms, and very rarely, suicidal ideation, suicide attempts and suicide have been reported in patients treated with Isotretinoin. Particular care needs to be taken in patients with a history of depression and all patients should be monitored for signs of depression and referred for appropriate treatment if necessary. However, discontinuation of Isotretinoin may be insufficient to alleviate symptoms and therefore further psychiatric or psychological evaluation may be necessary.<br />\r\n<br />\r\n<strong>Skin and subcutaneous tissues disorders</strong>: Acute exacerbation of acne is occasionally seen during the initial period but this subsides with continued treatment, usually within 7-10 days, and usually does not require dose adjustment. Exposure to intense sunlight or to UV rays should be avoided. Where necessary a sun-protection product with a high protection factor of at least SPF 15 should be used. Aggressive chemical dermabrasion and cutaneous laser treatment should be avoided in patients on Isotretinoin for a period of 5-6 months after the end of the treatment because of the risk of hypertrophic scarring in atypical areas and more rarely post inflammatory hyper or hypopigmentation in treated areas. Wax depilation should be avoided in patients on Isotretinoin for at least a period of 6 months after treatment because of the risk of epidermal stripping. Concurrent administration of Isotretinoin with topical keratolytic or exfoliative anti-acne agents should be avoided as local irritation may increase. Patients should be advised to use a skin moisturising ointment or cream and a lip balm from the start of treatment as Isotretinoin is likely to cause dryness of the skin and lips. There have been post-marketing reports of severe skin reactions (e.g. erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)) associated with Isotretinoin use. As these events may be difficult to distinguish from other skin reactions that may occur, patients should be advised of the signs and symptoms and monitored closely for severe skin reactions. If a severe skin reaction is suspected, Isotretinoin treatment should be discontinued. Allergic reactions: Anaphylactic reactions have been rarely reported, in some cases after previous topical exposure to retinoids. Allergic cutaneous reactions are reported infrequently. Serious cases of allergic vasculitis, often with purpura (bruises and red patches) of the extremities and extracutaneous involvement have been reported. Severe allergic reactions necessitate interruption of therapy and careful monitoring.<br />\r\n<br />\r\n<strong>Eye disorders</strong>: Dry eyes, corneal opacities, decreased night vision and keratitis usually resolve after discontinuation of therapy. Dry eyes can be helped by the application of a lubricating eye ointment or by the application of tear replacement therapy. Intolerance to contact lenses may occur which may necessitate the patient to wear glasses during treatment. Decreased night vision has also been reported and the onset in some patients was sudden. Withdrawal of Isotretinoin may be necessary.<br />\r\n<br />\r\n<strong>Musculo-skeletal and connective tissue disorders</strong>: Myalgia, arthralgia and increased serum creatine phosphokinase values have been reported in patients receiving Isotretinoin, particularly in those undertaking vigorous physical activity. Bone changes including premature epiphyseal closure, hyperostosis, and calcification of tendons and ligaments have occurred after several years of administration at very high doses for treating disorders of keratinisation. The dose levels, duration of treatment and total cumulative dose in these patients generally far exceeded those recommended for the treatment of acne.<br />\r\n<br />\r\n<strong>Benign intracranial hypertension</strong>: Cases of benign intracranial hypertension have been reported, some of which involved concomitant use of tetracyclines. Signs and symptoms of benign intracranial hypertension include headache, nausea and vomiting, visual disturbances and papilloedema. Patients who develop benign intracranial hypertension should discontinue Isotretinoin immediately.<br />\r\n<br />\r\n<strong>Hepatobiliary disorders</strong>: Liver enzymes should be checked before treatment, 1 month after the start of treatment, and subsequently at 3 monthly intervals unless more frequent monitoring is clinically indicated. Transient and reversible increases in liver transaminases have been reported. In many cases these changes have been within the normal range and values have returned to baseline levels during treatment. However, in the event of persistent clinically relevant elevation of transaminase levels, reduction of the dose or discontinuation of treatment should be considered.<br />\r\n<br />\r\n<strong>Renal insufficiency</strong>: Renal insufficiency and renal failure do not affect the pharmacokinetics of Isotretinoin. Therefore, Isotretinoin can be given to patients with renal insufficiency. However, it is recommended that patients are started on a low dose and titrated up to the maximum tolerated dose.<br />\r\n<br />\r\n<strong>Lipid Metabolism</strong>: Serum lipids (fasting values) should be checked before treatment, 1 month after the start of treatment, and subsequently at 3 monthly intervals unless more frequent monitoring is clinically indicated. Elevated serum lipid values usually return to normal on reduction of the dose or discontinuation of treatment and may also respond to dietary measures. Isotretinoin has been associated with an increase in plasma triglyceride levels. Isotretinoin should be discontinued if hypertriglyceridaemia cannot be controlled at an acceptable level or if symptoms of pancreatitis occur. Levels in excess of 800mg/dL or 9mmol/L are sometimes associated with acute pancreatitis, which may be fatal.<br />\r\n<br />\r\n<strong>Gastrointestinal disorders</strong>: Isotretinoin has been associated with inflammatory bowel disease (including regional ileitis) in patients without a prior history of intestinal disorders. Patients experiencing severe (hemorrhagic) diarrhoea should discontinue Isotretinoin immediately.<br />\r\n<br />\r\n<strong>High Risk Patients</strong>: In patients with diabetes, obesity, alcoholism or a lipid metabolism disorder undergoing treatment with Isotretinoin, more frequent checks of serum values for lipids and/or blood glucose may be necessary. Elevated fasting blood sugars have been reported, and new cases of diabetes have been diagnosed during Isotretinoin therapy.</p>', NULL, '<p>Oral retinoids for Acne</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-07 20:21:21', '2022-03-07 20:21:21'),
(788, 788, '<p>Isotretinoin topical gel is indicated for the treatment of mild to moderate inflammatory and non-inflammatory acne vulgaris.</p>', '<p>Isotretinoin produces its effects through altering progress through the cell cycle, cell differentiation, survival, and apoptosis. These actions reduce sebum production, preventing the blockage of pores, and growth of acne causing bacteria. Isotretinoin and 4-oxo-isotretinoin both significantly reduce the production of sebum. Isotretinoin has little to no affinity for retinol binding proteins (RBPs) and retinoic acid nuclear receptors (RARs). Tretinoin and 4-oxo-tretinion bind to the RAR-&gamma; receptor, which is suspected to be part of the action of acne treatment by isotretinoin. Isotretinoin induces apoptosis in sebocytes, leading to a decrease in sebum production. Isotretinoin also reduces the formation of comedones by reducing hyperkeratinization through an unknown mechanism. Isotretinoin does not directly kill bacteria but it does reduce the size of sebum ducts and makes the microenvironment less hospitable to acne causing bacteria. It may also increase immune mechanisms and alter chemotaxis of monocytes to reduce inflammation.</p>', '<p>Apply Isotretinoin 0.05% gel cautiously over the affected area once or twice daily. Patients should be advised that 6-8 weeks of treatment may be required before a therapeutic effect is observed. The safety and efficacy of Isotretinoin have not been established in children since acne vulgaris rarely present in this age group. There are no specific recommendations for use in the elderly. Acne vulgaris does not present in the elderly.</p>', '<p>Concomitant topical medication should be used with caution during therapy with Isotretinoin. Particular caution should be exercised when using preparations containing a peeling agent (for example Benzoyl Peroxide) or abrasive cleansers.</p>', '<p>Isotretinoin 0.05% gel is contra-indicated in patients with known hypersensitivity to Isotretinoin.</p>', '<p>In normal use, Isotretinoin may cause stinging, burning or irritation; erythema and&nbsp;peeling at the site of application may occur. If undue irritation occurs, treatment should be&nbsp;interrupted temporarily and resumed once the reaction subsides. If irritation persists, treatment&nbsp;should be discontinued. Reactions will normally resolve on discontinuation of therapy.</p>', '<p>Pregnancy Category B. There is inadequate evidence of the safety of topically applied Isotretinoin in human pregnancy. Isotretinoin has been associated with teratogenicity in humans when administered systemically. Reproduction studies conducted in rabbits using Isotretinoin applied topically at up to 60 times the human dose have, however, revealed no harm to the foetus. The use of Isotretinoin should be avoided during pregnancy. Percutaneous absorption of Isotretinoin from Isotretinoin 0.05% gel is negligible. It is not known, however, whether Isotretinoin is excreted in human milk. Isotretinoin should not be used during lactation.</p>', '<p>Contact with the mouth, eyes and mucous membranes and with abraded&nbsp;or eczematous skin should be avoided. Care should be taken not to let the medication&nbsp;accumulate in skin fold areas and in the angles of the nose. Application to sensitive areas of skin,&nbsp;such as the neck, should be made with caution. Although Tretinoin has not been shown to initiate&nbsp;or promote carcinogenesis in humans, Tretinoin applied topically to albino hairless mice had&nbsp;resulted in a dose-related acceleration in ultraviolet-B radiation induced cutaneous tumours. The&nbsp;same author also observed the opposite effect in another study of low, non-irritating&nbsp;concentrations of Tretinoin. The significance of these findings as related to man is unknown;&nbsp;however, caution should be observed in patients with a personal or family history of cutaneous&nbsp;epithelioma. Exposure to sunlight of areas treated with Isotretinoin should be avoided or&nbsp;minimised. When exposure to strong sunlight cannot be avoided a sunscreen product and&nbsp;protective clothing should be used. Patients with sunburn should not use Isotretinoin due to the&nbsp;possibility of increased sensitivity to sunlight. The use of sunlamps should be avoided during&nbsp;treatment.</p>', '<p>Acute overdosage of Isotretinoin has not been reported to date. Accidental ingestion&nbsp;of Isotretinoin resulting in overdosage of Isotretinoin could be expected to induce symptoms of&nbsp;hypervitaminosis A. These include severe headaches, nausea or vomiting, drowsiness, irritability&nbsp;and pruritus.</p>\r\n\r\n<p>&nbsp;</p>', '<p>Topical retinoid and related preparations</p>', '<p>Store in a cool and dry place, protected from light.</p>', NULL, '2022-03-07 21:07:26', '2022-03-07 21:07:26'),
(789, 789, '<p>This is indicated in constipation.</p>', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '<p>Bulk-forming laxatives</p>', NULL, NULL, '2022-03-07 21:08:38', '2022-03-07 21:08:38'),
(790, 790, '<p>Isradipine is indicated in the management of hypertension. It may be used alone or concurrently with thiazide-type diuretics.</p>', '<p>Isradipine is a dihydropyridine Calcium&nbsp;channel blocker. It prevents Ca++&nbsp;ions from entering the slow channels or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarisation, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation.</p>', '<p><strong>Adult</strong>: Initially, 2.5 mg bid, increase if necessary after 3-4 wk to 5 mg bid, or 10 mg bid as required.<br />\r\n<strong>Elderly</strong>: Initially, 1.25 mg bid. Maintenance: 2.5 or 5 mg once daily.<br />\r\n<strong>Hepatic Impairment</strong>: Initially 1.25 mg bid. Maintenance: 2.5 or 5 mg once daily.<br />\r\n<br />\r\nMay be taken with or without food.</p>', '<p>Concurrent admin with enzyme-inducing drugs (e.g. rifampicin, phenobarbital, carbamazepine) reduced plasma concentrations of isradipine. Increased bioavailability with cimetidine. May increase serum levels with CYP3A4 inhibitors (e.g. macrolides, HIV protease inhibitors, azole antifungals, delavirdine).</p>', '<p>Cardiogenic shock, within 1 mth of MI, unstable angina, treatment of hypertensive crisis.</p>\r\n\r\n<p>&nbsp;</p>', '<p>Headache, dizziness, palpitations, tachycardia, peripheral oedema, flushing, dyspnoea, abdominal discomfort, rash, pruritus, polyuria, fatigue, malaise.</p>', '<p>Pregnancy&nbsp;Category C.&nbsp;Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus</p>', '<p>Patients with CHF, severe aortic stenosis, hypertrophic cardiomyopathy with outflow tract obstruction. Hepatic impairment. Pregnancy and lactation.</p>', '<p><strong>Symptoms:</strong>&nbsp;Excessive peripheral vasodilation with subsequent marked and prolonged systemic hypotension and tachycardia.<br />\r\n<br />\r\n<strong>Management:</strong>&nbsp;Symptomatic and supportive treatment. Emesis, gastric lavage, admin of activated charcoal followed in 30 min by a saline cathartic. A vasoconstrictor (e.g. epinephrine) may be useful in restoring normotensive state. Refractory hypotension or AV conduction disturbances may be treated with IV Ca salts or glucagon.</p>', '<p>Calcium-channel blockers.</p>', '<p>Store below 30&deg; C.</p>', NULL, '2022-03-07 21:11:28', '2022-03-07 21:11:28'),
(791, 791, '<p>Itraconazole is indicated in-</p>\r\n\r\n<ul>\r\n	<li>Tinea corporis, Tinea cruris, Tinea pedis, Tinea manus,</li>\r\n	<li>Vulvovaginal candidiasis,</li>\r\n	<li>Fungal keratitis,</li>\r\n	<li>Pityriasis versicolor,</li>\r\n	<li>Oropharyngeal candidiasis,</li>\r\n	<li>Onychomycosis,</li>\r\n	<li>Histoplasmosis,</li>\r\n	<li>Systemic Infections: (Aspergillosis, Candidiasis and Cryptococcus when other drugs are effective)</li>\r\n	<li>Antifungal prophylaxis: To prevent systemic fungal infection in severely neutropenic patients.</li>\r\n</ul>', '<p>Itraconazole is an orally active triazole antifungal agent, having broad-spectrum activity and a favourable pharmacokinetic profile. Itraconazole inhibits cytochrome p-450 dependent enzymes resulting in impairment of the biosynthesis of ergoesterol, a major component of the cell membrane of yeast and fungal cells.</p>', '<p><strong>Tinea corporis, Tinea cruris</strong>: 100 mg daily for 2 weeks.<br />\r\n<br />\r\n<strong>Tinea pedis, Tinea manus</strong>: 100 mg daily for 4 weeks.<br />\r\n<br />\r\n<strong>Vulvovaginal candidiasis</strong>: 200 mg twice daily for 1 day or 200 mg daily for 3 days.<br />\r\n<br />\r\n<strong>Fungal keratitis</strong>: 200 mg daily for 3 weeks.<br />\r\n<br />\r\n<strong>Pityriasis versicolor</strong>: 200 mg daily for 1 week.<br />\r\n<br />\r\n<strong>Oropharyngeal candidiasis</strong>: 100 mg daily (200 mg for AIDS patients) for 15 days.<br />\r\n<br />\r\n<strong>Onychomycosis</strong>: 200 mg daily for 3 months; or 200 mg twice daily for 7 days (course), subsequent courses repeated after 21 day interval; fingernails 2 courses and toenails 3 courses.<br />\r\n<br />\r\n<strong>Histoplasmosis</strong>: 200 mg 1-2 times daily.<br />\r\n<br />\r\n<strong>Systemic Infections</strong>: (Aspergillosis, Candidiasis and Cryptococcus when other drugs are effective) 200 mg once daily, increased in invasive or in cryptococcal meningitis to 200 mg twice daily.<br />\r\n<br />\r\n<strong>Antifungal prophylaxis</strong>: To prevent systemic fungal infection in severely neutropenic patients: 100mg daily. Or as directed by the physician.</p>', '<p>Itraconazole inhibits the metabolism of Cyclosporine and Warfarin. Interaction with Terfenadine, Phenobarbitone, Midazolam has been reported.</p>', '<p>The drug is contraindicated in patients with a known history of hypersensitivity to it. The drug is also contraindicated in pregnant women and patients with known severe hepatic disease. It is also contraindicated with Rifampicin therapy.</p>', '<p>Nausea, abdominal pain, dyspepsia, constipation, headache, dizziness, raised liver enzymes, hepatitis, cholestatic jaundice, peripheral neuropathy have been reported.</p>', '<p>Not recommended during pregnancy &amp; lactation, unless otherwise indicated by the physician.</p>', '<p>Hepatic enzyme value should be monitored in patients with preexisting hepatic function abnormalities. It should also be done periodically in all patients receiving continuous treatment for more than one month or at any time a patients develops sign and symptoms suggestive liver dysfunction.</p>', '<p>There is no experience of overdosage with itraconazole.</p>', '<p>Drugs for subcutaneous and mycoses</p>', '<p>Store below 30&deg;C, away from light &amp; in a dry place. Keep out of the reach of children.</p>', '<p>The efficacy and safety of the Itraconazole capsule have not been established in pediatric patients.</p>', '2022-03-07 21:13:52', '2022-03-07 21:13:52'),
(792, 792, '<p>Symptomatic treatment of chronic stable angina pectoris in coronary artery disease patients with normal sinus rhythm. Ivabradine&nbsp;is indicated:</p>\r\n\r\n<ul>\r\n	<li>In patients unable to tolerate or with a contra-indication to the use of beta-blockers or</li>\r\n	<li>In combination with beta-blockers in patients inadequately controlled with an optimal beta-blocker dose and whose heart rate is &gt; 60 bpm.</li>\r\n</ul>', '<p>Ivabradine is a pure heart rate lowering agent. It acts by selective and specific inhibition of the cardiac pacemaker I f current that controls the spontaneous diastolic depolarization in the sinus node and regulates heart rate. By decreasing heart rate, Ivabradine decreases the cardiac workload and therefore oxygen consumption. Concomitantly, Ivabradine prolongs diastole allowing increased perfusion of coronary arteries and increased oxygen supply to the heart. The cardiac effects are specific to the sinus node with no effect on intra-atrial, atrioventricular or intraventricular conduction times, nor on myocardial contractility or ventricular repolarization.</p>', '<p><strong>Adult</strong>: The usual recommended starting dose of Ivabradine is 5 mg twice daily which may be increased after 3-4 weeks of treatment to 7.5 mg twice daily, depending on therapeutic response. Usual dose is 1 tablet in the morning and 1 tablet in the evening during meals. If the heart rate decreases persistently below 50 bpm at rest or if symptoms related to bradycardia, the dose must be adjusted downwards to 2.5 mg twice daily (one half of the 5 mg tablet twice daily). Treatment must be discontinued if heart rate remains below 50 bpm or symptoms of bradycardia persist.<br />\r\n<br />\r\n<strong>Elderly</strong>: Consider a lower starting dose (2.5 mg twice daily i.e. one half 5 mg tablet twice daily).</p>', '<p>QT wave prolonging medicinal products is not recommended. Cardiovascular QT wave prolonging medicinal products (e.g. quinidine, disopyramide, bepridil, sotalol, ibutilide, amiodarone). Non cardiovascular QT wave prolonging medicinal products (e.g. pimozide, ziprasidone, sertindole, mefloquine, halofantrine, pentamidine, cisapride, intravenous erythromycin). The concomitant use of cardiovascular and non cardiovascular QT wave prolonging medicinal products with ivabradine should be avoided since QT wave prolongation may be exacerbated by heart rate reduction. If the combination appears necessary, close cardiac monitoring is needed.</p>', '<p>History of hypersensitivity to Ivabradine or any of the excipients, resting heart rate below 60 bpm before treatment, cardiogenic shock, acute myocardial infarction, severe hypotension (&lt;90/50 mmHg), severe hepatic insufficiency, sick sinus syndrome, sino-atrial block, heart failure, pacemaker dependent, unstable angina, 3rd&nbsp;degree AV block, combination with strong cytochrome P-450 3A4 inhibitors (such as azole antifungals, macrolide antibiotics, HIV protease inhibitors).</p>', '<p>Visual symptoms, blurred vision, bradycardia, 1st degree AV block, ventricular extrasystoles, headaches, and dizziness.</p>', '<p>Studies in rats have shown no effect on fertility in males and females. There are no or limited amount of data from the use of ivabradine in pregnant women. Therefore, ivabradine is contra indicated during pregnancy. Animal studies indicate that ivabradine is excreted in milk. Therefore, ivabradine is contra-indicated during breast-feeding.</p>', '<p>Mild to moderate hypotension, atrial fibrillation, patients with congenital QT syndrome or treated with QT wave prolonging medicinal products, Moderate hepatic insufficiency, severe renal insufficiency.</p>', NULL, '<p>Other Anti-anginal &amp; Anti-ischaemic drugs</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', '<ul>\r\n	<li>Renal insufficiency: Use with caution in patients with creatinine clearance</li>\r\n	<li>Hepatic impairment: Use with caution in patients with moderate hepatic impairment; Contraindicated in severe hepatic impairment.</li>\r\n	<li>Children and adolescents: Not recommended.</li>\r\n</ul>', '2022-03-07 21:16:12', '2022-03-07 21:16:12'),
(793, 793, '<p><strong>Strongyloidiasis of the intestinal tract:</strong>&nbsp;Ivermectin is indicated for the treatment of intestinal (i.e., nondisseminated) strongyloidiasis due to the nematode parasite Strongyloides stercoralis. This indication is based on clinical studies of both comparative and open-label designs, in which 64-100% of infected patients were cured following a single 200-mcg/kg dose of ivermectin.<br />\r\n<br />\r\n<strong>Onchocerciasis</strong>: Ivermectin is indicated for the treatment of onchocerciasis due to the nematode parasite Onchocerca volvulus. This indication is based on randomized, double-blind, placebo-controlled and comparative studies conducted in 1427 patients in onchocerciasis-endemic areas of West Africa. The comparative studies used diethylcarbamazine citrate (DEC-C).</p>', '<p>Ivermectin selectively binds and with high affinity to glutamate-gated chloride ion channels, which occur in invertebrate nerve and muscle cells leading to an increase in the permeability of cell membranes to chloride ions with hyperpolarization of the nerve or muscle cell and, ultimately, death of the parasite.</p>', '<p><strong>For Treatment (If COVIO Positive)</strong>: 2 Tablets of Ivermectin 6 mg once daily for 5 days. (2+0+0 for 5 days).<br />\r\n<strong>For Prophylaxis</strong>: Single-dose as mentioned below to be taken on Day 1 &amp; same dose on Day 7.</p>\r\n\r\n<ul>\r\n	<li>Body Weight 15-24 kg: 1 Tablet of Ivermectin 3 mg</li>\r\n	<li>Body Weight 25-35 kg: 1 Tablet of Ivermectin 6 mg</li>\r\n	<li>Body Weight 36-50 kg: 1 Tablet of Ivermectin 6 mg + 1 Tablet of Ivermectin 3 mg</li>\r\n	<li>Body Weight 51-65 kg: 2 Tablets of Ivermectin 6 mg</li>\r\n	<li>Body Weight 66-79 kg: 2 Tablets of Ivermectin 6 mg + 1 Tablet of Ivermectin 3 mg</li>\r\n	<li>Body Weight &gt;80 kg: 3 Tablets of Ivermectin 6 mg</li>\r\n</ul>\r\n\r\n<p><br />\r\n<strong>Strongyloidiasis</strong>: The recommended dosage of Ivermectin for the treatment of strongyloidiasis is a single oral dose designed to provide approximately 200 mcg/kg of body weight. Patients should take tablets on an empty stomach with water. In general, additional doses are not necessary. However, follow-up stool examinations should be performed to verify eradication of infection.<br />\r\n<br />\r\nDosage Guidelines for Ivermectin for Strongyloidiasis:</p>\r\n\r\n<ul>\r\n	<li>Body Weight (kg) 15-24: Dose 3 mg/kg</li>\r\n	<li>Body Weight (kg) 25-35: Dose 6 mg/kg</li>\r\n	<li>Body Weight (kg) 36-50: Dose 9 mg/kg</li>\r\n	<li>Body Weight (kg) 51-65: Dose 12 mg/kg</li>\r\n	<li>Body Weight (kg) 66-79: Dose 15 mg/kg</li>\r\n	<li>Body Weight (kg) &gt;80: Dose 200 mcg/kg</li>\r\n</ul>\r\n\r\n<p><br />\r\n<strong>Onchocerciasis</strong>: The recommended dosage of Ivermectin is a single oral dose designed to provide approximately 150 mcg of Ivermectin per kg of body weight on an empty stomach with water, the most commonly used dose interval is 12 months. For the treatment of individual patients, retreatment may be considered at intervals as short as 3 months.<br />\r\n<br />\r\nDosage Guidelines for Ivermectin for Onchocerciasis:</p>\r\n\r\n<ul>\r\n	<li>Body Weight (kg) 15-25: Dose 3 mg/kg</li>\r\n	<li>Body Weight (kg) 26-44: Dose 6 mg/kg</li>\r\n	<li>Body Weight (kg) 45-64: Dose 9 mg/kg</li>\r\n	<li>Body Weight (kg) 65-84: Dose 12 mg/kg</li>\r\n	<li>Body Weight (kg) &gt;85: Dose 150 mcg/kg</li>\r\n</ul>', '<p>Post-marketing reports of increased INR (International Normalized Ratio) have been rarely reported when ivermectin was co-administered with warfarin.</p>', '<p>It is contraindicated in patients who are hypersensitive to any component of this product.</p>', '<p><strong>Strongyloidiasis</strong>: In four clinical studies involving a total of 109 patients given either one or two doses of 170 to 200 mcg/kg of Ivermectin, the following adverse reactions were reported as possibly, probably, or definitely related to Ivermectin.</p>\r\n\r\n<ul>\r\n	<li><strong>Body as a whole</strong>: asthenia/fatigue (0.9%), abdominal pain (0.9%)</li>\r\n	<li><strong>Gastrointestinal</strong>: anorexia (0.9%), constipation (0.9%), diarrhea (1.8%), nausea (1.8%), vomiting (0.9%) Nervous System/Psychiatric: dizziness (2.8%), somnolence (0.9%), vertigo (0.9%), tremor (0.9%)</li>\r\n	<li><strong>Skin</strong>: pruritus (2.8%), rash (0.9%), and urticaria (0.9%).</li>\r\n</ul>\r\n\r\n<p><strong>Onchocerciasis</strong>: arthralgia/synovitis (19.3%), axillary lymph node enlargement and tenderness (11.0% and 4.4%, respectively), cervical lymph node enlargement and tenderness (5.3% and 1.2%, respectively), inguinal lymph node enlargement and tenderness (12.6% and 13.9%, respectively), other lymph node enlargement and tenderness (3.0% and 1.9%, respectively), pruritus (27.5%), skin involvement including edema, papular and pustular or frank urticarial rash (22.7%), and fever (22.6%), abnormal sensation in the eyes, eyelid edema, anterior uveitis, conjunctivitis, limbitis, keratitis, and chorioretinitis or choroiditis. These have rarely been severe or associated with loss of vision and have generally resolved without corticosteroid treatment. The following adverse reactions have been reported since the drug was registered overseas: hypotension (mainly orthostatic hypotension), worsening of bronchial asthma, toxic epidermal necrolysis, and Stevens-Johnson syndrome.</p>', '<p>Pregnancy Category C. Ivermectin does not appear to be selectively fetotoxic to the developing fetus. There are, however, no adequate and well-controlled studies in pregnant women. Ivermectin should not be used during pregnancy since safety in pregnancy has not been established.<br />\r\n<br />\r\nNursing Mothers: Ivermectin is excreted in human milk in low concentrations. Treatment of mothers who intend to breast feed should only be undertaken when the risk of delayed treatment to the mother outweighs the possible risk to the newborn.</p>', '<p>Historical data have shown that microfilaricidal drugs, such as diethylcarbamazine citrate (DEC-C), might cause cutaneous and/or systemic reactions of varying severity (the Mazzotti reaction) and ophthalmological reactions in patients with onchocerciasis. These reactions are probably due to allergic and inflammatory responses to the death of microfilariae. Patients treated with Ivermectin for onchocerciasis may experience these reactions in addition to clinical adverse reactions possibly, probably, or definitely related to the drug itself. The treatment of severe Mazzotti reactions has not been subjected to controlled clinical trials. Oral hydration, recumbency, intravenous normal saline, and/or parenteral corticosteroids have been used to treat postural hypotension. Antihistamines and/or aspirin have been used for most mild to moderate cases. After treatment with microfilaricidal drugs, patients with hyperreactive onchodermatitis (sowda) may be more likely than others to experience severe adverse reactions, especially edema and aggravation of onchodermatitis. Rarely, patients with onchocerciasis who are also heavily infected with Loa loa may develop a serious or even fatal encephalopathy either spontaneously or following treatment with an effective microfilaricide. In these patients, the following adverse experiences have also been reported: back pain, conjunctival hemorrhage, dyspnea, urinary and/or fecal incontinence, difficulty in standing/walking, mental status changes, confusion, lethargy, stupor, or coma.</p>', NULL, '<p>Anthelmintic</p>', '<p>Keep in a dry place, below 30&deg;C. Protect from light. Keep out of the reach of children.</p>', '<p><strong>Pediatric Use</strong>: Safety and effectiveness in pediatric patients weighing less than 15 kg have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Clinical studies of Ivermectin did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.</p>', '2022-03-07 21:18:52', '2022-03-07 21:18:52');
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
(794, 794, '<p>Ivermectin is indicated for topical treatment of head lice infestations in patients 6 months of age and older.</p>', '<p>Ivermectin, a member of the avermectin class, causes death of parasites, primarily through binding selectively and with high affinity to glutamate-gated chloride channels, which occur in invertebrate nerve and muscle cells. This leads to an increase in the permeability of the cell membrane to chloride ions with hyperpolarization of the nerve or muscle cell, resulting in paralysis and death of the parasite. Compounds of this class may also interact with other ligandgated chloride channels, such as those gated by the neurotransmitter gamma-aminobutyric acid (GABA). The selective activity of compounds of this class is attributable to the fact that some mammals do not have glutamate-gated chloride channels, the avermectins have a low affinity for mammalian ligand-gated chloride channels, and Ivermectin does not readily cross the blood-brain barrier in humans.</p>', '<p>Only for topical use in scalp &amp; scalp hair. It is not for oral, ophthalmic or intravaginal use. Apply the Lotion to dry hair in an amount sufficient (up to 1 tube) to thoroughly coat the hair and scalp. After 10 minutes, rinse off with water. The tube is intended for single use. Discard any unused portion. Contact with eyes should be avoided</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>Your hair and scalp must be completely dry before applying Ivermectin Lotion</li>\r\n	<li>Apply Ivermectin Lotion directly to dry hair and scalp.</li>\r\n	<li>Completely cover your scalp and hair closest to the scalp first, and then apply outwards towards the ends of your hair.</li>\r\n	<li>Rub Ivermectin Lotion throughout your hair.</li>\r\n	<li>It is important to completely cover your entire head so that all lice and eggs are exposed to the lotion. Be sure that each hair is coated from the scalp to the tip.</li>\r\n	<li>Use sufficient quantities to completely cover hair and scalp.</li>\r\n	<li>Allow Ivermectin Lotion to stay on your hair and scalp for 10 minutes after it has been applied. Start timing after you have completely covered your hair and scalp with Ivermectin Lotion.</li>\r\n	<li>After 10 minutes, completely rinse Ivermectin Lotion from your hair and scalp using water only.</li>\r\n	<li>After application of Ivermectin Lotion, you or anyone who helps you to apply the lotion should wash hands properly</li>\r\n</ul>', NULL, NULL, '<p>Common side effects are-</p>\r\n\r\n<ul>\r\n	<li>Conjunctivitis</li>\r\n	<li>Ocular hyperemia</li>\r\n	<li>Eye irritation</li>\r\n	<li>Dandruff</li>\r\n	<li>Dry skin</li>\r\n	<li>Skin burning sensation etc.</li>\r\n</ul>', '<p>Pregnancy Category C. There are no adequate and well-controlled studies with Ivermectin Lotion in pregnant women. Ivermectin Lotion should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Following oral administration, Ivermectin is excreted in human milk in low concentrations. This has not been evaluated following topical administration. Caution should be exercised when Ivermectin Lotion is administered to a nursing woman.</p>', '<p>Accidental ingestion in pediatric patients may occur administer only under direct adult supervision.<br />\r\n<br />\r\nTips to prevent the spreading of lice:</p>\r\n\r\n<ul>\r\n	<li>Avoid direct head-to-head contact with anyone known to have live, crawling lice.</li>\r\n	<li>Do not share combs, brushes, hats, scarves, bandannas, ribbons, hair bands, towels, helmets, or other hair-related personal items with anyone else, whether they have lice or not.</li>\r\n	<li>After finishing treatment with anti-lice medicine, check everyone in your family for lice after one week. Be sure to talk to your healthcare provider about treatments for those who have lice.</li>\r\n</ul>', NULL, '<p>Miscellaneous topical agents.</p>', '<p>Keep away from light &amp; wet place. Keep out of reach of children.</p>', NULL, '2022-03-07 21:20:55', '2022-03-07 21:20:55'),
(795, 795, '<p>Kanamycin is in a group of drugs called aminoglycosides. It fights bacteria in the body. Kanamycin is used to treat serious infections caused by bacteria. Kanamycin may also be used for other purposes not listed in this medication guide.</p>', NULL, NULL, NULL, NULL, NULL, NULL, NULL, NULL, '<p>Ophthalmic antibacterial drugs</p>', NULL, NULL, '2022-03-07 21:22:59', '2022-03-07 21:22:59'),
(796, 796, '<p>Ketamine is recommended for:</p>\r\n\r\n<ul>\r\n	<li>As the sole anesthetic agent for diagnostic and surgical procedures that do not require skeletal muscle relaxation. Ketamine is best suited for short procedures and it can be used with additional doses, for longer procedures.</li>\r\n	<li>For the induction of anesthesia prior to the administration of other general anesthetic agents.</li>\r\n	<li>To supplement low-potency agents, such as nitrous oxide.&nbsp;</li>\r\n</ul>', '<p>Ketamine is a noncompetitive N-methyl-D-aspartate receptor antagonist that blocks glutamate. It has a direct action on the cortex and limbic system. It produces a cataleptic-like state wherein the patient is withdrawn from the surrounding environment.</p>', '<p><strong>Adult:</strong><br />\r\nGeneral Anesthesia-</p>\r\n\r\n<ul>\r\n	<li>IV Induction: 1-4.5 mg/kg single dose</li>\r\n	<li>IM Induction: 6.5-13mg</li>\r\n	<li>IV Infusion: 1-2mg/kg at 0.5mg/kg/min</li>\r\n</ul>\r\n\r\n<p><strong>Maintenance:</strong>&nbsp;The maintenance dose should be adjusted according to the patient&#39;s anesthetic needs and whether an additional anesthetic is employed. Increments of one-half to the full induction dose may be repeated as needed for maintenance of anesthesia.<br />\r\n<br />\r\nRapid sequence Intubation, Induction - 2mg/kg IV<br />\r\n<br />\r\n<strong>Pediatric:</strong><br />\r\nGeneral Anesthesia:</p>\r\n\r\n<ul>\r\n	<li>IV Induction: 1-2 mg/kg IV; range: 4-13 mg/kg</li>\r\n	<li>IM Induction: 5-10 mg/kg; range: 0.5-4.5 mg/kg</li>\r\n	<li>Maintenance: 0.01-0.03 mg/kg/min continuous IV infusion</li>\r\n</ul>\r\n\r\n<p><strong>Maintenance:</strong>&nbsp;The maintenance dose should be adjusted according to the patient&#39;s anesthetic needs and whether an additional anesthetic is employed. Increments of one-half to the full induction dose may be repeated as needed for maintenance of anesthesia.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p><strong>Rate of Administration:</strong>&nbsp;It is recommended that ketamine should be administered slowly (over a period of 60 seconds). More rapid administration may result in respiratory depression and enhanced pressor response.<br />\r\n<br />\r\nThe 100 mg/ml concentration of ketamine should not be injected intravenously without proper dilution. It is recommended the drug be diluted with an equal volume of either Sterile Water for Injection, USP, Normal Saline, or 5% Dextrose in Water.</p>', '<p>Prolonged recovery time with barbiturates or narcotics. May potentiate neuromuscular blocking effects of atracurium and tubocurarine including resp depression with apnoea. May increase risk of bradycardia, hypotension or decreased cardiac output with halogenated anaesthetics. May potentiate CNS depression and risk of resp depression with CNS depressants (e.g. phenothiazines, sedating H1-blockers, skeletal muscle relaxants). May antagonise hypnotic effect of thiopental. May increase risk of HTN with thyroid hormones. May increase risk of hypotension with antihypertensive agents. Reduction in seizure threshold resulting in unpredictable extensor-type seizures when given concurrently with theophylline.</p>', '<p>CV disease including severe HTN; patients with increased intraocular or CSF pressure.</p>', '<p>Emergence reactions (e.g. vivid dreams, hallucinations, confusion, irrational behaviour); increased muscle tone sometimes resembling seizures; temporary HTN and tachycardia, hypotension, bradycardia, arrhythmias, apnoea, laryngospasm, resp depression, diplopia, nystagmus, nausea, vomiting, lacrimation, hypersalivation, raised intraocular and CSF pressure, transient rash and pain at inj site, cystitis.</p>', '<p><strong>Pregnancy:</strong>&nbsp;The safe use of ketamine in pregnancy has not been established, and such use is not recommended.<br />\r\n<br />\r\n<strong>Lactation:</strong>&nbsp;Ketamine is likely to be excreted in breast milk and therefore breastfeeding should be discontinued when ketamine is in use.</p>', '<p>Patient with cardiac decompensation, chronic alcoholic or acutely alcohol-intoxicated patients, pre-anaesth elevated CSF pressure, globe injuries, increased intraocular pressure (e.g. glaucoma), neurotic traits or psychiatric illness (e.g. schizophrenia, acute psychosis), acute intermittent porphyria, seizures, hyperthyroidism, pulmonary or upper resp infection, intracranial mass lesions, head injury, or hydrocephalus, hypovolaemia, dehydration, cardiac disease esp coronary artery disease (e.g. CHF, myocardial ischaemia, MI). Pregnancy and lactation.</p>', '<p><strong>Symptoms:</strong>&nbsp;Resp depression.<br />\r\n<strong>Management</strong>: Employ supportive ventilation. Mechanical support of respiration is preferred to admin of analeptics.</p>', '<p>General (Intravenous) anesthetics.</p>', '<p>Store between 20-25&deg; C.</p>', NULL, '2022-03-07 21:25:35', '2022-03-07 21:25:35'),
(797, 797, '<p>Ketoconazole 2% cream is used for topical application in the treatment of dermatophyte infections of the skin such as tinea corporis, tinea cruris (dhobie itch), tinea manus and tinea pedis (athlete&rsquo;s foot) infections due to Trichophyton spp, Microsporon spp and Epidermophyton spp. Ketoconazole 2% cream is also indicated for the treatment of cutaneous candidosis (including vulvitis), candidal intertrigo (sweat rash), tinea (pityriasis) versicolor and seborrhoeic dermatitis caused by Malassezia (previously called Pityrosporum) spp.</p>', '<p>Ketoconazole interacts with 14-&alpha;-sterol demethylase, a cytochrome P-450 enzyme necessary for the conversion of lanosterol to ergosterol.&nbsp;This results in inhibition of ergosterol synthesis and increased fungal cellular permeability due to reduced amounts of ergosterol present in the fungal cell membrane. This metabolic inhibition also results in accumulation of 14&alpha;-methyl-3,6-diol, a toxic metabolite. The increase in membrane fluidity is also thought to produce impairment of membrane-bound enzyme systems as components become less closely packed.</p>', '<p><strong>Tinea pedis</strong>: Ketoconazole cream should be applied to the affected areas twice daily. The usual duration of treatment for mild infections is 1 week. For more severe or extensive infections (e.g. involving the sole or sides of the feet) treatment should be continued until a few days after all signs and symptoms have disappeared in order to prevent relapse.<br />\r\n<br />\r\n<strong>For other infections</strong>: Ketoconazole cream should be applied to the affected areas once or twice daily, depending on the severity of the infection. The treatment should be continued until a few days after the disappearance of all signs and symptoms. The usual duration of treatment is: tinea versicolor 2-3 weeks, tinea corporis 3-4 weeks. The diagnosis should be reconsidered if no clinical improvement is noted after 4 weeks. General measures in regard to hygiene should be observed to control sources of infection or reinfection. Seborrhoeic dermatitis is a chronic condition and relapse is highly likely.<br />\r\n<br />\r\n<strong>Administrations</strong>: For topical administration only.</p>', NULL, '<p>Ketoconazole 2% w/w cream is contra-indicated in patients with known&nbsp;hypersensitivity to Ketoconazole.</p>', '<p>Commonly observed adverse reactions to Ketoconazole cream in clinical trials were&nbsp;skin application site burning sensation, erythema and pruritus. Uncommon adverse reactions are&nbsp;application site bleeding, discomfort, dryness, inflammation, irritation, paraesthesia and&nbsp;reaction; bullous eruption, dermatitis contact, rash, skin exfoliation and sticky skin.</p>', '<p>There are no adequate and well-controlled studies in pregnant or lactating women. To date, no other relevant epidemiological data are available. Data on a limited number of exposed pregnancies indicate no adverse effects of topical Ketoconazole on pregnancy or on the health of the foetus/newborn child. Animal studies have shown reproductive toxicity following oral administration of Ketoconazole. No effects on the breastfed newborn/infant are anticipated.</p>', '<p>Not for ophthalmic use. If a potent topical corticosteroid has been used&nbsp;previously in the treatment of seborrhoeic dermatitis, a recovery period of 2 weeks should be&nbsp;allowed before using Ketoconazole 2% w/w cream, as an increased incidence of steroid induced&nbsp;skin sensitisation has been reported when no recovery period is allowed.</p>', '<p>Exaggerated topical application may lead to erythema, oedema and a burning&nbsp;sensation, which will disappear upon discontinuation of the treatment. If accidental ingestion of&nbsp;Ketoconazole 2% w/w cream occurs, no special measures have to be taken.</p>', '<p>Drugs for subcutaneous and mycoses.</p>', '<p>Keep below 25&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-07 21:27:40', '2022-03-07 21:27:40'),
(798, 798, '<p>ketoconazole 2% shampoo is indicated for the treatment and prophylaxis of infections in which the yeast Malassezia (previously called Pityrosporum) is involved, such as pityriasis versicolor (localized), seborrhoeic dermatitis and pityriasis capitis (dandruff).</p>', '<p>Ketoconazole 2% shampoo is a broad spectrum imidazole-dioxolane, synthetic antifungal agent which inhibits the in vitro growth of the following common dermatophytes and yeasts by altering the permeability of the cell membrane: dermatophytes: Trichophyton rubrum, T. mentagrophytes, T. tonsurans, Microsporum canis, M. audouini, M. gypseum and Epidermophyton floc-cosum; yeasts: Candida albicans, Malassezia ovale (Pityrosporum ovale) and C. tropicalis; and the organism responsible for tinea versicolor, Malassezia furfur (Pityrosporum orbiculare).</p>', '<p>The affected areas of the skin or the scalp should be washed with ketoconazole 2% shampoo, which should be left on the skin/scalp for 3 to 5 minutes before rinsing.<br />\r\nTreatment:</p>\r\n\r\n<ul>\r\n	<li><strong>Pityriasis versicolor</strong>: Once daily for 5 days.</li>\r\n	<li><strong>Seborrhoeic dermatitis and pityriasis capitis</strong>: Twice weekly for 2 to 4 weeks.</li>\r\n</ul>\r\n\r\n<p>Prophylaxis:</p>\r\n\r\n<ul>\r\n	<li><strong>Pityriasis versicolor</strong>: Once daily for 3 days during a single treatment course before the summer.</li>\r\n	<li><strong>Seborrhoeic dermatitis and pityriasis capitis</strong>: Once every 1 or 2 weeks</li>\r\n</ul>', '<p>No information was found for the Shampoo form of Ketoconazole.</p>', '<p>Contraindicated in patients with known hypersensitivity to ketoconazole.</p>', '<p>Topical treatment with ketoconazole shampoo 2% 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 ketoconazole shampoo 2%.</p>', '<p>Since ketoconazole is not absorbed through the skin after topical application, pregnancy and lactation are not a contraindication for the use of ketoconazole shampoo 2%.</p>', '<p>In patients who have been on prolonged treatment with topical corticosteroids, it is recommended that the steroid therapy be gradually withdrawn over a period of 2 to 3 weeks, while using ketoconazole shampoo 2%, to prevent any potential rebound effect. Increased hair shedding is often associated with seborrhoeic dermatitis and dandruff, and has been rarely reported with the use of ketoconazole shampoo 2%. Avoid contact with the eyes. If the shampoo should get into the eyes, they should be bathed with water.</p>', '<p>Not expected as ketoconazole shampoo 2% is intended for external use only. In the event of accidental ingestion, only supportive measures should be carried out. To avoid aspiration, emesis or gastric lavage should not be performed.</p>', '<p>Drugs for subcutaneous and mycoses</p>', '<p>Store in a cool and dry place, protected from light.</p>', NULL, '2022-03-07 21:29:49', '2022-03-07 21:29:49'),
(799, 799, '<p>Treatment of superficial and deep mycoses:</p>\r\n\r\n<ul>\r\n	<li>Infections of the skin, hair and nails by dermatophytes and/or yeasts (dermatomycosis, onychomycosis, perionyxis, pityriasis versicolor, chronic mucocutaneous candidiasis etc.) especially when topical treatment is difficult or not very effective, owing to involvement of large skin surfaces or to lesions affecting deeper dermal layers, nails and hairs</li>\r\n	<li>Yeast infection of the mouth (oral thrush, perleche) and the gastrointestinal tract</li>\r\n	<li>Vaginal candidiasis, especially chronic recurrent cases or cases responding poorly to topcial treatment</li>\r\n	<li>Systemic mycotic infections such as systemic candidiasis, paracoccidioidomycosis, histoplasmosis, coccidioidomycosis etc.</li>\r\n</ul>\r\n\r\n<p>Maintenance treatment to prevent recurrence in systemic mycotic infections and in chronic mucocutaneous candidiasis.<br />\r\n<br />\r\nProphylactic treatment to prevent mycotic infection in patients with reduced host defenses, e.g., patients with cancer, organ transplant and burns.</p>', '<p>Ketoconazole interferes with biosynthesis of triglycerides and phopholipids by blocking fungal CYP450, thus altering cell membrane permeability in susceptible fungi. It also inhibits other fungal enzymes resulting in the accumulation of toxic concentrations of hydrogen peroxide.</p>', '<p><strong>Vaginal candidiasis</strong>: 1 tablet (200 mg) tablet twice daily for 5 days.<br />\r\n<br />\r\n<strong>All other indications</strong>: 1 tablet (200 mg) once daily until at least one week after the symptoms have disappeared and the cultures have become negative.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>Ketoconazole should be taken at meal times for maximal resorption. Because resorption depends on intact gastric activity, the concomitant treatment with agents that reduce gastric secretion (anticholinergic drugs, antacids, H2 blockers) should be avoided. When indicated, such drugs should be taken not earlier than two hours after ketoconazole. If clinical responsiveness is insufficient within the expected time, the dose of ketoconazole may be doubled (400 mg once daily).</p>', '<p>Reduced absorption with antimuscarinics, antacids, H2-blockers, PPIs and sucralfate. Reduced plasma concentrations with rifampicin, isoniazid, efavirenz, nevirapine, phenytoin. May also reduce concentrations of isoniazid and rifampicin. May reduce efficacy of oral contraceptives. May increase serum levels of CYP3A4 substrates e.g. digoxin, oral anticoagulants, sildenafil, tacrolimus.</p>', '<p>Ketoconazole is contraindicated in pregnancy and in patients with acute liver pathology.</p>', '<p>Ketoconazole is very well tolerated. Nausea and itching may occasionally occur. In some patients, an idosyncratic liver reaction may occur (incidence 1:10000).</p>', '<p>Pregnancy category C. There is no adequate and well controlled studies in pregnant women. Ketoconazole Tablets should not be used during pregnancy and lactation.</p>', '<p>In patients with a previous history of liver disease, liver enzyme levels should be monitored during treatment. When patients develop symptoms indicative of liver reaction, such as nausea or fatigue, accompanied with pale faeces, dark urine or jaundice, Ketoconazole therapy should be stopped immediately.</p>', NULL, '<p>Drugs for subcutaneous and mycoses</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-07 21:32:03', '2022-03-07 21:32:03'),
(800, 800, '<p>The indications of ketoprofen are based on its anti-inflammatory, analgesic and antipyretic properties. Ketoprofen is indicated for symptomatic treatment of:</p>\r\n\r\n<ul>\r\n	<li>Rheumatoid arthritis</li>\r\n	<li>Degenerative joint diseases</li>\r\n	<li>Musculoskeletal and joint disorders such as tendinitis, sprain</li>\r\n	<li>Pain, regardless of the origin, such as dental pain, headache and primary dysmenorrhea.</li>\r\n</ul>', '<p>Ketoprofen is a non-steroidal anti-inflammatory drug (NSAID) with analgesic and antipyretic actions. In addition to the inhibition of prostaglandin synthesis, it stabilizes lysosomal membranes in vitro and in vivo, inhibits leukotriene synthesis in vitro at high concentrations, and also exhibits antibradykinin activity in vivo. Ketoprofen produces analgesia by inhibiting the synthesis of prostaglandins peripherally and centrally. It has also been suggested that Ketoprofen causes the suppression of prostaglandin synthesis in the CNS (probably in the hypothalamus) leading to its antipyretic effect.<br />\r\n<br />\r\nKetoprofen is rapidly and almost completely absorbed from the GI tract. It is approximately 99% bound to plasma protein, mainly albumin. Following single or multiple oral doses in healthy adults, the elimination half-life of the drug has averaged 1.1-4 hours. It is rapidly and extensively metabolized in the liver, principally via conjugation with glucoronic acid. Following a single oral dose of Ketoprofen in healthy adults, about 50-90% of the drug is excreted in urine and about 1-8% in faeces within 1-5 days ; most urinary excretion occurs within 12-24 hours and most faecal excretion occurs within 24-48 hours. In case of IM injection, peak concentration of approximately 10 mg/L is reached at about 0.5-0.75 hour after a 100 mg dose. The elimination half-life is approximately 1.88 hour.</p>', '<p><strong>Anti-inflammatory dosage</strong>: The recommended starting dose is 150 to 300 mg/day in 3 divided doses. Once the maintenance dosage has been established (usually 100 to 200 mg/day), the patient may be tried on a twice daily dose regimen. Alternatively, switching to the once daily form at the same dosage may be considered. The recommended maximum daily dose is 300 mg.<br />\r\n<br />\r\n<strong>Management of pain and primary dysmenorrhea</strong>: The usual recommended dose is 25 to 50 mg, every 6 to 8 hours as necessary. The total daily dose should not exceed 300 mg.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>The oral forms should be taken with fluids, preferably with food.</p>', '<p>Not recommended drug associations Other NSAIDs (including cyclooxygenase-2 selective inhibitors) and high dose salicylates: Increased risk of gastrointestinal ulceration and bleeding. Anticoagulants Increased risk of bleeding.</p>\r\n\r\n<ul>\r\n	<li>Heparin</li>\r\n	<li>Vitamin K antagonists (such as warfarin)</li>\r\n	<li>Platelet aggregation inhibitors (such as ticlopidine, clopidogrel)</li>\r\n	<li>Thrombin inhibitors (such as dabigatran)</li>\r\n	<li>Direct factor Xa inhibitors (such as apixaban, rivaroxaban, edoxaban)</li>\r\n</ul>\r\n\r\n<p>If coadministration is unavoidable, patient should be closely monitored.</p>\r\n\r\n<ul>\r\n	<li>Lithium: Risk of elevation of lithium plasma levels, sometimes reaching toxic levels due to decreased lithium renal excretion. Where necessary, plasma lithium levels should be closely monitored and the lithium dosage levels adjusted during and after NSAID therapy.</li>\r\n	<li>Methotrexate at doses greater than 15mg/week: Increased risk of haematologic toxicity of methotrexate, particularly if administered at high doses (&gt;15 mg/week), possibly related to displacement of protein-bound methotrexate and to its decreased renal clearance.</li>\r\n	<li>Drug associations requiring precautions for use Medicinal products and therapeutic categories that can promote hyperkalemia (i.e. potassium salts, potassium-sparing diuretics, ACE inhibitors and angiotensin II antagonists, NSAIDs, heparins (low molecular-weight or unfractioned), cyclosporin, tacrolimus and trimethoprim): The risk of hyperkalemia can be enhanced when the drugs mentioned above are administered concomitantly.</li>\r\n	<li>Corticosteroids: increased risk of gastrointestinal ulceration or bleeding.</li>\r\n	<li>Diuretics: Patients and particularly dehydrated patients taking diuretics are at a greater risk of developing renal failure secondary to a decrease in renal blood flow caused by prostaglandin inhibition. Such patients should be rehydrated before initiating co-administration therapy and renal function monitored when the treatment is started.</li>\r\n	<li>ACE inhibitors and Angiotensin II Antagonists: In patients with compromised renal function (e.g. dehydrated patients or elderly patients the co-administration of an ACE inhibitor or Angiotensin II antagonist and agents that inhibit cyclooxygenase may result in further deterioration of renal function, including possible acute renal failure.</li>\r\n	<li>Nicorandil: In patients concomitantly receiving nicorandil and NSAIDs, there is an increased risk for severe complications such as gastrointestinal ulceration, perforation and hemorrhage.</li>\r\n	<li>Cardiac glycosides: A pharmacokinetic interaction between ketoprofen and digoxin has not been demonstrated. However, caution is advised, in particular in patients with renal impairment, since NSAIDs may reduce renal function and decrease renal clearance of cardiac glycosides.</li>\r\n	<li>Cyclosporin: Increased risk of nephrotoxicity.</li>\r\n	<li>Tacrolimus: Increased risk of nephrotoxicity.</li>\r\n	<li>Methotrexate at doses lower than 15mg/week: During the first weeks of combination treatment, full blood count should be monitored weekly. If there is any alteration of the renal function or if the patient is elderly, monitoring should be done more frequently.</li>\r\n	<li>Pentoxifylline: There is an increased risk of bleeding. More frequent clinical monitoring and monitoring of bleeding time is required.</li>\r\n	<li>Tenofovir: Concomitant administration of tenofovir disoproxil fumarate and NSAIDs may increase the risk of renal failure.</li>\r\n	<li>Drug associations to be taken into account Antihypertensive agents (beta-blockers, angiotensin converting enzyme inhibitors, diuretics): Risk of decreased antihypertensive potency (inhibition of vasodilator prostaglandins by NSAIDs).</li>\r\n	<li>Thrombolytics: Increased risk of bleeding. Probenecid: Concomitant administration of probenecid may markedly reduce the plasma clearance of ketoprofen.</li>\r\n	<li>Selective serotonin reuptake inhibitors (SSRIs): increased risk of gastrointestinal bleeding.</li>\r\n</ul>', '<p>Ketoprofen is contraindicated in patients who have a history of hypersensitivity reactions such as asthmatic attacks or other allergic-type reactions to ketoprofen, ASA or other NSAIDs. Severe, rarely fatal, anaphylactic reactions have been reported in such patients. Ketoprofen is also contraindicated in the following cases:</p>\r\n\r\n<ul>\r\n	<li>Severe heart failure</li>\r\n	<li>Active or history of peptic ulcer/hemorrhage</li>\r\n	<li>History of gastrointestinal bleeding or perforation, related to previous NSAIDs therapy</li>\r\n	<li>Severe hepatic insufficiency</li>\r\n	<li>Severe renal insufficiency</li>\r\n	<li>Third trimester of pregnancy</li>\r\n	<li>Rectitis or history of proctorrhagia (rectal administration)</li>\r\n</ul>', '<ul>\r\n	<li>Blood and lymphatic system disorders- Rare: haemorrhagic anaemia; Unknown: agranulocytosis, thrombocytopenia, bone marrow failure, hemolytic anemia, leucopenia</li>\r\n	<li>Immune system disorders- Unknown: anaphylactic reactions (including shock) Psychiatric disorders; Unknown: depression, hallucinations, confusion, mood altered</li>\r\n	<li>Nervous system disorders- Uncommon: headache, dizziness, somnolence, Rare: paraesthesia; Unknown: aseptic meningitis, convulsions, dysgeusia, vertigo</li>\r\n	<li>Eye disorders- Rare: vision blurred</li>\r\n	<li>Ear and labyrinth disorders- Rare: tinnitus</li>\r\n	<li>Cardiac disorders- Unknown: exacerbation of heart failure, atrial fibrillation</li>\r\n	<li>Vascular disorders- Unknown: hypertension, vasodilatation, vasculitis (including leukocytoclastic vasculitis)</li>\r\n	<li>Respiratory, thoracic and mediastinal disorders- Rare: asthma; Unknown: bronchospasm (particularly in patients with known hypersensitivity to ASA and other NSAIDs)</li>\r\n	<li>Gastrointestinal disorders- Common: dyspepsia, nausea, abdominal pain, vomiting; Uncommon: constipation, diarrhoea, flatulence, gastritis; Rare: stomatitis, peptic ulcer; Unknown: exacerbation of colitis and Crohn&rsquo;s disease, gastrointestinal haemorrhage and perforation, pancreatitis</li>\r\n	<li>Hepatobiliary disorders- Rare: hepatitis, transaminases increased</li>\r\n	<li>Skin and subcutaneous disorders- Uncommon: rash, pruritis; Unknown: photosensitivity reaction, alopecia, urticaria, angioedema, bullous eruption including Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalized exanthematous pustulosis Renal and urinary disorders- Unknown: renal failure acute, tubulointerstitial nephritis, nephritic syndrome, renal function tests abnormal</li>\r\n	<li>General disorders and administration site conditions- Uncommon: oedema Metabolism and nutritional disorders; Unknown: hyponatremia, hyperkalemia Investigations; Rare: weight increased.</li>\r\n</ul>', '<p>During the first and second trimester: As the safety of ketoprofen in pregnant women has not been evaluated, the use of Ketoprofen&nbsp;during the first and second trimester of pregnancy should be avoided. During the third trimester of pregnancy: Prodenid is contraindicated during the last trimester of pregnancy. Ketoprofen is not recommended in nursing mothers.</p>', '<p>Oral Forms: NSAIDs should be given with care to patients with a history of gastrointestinal disease (ulcerative colitis, Crohn&rsquo;s disease) as their condition may be exacerbated. At the start of treatment, renal function must be carefully monitored in patients with heart failure, cirrhosis and nephrosis, in patients receiving diuretic therapy, in patients with chronic renal impairment, particularly if the patient is elderly. In these patients, administration of ketoprofen may induce a reduction in renal blood flow caused by prostaglandin inhibition and lead to renal decomposition.<br />\r\n<br />\r\nCaution is required in patients with a history of hypertension and/or mild to moderate congestive heart failure as fluid retention and oedema have been reported in association with NSAID therapy.<br />\r\n<br />\r\nIncreased risk of atrial fibrillation has been reported in association with the use of NSAIDs.Hyperkalemia may occur, especially in patients with underlying diabetes, renal failure, and/or concomitant treatment with hyperkalemia promoting agents. Potassium levels must be monitored under these circumstances.<br />\r\n<br />\r\nAs with other NSAIDs, in the presence of an infectious disease, it should be noted that the antiinflammatory, analgesic and the antipyretic properties of ketoprofen may mask the usual signs of infection progression such as fever.<br />\r\n<br />\r\nIn patients with abnormal liver function tests or with a history of liver disease, transaminase levels should be evaluated periodically, particularly during long-term therapy. Rare cases of jaundice and hepatitis have been described with ketoprofen.<br />\r\n<br />\r\nIf visual disturbances such a blurred vision occur, treatment should be discontinued. The use of NSAIDs may impair female fertility and is not recommended in women attempting to conceive. In women who have difficulties conceiving or who are undergoing investigation of infertility, withdrawal of the NSAID should be considered.</p>', '<p>Cases of overdose have been reported with doses up to 2.5 g of ketoprofen. In most instances, the symptoms observed have been benign and limited to lethargy, drowsiness, nausea, vomiting and epigastric pain. There are no specific antidotes to ketoprofen overdosages. In cases of suspected massive overdosages, a gastric lavage is recommended and symptomatic and supportive treatment should be instituted to compensate for dehydration, to monitor urinary excretion and to correct acidosis, if present. If renal failure is present, hemodialysis may be useful to remove circulating drug.</p>', '<p>Drugs for Osteoarthritis, Drugs used for Rheumatoid Arthritis, Non-steroidal Anti-inflammatory Drugs (NSAIDs)</p>', '<p>Protect from light. Store below 30&deg;C. Do not use later than the date of expiry. Keep all medicines out of the reach of children. To be dispensed only on the prescription of a registered physician.</p>', '<p><strong>Elderly</strong>: It is advisable to reduce the initial dosage and maintain such patients on the minimal effective dose.<br />\r\n<br />\r\n<strong>Hepatic impairment</strong>: These patients should be carefully monitored and kept at the minimal effective daily dosage.<br />\r\n<br />\r\n<strong>Renal impairment</strong>: It is advisable to reduce the initial dosage and maintain such patients on the minimal effective dose.</p>', '2022-03-07 21:34:43', '2022-03-07 21:34:43'),
(801, 801, '<p>For the symptomatic treatment of mild to moderate local pain associated with muscle and/or joints injuries, e.g. sport injuries.</p>', '<p>Ketoprofen is a non-steroidal anti-inflammatory drug (NSAID) with analgesic and antipyretic actions. In addition to the inhibition of prostaglandin synthesis, it stabilizes lysosomal membranes in vitro and in vivo, inhibits leukotriene synthesis in vitro at high concentrations, and also exhibits antibradykinin activity in vivo. Ketoprofen produces analgesia by inhibiting the synthesis of prostaglandins peripherally and centrally. It has also been suggested that Ketoprofen causes the suppression of prostaglandin synthesis in the CNS (probably in the hypothalamus) leading to its antipyretic effect.</p>', '<p><strong>Adults</strong>: The gel should be applied on to the painful or inflamed area two to three times daily. The amount of gel should be adjusted so that it covers the painful area. The total daily dose shall not exceed 15 grams per day. The length of treatment should not exceed one week. The gel should be massaged onto the skin for a few minutes.<br />\r\n<br />\r\n<strong>Children</strong>: The safety and efficacy of Ketoprofen&nbsp;gel in children have not been established.</p>', '<p>Interactions are unlikely as serum concentrations following topical administration are low.</p>', '<p>Ketoprofen gel must not be used in patients with:</p>\r\n\r\n<ul>\r\n	<li>Known hypersensitivity reactions, such as symptoms of asthma, allergic rhinitis or urticaria, to ketoprofen, fenofibrate, tiaprofenic acid, acetylsalicylic acid, or other non-steroidal anti-inflammatory agents.</li>\r\n	<li>History of hypersensitivity to any of the excipients.</li>\r\n	<li>History of photosensitivity reactions.</li>\r\n	<li>History of cutaneous reactions to ketoprofen, tiaprofenic acid, fenofibrate, UV blockers or perfumes.</li>\r\n</ul>\r\n\r\n<p>Ketoprofen gel must not be used on pathological skin changes such as eczema or acne; or in infected skin or open wounds. Do not use Ketoprofen&nbsp;gel if you cannot avoid sun exposure, even hazy sun, including UV light from solarium, during treatment and for 2 weeks after its discontinuation.</p>\r\n\r\n<p>&nbsp;</p>', '<p>Immune System disorders- Not known: Anaphylactic shock, angioedema, hypersensitivity reactions.<br />\r\n<br />\r\nGastrointestinal disorders- Although plasma levels after administration of Ketoprofen&nbsp;gel are much lower than those reached after oral administration, systemic gastrointestinal side effects (such as nausea, abdominal pain, vomiting, and flatulence) are possible under rare circumstances depending on the amount of gel applied and the application of the gel to a large area of skin. Uncommon: Nausea. Not known: Abdominal pain, vomiting, flatulence.<br />\r\n<br />\r\nSkin and Subcutaneous tissue disorders- Uncommon: Erythema, pruritus, eczema. Rare: Photosensitivity reactions, dermatitis bullous, urticaria. Localised skin reactions have been reported which may spread outside the application site. Not known: Burning sensations, Stevens-Johnson syndrome.<br />\r\n<br />\r\nRenal and Urinary disorders- Very rare: Worsening renal insufficiency.</p>', '<ul>\r\n	<li>During the first and second trimester: As the safety of ketoprofen in pregnant women has not been evaluated, the use of Ketoprofen&nbsp;during the first and second trimester of pregnancy should be avoided.</li>\r\n	<li>During the third trimester: During the third trimester of pregnancy, all prostaglandin synthetase inhibitors including ketoprofen may induce cardiopulmonary and renal toxicity in the fetus. At the end of the pregnancy, prolonged bleeding time in both mother and child may occur.</li>\r\n	<li>Ketoprofen is not recommended in nursing mothers.</li>\r\n</ul>', '<ul>\r\n	<li>The gel should be used with caution in patients with reduced heart, liver or renal function.</li>\r\n	<li>The gel must not be used with occlusive dressings.</li>\r\n	<li>The gel must not come into contact with mucous membranes of the eyes.</li>\r\n	<li>Serious skin reactions, such as Stevens-Johnson Syndrome (SJS), have been reported in association with the use of NSAIDs, including Ketoprofen&nbsp;Gel. Patients should be informed about the signs and symptoms of serious skin manifestations. Treatment should be discontinued at the first appearance of skin rash, mucosal lesions, or any other sign of hypersensitivity.</li>\r\n	<li>Treatment should be discontinued immediately upon development of any skin reaction, including cutaneous reactions after co-application of octocrylene -containing products.</li>\r\n	<li>Protect the treated region with clothing when outdoor, even in the absence of direct sun. This should be done during treatment with the product and for 2 weeks following its discontinuation to avoid the risk of photosensitization.</li>\r\n	<li>Careful and prolonged hand washing should be carried out after each use of the gel.</li>\r\n</ul>', '<p>Overdose is unlikely to be caused by topical administration. If accidentally ingested, the gel may cause systemic adverse effects depending on the amount ingested. However, if they occur, treatment should be symptomatic and supportive in accordance with overdosage of oral anti-inflammatory agents.</p>', '<p>Non-steroidal Anti-inflammatory Drugs (NSAIDs)</p>', '<p>To be stored below 25&deg;C. The tube should be closed after use. Keep all medicines out of the reach of children. Do not use later than the date of expiry. To be dispensed only on the prescription of a registered physician.</p>', NULL, '2022-03-07 21:37:11', '2022-03-07 21:37:11'),
(802, 802, '<p>Ketorolac Tromethamine is indicated for the short-term management of moderate to severe acute post-operative pain.</p>', '<p>Ketorolac Tromethamine is a potent analgesic of the non-steroidal anti-inflammatory drugs (NSAIDs). It acts by inhibiting the cyclooxygenase enzyme system and hence inhibits the prostaglandin synthesis. It demonstrates a minimal anti-inflammatory effect at its analgesic dose.</p>', '<p>Tablet-</p>\r\n\r\n<p>Recommended dose is 10 mg every 4-6 hours. It should be used short-term only (up to 7 days) and are not recommended for chronic use. Doses exceeding 40 mg/day is not recommended.<br />\r\n&nbsp;</p>\r\n\r\n<p>Injection-</p>\r\n\r\n<p>Ketorolac injection may be used as a single or multiple doses, on a regular or when necessary schedule for the management of moderately severe, acute pain that requires analgesia at the opioid level, usually in a postoperative setting. When administering Ketorolac injection, the IV bolus must be given over no less than 15 seconds. The IM administration should be given slowly and deeply into the muscle. The analgesic effect begins within 30 minutes with maximum effect in 1 to 2 hours after dosing IV or IM. Duration of analgesic effect is usually 4 to 6 hours.<br />\r\n<br />\r\nSingle-Dose Treatment-<br />\r\nIM Dosing (Adult):</p>\r\n\r\n<ul>\r\n	<li><strong>Patients &lt;65 years of age</strong>: One dose of 60 mg.</li>\r\n	<li><strong>Patients &gt;65 years of age, renally impaired and/or less than 50 kg of body weight</strong>: One dose of 30 mg.</li>\r\n</ul>\r\n\r\n<p>IV Dosing (Adult):</p>\r\n\r\n<ul>\r\n	<li><strong>Patients &lt;65 years of age</strong>: One dose of 30 mg.</li>\r\n	<li><strong>Patients &gt;65 years of age, renally impaired and/or less than 50 kg of body weight</strong>: One dose of 15 mg.</li>\r\n</ul>\r\n\r\n<p>IV or IM Dosing (2 to 16 years of age):</p>\r\n\r\n<ul>\r\n	<li><strong>IM Dosing</strong>: One dose of 1 mg/kg up to a maximum of 30 mg.</li>\r\n	<li><strong>IV Dosing</strong>: One dose of 0.5 mg/kg up to a maximum of 15 mg.</li>\r\n</ul>\r\n\r\n<p>Multiple-Dose Treatment (IV or IM)-</p>\r\n\r\n<ul>\r\n	<li><strong>Patients &lt;65 years of age</strong>: The recommended dose is 30 mg Ketorolac injection every 6 hours. The maximum daily dose should not exceed 120 mg. Patients &gt;65 years of age, renally impaired patients and patients less than 50 kg: The recommended dose is 15 mg Ketorolac injection every 6 hours. The maximum daily dose for these populations should not exceed 60 mg. For breakthrough pain, do not increase the dose or the frequency of Ketorolac Tromethamine.</li>\r\n	<li><strong>Conversion from Parenteral to Oral Therapy</strong>: Ketorolac tablets may be used either as monotherapy or as follow-on therapy to parenteral Ketorolac. When Ketorolac tablets are used as a follow-on therapy to parenteral Ketorolac, the total combined daily dose of ketorolac (oral + parenteral) should not exceed 120 mg in younger adult patients or 60 mg in elderly patients on the day the change of formulation is made. On subsequent days, oral dosing should not exceed the recommended daily maximum of 40 mg. Ketorolac IM should be replaced by Ketorolac tablet as soon as feasible. The total duration of combined parenteral and oral treatment should not exceed 5 days.</li>\r\n</ul>', '<p>Other NSAIDs or aspirin: Increase the side effects of ketorolac Tromethamine.<br />\r\nAnti-coagulants: Enhance anti-coagulant effect.<br />\r\nBeta Blocker: Reduce the anti-hypertensive effect .<br />\r\nACE Inhibitors: Increase the risk of renal impairment.<br />\r\nMethotrexate: Enhance the toxicity of methotrexate.</p>', '<p>Ketorolac is contraindicated in patients having hypersensitivity to this drug or other NSAIDs. It should not be used in children under 16 years of age. lt is also contraindicated as prophylactic analgesic before surgery.</p>', '<p>Commonly occurring side effects are nausea, vomiting, gastro-intestinal bleeding, melana, peptic ulcer, pancreatitis, anxiety, drowsiness, headache, excessive thirst, fatigue, bradycardia, hypertension, palpitation, chest pain, infertility in female and pulmonary edema.</p>', '<p>US FDA Pregnancy category of Ketorolac Tromethamine is C. So, Ketorolac Tromethamine should be avoided in pregnancy and lactation unless the potential benefits to the other outweigh the possible risks to the fetus.</p>', '<p>Caution should be exercised in patients over the age of 65 years. Caution should also be taken in patients with active or suspected peptic ulcer or gastrointestinal bleeding or asthma and liver dysfunction.</p>', NULL, '<p>Drugs used for Rheumatoid Arthritis, Non-Opioid Analgesics.</p>', '<p>Keep in a dry place away from light and heat. Keep out of the reach of children.</p>', NULL, '2022-03-07 21:39:10', '2022-03-07 21:39:10'),
(803, 803, '<p>Ketorolac Tromethamine is indicated for seasonal allergic conjunctivitis and for pain and inflammation in ocular surgery. It is also indicated for the treatment of postoperative inflammation in patients who have undergone cataract extraction.</p>', '<p>Ketorolac is a nonsteroidal anti-inflammatory drug (NSAID) chemically related to indomethacin and tolmetin. Ketorolac tromethamine is a racemic mixture of [-]S- and [+]R-enantiomeric forms, with the S-form having analgesic activity. Its antiinflammatory effects are believed to be due to inhibition of both cylooxygenase-1 (COX-1) and cylooxygenase-2 (COX-2) which leads to the inhibition of prostaglandin synthesis leading to decreased formation of precursors of prostaglandins and thromboxanes from arachidonic acid. The resultant reduction in prostaglandin synthesis and activity may be at least partially responsible for many of the adverse, as well as the therapeutic, effects of these medications. Analgesia is probably produced via a peripheral action in which blockade of pain impulse generation results from decreased prostaglandin activity. However, inhibition of the synthesis or actions of other substances that sensitize pain receptors to mechanical or chemical stimulation may also contribute to the analgesic effect. In terms of the ophthalmic applications of ketorolac - ocular administration of ketorolac reduces prostaglandin E2 levels in aqueous humor, secondary to inhibition of prostaglandin biosynthesis.</p>', '<p>For the treatment of relief of ocular itching due to seasonal allergic conjunctivitis, one drop (0.25 mg) four times a day. For the treatment of postoperative inflammation in patients who have undergone cataract extraction, one drop should be applied to the affected eye(s) four times daily beginning 24 hours after cataract surgery and continuing through the first 2 weeks of the postoperative period. It has been safely administered in conjunction with other ophthalmic medications such as antibiotics, beta blockers, carbonic anhydrase inhibitors, cycloplegics, and mydriatics.</p>', '<p>No information available.</p>', '<p>Contraindicated in patients with previously demonstrated hypersensitivity to any of the ingredients in the formulation.</p>', '<p>Transient stinging and burning on instillation, allergic reactions, corneal edema, iritis, ocular inflammation, ocular irritation, superficial keratitis and superficial ocular infections. Corneal infiltrates, corneal ulcer, eye dryness, headaches, and visual disturbance (blurry vision).</p>', '<p>Pregnancy Category C: There is no adequate and well-controlled studies in pregnant women. The drug should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. The use of drug during late pregnancy should be avoided.<br />\r\n<br />\r\nNursing Mothers: Caution should be exercised when ophthalmic solution is administered to a nursing woman.</p>', '<p>All topical nonsteroidal anti-inflammatory drugs (NSAIDs) may slow or delay healing. Topical corticosteroids are also known to slow or delay healing. Concomitant use of topical NSAIDS and topical steroids may increase the potential for healing problems. Use of topical NSAIDs may result in keratitis. In some susceptible patients, continued use of topical NSAIDs may result in epithelial breakdown, corneal thinning, corneal erosion, corneal ulceration or corneal perforation. These events may be sight threatening. Patients with evidence of corneal epithelial breakdown should immediately discontinue use of topical NSAIDs and should be closely monitored for corneal health.<br />\r\n<br />\r\nThere is the potential for cross-sensitivity to acetylsalicylic acid, phenylacetic acid derivatives, and other nonsteroidal anti inflammatory agents. Therefore, caution should be used when treating individuals who have previously exhibited sensitivities to these drugs. With some nonsteroidal antiinflammatory drugs, there exists the potential for increased bleeding time due to interference with thrombocyte aggregation. There have been reports that ocularly applied nonsteroidal anti-inflammatory drugs may cause increased bleeding of ocular tissues in conjunction with ocular surgery.</p>', NULL, '<p>Non opioid analgesics, Non-Opioid Analgesics.</p>', '<p>Store in a cool and dry place, away from light Keep out of reach of children.</p>', '<p><strong>Pediatric Use</strong>: Safety and efficacy in pediatric patients below the age of 3 have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: No overall differences in safety or effectiveness have been observed between elderly and younger patients.</p>', '2022-03-07 21:41:11', '2022-03-07 21:41:11');
