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
(1107, 1107, '<p>Tablet is indicated for treatment of moderate to severe pain like chronic cancer, arthritis, postoperative &amp; low back pain.<br />\r\n<br />\r\nInjection is indicated for the relief of moderate to severe pain. It is also indicated for pre-operative &amp; post-operative medication for support of anesthesia, for obstetrical analgesia and for relief of anxiety in patients with dyspnea associated with pulmonary edema secondary to acute left ventricular dysfunction.</p>', '<p>Oxymorphone is a full opioid agonist and is relatively selective for the mu-opioid receptor, although it can bind to other opioid receptors at higher doses. The principal therapeutic action of oxymorphone is analgesia. Like all full opioid agonists, there is no ceiling effect for analgesia with oxymorphone. Clinically, dosage is titrated to provide adequate analgesia and may be limited by adverse reactions, including respiratory and CNS depression.<br />\r\n<br />\r\nThe precise mechanism of the analgesic action is unknown. However, specific CNS opioid receptors for endogenous compounds with opioid-like activity have been identified throughout the brain and spinal cord and are thought to play a role in the analgesic effects of this drug.</p>', '<p><strong>Oxymorphone Tablet</strong>: This may be used as needed in the treatment of acute post-surgical pain with a dose of 5-10 mg every 4 hours. Administer Oxymorphone Tablet on an empty stomach at least one hour prior to or two hours after eating.<br />\r\n<br />\r\n<strong>Oxymorphone Injection</strong>:</p>\r\n\r\n<ul>\r\n	<li>Subcutaneous or Intramuscular Administration: Initially 1 mg to 1.5 mg, repeated every 4 to 6 hours as needed.</li>\r\n	<li>Intravenous: 0.5 mg initially. For analgesia during labor 0.5 mg to 1 mg intramuscularly is recommended.</li>\r\n</ul>\r\n\r\n<p><strong>Conversion from Oral Oxymorphone to Oxymorphone Injection</strong>: Given the absolute oral bioavailability of approximately 10%, patients receiving oral Oxymorphone may be converted to Oxymorphone Hydrochloride injection by administering one-tenth the patient&#39;s total daily oral Oxymorphone dose as Oxymorphone Hydrochloride injectable in four or six equally divided doses (e.g., total daily oral dose/ [10X4]). For example, approximately 1 mg of Oxymorphone Hydrochloride injectable IM every 6 hours (4 mg total IM dose) may be required to provide pain relief equivalent to a total daily dose of 40 mg oral Oxymorphone. As with any opioid drug product, it is necessary to adjust the dosing regimen for each patient individually taking into account the patient&#39;s prior analgesic treatment experience.</p>', '<p>Clinical drug interaction studies with Oxymorphone showed no induction of CYP450 3A4 or 2C9 enzyme activity indicating that no dose adjustment for CYP 3A4 or 2C9 mediated drug-drug interactions is required.</p>', '<ul>\r\n	<li>Significant respiratory depression</li>\r\n	<li>Acute or severe bronchial asthma or hypercarbia</li>\r\n	<li>Known or suspected paralytic ileus</li>\r\n	<li>Moderate and severe hepatic impairment</li>\r\n	<li>Hypersensitivity (e.g. anaphylaxis) to oxymorphone</li>\r\n</ul>', '<p><strong>General Disorders</strong>: Respiratory depression, Fatigue, Asthenia.<br />\r\n<strong>Metabolism and Nutrition Disorders</strong>: Anorexia.<br />\r\n<strong>Cardiac Disorders</strong>: Tachycardia, Bradycardia, Palpitations.<br />\r\n<strong>Eye Disorders</strong>: Miosis, Diplopia, Blurred vision.<br />\r\n<strong>Gastrointestinal Disorders</strong>: Vomiting, Constipation.<br />\r\n<strong>Psychiatric Disorders</strong>: Dysphoria, Euphoric mood, Nervousness, Restlessness, Insomnia, Agitation, Hallucination, Depression.<br />\r\n<strong>Vascular Disorders</strong>: Hypotension &amp; Flushing.</p>', '<p>Pregnancy Category C. The safety of using Oxymorphone in pregnancy has not been established with regard to possible adverse effects on fetal development. The use of Oxymorphone in pregnancy, in nursing mothers, or in women of child-bearing potential requires that the possible benefits of the drug be weighed against the possible hazards to the mother and the child.</p>', '<p>Do not stop abruptly; taper gradually to stop treatment. Use caution in patients with acute pancreatitis, Addison disease, benign prostatic hyperplasia, cardiac arrhythmias, central nervous system (CNS) depression, drug abuse or dependence, emotional lability, gallbladder disease, gastrointestinal (Gl) disorder, pseudomembranous colitis, Gl surgery, head injury, hypothyroidism or untreated myxedema, intracranial hypertension, brain tumor, toxic psychosis, urethral stricture, urinary tract surgery, seizures, acute alcoholism, delirium tremens, shock, cor pulmonale, chronic pulmonary disease, emphysema, kyphoscoliosis, severe obesity, renal or hepatic impairment, elderly or debilitated patients.<br />\r\n<br />\r\nAvoid alcohol. Reduce dosage if drug is coadministered with other CNS depressants. Thrombocytopenia purpura resulting in kidney failure or death has been reported when extended-release tablets are dissolved and injected IV. May obscure diagnosis of abdominal conditions.<br />\r\n<br />\r\nRisk of opioid addiction, abuse, and misuse, which can lead to overdose and death Assess each patient&#39;s risk prior to prescribing and monitor all patients regularly for the development of these behaviors or conditions Life-threatening respiratory depression, life-threatening, or fatal respiratory depression may occur<br />\r\n<br />\r\nMonitor for respiratory depression, especially during initiation or following a dose increase</p>', '<p><strong>Signs and Symptoms</strong>: Acute overdosage with Oxymorphone is characterized by respiratory depression, extreme somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, constricted pupils and sometimes bradycardia and hypotension.<br />\r\n<br />\r\n<strong>Treatment</strong>: In the treatment of Oxymorphone overdosage, primary attention should be given to the re-establishment of a patient airway and institution of assisted or controlled ventilation. Supportive measures (including oxygen and vasopressors) should be employed in the management of circulatory shock and pulmonary edema accompanying overdose as indicated. The opioid antagonist naloxone hydrochloride is a specific antidote against respiratory depression that may result from overdosage or unusual sensitivity to opioids including Oxymorphone</p>', '<p>Opioid analgesics</p>', '<p>Tablet: Store in a cool and dry place, protect from light.<br />\r\nInjection: Store at 25&deg;C, protect from light.</p>', '<p><strong>Pediatric use</strong>: Safety and effectiveness of Oxymorphone Hydrochloride tablet and injection in pediatric patients below the age of 18 years have not been established.<br />\r\n<br />\r\n<strong>Geriatric use</strong>: Oxymorphone Hydrochloride tablet and injection should be used with caution in elderly patients. These adverse events included dizziness, somnolence, confusion and nausea.</p>', '2022-03-11 06:26:51', '2022-03-11 06:26:51'),
(1108, 1108, '<p>Oxyphencyclimine is indicated for the treatment of peptic ulcer disease and the relief of smooth muscle spasms in gastrointestinal disorders.</p>', '<p>Oxyphencyclimine binds the muscarinic acetylcholine receptor. It may block all three types of muscarinic receptors including M-1 receptors in the CNS and ganglia, M-2 receptors in the heart (vagus) and M-3 receptors at the parasympathetic NEJ system. The muscarinic acetylcholine receptors mediate various cellular responses, including inhibition of adenylate cyclase, breakdown of phosphoinositides and modulation of potassium channels through the action of G proteins. Oxphencyclimine inhibits vagally mediated reflexes by antagonizing the action of acetylcholine. This in turn reduces the secretion of gastric acids in the stomach.</p>', '<p><strong>Adult</strong>: 10 mg twice daily orally.</p>', '<p>Enhanced effect with concurrent admin of other drugs with antimuscarinic properties and MAOIs. May affect absorption of other drugs. Antagonistic effect with parasympathomimetics.</p>', '<p>Closed-angle glaucoma; obstructive uropathy; GI obstruction, paralytic ileus, intestinal atony, ulcerative colitis; toxic megacolon; myasthenia gravis.</p>', '<p>Xerostomia, decreased sweating, urinary hesitancy and retention, blurred vision, cycloplegia, increased ocular tension, loss of taste, headache, nervousness, mental confusion, impotence, suppression of lactation, urticaria, constipation.</p>', '<p>Pregnancy category- Not classified.</p>', '<p>Elderly; autonomic neuropathy; hepatic or renal disease; hyperthyroidism, CHF, thyrotoxicosis, MI, tachyarrhythmias, hypertension, prostatic hypertrophy; hiatal hernia. May impair ability to drive or operate machinery. Pregnancy and lactation. Down&#39;s syndrome.</p>', '<p>Symptoms range from increased side effects to CNS disturbances, circulatory changes, respiratory failure, paralysis and coma. treat with immediate gastric lavage and injection of physostimine 0.5-2 mg up to a total of 5 mg. Treat symptomatically and supportively.</p>', '<p>Anticholinergics (antimuscarinics)/ Anti-spasmodics.</p>', NULL, NULL, '2022-03-11 06:29:19', '2022-03-11 06:29:19'),
(1109, 1109, '<p>Oxyphenonium is indicated in Gastro-intestinal spasm and hypermotility, cardiospasm, esophagospasm, gastroduodenitis, spastic constipation, pylorospasm, peptic ulcer, spasm associated with carcinoma. Pain and spasm of the biliary tract. Pain and spasm of the urinary tract.</p>', '<p>Oxyphenonium is an anticholinergic drug, a medication that reduces the effect of acetylcholine, a chemical released from nerves that stimulates muscles, by blocking the receptors for acetylcholine on smooth muscle (a type of muscle). It also has a direct relaxing effect on smooth muscle. Oxyphenonium is used to treat or prevent spasm in the muscles of the gastrointestinal tract in the irritable bowel syndrome. In addition, Oxyphenonium inhibits gastrointestinal propulsive motility and decreases gastric acid secretion and controls excessive pharyngeal, tracheal and bronchial secretions.</p>', '<p>Average adult dosage is 10 mg (2 tablets) 4 times daily for several days. Dosage may be reduced depending on patient&#39;s response or as directed by the physician.</p>', '<p>Reduced gastric motility interferes with absorption of other drugs. Effects potentiated by other antimuscarinics including amantadine, some antihistamines, phenothiazines and TCA.</p>', '<p>Glaucoma, obstructive uropathy (for example, bladder neck obstruction due to prospective hypertrophy), obstructive disease of the gastrointestinal tract (as in achalasia, paralytic ileus, pyloroduodenal stenosis, etc.), intestinal atony of the elderly or debilitated patient, unstable cardiovascular status in acute hemorrhage, severe ulcerative colitis, toxic megacolon, complicating ulcerative colitis, myasthenia gravis, hypersensitivity.</p>', '<p>Common side effects are dryness of mouth, headache, palpitations, etc.</p>', '<p>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>Children; elderly; benign prostatic hyperplasia; acute MI, cardiac failure, hypertension, thyrotoxicosis; pregnancy and lactation; fever; angle-closure glaucoma.</p>', '<p>Treatment is the same as for atropine overdosage.</p>', '<p>Anticholinergics (antimuscarinics)/ Anti-spasmodics.</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-11 06:32:19', '2022-03-11 06:32:19'),
(1110, 1110, '<p>Oxytetracycline is indicated in-</p>\r\n\r\n<ul>\r\n	<li>Respiratory tract infections</li>\r\n	<li>Mycoplasma pneumonia</li>\r\n	<li>Urinary tract infections</li>\r\n	<li>Sexually transmitted diseases: Infections due to Chlamydia trachomatis including uncom-plicated urethral, endocervical or rectal infections, non gonococcal urethritis, chancroid, granuloma inguinale, lymphogranuloma venereum, gonorrhoea, syphilis</li>\r\n	<li>Skin infections: Acne and rosacea</li>\r\n	<li>Ophthalmic infections: Trachoma</li>\r\n	<li>Rickettsial infections</li>\r\n	<li>Other infections: Psittacosis, brucellosis, cholera, acute</li>\r\n	<li>intestinal amoebiasis etc.</li>\r\n</ul>', '<p>Oxytetracycline inhibits cell growth by inhibiting translation. It binds to the 30S ribosomal subunit and prevents the amino-acyl tRNA from binding to the A site of the ribosome. The binding is reversible in nature. Oxytetracycline is lipophilic and can easily pass through the cell membrane or passively diffuses through porin channels in the bacterial membrane.</p>', '<p>Adults: 250-500 mg every 6 hours. Food, milk and some dairy products interfere with the absorption of Tetracyclines. So Tetracyclines should be given one hour before or two hours after meals.</p>', '<p>Antacids containing Aluminium, Calcium, Magnesium, Zinc or Iron salts may impair the absorption of Oxytetracycline. In long term therapy, Tetracyclines depress plasma prothrombin activity and reduced doses of concomitant anticoagulants may be necessary. A few cases of pregnancy or breakthrough bleeding have been attributed to the concurrent use of Tetracyclines or Oxytetracyclines with oral contraceptives.</p>', '<p>Oxytetracycline should not be used with patients who are hypersensitive to Tetracyclines. It should not be used in children under 12 years of age. It is contraindicated in pregnant women because of tooth staining in the fetus and possible growth retardation effects.</p>', '<p>Side effects of Oxytetracycline, which have been reported in some patients, are anorexia, nausea, vomiting, diarrhoea, glossitis, skin rashes and urticaria.</p>', '<p>Results of animal studies indicate that tetracyclines cross the placenta, are found in fetal tissues and can have toxic effects on the developing fetus. Evidence of embryotoxicity has also been noted in animals treated early in pregnancy. Tetracyclines are present in the milk of lactating women who are taking a drug in this class.</p>', '<p>Oxytetracycline should be used with caution in renal impairment.</p>', NULL, '<p>Eye Anti-Infectives &amp; Antiseptics, Tetracycline group of drugs, Topical antibiotics for Acne</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-11 06:35:20', '2022-03-11 06:35:20'),
(1111, 1111, '<p>This is indicated for the prophylaxis and local treatment of superficial ocular infections due to oxytetracycline and polymyxin-sensitive organisms, including infections due to streptococci, rickettsiae, E. coli, and A. aerogenes, such as conjunctivitis, keratitis, pink eye, corneal ulcer, blepharitis in dogs, cats, cattle, sheep, and horses; ocular infections due to secondary bacterial complications of distemper in dogs, and bacterial inflammatory conditions which may occur secondary to other infectious diseases in the above species.</p>', '<p>Oxytetracycline inhibits cell growth by inhibiting translation. It binds to the 30S ribosomal subunit and prevents the amino-acyl tRNA from binding to the A site of the ribosome. The binding is reversible in nature. Oxytetracycline is lipophilic and can easily pass through the cell membrane or passively diffuses through porin channels in the bacterial membrane.<br />\r\n<br />\r\nThe broad-spectrum effectiveness of this ointment against both gram-positive and gram-negative organisms is enhanced by the particular effectiveness of polymyxin B against infections associated with gram-negative organisms, especially those due to Pseudomonas aeruginosa, where polymyxin B is the antibiotic of choice. In addition, there is evidence to indicate that polymyxin B sulfate possesses some antifungal activity.</p>', '<p>Oxytetracycline Hydrochloride and Polymyxin B Sulfate Ophthalmic Ointment should be administered topically to the eye 2-4 times daily.</p>', NULL, NULL, '<p>All medicines may cause side effects, but many people have no, or minor, side effects. When used in small doses, no common side effects have been reported with this product. Seek medical attention right away if any of these severe side effects occur: Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); eye swelling or redness.</p>', '<p>If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using oxytetracycline or polymyxin b sulfate ointment while you are pregnant. It is not known if this medicine is found in breast milk. If you are or will be breast-feeding while you use oxytetracycline or polymyxin b sulfate ointment, check with your doctor. Discuss any possible risks to your baby.</p>', '<p>Serious, life threatening, hypersensitivity (anaphylactic) reactions have been reported in some cats following application of antibiotic ophthalmic preparations. If your cat has swelling of the face, itching, appears weak, vomits, or has difficulty breathing within 4 hours of application you should discontinue treatment and contact your veterinarian immediately. The use of oxytetracycline and other antibiotics may result in an overgrowth of resistant organisms such as Monilia, staphylococci, and other species of bacteria. If new infections due to nonsensitive bacteria or fungi appear during therapy, appropriate measures should be taken.</p>', NULL, '<p>Topical Antibiotic preparations.</p>', '<p>Store at controlled room temperature between 20&deg; to 25&deg;C.</p>', NULL, '2022-03-11 06:36:54', '2022-03-11 06:36:54'),
(1112, 1112, '<p>In Antepartum:</p>\r\n\r\n<ul>\r\n	<li>Induction of labor in patients with a medical indication for the initiation of labor, such as Rh problems, maternal diabetes, (pre-) eclampsia at or near term, when delivery is in the best interests of mother and fetus or when membranes are prematurely ruptured and delivery is indicated;&nbsp;</li>\r\n	<li>Stimulation or reinforcement of labor, as in selected cases of uterine inertia;</li>\r\n	<li>As adjunctive therapy in the management of incomplete or inevitable abortion.&nbsp;</li>\r\n</ul>\r\n\r\n<p>In Postpartum:</p>\r\n\r\n<ul>\r\n	<li>Oxytocin is indicated to produce uterine contractions during the third stage of labor and to control postpartum bleeding or hemorrhage.</li>\r\n</ul>', '<p>Uterine motility depends on the formation of the contractile protein actomyosin under the influence of the Ca2+&nbsp;dependent phosphorylating enzyme myosin light-chain kinase. Oxytocin promotes contractions by increasing the intracellular Ca2+, which in turn activates myosin&#39;s light chain kinase. Oxytocin has specific receptors in the muscle lining of the uterus and the receptor concentration increases greatly during pregnancy, reaching a maximum in early labor at term.</p>', '<p>Induction or Stimulation of Labor:</p>\r\n\r\n<ul>\r\n	<li>The standard solution for infusion of Oxytocin is prepared by adding the contents of one 1ml vial containing 10 units of Oxytocin to 1000 ml of infusion fluids. The combined solution containing 10 mU (1mU=0.001U) of Oxytocin/ml is rotated in the infusion bottle for thorough mixing.</li>\r\n	<li>The initial dose should be 0.5-1 mU/min (equal to 3-6 ml of the dilute Oxytocin solution per hour). At 30-60 minutes intervals the dose should be gradually increased in increments of 1-2 mU/min until the desired contraction pattern has been established. Once the desired frequency of contractions has been reached and labor has progressed to 5-6 cm dilation, the dose may be reduced by similar increments.</li>\r\n	<li>At term, higher infusion rates should be given with great care and rates exceeding 9-10 mU/min are rarely required.</li>\r\n	<li>Before term, when the sensitivity of the uterus is lower because of a lower concentration of Oxytocin receptors, a higher infusion rate may be required.</li>\r\n</ul>\r\n\r\n<p>Control of Postpartum Uterine Bleeding:</p>\r\n\r\n<ul>\r\n	<li><strong>Intravenous Infusion (Drip Method)</strong>: To control postpartum bleeding, 10 to 40 units of Oxytocin may be added to the bottle, depending on the amount of infusion fluids solution remaining (maximum 40 units to 1000 ml). Adjust infusion rate to sustain uterine contraction and control uterine atony.</li>\r\n	<li><strong>Intramuscular Administration</strong>: 1 mL (10 units) of Oxytocin can be given after the delivery of the placenta.</li>\r\n</ul>\r\n\r\n<p>Treatment of Incomplete or Inevitable Abortion:</p>\r\n\r\n<ul>\r\n	<li>Intravenous infusion of 10 units of Oxytocin added to 500 ml of a 0.9% sodium chloride solution may help the uterus contract after a suction or sharp curettage for an incomplete, inevitable or elective abortion.</li>\r\n	<li>Subsequent to intra-amniotic injection of hypertonic saline, prostaglandins, urea etc., for mid trimester elective abortion, the injection-to-abortion time may be shortened by infusion of Oxytocin at the rate of 10 to 20 mU (20 to 40 drops) per minute. The total dose should not exceed 30 units in a 12-hour period due to the risk of water intoxication.</li>\r\n</ul>', '<p>Severe hypertension has been reported when Oxytocin was given three to four hours following prophylactic administration of a vasoconstrictor in conjunction with caudal-block anesthesia. Cyclopropane anesthesia may modify Oxytocin&rsquo;s cardiovascular effects, so as to produce unexpected results such as hypotension. Maternal sinus bradycardia with abnormal atrioventricular rhythms has also been noted when Oxytocin was used concomitantly with cyclopropane anesthesia.</p>', '<p>This drug is contraindicated in- significant cephalopelvic disproportion; unfavorable fetal positions or presentations which are undeliverable without conversion prior to delivery, e.g., transverse lies; in obstetrical emergencies where the benefit-to-risk ratio for either the fetus or the mother favors surgical intervention; in cases of fetal distress where delivery is not imminent; hypertonic uterine patterns; hypersensitivity to the drug. Prolonged use in uterine inertia or severe toxemia is contraindicated. Oxytocin should not be used in cases where vaginal delivery is not indicated.</p>', '<ul>\r\n	<li>Hypersensitivity to the drug may result in uterine hypertonicity, spasm, titanic contraction or rupture of the uterus.&nbsp;</li>\r\n	<li>The possibility of increased blood loss and afbrinigenemia should be kept in mind when administering the drug.</li>\r\n	<li>Severe water intoxication with convulsions and coma has occurred.&nbsp;</li>\r\n	<li>Oxytocin may occasionally cause nausea, vomiting, haemorrhage or cardiac arrhythmias, anaphylactic reaction.</li>\r\n</ul>', '<p>Pregnancy category C. It is not known whether Oxytocin is excreted in human milk</p>', '<p>Oxytocin should not be administered in the following conditions: prematurity, borderline cephalopelvic disproportion, previous major surgery on the cervix or uterus including caesarean section, overdistention of the uterus, grand multiparity or invasive cervical carcinoma.</p>', '<p>Overdosage with Oxytocin depends essentially on uterine hyperactivity whether or not due to hypersensitivity to this agent. Hyperstimulation with strong (hypertonic) or prolonged (tetanic) contractions, or a resting tone of 15 to 20 mm H2O or more between contractions can lead to tumultuous labor, uterine rupture, cervical and vaginal lacerations, postpartum hemorrhage, utero-placental hypoperfusion, and variable deceleration of fetal heart, fetal hypoxia, hypercapnia, or death. Water intoxication with convulsions, which is caused by the inherent antidiuretic effect of Oxytocin, is a serious complication that may occur if large doses (40 to 50 mU/minute) are infused for long periods. Management consists of immediate discontinuation of Oxytocin and symptomatic and supportive therapy.</p>', '<p>Drugs acting on the Uterus</p>', '<p>Store in between 2 to 8&deg;C, in dark &amp; frost free place. Keep out of the reach of children.</p>', NULL, '2022-03-11 06:38:59', '2022-03-11 06:38:59'),
(1113, 1113, '<p>Ozenoxacin is indicated for the topical treatment of impetigo due to Staphylococcus aureus or Streptococcus pyogenes in adult and pediatric patients 2 months of age and older.</p>', '<p><strong>Mechanism of Action</strong>: Ozenoxacin is a quinolone antimicrobial drug. The mechanism of action involves the inhibition of bacterial DNA replication enzymes, DNA gyrase A and topoisomerase IV. Ozenoxacin has been shown to be bactericidal against S. aureus and S. pyogenes organisms.<br />\r\n<br />\r\n<strong>Absorption</strong>: Four pharmacokinetic studies were conducted in 110 patients utilizing varying strengths of ozenoxacin cream, up to 2% (twice the concentration of the marketed formulation). Three of these studies assessed systemic absorption in healthy subjects and in subjects with impetigo. These studies were conducted with either single or repeated application of up to 1 g ozenoxacin cream to intact or abraded skin (up to 200 cm2&nbsp;surface area). No systemic absorption was observed in 84 of 86 subjects, and negligible systemic absorption was observed at the level of detection (0.489 ng/mL) in 2 subjects.<br />\r\n<br />\r\n<strong>Distribution</strong>: Plasma protein binding of ozenoxacin was moderate (~80 to 85%) and did not appear to be dependent on concentration. Since negligible systemic absorption was observed in clinical studies, tissue distribution has not been investigated in humans.<br />\r\n<br />\r\n<strong>Metabolism</strong>: Ozenoxacin was not metabolized in the presence of fresh human skin discs and was minimally metabolized in human hepatocytes.<br />\r\n<br />\r\n<strong>Excretion</strong>: Studies have not been investigated in humans due to the negligible systemic absorption observed in clinical studies.</p>', '<p>Apply a thin layer of Ozenoxacin topically to the affected area twice daily for five days. The affected area may be up to 100 cm2&nbsp;in adult and pediatric patients 12 years of age and older or 2% of the total body surface area and not exceeding 100 cm2&nbsp;in pediatric patients less than 12 years of age.</p>\r\n\r\n<ul>\r\n	<li>Wash hands after applying Ozenoxacin cream.</li>\r\n	<li>Ozenoxacin cream is for topical use only.</li>\r\n	<li>Not for oral, ophthalmic, intranasal, or intravaginal use.</li>\r\n	<li>The treated area may be covered with a sterile bandage or gauze dressing.</li>\r\n</ul>', NULL, '<p>None</p>', '<p>Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice. The safety profile of Ozenoxacin was assessed in two clinical trials (Trial 1 and Trial 2) in 362 adult and pediatric patients two months of age and older with impetigo. The patients used at least one dose from a 5-day, twice a day regimen of Ozenoxacin. Control groups included 361 patients who used placebo and 152 patients who used retapamulin ointment. The median age of the patients enrolled in the clinical trials was 10 years; 3 % of patients were 2 months to less than 2 years of age, 55 % of patients were 2 to less than 12 years of age, 11 % of patients were 12 to less than 18 years of age, and 31 % of patients were 18 years of age or older. Adverse reactions (rosacea and seborrheic dermatitis) were reported in 1 adult patient treated with Ozenoxacin.</p>', '<p><strong>Pregnancy</strong>: There are no available data on the use of ozenoxacin in pregnant women to inform a drug associated risk. Systemic absorption of ozenoxacin in humans is negligible following topical administration of ozenoxacin (up to twice the concentration of the marketed formulation). Due to the negligible systemic exposure, it is not expected that maternal use of ozenoxacin will result in fetal exposure to the drug. Animal reproduction studies were not conducted with ozenoxacin. However, toxicity studies conducted in pregnant rats and rabbits administered the oral form of ozenoxacin showed no significant adverse developmental effects (at &gt;10,000 times the maximum human plasma concentration seen with dermal application of ozenoxacin). The estimated background risk of major birth defects and miscarriage for the indicated population are unknown. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.<br />\r\n<br />\r\n<strong>Lactation</strong>: No data are available regarding the presence of ozenoxacin in human milk, and the effects of ozenoxacin on the breastfed infant or on milk production. However, breastfeeding is not expected to result in exposure of the child to ozenoxacin due to the negligible systemic absorption of ozenoxacin in humans following topical administration of ozenoxacin. The developmental and health benefits of breastfeeding should be considered along with the mother&rsquo;s clinical need for ozenoxacin and any potential adverse effects on the breast-fed child from ozenoxacin or from the underlying maternal condition.</p>', '<p>Potential for Microbial Overgrowth: The prolonged use of Ozenoxacin may result in overgrowth of nonsusceptible bacteria and fungi. If such infections occur during therapy, discontinue use and institute appropriate supportive measures.</p>', '<p>Any sign or symptom of overdose, either topically or by accidental ingestion, should be treated symptomatically. No specific antidote is known.</p>', '<p>Topical Antibiotic preparations.</p>', '<p>Store at 20&ordm;C - 25&ordm;C; excursions permitted to 15&ordm;C to 30&ordm;C. Keep away from light &amp; moisture. Keep out of the reach of children.</p>', '<p><strong>Pediatric Use</strong>: The safety and effectiveness of ozenoxacin in the treatment of impetigo have been established in pediatric patients 2 months to 17 years of age. Use of ozenoxacin in pediatric patients (2 months to 17 years of age) is supported by evidence from adequate and well-controlled studies of ozenoxacin in which 251 pediatric patients received at least one dose of ozenoxacin. The median age of the patients enrolled in the clinical trials was 10 years; 3% of patients were 2 months to less than 2 years of age, 55 % of patients were 2 to less than 12 years of age, 11% of patients were 12 to less than 18 years of age, and 31 % of patients were 18 years of age or older. In these studies, the maximum dose applied was approximately 0.5 g of ozenoxacin applied twice daily for up to 5 days (i.e., up to 10 applications total). The safety profile of ozenoxacin in pediatric patients 2 months and older was similar to that of adults. The safety and effectiveness of ozenoxacin in pediatric patients younger than 2 months of age have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Clinical studies of ozenoxacin did not include sufficient numbers of subjects aged 65 and older to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients.</p>', '2022-03-11 06:40:50', '2022-03-11 06:40:50'),
(1114, 1114, '<p>Zafirlukast is indicated for the prophylaxis and chronic treatment of asthma in adults and children 5 years of age and older.</p>', '<p>Zafirlukast is a selective and competitive leukotriene-receptor antagonist (LTRA) of leukotriene D4 and E4 (LTD4 and LTE4), components of slow-reacting substance of anaphylaxis (SRSA). Cysteinyl leukotriene production and receptor occupation have been correlated with the pathophysiology of asthma, including airway oedema, smooth muscle constriction, and altered cellular activity associated with the inflammatory process, which contribute to the signs and symptoms of asthma.</p>', '<p>Zafirlukast should be taken continuously.<br />\r\n<br />\r\n<strong>Children under 7 years of age:</strong>&nbsp;There is no clinical experience of the use of Zafirlukast in children under 7 years of age until safety information is available.<br />\r\n<br />\r\n<strong>Children over 7 years through 11 years of age</strong>: The recommended dose of Zafirlukast in this age group is 10 mg twice daily.<br />\r\n<br />\r\n<strong>Adult and children aged 12 years and over</strong>: The dosage is one 20 mg tablet twice daily. This dosage should not be exceeded. Higher doses may be associated with elevations of one or more liver enzymes consistent with hepatotoxicity. As food may reduce the bioavailability of Zafirlukast, Zafirlukast should not be taken with meals<br />\r\n<br />\r\n<strong>Elderly</strong>: The clearance of Zafirlukast is significantly reduced in elderly patients (over 65 years old), and Cmax and AUC are approximately double than those of younger adults. However, accumulation of Zafirlukast is not greater than that seen in multiple dose trials conducted in adult subjects with asthma and the consequences of the altered kinetic in the elderly are unknown. Clinical experience with Zafirlukast in the elderly (over 65 years) is limited and caution is recommended until further information is available.<br />\r\n<br />\r\n<strong>Renal impairment</strong>: No dosage adjustment is necessary in patients with mild renal impairment.</p>', '<p>Zafirlukast may be administered with other therapies routinely used in the management of asthma and allergy. Inhaled steroids, inhaled and oral bronchodilator therapy, antibiotics and antihistamines are examples of agents which have been co-administered with Zafirlukast without adverse interaction.<br />\r\n<br />\r\nZafirlukast may be administered with oral contraceptives without adverse interaction. Co-administration with Warfarin results in an increase in maximum prothrombin time by approximately 35%. It is therefore recommended that if Zafirlukast is co-administered with Warfarin, prothrombin time should be closely monitored. The interaction is probably due to an inhibition by Zafirlukast of the cytochrome P450 2C9 enzyme system. In clinical trials co-administration with Theophylline resulted in decreased plasma levels of Zafirlukast, by approximately 30%, but with no effect on plasma Theophylline levels. However, during postmarketing surveillance, there have been rare cases of patients experiencing increased Theophylline levels when co-administered with Zafirlukast.<br />\r\n<br />\r\nCo-administration with Terfenadine resulted in a 54% decrease in AUC for Zafirlukast, but with no effect on plasma Terfenadine levels. Coadministration with Acetylsalicylic acid (650 mg four times a day) may result in increased plasma levels of Zafirlukast, by approximately 45%.<br />\r\n<br />\r\nCo-administration with Erythromycin will result in decreased plasma levels of Zafirlukast, by approximately 40%. The clearance of Zafirlukast in smokers may be increased by approximately 20%</p>', '<p>Zafirlukast should not be given to patients who have previously experienced hypersensitivity to the product or any of its ingredients. Zafirlukast is contraindicated in patients with a history of moderate or severe renal impairment. Zafirlukast is contraindicated in patients with hepatic impairment or cirrhosis; it has not been studied in patients with hepatitis or in long term studies of patients with cirrhosis. Zafirlukast is contraindicated in children under 7 years of age until safety information is available.</p>', '<p><strong>Effect on ability to drive or operate machinery</strong>: There is no evidence that Zafirlukast affects the ability to drive and use machinery. Administration of Zafirlukast in clinical trials against placebo has been associated with headache (9.9% vs. 9.0%) or gastrointestinal disturbance (nausea 2.6% vs. 2.2%, vomiting 1.2% vs. 1.0%, diarrhoea 2.3% vs. 1.8%, abdominal pain 1.6% vs. 1.2%). These symptoms are usually mild and do not necessitate withdrawal from therapy. During post-marketing experience, bruising, bleeding disorders, including menorrhagia (rare), thrombocytopaenia and agranulocytosis (very rare) have also been reported.<br />\r\n<br />\r\nHypersensitivity reactions, including urticaria and angio-oedema have been reported. Rashes, including blistering, have also been reported. The above events have usually resolved during continued treatment or following cessation of therapy.<br />\r\n<br />\r\nInfrequently, elevated serum transaminase levels have been observed in clinical trials against placebo with Zafirlukast (increased AST 1.0% vs. 0.9%, increased AST 0.6% vs. 0.6%); at recommended doses the incidence was equivalent to placebo. Rarely the transaminase profile has been consistent with drug-induced hepatitis, which resolved following cessation of Zafirlukast therapy. During post-marketing experience there have been rare reports of hepatitis, with or without elevated bilirubin levels. These cases were usually reversible.<br />\r\n<br />\r\nIn placebo controlled clinical trials, an increased incidence of infection has been observed in elderly patients given Zafirlukast (7.8% vs. 1.4%). Infections were usually mild, predominantly affecting the respiratory tract.</p>', '<p><strong>Pregnancy</strong>: The safety of Zafirlukast in human pregnancy has not been established. In animal studies, Zafirlukast did not have any apparent effect on fertility and did not appear to have any teratogenic or selective toxic effect on the foetus. The potential risks should be weighed against the benefits of continuing therapy during pregnancy and Zafirlukast should be used during pregnancy only if clearly needed.<br />\r\n<br />\r\n<strong>Lactation</strong>: Zafirlukast is excreted in human breast milk. Zafirlukast should not be administered to nursing mothers.</p>', '<p>Zafirlukast should be taken regularly to achieve benefit, even during symptom free periods. Zafirlukast therapy should normally be continued during acute exacerbations of asthma. Zafirlukast does not allow a reduction in existing steroid treatment. As with inhaled steroids and hormones (disodium cromoglycate, nedocromil sodium), Zafirlukast is not indicated for use in the reversal of bronchospasm in acute asthma attacks. Zafirlukast has not been evaluated in the treatment of labile (brittle) or unstable asthma.<br />\r\n<br />\r\nCases of Churg Strauss syndrome have been reported in association with Zafirlukast usage. A causal relationship has neither been confirmed nor refuted. If a patient develops a Churg Strauss syndrome type illness, Zafirlukast should be stopped, a re-challenge test should not be performed and treatment should not be restarted.<br />\r\n<br />\r\nElevations in serum transaminases can occur during treatment with Zafirlukast. These are usually asymptomatic and transient but could represent early evidence of hepatotoxicity.<br />\r\n<br />\r\nIf clinical symptoms or signs suggestive of liver dysfunction occur (e.g., nausea, vomiting, right upper quadrant pain, fatigue, lethargy, flu-like symptoms, enlarged liver, pruritus and jaundice), the serum transaminases, in particular serum ALT, should be measured and the patient managed accordingly. A decision to discontinue Zafirlukast should be individualized to the patient&rsquo;s condition, weighing the risk of hepatic dysfunction against the clinical benefit of Zafirlukast to the patient.</p>', NULL, '<p>Leukotriene receptor antagonists</p>', '<p>Store between 20-25&deg; C. Protect from light and moisture.</p>', NULL, '2022-03-12 00:17:15', '2022-03-12 00:17:15'),
(1115, 1115, '<p>Zaleplon is indicated for the short-term treatment of insomnia. Zaleplon has been shown to decrease the time to sleep onset for up to 30 days in controlled clinical trials.</p>', '<p>Zaleplon is a newer non-benzodiazepine hypnotic from the pyrazolopyrimidine class. So, its chemical structure is unrelated to benzodiazepines, barbiturates, or other drugs with known hypnotic properties. It interacts with the gamma aminobutyric acid-benzodiazepine (GABA-BZ) receptor complex.</p>', '<p>The dose of Zaleplon should be individualized. The recommended dose of Zaleplon for most non elderly adults is 10 mg. For certain low weight individuals, 5 mg may be a sufficient dose. Although the risk of certain adverse events associated with the use of Zaleplon appears to be dose dependent, the 20 mg dose has been shown to be adequately tolerated and may be considered for occasional patient who does not benefit from a trial of lower dose. Dosage above 20 mg has not been adequately evaluated and is not recommended.<br />\r\n<br />\r\nZaleplon should be taken immediately before bedtime. Taking Zaleplon with or immediately after a heavy, high fat meal results in slower absorption and would be expected to reduce the effect of Zaleplon on sleep latency. Elderly patients and debilitated patients appear to be more sensitive to the effects of hypnotic, and respond to 5 mg of Zaleplon. The recommended dose for these patients is therefore 5 mg, doses over 10 mg are not recommended.<br />\r\n<br />\r\nFor patients with mild to moderate renal impairment, no dose adjustment is necessary.<br />\r\n<br />\r\nAn initial dose of 5 mg should be given to patients concomitantly taking Cimetidine because Zaleplon clearance is reduced in this population.<br />\r\n<br />\r\n<strong>Pediatric use</strong>: The safety and effectiveness of Zaleplon in pediatric patients have not been established.</p>', '<p>Zaleplon has been shown to have minimal effects on the kinetic of Warfarin, Imipramine, Ethanol, Ibuprofen, Diphenhydramine, Thioridazine, and Digoxin.</p>', '<p>Zaleplon is contraindicated in patients with known hypersensitivity to any of its components.</p>', '<p>Side effects of Zaleplon appear to be dose related. So, it is important to use the lowest possible effective dose, specially in the elderly. The side effects are usually mild and transient, the most common are diarrhoea, nausea, vomiting, vertigo, headache, asthenia, nightmare etc.</p>', '<p><strong>Pregnancy</strong>: There are no studies of Zaleplon in pregnant women; therefore, it is not recommended for use in women during pregnancy. Zaleplon has no established use in labour and delivery.<br />\r\n<br />\r\n<strong>Lactation</strong>: A study in lactating mothers indicated that the clearance and half-life of Zaleplon is similar to that in young normal subjects. A small amount of Zaleplon is excreted in breast milk, with the highest excreted amount occurring during a feeding at approximately 1 hour after Zaleplon administration. Since the small amount of the drug from breast milk may result in potentially important concentrations in infants, and because the effects of Zaleplon on a nursing infant are not known, it is not recommended in nursing mothers.</p>', '<p><strong>Timing of drug administration</strong>: Zaleplon should be taken immediately before bedtime or after the patient has gone to bed.<br />\r\n<br />\r\n<strong>Use in the elderly and/or debilitated patients</strong>: Impaired motor and/or cognitive performance after repeated exposure or unusual sensitivity to sedative/hypnotic drugs is a concern in the treatment of elderly and/or debilitated patients. A dose of 5 mg is recommended for elderly patients to decrease the possibility of side effects. Elderly and/or debilitated patients should be monitored closely.<br />\r\n<br />\r\n<strong>Use in patients with concomitant illness</strong>: Zaleplon should be used with caution in patients with diseases or conditions that could affect metabolism or haemodynamic responses. Although preliminary studies did not reveal respiratory depressant effects at hypnotic doses of Zaleplon in normal subjects, caution should be observed if Zaleplon is prescribed to patients with compromised respiratory function, because sedative/hypnotic have the capacity to depress respiratory drive. However, patients with compromised respiration due to preexisting illness should be monitored carefully. The dose of Zaleplon should be reduced to 5 mg in patients with mild to moderate hepatic impairment. It is not recommended for use in patients with severe hepatic impairment.<br />\r\n<br />\r\n<strong>Renal impairment patients</strong>: No dose adjustment is necessary in patients with mild to moderate renal impairment. Zaleplon has not been adequately studied in patients with severe renal impairment.<br />\r\n<br />\r\n<strong>Use in patients with depression</strong>: As with other sedative or hypnotic drugs, Zaleplon should be administered with caution to patients exhibiting signs or symptoms of depression.</p>', NULL, '<p>Benzodiazepine hypnotics, Benzodiazepine sedatives.</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-12 00:19:03', '2022-03-12 00:19:03');
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
(1116, 1116, '<p>Zidovudine, a nucleoside&nbsp;reverse transcriptase&nbsp;inhibitor, is indicated in combination with other&nbsp;antiretroviral&nbsp;agents for the treatment of&nbsp;HIV-1 infection.<br />\r\n<br />\r\nPrevention Of Maternal-Fetal HIV-1 Transmission Zidovudine is indicated for the prevention of maternal-fetal HIV-1 transmission. The indication is based on a dosing regimen that included 3 components:</p>\r\n\r\n<ul>\r\n	<li>Antepartum therapy of HIV-1&ndash;infected mothers</li>\r\n	<li>Intrapartum therapy of HIV-1&ndash;infected mothers</li>\r\n	<li>Post-partum therapy of HIV-1&ndash;exposed&nbsp;neonate</li>\r\n</ul>\r\n\r\n<p>Points to consider prior to initiatingZidovudine in pregnant women for the prevention of maternal-fetal HIV-1 transmission include:</p>\r\n\r\n<ul>\r\n	<li>In most cases,Zidovudine for prevention of maternal-fetal HIV-1 transmission should be given in combination with other antiretroviral drugs.</li>\r\n	<li>Prevention of HIV-1 transmission in women who have receivedZidovudine for a prolonged period before pregnancy has not been evaluated.</li>\r\n	<li>Because the fetus is most susceptible to the potential&nbsp;teratogenic&nbsp;effects of drugs during the first 10 weeks of gestation and the risks of therapy withZidovudine during that period are not fully known, women in the first trimester of pregnancy who do not require immediate initiation of&nbsp;antiretroviral therapy&nbsp;for their own health may consider delaying use; this indication is based on use after 14 weeks&rsquo; gestation.</li>\r\n</ul>', '<p>Zidovudine is converted intracellularly to zidovudine triphosphate, which inhibits replication of retroviruses, including HIV, by interfering with viral RNA-directed DNA polymerase (reverse transcriptase).</p>', '<p>Prophylaxis of HIV infection in neonates:</p>\r\n\r\n<ul>\r\n	<li><strong>Child</strong>:&nbsp;2 mg/kg 6 hrly, starting within 12 hr after birth and continuing for 6 wk.</li>\r\n</ul>\r\n\r\n<p>HIV infection:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>:&nbsp;250 mg or 300 mg bid, in combination with other antiretroviral agents.</li>\r\n	<li><strong>Child</strong>:&nbsp;As soln: 4 to &lt;9 kg: 12 mg/kg bid; 9 to &lt;30 kg: 9 mg/kg bid; &ge;30 kg: 250 mg or 300 mg bid. As cap/tab: 8-13 kg: 100 mg bid; 14-21 kg: 100 mg in the morning, 200 mg in the evening; 22-30 kg: 200 mg bid; &ge;30 kg: 250 mg or 300 mg bid. Alternatively (based on BSA), 480 mg/m2&nbsp;daily in 2-3 divided doses. Doses are given in combination with other antiretroviral agents.</li>\r\n</ul>\r\n\r\n<p>Prophylaxis of maternal-fetal HIV transmission:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>:&nbsp;100 mg 5 times daily, starting on the 14th wk of gestation until the start of labour.</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>May be taken with or without food.</p>', '<p>Decreased plasma concentration with rifampicin resulting in partial or total loss of efficacy of zidovudine. Increased risk of anaemia with ribavirin in patients co-infected with HCV. Antagonistic effect with stavudine or doxorubicn. Increased plasma level with probenecid, atovaquone, valproic acid, fluconazole, or methadone. May alter phenytoin blood levels. Increased adverse effect with potentially nephrotoxic or myelosuppressive drugs (e.g. systemic pentamidine, dapsone, pyrimethamine, co-trimoxazole, amphotericin, flucytosine, ganciclovir, interferon, vincristine, vinblastine, doxorubicin). Reduced absorption with clarithromycin.</p>', '<p>Hypersensitivity; abnormally low neutrophil counts (&lt;0.75 x 109/L) or Hb levels (&lt;7.5 g/dL or 4.65 mmol/L); newborn infants with hyperbilirubinaemia requiring treatment other than phototherapy, or with increased transaminase levels &gt;5 times the ULN. Lactation. Concomitant use with interferon alfa (with or witho ribavirin) in HIV and hepatitis B or C virus co-infected patients.</p>', '<p>Dizziness, headache, malaise, myalgia, GI symptoms (e.g. abdominal pain, diarrhoea, nausea, vomiting), anorexia, immune reconstitution syndrome, lipodystrophy, metabolic abnormalities, mitochondrial dysfunction, osteonecrosis; raised liver enzymes, creatine phosphokinase; hyperbilirubinaemia, myalgia, myositis. Rarely, aplastic anaemia, pure red cell aplasia, pancytopenia, thrombocytopenia, rhabdomyolysis, cardiomyopathy, convulsions, pancreatitis.</p>', '<p>Pregnancy&nbsp;Category C. Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.</p>', '<p>Severe renal and hepatic impairment. Childn. Pregnancy.</p>', '<p>Symptoms: Vomiting, CNS effects (e.g. fatigue, dizziness, drowsiness, lethargy, confusion), haematologic effects (e.g. anaemia, decreased Hb). Bone marrow hypoplasia, mild ataxia, tonic-clonic seizure and increased serum concentration of AST and ALT may also occur.<br />\r\n<br />\r\nManagement: Supportive and symptomatic treatment. Induce emesis and admin activated charcoal to prevent further absorption of unrecovered drug.</p>', '<p>Drugs for HIV / Anti-retroviral drugs</p>', '<p>Store between 15-25&deg; C.</p>', '<p>Renal Impairment:</p>\r\n\r\n<ul>\r\n	<li>ESRD maintained on haemodialysis or peritoneal dialysis: 100 mg 6-8 hrly.</li>\r\n	<li>CrCl &lt;10-15 mL/min: 100 mg 6-8 hrly.</li>\r\n</ul>\r\n\r\n<p>Hepatic Impairment: Dose reduction may be needed.</p>', '2022-03-12 00:21:23', '2022-03-12 00:21:23'),
(1117, 1117, '<p>Oral zinc therapy is indicated in zinc deficiency and/or zinc losing conditions like- Hair loss, Skin rashes, Major depression, Loss of smell, taste and memory, White spots on the fingernails, Increased susceptibility to infection, Loss of activity of growth hormone (GH), Visual impairment, fingernails, Diarrhea, Male infertility, Sickle cell anemia, Delayed wound healing, Type-2 diabetes.</p>', '<p>Zinc, a major mineral,&nbsp;plays a part in almost all the body&#39;s cellular and enzymatic processes. Its bioavailability and digestive assimilation increases significantly when bound to orotic acid. An essential component of over 80 enzymes, it plays a role in all metabolism and has a specific&nbsp;antioxidant, anti-free radical action.</p>', '<p><strong>Adults</strong>: One tablet twice daily with meal.</p>', '<p>Concomitant intake of tetracycline, quinolone and penicillamine along with zinc may decrease the absorption of both drugs.</p>', NULL, '<p>Zinc might cause nausea, vomiting, metallic taste and stomach upset etc.</p>', '<p>It should be used in pregnant or lactating mother after consultation with a health care professional.</p>', '<p>Patients with diabetes &amp; acute renal failure should use zinc products cautiously.</p>', '<p>Taking doses higher than 40 mg (elemental zinc) daily might cause fever, cough, upset stomach.</p>', '<p>Specific mineral preparations</p>', '<p>Store in a cool and dry place, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-12 00:23:08', '2022-03-12 00:23:08'),
(1118, 1118, '<p>Zinc Oxide helps treat and prevent diaper rash while it moisturizes and nourishes the skin. The Zinc Oxide based formulation provides a protective barrier on the skin against the natural causes of irritation. Zinc Oxide spreads on smooth and wipes off the baby easily, without causing irritation to the affected area.</p>', '<p>Zinc oxide is used to treat or prevent minor skin irritations such as burns, cuts, poison ivy, poison oak, poison sumac, and diaper rash. It is also used as sunscreen.</p>', '<p>Change wet and soiled diapers promptly, cleanse the diaper area, and allow drying. Apply ointment liberally as often as necessary, with each diaper change, especially at bedtime or anytime when exposure to wet diapers may be prolonged.</p>', '<p>No hazardous drug interactions have been reported.</p>', '<p>Known hypersensitivity to any component of the preparation.</p>', '<p>Usually well tolerated. Extremely low frequency of hypersensitivity reaction.</p>', '<p>This medication should be used with precautions only if clearly needed during pregnancy or while breast feeding.</p>', '<p>When using this product avoid contact with eyes Stop use and ask a doctor if the condition worsens or does not improve within 7 days. This may be a sign of a serious condition. Keep out of reach of children. If swallowed, get medical help immediately.</p>', '<p>No overdose related problem is yet reported.</p>', '<p>Drugs used in diaper rash</p>', '<p>Keep at cool and dry place, away from light. Keep out of the reach of children.</p>', NULL, '2022-03-12 00:27:44', '2022-03-12 00:27:44'),
(1119, 1119, '<p>Regular use may help protect against premature skin aging, appearance of wrinkles and pigmentation and sunburn. Improve quality of skin and leave the skin supple and healthy.</p>', '<p>Zinc oxide has astringent, soothing and protective properties and is used in topical preparations for eczema, slight excoriations, wounds and haemorrhoids. It also reflects ultraviolet radiation and can be used as a physical sunscreen.</p>', '<p>Apply on the area exposed to sunlight (such as face, neck &amp; body) at least 30 min before exposure and whenever necessary. Massage on to skin until absorbed. To ensure maximum protection, we recommend repeating the application every two hours after continuous exposure to the sun and after swimming, physical exercise (sweat or dry with towel).</p>', '<p>There are no known drug interactions and none well documented.</p>', '<p>Hypersensitivity to any ingredient in zinc oxide cream, lotion.</p>', '<p>Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue).</p>', '<p>Pregnancy Category C. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.</p>', '<p>Zinc oxide cream may be harmful if swallowed. Pregnancy &amp; Lactation.</p>', NULL, '<p>Sunblock Preparation.</p>', '<p>Store below 30&deg;C.</p>', NULL, '2022-03-12 00:29:32', '2022-03-12 00:29:32'),
(1120, 1120, '<p>In the treatment of Napkin rash, Eczema, Bedsores, Acne, Minor burns, Surface wounds, Sunburn, Chilblains.</p>', '<ul>\r\n	<li>Zinc oxide: A&nbsp;dermatological agent with astringent, soothing and protective properties.</li>\r\n	<li>Benzyl alcohol: A&nbsp;local anaesthetic with disinfectant properties.</li>\r\n	<li>Benzyl benzoate: An acaricide and has been used as a pediculicide, insect repellent and pharmaceutical solubilising agent. It is a constituent of many natural balsams and is one of the principal esters of Peru Balsam.</li>\r\n	<li>Benzyl cinnamate: This is the other principal ester of Peru Balsal BPC 1973. It is synthetised from benzyl alcohol and cinnamic acid which has antibacterial and antifungal properties. Peru Balsam is categorised as having a mild antiseptic action because of cinnamic acid and its derivatives present.</li>\r\n	<li>Lanolin: Resembles the sebaceous secretions of human skin. The grade (hypoallergenic) used is manufactured so as to exclude many sensitising substances present in the lanolin.</li>\r\n</ul>', '<p>Apply a thin layer with suitable covering where necessary. Renew application as required. No distinction is required between indications or between adults, children and the elderly. Topical cream for external use only.</p>', NULL, '<p>Hypersensitivity to any of the ingredients.</p>', '<p>Side effects include local hypersensitivity occasionally.</p>', '<p>There are no known contraindications in pregnancy &amp; lactation.</p>', '<p>For external use only and should not be allowed to come into contact with the eyes and the mucous membranes. Instruct patients not to smoke or go near naked flames- risk of severe burns. Fabric (clothing, bedding, dressings etc) that has been in contact with this product burns more easily and is a serious fire hazard. Washing clothing and bedding may reduce product build-up but not totally remove it.</p>', '<p>No case of overdose has been reported. If large amounts are swallowed accidentally, this may cause vomiting, diarrhoea, CNS stimulation and convulsions. Symptomatic treatment should be provided.</p>', '<p>Drugs used in diaper rash, Sunblock Preparation.</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-12 00:31:15', '2022-03-12 00:31:15'),
(1121, 1121, '<p>This cream is ideal for those with photodermatoses &amp; reduced skin pigmentation, Protection from harmful UV rays, Sunblock. Benefit of this cream is Sunblock with SPF60/ PA+++, Non-greasy &amp; hypoallergenic, Perfume-free, Contains Vitamin E, Water resistant.</p>', '<p>Zinc oxide has astringent, soothing and protective properties and is used in topical preparations for eczema, slight excoriations, wounds and haemorrhoids. It also reflects ultraviolet radiation and can be used as a physical sunscreen.</p>', '<p>Apply on the area exposed to sunlight (such as face, neck &amp; body) at least 30 min before exposure and whenever necessary. Massage on to skin until absorbed.<br />\r\n<br />\r\nTo ensure maximum protection, we recommend repeating the application every two hours after continuous exposure to the sun and after swimming, physical exercise (sweat or dry with towel).</p>', '<p>There are no known drug interactions and none well documented.</p>', '<p>Hypersensitivity to any ingredient in zinc oxide cream, lotion.</p>', '<p>Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue).</p>', '<p>Pregnancy Category C. Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks</p>', '<p>Zinc oxide cream may be harmful if swallowed. Pregnancy &amp; Lactation.</p>', NULL, '<p>Sunblock Preparation.</p>', NULL, NULL, '2022-03-12 00:33:50', '2022-03-12 00:33:50'),
(1122, 1122, '<p>For relief of the symptoms of nappy rash and as a protective water resistant cream for dry, chapped skin.</p>', '<p>Zinc oxide has a mild antiseptic action, and is useful for relieving the symptoms of nappy rash and other minor skin irritations. The formulation as a whole acts to provide a mildly antiseptic water resistant emollient barrier for dry skin conditions and nappy rash.</p>', '<p>Applied directly to the skin. As required, up to four times daily or at each nappy change. The product is suitable for use by adults, children and the elderly.</p>', '<p>May mask x-ray pictures under certain circumstances.</p>', '<p>Known hypersensitivity to any of the ingredients listed.</p>', NULL, '<p>No information is available on the safety of the product when used during pregnancy and lactation.</p>', '<p>For external use only. Keep all medicines out of sight and reach of children. Instruct patients not to smoke or go near naked flames&ndash; risk of severe burns. Fabric (clothing, bedding, dressings, etc.) that has been in contact with this product burns more easily and is a serious fire hazard. Washing clothing and bedding may reduce product build-up but not totally remove it.<br />\r\n<br />\r\nZinc and Castor Oil Ointment BP contains Arachis Oil (peanut oil) and should not be applied by patients known to be allergic to peanut. As there is a possible relationship between allergy to peanut and allergy to Soya, patients with soya allergy should also avoid Zinc and Castor Oil Ointment. or<br />\r\n<br />\r\nZinc and Castor Oil Cream contains Arachis Oil (peanut oil) and should not be applied by patients known to be allergic to peanut. As there is a possible relationship between allergy to peanut and allergy to Soya, patients with soya allergy should also avoid Zinc and Castor Oil Cream.</p>', '<p>Overdosage is unlikely. If accidentally ingested treatment should be symptomatic. Oral ingestion of large quantities of castor oil may cause nausea, vomiting, colic and diarrhoea.</p>', '<p>Emollients &amp; combined preparations.</p>', '<p>Store below 25&deg;C.</p>', NULL, '2022-03-12 00:35:59', '2022-03-12 00:35:59'),
(1123, 1123, '<p>This cream is indicated for protection from harmful UV rays and thus managing photodermatoses, skin pigmentation, solar urticaria, acute solar dermatitis, drug-induced photosensitivity, acute lupus erythematosus, polymorphic light eruption, etc.</p>', '<p>This cream is a combination of 4 ingredients which provide a highly protective sunscreen action.Thus, it protects against the harmful effects of ultraviolet rays of sun which can cause skin cancer, wrinkle, premature aging and darkening of skin. Its Sun Protection Factor (SPF) is 60 &amp; Protection Grade of UVA (PA) is +++, making it perfect for both UVA &amp; UVB protection. Zinc Oxide acts as screen and reflects &amp; scatters UV radiation in order to protect the skin.Avobenzone,Octinoxate and Enzacamene absorb UV radiation and convert it to heat, which is then released from the skin. Strong stay-on properties making it long lasting sunscreen.</p>', '<p>Apply on the exposed area of the body to sunlight (such as face, neck &amp; body) at least 30 minutes before exposure and whenever necessary. Massage on to skin until absorbed. To ensure maximum protection, repeat the application every two hours after continuous exposure to the sun and after swimming, physical exercise.</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>Take an adequate amount of cream</li>\r\n	<li>Apply as a thin layer on the face or, other exposed body area</li>\r\n	<li>Gently massage onto the skin</li>\r\n</ul>', '<p>It is not known whether this preparation has any interaction with other topically applied drug products.</p>', '<p>This preparation is contraindicated in patients with a history of sensitivity to any components of the preparation.</p>', '<p>Signs of irritations (erythema, burning or rash) may appear when applied to sensitive or broken skin.</p>', '<p>Pregnancy Category C. It is not known whether this preparation is excreted in human milk. Caution should be exercised when this cream is administered to a nursing woman.</p>', '<p>For external use only. Transient stinging or burning may occur when applied to abraded or broken skin.</p>', NULL, '<p>Sunblock Preparation</p>', '<p>Store below 30&deg;C. Do not freeze. Keep out of reach of children.</p>', '<p>Pediatric Use: The safety and effectiveness of this cream have not been established in pediatric patients.</p>', '2022-03-12 00:38:18', '2022-03-12 00:38:18'),
(1124, 1124, '<p>Zinc Sulfate Monohydrate is indicated in zinc deficiency and/or zinc losing conditions. Zinc deficiency can occur as a result of inadequate diet or malabsorption. Excessive loss of zinc can occur in trauma, burns, diarrhoea and protein losing conditions. A zinc supplement is given until clinical improvement occurs but it may need to be continued in severe malabsorption, metabolic disease or in zinc losing states.</p>', '<p>Zinc sulphate monohydrate is an essential trace element and is involved in a number of body enzyme systems. The body needs zinc for normal growth and health. Zinc is also vital for sexual maturation and reproduction, dark vision adaptation, olfactory and gustatory activity, insulin storage &amp; release and for a variety of host immune defenses. Zinc deficiency may lead to impaired immune function, delayed wound healing, a decrease in sense of taste and smell, a reduced ability to fight infections, poor night vision, increased risk of abortion, alopecia, mental lethargy, skin changes and poor development of reproductive organs.</p>', '<p><strong>Child under 10 kg</strong>: 5 ml (1 teaspoonful) 2 times daily after food.<br />\r\n<strong>Child between 10-30 kg</strong>: 10 ml (2 teaspoonfuls) 1-3 times daily after food.<br />\r\n<strong>Adults and child over 30 kg</strong>: 20 ml (4 teaspoonfuls) 1-3 times daily after food.<br />\r\n<br />\r\nThis drug is most effective if they are taken at least 1 hour before or 2 hour after meals. However, if causes stomach upset, this may be taken with a meal.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>For dispersible tablet<strong>-</strong></p>\r\n\r\n<ul>\r\n	<li>Place the tablet in a teaspoon</li>\r\n	<li>Add adequate amount of water</li>\r\n	<li>Let the tablet dissolve completely</li>\r\n	<li>Give the entire spoonful solution</li>\r\n</ul>', '<p>Concomitant intake of a tetracycline and zinc may decrease the absorption of both the tetracycline and zinc. Similarly concomitant administration of zinc and quinolone drug may also decrease the absorption of both. Concomitant intake of penicillamine and zinc may decrese absorption of zinc.</p>', '<p>It is contraindicated in those who are hypersensitive to any component of the ingredient of this preparation.</p>', '<p>Zinc may cause nausea, vomiting, diarrhoea, stomach upset, heartburn and gastritis.</p>', '<p>The safety of this product in human pregnancy has not been established. Zinc crosses the placenta and is present in breast milk.</p>', '<p>In acute renal failure, zinc accumulation may occur in body; so dose adjustment is needed.</p>', NULL, '<p>Specific mineral preparations</p>', '<p>Keep in a dry place away from light and heat. Keep out of the reach of children.</p>', NULL, '2022-03-12 00:40:44', '2022-03-12 00:40:44'),
(1125, 1125, '<p>Ziprasidone is indicated for the treatment of&nbsp;schizophrenia, as monotherapy for the acute treatment of bipolar&nbsp;manic&nbsp;or mixed episodes, and as an adjunct to&nbsp;lithium&nbsp;or valproate for the maintenance treatment of bipolar disorder. Ziprasidone&nbsp;intramuscular&nbsp;is indicated for acute agitation in schizophrenic patients. When deciding among the alternative treatments available for the condition needing treatment, the prescriber should consider the finding of ziprasidone&#39;s greater capacity to prolong the QT/QTc interval compared to several other&nbsp;antipsychotic&nbsp;drugs. Prolongation of the QTc interval is associated in some other drugs with the ability to cause torsade de pointes-type&nbsp;arrhythmia, a potentially fatal&nbsp;polymorphic&nbsp;ventricular tachycardia, and sudden death. In many cases this would lead to the conclusion that other drugs should be tried first. Whether ziprasidone will cause torsade de pointes or increase the rate of sudden death is not yet known.</p>', '<p>Ziprasidone, a benzylisothiazolylpiperazine is an atypical antipsychotic which may produce antischizophrenic effect by the antagonism of central dopamine D2 receptors and central type 2 serotonergic (5-HT2) receptors.</p>', '<p><strong>Schizophrenia:</strong></p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>: Initially, 20 mg bid, increase if necessary at intervals of not</li>\r\n	<li><strong>Elderly</strong>: Lower initial dose and slower titration.</li>\r\n</ul>\r\n\r\n<p><strong>Acute mixed or manic episodes in bipolar disorder:</strong></p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>: Initially, 40 mg bid, increased to 60 mg or 80 mg bid on the 2nd day. Adjust subsequent doses according to patient&#39;s response and tolerance level. Maintenance treatment of bipolar I disorder (adjunctive therapy to either lithium or valproate): Continue at the same dosage on which the patient was initially stabilised within 40-80 mg bid.</li>\r\n	<li><strong>Elderly</strong>: Lower initial dose and slower titration.</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>Should be taken with food.</p>', '<p>May antagonise effects of levodopa and dopaminergics. May enhance effects of other CNS depressants and certain antihypertensives. Altered metabolism with CYP3A4 inducers (e.g. carbamazepine), and inhibitors (e.g. ketoconazole).</p>', '<p>Patient with history of QT prolongation or cardiac arrhythmias, recent acute MI or decompensated heart failure. Concurrent use with other drugs known to prolong the QT interval.</p>', '<p>Somnolence, rash or urticaria, GI disturbances, dizziness, flu-like symptoms, HTN, headache, agitation, confusion, dyspnoea, orthostatic hypotension, increased prolactin levels, wt gain, sexual dysfunction, extrapyramidal symptoms, tardive dyskinesia, hyperglycaemia. Rarely, cholestatic jaundice, hepatitis, seizures, leucopenia, neutropenia, thrombocytopenia, hyperlipidaemia.</p>', '<p>Pregnancy Category C. Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.</p>', '<p>Patient with history of seizures or conditions that lower the seizure threshold, CV or cerebrovascular disease, conditions which predispose to hypotension. Renal impairment. Elderly with dementia-related psychosis. Pregnancy and lactation.</p>', '<p><strong>Symptoms</strong>: Minimal sedation, slurred speech, transitory HTN, extrapyramidal symptoms, somnolence, tremor, anxiety.<br />\r\n<br />\r\n<strong>Management</strong>: Establish and maintain an airway, ensure adequate oxygenation and ventilation. Consider admin of activated charcoal together with a laxative, gastric lavage (after intubation for unconscious patient); established IV access. Treat hypotension and circulatory collapse with IV fluids. In case of severe extrapyramidal symptoms, anticholinergic medication should be given.</p>', '<p>Atypical neuroleptic drugs.</p>', '<p>Store between 15-30&deg; C.</p>', NULL, '2022-03-12 00:44:01', '2022-03-12 00:44:01'),
(1126, 1126, '<p>Zoledronic Acid is indicated in:</p>\r\n\r\n<ul>\r\n	<li>Hypercalcaemia of malignancy,&nbsp;</li>\r\n	<li>Bone metastases associated with solid tumours, Osteolytic lesions associated with multiple myeloma,&nbsp;</li>\r\n	<li>Corticosteroid-induced osteoporosis, Increase bone mass in men with osteoporosis, Osteoporosis in postmenopausal women</li>\r\n	<li>Paget&#39;s disease of bone</li>\r\n	<li>Prophylaxis of postmenopausal osteoporosis</li>\r\n</ul>', '<p>Zoledronic acid belongs to the class of nitrogen-containing bisphosphonates and acts primarily on bone. It is an inhibitor of osteoclast-mediated bone resorption. The action of bisphosphonates on bone is based on their high affinity for mineralized bone. Intravenously administered Zoledronic acid is rapidly distributed to bone. The main molecular target of Zoledronic acid in the osteoclast is the enzyme farnesyl pyrophosphate synthase, but this does not exclude other mechanisms. Clinical studies in tumour-induced hypercalcemia demonstrated that the effect of Zoledronic acid is characterized by decreases in serum calcium and urinary calcium excretion. In addition to its inhibitory activity against bone resorption, Zoledronic acid also possesses anti-tumour activity, anti-angiogenic activity, anti-pain activity, cytostatic and pro-apoptotic activity on tumour cells and synergistic cytostatic effect with other anti-cancer drugs. There was no accumulation of the active substance in plasma after multiple doses given every 28 days. Zoledronic acid is not metabolized and is excreted unchanged via the kidney.</p>', '<p><strong>Hypercalcemia of malignancy</strong>: The maximum recommended dose of Zoledronic Acid in hypercalcemia of malignancy (serum calcium 12 mg/dl or 3.0 mmol/l) is 4 mg. The 4 mg dose must be given as a single-dose intravenous infusion. Dose adjustment of Zoledronic Acid is not necessary in treating patients for hypercalcemia of malignancy presenting with mild-to-moderate renal impairment. Re-treatment with Zoledronic Acid may be considered if serum calcium does not return to normal after initial treatment. It is recommended that a minimum of 7 days elapse before re-treatment, to allow for full response to the initial dose.&nbsp;<br />\r\n<br />\r\n<strong>Multiple myeloma and bone metastases of solid tumors</strong>: The recommended dose of Zoledronic Acid in patients with multiple myeloma and metastatic bone lesions from solid tumors is 4 mg infused every 3-4 weeks. Patients should also be administered an oral calcium supplement of 500 mg and 400 IU of Vitamin-D daily.</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>Prior to administration, the required amount of concentrate from one vial must be further diluted with 100 ml of calcium-free infusion solution (0.9% w/v sodium chloride solution or 5% w/v glucose solution). The duration of infusion must not be less than 15 minutes. After addition of the solution to the infusion media, the infusion solution should be used as soon as possible. If storage of the infusion solution is necessary, hold at 2-8&ordm; C for not more than 24 hours. If refrigerated, the solution must be allowed to reach room temperature before administration.<br />\r\n<br />\r\nZoledronic Acid must not be mixed with calcium or other divalent cation-containing infusion solutions, such as Lactated Ringer&#39;s solution, and should be administered as a single intravenous solution in a line separate from all other drugs.</p>', '<p>In clinical studies, Zoledronic acid has been administered concomitantly with commonly used anticancer agents, diuretics, antibiotics and analgesics without interactions. Caution is advised when Zoledronic acid are administered with aminoglycosides, since these agents may have an additive effect to lower serum calcium level for prolonged periods. In multiple myeloma patients, the risk of renal dysfunction may be increased when Zoledronic acid is used in combination with thalidomide. Concomitant use of loop diuretics with Zoledronic acid increases the risk of hypocalcemia. Caution is indicated when Zoledronic acid is used with other potentially nephrotoxic drugs.</p>', '<p>The drug is contraindicated if patients have hypersensitivity to the active substance or to any of the excipients or to any bisphosphonates; severe renal impairment (Creatinine clearance &lt;30 ml/min); pregnancy and lactation.</p>', '<p>The post-dose side-effects are headache, nausea, anorexia, fatigue, osteonecrosis of jaw, anemia, bone pain, constipation, fever, vomiting, flu-like syndrome, hypocalcemia, myalgia, arthralgia and hypophosphataemia.</p>', '<p>Zoledronic acid is contraindicated during pregnancy and in breast-feeding women. It is also not recommended for use in children and adolescents below 18 years of age.</p>', '<p>Patients must be appropriately hydrated prior to administration of Zoledronic Acid. This is especially important in the elderly and for patients receiving diuretic therapy. Adequate hydration can be achieved by the patient drinking two glasses of fluid (such as water) before and after the infusion. Serum levels of calcium, phosphate, magnesium and potassium, as well as serum creatinine should be carefully monitored after initiating Zoledronic Acid therapy. If hypocalcemia, hypophosphatemia or hypomagnesemia occurs, short-term supplemental therapy may be necessary. Moreover, careful renal function monitoring should be considered.</p>', '<p>Clinical experience with acute over dosage is limited. Over dosage may cause hypocalcemia, hypophosphatemia, and hypomagnesemia. In such case, reduction in serum levels of calcium, phosphorus, and magnesium should be corrected by intravenous administration of calcium gluconate, potassium or sodium phosphate and magnesium sulfate respectively.</p>', '<p>Bisphosphonate preparations.</p>', '<p>Store below 30&deg; C prior to opening. Protect from moisture and light. Zoledronic Acid must be kept out of the reach and sight of children.</p>', '<p><strong>Patients with renal impairment</strong>: The use of Zoledronic Acid is not recommended in patients with severe renal impairment (Creatinine clearance &lt;30 ml/min). No dose adjustment is necessary in patients with creatinine clearance &gt;60 ml/min. Based on creatinine clearance the following dose should be used in patient with impaired renal function:</p>\r\n\r\n<ul>\r\n	<li>CrCl &gt; 60 ml/min: 4 mg (5 ml)</li>\r\n	<li>CrCl 50-60 ml/min: 3.5 mg (4.4 ml)</li>\r\n	<li>CrCl 40-49 ml/min: 3.3 mg (4.1 ml)</li>\r\n	<li>CrCl 30-39 ml/min: 3 mg (3.8 ml)</li>\r\n</ul>', '2022-03-12 00:46:21', '2022-03-12 00:46:21'),
(1127, 1127, '<p>Zoledronic Acid is indicated for the treatment of osteoporosis in postmenopausal women to reduce the incidence of hip, vertebral and non-vertebral fractures; prevention of clinical fractures after a hip fracture; treatment and prevention of glucocorticoid-induced osteoporosis; treatment of osteoporosis in men and for the treatment of paget&#39;s disease of bone. Treatment should be restricted to three annual doses.</p>', '<p>Zoledronic acid belongs to the class of nitrogen-containing bisphosphonates and acts primarily on bone. It is an inhibitor of osteoclast-mediated bone resorption. The action of bisphosphonates on bone is based on their high affinity for mineralized bone. Intravenously administered Zoledronic acid is rapidly distributed to bone. The main molecular target of Zoledronic acid in the osteoclast is the enzyme farnesyl pyrophosphate synthase, but this does not exclude other mechanisms. There was no accumulation of the active substance in plasma after multiple doses given every 28 days. Zoledronic acid is not metabolized and is excreted unchanged via the kidney.</p>', '<p><strong>Treatment of postmenopausal osteoporosis</strong>: Recommended dose is a single intravenous infusion of 5 mg Zoledronic Acid administered once a year. Adequate supplemental Calcium and Vitamin-D intake is important in women with osteoporosis if dietary intake is inadequate.&nbsp;<br />\r\n<br />\r\n<strong>Prevention of clinical fractures after a hip fracture</strong>: Recommended dose is a single intravenous infusion of 5 mg Zoledronic Acid&nbsp;administered once a year. In patients with a recent low-trauma hip fracture, it is recommended to give the first Zoledronic Acid solution for infusion two or more weeks after hip fracture repairs. It is also recommended to have a loading dose of 50,000 to 125,000 IU of Vitamin-D given orally or via intramuscular route prior to the first administration of Zoledronic Acid solution for infusion. Supplemental Calcium and Vitamin-D intake is recommended for patients treated to prevent clinical fractures after a hip fracture.<br />\r\n<br />\r\n<strong>Treatment of osteoporosis in men</strong>: Recommended dose is a single intravenous infusion of 5 mg Zoledronic Acid administered once a year. Adequate supplemental Calcium and Vitamin-D intake is important in men with osteoporosis if dietary intake is inadequate.&nbsp;<br />\r\n<br />\r\n<strong>Treatment and prevention of glucocorticoid-induced osteoporosis</strong>: Recommended dose is a single intravenous infusion of 5 mg Zoledronic Acid administered once a year. Adequate supplemental Calcium and Vitamin-D intake is important in patients with osteoporosis if dietary intake is inadequate.<br />\r\n<br />\r\n<strong>Treatment of paget&#39;s disease of bone</strong>: Recommended dose is a single intravenous infusion of 5 mg Zoledronic Acid. Re-treatment with Zoledronic Acid may be considered in patients who have relapsed, based on increases in serum alkaline phosphatase, in patients who failed to achieve normalization of serum alkaline phosphatase, or in patients with symptoms, as dictated by medical practice 12 months after the initial dose.<br />\r\n<br />\r\nIn patients with paget&#39;s disease, adequate Vitamin-D intake is recommended in association with Zoledronic Acid administration. In addition, it is strongly advised that adequate supplemental Calcium corresponding to at least 500 mg elemental Calcium twice daily is ensured in patients with paget&#39;s disease for at least 10 days following Zoledronic Acid administration.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>The dose of 5 mg Zoledronic acid must be administered over at least 15 minutes. Zoledronic Acid&nbsp;should be administered intravenously via a infusion line, given at a constant infusion rate. The infusion time must not be less than 15 minutes.</p>', '<p>Specific drug-drug interaction studies have not been conducted with Zoledronic acid. Zoledronic acid is eliminated by renal excretion. Caution is indicated when Zoledronic Acid is administered in conjunction with drugs that can significantly impact renal function (e.g. aminoglycosides or diuretics that may cause dehydration).</p>', '<p>The drug is contraindicated if patients have hypersensitivity to the active substance or to any of the excipients or to any bisphosphonates, hypocalcaemia, renal impairment (creatinine clearance &lt;35 mL/min), current or recent uveitis, or a history of bisphosphonate-associated uveitis, pregnancy and lactation.</p>', '<p>The post-dose side-effects are fever, myalgia, flu-like symptoms, arthralgia and headache, the majority of which occur within the first 3 days following Zoledronic Acid administration. The majority of these symptoms were mild to moderate in nature and resolved within 3 days of the event onset. The incidence of these symptoms occurring within the first 3 days after administration of Zoledronic Acid, can be reduced with the administration of Paracetamol or Ibuprofen shortly following Zoledronic Acid administration. Severe and occasionally incapacitating bone, joint, and/or muscle pain have been infrequently reported in patients taking Zoledronic Acid.</p>', '<p>Zoledronic Acid is contraindicated during pregnancy and in breast-feeding women. It is also not recommended for use in children and adolescents below 18 years of age.</p>', '<p>Patients must be appropriately hydrated prior to administration of Zoledronic Acid. This is especially important in the elderly and for patients receiving diuretic therapy. Adequate hydration can be achieved by the patient drinking two glasses of fluid (such as water) before and after the infusion. Pre-existing hypocalcaemia must be treated by adequate intake of Calcium and Vitamin-D before initiating therapy with Zoledronic Acid. Other disturbances of mineral metabolism must also be effectively treated (e.g. diminished parathyroid reserve, thyroid surgery, parathyroid surgery, intestinal Calcium malabsorption). Physicians should consider clinical monitoring for these patients.</p>', '<p>Clinical experience with acute over dosage is limited. Patients who have received doses higher than those recommended should be carefully monitored. In the event of overdose leading to clinically significant hypocalcaemia, reversal may be achieved with supplemental oral Calcium and/or an infusion of Calcium.</p>', '<p>Bisphosphonate preparations.</p>', '<p>Store below 30&deg; C prior to opening. Protect from moisture and light. Zoledronic Acid must be kept out of the reach and sight of children.</p>', '<p><strong>Patients with renal impairment</strong>: The use of Zoledronic Acid in patients with creatinine clearance &lt;35 mL/min is not recommended due to limited clinical safety data in such patients. No dose adjustment is necessary in patients with creatinine clearance &gt;35 mL/min.<br />\r\n<br />\r\n<strong>Patients with hepatic impairment</strong>: No dose adjustment is required for patients with hepatic impairment.<br />\r\n<br />\r\n<strong>Elderly patients</strong>: No dose adjustment is required. However, because decreased renal function occurs more commonly in the elderly, special care should be taken to monitor renal function.<br />\r\n<br />\r\nZoledronic Acid must not be mixed or given intravenously with any other medication and must be given through a separate infusion line at a constant infusion rate. If refrigerated, allow the refrigerated solution to reach room temperature before administration. Aseptic techniques must be followed during the preparation of the infusion. Any unused solution should be discarded. Only clear solution free from particles and discoloration should be used.<br />\r\n<br />\r\nAfter opening, the solution is chemically and physically stable for at least 24 hours at 2&deg;C to 8&deg;C. From a microbiological point of view, the product should be used immediately. Zoledronic Acid solution for infusion must not be allowed to come into contact with any Calcium or other divalent cation-containing solutions.</p>', '2022-03-12 00:48:38', '2022-03-12 00:48:38'),
(1128, 1128, '<p>Zolmitriptan is indicated for the acute treatment of migraines with or without aura in adults.</p>', '<p>Migraines are likely due to local cranial vasodilatation and/or to the release of sensory neuropeptides through nerve endings in the trigeminal system. The therapeutic activity of Zolmitriptan&nbsp;for the treatment of migraine headache is thought to be due to the agonist effects at the 5-HT1B/1D&nbsp;receptors on intracranial blood vessels and sensory nerves of the trigeminal system which results in cranial vessel constriction and inhibition of pro-inflammatory neuropeptide release.</p>', '<p><strong>Tablet</strong>: The recommended starting dose of Zolmitriptan is 2.5 mg tablet. Maximum recommended single dose is 5 mg. If the migraine has not resolved by 2 hours after taking Zolmitriptan, or returns after a transient improvement, a second dose may be administered at least 2 hours after the first dose. The maximum daily dose is 10 mg in any 24-hours period.<br />\r\n<br />\r\n<strong>Nasal Spray</strong>: Administer one dose of Zolmitriptan Nasal Spray 5 mg for the treatment of acute migraine. If the headache returns the dose may be repeated after 2 hours. The maximum daily dose should not exceed 10 mg in any 24-hour period. In controlled clinical trials, single doses of 5 mg zolmitriptan nasal spray were administered into one nostril and were effective for the treatment of acute migraines in adults. Individuals may vary in response to Zolmitriptan Nasal Spray. The pharmacokinetics of a 5 mg nasal spray dose is similar to the 5 mg oral formulations. Doses lower than 5 mg can only be achieved through the use of an oral formulation. The choice of dose, and route of administration should therefore be made on an individual basis. The effectiveness of a second dose has not been established in placebo-controlled trials. The safety of treating an average of more than four headaches in a 30 day period has not been established.</p>', NULL, '<p>Contraindicated in patients with ischemic coronary artery disease, history of stroke, concurrent or recent use of a monoamine oxidase inhibitor and known hypersensitivity to Zolmitriptan.</p>', '<p>Most common adverse reactions were neck/throat/jaw pain or pressure, dizziness, paresthesia, asthenia, somnolence, warm/cold sensation, nausea, heaviness sensation, and dry mouth.</p>', '<p>Pregnancy Category C. Zolmitriptan should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether Zolmitriptan is excreted in human milk. A decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.</p>', '<p>There have been rare reports of serious cardiac adverse reactions, including acute myocardial infarction, occurring within a few hours following administration. Sensations of tightness, pain, and pressure may occur in the chest, throat, neck, and jaw after treatment with Zolmitriptan.</p>', NULL, '<p>5-HT Agonists</p>', '<p>Protect from light and moisture, store below 30&deg;C. Keep the medicine out of the reach of children.</p>', '<p>Pediatric Use: Not recommended for use in patients under 18 years of age.</p>', '2022-03-12 00:50:31', '2022-03-12 00:50:31');
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
(1129, 1129, '<p>Zolpidem is indicated for the short-term treatment of insomnia characterized by difficulties with sleep initiation. Zolpidem has been shown to decrease sleep latency for up to 35 days in controlled clinical studies&nbsp;<br />\r\n<br />\r\nThe clinical trials performed in support of efficacy were 4-5 weeks in duration with the final formal assessments of sleep latency performed at the end of treatment.</p>', '<p>Zolpidem is an imidazopyridine derivative that acts by binding to the benzodiazepine (BZD) receptors of the GABA receptor complex resulting in neuronal hyperpolarisation, action potential inhibition, increased in chloride conductance and decreased in neuronal excitability. It has strong sedative action but only minimal anxiolytic, myorelaxant and anticonvulsant properties due to its selectivity for the BZ1-receptor over the BZ2-receptor. Zolpidem has a rapid onset but short duration of hypnotic action.</p>', '<p><strong>Dosage In Adults</strong>: Use the lowest&nbsp;effective dose&nbsp;for the patient. The recommended initial dose is 5 mg for women and either 5 or 10 mg for men, taken only once per night immediately before bedtime with at least 7&ndash;8 hours remaining before the planned time of awakening. If the 5 mg dose is not effective, the dose can be increased to 10 mg. In some patients, the higher morning blood levels following use of the 10 mg dose increase the risk of next day impairment of driving and other activities that require full alertness. The total dose of Zolpidem should not exceed 10 mg once daily immediately before bedtime. Zolpidem should be taken as a single dose and should not be readministered during the same night.<br />\r\n<br />\r\nThe recommended initial doses for women and men are different because zolpidem clearance is lower in women.<br />\r\n<br />\r\n<strong>Special Populations</strong>: Elderly or debilitated patients may be especially sensitive to the effects of zolpidem tartrate. The recommended dose of Zolpidem in these patients is 5 mg once daily immediately before bedtime<br />\r\n<br />\r\nPatients with mild to moderate hepatic impairment do not clear the drug as rapidly as normal subjects. The recommended dose of Zolpidem in these patients is 5 mg once daily immediately before bedtime. Avoid Zolpidem use in patients with severe hepatic impairment as it may contribute to&nbsp;encephalopathy<br />\r\n<br />\r\n<strong>Use With CNS Depressants</strong>: Dosage adjustment may be necessary when Zolpidem is combined with other CNS depressant drugs because of the potentially additive effects</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>The effect of Zolpidem may be slowed by ingestion with or immediately after a meal.</p>', '<p>Co-administration of zolpidem with other CNS depressants increases the risk of CNS depression. Concomitant use of zolpidem with these drugs may increase drowsiness and psychomotor impairment, including impaired driving ability. Zolpidem tartrate was evaluated in healthy volunteers in single-dose interaction studies for several CNS drugs.<br />\r\n<br />\r\n<strong>Imipramine, Chlorpromazine</strong>: Imipramine in combination with zolpidem produced no pharmacokinetic interaction other than a 20% decrease in peak levels of imipramine, but there was an additive effect of decreased alertness. Similarly, chlorpromazine in combination with zolpidem produced no pharmacokinetic interaction, but there was an additive effect of decreased alertness and psychomotor performance&nbsp;<br />\r\n<br />\r\n<strong>Haloperidol</strong>: A study involving haloperidol and zolpidem revealed no effect of haloperidol on the pharmacokinetics or pharmacodynamics of zolpidem. The lack of a drug interaction following single-dose administration does not predict the absence of an effect following chronic administration&nbsp;<br />\r\n<br />\r\n<strong>Alcohol</strong>: An additive&nbsp;adverse effect&nbsp;on psychomotor performance between alcohol and oral zolpidem was demonstrated&nbsp;<br />\r\n<br />\r\n<strong>Sertraline</strong>: Concomitant administration of zolpidem and sertraline&nbsp;increases exposure to zolpidem<br />\r\n<br />\r\n<strong>Fluoxetine</strong>: After multiple doses of zolpidem tartrate and fluoxetine an increase in the zolpidem half-life (17%) was observed. There was no evidence of an additive effect in psychomotor performance</p>', '<p>Severe hepatic impairment.</p>', '<p>Atypical thinking and behaviour, hallucination, nightmare, somnolence, somnambulism, headache, nausea, vomiting, dizziness, vertigo, drowsiness, asthenia, ataxia, rebound insomnia, amnesia, GI disturbances, upper and lower respiratory tract infection, fatigue, visual disturbances, increased ALT serum concentrations, abnormal LFT.</p>', '<p><strong>Pregnancy</strong>&nbsp;Category C. Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.</p>', '<p>Obstructive sleep apnoea, myasthenia gravis, compromised respiratory function. Patients exhibiting symptoms of depression. History of drug or alcohol abuse. Avoid abrupt withdrawal and rapid dose reduction after prolonged therapy. Re-evaluate if insomnia fail to remit after 7-10 days as this may indicate the presence of underlying psychiatric and/or medical condition. Pregnancy, lactation, childn &lt;18 yr.</p>', '<p><strong>Symptoms</strong>: Drowsiness, impairment of consciousness from somnolence to coma, compromised CV and respiratory function.<br />\r\n<br />\r\n<strong>Management</strong>: Treatment is largely symptomatic and supportive. IV fluids should be administered as needed. Activated charcoal may be given if presented w/in 1 hr of ingestion of &gt;1 mg/kg zolpidem in adults or childn. Gastric lavage may be considered if presented w/in 1 hr of ingestion of &gt;100 mg zolpidem and monitor for at least 12 hr. Flumazenil may be used if there is severe CNS depression, but generally not needed. Haemodialysis is unlikely to be useful.</p>', '<p>Miscellaneous sedatives &amp; hypnotics.</p>', '<p>Store between 20-25&deg; C.</p>', '<p><strong>Pediatric Use</strong>: Zolpidem is not recommended for use in children. Safety and effectiveness of zolpidem in pediatric patients below the age of 18 years have not been established.</p>', '2022-03-12 00:56:51', '2022-03-12 00:56:51'),
(1130, 1130, '<p>Zonisamide is indicated as adjunctive therapy in the treatment of partial seizures in adults with&nbsp;epilepsy.</p>', '<p>The precise mechanism(s) by which zonisamide exerts its antiseizure effect is unknown. Zonisamide demonstrated&nbsp;anticonvulsant&nbsp;activity in several experimental models. In animals, zonisamide was effective against tonic&nbsp;extension&nbsp;seizures induced by maximal electroshock but ineffective against clonic seizures induced by subcutaneous pentylenetetrazol. Zonisamide raised the threshold for generalized seizures in the kindled rat model and reduced the duration of&nbsp;cortical&nbsp;focal&nbsp;seizures induced by electrical stimulation of the visual&nbsp;cortex&nbsp;in cats. Furthermore, zonisamide suppressed both interictal spikes and the secondarily generalized seizures produced by cortical application of tungstic acid gel in rats or by cortical freezing in cats. The relevance of these models to human&nbsp;epilepsy&nbsp;is unknown.<br />\r\n<br />\r\nZonisamide may produce these effects through action at sodium and calcium channels. In vitro pharmacological studies suggest that zonisamide blocks sodium channels and reduces voltagedependent, transient inward currents (T-type Ca2+&nbsp;currents), consequently stabilizing neuronal membranes and suppressing neuronal hypersynchronization. In vitro binding studies have demonstrated that zonisamide binds to the GABA/benzodiazepine receptor ionophore complex in an allosteric fashion which does not produce changes in chloride flux. Other in vitro studies have demonstrated that zonisamide (10&ndash;30 &mu;g/mL) suppresses synaptically-driven electrical activity without affecting postsynaptic GABA or&nbsp;glutamate&nbsp;responses (cultured mouse&nbsp;spinal cord&nbsp;neurons) or neuronal or glial uptake of [3H]-GABA (rat hippocampal slices). Thus, zonisamide does not appear to potentiate the synaptic activity of GABA. In vivo microdialysis studies demonstrated that zonisamide facilitates both dopaminergic and serotonergic neurotransmission.<br />\r\n<br />\r\nZonisamide is a carbonic anhydrase inhibitor. The contribution of this pharmacological action to the therapeutic effects of zonisamide is unknown. However, as a carbonic anhydrase inhibitor, zonisamide may cause metabolic&nbsp;acidosis</p>', '<p>Zonisamide&nbsp;is recommended as adjunctive therapy for the treatment of partial seizures in adults. Safety and efficacy in pediatric patients below the age of 16 have not been established. Zonisamide should be administered once or twice daily, using 25 mg or 100 mg capsules. Zonisamide is given orally and can be taken with or without food. Capsules should be swallowed whole.<br />\r\n<br />\r\n<strong>Adults Over Age 16</strong>: The prescriber should be aware that, because of the long half-life of zonisamide, up to two weeks may be required to achieve steady state levels upon reaching a stable dose or following dosage adjustment. Although the regimen described below is one that has been shown to be tolerated, the prescriber may wish to prolong the duration of treatment at the lower doses in order to fully assess the effects of zonisamide at steady state, noting that many of the side effects of zonisamide are more frequent at doses of 300 mg per day and above. Although there is some evidence of greater response at doses above 100-200 mg/day, the increase appears small and formal dose-response studies have not been conducted.<br />\r\n<br />\r\nThe initial dose of Zonisamide should be 100 mg daily. After two weeks, the dose may be increased to 200 mg/day for at least two weeks. It can be increased to 300 mg/day and 400 mg/day, with the dose stable for at least two weeks to achieve steady state at each level. Evidence from controlled trials suggests that Zonisamide doses of 100-600 mg/day are effective, but there is no suggestion of increasing response above 400 mg/day. There is little experience with doses greater than 600 mg/day.</p>', NULL, '<p>Zonisamide is contraindicated in patients who have demonstrated hypersensitivity to&nbsp;sulfonamides&nbsp;or zonisamide.</p>', '<p>The most common adverse reactions with Zonisamide (an incidence at least 4% greater than placebo) in controlled clinical trials and shown in descending order of frequency were&nbsp;somnolence,&nbsp;anorexia, dizziness,&nbsp;ataxia, agitation/irritability, and difficulty with memory and/or concentration.<br />\r\n<br />\r\nIn controlled clinical trials, 12% of patients receiving Zonisamide as adjunctive therapy discontinued due to an adverse reaction compared to 6% receiving placebo. Approximately 21% of the 1,336 patients with&nbsp;epilepsy&nbsp;who received Zonisamide in clinical studies discontinued treatment because of an adverse reaction. The most common adverse reactions leading to discontinuation were somnolence, fatigue and/or ataxia (6%), anorexia (3%), difficulty concentrating (2%), difficulty with memory, mental slowing, nausea/vomiting (2%), and weight loss (1%). Many of these adverse reactions were doserelated.</p>', '<p>Zonisamide may cause serious adverse fetal effects, based on clinical and nonclinical data. Zonisamide was teratogenic in multiple animal species.<br />\r\n<br />\r\nZonisamide treatment causes metabolic acidosis in humans. The effect of zonisamide-induced metabolic acidosis has not been studied in pregnancy; however, metabolic acidosis in pregnancy (due to other causes) may be associated with decreased fetal growth, decreased fetal&nbsp;oxygenation, and fetal death, and may affect the fetus&#39;s ability to tolerate labor. Pregnant patients should be monitored for metabolic acidosis and treated as in the non-pregnant state.&nbsp;<br />\r\n<br />\r\nNewborns of mothers treated with zonisamide should be monitored for metabolic acidosis because of transfer of zonisamide to the fetus and possible occurrence of transient metabolic acidosis following birth. Transient metabolic acidosis has been reported in neonates born to mothers treated during pregnancy with a different carbonic anhydrase inhibitor.</p>', '<p>Somnolence is commonly reported, especially at higher doses of Zonisamide. Zonisamide is metabolized by the liver and eliminated by the kidneys; caution should therefore be exercised when administering Zonisamide to patients with hepatic and renal dysfunction.</p>', '<p><strong>Human Experience</strong>: Experience with Zonisamide daily doses over 800 mg/day is limited. During Zonisamide clinical development, three patients ingested unknown amounts of Zonisamide as suicide attempts, and all three were hospitalized with CNS symptoms. One patient became comatose and developed&nbsp;bradycardia,&nbsp;hypotension, and&nbsp;respiratory depression; the zonisamide plasma level was 100.1 &mu;g/mL measured 31 hours post-ingestion. Zonisamide plasma levels fell with a half-life of 57 hours, and the patient became alert five days later.<br />\r\n<br />\r\n<strong>Management</strong>: No specific antidotes for Zonisamide overdosage are available. Following a suspected recent overdose,&nbsp;emesis&nbsp;should be induced or&nbsp;gastriclavage performed with the usual precautions to protect the airway. General&nbsp;supportive care&nbsp;is indicated, including frequent monitoring of vital signs and close observation.<br />\r\n<br />\r\nZonisamide has a long half-life. Due to the low protein binding of zonisamide (40%), renal&nbsp;dialysis&nbsp;may be effective. The effectiveness of renal dialysis as a treatment of overdose has not been formally studied. A poison control center should be contacted for information on the management of Zonisamide overdosage.</p>', '<p>Adjunct anti-epileptic drugs.</p>', NULL, '<p><strong>Patients With Renal Or Hepatic Disease</strong>: Because zonisamide is metabolized in the liver and excreted by the kidneys, patients with renal or hepatic disease should be treated with caution, and might require slower titration and more frequent monitoring<br />\r\n<br />\r\n<strong>Pediatric Use</strong>: The safety and effectiveness of Zonisamide in children under age 16 have not been established. Cases of oligohidrosis and hyperpyrexia have been reported. Zonisamide commonly causes metabolic acidosis in pediatric patients. Chronic untreated metabolic acidosis in pediatric patients may cause nephrolithiasis and/or nephrocalcinosis, osteoporosis and/or osteomalacia (potentially resulting in rickets), and may reduce growth rates. A reduction in growth rate may eventually decrease the maximal height achieved. The effect of zonisamide on growth and bonerelated sequelae has not been systematically investigated.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Single dose pharmacokinetic parameters are similar in elderly and young healthy volunteers. Clinical studies of zonisamide did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.</p>', '2022-03-12 00:58:58', '2022-03-12 00:58:58'),
(1131, 1131, '<p>Zopiclone is indicated for the short-term treatment and symptomatic relief of insomnia characterized by difficulty in falling asleep, frequent nocturnal awakenings and/or early morning awakenings.</p>', '<p>Zopiclone, a cyclopyrrolone derivative, is a short-acting hypnotic agent. This is structurally unrelated to existing hypnotics. However, the pharmacological profile of Zopiclone is similar to that of the benzodiazepines. Zopiclone pharmacological properties are: hypnotic, sedative, anxiolytic, anti-convulsant, muscle-relaxant. These effects are related to a specific agonist action at central receptors belonging to the GABAA&nbsp;macromolecular complex, modulating the opening of the chloride ion channel.</p>', '<p>The recommended initial dose is 3.75 mg (one-half of a 7.5 mg tablet). The dose can be increased to 5 mg and further to 7.5 mg if clinically indicated. In some patients, the higher doses result in zopiclone blood levels in the morning high enough to produce impairment of driving and other activities that require full alertness. The 7.5 mg dose should not be exceeded.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>Treatment with Zopiclone should usually not exceed 7-10 consecutive days. Use for more than 2-3 consecutive weeks requires complete re-evaluation of the patient. Prescriptions for Zopiclone should be written for short-term use (7-10 days) and it should not be prescribed in quantities exceeding a 1-month supply. The use of hypnotics should be restricted for insomnia where disturbed sleep results in impaired daytime functioning.</p>', '<p>Zopiclone may produce more pronounced side effects when co- administered with:</p>\r\n\r\n<ul>\r\n	<li>Alcohol</li>\r\n	<li>Other tranquilizers or sleeping pills</li>\r\n	<li>Sedative antihistamines</li>\r\n	<li>Anticonvulsants (medicines used to control or prevent convulsions)</li>\r\n	<li>Narcotic analgesics (opioids)</li>\r\n	<li>Antipsychotics, antidepressants and other psychotropic medications (mood altering drugs) which themselves can make you sleepy.</li>\r\n</ul>', '<p>Zopiclone is contraindicated in patients with severe hepatic insufficiency, contraindicated in patients with severe impairment of respiratory function.</p>', '<p>Common side effects are somnolence, dizziness, confusion, anterograde amnesia or memory impairment, feeling of drunkenness, euphoria, nightmares, agitation, anxiety or nervousness, hostility, depression, decreased libido, libido disorder, coordination abnormality, headache, hypotonia, tremor, muscle spasms, paresthesia, and speech disorder, palpitations, dysgeusia (bitter taste), dry mouth, coated tongue, bad breath, nausea, vomiting, diarrhea, constipation, anorexia or increased appetite.</p>', '<p>Do no take Zopiclone at anytime during pregnancy, it may affect the developing baby. Zopiclone passes into breast milk. Therefore, if you are breast feeding, this medicine should be avoided. Your doctor will discuss this with you.</p>', '<ul>\r\n	<li>Do not take more Zopiclone than prescribed.</li>\r\n	<li>Do not use for longer than recommended by your physician. Treatment should be as short as possible, because the risk of dependence increases with the duration of treatment.</li>\r\n	<li>Do not take Zopiclone if you drink alcohol.</li>\r\n	<li>Talk to your doctor if you have had episodes of sleepwalking in the past, or if there is a history of sleepwalking in your family.</li>\r\n	<li>Talk to your doctor if you have a condition that affects your sleep, such as Periodic Limb Movement Disorder (involuntary movement of limbs during sleep) or Restless Legs Syndrome (urge to move legs, usually accompanied by uncomfortable and unpleasant sensations, that begins or worsens during periods of inactivity, typically in the evening and night).</li>\r\n</ul>', '<p>Overdose is usually manifested by varying degrees of central nervous system depression ranging from drowsiness to coma according to the quantity ingested. In mild cases, symptoms include drowsiness, confusion, and lethargy; in more severe cases, symptoms may include ataxia, hypotonia, hypotension, methaemoglobinaemia, respiratory depression, and coma. Overdose should not be life threatening unless combined with other CNS depressants, including alcohol. Other risk factors, such as the presence of concomitant illness and the debilitated state of the patient, may contribute to the severity of symptoms and very rarely can result in fatal outcome. Symptomatic and supportive treatment in adequate clinical environment is recommended, attention should be paid to respiratory and cardiovascular functions. Gastric lavage or activated charcoal is only useful when performed soon after ingestion.</p>', '<p>Miscellaneous sedatives &amp; hypnotics.</p>', '<p>Store in a dry place, at room temperature (15&deg;C to 30&deg;C). Protect from light. Keep in a safe place out of reach of children.</p>', '<p>Zopiclone is not indicated for patients under 18 years of age.</p>', '2022-03-12 01:01:54', '2022-03-12 01:01:54'),
(1132, 1132, '<p>Zuclopenthixol is indicated for the management of the manifestations of schizophrenia. This is intended for the initial treatment of acute psychotic episodes or exacerbation of psychosis associated with schizophrenia.</p>', '<p>Zuclopenthixol, a thioxanthene derivative, has high affinity for both dopamine D1 receptors and dopamine D2 receptors. Zuclopenthixol also has high affinity for &alpha;1 -adrenergic and 5 HT2 receptors. It has weaker histamine H1 receptor blocking activity, and even lower affinity for muscarinic cholinergic and &alpha;2 -adrenergic receptors.</p>', '<p><strong>Zuclopenthixol Tablets</strong>: When initiating treatment with Zuclopenthixol tablets, it is recommended that the drug be given in divided doses (BID or TID). During the maintenance phase of treatment Zuclopenthixol tablets may be given as a single nighttime dose. For acute psychosis, the usual starting dose is 10-50 mg/day, which may be increased by 10-20 mg every 2-3 days, according to the patient&rsquo;s response. The usual therapeutic range is 20 mg to 60 mg daily. However, as with other antipsychotic drugs, some patients may require lower, while others may require higher dosage in order to obtain optimal benefit. Daily dosage higher than 100 mg is not recommended. For maintenance therapy, dosage should be reduced to the lowest level compatible with symptom control. The usual maintenance dose is 20-40 mg/day.<br />\r\n<br />\r\n<strong>Zuclopenthixol Acuphase</strong>: Dosage should be individually adjusted according to the patient&rsquo;s condition. The usual dose is 50-150 mg (1-3 ml) administered intramuscularly and repeated if necessary, at intervals of 2-3 days. Some patients may need an additional injection 1 or 2 days after the first injection.<br />\r\n<br />\r\n<strong>Zuclopenthixol Depot</strong>: Close supervision is required during the period following initiation of Zuclopenthixol Depot treatment, in order to minimize the risk of over-medication or insufficient suppression of psychotic symptoms. Supplemental oral antipsychotic medication may be required in diminishing dosage during this period. The usual maintenance dose is 150-300 mg intramuscularly, every 2-4 weeks. Some patients may require higher or lower doses, or shorter intervals between doses.</p>', '<p>Drugs that may interact with Zuclopenthixol include:</p>\r\n\r\n<ul>\r\n	<li>tricyclic antidepressant medicines</li>\r\n	<li>guanethidine and similar medicines (used to lower the blood pressure)</li>\r\n	<li>barbiturates and similar medicines</li>\r\n	<li>levodopa and similar medicines (used to treat Parkinson&rsquo;s disease)</li>\r\n	<li>metoclopramide (used in the treatment of gastro-intestinal disorders)</li>\r\n	<li>other antipsychotic medicines (e.g. thioridazine)</li>\r\n	<li>medicines that change the heartbeat (e.g. quinidine, amiodarone, sotalol, erythromycine, moxifloxacin, lithium)</li>\r\n</ul>', '<ul>\r\n	<li>Acute alcohol, barbiturate or opiate intoxication.</li>\r\n	<li>CNS depression due to any cause, comatose states, suspected or established subcortical brain damage or circulatory collapse.</li>\r\n	<li>Patients with known hypersensitivity to thioxanthenes, zuclopenthixol or to any ingredient in the formulation or component of the container.</li>\r\n</ul>', '<p>Common side effects are Racing heart (tachycardia), a sensation of a rapid, forceful, or irregular beating of the heart (palpitations) Tremor, twisting or repetitive movements or abnormal postures due to sustained muscle contractions (dystonia), increased muscle stiffness (hypertonia).</p>', '<p>The safe use of zuclopenthixol during pregnancy has not been established. Zuclopenthixol is excreted in human milk. The safe use of zuclopenthixol during lactation has not been established.</p>', '<p>Caution should be taken if-</p>\r\n\r\n<ul>\r\n	<li>you have used zuclopenthixol or any other treatment for schizophrenia before and if you had any problems</li>\r\n	<li>you are taking any other prescription or non-prescription medicines</li>\r\n	<li>you are pregnant or thinking of becoming pregnant, or if you are breast-feeding</li>\r\n	<li>you regularly drink a lot of alcohol</li>\r\n	<li>you have any liver problems, Parkinson&rsquo;s disease or have ever had seizures</li>\r\n	<li>you have dementia</li>\r\n	<li>you have glaucoma</li>\r\n	<li>you have any kidney problems</li>\r\n	<li>you have risk factors for stroke (e.g. smoking, high blood pressure).</li>\r\n	<li>you have hypokalemia or hypomagnesia (too little potassium or magnesium in your blood)</li>\r\n	<li>you have a history of cardiovascular disorders</li>\r\n	<li>you or someone in your family has a history of blood clots</li>\r\n	<li>you are being treated for cancer (applies to zuclopenthixol Depot only)</li>\r\n	<li>you use any other antipsychotic medicine</li>\r\n</ul>', '<p>Symptoms of overdose may include: somnolence, coma, unusual movements, convulsions, shock, high or low body temperature.</p>', '<p>Phenothiazine related drugs.</p>', '<p>Should be stored between 15&deg;C and 25&deg;C. Protect from light.</p>', '<p>The safety and efficacy of zuclopenthixol in children under the age of 18 years have not been established, therefore its use is not recommended.</p>', '2022-03-12 01:04:36', '2022-03-12 01:04:36'),
(1133, 1133, '<p>Yellow Fever Vaccine provides protection against a serious infectious disease called yellow fever. Yellow fever occurs in certain areas of the world and is spread to man through the bites of infected mosquitoes.<br />\r\n<br />\r\nYellow Fever Vaccine is given to people who:</p>\r\n\r\n<ul>\r\n	<li>are travelling to, passing through or living in an area where yellow fever occurs,</li>\r\n	<li>are travelling to any country that requires an International Certificate of Vaccination for entry (this may depend on the countries previously visited during the same trip),</li>\r\n	<li>may handle infectious materials such as laboratory workers.</li>\r\n</ul>\r\n\r\n<p>To obtain a valid vaccination certificate against yellow fever, it is necessary to be vaccinated in an approved vaccination centre by a qualified and trained healthcare professional so that an International Certificate of Vaccination can be issued. This certificate is valid from 10 days after the first dose of vaccine. In some circumstances, when a booster is needed, the certificate (see Section 3) is valid immediately after the injection.</p>', '<p>Live, attenuated virus stimulates active immunity to Yellow fever; conveys active immunity via stimulation of production of endogenously produced antibodies. Yellow fever vaccine is used for active immunisation against yellow fever. Each dose (usually 0.5 ml) contains at least 1000 mouse LD50&nbsp;units.</p>', '<p>Yellow Fever Vaccine is given as a single, 0.5 millilitre dose to adults and children from 6 months of age. The first dose should be given at least 10 days before protection from yellow fever is needed. This is because it takes 10 days for the first dose of vaccine to work and provide good protection against the yellow fever virus. The protection provided by this dose is expected to last at least 10 years and maybe life-long. In some circumstances, a booster with one dose (0.5 millilitre) may be needed:</p>\r\n\r\n<ul>\r\n	<li>if you or your child had an insufficient response to the first dose and you or your child continue to be at risk for yellow fever virus infection.</li>\r\n	<li>or depending on official recommendations.</li>\r\n</ul>\r\n\r\n<p>Yellow Fever Vaccine is given as an injection by a qualified and trained healthcare professional. It is usually injected just underneath the skin but it can be given into a muscle. It must not be injected into a blood vessel.</p>', '<p>Tell your healthcare professional if you are taking, have recently taken or might take any other medicines. If you have recently had any treatment or medicine which may have weakened your immune system, the vaccination must be delayed until your laboratory results show that your immune system has recovered. Your doctor will advise you when it is safe for you to be vaccinated. Yellow Fever Vaccine can be given at the same time as measles vaccine or vaccines against typhoid fever (those containing the Vi capsular polysaccharide) and/or hepatitis A. Vaccination with Yellow Fever Vaccine may lead to false positive results of blood tests for dengue or Japanese encephalitis. If you or your child have in the future such tests prescribed, please inform your doctor about this vaccination.</p>', '<p>Do not use Yellow Fever Vaccine if you or your child are allergic to:</p>\r\n\r\n<ul>\r\n	<li>the active substance, or</li>\r\n	<li>any of the other ingredients of this vaccine (listed in Section 6), or</li>\r\n	<li>eggs or chicken proteins.</li>\r\n	<li>have experienced a severe allergic reaction after a previous dose of any yellow fever vaccine,</li>\r\n	<li>is less than 6 months old,</li>\r\n	<li>have a poor or weakened immune system for any reason, such as illness or medical treatments (for example high-dose steroids, or any other medicines that affect the immune system, or chemotherapy). If you are unsure whether the medication may affect your or your child&rsquo;s immune system, discuss with your healthcare professional before the vaccine is administered.</li>\r\n	<li>have a weakened immune system due to HIV infection. Your healthcare professional will advise you if you or your child can still receive Yellow Fever Vaccine based on the results of your blood tests,</li>\r\n	<li>are infected with HIV and have active symptoms due to the infection,</li>\r\n	<li>have a history of problems with your or your child&rsquo;s thymus gland or have had the thymus gland removed for any reason,</li>\r\n	<li>have an illness with a high or moderate fever or an acute illness. The vaccination will be postponed until you or your child have recovered.</li>\r\n</ul>', '<p>The following serious side effects have sometimes been reported: Allergic reactions:</p>\r\n\r\n<ul>\r\n	<li>Rash, itching or hives on the skin</li>\r\n	<li>Swelling of the face, lips, tongue or other parts of the body</li>\r\n	<li>Difficulty swallowing or breathing</li>\r\n	<li>Loss of consciousness</li>\r\n</ul>', '<p>If you are pregnant, or breastfeeding, think you may be pregnant or are planning to have a baby, ask your healthcare professional for advice before being vaccinated. You should not receive Yellow Fever Vaccine during pregnancy or breastfeeding unless this cannot be avoided. Also, it is recommended that you do not become pregnant within one month after receiving Yellow Fever Vaccine. Your healthcare professional can advise you on whether it is essential that you are vaccinated. In case vaccination is needed, it is recommended to interrupt breastfeeding for at least 2 weeks after you receive Yellow Fever Vaccine. In case you receive the vaccine while pregnant or breastfeeding, consult your healthcare professional.</p>', '<p>It is important to tell your healthcare professional if any of the points below apply to you or your child. If there is anything you do not understand, ask your healthcare professional to explain.<br />\r\n<br />\r\nBefore using Yellow Fever Vaccine, it is important that you complete a risk assessment with a trained healthcare professional, to determine whether you should receive the vaccine.</p>\r\n\r\n<ul>\r\n	<li>If you are over 60 years old or if your child is less than 9 months as you have an increased risk of certain types of severe but rare reactions to the vaccine (including serious reactions that affect the brain and nerves, and vital organs). You will only be given the vaccine if the risk of infection with the virus is well established in countries where you are going to stay.</li>\r\n	<li>If your child is aged 6 to 9 months. Yellow Fever Vaccine may be given to children aged between 6 and 9 months only in special situations and on the basis of current official advice.</li>\r\n	<li>If you or your child are infected by the HIV virus but do not have active symptoms due to the infection. Your healthcare professional will advise if Yellow Fever Vaccine can be given based on the results of laboratory tests and specialist advice.</li>\r\n	<li>If you or your child have any bleeding disorder (such as haemophilia or low level of platelets) or are taking any medicines that stop the blood clotting normally. You can still be given Yellow Fever Vaccine provided that it is injected under the skin and not into muscle.</li>\r\n	<li>If you had any allergic reaction to latex. The tip cap of the pre-filled syringe contains a natural rubber latex derivative which may cause an allergic reaction.</li>\r\n</ul>', NULL, NULL, '<p>Keep out of the sight and reach of children. Do not use this vaccine after the expiry date which is stated on the carton after EXP. The expiry date refers to the last day of that month. Store in a refrigerator (2&deg;C-8&deg;C). Do not freeze.</p>', NULL, '2022-03-12 01:07:57', '2022-03-12 01:07:57'),
(1134, 1134, '<p>Xylometazoline is indicated in-</p>\r\n\r\n<ul>\r\n	<li>Nasal congestion in colds, rhinitis, sinusitis, headache.</li>\r\n	<li>Tubal block and serous otitis media associated with nasal congestion.</li>\r\n</ul>', '<p>Nasal congestion is caused by various etiologies, such as rhinosinusitis and allergic or non-allergic rhinitis, leading to congestion of the venous sinusoids lining the nasal mucosa. Activation of &alpha;-adrenergic receptors leads to vasoconstriction of the blood vessels of the nasal mucosa and resumption of nasal airflow. As the most abundantly expressed in the human nasal mucosa, &alpha;1A- and &alpha;2B-adrenoceptors may play the most important role in vasoconstriction of the human nasal mucosa. Xylometazoline is a more selective agonist at &alpha;2B-adrenoceptors, with affinity at &alpha;1A-, &alpha;2A-, &alpha;2C-, &alpha;1B-, and &alpha;1D-adrenoceptors. Xylometazoline decreases nasal resistance during inspiration and expiration and increases the volume of nasal airflow. Compared to oxymetazoline, another imidazoline nasal decongestant, xylometazoline had a slightly faster onset of action although they had a similar duration of action. In one study, subjects with nasal congestion reported relief of earache and sore throat in addition to nasal decongestion: it is speculated that oxymetazoline mediates this effect by causing vasoconstriction of the nasal mucosa that contains the venous sinuses and nasal decongestion allows breathing through the nose, providing relief from sore throat caused by mouth breathing that dries and irritates the throat.</p>', '<p><strong>Adults</strong>: Xylometazoline 0.1%: 2 or 3 drops in each nostril two to three times daily. Xylometazoline 0.1% should not be used for children under the age of 12 years.<br />\r\n<br />\r\n<strong>Children 6 to 12 years of age</strong>: Xylometazoline 0.05%: 2 or 3 drops in each nostril two or three times daily.<br />\r\n<br />\r\n<strong>Children less than 6 years of age</strong>: Xylometazoline 0.05%: 1 drop in each nostril two or three times daily.<br />\r\n<br />\r\n<strong>Infants less than 3 months</strong>: Not to be used in infants less than 3 months.</p>', '<p>No drug interactions have been reported.</p>', '<p>Xylometazoline nasal drops is contraindicated in patients with transsphenoidal hypophysectomy or surgery exposing the dura mater. It is also contraindicated in patients who are hypersensitive to Xylometazoline. Each Xylometazoline nasal drop should be used by one person only to prevent any cross-infection. Patients are advised not to take decongestants for more than seven consecutive days.</p>', '<p>The following side-effects have occasionally been encountered:</p>\r\n\r\n<ul>\r\n	<li>A burning sensation in the nose and throat</li>\r\n	<li>Local irritation</li>\r\n	<li>Nausea and dryness of the nasal mucosa.</li>\r\n</ul>', '<p>Pregnancy category C. Xylometazoline should not be used during pregnancy. The use of Otrivin while breastfeeding should only take place on the instructions of a doctor.</p>', '<p>Xylometazoline Hydrochloride nasal drops for adults (0.1%) should not be used for children below 12 years. Drops should not be used for long time in cases with chronic rhinitis. Prolonged use of the drops may cause rebound congestion and drug induced rhinitis.</p>', NULL, '<p>Nasal Anti-histamine preparations.</p>', '<p>Protect from light. For reasons of hygiene, do not use the bottle more than 28 days after opening it.</p>', NULL, '2022-03-12 01:26:38', '2022-03-12 01:26:38'),
(1135, 1135, '<p>Warfarin is indicated in the following conditions-</p>\r\n\r\n<ul>\r\n	<li>Prophylaxis and/or treatment of thromboembolic complications associated with atrial fibrillation and/or cardiac valve replacement</li>\r\n	<li>Indicated to reduce the risk of death, recurrent myocardial infarction, and thromboembolic events such as stroke or systemic embolization after myocardial infarction</li>\r\n	<li>Prophylaxis and treatment of venous thrombosis and pulmonary embolism</li>\r\n	<li>Transient ischaemic attacks.</li>\r\n</ul>', '<p>Warfarin is a [vitamin K] antagonist which acts to inhibit the production of vitamin K by vitamin K epoxide reductase. The reduced form of vitamin K, vitamin KH2&nbsp;is a cofactor used in the &gamma;-carboxylation of coagulation factors VII, IX, X, and thrombin. Carboxylation induces a conformational change allowing the factors to bind Ca2+&nbsp;and to phospholipid surfaces. Uncarboxylated factors VII, IX, X, and thrombin are biologically inactive and therefore serve to interrupt the coagulation cascade. The endogenous anticoagulation proteins C and S also require &gamma;-carboxylation to function. This is particularly true in the case of thrombin which must be activated in order to form a thrombus. vitamin KH2&nbsp;is converted to vitamin K epoxide as part of the &gamma;-carboxylation reaction catalyzed by &gamma;-glutamyl carboxylase. Vitamin K epoxide is then converted to vitamin K1&nbsp;by vitamin K epoxide reductase then back to vitamin KH2&nbsp;by vitamin K reductase. Warfarin binds to vitamin K epoxide reductase complex subunit 1 and irreversibly inhibits the enzyme thereby stopping the recycling of vitamin K by preventing the conversion of vitamin K epoxide to vitamin K1. This process creates a hypercoagulable state for a short time as proteins C and S degrade first with half lives of 8 and 24 hours, with the exception of factor VII which has a half life of 6 hours. Factors IX, X, and finally thrombin degrade later with half lives of 24, 36, and 50 hours resulting in a dominant anticoagulation effect. In order to reverse this anticoagulation vitamin K must be supplied, either exogenously or by removal of the vitamin K epoxide reductase inhibition, and time allowed for new coagulation factors to be synthesized. It takes approximately 2 days for new coagulation factors to be synthesized in the liver. Vitamin K2, functionally identical to vitamin K1, is synthesized by gut bacteria leading to interactions with antibiotics as elimination of these bacteria can reduce vitamin K2.</p>', '<p>Whenever possible, the baseline prothrombin time should be determined but the initial dose should not be delayed whilst awaiting the result.<br />\r\n<br />\r\n<strong>Use in adults</strong>: The usual adult induction dose of warfarin is 10 mg daily for 2 days. The subsequent maintenance dose depends upon the prothrombin time, reported as INR (international normalized ratio). The daily maintenance dose of warfarin is usually 3 to 9 mg (taken at the same time each day). The maintenance dose is omitted if the prothrombin time is excessively prolonged. Once the maintenance dose is established in the therapeutic range, it is rarely necessary to alter. In emergencies, anticoagulant therapy should be initiated with heparin and warfarin together. Where there is less urgency, as in patients disposed to or at special risk of thromboembolism, anticoagulant therapy may be initiated with warfarin alone. Control tests must be made at regular intervals and maintenance dosage further adjusted according to the results obtained.<br />\r\n<br />\r\n<strong>Use in children</strong>: Safety and efficacy in children &lt;18 years old have not been established. However, there is evidence of use and the initial dose is usually 0.1 mg.kg-1.d-1&nbsp;adjusted subsequently to aim for an INR range the same as in adults.</p>', '<p>Oral anticoagulants have a greater potential for clinically significant drug interactions. Warn all patients about potential hazards and instruct against taking or withdrawing any drug, including non-prescription products, without the advice of a physician.</p>', '<p>Warfarin can not be administered in the following cases;</p>\r\n\r\n<ul>\r\n	<li>Actual or potential hemorrhagic conditions, eg. Peptic ulcer, or to patients with uncontrolled hypertension</li>\r\n	<li>Severe hepatic or renal disease</li>\r\n	<li>Pregnancy</li>\r\n	<li>Known hypersensitivity to warfarin</li>\r\n	<li>Bacterial endocarditis</li>\r\n</ul>\r\n\r\n<p>Its use within 24 hours following surgery or labor should be undertaken with caution, if at all.</p>', '<p>Hemorrhage is the principal adverse effect of oral anticoagulants. Other adverse reactions include nausea, vomiting, diarrhea, hypersensitivity, rash, alopecia, and unexplained drop in haematocrit, &quot;purple toes&quot;, skin necrosis, jaundice, and hepatic dysfunction.</p>', '<p>Warfarin is contraindicated in the first trimester of pregnancy because of the risk of teratogenicity. It should not be used in women who are or may become pregnant because the drug passes through the placental barrier and may cause fatal hemorrhage to the fetus. Warfarin appears in the milk of nursing mothers in an inactive form. Infants nursed by mothers treated with Warfarin had no change in prothrombin times. Effects in premature infants have not been evaluated.</p>', '<p>Periodic determination of prothrombin time (PT)/international normalized ratio (INR) or other suitable coagulation test is essential. Numerous factors, alone or in combination, including travel, changes in diet, environment, physical state and medication may influence response of the patient to anticoagulants. It is generally good practice to monitor the patient&#39;s response with additional PT/INR determination in the period immediately after discharge from the hospital, and whenever other medications are initiated, discontinued or taken irregularly. The following factors may exaggerate the effects of warfarin and necessitate a reduction in dosage; loss of weight, elderly subject, acute illness, deficient renal function, decreased dietary intake of vitamin K, administration of certain drugs (see drug interaction). Factors which may call for an increase in maintenance dosage include weight gain, diarrhea and vomiting, increased intake of vitamin K, fats and oils, and the administration of certain drugs. Careful additional laboratory control is necessary if the patient is to be changed from one formulation to another. Reversal of warfarin anticoagulation by vitamin K takes several days. In emergency situations fresh frozen plasma should be given.</p>', '<p>If hemorrhage occurs or a potential bleeding state arises, excessive depression of the coagulation activity can be corrected by temporary withdrawal of warfarin accompanied, if necessary, by infusion of fresh-frozen plasma or whole blood. Vitamin K, 5 mg to 10 mg orally or intravenously, may be required to supplement specific treatment with co-factor concentrates.</p>', '<p>Anti-coagulants, Oral Anti-coagulants.</p>', '<p>Do not store above 30&deg;C. Keep away from light and out of the reach of children.</p>', NULL, '2022-03-12 01:29:24', '2022-03-12 01:29:24'),
(1136, 1136, '<p>Water for injection is water of extra high quality without significant contamination. A sterile version is used for making solutions that will be given by injection. Before such use other substances generally must be added to make the solution more or less isotonic. It can be given by injection into a vein, muscle, or under the skin. A non-sterile version may be used in manufacturing with sterilization occurring later in the production process.</p>', '<p>If it is given by injection into a vein without making it more or less isotonic, breakdown of red blood cells may occur. This can then result in kidney problems. Excessive amount may also result in fluid overload. Water for injection is generally made by distillation or reverse osmosis. It should contain less than a mg of elements other than water per 100 ml. Versions with agents that stop bacterial growth are also available.</p>', NULL, NULL, NULL, NULL, NULL, NULL, NULL, '<p>Other preparations.</p>', NULL, NULL, '2022-03-12 01:30:27', '2022-03-12 01:30:27'),
(1137, 1137, '<p>For general use as an emollient in the symptomatic relief of dry skin conditions.</p>', '<p>White Soft Paraffin and Liquid Paraffin are emollients with occlusive properties for topical application. There is no significant systemic absorption of the active ingredients but has substantial penetration into the stratum corneum.</p>', '<p>Apply a thin film of the ointment to the affected area of the skin, in the direction of hair growth, as required. Repeat as necessary. Ideally the product should be applied three or four times a day or at least twice a day. In adults, where a large area of the body is affected, up to 500 g a week may be used. For topical administration only.</p>', NULL, NULL, '<p>Prolong use may cause folliculitis, should this occur, use of the product should be discontinued.</p>', '<p>The safety of White Soft Paraffin and Liquid Paraffin during pregnancy and lactation has not been established, but use during this periods is not considered to constitute a hazard.</p>', '<p>This topical agent should be applied in the direction of hair growth to reduce the incidence of folliculitis.</p>', '<p>This topical agent has low toxicity and if ingested treatment should be supportive and symptomatic. Gastric lavage should not be attempted following ingestion of paraffin-based products, due to the risk of inhalation or aspiration into the lungs.</p>', '<p>Emollients &amp; combined preparations.</p>', '<p>Do not store above 30&deg; C. Keep away from light and out of the reach of children.</p>', NULL, '2022-03-12 01:32:10', '2022-03-12 01:32:10');
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
(1138, 1138, '<p>White soft paraffin, Liquid paraffin &amp; Wool alcohol combination eye ointment is indicated in dry eye condition particularly useful at night as it remains in the eye longer than drops. It is used as adjunctive therapy to lubricate and protect the eye in conditions such as exposure keratitis, decreased corneal sensitivity, recurrent corneal erosions, keratitis sicca, and ophthalmic surgery.</p>', '<p>White soft paraffin, Liquid paraffin &amp; Wool alcohol combination eye ointment produce a transparent, lubricating and moistening film on the surface of the eyeball. White soft paraffin, Liquid paraffin &amp; Wool alcohol eye ointment provides soothing relief from the symptoms of dry eyes such as soreness, irritation or a gritty sensation. These may be caused by inadequate production of tears to keep the eye moist or by things such as certain medical conditions or treatment. The ointment also helps to protect the eyeball and can thus be useful for people who suffer from recurrent corneal epithelial erosion.</p>', '<p>Apply a ribbon of ointment (1-1.5 cm) into the affected eye(s) prior to going to sleep or as directed by doctor.</p>', NULL, '<p>Hypersensivity to any components of the medication.</p>', '<p>Stinging/redness in the eye, widened pupils or blurred vision may occur.</p>', '<p><strong>Pregnancy</strong>: There is no data from the use of White paraffin, Liquid paraffin &amp; Wool alcohol combination eye ointment in pregnant women. However, all three components are pharmacologically inert, non-irritating and nontoxic.<br />\r\n<br />\r\n<strong>Lactation</strong>: It is unknown that White paraffin, Liquid paraffin &amp; Wool alcohol eye ointment are excreted in human milk.</p>', '<p>Ophthalmic use only. If patients experience headache, eye pain, vision changes, irritation of the eyes, persistent redness or if the condition worsens or persists for more than 72 hours discontinue use and consult with doctor.</p>', NULL, '<p>Emollients &amp; combined preparations</p>', '<p>Store in a cool and dry place, away from light. Keep out of reach of children. Do not touch the tip to surfaces since this may contaminate the product. Do not use the medicine after one month of first opening.</p>', NULL, '2022-03-12 01:33:45', '2022-03-12 01:33:45'),
(1139, 1139, '<p>Ulipristal Acetate is indicated for emergency contraception within 120 hours (5 days) of unprotected sexual intercourse or contraceptive failure.</p>', '<p>Ulipristal Acetate is an orally-active synthetic SPRM that acts via high-affinity binding to the human progesterone receptor. The primary mechanism of action is inhibition or delay of ovulation. Data shows that even when taken immediately before ovulation is scheduled to occur, Ulipristal Acetate is able to postpone follicular rupture in some women.</p>', '<p>One 30 mg tablet must be taken as soon as possible but no later than 120 hours of unprotected intercourse or contraceptive failure, with or without food. If vomiting occurs within 3 hours of intake, then another tablet needed to be taken. Ulipristal Acetate can be taken at any time of menstrual cycle.</p>', '<p>Ulipristal Acetate interacts with the following drugs: Barbiturates, Carbamazepine, Phenobarbital, Rifampicin, Itraconazole, Ketoconazole etc.</p>', '<p>Ulipristal Acetate is contraindicated in case of hypersensitivity to active substances and in pregnancy.</p>', '<p>Most common side-effects are headache, nausea, abdominal pain, dysmenorrhea, fatigue, dizziness, breast tenderness etc.</p>', '<p>Contraindicated in suspected or existing pregnancy. Ulipristal Acetate excretes in breast milk. So breastfeeding is not recommended for one week after intake. Extremely limited data are available on the health of the fetus/newborn exposed to Ulipristal acetate.</p>', '<p><strong>Existing Pregnancy</strong>: Ulipristal Acetate is not indicated for termination of an existing pregnancy.<br />\r\n<br />\r\n<strong>Ectopic Pregnancy</strong>: A history of ectopic pregnancy is not a contraindication to the use of this emergency contraceptive method.<br />\r\n<br />\r\n<strong>Repeated Use</strong>: Ulipristal Acetate is for occasional use as an emergency contraceptive. It should not replace a regular method of contraception. Repeated use of Ulipristal Acetate within the same menstrual cycle is not recommended, as safety and efficacy of repeat use within the same cycle has not been evaluated.<br />\r\n<br />\r\n<strong>Fertility Following Use</strong>: A rapid return of fertility is likely following treatment with Ulipristal Acetate for emergency contraception. So, to prevent pregnancy on a later episode of sexual intercourse one should use the barrier method (ex. Condom).<br />\r\n<br />\r\n<strong>Effect on Menstrual Cycle</strong>: After Ulipristal Acetate intake, menses sometimes occur earlier or later than expected by a few days. In clinical trials, cycle length was increased by a mean of 2.5 days but returned to normal in the subsequent cycle. 7% of subjects reported menses occurring more than 7 days earlier than expected, and 19% reported a delay of more than 7 days. If there is a delay in the onset of expected menses beyond 1 week, a pregnancy test should be performed. 9% of women studied reported intermenstrual bleeding after the use of Ulipristal Acetate.</p>', '<p>Experience with Ulipristal Acetate overdose is limited, in a clinical study, a single dose equivalent to four times Ulipristal Acetate was administered to a limited number of subjects without any adverse reactions.</p>', '<p>Drugs acting on the Uterus, Emergency Contraceptive Pill.</p>', '<p>Store in a dry and cool place, protected from sunlight. Do not freeze. Keep out of reach of children.</p>', '<p><strong>Children and Adolescents</strong>: Limited safety and efficacy data available on women under 18 years old.<br />\r\n<br />\r\n<strong>Hepatic Impairment</strong>: No studies have been conducted to evaluate the effect of hepatic disease on the disposition of Ulipristal Acetate.<br />\r\n<br />\r\n<strong>Renal Impairment</strong>: No studies have been conducted to evaluate the effect of renal disease on the disposition of Ulipristal Acetate.</p>', '2022-03-12 01:36:25', '2022-03-12 01:36:25'),
(1140, 1140, '<p>Ulipristal Acetate is used before surgery to treat moderate to severe symptoms of uterine fibroids, which are noncancerous (benign) tumors of the womb (uterus). Ulipristal Acetate&nbsp;is used in adult women who have not yet reached menopause.</p>', '<p>Ulipristal acetate is a selective progesterone receptor modulator. It acts by blocking the receptor of a hormone in the body called progesterone, which is involved in controlling the growth of the lining of the womb. In some women, progesterone may promote the growth of fibroids, which may cause symptoms such as heavy uterine bleeding, anaemia and abdominal pain. When progesterone activity is blocked, fibroid cells stop dividing and eventually die which reduces the size of the fibroids and reduces the symptoms caused by them.</p>', '<p>Ulipristal acetate is taken by mouth and the recommended dose is one tablet (5 mg) a day for up to three months. The three month treatment can be repeated but only once. Treatment should always be started during the first week of the menstrual cycle (period bleeding).</p>', NULL, '<p>Contraindicated in patients with-</p>\r\n\r\n<ul>\r\n	<li>Hypersensitivity to the active substance or to any of the excipients.</li>\r\n	<li>Pregnancy and breastfeeding.</li>\r\n	<li>Genital bleeding of unknown aetiology or for reasons other than uterine fibroids.</li>\r\n	<li>Uterine, cervical, ovarian or breast cancer.</li>\r\n</ul>', '<p>Common side effects are&nbsp;Endometrial thickening, Hot flush, Headache, Uterine haemorrhage.</p>', '<p>Pregnancy Category X. Ulipristal acetate is contraindicated during pregnancy. Ulipristal acetate is excreted in human milk and is not recommended.</p>', '<p>Ulipristal acetate should only be prescribed after careful diagnosis and Pregnancy should be precluded prior to treatment.</p>\r\n\r\n<ul>\r\n	<li><strong>Contraception</strong>: Concomitant use of progestagen-only pills, a progestagen releasing intrauterine device or combined oral contraceptive pills is not recommended. Although a majority of women taking a therapeutic dose of ulipristal acetate have anovulation, a non-hormonal contraceptive method is recommended during treatment.</li>\r\n	<li><strong>Endometrial Changes</strong>: Endometrial Thickening or Progesterone receptor modulator Associated Endometrial Changes (PAEC). Ulipristal acetate has a specific pharmacodynamic action on the endometrium. An increase in thickness of the endometrium may occur. The thickness of the endometrium decreases to baseline levels upon treatment cessation. If the endometrial thickening persists beyond 3 months following the end of treatment and return of menstruations, this may need to be investigated as per usual clinical practice to exclude underlying conditions.</li>\r\n	<li><strong>Bleeding Pattern</strong>:&nbsp;Patients should be informed that treatment with ulipristal acetate usually leads to a significant reduction in menstrual blood loss or amenorrhea within the first 10 days of treatment. Should the excessive bleeding persist, patients should notify their physician.</li>\r\n	<li><strong>Asthma Patients</strong>:&nbsp;Use in women with severe asthma insufficiently controlled by oral glucocorticoids is not recommended.</li>\r\n</ul>', '<p>Experience with ulipristal acetate overdose is limited. Single doses up to 200 mg and daily doses of 50 mg for 10 consecutive days were administered to a limited number of subjects, and no severe or serious adverse reactions were reported.</p>', '<p>Drugs acting on the Uterus.</p>', '<p>Keep protected from light &amp; moisture, store below 25&deg; C. Keep out of reach of children.</p>', '<p><strong>Hepatic Impairment</strong>:&nbsp;Ulipristal acetate is not recommended in patients with severe hepatic impairment unless the patient is closely monitored.<br />\r\n<br />\r\n<strong>Renal Impairment</strong>:&nbsp;Renal impairment is not expected to significantly alter the elimination of ulipristal acetate. In the absence of specific studies, ulipristal acetate is not recommended for patients with moderate and severe renal impairment unless the patient is closely monitored.</p>', '2022-03-12 01:38:19', '2022-03-12 01:38:19'),
(1141, 1141, '<p>Upadacitinib is a Janus kinase (JAK) inhibitor indicated for the treatment of adults with moderate to severe active rheumatoid arthritis who have had an inadequate response or intolerance to methotrexate.</p>', '<p>Upadacitinib is a Janus kinase (JAK) inhibitor. JAKs are intracellular enzymes which transmit signals arising from cytokine or growth factor-receptor interactions on the cellular membrane to influence cellular processes of hematopoiesis and immune cell function. Within the signaling pathway, JAKs phosphorylate and activate Signal Transducers and Activators of Transcription (STATs) which modulate intracellular activity including gene expression. Upadacitinib modulates the signaling pathway at the point of JAKs, preventing the phosphorylation and activation of STATs.</p>', '<p>The recommended dose of Upadacitinib is 15 mg once daily. Upadacitinib may be used as monotherapy or in combination with methotrexate or other non-biologic DMARDs. Avoid initiation or interrupt Upadacitinib if absolute lymphocyte count is less than 500 cells/mm3, absolute neutrophil count is less than 1000 cells/mm3&nbsp;or hemoglobin level is less than 8 g/dL.<br />\r\n<br />\r\nPediatric Use: The safety and efficacy of Upadacitinib in children and adolescents aged 0 to 18 years have not yet been established. No data are available.</p>', '<p><strong>Strong CYP3A4 Inhibitors</strong>: Upadacitinib exposure is increased when co-administered with strong CYP3A4 inhibitors (such as ketoconazole). Upadacitinib should be used with caution in patients receiving chronic treatment with strong CYP3A4 inhibitors.<br />\r\n<br />\r\n<strong>Strong CYP3A4 Inducers</strong>: Upadacitinib exposure is decreased when co-administered with strong CYP3A4 inducers (such as rifampin), which may lead to reduced therapeutic effect of Upadacitinib. Coadministration of Upadacitinib with strong CYP3A4 inducers is not recommended.</p>', NULL, '<p>Adverse reactions (greater than or equal to 1%) are: upper respiratory tract infections, nausea, cough, and pyrexia.</p>', '<p>The limited human data on use of Upadacitinib in pregnant women are not sufficient to evaluate a drug-associated risk for major birth defects or miscarriage. Based on animal studies, upadacitinib has the potential to adversely affect a developing fetus. Advise not to breastfeed.</p>', '<ul>\r\n	<li><strong>Serious Infections</strong>: Avoid use of Upadacitinib in patients with active, serious infection, including localized infections.</li>\r\n	<li><strong>Malignancy</strong>: Consider the risks and benefits of Upadacitinib treatment prior to initiating therapy in patients with a known malignancy.</li>\r\n	<li><strong>Thrombosis</strong>: Consider the risks and benefits prior to treating patients who may be at increased risk of thrombosis. Promptly evaluate patients with symptoms of thrombosis and treat appropriately.</li>\r\n	<li><strong>Gastrointestinal Perforations</strong>: Use with caution in patients who may be at increased risk.</li>\r\n	<li>Laboratory Monitoring: Recommended due to potential changes in lymphocytes, neutrophils, hemoglobin, liver enzymes and lipids.</li>\r\n	<li><strong>Embryo-Fetal Toxicity</strong>: Upadacitinib may cause fetal harm based on animal studies. Advise females of reproductive potential of the potential risk to a fetus and to use effective contraception.</li>\r\n	<li>Vaccinations: Avoid use of Upadacitinib with live vaccines.</li>\r\n</ul>', '<p>Upadacitinib was administered in clinical trials up to doses equivalent in daily AUC to 60 mg extended-release once daily. Adverse events were comparable to those seen at lower doses and no specific toxicities were identified. Approximately 90% of upadacitinib in the systemic circulation is eliminated within 24 hours of dosing (within the range of doses evaluated in clinical studies). In case of an overdose, it is recommended that the patient be monitored for signs and symptoms of adverse reactions. Patients who develop adverse reactions should receive appropriate treatment.</p>', '<p>Drugs used for Rheumatoid Arthritis.</p>', '<p>Do not store above 25&deg;C. Protect from light. Keep out of reach of children.</p>', NULL, '2022-03-12 01:40:36', '2022-03-12 01:40:36'),
(1142, 1142, '<p>Urea 10% cream is indicated for-</p>\r\n\r\n<ul>\r\n	<li>Ichthyosis and dry skin conditions</li>\r\n	<li>Management of eczemas</li>\r\n	<li>Management of psoriasis</li>\r\n</ul>', '<p>Topical urea is bacteriostatic, bactericidal, fungistatic, proteolytic, hygroscopic and has mild local anesthetic properties. These actions are dose dependent. Most of its therapeutic applications depend on its hygroscopic properties. The hygroscopic property is due to its ability to cause configurational change in proteins in the stratum corneum. A 10% urea cream has been shown to increase the water holding capacity of ichthyotic scale by 100% after 3 weeks of treatment. There is no information available about percutaneous absorption of urea. Therapeutic effects depend on local concentrations, not on systemic absorption of the drug. If absorbed, urea would be excreted unchanged in the urine.</p>', '<p>Urea 10% cream is applied topically. Wash affected areas well, rinse off all traces of soap, dry and apply sparingly twice daily. Occlusive dressings may be used, but are usually unnecessary because of the self-occlusive nature of the cream.<br />\r\n<br />\r\nUse in children: Urea 10% cream can be used in all age groups.</p>', '<p>No hazardous drug interaction has been reported.</p>', '<p>This is contraindicated in any other ingredient of this preaparation.</p>', '<p>No serious toxicity has been reported with topical urea. Historically it is considered a safe drug. But on some occasions, topical urea has been shown to cause burning and irritation, if applied to inflamed, broken or exudative skin eruptions.</p>', '<p>Urea cream can be used during pregnancy and lactation.</p>', '<p>In some instances, urea 10% cream may cause local irritation and edema, when applied to sensitive skin. If the condition is aggravated or there is no improvement the doctor should be consulted. Avoid application to moist or broken skin.</p>', NULL, '<p>Topical urea preparations.</p>', '<p>Keep out of the reach of children. Do not freeze. Keep at cool and dry place.</p>', NULL, '2022-03-12 01:42:14', '2022-03-12 01:42:14'),
(1143, 1143, '<p><strong>Adults &amp; children over 12 years</strong>: It is intended to be used for the symptomatic treatment of heels &amp; feet anhydrosis including in consumers and diabetics.</p>', '<p>Topical urea is bacteriostatic, bactericidal, fungistatic, proteolytic, hygroscopic and has mild local anesthetic properties. These actions are dose-dependent. Most of its therapeutic application depends on its hygroscopic properties. The hygroscopic property is due to its ability to cause a configurational change in proteins in the stratum corneum. Urea gently dissolves the intracellular matrix which results in loosening the horny layer of skin and shedding scaly skin at regular intervals, thereby softening hyperkeratotic areas. Therapeutic effects depend on local concentrations, not on systemic absorption of the drug. If absorbed, urea would be excreted unchanged in the urine.</p>', '<p>Apply enough Urea 25% Cream to cover affected area, once or twice daily or as directed by the physician. For external use only.</p>', '<p>No hazardous drug interaction has been reported.</p>', '<p>Allergy to any of the ingredients of this product.</p>', '<p>No serious toxicity has been reported with topical urea. Historically it is considered a safe drug. But on some occasions, topical urea has been shown to cause burning and irritation, if applied to inflamed, broken or exudative skin eruptions.</p>', '<p>There are no adequate &amp; well-controlled studies in pregnant women. Urea should only be used if the anticipated benefits outweigh the risks.</p>', '<p>Avoid contact with eyes. Do not use, if sensitive to any of the ingredients, on genitals or other areas of sensitive skin, on skin that is badly cracked, infected or bleeding and at the same time as other skin care products. Stop use if skin irritation or rash occurs during use.</p>', NULL, '<p>Topical urea preparations.</p>', '<p>Store in a cool &amp; dry place, protect from light. Do not freeze.</p>', NULL, '2022-03-12 01:44:05', '2022-03-12 01:44:05'),
(1144, 1144, '<p><strong>Urokinase injection is indicated in adults</strong>:</p>\r\n\r\n<ul>\r\n	<li>For the&nbsp;lysis&nbsp;of&nbsp;acute&nbsp;massive pulmonary emboli, defined as&nbsp;obstruction&nbsp;of blood flow to a&nbsp;lobe&nbsp;or multiple segments.</li>\r\n	<li>For the lysis of pulmonary emboli accompanied by unstable hemodynamics, i.e., failure to maintain&nbsp;blood pressure&nbsp;without supportive measures.</li>\r\n</ul>\r\n\r\n<p>The&nbsp;diagnosis&nbsp;should be confirmed by objective means, such as pulmonary&nbsp;angiography&nbsp;or noninvasive procedures such as lung scanning.</p>', '<p>Urokinase is used for the treatment of pulmonary embolisms. The low molecular weight form of human urokinase consists of an A chain of 2,000 daltons linked by a sulfhydryl bond to a B chain of 30,400 daltons. Urokinase is an enzyme (protein) produced by the kidney, and found in the urine. There are two forms of urokinase which differ in molecular weight but have similar clinical effects. Urokinase is the low molecular weight form. Urokinase acts on the endogenous fibrinolytic system. It converts plasminogen to the enzyme plasmin. Plasmin degrades fibrin clots as well as fibrinogen and some other plasma proteins.<br />\r\n<br />\r\nUrokinase acts on the endogenous fibrinolytic system. It cleaves the Arg-Val bond in plasminogen to produce active plasmin. Plasmin degrades fibrin clots as well as fibrinogen and other plasma proteins.</p>', '<p><strong>Deep vein thrombosis</strong>: Initial loading dose of 4,400 IU/kg in 15 mL soln over 10 min, followed by 4,400 IU/kg/hr IV infusion for 12-24 hr.&nbsp;<br />\r\n<br />\r\n<strong>Pulmonary embolism</strong>: Initial loading dose of 4,400 IU/kg in 15 mL soln over 10 min followed by 4,400 IU/kg/hr IV infusion for 12 hr.&nbsp;<br />\r\n<br />\r\n<strong>Peripheral vascular occlusion</strong>: Infuse 2,500 IU/mL (500,000 IU in 200 mL) into clot at a rate of 4,000 IU/min for 2 hr.<br />\r\n<br />\r\nAdvance the catheter into the remaining occluded area &amp; infuse at 4,000 IU/min for another 2 hr. This may be repeated up to 4 times.&nbsp;<br />\r\n<br />\r\n<strong>Hyphaema</strong>: 5,000 IU in 2 mL saline soln is injected and withdrawn repeatedly over the iris. If residual clot remains, leave 0.3 mL in the anterior chamber for 24-48 hr to facilitate further dissolution.&nbsp;<br />\r\n<br />\r\n<strong>Clotted arterio-venous shunts</strong>: Instill 5,000-25,000 IU into affected shunt limb &amp; clamp for 2-4 hr, followed by aspiration of lysate. Repeat if necessary.</p>', '<p>Concomitant use of oral anticoagulant or heparin &amp; drugs that affect platelet function may increase risk of haemorrhage.</p>', '<p>Recent surgery or biopsy, severe HTN, severe hepatic or renal insufficiency. Pregnancy &amp; immediate postpartum period.</p>', NULL, '<p>Pregnancy&nbsp;Category B. Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1sttrimester (and there is no evidence of a risk in later trimesters).</p>', '<p>GI lesions &amp; in multiple intracardiac or intravascular punctures as a consequence of cardiopulmonary resuscitation.</p>', '<p>If severe haemorrhage occurs, treatment with Urokinase-GCC must be stopped. Aprotinin and synthetic inhibitors eg, epsilon aminocaproic acid, tranexamic acid or p-aminomethylbenzoic acid can be used to inhibit the fibrinolytic action of Urokinase-GCC. In serious cases, human fibrinogen, Factor XIII, Cohn-Fraction I, packed red cells or whole blood can be given, as appropriate.</p>', '<p>Fibrinolytics (Thrombolytics).</p>', NULL, NULL, '2022-03-12 01:45:43', '2022-03-12 01:45:43'),
(1145, 1145, '<p>Ursodeoxycholic Acid is indicated for the treatment of</p>\r\n\r\n<ul>\r\n	<li>Cholestasis (Jaundice)</li>\r\n	<li>Viral Hepatitis</li>\r\n	<li>Alcoholic Fatty Liver</li>\r\n	<li>Primary Billiary Cirrhosis (PBC)</li>\r\n	<li>Primary Sclerosing Cholangitis (PSC)</li>\r\n	<li>Dissolution of Gallstones and Non-Alcoholic Steato Hepatitis (NASH).</li>\r\n</ul>', '<p>Ursodeoxycholic Acid is a naturally occurring bile acid used to treat different hepatobilliary disorders. The activity of Ursodeoxycholic Acid is achieved through a decrease in secretion of cholesterol in bile. Ursodeoxycholic Acid achieves this through a few mechanisms: it reduces cholesterol absorption, suppresses liver cholesterol synthesis and it does not inhibit bile acid synthesis.<br />\r\n<br />\r\nTherefore, alters bile composition from supersaturated to unsaturated. Ursodeoxycholic Acid also promotes the formation of liquid cholesterol crystal complexes which enhance removal of the cholesterol from the gallbladder into the intestine to be expelled. Ursodeoxycholic Acid improves cholestatic liver diseases by-</p>\r\n\r\n<ul>\r\n	<li>Protecting cholangiocytes against cytotoxicity of hydrophobic bile acids</li>\r\n	<li>Stimulating hepatobilliary secretion</li>\r\n	<li>Protecting hepatocytes against bile acid-induced apoptosis</li>\r\n</ul>\r\n\r\n<p>Ursodeoxycholic Acid is completely absorbed in the upper intestine. Time to peak serum concentration varies from 30 to 150 minutes. The rate of absorption ranges from 60-80%. After absorption Ursodeoxycholic Acid enters the portal vein and undergoes extraction from portal blood by liver where it is conjugated with amino acid &amp; that may be either glycine or taurine and then secreted into the hepatic bile ducts. Small quantities of Ursodeoxycholic Acid appear in the circulation and very small amounts are excreted into urine. The biologic half life of Ursodeoxycholic Acid ranges from 3.5-5.8 days.</p>', '<p><strong>Dissolution of Gall stones</strong>: 8-12 mg/kg/day either as single night time dose or in divided doses.<br />\r\n<br />\r\n<strong>Primary Billiary Cirrhosis</strong>: 10-15 mg/kg/day in 2-4 divided doses.<br />\r\n<br />\r\n<strong>Acute Viral Hepatitis</strong>: 600 mg/day.<br />\r\n<br />\r\n<strong>Alcoholic Fatty Liver</strong>: 300 mg/day.<br />\r\n<br />\r\n<strong>Primary Sclerosing Cholangitis</strong>: 25-30 mg/kg/day.<br />\r\n<br />\r\n<strong>Dissolution of Gallstones and Non-Alcoholic Steato Hepatitis</strong>: 13-15 mg/kg/day.</p>', '<p>Ursodeoxycholic Acid should not be used with drugs, such as oestrogenic hormones, that increase bile cholesterol. Concomitant administration with bile-acid binding drugs including antacids, charcoal and cholestyramine should be avoided, since this may reduce the effectiveness of therapy with Ursodeoxycholic acid.</p>', '<p>Non-functioning gall-bladder calcified and pigmented gallstones, inflammatory bowel disease.</p>', '<p>Commonly reported side effects are nausea, vomiting, diarrhoea, gallstone opacilication, pruritus.</p>', '<p>Pregnancy category B. No evidence of harm has been reported in pregnancy. It has been effectively used for the treatment of cholestasis of pregnancy during the last trimester without any side effects. Problems have not been documented in humans regarding breast feeding.</p>', '<p>It should be used cautiously in those with liver disease.</p>', NULL, '<p>Anti-gallstones drugs: Bile Acids.</p>', '<p>Store below 25&deg; C. Protected from light and moisture. Keep the medicine out of the reach of children.</p>', NULL, '2022-03-12 01:47:31', '2022-03-12 01:47:31'),
(1146, 1146, '<p>Quetiapine is indicated for the treatment of Acute and chronic psychoses, including schizophrenia, Bipolar Disorder including: treatment of manic episodes satisfying DSM-IV criteria for mania associated with bipolar&nbsp; disorder, treatment of depressive episodes associated with bipolar disorder, maintenance treatment of bipolar I disorder, in combination with a mood stabilizer, for the prevention of recurrence of manic, depressive or mixed episodes.</p>', '<p>The mechanism of action of Quetiapine, as with other drugs having efficacy in the treatment of schizophrenia and acute manic episodes associated with bipolar disorder, is unknown. However, it has been proposed that this drug&#39;s efficacy in schizophrenia is mediated through a combination of dopamine type 2 (D2 ) and serotonin type 2 (5HT2) antagonism. Antagonism at receptors other than dopamine and 5HT 2 with similar receptor affinities may explain some of the other effects of Quetiapine. Quetiapine&#39;s antagonism of histamine H1 receptors may explain the somnolence observed with this drug. Quetiapine&#39;s antagonism of adrenergic &alpha;1 receptors may explain the orthostatic hypotension observed with this drug.</p>', '<p><strong>Acute and chronic psychoses, including schizophrenia</strong>: Quetiapine should be administered twice daily, with or without food. The total daily dose for the first four days of therapy is 50 mg (Day 1), 100 mg (Day 2), 200 mg (Day 3) and 300 mg (Day 4). From Day 4 onwards, the dose should be titrated to the usual effective dose range of 300-450 mg/day. However, this may be adjusted, depending on the clinical response and tolerability of the individual patient, within the range 150 to 750 mg/day.<br />\r\n<br />\r\n<strong>Manic episodes associated with bipolar disorder</strong>: Quetiapine should be administered twice daily, with or without food. The total daily dose for the first four days of therapy is 100 mg (Day 1), 200 mg (Day 2), 300 mg (Day 3) and 400 mg (Day 4). Further dosage adjustments up to 800mg/day by Day 6 should be in increments of no greater than 200 mg/day. The dose may be adjusted depending on clinical response &amp; tolerability of the individual patient, within the range of 200 to 800 mg/day. The usual effective dose is in the range of 400 to 800mg/day.<br />\r\n<br />\r\n<strong>Depressive episodes associated with bipolar disorder</strong>: Quetiapine should be administered once daily at bedtime, with or without food. The usual dose is 300 mg/day. The daily dose for the first four days of therapy is 50 mg (Day 1), 100 mg (Day 2), 200 mg (Day 3) and 300 mg (Day 4). Quetiapine can be titrated to 400 mg on Day 5 and up to 600mg by Day 8. Antidepressant efficacy was demonstrated with Quetiapine at 300mg and 600 mg, however no additional benefit was seen in the 600mg group during short term treatment.<br />\r\n<br />\r\n<strong>Maintenance treatment of bipolar I disorder in combination with mood stabilizers</strong>: Patients who have responded to Quetiapine in combination therapy with a mood stabiliser for acute treatment of bipolar disorder should continue on Quetiapine therapy at the same dose. Quetiapine dose can be re-adjusted depending on clinical response and tolerability of the individual patient. Efficacy was demonstrated with Quetiapine (administered twice daily totalling 400mg to 800mg a day) as combination therapy with a mood stabilizer.</p>', '<p>Caution should be exercised when Quetiapine is used concomitantly with medicines known to cause electrolyte imbalance or to increase QT interval. Co-administration of Quetiapine and thioridazine or carbamazepine caused increases in the clearance of Quetiapine. Co-administration of Quetiapine with another microsomal enzyme inducer, phenytoin, also caused increases in the clearance of Quetiapine.</p>', '<p>Quetiapine is contra-indicated in patients who are hypersensitive to it.</p>', '<p>The most commonly reported Adverse Drug Reactions (ADRs) with Quetiapine are somnolence, dizziness, dry mouth, withdrawal (discontinuation) symptoms, elevations in serum triglyceride levels, elevations in total cholesterol (predominantly LDL cholesterol), decreases in HDL cholesterol, weight gain, decreased haemoglobin and extrapyramidal symptoms.</p>', '<p>The safety and efficacy of Quetiapine during human pregnancy have not been established. Therefore, Quetiapine should only be used during pregnancy if the benefits justify the potential risks and the administered dose and duration of treatment should be as low and as short as possible. The degree to which Quetiapine is excreted into human milk is unknown. Women who are breast-feeding should therefore be advised to avoid breast-feeding while taking Quetiapine.</p>', '<ul>\r\n	<li><strong>Suicide/suicidal thoughts or clinical worsening</strong>: Depression is associated with an increased risk of suicidal thoughts, self-harm and suicide (suicide-related events). This risk persists until significant remission occurs.&nbsp;</li>\r\n	<li><strong>Concomitant Illness</strong>:&nbsp;Quetiapine should be used with caution in patients with known cardiovascular disease, cerebrovascular disease, or other conditions predisposing to hypotension. Quetiapine may induce orthostatic hypotension especially during the initial dose-titration period.&nbsp;</li>\r\n	<li><strong>Seizures</strong>:&nbsp;As with other antipsychotics, caution is recommended when treating patients with a history of seizures.</li>\r\n	<li><strong>Tardive Dyskinesia and Extrapyramidal Symptoms (EPS)</strong>: If signs and symptoms of tardive dyskinesia appear, dose reduction or discontinuation of Quetiapine should be considered.</li>\r\n	<li><strong>Neuroleptic Malignant Syndrome</strong>: This syndrome has been associated with antipsychotic treatment. Quetiapine should be discontinued and appropriate medical treatment given.</li>\r\n	<li><strong>QT Prolongation</strong>: As with other antipsychotics, caution should be exercised when Quetiapine is prescribed in patients with cardiovascular disease or family history of QT prolongation.</li>\r\n	<li><strong>Neutropenia</strong>: Severe neutropenia (&lt;0.5x109/L) has been uncommonly reported in Quetiapine clinical trials. Most cases of severe neutropenia have occurred within the first two months of starting therapy with Quetiapine.</li>\r\n	<li><strong>Hyperglycemia &amp; diabetes mellitus</strong>: Increases in blood glucose and hyperglycaemia, and occasional reports of diabetes, have been observed in clinical trials with Quetiapine.</li>\r\n</ul>', '<p>In clinical trials, survival has been reported in acute overdoses of up to 30 grams of Quetiapine. There is no specific antidote to Quetiapine. In cases of severe intoxication, the possibility of multiple drug involvement should be considered, and intensive care procedures are recommended, including establishing and maintaining a patent airway, ensuring adequate oxygenation and ventilation, and monitoring and support of the cardiovascular system. In cases of Quetiapine overdose, refractory hypotension should be treated with appropriate measures such as intravenous fluids and/or sympathomimetic agents (adrenaline and dopamine should be avoided, since beta stimulation may worsen hypotension in the setting of Quetiapine-induced alpha blockade). Close medical supervision and monitoring should be continued until the patient recovers.</p>', '<p>Atypical neuroleptic drugs.</p>', '<p>Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the blister pack and the carton. The expiry date refers to the last day of that month. Store in a cool and dry place away from light.</p>', '<p><strong>Elderly</strong>: As with other antipsychotics, Quetiapine should be used with caution in the elderly, especially during the initial dosing period. The rate of dose titration may need to be slower, and the daily therapeutic dose lower, than that used in younger patients, depending on the clinical response and tolerability of the individual patient. The mean plasma clearance of Quetiapine was reduced by 30% to 50% in elderly subjects when compared with younger patients.<br />\r\n<br />\r\n<strong>Children and Adolescents</strong>: Quetiapine is not indicated for use in children and adolescents below 18 years of age.</p>', '2022-03-12 01:51:06', '2022-03-12 01:51:06'),
(1147, 1147, '<p>Quinine Sulfate is indicated in-</p>\r\n\r\n<ul>\r\n	<li>Uncomplicated, severe and complicated falciparum malaria</li>\r\n	<li>Falciparum malaria resistant to other drugs</li>\r\n	<li>Prevention of nocturnal muscle cramps</li>\r\n	<li>Alleviation of muscle cramps in Thomsen&#39;s disease.</li>\r\n</ul>', '<p>Quinine is believed to interfere with protein metabolism and inhibits nucleic acid synthesis in malarial parasites. Quinine is a highly active blood schizonticide and suppresses the asexual cycle of development of malaria parasites in the erythrocytes. It is effective both as a suppressive drug and in the over clinical attack of malaria.</p>', '<p><strong>Adult</strong>:</p>\r\n\r\n<ul>\r\n	<li>Oral: 600 mg (of quinine salt) every 8 hours for 7 days.</li>\r\n	<li>Parenteral: lf the patient is seriously ill quinine should be given by intravenous infusion. The adult dosage regimen for quinine by infusion is loading dose of 20 mg/kg (up to maximum 1.4 g) of quinine salt infused over 4 hours then after 8-12 hours maintenance dose of 10 mg/kg (up to maximum 700 mg) of quinine salt infused over 4 hours every 8-12 hours (until patient can swallow tablets to complete the 7 days course).</li>\r\n</ul>\r\n\r\n<p><strong>Children</strong>:</p>\r\n\r\n<ul>\r\n	<li>Oral: Quinine is well tolerated by children. The dosage regimen for quinine by mouth for children is 10 mg/kg (of quinine salt) every 8 hours for 7 days.</li>\r\n	<li>Parenteral: The dosage regimen for quinine by intravenous infusion for children is calculated on a mg/kg basis as for adult.</li>\r\n</ul>\r\n\r\n<p><strong>Pregnancy:</strong>&nbsp;The adult treatment doses of oral and intravenous quinine given above (including the loading dose) can safely be given to pregnant women.</p>', NULL, '<p>Hypersensitivity reaction, optic neuritis, in case of black water fever etc.</p>', '<p>Cinchonism which includes tinnitus, headache, nausea and visual disturbances. Hematological disorders and skin reaction may occur.</p>', '<p>In pregnancy, the quinine is not necessarily contraindicated. It is considered to be safe when used in therapeutic dosage in pregnancy. It is excreted in breast milk in insignificant amount which does not discard the use in lactation.</p>', '<p>Severe heart disease, myasthenia gravis, diabetes mellitus, IV injection should be given slowly. Use of Mefloquine with Quinine sulphate may increase the chance of side effects.</p>', '<p>Cinchonism which includes tinnitus, headache, nausea and visual disturbances. Hematological disorders and skin reaction may occur.</p>', '<p>Anti-malarial drugs</p>', '<p>Use of Mefloquine with Quinine sulphate may increase the chance of side effects.</p>', NULL, '2022-03-12 01:54:27', '2022-03-12 01:54:27'),
(1148, 1148, '<p>Amoxicillin, Clarithromycin &amp; Rabeprazol combination is indicated for the eradication of H. pylori in active chronic gastric, duodenal and gastric ulcers.</p>', '<p><strong>Amoxicillin</strong>&nbsp;is similar to&nbsp;penicillin&nbsp;in its bactericidal action against susceptible bacteria during the stage of active multiplication. It acts through the inhibition of cell wall biosynthesis that leads to the death of the bacteria.<br />\r\n<br />\r\n<strong>Clarithromycin</strong>&nbsp;acts by inhibiting microsomal protein synthesis in susceptible organisms mainly by binding to the donor site on the 50S subunit of the bacterial ribosome and preventing translocation to that site.<br />\r\n<br />\r\n<strong>Rabeprazole</strong>&nbsp;belongs to a class of antisecretory compounds (substituted benzimidazole proton-pump inhibitors) that do not exhibit anticholinergic or histamine H2-receptor antagonist properties, but suppress gastric acid secretion by inhibiting the gastric H+,K+ ATPase at the secretory surface of the gastric parietal cell. Because this enzyme is regarded as the acid (proton) pump within the parietal cell, rabeprazole has been characterized as a gastric proton-pump inhibitor. Rabeprazole blocks the final step of gastric acid secretion.</p>', '<p>Each tablet twice daily for 7-14 days or as per the physician&#39;s advice.</p>', '<p>Rabeprazole is metabolized through the cytochrome P450 system, specially through the CYP3A and CYP2C19 isozymes. Studies have shown that Rabeprazole does not have clinically significant interactions with other drugs metabolized by the cytochrome P450 system, such as warfarin, antipyrine, indomethacin, ibuprofen, phenytoin, propranolol, prednisolone, diazepam, clarithromycin or terfenadine in healthy subjects. Use of Clarithromycin in patients who are receiving theophylline may be associated with an increase of serum theophylline concentrations. There have been reports of interactions of erythromycin and/or clarithromycin with carbamazepine, cyclosporine, tacrolimus, hexobarbital, phenytoin, alfetanil, disopyramide, lovastatin, bromocriptine, valproate, terfenadine, cisapride, pimozide &amp; astemizole.</p>', '<p>This drug is contraindicated in patients with known hypersensitivity to any of its component.</p>', '<p>Adverse reactions which were reported as possibly or probably related to treatment (&lt;3%) in clinical trials when all three components of this therapy were given concomitantly are listed below and divided by body systems.<br />\r\n<br />\r\n<strong>Digestive system</strong>: Nausea, vomiting, diarrhoea, dark stools, dry mouth, glossitis, oral moniliasis, stomatitis, tongue discoloration; Musculoskeletal system: Myalgia;<br />\r\n<br />\r\n<strong>Nervous System</strong>: Confusion, headache, dizziness; Skin: Skin reactions; Urogenital System: Vaginitis, vaginal moniliasis.</p>', '<p>There were no adequate and well-controlled studies of in pregnant women. Should be used during pregnancy only if the potential benefit justifies the potential risk of the mother.<br />\r\n<br />\r\nBecause of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug therapy, taking into account the importance of the therapy to the mother.<br />\r\n<br />\r\nClarithromycin should not be used in pregnant women except in clinical circumstances where no alternative therapy is appropriate. Amoxicillin is excreted in human milk in very small amounts.&nbsp;There are no available human data on Rabeprazol use in pregnant women to inform the drug associated risk.</p>', '<p>Serious and occasionally fatal hypersensitivity (anaphylactoid) reactions have been reported in patients on Amoxicillin therapy.</p>', '<p>There has been no experience of overdoses with Rabeprazole. In case of overdosage of Amoxicillin, medication is discontinued, treatment should be symptomatic and supportive measures are institued as required. Overdosage of Clarithromycin can cause gastrointestinal symptoms such as abdominal pain, vomiting, nausea and diarrhea.</p>', '<p>Anti H. pylori drugs.</p>', '<p>Store in a cool and dry place, protected from light.</p>', '<p><strong>Use in Geriatrics</strong>: Elderly patients may suffer from asymptomatic renal and hepatic dysfunction. Care should be taken when administering to this patient population.<br />\r\n<br />\r\n<strong>Renal Dose Adjustments</strong>: No adjustment recommended.<br />\r\n<br />\r\n<strong>Mild to moderate hepatic impairment</strong>: No adjustment recommended.<br />\r\n<br />\r\n<strong>Severe hepatic impairment</strong>: Use with caution.</p>', '2022-03-12 04:31:17', '2022-03-12 04:31:17');
INSERT INTO `generic_details` (`id`, `generic_id`, `indications`, `pharmacology`, `dosage_and_administration`, `interaction`, `contraindications`, `side_effects`, `pregnancy_and_lactation`, `precautions_and_warnings`, `overdose_effects`, `therapeutic_class`, `storage_conditions`, `use_in_special_populations`, `created_at`, `updated_at`) VALUES
(1149, 1149, '<p>Rabeprazole Gastro-resistant tablets are indicated for the treatment of:</p>\r\n\r\n<ul>\r\n	<li>Active duodenal ulcer</li>\r\n	<li>Active benign gastric ulcer</li>\r\n	<li>Symptomatic erosive or ulcerative gastro-esophageal reflux disease (GERD).</li>\r\n	<li>Gastro-esophageal Reflux Disease Long-term Management (GERD Maintenance)</li>\r\n	<li>Symptomatic treatment of moderate to very severe gastro-esophageal reflux disease (symptomatic GERD)</li>\r\n	<li>Zollinger-Ellison Syndrome</li>\r\n	<li>In combination with appropriate antibacterial therapeutic regimens for the eradication of Helicobacter pylori in patients with peptic ulcer disease.</li>\r\n</ul>', '<p>Rabeprazole suppresses gastric acid secretion by inhibiting the gastric H+/K+-ATPase at the secretory surface of the gastric parietal cell. Because this enzyme is regarded as the acid (proton) pump within the parietal cell, Rabeprazole has been characterized as a gastric proton-pump inhibitor.</p>', '<p><strong>Active Duodenal Ulcer and Active Benign Gastric Ulcer</strong>: The recommended oral dose for both bioactive duodenal ulcer and active benign gastric ulcer is 20 mg to be taken once daily in the morning. Most patients with active duodenal ulcer heal within four weeks. However, a few patients may require an additional four weeks of therapy to achieve healing. Most patients with active benign gastric ulcer heal within six weeks. However, again a few patients may require an additional six weeks of therapy to achieve healing.<br />\r\n<br />\r\n<strong>Erosive or Ulcerative Gastro-Esophageal Reflux Disease (GERD)</strong>: The recommended oral dose for this condition is 20 mg to be taken once daily for four to eight weeks.<br />\r\n<br />\r\n<strong>Gastro-Esophageal Reflux Disease Long-term Management (GERD Maintenance)</strong>: For long-term management, a maintenance dose of rabeprazole sodium 20 mg or 10 mg once daily can be used depending upon patient response.<br />\r\n<br />\r\n<strong>Symptomatic treatment of moderate to very severe Gastro-Esophageal Reflux Disease (symptomatic GERD)</strong>: 10 mg once daily in patients without oesophagitis. If symptom control has not been achieved during four weeks, the patient should be further investigated. Once symptoms have resolved, subsequent symptom control can be achieved using an on-demand regimen taking 10 mg once daily when needed.<br />\r\n<br />\r\n<strong>Zollinger-Ellison Syndrome</strong>: The recommended adult starting dose is 60 mg once a day. The dose may be titrated upwards to 120 mg/day based on individual patient needs. Single daily doses up to 100 mg/day may be given. 120 mg dose may require divided doses, 60 mg twice daily. Treatment should continue for as long as clinically indicated.<br />\r\n<br />\r\n<strong>Eradication of H. pylori</strong>: Patients with H. pylori infection should be treated with eradication therapy. The following combination given for 7 days is recommended. Rabeprazole sodium 20 mg twice daily, clarithromycin 500 mg twice daily and amoxicillin 1g twice daily.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>For indications requiring once-daily treatment Rabeprazole tablets should be taken in the morning, before eating; and although neither the time of day nor food intake was shown to have any effect on rabeprazole sodium activity, this regimen will facilitate treatment compliance. Patients should be cautioned that the Rabeprazole tablets should not be chewed or crushed, but should be swallowed whole.</p>', '<p>Respite produces a profound and long-lasting inhibition of gastric acid secretion. An interaction with a compound whose absorption is pH dependent may occur. Co-administration of rabeprazole sodium with ketoconazole or itraconazole may result in a significant decrease in antifungal plasma levels. Therefore individual patients may need to be monitored to determine if a dosage adjustment is necessary when ketoconazole or itraconazole are taken concomitantly with Respite. No interaction with liquid antacids was observed. The absorption of atazanavir is pH-dependent. Therefore PPIs, including rabeprazole, should not be co-administered with atazanavir.</p>', '<p>Hypersensitivity to the active substance or to any of the excipients. Rabeprazole is contra-indicated in pregnancy and during breastfeeding.</p>', '<p>In general, Rabeprazole is well-tolerated in both short-term and long-term studies. Rabeprazole may sometimes cause headache, diarrhoea, abdominal pain, vomiting, constipation, dry mouth, increased or decreased appetite, muscle pain, drowsiness, dizziness.</p>', '<p>US FDA pregnancy category &#39;C&#39;. Studies have been performed in animals and have revealed no evidence of impaired fertility or harm to the fetus due to Rabeprazole. There are however, no adequate and well-controlled studies in pregnant women. Rabeprazole is likely to be excreted in human milk, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.</p>', '<ul>\r\n	<li>Symptomatic response to therapy with Rabeprazole does not preclude the presence of gastric or oesophageal malignancy, therefore the possibility of malignancy should be excluded prior to commencing treatment with Rabeprazole 20 mg Gastro-resistant Tablets.</li>\r\n	<li>Patients on long-term treatment (particularly those treated for more than a year) should be kept under regular surveillance.</li>\r\n	<li>Proton pump inhibitors, especially if used in high doses and over long durations (&gt;1 year), may modestly increase the risk of hip, wrist and spine fracture, predominantly in the elderly or in presence of other recognised risk factors. Observational studies suggest that proton pump inhibitors may increase the overall risk of fracture by 10&ndash;40%. Some of this increase may be due to other risk factors. Patients at risk of osteoporosis should receive care and they should have an adequate intake of vitamin D and calcium.</li>\r\n	<li>A risk of cross-hypersensitivity reactions with other proton pump inhibitor or substituted benzimidazoles cannot be excluded.</li>\r\n	<li>Patients should be cautioned that Rabeprazole gastro-resistant tablets should not be chewed or crushed, but should be swallowed whole.</li>\r\n	<li>There have been post marketing reports of blood dyscrasias (thrombocytopenia and neutropenia). In the majority of cases where an alternative aetiology cannot be identified, the events were uncomplicated and resolved on discontinuation of rabeprazole.</li>\r\n	<li>Hepatic enzyme abnormalities have been seen in clinical trials and have also been reported since market authorisation. In the majority of cases where an alternative aetiology cannot be identified, the events were uncomplicated and resolved on discontinuation of rabeprazole.</li>\r\n	<li>No evidence of significant drug related safety problems was seen in a study of patients with mild to moderate hepatic impairment versus normal age and sex matched controls. However because there are no clinical data on the use of rabeprazole in the treatment of patients with severe hepatic dysfunction the prescriber is advised to exercise caution when treatment with Rabeprazole 20mg Gastro-resistant. Tablets is first initiated in such patients.</li>\r\n	<li>Co-administration of atazanavir with Rabeprazole is not recommended.</li>\r\n	<li>Treatment with proton pump inhibitors, including rabeprazole, may possibly increase the risk of gastrointestinal infections such as Salmonella, Campylobacter and Clostridium difficile.</li>\r\n</ul>\r\n\r\n<p><strong>Hypomagnesaemia</strong>: Severe hypomagnesaemia has been reported in patients treated with PPIs like rabeprazole for at least three months, and in most cases for a year. Serious manifestations of hypomagnesaemia such as fatigue, tetany, delirium, convulsions, dizziness and ventricular arrhythmia can occur but they may begin insidiously and be overlooked. In most affected patients, hypomagnesaemia improved after magnesium replacement and discontinuation of the PPI. For patients expected to be on prolonged treatment or who take PPIs with digoxin or drugs that may cause hypomagnesaemia (e.g., diuretics), health care professionals should consider measuring magnesium levels before starting PPI treatment and periodically during treatment.<br />\r\n<br />\r\n<strong>Influence on vitamin B12 absorption</strong>: Rabeprazole sodium, as all acid-blocking medicines, may reduce the absorption of vitamin B12 (cyanocobalamin) due to hypo- or a- chlorhydria. This should be considered in patients with reduced body stores or risk factors for reduced vitamin B12 absorption on long-term therapy or if respective clinical symptoms are observed.<br />\r\n<br />\r\n<strong>Subacute cutaneous lupus erythematosus (SCLE)</strong>: Proton pump inhibitors are associated with very infrequent cases of SCLE. If lesions occur, especially in sun-exposed areas of the skin, and if accompanied by arthralgia, the patient should seek medical help promptly and the health care professional should consider stopping Rabeprazole. SCLE after previous treatment with a proton pump inhibitor may increase the risk of SCLE with other proton pump inhibitors.<br />\r\n<br />\r\n<strong>Interference with laboratory tests</strong>: Increased Chromogranin A (CgA) level may interfere with investigations for neuroendocrine tumours. To avoid this interference, Rabeprazole 20mg Gastro-resistant Tablets treatment should be stopped for at least 5 days before CgA measurements. If CgA and gastrin levels have not returned to reference range after initial measurement, measurements should be repeated 14 days after cessation of proton pump inhibitor treatment.</p>', '<p>The maximum established exposure has not exceeded 60 mg twice daily, or 160 mg once daily. Effects are&nbsp; generally minimal, representative of the known adverse event profile and reversible without further medical intervention. No specific antidote is known. Rabeprazole&nbsp;is extensively protein bound and is, therefore, not dialysable. As in any case of overdose, treatment should be symptomatic and general supportive measures should be utilised.</p>', '<p>Proton Pump Inhibitor.</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', '<p><strong>Renal and hepatic impairment</strong>: No dosage adjustment is necessary for patients with renal or hepatic impairment.<br />\r\n<br />\r\n<strong>Pediatric populations</strong>: Rabeprazole&nbsp;is not recommended for use in children due to a lack of data on safety and efficacy.</p>', '2022-03-12 04:33:40', '2022-03-12 04:33:40'),
(1150, 1150, '<p>For the seroprophylaxis (prevention by injecting antibodies) of rabies in subjects suspected to have been exposed to the rabies virus, particularly in the event of severe exposure e.g.:</p>\r\n\r\n<ul>\r\n	<li>Multiple transdermal bites or scratches</li>\r\n	<li>Contamination of mucous membrane with saliva</li>\r\n	<li>Severe bites located on the face, head, neck and hands</li>\r\n	<li>When the domestic or wild animal responsible cannot be examined or is infected or suspected to be infected by the rabies virus</li>\r\n	<li>Bites to young children</li>\r\n</ul>\r\n\r\n<p>Rabies Immunoglobulin provides passive immunization against rabies for prevention of rabies in patients after contact with a rabid animal or an animal presumed to be rabid. Anti rabies serum itself does not constitute an anti-rabies treatment and should always be used in conjunction with rabies vaccine.</p>', NULL, '<p>First-aid treatment: Prompt local treatment of bite wounds and scratches that may be contaminated with rabies virus is important, whatever the time elapsed since the contact. The recommended first-aid measures consist of immediate flushing and washing of the wound with soap and water, detergent or other substance of proven lethal effect on rabies virus. The rabies immune globulin should be injected as soon as possible after exposure.<br />\r\n<br />\r\nThe recommended dose for both adults and children is 40 IU/kg of body weight. If anatomically feasible, as much as possible of the dose should be infiltrated around and into the wound(s). The remainder should be administered intramuscularly (into the gluteal region) in a single injection.<br />\r\n<br />\r\nHowever, for children, particularly in the case of multiple wounds, it has been proposed to dilute the dose 2-3 times in a 0.9% sodium chloride solution to obtain a sufficient quantity of equine rabies immune globulin to infiltrate the wound(s) correctly. Wounds in certain anatomical sites (fingertips) should be infiltrated with care so as to prevent a local increase in pressure in the tissue.<br />\r\n<br />\r\nFor prevention of rabies, combined immune globulin-vaccine treatment is recommended. The 1st dose of the rabies vaccine should be given at the same time as the Rabies immunoglobulin, but in different parts of the body. If Rabies immunoglobulin is not available when the rabies vaccine is administered, it can be administered up to the 7th or 8th day after the first dose of rabies vaccine. When indicated, begin anti-tetanus treatment and administer anti-microbial drugs to control infections other than rabies.<br />\r\n<br />\r\nThe WHO expert committee on rabies has issued the following therapeutic recommendations:<br />\r\n<br />\r\nCategory Type of contact with a suspect or confirmed rabid domestic or wild animal or animal not available for observation Recommended Treatment:</p>\r\n\r\n<ul>\r\n	<li>Touching or feeding, licks on intact skin None, if reliable case history is available</li>\r\n	<li>Nibbling of uncovered skin, minor scratches superficial bites (except on head, neck, shoulder girdle, arms or hands) or abrasions without bleeding, licks on broken skin. Administer vaccine immediately on Day 0, D3, D7, D14 and D28. Stop treatment if animal remains healthy throughout the observation period of 10 days or if animal is killed humanely and found to be negative by appropriate laboratory techniques.</li>\r\n</ul>\r\n\r\n<p>Single or multiple transdermal bites or scratches specially on head, neck, shoulder girdle,arms or hands. Contamination of mucus membrane with saliva (i.e. licks on broken skin). Administer rabies vaccine immediately on Day 0, D3, D7, D14 and D28 or D90 (optional) and rabies immune globulin on D0 immediately. Stop treatment if animal remains healthy throughout the observation period of 10 days or if animal is killed humanely and found to be negative by appropriate laboratory techniques.</p>', NULL, '<p>Known history of allergic symptoms to horse proteins. Nevertheless, the lethal risk associated with rabies overcomes any potential contraindication.</p>', '<p>Immediate or delayed hypersensitive type reactions may be developed on administration of rabies immune globulin. The observed immediate reactions are hypotension, dyspnoea, and urticaria. Delayed reactions consist of inflammatory reaction, fever, pruritis, rash or urticaria, adenopathy and arthralgia.</p>', '<p>The safety of rabies immune globulin when used during pregnancy has not been established in clinical trials in human beings. Considering the lethal risk associated with rabies, pregnancy may not be a contraindication to the administration of rabies immune globulin subsequent to exposure.</p>', '<p>Do not administer rabies immunoglobulin intravenously (due to the risk of shock i.e., sudden collapse with drop in blood pressure). Consequently, make sure that the needle has not penetrated a blood vessel. Rabies immunoglobulin should not be administered in repeated doses. Once the vaccine treatment has been started, repeating injections of rabies immunoglobulin may reduce the protective efficacy that must be guaranteed by the vaccine. Shake well before use. Do not shake vigorously.</p>', '<p>If the recommended dosage is not strictly observed, there is a risk of immunosuppressive interference (suppression of immune defenses) with rabies vaccine.</p>', '<p>Vaccines, Anti-sera &amp; Immunoglobulin.</p>', '<p>Keep out of the reach and sight of children. Store at 2&deg;C to 8&deg;C. Transportation should also be at 2&deg;C to 8&deg;C. Protect from light. Do not freeze.</p>', NULL, '2022-03-12 04:35:21', '2022-03-12 04:35:21'),
(1151, 1151, '<p>Rabies vaccine is indicated for prophylactic immunization against rabies and treatment of patients following suspected rabies contact.<br />\r\n<br />\r\nPre-exposure Immunization:</p>\r\n\r\n<ul>\r\n	<li>Professional groups exposed to frequent contamination</li>\r\n	<li>Veterinary surgeons (including students at veterinary colleges)</li>\r\n	<li>Technical personnel working with veterinary surgeons</li>\r\n	<li>Laboratory personnel handling material contaminated with rabies vims</li>\r\n	<li>Personnel in abattoirs and knackers yards</li>\r\n	<li>Taxidermists</li>\r\n	<li>Gamekeepers, forestry workers and naturalists in enzootic areas</li>\r\n	<li>Infants particularly exposed to the risk of rabies</li>\r\n</ul>\r\n\r\n<p>Post-exposure Immunization:</p>\r\n\r\n<ul>\r\n	<li>Treatment of subjects bitten by rabid animals or those suspected of being so</li>\r\n	<li>Treatment of contact subjects.</li>\r\n</ul>', '<p>Rabies Vaccine for human use is a freeze-dried preparations of inactivated rabies virus produced on Vero cell. After reconstitution the vaccine is a clear, colorless sterile solution for intramuscular use.</p>', '<p>To reconstitute the vaccine, transfer content of supplied diluent into the vial containing freeze-dried preparation. Do not shake. After reconstitution the solution should be homogeneous, clear and free from any particles. Vaccine must be injected immediately after reconstitution and the syringe should be destroyed after use.<br />\r\n<br />\r\n<strong>Method of administration for intramuscular use</strong>: The 1 ml dose of Rabies vaccine should be given intramuscularly in the deltoid in adults and in the anterolateral aspect of the thigh muscle in children under 1 year. It should not be injected into the gluteal region. Do not inject intravenously.<br />\r\n<br />\r\n<strong>Pre-exposure immunization</strong>:</p>\r\n\r\n<ul>\r\n	<li>1 ml for children and adults.</li>\r\n	<li>Primary-vaccination: According to the WHO recommendations 1 injection by the intramuscular route on days DO, D7, D21 or D28, followed by a booster dose one year later.</li>\r\n	<li>Boosters: Thereafter, one injection every 5 years or when the titre is found to be less than 0.5 lU/ml</li>\r\n</ul>\r\n\r\n<p><strong>Post-exposure immunization</strong>:</p>\r\n\r\n<ul>\r\n	<li>Local treatment of the wound: Prompt and gentle through washing with soap or detergent and flushing the wound with running tap water for at least 15 minutes. After washing, disinfectants like either ethanol (700 ml/l) or tincture or aqueous solution of iodine or povidone iodine must be applied. Don&#39;t bandage or suture the wound.</li>\r\n	<li>Vaccination of non-immunized subjects</li>\r\n</ul>\r\n\r\n<p>Intramuscular schedules: One Intramuscular (IM) dose comprised of 1 ml.<br />\r\n<br />\r\nStandard intramuscular (1-1-1-1-1) regimen:</p>\r\n\r\n<ul>\r\n	<li>Day 0: 1 injection of 1 ml</li>\r\n	<li>Day 3: 1 injection of 1 ml</li>\r\n	<li>Day 7: 1 injection of 1 ml</li>\r\n	<li>Day 14: 1 injection of 1 ml</li>\r\n	<li>Day 28: 1 injection of 1 ml</li>\r\n</ul>\r\n\r\n<p>Or abbreviated multisite (2-1-1) regimen:</p>\r\n\r\n<ul>\r\n	<li>Day 0: 2 injections each of 1 ml at separate sites</li>\r\n	<li>Day 7: 1 injection of 1 ml</li>\r\n	<li>Day 21: 1 injection of 1 ml</li>\r\n</ul>\r\n\r\n<p>In case of severe (WHO category 3) wounds, rabies immunoglobulin should be administered as soon as possible with the first dose of rabies vaccine. The anti-rabies immunoglobulin should be used as local wound soakage injections as much as possible, with the rest part for muscle injection. The rabies vaccine should be administered in different injection site.<br />\r\n<br />\r\nVaccination of subjects already immunized: Patients had complete post exposure immunization schedule within 1 year. Bitten by suspected rabid animal, 1 dose injection is required on Day 0, Day 3, respectively. Patients had complete post-exposure immunization schedule 1 year ago, Bitten by suspected rabid animal, complete post-exposure immunization required. Patient had complete immunization schedule and booster immunization within 3 years. Bitten by suspected rabid animal, 1 dose injection is required on Day 0, Day 3, respectively. Patient had complete immunization schedule and booster immunization 3 years ago. Bitten by suspected rabid animal, complete post-exposure immunization required. Post-exposure vaccination must be administered on the basis of severity under medical supervision.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>Co-administration: Corticosteroid and immunosuppressive treatment may interfere with antibody production and cause vaccination failure. In these cases, a titration of neutralizing antibodies should be performed.</p>', '<p>Concurrent use with immunosuppressants may reduce the efficacy of vaccines.</p>', '<p>Rabies vaccine is contraindicated in the following cases:<br />\r\n<br />\r\n<strong>Pre-exposure</strong>: Severe fever, febrile infection, acute disease, progressive chronic diseases. Known hypersensitivity reactions to rabies vaccine or any of its components<br />\r\n<br />\r\n<strong>Post-exposure</strong>: No contraindication to post-exposure treatment, because rabies is lethal disease, any contraindication to exposure, treatment should be considered carefully before disqualifying an individual for anti-rabies treatment.</p>', '<p>Minor local reactions like pain, erythema, oedema, pruritus and induration at the injection site and lasting to 24-48 hours. Moderate fever, shivering, fainting, asthenia, dizziness, respiratory manifestations (dyspnoea, wheezing), fever, abdominal pain, vomiting and allergic skin reactions (urticaria, rash, itching).</p>', '<p><strong>Pregnancy</strong>. The potential risk of administration of rabies vaccine during pregnancy is unknown. Due to the severity of the disease, pregnancy is not considered to be a contraindication to post-exposure prophylaxis.<br />\r\n<br />\r\n<strong>Lactation</strong>: It is not known whether the vaccine is excreted in human breast milk. Due to the severity of the disease, breast-feeding is not considered a contraindication.</p>', '<ul>\r\n	<li>Intravenous injection is prohibited.</li>\r\n	<li>The vaccine and anti-rabies immunoglobulin must not be administered with same syringe and in the same injection site.</li>\r\n	<li>Before use, please carefully check package, label, appearance and the validity period.</li>\r\n	<li>After reconstitution, the freeze-dried rabies vaccine should be administered as soon as possible.</li>\r\n	<li>Any reconstituted vaccine should be used as soon as possible. It must be stored in a refrigerator at 2&deg;C to 8&deg;C and used within 8 hours after reconstitution or discarded.</li>\r\n</ul>', NULL, '<p>Vaccines, Anti-sera &amp; Immunoglobulin.</p>', '<p>Keep out of the reach and sight of children. Store &amp; transport at 2&deg;C to 8&deg;C. Protect from light. Do not keep in the deep freeze.</p>', NULL, '2022-03-12 04:59:08', '2022-03-12 04:59:08'),
(1152, 1152, '<p>Racecadotril is indicated for the symptomatic treatment of acute diarrhea.</p>', '<p>Racecadotril increases the availability of endogenous opioids (enkephalins) by inhibiting the membrane-bound enkephalinase. The enkephalins in turn mediate their effect through &delta; receptor ( delta opioid receptor) activation that induces a selective increase in Cl absorption by inhibiting adenylate cyclase.<br />\r\n<br />\r\nOnset: 30 min (plasma enkephalinase inhibition).</p>', '<p><strong>Adults</strong>: One capsule initially, regardless of the time of day. Then one capsule three times daily preferably before the main meals.<br />\r\n<br />\r\n<strong>Children</strong>&nbsp;(from 3 months of age): Racecadotril granules should be administered together with oral rehydration. The recommended dose is determined according to body weight: 1.5 mg/kg per administration, three times daily.</p>\r\n\r\n<ul>\r\n	<li><strong>Infants less than 9 kg</strong>: one 10 mg sachet 3 times daily.</li>\r\n	<li><strong>Infants from 9 kg to 13 kg</strong>: two 10 mg sachets 3 times daily.</li>\r\n	<li><strong>Children from 13 kg to 27 kg</strong>: one 30mg sachet 3 times daily.</li>\r\n	<li><strong>Children of more than 27 kg</strong>: two 30mg sachets 3 times daily.</li>\r\n</ul>', '<p>No drug interactions found. Joint treatment with Racecadotril and Loperamide or Nifuroxazide does not modify the kinetics of Racecadotril.</p>', '<p>Hypersensitivity to Racecadotril, or to any of the excipients.</p>', '<p>Headache, erythema multiforme, urticaria, angioedema may be seen.</p>', '<p>Due to a lack of clinical data, Racecadotril should not be administered to pregnant or breastfeeding women.</p>', '<p>The administration of Racecadotril does not modify the usual rehydration regimens. The presence of bloody stools and fever may indicate the presence of invasive bacteria as a reason for diarrhea or the presence of other severe disease. Racecadotril has not been tested in antibiotic-associated diarrhea and should therefore not be administered under these conditions. Caution should be taken in patients with renal or liver impairment.</p>', '<p>No cases of overdose have been reported. In adults, single doses above 2 g which is equivalent to 20 times the therapeutic dose, have been administered, and no harmful effects have been described.</p>', '<p>Anti-diarrhoeal</p>', NULL, NULL, '2022-03-12 05:00:51', '2022-03-12 05:00:51'),
(1153, 1153, '<p>For temporary relief of mild symptoms of intermittent asthma: Wheezing, tightness of chest and shortness of breath.</p>', '<p>Racepinephrine is an alpha- and beta-adrenoreceptor stimulant. Racepinephrine works by widening the airways, reducing spasms of bronchial muscles of asthma patients, which makes it easier to breathe.</p>', '<p>Adults and children 4 years of age and over-</p>\r\n\r\n<ul>\r\n	<li><strong>Jet Nebulizer</strong>: Nebulisation for fifteen minutes every 3 to 4 hours. One 0.5 ml ampoule should be diluted to a volume of 3 to 5 ml with sterile 0.9% sodium chloride solution.</li>\r\n	<li><strong>Hand-held Bulb Nebulizer</strong>: 1 to 3 inhalations not more often than every 3 hours. The racepinephrine inhalation solution does not require dilution. Should not use more than 12 inhalations in 24 hours.</li>\r\n</ul>\r\n\r\n<p>Children under 4 years of age: Use according to the physician&#39;s direction.</p>', '<p>Concurrent use with other adrenergic agents will have additive adrenergic side effects. Use with MAO inhibitors may lead to hypertensive crisis. Beta-blockers may negate the therapeutic effect. Tricyclic antidepressants enhance response to epinephrine.</p>', NULL, '<p>Side effects of Racepinephrine includes headache, loss of appetite, nausea &amp; vomiting, nervousness, tremors, trouble sleeping, fear, agitation, anxiety, restlessness, dizziness, impaired memory, hallucinations, and psychosis. Severe allergic reactions (rash, hives, itching, and difficulty in breathing, swelling of the mouth, face, lips, or tongue), chest pain, fast heartbeat and wheezing may occur. Besides, elevations of heart rate and blood pressure or arrhythmias may occur. Cardiac patients with coronary artery disease or hypertension may worsen condition.</p>', '<p>Racemic epinephrine is a 1:1 mixture of the Dextrorotatory and Levorotatory isomers of epinephrine. Epinephrine has been assigned to pregnancy category C by the US FDA. Epinephrine is only recommended for use during pregnancy when there are no alternatives and benefit outweighs the risk. Epinephrine is excreted into human milk. Due to the potential for serious adverse effects in nursing infants, a decision should be made to discontinue nursing or discontinue the drug.</p>', '<p>Racepinephrine should be used cautiously in patients with: cardiac disease (angina, tachycardia, myocardial infarction, hypertension), hyperthyroidism, diabetes, cerebral arteriosclerosis. Excessive use may lead to tolerance and paradoxical bronchospasm. Besides, it is advised not to use Racepinephrine if symptoms are not relieved within 20 minutes or become worse. Racepinephrine solution should not be used if it is brown in color or cloudy, pinkish or if it contains a precipitate.</p>', '<p>Excessive use may cause nervousness and rapid heartbeat, adverse effects on the heart. In case of overdose, the patient should get medical help right away.</p>', '<p>Other adrenoceptor stimulants.</p>', '<p>Store at 2&deg; to 8&deg;C. Keep away from light and out of the reach of children.</p>', NULL, '2022-03-12 05:02:35', '2022-03-12 05:02:35'),
(1154, 1154, '<p>Raloxifene is an estrogen agonist/antagonist indicated for:</p>\r\n\r\n<ul>\r\n	<li>Treatment and prevention of osteoporosis in postmenopausal women</li>\r\n	<li>Reduction in risk of invasive breast cancer in postmenopausal women with osteoporosis</li>\r\n	<li>Reduction in risk of invasive breast cancer in postmenopausal women at high risk for invasive breast cancer</li>\r\n</ul>\r\n\r\n<p>Important Limitations: Raloxifene is not indicated for the treatment of invasive breast cancer, reduction of the risk of recurrence of breast cancer, or reduction of risk of noninvasive breast cancer</p>', '<p>Raloxifene is a selective estrogen receptor modulator (SERM). The biological actions of Raloxifene are largely mediated through binding to estrogen receptor. This binding results in activation of certain estrogenic pathways and blockade of others. Raloxifene reduces resorption of bone and decreases overall bone turnover. These effects on bone are manifested as reductions in the serum and urine levels of bone turnover markers. Clinical trials and data suggest that Raloxifene lacks estrogen like effects on the uterus and breast tissues. Raloxifene is rapidly absorbed after oral administration, metabolized in liver, and primarily excreted in faeces and rest in urine.</p>', '<p>One tablet (60 mg) once daily orally. It can be taken without regard to meal. High fat meal increases the absorption of Raloxifene.</p>', '<p>Co-administered with cholestyramin, ampicillin and amoxicillin may reduce the absorption of Raloxifene.</p>', '<p>Hepatic &amp; renal impairment. In active or past history of venous thromboembolic events, including deep vein thrombosis, pulmonary embolism and retinal vein thrombosis. Hypersensitivity to Raloxifene or any other constituents of the tablet.</p>', '<p>Raloxifene is generally well tolerated. However, a few side effects like hot flushes, leg cramps, and influenza like symptoms, gastro-intestinal disturbances etc may be seen usually during first 6 months of treatment and were not different from placebo.</p>', '<p><strong>Pregnancy Category X:</strong>&nbsp;Raloxifene should not be used in women who are or may become pregnant.<br />\r\n<strong>Lactation:</strong>&nbsp;It is not known whether Raloxifene is excreted in breast milk. Lactating mother should not use Raloxifne.</p>', '<p><strong>Concurrent Estrogen Therapy:</strong>&nbsp;Concomitant use of Raloxifene with systemic estrogens is not recommended.<br />\r\n<br />\r\n<strong>Lipid Metabolism:</strong>&nbsp;Concurrent use of Raloxifene and lipid-lowering agents has not been studied.</p>', '<p>Incidents of overdose in humans have not been reported.</p>', '<p>Inhibiting bone resorption.</p>', NULL, '<p>Severe Renal Impairment: Contraindicated.<br />\r\nHepatic Impairment: Contraindicated.</p>', '2022-03-12 05:04:37', '2022-03-12 05:04:37'),
(1155, 1155, '<p>Ramelteoni s indicated for the treatment of insomnia characterized by difficulty with sleep onset.</p>', '<p>Ramelteon is a melatonin receptor agonist with both high affinity for melatonin MT1&nbsp;and MT2receptors, and lower selectivity for the MT3&nbsp;receptor. Melatonin production is concurrent with nocturnal sleep, meaning that an increase in melatonin levels is related to the onset of self-reported sleepiness and an increase in sleep propensity. MT1&nbsp;receptors are believed to be responsible for regulation of sleepiness and facilitation of sleep onset, and MT2&nbsp;receptors are believed to mediate phase-shifting effects of melatonin on the circadian rhythm. While MT1&nbsp;and MT2&nbsp;receptors are associated with the sleep-wake cycle, MT3&nbsp;has a completely different profile, and therefore is not likely to be involved in the sleep-wake cycle. Remelteon has no appreciable affinity for the gamma-aminobutyric acid (GABA) receptor complex or receptors that bind neuropeptides, cytokines, serotonin, dopamine, norepinephrine, acetylcholine, or opiates.</p>', '<p><strong>Adult dose</strong>: 8 mg taken within 30 minutes of going to bed. Should not be taken with or immediately after a high-fat meal. The total daily dose should not exceed 8 mg.</p>', '<p><strong>Rifampin (strong CYP enzyme inducer)</strong>: Decreases exposure to and effects of ramelteon.<br />\r\n<br />\r\n<strong>Ketoconazole (strong CYP3A4 inhibitor)</strong>: Increases AUC for ramelteon; administer with caution.<br />\r\n<br />\r\n<strong>Fluconazole (strong CYP2C9 inhibitor)</strong>: Increases systemic exposure of ramelteon; administer with caution. Donepezil increases systemic exposure of ramelteon; patients should be closely monitored when ramelteon is co administered with donepezil. Doxepin increases systemic exposure of ramelteon; patients should be closely monitored when ramelteon is co administered with doxepin.<br />\r\n<br />\r\n<strong>Alcohol</strong>: Causes additive psychomotor impairment; should not be used in combination</p>', '<ul>\r\n	<li>History of angioedema while taking Ramelteon.</li>\r\n	<li><strong>Fluvoxamine (strong CYP1A2 inhibitor)</strong>: Increases AUC for ramelteon and should not be used in combination</li>\r\n</ul>', '<p><strong>Most common adverse reactions (&ge;3% and more common than with placebo) are</strong>: somnolence, dizziness, fatigue, nausea, and exacerbated insomnia.</p>', '<p><strong>Pregnancy</strong>: Based on animal data may cause fetal harm. Do not use unless the potential benefit justifies the potential risk.<br />\r\n<br />\r\n<strong>Nursing mothers</strong>: Use with caution.</p>', '<p><strong>Severe anaphylactic/anaphylactoid reactions</strong>: Angioedema and anaphylaxis have been reported. Do not rechallenge if such reactions occur.<br />\r\n<br />\r\n<strong>Need to evaluate for co-morbid diagnoses</strong>: Reevaluate if insomnia persists after 7 to 10 days of treatment.<br />\r\n<br />\r\n<strong>Abnormal thinking, behavioral changes, complex behaviors</strong>: May include &quot;sleep-driving&quot; and hallucinations. Immediately evaluate any new onset behavioral changes.<br />\r\n<br />\r\n<strong>Depression</strong>: Worsening of depression or suicidal thinking may occur.<br />\r\n<br />\r\n<strong>CNS effects</strong>: Potential impairment of activities requiring complete mental alertness such as operating machinery or driving a motor vehicle, after ingesting the drug.&nbsp;<br />\r\n<br />\r\n<strong>Reproductive effects</strong>: Include decreased testosterone and increased prolactin levels. Effect on the reproductive axis in developing humans is unknown<br />\r\n<br />\r\n<strong>Patients with severe sleep apnea</strong>: Rozerem is not recommended for use in this population.</p>', NULL, '<p>Miscellaneous sedatives &amp; hypnotics.</p>', '<p>Store at 25&deg;C; excursions permitted to 15&deg; to 30&deg;C. Keep container tightly closed and protected from moisture and humidity.</p>', '<p><strong>Pediatric use</strong>: Safety and effectiveness not established.<br />\r\n<br />\r\n<strong>Geriatric use</strong>: No overall differences in safety and efficacy between elderly and younger adult subjects.<br />\r\n<br />\r\n<strong>Hepatic impairment</strong>: Is not recommended in patients with severe impairment; use with caution in moderate impairment.</p>', '2022-03-12 05:06:29', '2022-03-12 05:06:29'),
(1156, 1156, '<p>Ramipril indicated in the following cases:</p>\r\n\r\n<ul>\r\n	<li>Hypertension; to lower blood pressure, as single-drug therapy or in combination with other antihypertensive agents.</li>\r\n	<li>Congestive heart failure; also in combination with diuretics.</li>\r\n	<li>Treatment of patients who- within the first few days after an acute myocardial infarction- have demonstrated clinical signs of congestive heart failure.</li>\r\n	<li>Treatment of non-diabetic or diabetic overt glomerular or incipient nephropathy.</li>\r\n	<li>Reduction in the risk of myocardial infarction, stroke, or cardiovascular death in patients with an increased cardiovascular risk, such as manifest coronary heart disease (with or without a history of myocardial infarction), a history of stroke, a history of peripheral vascular disease, or diabetes mellitus that is accompanied by at least one other cardiovascular risk factor (microalbuminuria, hypertension, elevated total cholesterol levels, low high-density lipoprotein cholesterol levels, smoking).</li>\r\n</ul>', '<p>Ramipril is an angiotensin converting enzyme (ACE) inhibitor, which after hydrolysis to ramiprilat, blocks the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II. So, inhibition of ACE by ramipril results in decreased plasma angiotensin II, which leads to decreased vasopressor activity and decreased aldosterone secretion. Thus ramipril exerts its antihypertensive activity. It is also effective in the management of heart failure and reduction of the risk of stroke, myocardial infarction and death from cardiovascular events. It is long acting and well tolerated; so, can be used in long term therapy.</p>', '<p>Dosage of Ramipril must be adjusted according to the patient tolerance and response.<br />\r\n<br />\r\n<strong>Hypertension</strong>: For the management of hypertension in adults not receiving a diuretic, the usual initial dose of Ramipril is 1.25-2.5 mg once daily. Dosage generally is adjusted no more rapidly than at 2 week intervals. The usual maintenance dosage in adults is 2.5-20 mg daily given as a single dose or in 2 divided doses daily. If BP is not controlled with Ramipril alone, a diuretic may be added.<br />\r\n<br />\r\n<strong>Congestive heart failure after myocardial infarction</strong>: In this case, Ramipril therapy may be initiated as early as 2 days after myocardial infarction. An initial dose of 2.5 mg twice daily is recommended, but if hypotension occurs, dose should be reduced to 1.25 mg twice daily. Therapy is then titrated to a target daily dose of 5 mg twice daily.<br />\r\n<br />\r\n<strong>Prevention of major cardiovascular events</strong>: In this case, the recommended dose is 2.5 mg once daily for the first week of therapy and 5 mg once daily for the following 3 weeks; dosage then may be increased, as tolerated, to a maintenance dosage of 10 mg once daily.<br />\r\n<br />\r\n<strong>Dosage in renal impairment</strong>:</p>\r\n\r\n<ul>\r\n	<li><strong>For patients with hypertension and renal impairment</strong>: The recommended initial dose is 1.25 mg Ramipril once daily. Subsequent dosage should be titrated according to individual tolerance and BP response, up to a maximum of 5 mg daily.</li>\r\n	<li><strong>For patients with heart failure and renal impairment</strong>: The recommended dose is 1.25 mg once daily. The dose may be increased to 1.25 mg twice daily and up to a maximum dose of 2.5 mg twice daily depending upon clinical response and tolerability.</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>Ramipril tablets have to be swallowed with sufficient amounts of liquid. The tablets must not be chewed or crushed. Absorption of Ramipril is not significantly affected by food. Ramipril may, therefore, be taken before, during or after a meal.</p>', '<p>Concomitant administration with diuretics may lead to serious hypotension and in addition dangerous hyperkalemia with potassium sparing diuretics. Concomitant therapy with lithium may increase the serum lithium concentration. Reduction in BP may affect the ability to drive and operate machinery and this may be exacerbated by alcohol. NSAIDs may reduce the antihypertensive effect of Ramipril and cause deterioration of renal function.</p>', '<p>Ramipril must not be used</p>\r\n\r\n<ul>\r\n	<li>in patients with hypersensitivity to ramipril, to any other ACE inhibitor, or any of the excipients of Ramipril.</li>\r\n	<li>in patients with a history of angioedema.</li>\r\n	<li>concomitantly with sacubitril/valsartan therapy. Do not initiate Ramipril until sacubitril/valsartan is eliminated from the body. In case of switch from Ramipril to sacubitril/valsartan, do not start sacubitril/valsartan until Ramipril is eliminated from the body.</li>\r\n	<li>in patients with haemodynamically relevant renal artery stenosis, bilateral or unilateral in the single kidney.</li>\r\n	<li>in patients with hypotensive or haemodynamically unstable states.</li>\r\n	<li>with aliskiren-containing medicines in patients with diabetes or with moderate to severe renal impairment (creatinine clearance &lt;60 ml/min).</li>\r\n	<li>with angiotensin II receptor antagonists (AIIRAs) in patients with diabetic nephropathy.</li>\r\n	<li>during pregnancy.</li>\r\n</ul>\r\n\r\n<p>Concomitant use of ACE inhibitors and extracorporeal treatments leading to contact of blood with negatively charged surfaces must be avoided, since such use may lead to severe anaphylactoid reactions. Such extracorporeal treatments include dialysis or haemofiltration with certain high-fux (e.g. polyacrylonitril) membranes and low-density lipoprotein apheresis with dextran sulfate.</p>', '<p>Ramipril is generally well tolerated. Dizziness, headache, fatigue and asthenia are commonly reported side effects. Other side effects occurring less frequently include symptomatic hypotension, cough, nausea, vomiting, diarrhoea, rash, urticaria, oliguria, anxiety, amnesia etc. Angioneurotic oedema, anaphylactic reactions and hyperkalaemia have also been reported rarely.</p>', '<p>Ramipril must not be taken during pregnancy. Therefore, pregnancy must be excluded before starting treatment. Pregnancy must be avoided in cases where treatment with ACE inhibitors is indispensable. If the patient intends to become pregnant, treatment with ACE inhibitors must be discontinued, i.e. replaced by another form of treatment. If the patient becomes pregnant during treatment, medication with Ramipril must be replaced as soon as possible by a treatment regimen without ACE inhibitors. Otherwise, there is a risk of harm to the fetus. Ramipril is not recommended during breastfeeding.</p>', '<p>Ramipril should be used with caution in patients with impaired renal function, hyperkalaemia, hypotension, and impaired hepatic function.</p>', '<p><strong>Sign and symptom</strong>: Overdosage may cause excessive peripheral vasodilatation (with marked hypotension, shock), bradycardia, electrolyte disturbances, and renal failure.<br />\r\n<br />\r\n<strong>Management</strong>: Primary detoxifcation by, for example, gastric lavage, administration of adsorbents, sodium sulfate; (if possible during the frst 30 minutes). In the event of hypotension administration of &alpha;1-adrenergic agonists (e.g. norepinephrine, dopamine) or angiotensin II (angiotensinamide), which is usually available only in scattered research laboratories, must be considered in addition to volume and salt substitution.</p>', '<p>Angiotensin-converting enzyme (ACE) inhibitors.</p>', '<p>Store at 30&deg; or below, protect from light. Keep 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>', '<p><strong>Elderly</strong>: A reduced initial dose of 1.25 mg Ramipril daily must be considered.<br />\r\n<br />\r\n<strong>Hepatic impairment</strong>: Treatment in these patients must therefore be initiated only under close medical supervision. The maximum permitted daily dose in such cases is 2.5 mg Ramipril.<br />\r\n<br />\r\n<strong>Renal impairment</strong>: With a creatinine clearance between 50 and 20 ml/min per 1.73 m2 body surface area, the initial daily dose is generally 1.25 mg Ramipril. The maximum permitted daily dose, in this case, is 5 mg Ramipril. Patients with incompletely corrected fuid or salt depletion, in patients with severe hypertension, as well as in patients in whom a hypotensive reaction would constitute a particular risk, (e.g., with relevant stenoses of the coronary vessels or those supplying the brain) A reduced initial dose of 1.25 mg Ramipril daily must be considered.<br />\r\n<br />\r\n<strong>Patients pretreated with a diuretic</strong>: Consideration must be given to discontinuing the diuretic for at least 2 to 3 days or- depending on the duration of action of the diuretic- longer before starting treatment with Ramipril, or at least to reducing the diuretic dose. The initial daily dose in patients previously treated with a diuretic is generally 1.25 mg Ramipril.</p>', '2022-03-12 05:08:45', '2022-03-12 05:08:45');
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
(1157, 1157, '<p>Indicated for the treatment of mild to moderate hypertension in patients (in whom combination therapy is appropriate) who have been stabilised on the individual components given in the same proportion.</p>', '<p><strong>Ramipril</strong>&nbsp;is an angiotensin converting enzyme (ACE) inhibitor, which after hydrolysis to ramiprilat, blocks the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II. So, inhibition of ACE by ramipril results in decreased plasma angiotensin II, which leads to decreased vasopressor activity and decreased aldosterone secretion. Thus ramipril exerts its antihypertensive activity. It is also effective in the management of heart failure and reduction of the risk of stroke, myocardial infarction and death from cardiovascular events. It is long acting and well tolerated; so, can be used in long term therapy.<br />\r\n<br />\r\n<strong>Hydrochlorothiazide</strong>&nbsp;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 co-administration of anangiotensin converting enzyme (ACE) inhibitor tends to reverse the potassium loss associated with these diuretics.</p>', '<p>Dose Titration Guided by Clinical Effect. A patient whose blood pressure is not adequately controlled with ramipril (or another ACE inhibitor) alone or with hydrochlorothiazide (or another thiazide diuretic) alone may be switched to combination therapy with Ramipril 2.5 mg + Hydrochlorothiazide 12.5 mg or Ramipril 5 mg + Hydrochlorothiazide 25 mg tablet.<br />\r\n<br />\r\n<strong>Replacement Therapy</strong>: For convenience, patients receiving ramipril and hydrochlorothiazide from separate tablets may instead wish to receive tablets of combination of Ramipril 2.5 mg + Hydrochlorothiazide 12.5 mg or Ramipril 5 mg + Hydrochlorothiazide 25 mg. If necessary, the dose may be increased to two tablets of Ramipril 2.5 mg + Hydrochlorothiazide 12.5 mg or Ramipril 5 mg + Hydrochlorothiazide 25 mg once daily.<br />\r\n<br />\r\n<strong>Maximum daily dose</strong>: 10 mg ramipril and 50 mg hydrochlorothiazide (four tablets of Ramipril 2.5 mg + Hydrochlorothiazide 12.5 mg or two tablets of Ramipril 5 mg + Hydrochlorothiazide 25 mg).</p>', '<p>Combination with diuretics or other antihypertensive agents or nitrates and tricyclic antidepressants may potentiate the antihypertensive response to Ramipril and Hydrochlorothiazide combination. Patients previously treated with diuretics may experience a marked drop in blood pressure. Ramipril / Hydrochlorothiazide may weaken the effectiveness of blood sugar lowering medications (antidiabetic agents, e.g. insulin and sulphonylurea derivatives). When Ramipril/Hydrochlorothiazide is administered simultaneously with acetyl salicylic acid or indomethacin, attenuation of antihypertensive effect and moreover acute renal failure may occur. Ramipril / Hydrochlorothiazide may potentiate the effects of alcohol.</p>', '<p>This preparation must not be used in patients with hypersensitivity to ramipril, hydrochlorothiazide or other thiazide diuretics. History of hereditary angioneurotic oedema. Severe impairment of renal function. Haemodynamically relevant unilateral or bilateral renal artery stenosis, mitral stenosis, aortic stenosis, and in patients with low blood pressure (hypotensive patients) or in patients with an unstable circulatory situation (haemodynamically unstable patients) where there might be a risk of life-threatening fall in blood pressure and renal failure. Clinically relevant electrolyte disturbances e.g. hypokalemia, hyponatremia or hypercalcemia which may worsen following treatment.</p>', '<p>The combination of Ramipril and Hydrochlorothiazide is generally well tolerated. Side effects commonly reported include headache, dizziness, asthenia, nausea, vomiting, hypotension, cough, weakness, diarrhoea, fever, gastric irritation, pulmonary oedema, photosensitivity, electrolyte imbalance, hyperglycaemia, hyperuricaemia and vertigo.</p>', '<p>ACE inhibitors can cause foetal and neonatal morbidity and death when administered to pregnant women. Also, thiazides cross the placental barrier and appear in cord blood. There is a risk of foetal or neonatal jaundice, thrombocytopenia, and possibly other adverse reactions that have occurred in adults. When pregnancy is detected, Ramipril and Hydrochlorothiazide combination should be discontinued as soon as possible. This product is excreted in breast milk. Because of the potential for serious adverse reactions in nursing infants, women receiving Ramipril and Hydrochlorothiazide combination should not breast feed.</p>', '<p>Treatment with Ramipril and Hydrochlorothiazide combination requires regular medical supervision. Generally dehydration, reduced blood volume (hypovolumia) or salt depletion should be corrected before initiating the treatment (in patients with concomitant heart failure, however, this must be carefully weighed against the risk of volume overload).<br />\r\n<br />\r\n<strong>Special caution is necessary during the treatment of</strong>: Patients with severe and particularly with malignant hypertension. Patients with concomitant and particularly with severe heart failure. Patients in whom fluid or salt deficiency exists or may develop (as a result of inadequate fluid or salt intake) or as a result of diarrhoea, vomiting or excessive sweating in cases where salt and fluid replacement is inadequate. Patients with haemodynamically relevant renal artery stenosis. In patients with pre-existing impairment of renal function or in kidney transplant patients. White blood cell count should be monitored (more frequent in the initial phase of the treatment) so that leucopenia can be detected. Insufficient experience has been gained concerning the use of Ramipril and Hydrochlorothiazide combination in children.</p>', '<p><strong>Ramipril:</strong>&nbsp;Limited data on human overdosage are available. The most likely clinical manifestations would be symptoms attributable to hypotension. Because the hypotensive effect of Ramipril is achieved through vasodilation and effective hypovolemia, it is reasonable to treat Ramipril overdosage by infusion of normal saline solution.<br />\r\n<br />\r\n<strong>Hydrochlorothiazide:</strong>&nbsp;The most common signs and symptoms observed are those caused by electrolyte depletion (hypokalemia, hypochloremia, 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.</p>', '<p>Combined antihypertensive preparations</p>', '<p>Store in a cool and dry place, protected from light.</p>', '<p><strong>Dosage in renal impairment:</strong>&nbsp;In patients with a creatinine clearance between 60 and 30 ml/min, treatment should be initiated with Ramipril 1.25 mg monotherapy. If blood pressure is not adequately controlled, the dose of Ramipril may be increased to 2.5 mg. If blood pressure is still not controlled, patient may be switched to one tablet of Ramoril 2.5 Plus once daily. Dosage may be titrated upward to Ramoril 5 Plus until blood pressure is controlled.<br />\r\n<br />\r\n<strong>Uue in children</strong>: Safety and effectiveness in paediatric patients have not been established.</p>', '2022-03-12 05:39:06', '2022-03-12 05:39:06'),
(1158, 1158, '<p>Ramucirumab is a human vascular endothelial growth factor receptor 2 (VEGFR2) antagonist indicated:</p>\r\n\r\n<ul>\r\n	<li>As a single agent or in combination with paclitaxel, for treatment of advanced or metastatic gastric or gastro-esophageal junction adenocarcinoma with disease progression on or after prior fluoropyrimidine- or platinum-containing chemotherapy.</li>\r\n	<li>In combination with erlotinib, for first-line treatment of metastatic non-small cell lung cancer with epidermal growth factor receptor (EGFR) exon 19 deletions or exon 21 (L858R) mutations.</li>\r\n	<li>In combination with docetaxel, for treatment of metastatic non-small&nbsp;cell lung cancer with disease progression on or after platinum-based chemotherapy. Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for these aberrations prior to receiving Ramucirumab.</li>\r\n	<li>In combination with FOLFIRI, for the treatment of metastatic colorectal cancer with disease progression on or after prior therapy with bevacizumab, oxaliplatin, and a fluoropyrimidine.</li>\r\n	<li>As a single agent, for the treatment of hepatocellular carcinoma in patients who have an alpha-fetoprotein of &ge;400 ng/mL and have been treated with sorafenib.</li>\r\n</ul>', '<p>Ramucirumab is a VEGFR2 antagonist that specifically binds VEGFR2 and blocks binding of VEGFR ligands, VEGF-A, VEGF-C, and VEGF-D. As a result, ramucirumab inhibits ligand-stimulated activation of VEGFR2, thereby inhibiting ligand-induced proliferation, and migration of human endothelial cells. Ramucirumab inhibited angiogenesis in an in vivo animal model.</p>', '<p>For intravenous infusion only. Do not administer as an intravenous push or bolus. Premedicate before each infusion.</p>\r\n\r\n<ul>\r\n	<li><strong>Gastric Cancer</strong>: Administer Ramucirumab 8 mg/kg every 2 weeks as a single agent or in combination with weekly paclitaxel.</li>\r\n	<li><strong>Non-Small Cell Lung Cancer</strong>: Administer Ramucirumab 10 mg/kg every 2 weeks with daily erlotinib. Administer Ramucirumab 10 mg/kg on Day 1 of a 21-day cycle prior to docetaxel.</li>\r\n	<li><strong>Colorectal Cancer</strong>: Administer Ramucirumab 8 mg/kg every 2 weeks prior to FOLFIRI.</li>\r\n	<li><strong>Hepatocellular Carcinoma</strong>: Administer Ramucirumab 8 mg/kg every 2 weeks.</li>\r\n</ul>', NULL, NULL, '<p>The most common adverse reactions observed in single agent Ramucirumab-treated gastric cancer patients at a rate of &ge;10% and &ge;2% higher than placebo were hypertension and diarrhea.<br />\r\n<br />\r\nThe most common adverse reactions observed in patients treated with Ramucirumab with paclitaxel at a rate of &ge;30% and &ge;2% higher than placebo with paclitaxel were fatigue/asthenia, neutropenia, diarrhea, and epistaxis.<br />\r\n<br />\r\nThe most common adverse reactions observed in patients treated with Ramucirumab with erlotinib at a rate of &ge;30% and &ge;2% higher than placebo with erlotinib were, infections, hypertension, stomatitis, proteinuria, alopecia, and epistaxis. The most common laboratory abnormalities at a rate of &ge;30% and &ge;2% higher difference in incidence between arms were increased alanine aminotransferase, increased aspartate aminotransferase, anemia, thrombocytopenia, and neutropenia.<br />\r\n<br />\r\nThe most common adverse reactions observed in patients treated with Ramucirumab with docetaxel at a rate of &ge;30% and &ge;2% higher than placebo with docetaxel were neutropenia, fatigue/asthenia, and stomatitis/mucosal inflammation.<br />\r\n<br />\r\nThe most common adverse reactions observed in patients treated with Ramucirumab with FOLFIRI at a rate of &ge;30% and &ge;2% higher than placebo with FOLFIRI were diarrhea, neutropenia, decreased appetite, epistaxis, and stomatitis.<br />\r\n<br />\r\nThe most common adverse reactions observed in single agent Ramucirumab-treated HCC patients at a rate of &ge;15% and &ge;2% higher than placebo were fatigue, peripheral edema, hypertension, abdominal pain, decreased appetite, proteinuria, nausea, and ascites. The most common laboratory abnormalities at a rate of &ge;30% and a &ge;2% higher difference in incidence between arms were thrombocytopenia, hypoalbuminemia, and hyponatremia.</p>', '<p>Based on its mechanism of action, Ramucirumab can cause fetal harm when administered to a pregnant woman. There are no available data on Ramucirumab use in pregnant women. Animal models link angiogenesis, VEGF and VEGFR2 to critical aspects of female reproduction, embryo-fetal development, and postnatal development. No animal studies have been conducted to evaluate the effect of ramucirumab on reproduction and fetal development. Advise a pregnant woman of the potential risk to a fetus. In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2-4% and 15-20%, respectively.<br />\r\n<br />\r\nThere is no information on the presence of ramucirumab in human milk or its effects on the breastfed child or on milk production. Human IgG is present in human milk, but published data suggest that breast milk antibodies do not enter the neonatal and infant circulation in substantial amounts. Because of the potential risk for serious adverse reactions in breastfed children from ramucirumab, advise women not to breastfeed during treatment with Ramucirumab and for 2 months after the last dose.</p>', '<p><strong>Hemorrhage</strong>: Ramucirumab increases the risk of hemorrhage and gastrointestinal hemorrhage, including severe and fatal events. Permanently discontinue Ramucirumab in patients who experience severe bleeding.<br />\r\n<br />\r\n<strong>Gastrointestinal Perforations</strong>: Ramucirumab increases the risk of gastrointestinal perforation, which can be fatal. Permanently discontinue Ramucirumab in patients who experience a gastrointestinal perforation.<br />\r\n<br />\r\n<strong>Impaired Wound Healing</strong>: Withhold Ramucirumab for 28 days prior to elective surgery. Do not administer Ramucirumab for at least 2 weeks following a major surgical procedure and until adequate wound healing. The safety of resumption of Ramucirumab after resolution of wound healing complications has not been established.<br />\r\n<br />\r\n<strong>Arterial Thromboembolic Events (ATEs)</strong>: Serious and sometimes fatal ATEs can occur with Ramucirumab. Permanently discontinue Ramucirumab in patients who experience an ATE.<br />\r\n<br />\r\n<strong>Hypertension</strong>: Monitor blood pressure and treat hypertension. Withhold Ramucirumab for severe hypertension. Permanently discontinue Ramucirumab for hypertension that cannot be controlled with antihypertensive therapy and for hypertensive crisis or hypertensive encephalopathy.<br />\r\n<br />\r\n<strong>Infusion-Related Reactions (IRR)</strong>: Monitor for signs and symptoms during infusion. Reduce the infusion rate for Grade 1 or 2 IRR and permanently discontinue for Grade 3 or 4 IRR.<br />\r\n<br />\r\n<strong>Worsening of Pre-existing Hepatic Impairment</strong>: New onset or worsening encephalopathy, ascites or hepatorenal syndrome can occur in patients with Child-Pugh B or C cirrhosis.<br />\r\n<br />\r\n<strong>Posterior Reversible Encephalopathy Syndrome</strong>: Permanently discontinue Ramucirumab.<br />\r\n<br />\r\n<strong>Proteinuria Including Nephrotic Syndrome</strong>: Monitor for proteinuria. Withhold Ramucirumab for urine protein levels greater than or equal to 2 g per 24 hours. Permanently discontinue Ramucirumab for urine protein levels greater than 3 g per 24 hours or nephrotic syndrome.<br />\r\n<br />\r\n<strong>Thyroid Dysfunction</strong>: Monitor thyroid function during treatment.<br />\r\n<br />\r\n<strong>Embryo-Fetal Toxicity</strong>: Can cause fetal harm. Advise females of reproductive potential of the potential risk to a fetus and to use effective contraception.</p>', NULL, '<p>Cytotoxic Chemotherapy</p>', '<p>Store vials in a refrigerator at 2&deg;C to 8&deg;C in the original carton to protect from light until time of use. Do not freeze or shake the vial.</p>', NULL, '2022-03-12 05:40:58', '2022-03-12 05:40:58'),
(1159, 1159, '<p>Ranibizumab is indicated for the treatment of patients with:</p>\r\n\r\n<ul>\r\n	<li>Neovascular (Wet) Age-Related Macular Degeneration (AMD)</li>\r\n	<li>Macular Edema Following Retinal Vein Occlusion (RVO)</li>\r\n	<li>Diabetic Macular Edema (DME)</li>\r\n	<li>Diabetic Retinopathy (Non Proliferative Diabetic Retinopathy (NPDR), Proliferative Diabetic Retinopathy (PDR)) in patients with Diabetic Macular Edema (DME)</li>\r\n	<li>Myopic Choroidal Neovascularization (mCNV)</li>\r\n</ul>', '<p>Ranibizumab is a recombinant humanised IgG1 kappa monoclonal antibody fragment which binds to active forms of human vascular endothelial growth factor A (VEGF-A) and inhibits their biologic activity. Binding of ranibizumab to VEGF-A inhibits VEGF from binding to its receptors, thereby suppressing neovascularisation (angiogenesis), endothelial cell proliferation and vascular permeability.</p>', '<p>Intravitreal (Adult)-<br />\r\n<br />\r\n<strong>Neovascular (wet) age-related macular degeneration:</strong>&nbsp;0.5 mg mthly into the affected eye as a single dose. Continue treatment until visual acuity is stable for 3 consecutive mth. Doses are given at intervals of at least 1 mth.<br />\r\n<br />\r\n<strong>Choroidal neovascularisation secondary to pathologic myopia</strong>: 0.5 mg into the affected eye as a single dose. Further injections may be given if monitoring reveals signs of disease activity (1-2 inj during the 1st yr; some patients may need more frequent treatment). Doses are given at intervals of at least 1 mth.<br />\r\n<br />\r\n<strong>Diabetic macular oedema, Macular oedema secondary to retinal vein occlusion</strong>: 0.5 mg mthly into the affected eye as a single dose. Continue treatment until visual acuity is stable for 3 consecutive mth. Doses are given at intervals of at least 1 mth. Discontinue treatment if no improvement in visual acuity after 3 initial inj.</p>', '<p>May enhance the adverse/toxic effect of belimumab. Serious intraocular inflammation may occur when used adjunctively with verteporfin photodynamic therapy (PDT).</p>', '<p>Active or suspected ocular or periocular infection, active severe intraocular inflammation, signs of irreversible ischaemic visual function loss in patients with retinal vein occlusion.</p>', '<p>Ocular pain, hyperaemia, irritation and pruritus; increased intraocular pressure, vitritis, vitreous detachment, retinal haemorrhage, visual disturbance, vitreous floaters, conjunctival haemorrhage, foreign body sensation in eyes, increased lacrimation, blepharitis, dry eye, headache, nasopharyngitis, arthralgia, thromboembolic events. Less frequently, endophthalmitis, blindness, retinal detachment, retinal tear and iatrogenic traumatic cataract.</p>', '<p><strong>Pregnancy</strong>&nbsp;Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.</p>', '<p>Patient with risk factors for retinal pigment epithelial tears, history of stroke or transient ischaemic attack, uncontrolled HTN, previous intravitreal inj, active systemic infections, proliferative diabetic retinopathy, diabetic macular oedema due to type 1 DM. Discontinue treatment if rhegmatogenous retinal detachment or stage 3 or 4 macular hole develops. Diabetic patients w/ glycosylated Hb over 12%.</p>', '<p><strong>Symptoms:</strong>&nbsp;Increased intraocular pressure, transient blindness, reduced visual acuity, corneal oedema, corneal pain, and eye pain.<br />\r\n<br />\r\n<strong>Management</strong>: Intraocular pressure should be monitored and treated by the attending physician, if necessary.</p>', '<p>Drugs for Age-Related Macular Degeneration (AMD).</p>', '<p>Store between 2-8&deg; C. Protect from light.</p>', NULL, '2022-03-12 05:42:42', '2022-03-12 05:42:42'),
(1160, 1160, '<p>Ranitidine is indicated in:</p>\r\n\r\n<ul>\r\n	<li>Treatment of active duodenal ulcer</li>\r\n	<li>Benign gastric ulcer</li>\r\n	<li>Treatment &amp; prevention of ulcer associated with non-steroidal anti-inflammatory agent</li>\r\n	<li>Post operative stress ulcer.</li>\r\n	<li>Zollinger-Ellison Syndrome.</li>\r\n	<li>Gastroesophageal reflux disease (GERD).</li>\r\n	<li>Gastro-intestinal haemorrhage from stress ulcer in seriously ill patient.</li>\r\n	<li>Recurrent haemorrhage in patients with bleeding peptic ulcer.</li>\r\n	<li>Before general anesthesia in patient considered to be at risk of acid aspiration particulary obstetric patients.</li>\r\n</ul>', '<p>Ranitidine competitively blocks histamine at H2-receptors of the gastric parietal cells which inhibits gastric acid secretion. It does not affect pepsin secretion, pentagastrin-stimulated intrinsic factor secretion or serum gastrin.</p>', '<p>Ranitidine Tablet &amp; Syrup:</p>\r\n\r\n<p><strong>Duodenal and gastric ulcer</strong>: The usual dosage is 150 mg twice daily taken in the morning and evening or 300 mg as a single daily dose at night for 4 to 8 weeks.<br />\r\n<br />\r\n<strong>Reflux oesophagitis</strong>: 150 mg twice daily or 300 mg at bed time for up to 8 weeks.<br />\r\n<br />\r\n<strong>Zollinger Ellison syndrome</strong>: 150 mg 3 times daily and increased if necessary up to 6 g daily in divided doses. Dosage should be continued as long as clinically indicated.<br />\r\n<br />\r\n<strong>Episodic dyspepsia</strong>: 150 mg twice daily or 300 mg at bed time for up to 6 weeks.<br />\r\n<br />\r\n<strong>Maintenance</strong>: 150 mg at night for preventing recurrences.<br />\r\n<br />\r\n<strong>Child (peptic ulcer)</strong>: 2-4 mg/kg twice daily, maximum 300 mg daily.<br />\r\n<br />\r\n&nbsp;</p>\r\n\r\n<p>Ranitidine IV injection &amp; IV Infusion:</p>\r\n\r\n<p>Ranitidine injection may be given either as a slow (over a period of at least two minutes) intravenous injection of 50 mg, after dilution to a volume of 20 ml per 50 mg dose, which may be repeated every six to eight hours; or as an intermittent intravenous infusion at a rate of 25 mg per hour for two hours; the infusion may be repeated at six to eight hour intervals; or as an intramuscular injection of 50 mg (2 ml) every six to eight hours. In the prophylaxis of haemorrhage from stress ulceration in seriously ill patients or the prophylaxis of recurrent haemorrhage in patients bleeding from peptic ulceration, parenteral administration may be continued until oral feeding commences.<br />\r\n<br />\r\nIn the prophylaxis of upper gastrointestinal haemorrhage from stress ulceration in seriously ill patient sapriming dose of 50 mg as low as intravenous injection followed by a continuous intravenous infusion of 0.125-0.250 mg/kg/hour may be preferred. In patients considered to be at risk of developing aspiration syndrome Ranitidine injection 50 mg may be given intramuscularly or by slow intravenous injection 45 to 60 minutes before induction of general anaesthesia.<br />\r\n<br />\r\n<strong>Children</strong>: The recommended oral dose for the treatment of peptic ulcer in children is 2 mg/kg to 4 mg/kg twice daily to a maximum of 300 mg ranitidine per day. Safety and effectiveness of Ranitidine injection have not been established in case of children.</p>', '<p>Delayed absorption and increased peak serum concentration with propantheline bromide. Ranitidine minimally inhibits hepatic metabolism of coumarin anticoagulants, theophylline, diazepam and propanolol. May alter absorption of pH-dependent drugs (e.g. ketoconazole, midazolam, glipizide). May reduce bioavailability with antacids.</p>', '<p>Patients hypersensitive to Ranitidine.</p>', '<p>Ranitidine is well tolerated and side effects are usually uncommon. Altered bowel habit, dizziness, rash, tiredness, reversible confusional states, headache, decreased blood counts, muscle or joint pain have rarely been reported.</p>', '<p><strong>Pregnancy</strong>: Ranitidine crosses the placenta. But there is no evidence of impaired fertility or harm to the foetus due to Ranitidine. Like other drugs, Ranitidine should only be used during pregnancy if considered essential.<br />\r\n<br />\r\n<strong>Lactation</strong>: Ranitidine is excreted in human breast milk. Caution should be exercised when the drug is administered to a nursing mother.</p>', '<p>Ranitidine should be given in reduced dosage to patients with impaired renal and hepatic function.</p>', '<p>Ranitidine is very specific in action and accordingly no particular problems are expected following overdosage with the drug. Symptomatic and supportive therapy should be given as appropriate. If required, the drug may be removed from the plasma by&nbsp;haemodiaiysis.</p>', '<p>H2 receptor antagonist.</p>', '<p>Store in a cool and dry place. protect from light.</p>', '<p><strong>Use in elderly patients</strong>: In clinical trial the ulcer healing rates have been found similar in patients age 65 and over with those in younger patients. Additionally, there was no difference in the incidence of adverse effects.</p>', '2022-03-12 05:44:42', '2022-03-12 05:44:42'),
(1161, 1161, '<p>Ranolazine is indicated for the treatment of chronic angina. Ranolazine may be used with beta-blockers, nitrates, calcium channel blockers, anti-platelet therapy, lipid-lowering therapy, ACE inhibitors, and angiotensin receptor blockers. It has been shown to decrease angina episodes in patients with coronary artery disease on maximal doses of amlodipine. Because Ranolazine prolongs the QT interval, it should be reserved for patients who have not achieved an adequate response with other antianginal drugs.The effect on angina rate or exercise tolerance appeared to be smaller in women than men.</p>', '<p>Ranolazine has anti-ischemlc and antlanginal effects that do not depend upon reductions in heart rate or blood pressure.The exact mechanism of action of ranolazine is unknown. Ranolazine at therapeutic levels can inhibit the cardiac late sodium current (INa). However, the relationship of this inhibition to angina symptoms is uncertain.<br />\r\n<br />\r\nThe QT prolongation effect of ranolazine on the surface electrocardiogram is the result of inhibition of IKr&nbsp;which prolongs the ventricular action potential.</p>', '<p>Initiate Ranolazine dosing at 500 mg twice daily and increase to 1000 mg twice daily, if needed, based on clinical symptoms. Take Ranolazine with or without meals. Swallow Ranolazine tablets whole; do not crush, break or chew. The maximum recommended daily dose of Ranolazine is 1000 mg twice daily. If a dose of Ranolazine is missed, take the prescribed dose at the next scheduled time; do not double the next dose.</p>', '<p><strong>CYP 3A Inhibitors</strong>: Do not use Ranolazine with strong CYP 3A inhibitors. With moderate CYP 3A inhibitors (e.g., diltiazem, verapamil, erythromycin) limit maximum dose of ranolazine to 500 mg twice daily.<br />\r\n<br />\r\n<strong>CYP 3A Inducers</strong>: Do not use Ranolazine with inducers.<br />\r\n<br />\r\n<strong>P-gp Inhibitors (e.g., Cyclosporin)</strong>: May need to lower the Ranolazine dose based on clinical dose.<br />\r\n<br />\r\n<strong>Drugs transported by P-gp or metabolized by CYP2D6 (eg., digoxin, TCA)</strong>: May need reduced doses of these drugs when used with ranolazine.</p>', '<p>Ranolazine is contraindicated in patients:</p>\r\n\r\n<ul>\r\n	<li>With pre-existing QT prolongation</li>\r\n	<li>With hepatic impairment</li>\r\n	<li>Taking QT prolonging drugs</li>\r\n	<li>Taking potent and moderately potent CYP3A inhibitors such as ketoconazole, itraconazole, clarithromycin, nefazodone, nelfinavir, ritonavir, indinavir, and saquinavir, including diltiazem.</li>\r\n</ul>', '<p><strong>Cardiac Disorders</strong>: bradycardia, palpitations<br />\r\n<strong>Ear and Labyrinth Disorders</strong>: tinnitus, vertigo<br />\r\n<strong>Gastrointestinal Disorders</strong>: abdominal pain, dry mouth, vomiting<br />\r\n<strong>General Disorders and Administrative Site Adverse Events</strong>: peripheral edema<br />\r\n<strong>Respiratory, Thoracic, and Mediastinal Disorders</strong>: dyspnea<br />\r\n<strong>Vascular Disorders:</strong>&nbsp;hypotension, orthostatic hypotension</p>', '<p>Pregnancy Category C. There are no adequate studies assessing the effect of ranolazine on the developing fetus. There are no adequate well-controlled studies in pregnant women. Ranolazine should be used during pregnancy only when the potential benefit to the patient justifies the potential risk to the fetus.lt is not known whether ranolazine is excreted in human milk. Because of the potentiality for serious adverse reactions from ranolazine in nursing infants, a decision should be made whether to discontinue nursing or to discontinue Ranolazine, taking into account the importance of the drug to the mother.</p>', '<p>Ranolazine blocks QTc and prolongs the QTc interval in a dose-related manner. Clinical experience in an acute coronary syndrome population did not show an increased risk of proarrhythmia or sudden death.<br />\r\n<br />\r\nCo-administration of ranolazine with digoxin increases the plasma concentrations of digoxin by approximately 1.5-fold and the dose of digoxin may have to be reduced accordingly. The dose of other P-gp substrates may have to be reduced as well when ranolazine Is co-admlnistered. Caution should be exercised when co-adminlstering ranolazine with P-gp inhibitors such as ritonavir or cydosporine.</p>', '<p><strong>Symptoms:</strong>&nbsp;Dizziness, nausea, vomiting, diplopia, lethargy, syncope, severe tremor, incoordination, dysplasia, hallucination.<br />\r\n<br />\r\n<strong>Management:</strong>&nbsp;Symptomatic and supportive treatment.</p>', '<p>Other Anti-anginal &amp; Anti-ischaemic drugs</p>', '<p>Store Ranolazine tablets at 25&deg;C with excursion permitted to 15&deg; to 30&deg;C. Protect from light and moisture.</p>', '<p><strong>Pediatric use</strong>: Safety and effectiveness in pediatric patients have not been established.<br />\r\n<br />\r\nRenal Impairment:</p>\r\n\r\n<ul>\r\n	<li><strong>Mild to moderate (CrCl 30-80 mL/min)</strong>: Dose titration needed</li>\r\n	<li><strong>Severe (CrCl &lt;30 mL/min)</strong>: Contraindicated</li>\r\n</ul>\r\n\r\n<p>Hepatic Impairment:</p>\r\n\r\n<ul>\r\n	<li><strong>Mild</strong>: Dose titration needed</li>\r\n	<li><strong>Moderate to severe</strong>: Contraindicated</li>\r\n</ul>', '2022-03-12 05:47:25', '2022-03-12 05:47:25'),
(1162, 1162, '<p>Rasagiline is indicated for the treatment of the signs and symptoms of idiopathic Parkinson&#39;s disease as initial monotherapy, and as adjunct therapy to dopamine agonists or to levodopa.</p>', '<p>Rasagiline is a potent, irreversible, selective MAO-B inhibitor that effectively crosses the blood brain barrier after oral administration. The precise mechanisms of action of Rasagiline are unknown. One mechanism is believed to be related to its MAO-B inhibitory activity, which causes an increase in extracellular levels of dopamine in the brain. The elevated dopamine level and subsequent increased dopaminergic activity are likely to mediate Rasagiline&#39;s beneficial effects.</p>', '<p>Monotherapy: Rasagiline 1 mg once daily<br />\r\nAs adjunct without Levodopa: Rasagiline 1 mg once daily<br />\r\nAs adjunct to Levodopa: Rasagiline 0.5 mg once daily</p>', '<p>Concomitant use of Rasagiline with meperidine, dextromethorphan, antidepressants is not recommended.</p>', '<p>Rasagiline is contraindicated for use with meperidine, tramadol, methadone, propoxyphene and MAO inhibitors (MAOIs), including other selective MAO-B inhibitors, because of risk of serotonin syndrome.</p>', '<p>Common side effects of Rasagiline include: dizziness, spinning sensation, joint pain, headache, heartburn, nausea, muscle pain etc.</p>', '<p>Pregnancy Category C. Rasagiline should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is not known whether this drug is excreted in human milk. So, caution should be exercised when administered to a nursing woman.</p>', '<p>Exacerbation of hypertension may occur during treatment with Rasagiline. Medication adjustment may be necessary if elevation of blood pressure is sustained. Dose should not exceed 0.5 mg once daily for patients with mild hepatic impairment or taking concomitant Ciprofloxacin or other CYP1A2 inhibito</p>', NULL, '<p>Antiparkinson drugs</p>', '<p>Store below 30&deg; c, protected from light and moisture. Keep all the medicines out of reach of children.</p>', '<p><strong>Pediatric use</strong>: The safety and effectiveness in pediatric patients have not been established.</p>', '2022-03-12 05:49:21', '2022-03-12 05:49:21'),
(1163, 1163, '<p>In the Female:</p>\r\n\r\n<ul>\r\n	<li><strong>Ovulation Induction</strong>: rFSH administered SC with HCG in a sequential manner, which is indicated for ovulation induction in patients who have previously received pituitary suppression.</li>\r\n	<li><strong>Multi-follicular Development</strong>: During ART: rFSH administered SC in conjunction with HCG is indicated for multiple follicular developments (controlled ovarian stimulation) during ART cycles in patients who have previously received pituitary suppression.</li>\r\n	<li><strong>Polycystic Ovarian Syndrome (PCOS)</strong>: Used to treat Polycystic Ovarian Syndrome (PCOS) related infertility</li>\r\n</ul>\r\n\r\n<p>In the Male: Male infertility treatment in combination with HCG Induction of Spermatogenesis in men deficient spermatogenesis due to Hypogonadotrophic-hypogonadism.</p>', '<p>rFSH is a Follicle Stimulating Hormone (FSH) preparation of recombinant DNA origin, which consists of two non-covalently linked, nonidentical glycoproteins designated as the &alpha;- and &beta; subunits. The &alpha;- and &beta;-subunits have 92 and 111 amino acids respectively, and their primary and tertiary structure are indistinguishable from those of human Follicle Stimulating Hormone. Recombinant FSH production occurs in genetically modified Chinese Hamster Ovary (CHO) cells cultured in bioreactors. Purification by immunochromatography using an antibody specifically binding FSH results in a highly purified preparation with a consistent FSH isoform profile and a high specific activity. The biological activity of rFSH is determined by measuring the increase in ovary weight in female rats. The in vivo biological activity of rFSH has been calibrated against the first International Standard for Recombinant Human Follicle Stimulating Hormone established in 1995 by the Expert Committee on Biological Standards of the World Health Organization. rFSH contains no Luteinizing Hormone (LH) activity.</p>', '<p>To prevent painful injections and minimize leakage from the injection site rFSH should be slowly administered subcutaneously. The subcutaneous injection site should be alternated to prevent lipoathrophy. Any unused solution should be discarded. Subcutaneous injection of rFSH may be carried out by patient or partner, provided that proper instructions are given by the physician. Self-administration of rFSH should only be performed by patients who are well motivated, adequately trained and with access to expert advice.<br />\r\n<br />\r\n<strong>Dosage in Female:</strong>&nbsp;There are great inter and intra-individual variations in the response of the ovaries to exogenous gonadotrophins. This makes it impossible to set an uniform dosage scheme. The dosage should, therefore, be adjusted individually depending on the ovarian response. This requires ultrasonography and monitoring of estradiol levels. There should be consideration to minimize the risk of unwanted ovarian hyperstimulation. rFSH can be given either alone, or in combination with a GnRH analogue to prevent premature luteinisation. In the latter case, especially when using a GnRH agonist, a higher total treatment dose of rFSH may be required to achieve an adequate follicular response. Clinical experience with rFSH is based on up to three treatment cycles in both indications. Overall experience with IVF indicates that in general the treatment success rate remains stable during the first four attempts and gradually declines thereafter.<br />\r\n<br />\r\n<strong>Ovulation Induction in Women</strong>: Starting daily dose of 75 international units (IU) of rFSH is administered subcutaneously or subcutaneous for at least the first 7 days. The dose is increased by 25 or 75 international units (IU) at weekly intervals until follicular growth and/or serum estradiol levels indicate an adequate response. When an acceptable pre-ovulatory state is achieved, final oocyte maturation is achieved with 5000 to 10,000 international units (IU) of human chorionic gonadotropin (HCG). The woman and her partner should have intercourse daily, beginning on the day prior to the administration of HCG and until ovulation becomes apparent.<br />\r\n<br />\r\n<strong>Assisted Reproductive Technology (ART)</strong>: In Women, Starting dose of 150 to 300 international units (IU) of rFSH is administered subcutaneous for at least the first 4 days of treatment. Subsequent doses are adjusted based upon ovarian response as determined by ultrasound evaluation of follicular growth and serum estradiol levels. Final oocyte maturation is induced with a dose of 5000-10000 international units of HCG Oocyte (egg) retrieval is performed 34 to 36 hours later.<br />\r\n<br />\r\n<strong>PCOS</strong>: rFSH injections are therefore given each morning as a subcutaneous injection. It is best to start with the lowest dose of rFSH per day (using 75 IU per day). These doses are used for 4 to 6 days at a time. The ovarian response is determined by measuring estrogen levels in the blood. When the estrogen begins to rise, the rFSH is successfully growing an egg or eggs. If there is no response to a dose of rFSH in 5-6 days of injections the dose will be increased. The normal dose increments are 75 units, 100 units, 150 units and 300 units per day. Most patients respond with 75 IU to 150 IU per day. However it is very important that increments are only made cautiously.<br />\r\n<br />\r\n<strong>Dosage in Male</strong>: Induction of Spermatogenesis in Men: Pre-treatment with HCG alone (2500 international units twice weekly) is required. If serum testosterone levels have not normalized after 8 weeks of HCG treatment, the dose may be increased to 5000 international units (IU) twice a week. After normalization of serum testosterone levels, administer 300 international units (IU) per week (300 international units twice weekly or 100 international units three times weekly) of rFSH subcutaneously with the same pre-treatment HCG dose used to normalize testosterone level.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>rFSH administered for 7 to 12 days produces ovarian follicular growth in women who do not have primary ovarian failure. Treatment with rFSH in most instances results only in follicular growth and maturation. When sufficient follicular maturation has occurred, HCG must be given to induce ovulation.</p>', NULL, '<ul>\r\n	<li>Tumors of the ovary, breast, uterus, pituitary or hypothalamus</li>\r\n	<li>Pregnancy or lactation</li>\r\n	<li>Undiagnosed vaginal bleeding</li>\r\n	<li>Hypersensitivity to the active substance or to any of the excipients</li>\r\n	<li>Primary ovarian failure</li>\r\n	<li>Fibroid tumors of the uterus incompatible with pregnancy</li>\r\n	<li>Primary testicular failure.</li>\r\n</ul>', '<p>Recombinant FSH sometimes excites the ovaries too much. This may cause pelvic pain or breathing problems. It may also make you urinate less. In rare cases, patients with this problem have had serious lung problems, including fluid in the lungs, troublebreathing, and worsening of asthma blood clots, Severe Pelvic pain, Chest pain, or Abdominal pain, Nausea, Vomiting, Sudden weight gain, Bloating, Trouble, Breathing. Recombinant FSH may cause twins or multiple births.</p>', '<p>Pregnancy category X. Recombinant FSH must not be used during pregnancy and lactation.</p>', '<ul>\r\n	<li>The presence of uncontrolled non gonodal endocrinopathies (e.g. thyroid, adrenal or pituitary disorders) should be excluded.</li>\r\n	<li>In pregnancies occurring after induction of ovulation with gonadotrophin preparations, there is an increased risk of multiple gestations (Multiple birth).</li>\r\n	<li>There has been no reports of hypersensitivity to Recombinant FSH, but there remains the possibility of anaphylactic responses.</li>\r\n	<li>The first injection of Recombinant FSH should be performed under direct medical supervision.</li>\r\n	<li>Since infertile women undergoing assisted reproduction and particularly IVF, often have tubal abnormalities the incidence of ectopic pregnancies might be increased. Early ultrasound confirmation that a pregnancy is intrauterine is therefore important.</li>\r\n	<li>Rates of pregnancy loss in women undergoing assisted reproduction techniques are higher than in the normal population.</li>\r\n	<li>Unwanted ovarian hyperstimulation in the treatment of female patients, ultrasonographic assessment of follicular development, and determination of oestradiol levels should be performed prior to treatment and at regular intervals during treatment. Apart from the development of a high number of follicles, oestradiol levels may rise very rapidly, e.g. more than a daily doubling for two or three consecutive days, and possibly reaching excessively high values. The diagnosis of ovarian hyperstimulation may be confirmed by ultrasound examination. If this unwanted ovarian hyperstimulation occurs (i.e. not as part of controlled ovarian hyperstimulation in medically assisted reproduction programs), the administration of Recombinant FSH should be discontinued. In that case pregnancy should be avoided and HCG must be withheld, because it may induce in addition to multiple ovulation, the Ovarian Hyperstimulation Syndrome (OHSS).</li>\r\n	<li>In men, semen analysis is recommended 4 to 6 months after the beginning of treatment in assessing the response.</li>\r\n</ul>', '<p>No data on acute toxicity of Recombinant FSH in humans is available, but the acute toxicity of Recombinant FSH and of urinary gonadotrophin preparations in animal studies have been shown to be very low. Too high a dosage of Recombinant FSH may lead to hyperstimulation of the ovaries.</p>', '<p>Drugs for Infertility, Trophic Hormones &amp; Related Synthetic Drugs.</p>', '<p>Store at 2&deg;C-8&deg;C (in refrigerator). Do not keep in deep freeze. Keep out of reach of children.</p>', NULL, '2022-03-12 05:51:28', '2022-03-12 05:51:28'),
(1164, 1164, '<p>Red Clover is indicated in-</p>\r\n\r\n<ul>\r\n	<li>Menopausal hot flashes, night sweats, redness</li>\r\n	<li>Mood swing</li>\r\n	<li>Osteoporosis</li>\r\n</ul>', '<p>Red Clover extracts act as an estrogen agonist by binding to intracellular estradiol receptors. it was defined as an antiprogestin, due to the extract&#39;s inhibition of progesterone induction of alkaline phosphate, an end product of progestin activity. Red Clover increases uterine weight and decreased cervical mucus viscoelasticity.<br />\r\n<br />\r\nRed Clover (Trifolium pratense) is a herbal extract, which is high in isoflavones (natural plant estrogens). Red Clover isoflavones mimic the action of estrogens and are widely used by women to maintain their health and vitality especially during the time of menopause. Red Clover contains 4 key isoflavones (Genistein, Daidzein, Biochanin A and Formonoetin) that help balance female hormones by mimicking the effects of estrogens in the body, which in turn help support women during menopause. Unlike traditional hormone therapy (HRT), these natural plant estrogens prefer to bond with beta estrogens receptors and show no affinity to bond with alpha estrogens receptors.</p>', '<p>1 or 2 capsules 1 to 3 times daily or as advised by the registered physician.</p>', NULL, '<p>Not to be used in patients with estrogen receptor-positive neoplasias.</p>', '<p>General side effects may include headache, nausea and rash. Due to its coumarin derivatives, Trifolium Pratense should be used with caution in individuals with coagulation disorders or currently undergoing anticoagulation therapy.</p>', '<p>Not to be used during pregnancy &amp; breastfeeding.</p>', NULL, NULL, '<p>Miscellaneous topical agents.</p>', '<p>Store in a cool and dry place. Keep away from light and children.</p>', NULL, '2022-03-12 05:52:56', '2022-03-12 05:52:56');
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
(1165, 1165, '<p>Regorafenib is a kinase inhibitor that is indicated:</p>\r\n\r\n<ul>\r\n	<li>For the treatment of metastatic colorectal cancer (CRC) after disease progression on or intolerance to fluoropyrimidine-based chemotherapy, anti-VEGF therapy and anti-EGFR therapy.</li>\r\n	<li>For the treatment of unresectable or metastatic gastrointestinal stromal tumours (GIST) after disease progression on or intolerance to prior treatment with imatinib and sunitinib.</li>\r\n	<li>For the treatment of hepatocellular carcinoma (HCC) in patients who have been previously treated with sorafenib</li>\r\n</ul>', '<p>Regorafenib is a kinase inhibitor and it inhibits multiple membrane-bound and intracellular kinases involved in normal cellular functions and in pathologic processes such as oncogenesis, tumor angiogenesis, and maintenance of the tumor microenvironment. Regorafenib or its major human active metabolites M-2 and M-5 inhibits the activity of RET, VEGFR1, VEGFR2, VEGFR3, KIT, PDGFR-alpha, PDGFR-beta, FGFR1, FGFR2, TIE2, DDR2, Trk2A, Eph2A, RAF-1, BRAF, BRAFV600E, SAPK2, PTK5, and Abl. Due to its inhibitory functions, regorafenib can inhibit the progression of certain solid tumors.</p>', '<p><strong>Metastatic colorectal cancer (CRC)</strong>: 160 mg orally, once daily for the first 21 days of each 28-day cycle.<br />\r\n<br />\r\n<strong>Gastrointestinal stromal tumours (GIST)</strong>: 160 mg orally, once daily for the first 21 days of each 28-day cycle.<br />\r\n<br />\r\n<strong>Hepatocellular carcinoma (HCC)</strong>: 160 mg orally, once daily for the first 21 days of each 28-day cycle.</p>', '<p><strong>CYP3A4 Inhibitors</strong>: Avoid concomitant use of strong CYP3A4 inhibitors with Regorafenib.<br />\r\n<strong>CYP3A4 Inducers</strong>: Avoid concomitant use of strong CYP3A4 inducers with Regorafenib.</p>', NULL, '<p>The most common side effects (&ge;30%) are asthenia/fatigue, decreased appetite and food intake, hand-foot skin reaction (HFSR) [palmar-plantar erythrodysesthesia (PPE)], diarrhea, mucositis, weight loss, infection, hypertension, and dysphonia.</p>', '<p>Regorafenib is Pregnancy Category D. Based on its mechanism of action, Regorafenib can cause fetal harm when administered to a pregnant woman. There are no adequate and well-controlled studies with Regorafenib in pregnant women. Based on animal reproduction studies Regorafenib was seen to cause embryo lethal and teratogenic defects and also increased the incidences of cardiovascular, genitourinary, and skeletal malformations in animals. Advice pregnant women or women with reproductive potential of the potential hazards of Regorafenib to the fetus. There is no information regarding the presence of regorafenib or its metabolites being excreted in human milk. Regorafenib and its metabolites were excreted in rat milk and because of the potential for serious adverse reactions in nursing infants from Regorafenib, a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.</p>', '<ul>\r\n	<li>Hemorrhage: Permanently discontinue regorafenib for severe or life-threatening hemorrhage.</li>\r\n	<li>Dermatological toxicity: Interrupt and then reduce or discontinue regorafenib depending on severity and persistence of dermatologic toxicity.</li>\r\n	<li>Hypertension: Temporarily or permanently discontinue regorafenib for severe or uncontrolled hypertension.</li>\r\n	<li>Cardiac ischemia and infarction: Withhold regorafenib for new or acute cardiac ischemia/infarction and resume only after resolution of acute ischemic events.</li>\r\n	<li>Reversible Posterior Leukoencephalopathy Syndrome (RPLS): Discontinue regorafenib.</li>\r\n	<li>Gastrointestinal perforation or fistulae: Discontinue regorafenib.</li>\r\n	<li>Wound healing complications: Stop regorafenib before surgery. Discontinue in patients with wound dehiscence.</li>\r\n	<li>Embryofetal toxicity: Can cause fetal harm. Advise women of potential risk to a fetus.</li>\r\n</ul>', NULL, '<p>Targeted Cancer Therapy</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', '<p><strong>Pediatric Use</strong>: The safety and effectiveness of Regorafenib in pediatric patients less than 18 years have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: No overall differences in safety or effectiveness were observed between adult subjects and younger subjects.<br />\r\n<br />\r\n<strong>Hepatic Impairment</strong>: No clinically important differences in the mean exposure of regorafenib or the active metabolites M-2 and M-5 were observed in patients with hepatocellular carcinoma and mild (Child-Pugh A) or moderate (Child-Pugh B) hepatic impairment compared to patients with normal hepatic function. No dose adjustment is recommended in patients with mild or moderate hepatic impairment. Closely monitor patients with hepatic impairment for adverse reactions. Regorafenib is not recommended for use in patients with severe hepatic impairment (Child-Pugh Class C) as it has not been studied in this population.<br />\r\n<br />\r\n<strong>Renal Impairment</strong>: No dose adjustment is recommended for patients with mild renal impairment. Limited pharmacokinetic data are available from patients with moderate renal impairment (CLcr 30-59 mL/min/1.73m2). Regorafenib has not been studied in patients with severe renal impairment or end-stage renal disease.<br />\r\n<br />\r\n<strong>Females and Males of Reproductive Potential</strong>: Contraception: Use effective contraception during treatment and up to 2 months after completion of therapy.<br />\r\n<br />\r\n<strong>Infertility</strong>: There are no data on the effect of regorafenib on human fertility. Results from animal studies indicate that regorafenib can impair male and female fertility</p>', '2022-03-12 05:54:53', '2022-03-12 05:54:53'),
(1166, 1166, '<p>Emergency use of Remdesivir for treatment of suspected or laboratory confirmed Corona Virus Disease 2019 (COVID-19). Severe disease is defined as patients with an oxygen saturation (Sp02) &lt;94% on room air or requiring supplemental oxygen or requiring mechanical ventilation or requiring extracorporeal membrane oxygenation (ECMO). Specifically, Remdesivir is only authorized for hospitalized adult and pediatric patients for whom use of an intravenous agent is clinically appropriate.</p>', '<p>Remdesivir is a preparation of Remdesivir. It is an adenosine nucleotide prodrug that distributes into cells where it is metabolized to form the pharmacologically active nucleoside triphosphate metabolite. Metabolism of Remdesivir to Remdesivir Triphosphate has been demonstrated in multiple cell types. Remdesivir Triphosphate act as an analogue of adenosine triphosphate (ATP) and competes with the natural ATP substrate for incorporation into nascent RNA chains by the SARS-CoV-2 RNA-dependent RNA polymerase, which results in delayed chain termination during replication of the viral RNA. Remdesivir triphosphate is a weak inhibitor of mammalian DNA and RNA polymerase with low potential for mitochondrial toxicity.</p>', '<p>General Information-</p>\r\n\r\n<ul>\r\n	<li>Adult and pediatric patients (&gt;28 days and old) must have an eGFR determined and full-term neonates (&ge;7 days to &le;28 days old) must have serum creatinine determined before dosing of Remdesivir.</li>\r\n	<li>Hepatic laboratory testing should be performed in all patients prior to starting Remdesivir and daily while receiving Remdesivir.</li>\r\n	<li>Remdesivir should be administered via intravenous infusion only. Do not administer as intramuscular injection.</li>\r\n</ul>\r\n\r\n<p>Adult Patients-</p>\r\n\r\n<ul>\r\n	<li>The recommended dosage in adults requiring invasive mechanical ventilation and/or ECMO is a single loading dose of Remdesivir 200 mg on day 1 followed by once daily maintenance dose of Remdesivir 100 mg for 9 days.</li>\r\n	<li>The recommended dose in adults not requiring invasive mechanical ventilation and/or ECMO is a single dose of Remdesivir 200 mg on day 1 followed by once daily maintenance dose of Remdesivir 100 mg for 4 days. If a patient dose not demonstrate clinical improvement, treatment may be extended for up to 5 additional days (i.e. up to a total of 10 days)</li>\r\n	<li>Remdesivir is to be administered via intravenous infusion in a total volume of up to 250 ml 0.9% saline over 30 to 120 minutes.</li>\r\n</ul>\r\n\r\n<p>Pediatric Patients-</p>\r\n\r\n<ul>\r\n	<li>The recommended pediatric dose for pediatric patients weighing between 3.5 kg &lt;40 kg should be calculated using the mg/kg dose according to the patient&rsquo;s weight.</li>\r\n	<li>For pediatric patients with body weight between 3.5 kg &lt;40 kg use Remdesivir for injection 100 mg lyophilized powder only. Administer a body weight-based dosing regimen of one loading dose of Remdesivir 5 mg/kg IV (infused over 30 to 120 minutes) on day 1 followed by Remdesivir 2.5 mg/kg IV (infused over 30 to 120 minutes) once daily for 9 days (for pediatric patients requiring invasive mechanical ventilation and/or ECMO, days 2 through 5). If a patient dose not demonstrate clinical improvement, treatment may be extended for up to 5 additional days (i.e. up to a total of 10 days)</li>\r\n	<li>For pediatric patients with body weight &ge;40 kg requiring invasive mechanical ventilation and/or ECMO, the adult dosage regimen of one loading dose of Remdesivir 200 mg IV (infused over 30 to 120 minutes) on day 1 followed by Remdesivir 100 mg IV (infused over 30 to 120 minutes) once daily for 9 days will be administered.</li>\r\n	<li>For pediatric patients with body weight &ge;40 kg requiring invasive mechanical ventilation and/or ECMO, the adult dosage regimen of one loading dose of Remdesivir 200 mg IV (infused over 30 to 120 minutes) on day 1 followed by Remdesivir 100 mg IV (infused over 30 to 120 minutes) once daily for 4 days (days 2 through 5) will be administered. If a patient does not demonstrate clinical improvement, treatment may be extended for up to 5 additional days (i.e. up to a total of 10 days).</li>\r\n</ul>\r\n\r\n<p><a href=\"https://medex.com.bd/news/104/danger-of-taking-medication-without-doctors-advice\" target=\"_blank\"><em>* চিকিৎসকের পরামর্শ মোতাবেক ঔষধ সেবন করুন</em></a>&#39;</p>\r\n\r\n<p>Administration</p>\r\n\r\n<p>The prepared dilution should not be administered simultaneously with any other medication. The compatibility of Remdesivir injection with IV solutions and medications other than saline is not known. Please administered the diluted solution with the infusion rate described in the below table. Recommended Rate of Infusion- Diluted Remdesivir for Injection Lyophilized Powder in Adults and Pediatric Patients Weighing &gt; 40 kg<br />\r\n<br />\r\nInfusion bag 250 ml:</p>\r\n\r\n<ul>\r\n	<li>Infusion Time: 30 min, Rate of Infusion: 8.33 ml/min</li>\r\n	<li>Infusion Time: 60 min, Rate of Infusion: 4.17 ml/min</li>\r\n	<li>Infusion Time: 120 min, Rate of Infusion: 2.08 ml/min</li>\r\n</ul>\r\n\r\n<p>Infusion bag 100 ml:</p>\r\n\r\n<ul>\r\n	<li>Infusion Time: 30 min, Rate of Infusion: 3.33 ml/min</li>\r\n	<li>Infusion Time: 60 min, Rate of Infusion: 1.67 ml/min</li>\r\n	<li>Infusion Time: 120 min, Rate of Infusion: 0.83 ml/min</li>\r\n</ul>', NULL, '<p>Remdesivir is contraindicated in patients with known hypersensitivity to Remdesivir.</p>', '<p>An adverse reaction associated with Remdesivir in clinical trials in healthy adult subjects was increased liver transaminases.</p>', '<p>No adequate and well controlled studies of Remdesivir use in pregnant women have been conducted. Remdesivir should be used in pregnancy only if the potential benefit justifies the potential risk for the mother fetus. There is no information regarding the presence of Remdesivir in human milk, the effects on the breastfeed infants, or the effects on milk production. Because of the potential for viral transmission of SARS-CoV-2 negative infants and adverse reactions from the drug in breastfeeding infants, the development and health benefits of breastfeeding should be considered along with the mother&#39;s clinical need for Remdesivir and any potential adverse effects on the breastfed child from Remdesivir or from the underlying maternal condition.</p>', '<p>There are limited clinical data available for Remdesivir. Serious and unexpected adverse events may occur that have not been previously reported with Remdesivir use.</p>', NULL, '<p>Anti-viral drugs</p>', '<p>Please do not reuse or save unused Remdesivir Lyophilized powder, injection solution or diluted solution for infusion for further use. This product contains no preservatives.<br />\r\n<br />\r\n<strong>Lyophilized Powder</strong>: Please store Remdesivir for injection, 100 mg, vials at temperature not exceeding 30&deg;C in a dry place until required for use. Protect from light &amp; moisture. Do not use after expiration date.<br />\r\n<br />\r\n<strong>After reconstitution</strong>: vials can be stored up to 4 hours at room temperature (20&deg;C-25&deg;C) prior to administration or 24 hours at refrigerated temperature (2&deg;C-8&deg;C). Please dilute within the same day as administration.<br />\r\n<br />\r\n<strong>Diluted Solution for Infusion</strong>: Please store diluted Remdesivir solution for infusion up to 4 hours at room temperature (20&deg;C-25&deg;C) or 24 hours at refrigerated temperature (2&deg;C-8&deg;C).</p>', NULL, '2022-03-12 05:56:35', '2022-03-12 05:56:35'),
(1167, 1167, '<p>Repaglinide is indicated as an adjunct to diet and exercise to lower the blood glucose in patients with type 2 diabetes mellitus (NIDDM) whose hyperglycemia cannot be controlled satisfactorily by diet and exercise alone. It is also indicated for use in combination with Metformin to lower blood glucose in patients whose hyperglycemia cannot be controlled by exercise, diet, and either Repaglinide or Metformin alone.</p>', '<p>Repaglinide binds to specific receptors in the cell membrane leading to the closure of ATP dependent K+&nbsp;channels and the depolarisation of cell membrane. This in turn, leads to Ca++&nbsp;influx, increased intracellular Ca++&nbsp;and the stimulation of insulin secretion.</p>', '<ul>\r\n	<li>For patients not previously treated or whose HbA1c is &lt;8%, the starting dose should be 0.5 mg before each meal.</li>\r\n	<li>For patients previously treated with blood glucose-lowering drugs and whose HbA1c is &gt;8%, the initial dose is 1 or 2 mg before each meal.</li>\r\n	<li>Repaglinide should be taken immediately or up to 30 minutes before each meal.</li>\r\n	<li>Dosage should be adjusted according to response at intervals of 1-2 weeks; up to 4 mg may be given as a single-dose, maximum 16 mg daily.</li>\r\n</ul>', '<p>The dose of Repaglinide may need to be adjusted, if taken with other medications. The possible interactions of Repaglinide with other drugs are:</p>\r\n\r\n<ul>\r\n	<li>Inhibitors of the cytochrome P450 enzyme system (azole antifungals and macrolides) may lead to lower Repaglinide clearance and longer half life.</li>\r\n	<li>Inducers of the cytochrome P450 enzyme system (Rifampin, Phenobarbital, Carbamazepine, Troglitazone, etc.) may accelerate Repaglinide metabolism and shorten its effect.</li>\r\n	<li>Cimetidine has no significant effect on Repaglinide absorption or clearance.</li>\r\n	<li>Repaglinide has no significant effect on Digoxin, Theophyllin, or Warfarin.</li>\r\n	<li>Highly protein bound drugs (e.g., NSAIDs) may increase the plasma level of unbound Repaglinide and potentiate its glucose lowering effect. Thus, co-administration of these drugs with Repaglinide may increase the risk of hypoglycaemia.</li>\r\n	<li>The risk of hypoglycaemia may also be increased when hypoglycaemic agents are co-administered with certain drugs such as salicylates, sulphonamides, Chloramphenicol, coumarins, Probenecid, monoamine oxidase (MAO) inhibitors, and adrenergic blockers.</li>\r\n</ul>', '<p>Repaglinide is contraindicated in patients with:</p>\r\n\r\n<ul>\r\n	<li>Diabetic ketoacidosis, with or without coma.</li>\r\n	<li>Type 1 diabetes mellitus and</li>\r\n	<li>Known hypersensitivity to the drug or its inactive ingredients.</li>\r\n</ul>', '<p>The most common side effects of Repaglinide are hypoglycemia and related symptoms. Others include upper respiratory tract infections, diarrhea, constipation, nausea and vomiting. Hypersensitivity reactions include rashes and urticaria.</p>', '<p>Safety in pregnant women has not been established. Repaglinide should be used during pregnancy only if it is clearly needed. It is not known whether Repaglinide is excreted in human milk. Because many drugs are excreted in human milk and because of the potential for serious adverse reactions in nursing infants from Repaglinide, a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the mother.</p>', '<p>Insulin should be substituted during concurrent illness (such as myocardial infarction, coma, infection, and trauma) and during surgery. All oral blood glucose-lowering drugs are capable of producing hypoglycemia. Repaglinide should be administered with meals to lessen the risk of hypoglycemia.</p>', '<p>Patients receiving up to 80 mg of Repaglinide developed few adverse effects other than lowering of blood glucose. Hypoglycemia did not occur when meals were given with these high doses. Severe hypoglycemic reactions with coma, seizure or other neurological impairment occur infrequently.</p>', '<p>Meglitinide Analogues.</p>', '<p>Do not store above 30&deg;C. Keep away from light and out of the reach of children.</p>', NULL, '2022-03-12 05:58:22', '2022-03-12 05:58:22'),
(1168, 1168, '<p><strong>Ovarian Carcinoma</strong>: Paclitaxel is indicated as first line and subsequent therapy for the treatment of advanced carcinoma of the ovary. As first line therapy, Paclitaxel is indicated in combination with cisplatin.<br />\r\n<br />\r\n<strong>Breast Carcinoma</strong>: Paclitaxel is indicated for the adjuvant treatment of node-positive breast cancer administered sequentially to standard doxorubicin-containing combination chemotherapy. Paclitaxel is indicated for the treatment of breast cancer after failure of combination chemotherapy for metastatic disease or relapse within 6 months of adjuvant chemotherapy. Prior therapy should have included an anthracline unless clinically contraindicated. Paclitaxel is indicated for the first-line therapy of advanced or metastatic breast cancer either in combination with an anthracycline in patients for whom anthracline therapy is suitable or in combination with trastuzumab in patients who overexpress HER2 at a 2+ or 3+ level as determined by immuno-histochemistry.<br />\r\n<br />\r\nGemcitabine, in combination of Paclitaxel, is indicated in the treatment of patients with unresectable, locally recurrent or metastatic breast cancer who have relapsed following adjuvant/neoadjuvant chemotherapy. Prior chemotherapy should have included an anthracycline unless clinically contraindicated.<br />\r\n<br />\r\nPaclitaxel is indicated for the treatment of metastatic cancer of the breast, in combination with trastuzumab, in patients who have tumors that over-express HER2 and who have not received previous chemotherapy for their metastatic disease.<br />\r\n<br />\r\n<strong>Non-Small Cell Lung Carcinoma</strong>: Paclitaxel, in combination with cisplatin, is indicated for the first line treatment of non-small cell lung cancerin patients who are not candidates for potential curative surgery and/or radiation therapy.<br />\r\n<br />\r\n<strong>Kaposi&#39;s Sarcoma</strong>: Paclitaxel is indicated for the second line treatment of AIDS related Kaposi&#39;s Sarcoma.<br />\r\n<br />\r\n<strong>Gastric Carcinoma</strong>: Paclitaxel is indicated for the treatment of Gastric Carcinoma.</p>', '<p>Paclitaxel is a novel anti-microtubule agent that promotes the assembly of microtubules from tubulin dimers and stabilizes microtubules by preventing depolymerization. This stability results in the inhibition of the normal dynamic reorganization of the microtubule network that is essential for vital interphase and mitotic cellular functions. In addition, paclitaxel induces abnormal arrays or &ldquo;bundles&rdquo; of microtubules throughout the cell cycle and multiple asters of microtubules during mitosis. Following intravenous administration of Paclitaxel, paclitaxel plasma concentrations declined in a biphasic manner. The initial rapid decline represents distribution to the peripheral compartment and elimination of the drug. The later phase is due, in part, to a relatively slow efflux of paclitaxel from the peripheral compartment.</p>', '<p>All patients should be premedicated prior to Paclitaxel administration in order to prevent severe hypersensitivity reactions. Such premedication may consist of dexamethasone 20 mg PO administered approximately 12 and 6 hours before Paclitaxel, diphenhydramine (or its equivalent) 50 mg IV 30 to 60 minutes prior to Paclitaxel, and cimetidine (300 mg) or ranitidine (50 mg) IV 30 to 60 minutes before Paclitaxel.<br />\r\n<br />\r\n<strong>First-line treatment of ovarian cancer</strong>: Although alternative medication regimens for paclitaxel are under investigation at present, a combination therapy of paclitaxel and cisplatin is recommended. Depending on the duration of infusion, two different dosages are recommended for paclitaxel treatment: 175 mg/m2 of paclitaxel is administered as an intravenous infusion over a period of three hours followed thereafter by 75 mg/m2 of cisplatin and the therapy is repeated at 3-week intervals, or 135 mg/m2 of paclitaxel is administered as an intravenous infusion over a period of 24 hours followed thereafter by 75 mg/m2 of cisplatin and the therapy is repeated at 3-week intervals.<br />\r\n<br />\r\n<strong>Second-line treatment of ovarian cancer</strong>: The recommended dose of paclitaxel is 175 mg/m2 administered over 3 hours, with a 3-week interval between courses.<br />\r\n<br />\r\n<strong>Adjuvant chemotherapy in breast carcinoma</strong>: The recommended dose of paclitaxel is 175 mg/m2 administered over a period of 3 hours every 3 weeks for four courses, following AC therapy.<br />\r\n<br />\r\n<strong>First-line chemotherapy of breast carcinoma</strong>: When used in combination with doxorubicin (50 mg/m2), paclitaxel should be administered 24 hours after doxorubicin. The recommended dose of paclitaxel is 220 mg/m2 administered intravenously over a period of 3 hours, with a 3-week interval between courses. When used in combination with trastuzumab, the recommended dose of paclitaxel is 175 mg/m2 administered intravenously over a period of 3 hours, with a 3-week interval between courses. Paclitaxel infusion may be started the day following the first dose of trastuzumab or immediately after the subsequent doses of trastuzumab if the preceding dose of trastuzumab was well tolerated.<br />\r\n<br />\r\n<strong>Second-line chemotherapy of breast carcinoma</strong>: The recommended dose of paclitaxel is 175 mg/m2 administered over a period of 3 hours, with a 3-week interval between courses.<br />\r\n<br />\r\n<strong>Advanced non-small-cell lung cancer</strong>: The recommended dose of paclitaxel is 175 mg/m2 administered over 3 hours followed by 80 mg/m2 of cisplatin, with a 3-week interval between courses.<br />\r\n<br />\r\n<strong>Treatment of AIDS-related KS</strong>: The recommended dose of paclitaxel is 100 mg/m2 administered as a 3-hour intravenous infusion every two weeks.<br />\r\n<br />\r\n<strong>Dose adjustment</strong>: Subsequent doses of paclitaxel should be administered according to individual patient tolerance. Paclitaxel should not be re-administered until the neutrophil count is &gt;1.5 x 109/1 (&gt;1 x 109/1 for KS patients) and the platelet count is &gt;100 x 109/1 (&gt;75 x 109/1 for KS patients).</p>', '<p>Paclitaxel clearance is not affected by cimetidine premedication.<br />\r\n<br />\r\n<strong>Cisplatin</strong>: Administration of paclitaxel after cisplatin treatment leads to greater myelosuppression and about a 20% decrease in paclitaxel clearance. Patients treated with paclitaxel and cisplatin may have an increased risk of renal failure as compared to cisplatin alone in gynecological cancers.<br />\r\n<br />\r\n<strong>Doxorubicin</strong>: Since the elimination of doxorubicin and its active metabolites can be reduced when paclitaxel and doxorubicin are given closer in time, paclitaxel for initial treatment of metastatic breast cancer should be administered 24 hours after doxorubicin. Sequence effects characterized by more profound neutropenic and stomatitis episodes have been observed with combination use of paclitaxel and doxorubicin when paclitaxel was administered before doxorubicin and using longer than recommended infusion times (paclitaxel administered over 24 hours; doxorubicin over 48 hours).<br />\r\n<br />\r\n<strong>Active substances metabolized in the liver</strong>: The metabolism of paclitaxel is catalysed, in part, by cytochrome P450 isoenzymes CYP2C8 and CYP3A4. Therefore, in the absence of a PK drug-drug interaction study, caution should be exercised when administering paclitaxel concomitantly with medicines known to inhibit either CYP2C8 or CYP3A4 (e.g. ketoconazole and other imidazole antifungals, erythromycin, fluoxetine, gemfibrozil, clopidogrel, cimetidine, ritonavir, saquinavir, indinavir, and nelfinavir) because toxicity of paclitaxel may be increased due to higher paclitaxel exposure. Administering paclitaxel concomitantly with medicines known to induce either CYP2C8 or CYP3A4 (e.g. rifampicin, carbamazepine, phenytoin, efavirenz, nevirapine) is not recommended because efficacy may be compromised because of lower paclitaxel exposures.</p>', '<ul>\r\n	<li>Paclitaxel is contraindicated in patients with severe hypersensitivity reactions to paclitaxel, macrogolglycerol ricinoleate (polyoxyl castor oil.)</li>\r\n	<li>Paclitaxel is contraindicated during lactation.</li>\r\n	<li>Paclitaxel should not be used in patients with baseline neutrophils &lt;1.5x109/I (&lt;1x109/I for KS patients) or platelets &lt;100x109/I (&lt;75x109/I for KS patients).</li>\r\n	<li>In KS, paclitaxel is also contraindicated in patients with concurrent, serious, uncontrolled infections.</li>\r\n	<li>Patients with severe hepatic impairment must not be treated with paclitaxel.</li>\r\n</ul>', '<p><strong>Common</strong>: Low blood counts leading to increased risk for infection, anemia and/or bleeding, hair loss, arthralgias and myalgias, pain in the joints and muscles, peripheral neuropathy, nausea, vomiting (usually mild), diarrhea, Mouth sores, hypersensitivity reaction, fever, facial flushing, chills, shortness of breath, or hives after paclitaxel is given.<br />\r\n<br />\r\n<strong>Rare</strong>: swelling of the feet or ankles (edema), liver problems, low blood pressure, darkening of the skin where previous radiation treatment has been given.</p>', '<p>Pregnancy Category D. There is no adequate data from the use of paclitaxel in pregnant women, however as with other cytotoxic medicinal products, paclitaxel may cause foetal harm when administered to pregnant women. Paclitaxel is contraindicated during lactation.</p>', '<p>Paclitaxel should be administered under the supervision of a physician experienced in the use of cancer chemotherapeutic agents. Since significant hypersensitivity reactions may occur, appropriate supportive equipment should be available. Given the possibility of extravasation, it is advisable to closely monitor the infusion site for possible infiltration during drug administration. Paclitaxel should be given before cisplatin when used in combination.<br />\r\n<br />\r\nSignificant hypersensitivity reactions, as characterised by dyspnoea and hypotension requiring treatment, angioedema, and generalised urticaria have occurred in &lt;1% of patients receiving paclitaxel after adequate premedication. Fatal hypersensitivity reactions have occurred in patients despite premedication. These reactions are probably histamine-mediated. In the case of severe hypersensitivity reactions, paclitaxel infusion should be discontinued immediately.<br />\r\n<br />\r\nBone marrow suppression, primarily neutropenia, is the dose-limiting toxicity. Neutrophil nadirs occurred at a median of 11 days. Frequent monitoring of blood counts should be instituted. Patients should not be retreated until the neutrophil count is &ge;1.5 x 109/1 (&ge;1 x 109/1 for KS patients) and the platelets recover to &ge;100 x 109/1 (&ge;75 x 109/1 for KS patients).<br />\r\n<br />\r\nSevere cardiac conduction abnormalities have been reported rarely with single agent paclitaxel. If patients develop significant conduction abnormalities during paclitaxel administration, appropriate therapy should be administered and continuous cardiac monitoring should be performed during subsequent therapy with paclitaxel.</p>', '<p>There is no known antidote for paclitaxel overdose. In case of overdose, the patient should be closely monitored. Treatment should be directed at the primary anticipated toxicities, which consist of bone marrow suppression, peripheral neurotoxicity and mucositis. Overdoses in paediatric patients may be associated with acute ethanol toxicity.</p>', NULL, '<p>Keep in a dry place and store below 30&deg;C. Protect from light and keep out of the reach of children. Use only freshly prepared solution.</p>', '<p><strong>Patients who experience severe neutropenia</strong>: (neutrophil count &lt;0.5 x 109/1 for a minimum of 7 days) or severe peripheral neuropathy, should receive a dose reduction of 20% for subsequent courses (25% for KS patients).<br />\r\n<br />\r\n<strong>Patients with hepatic impairment</strong>: Inadequate data are available to recommend dosage alterations in patients with mild to moderate hepatic impairments. Patients with severe hepatic impairment must not be treated with paclitaxel.<br />\r\n<br />\r\n<strong>Pediatric use</strong>: Paclitaxel is not recommended for use in children below 18 years due to lack of data on safety and efficacy.</p>', '2022-03-14 04:17:50', '2022-03-14 04:17:50'),
(1169, 1169, '<p>This combination is indicated for-</p>\r\n\r\n<ul>\r\n	<li>Normal skin types when exposed to intense sunlight</li>\r\n	<li>Photodermatoses including those caused by radiotherapy</li>\r\n	<li>Photosensitisation</li>\r\n	<li>Solar urticaria</li>\r\n	<li>Acute solar dermatitis</li>\r\n	<li>Drug-induced photosensitivity</li>\r\n	<li>Acute lupus erythematosus</li>\r\n	<li>Herpes simplex</li>\r\n	<li>Polymorphic light eruption</li>\r\n	<li>Cutaneous albinism</li>\r\n	<li>Vitiligo</li>\r\n</ul>', '<p>This&nbsp;lotion is a non-greasy, water resistant, protective sun block, which helps prevent sunburn in all types of skin. It provides a high degree of protection against the harmful effects of ultraviolet components of sunlight which are responsible for skin cancer, wrinkling, premature ageing and darkening of the skin due to overexposure.<br />\r\n<br />\r\nThis&nbsp;provides a sun protection factor (SPF) of 6 against UVA rays and 28 against UVB rays. The SPF describes how much longer you can remain in the sun without being affected by these rays, compared with unprotected skin. This&nbsp;gives you 28 times more&nbsp;natural sunburn protection and maintains its degree of protection up to 60 minutes in water.</p>', '<p>This&nbsp;lotion should be applied carefully and evenly on skin before sun exposure. Apply 45 minutes before swimming or sweat producing exercise. A single application may give day-long protection but the product should be re-applied during prolonged periods of sunning and after swimming or excessive sweating.</p>', '<p>There are no known drug interactions and none well documented.</p>', '<p>Known hypersensitivity to any of its components.</p>', '<p>Signs of irritations (including erythema, burning or rash) may appear when applied to sensitive or broken skin.</p>', '<p>This&nbsp;lotion should only be used if the anticipated benefits outweigh the risks.</p>', '<p>Application to broken skin should be avoided. Contact with the eyes and other mucous membranes should be avoided.</p>', NULL, '<p>Sunblock Preparation</p>', NULL, NULL, '2022-03-14 04:19:35', '2022-03-14 04:19:35'),
(1170, 1170, '<p>Palbociclib is a kinase inhibitor indicated for the treatment of hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative advanced or metastatic breast cancer in combination with:</p>\r\n\r\n<ul>\r\n	<li>An aromatase inhibitor as initial endocrine-based therapy in postmenopausal women; or</li>\r\n	<li>Fulvestrant in women with disease progression following endocrine therapy.</li>\r\n</ul>', '<p>Palbociclib is an inhibitor of Cyclin-dependent kinases (CDK) 4 and 6. cyclin D1 and CDK4/6 are downstream of signaling pathways that lead to cellular proliferation. Palbociclib reduced cellular proliferation of Estrogen receptor (ER)-positive breast cancer cell lines by blocking progression of the cell from G1 into s phase of the cell cycle. Treatment of breast cancer cell lines with the combination of Palbociclib and antiestrogens leads to decreased retinoblastoma (RB) protein phosphorylation resulting in reduced E2F expression and signaling, and increased growth arrest compared to treatment with each drug alone. Treatment of ER-positive breast cancer cell lines with the combination of Palbociclib and antiestrogens led to increased cell senescence compared to each drug alone, which was sustained for up to 6 days following Palbociclib removal and was greater if antiestrogen treatment was continued. In vivo studies using a patient-derived ER-positive breast cancer xenograft model demonstrated that the combination of Palbociclib and letrozole increased the inhibition of RB phosphorylation, downstream signaling, and tumor growth compared to each drug alone.</p>', '<p>The recommended dose of Palbociclib is a 125 mg capsule taken orally once daily for 21 consecutive days followed by 7 days off treatment to comprise a complete cycle of 28 days. Palbociclib should be taken with food. Patients should be encouraged to take their dose of Palbociclib at approximately the same time each day. For men treated with combination Palbociclib plus aromatase inhibitor therapy, consider treatment with an LHRH agonist according to current clinical practice standards.<br />\r\n<br />\r\nRecommended Dose Modification for Adverse Reactions:</p>\r\n\r\n<ul>\r\n	<li>Recommended Starting Dose: 125 mg/day</li>\r\n	<li>First Dose Reduction: 100 mg/day</li>\r\n	<li>Second Dose Reduction: 75 mg/day</li>\r\n</ul>\r\n\r\n<p>If further dose reduction below 75 mg/day is required, discontinue. Or, as directed by the registered physician.<br />\r\n<br />\r\nUse in Children: Palbociclib is not indicated for use in children.</p>', '<p>Palbociclib is primarily metabolized by CYP3A and Sulfotransferase (SULT) enzyme SULT2A1. Palbociclib is a<br />\r\ntime-dependent inhibitor of CYP3A.<br />\r\n<br />\r\n<strong>Agents That May Increase Palbociclib Plasma Concentrations</strong>: Effect of CYP3A-Inhibitors: Coadministration of a strong CYP3A inhibitor (Itraconazole) increased the plasma exposure of Palbociclib in patients by 87%. Avoid concomitant use of strong CYP3A inhibitors (e.g., Clarithromycin, Indinavir, Itraconazole, Ketoconazole, Lopinavir/Ritonavir, Nefazodone, Nelfinavir, Posaconazole, Ritonavir, Saquinavir, Telaprevir, Telithromycin, And Voriconazole). Avoid grapefruit or grapefruit juice during Palbociclib treatment. If coadministration of Palbociclib with a strong CYP3A inhibitor cannot be avoided, reduce the dose of Palbociclib.<br />\r\n<br />\r\n<strong>Agents That May Decrease Palbociclib Plasma Concentrations</strong>: Effect of CYP3A Inducers: Coadministration of a strong CYP3A Inducer (Rifampin) decreased the plasma exposure of Palbociclib in healthy subjects by 85%. Avoid concomitant use of strong CYP3A inducers (E.G., Phenytoin, Rifampin, Carbamazepine, Enzalutamide, and St John&rsquo;s Wort).<br />\r\n<br />\r\n<strong>Drugs That May Have Their Plasma Concentrations Altered By Palbociclib</strong>: Coadministration of Midazolam with multiple doses of Palbociclib increased the Midazolam plasma exposure by 61%, in patients, compared to administration of Midazolam alone. The dose of the sensitive CYP3A substrate with a narrow therapeutic index (e.g., Alfentanil, Cyclosporine, Dihydroergotamine, Ergotamine, Everolimus, Fentanyl, Pimozide, Quinidine, Sirolimus, And Tacrolimus) may need to be reduced, as Palbociclib may increase its exposure.</p>', NULL, '<p>Common side effects of Palbociclib include: WBC decreased, Neutrophils decreased, Neutropenia, Platelets decreased, infections, AST increased, ALT increased, Leukopenia, Fatigue, Nausea, Hair loss, Inflammation of the mouth and lips, Diarrhea, Anemia, Rash, Weakness/lethargy, Vomiting, Thrombocytopenia, Dry skin, Fever.</p>', '<p>Palbociclib can cause fetal harm when administered to a pregnant woman. Advise pregnant women of the potential risk to a fetus. Risk of major birth defects and miscarriage in clinically recognized pregnancies is 2%-4% and 15%-20%, respectively.</p>', '<p><strong>Neutropenia</strong>: Neutropenia was the most frequently reported adverse reaction. Monitor complete blood counts prior to starting Palbociclib therapy and at the beginning of each cycle, as well as on day 15 of the first 2 cycles, and as clinically indicated. Dose interruption, dose reduction, or delay in starting treatment cycles is recommended for patients who develop grade 3 or 4 neutropenia. Febrile neutropenia has been reported in 1.8% of patients exposed to Palbociclib. One death due to neutropenic sepsis was observed. Physicians should inform patients to promptly report any episodes of fever.<br />\r\n<br />\r\n<strong>Embryo-Fetal Toxicity</strong>: Palbociclib can cause fetal harm when administered to a pregnant woman. Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with Palbociclib and for at least 3 weeks after the last dose.</p>', '<p>There is no known antidote for Palbociclib. The treatment of overdose of Palbociclib should consist of general supportive measures.</p>', NULL, '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-14 04:21:08', '2022-03-14 04:21:08'),
(1171, 1171, '<p>Paliperidone extended release tablet is indicated for-</p>\r\n\r\n<ul>\r\n	<li>Schizophrenia, including acute treatment and recurrence prevention</li>\r\n	<li>Treatment of schizoaffective disorder as monotherapy and in combination with antidepressants or mood stabilizers</li>\r\n</ul>', '<p>Paliperidone is a psychotropic agent belonging to the chemical class of benzisoxazole derivatives. Paliperidone is the major active metabolite of Risperidone. It is a centrally active dopamine Type 2 (D2) antagonist and with predominant serotonin Type 2 (5-HT2A) antagonist activity. It is also active as an antagonist at &alpha;1 and &alpha;2 adrenergic receptors and H1 histaminergic receptors, which may explain some of the other effects of the drug. It has no affinity for cholinergic muscarinic or &beta;1-and &beta;2-adrenergic receptors.</p>', '<p><strong>Schizophrenia</strong>:</p>\r\n\r\n<ul>\r\n	<li><strong>Adults</strong>: Initial dose is 6 mg/day. Recommended dose is 3-12 mg/day, Maximum dose is 12 mg/day</li>\r\n	<li><strong>Adolescents (Weight &lt;51kg)</strong>: Initial dose is 3 mg/day, Recommended dose is 3-6 mg/day, Maximum dose is 6 mg/day</li>\r\n	<li><strong>Adolescents (Weight &ge;51kg)</strong>: Initial dose is 3 mg/day, Recommended dose is 3-12 mg/day, Maximum dose is 12 mg/day</li>\r\n</ul>\r\n\r\n<p><strong>Schizoaffective disorder</strong>: adults Initial dose is 6 mg/day. Recommended dose is 3-12 mg/day, Maximum dose is 12 mg/day.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>Paliperidone extended release tablet can be taken with or without food. It must be swallowed whole with the aid of liquids. Tablets should not be chewed, divided or crushed.</p>', '<ul>\r\n	<li>Paliperidone should be used with caution in combination with other centrally acting drugs and alcohol. It may antagonize the effect of Levodopa and other dopamine agonists.</li>\r\n	<li>Because of its potential for inducing orthostatic hypotension, an additive effect may be observed when Paliperidone is administered with other therapeutic agents that have this potential.</li>\r\n	<li>Strong CYP3A4/P-glycoprotein (P-gp) inducers: It may be necessary to increase the dose of Paliperidone when a strong inducer of both CYP3A4 and P-gp (e.g., carbamazepine) is co-administered. Conversely, on discontinuation of the strong inducer, it may be necessary to decrease the dose of Paliperidone.</li>\r\n	<li>Co-administration of divalproex sodium increased Cmax and AUC of Paliperidone by approximately 50%. Adjust dose of Paliperidone if necessary based on clinical assessment.</li>\r\n</ul>', NULL, '<p>The most common adverse reactions of Paliperidone are tachycardia, akathisia, somnolence, tremor, dystonia, cogwheel rigidity, anxiety, weight increased, dyspepsia, constipation, nasopharyngitis etc.</p>', '<p>Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. Paliperidone should be used during pregnancy only if the potential benefits justifies the potential risk to the fetus. Paliperidone is excreted in human breast milk. The known benefits of breastfeeding should be weighed against the unknown risks of infant exposure to Paliperidone.</p>', '<p>Caution should be exercised when Paliperidone is prescribed in patients with known Cardiovascular diseases, QT prolongation, Neuroleptic malignant syndrome, Tardive dyskinesia, Hyperglycemia, Dyslipidemia, Obesity, Hyperprolactinemia, Leukopenia, Neutropenia, Agranulocytosis, Seizures, Potential for Cognitive &amp; Motor impairment etc.</p>', '<p>Overdose of Paliperidone is limited; there is no specific antidote to Paliperidone. If overdose occurs general supportive and symptomatic measures should be employed.</p>', '<p>Atypical neuroleptic drugs</p>', '<p>Store in a cool and dry place, away from light. Keep out of reach of children.</p>', '<p>Pediatric use: Safety and effectiveness in the treatment of schizophrenia not established in patients less than 12 years of age. Safety and effectiveness in the treatment of schizoaffective disorder not established in patients less than 18 years of age.</p>', '2022-03-14 04:25:24', '2022-03-14 04:25:24'),
(1172, 1172, '<p>Paliperidone Palmitate is an atypical antipsychotic indicated for</p>\r\n\r\n<ul>\r\n	<li>Treatment of schizophrenia in adults.</li>\r\n	<li>Treatment of schizoaffective disorder in adults as monotherapy and as an adjunct to mood stabilizers or antidepressants.</li>\r\n</ul>', '<p>Paliperidone palmitate is hydrolyzed to paliperidone. Paliperidone is the major active metabolite of risperidone. The mechanism of action of paliperidone is unclear. However, the drug&rsquo;s therapeutic effect in schizophrenia could be mediated through a combination of central dopamine Type 2 (D2 ) and serotonin Type 2 (5HT 2A ) receptor antagonism.<br />\r\n<br />\r\nIn vitro, paliperidone acts as an antagonist at the central dopamine Type 2 (D2) and serotonin Type 2 (5HT 2A) receptors with binding affinities (Ki values) of 1.6-2.8 nM for D 2 and 0.8-1.2 nM for 5HT 2A receptors. Paliperidone is also active as an antagonist at the &alpha; 1 and &alpha; 2 adrenergic receptors and H 1 histaminergic receptors, which may explain some of the other effects of the drug. Paliperidone has no affinity for cholinergic muscarinic or &beta;1 and &beta;2-adrenergic receptors. The pharmacological activity of the (+)- and (-)- paliperidone enantiomers is qualitatively and quantitatively similar in vitro.</p>', '<p>Schizophrenia:</p>\r\n\r\n<ul>\r\n	<li>Initiation Dosing: Day 1-234 mg and Day 8-156 mg</li>\r\n	<li>Monthly Maintenance Dose: 39-234 mg</li>\r\n	<li>Maximum Monthly Dose: 234 mg</li>\r\n</ul>\r\n\r\n<p>Schizoaffective disorder:</p>\r\n\r\n<ul>\r\n	<li>Initiation Dosing: Day 1-234 mg and Day 8-156 mg</li>\r\n	<li>Monthly Maintenance Dose: 78-234 mg</li>\r\n	<li>Maximum Monthly Dose: 234 mg</li>\r\n</ul>\r\n\r\n<p>Administered 5 weeks after the first injection. The recommended maintenance dose for treatment of schizophrenia is 117 mg. Some patients may benefit from lower or higher maintenance doses within the additional available strengths (39 mg, 78 mg, 156 mg, and 234 mg). Adjust dose based on tolerability and/or efficacy using available strengths. The 39 mg strength was not studied in the long-term schizoaffective disorder study.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>For intramuscular injection only. Each injection must be administered only by a healthcare professional. For deltoid injection, use 1-inch 23G needle for patients weighing less than 90 kg or 1 &frac12;-inch 22G needle for patients weighing 90 kg or more. For gluteal injection, use 1 &frac12;-inch 22G needle regardless of patient weight.</p>', '<p><strong>Drugs that may cause orthostatic hypotension</strong>: An additive effect may occur when co-administered with Paliperidone Palmitate<br />\r\n<br />\r\n<strong>Strong CYP3A4/P-glycoprotein (P-gp) inducers</strong>: Avoid using a strong inducer of CYP3A4 and/or P-gp (e.g., carbamazepine, rifampin, St John&rsquo;s Wort) during a dosing interval for Paliperidone Palmitate. If administering a strong inducer is necessary, consider managing the patient using paliperidone extended release tablets</p>', '<p>Known hypersensitivity to paliperidone, risperidone, or to any excipients in Paliperidone Palmitate.</p>', '<p>The most common adverse reactions (incidence &ge; 5% and occurring at least twice as often as placebo) were injection site reactions, somnolence/sedation, dizziness, akathisia, and extrapyramidal disorder.</p>', '<p>Limited data from published literature report the presence of paliperidone in human breast milk. There is no information on the effects on the breastfed infant or the effects on milk production.</p>', '<p><strong>Cerebrovascular Adverse Reactions, Including Stroke, in Elderly Patients with Dementia-Related Psychosis</strong>: Increased incidence of cerebrovascular adverse reactions (e.g. stroke, transient ischemic attack).<br />\r\n<br />\r\n<strong>Neuroleptic Malignant Syndrome</strong>: Manage with immediate discontinuation of drug and close monitoring.<br />\r\n<br />\r\n<strong>QT Prolongation</strong>: Avoid use with drugs that also increase QT interval and in patients with risk factors for prolonged QT interval.<br />\r\n<br />\r\n<strong>Tardive Dyskinesia</strong>: Discontinue drug if clinically appropriate.<br />\r\n<br />\r\n<strong>Metabolic Changes</strong>: Monitor for hyperglycemia/diabetes mellitus, dyslipidemia and weight gain.<br />\r\n<br />\r\n<strong>Orthostatic Hypotension and Syncope</strong>: Monitor heart rate and blood pressure and warn patients with known cardiovascular or cerebrovascular disease, and risk of dehydration or syncope.<br />\r\n<br />\r\n<strong>Leukopenia, Neutropenia, and Agranulocytosis</strong>: Perform complete blood counts (CBC) in patients with pre-existing low white blood cell count (WBC) or history of leukopenia or neutropenia. Consider discontinuing Paliperidone Palmitate if clinically significant decline in WBC in the absence of other causative factors.<br />\r\n<br />\r\n<strong>Hyperprolactinemia</strong>: Prolactin elevations occur and persist during chronic administration.<br />\r\n<br />\r\n<strong>Potential for Cognitive and Motor Impairment</strong>: Use caution when operating machinery.<br />\r\n<br />\r\n<strong>Seizures</strong>: Use cautiously in patients with a history of seizures or with conditions that lower the seizure threshold.</p>', NULL, '<p>Atypical neuroleptic drugs</p>', '<p>Store at room temperature; excursions between 15&deg;C and 30&deg;C are permitted. Do not mix with any other product or diluent.</p>', '<p><strong>Pediatric Use</strong>: Safety and effectiveness of Paliperidone Palmitate in patients &lt;18 years of age have not been established.<br />\r\n<br />\r\n<strong>Renal Impairment</strong>: Not recommended in patients with moderate or severe renal impairment<br />\r\n<br />\r\n<strong>Hepatic Impairment</strong>: Paliperidone has not been studied in patients with hepatic impairment. Based on a study with oral paliperidone, no dose adjustment is required in patients with mild or moderate hepatic impairment.</p>', '2022-03-14 04:27:48', '2022-03-14 04:27:48');
INSERT INTO `generic_details` (`id`, `generic_id`, `indications`, `pharmacology`, `dosage_and_administration`, `interaction`, `contraindications`, `side_effects`, `pregnancy_and_lactation`, `precautions_and_warnings`, `overdose_effects`, `therapeutic_class`, `storage_conditions`, `use_in_special_populations`, `created_at`, `updated_at`) VALUES
(1173, 1173, '<p>Palonosetron indicated in-</p>\r\n\r\n<ul>\r\n	<li>Acute and delayed nausea and vomiting</li>\r\n	<li>Uncontrolled nausea and vomiting</li>\r\n	<li>Chemotherapy-induced nausea and vomiting (CINV): Acute CINV resulting in on the day of treatment with certain types of chemotherapy</li>\r\n	<li>Delayed CINV resulting in on days later with certain types of chemotherapy</li>\r\n	<li>Radiotherapy-induced nausea and vomiting (RINV)</li>\r\n	<li>Post-operative &amp; Post-discharge nausea and vomiting (PONV &amp; PDNV).</li>\r\n</ul>', '<p>Palonosetron is a 5-HT3 receptor antagonist with a strong binding affinity for this receptor and little or no affinity for other receptors. It is thought that chemotherapeutic agents produce nausea and vomiting by releasing serotonin from the enterochromaffin cells of the small intestine and that the released serotonin then activates 5-HT3 receptors that are located on the nerve terminals of the vagus in the periphery and centrally in the chemoreceptor trigger zone of the area postrema, to initiate the vomiting reflex. Postoperative nausea and vomiting is influenced by multiple patient, surgical and anesthesia related factorcs and is triggered by release of 5-HT3 in a cascade of neuronal event involving both the central nervous system and the gastrointestinal tract. The 5-HT3 receptor has been demonstrated to selectively participate in the emetic response. Palonosetron works by blocking the actions of Serotonin, associated with nausea and vomiting, at 5-HTs receptor. It is likely that Palonosetron works in the small intestine but it may also work in the brain.<br />\r\n<br />\r\nPharmacokinetics: Palonosetron exhibits linear dose-proportional pharmacokinetics over the doserange 1-90 pg/kg in healthy subjects and in patients with cancer. In cancer patients receiving single intravenous doses of Palonosetron in this dose range, the mean maximum plasma concentration (Cmax) ranges from 0.89 to 336 ng/ml and the area under the plasma concentration-time curve from zero to infinity (AUCo-co) ranges from 13.8 to 957 ng.h/ml. Palonosetron has a volume of distribution of approximately 6.9-7.9 L/kg, with approximately 62% bound to plasma proteins. Approximately 50% of Palonosetron is metabolized into two inactive metabolites that exhibit &lt;1% of the 5-HT3 receptor antagonist activity. Approximately 40% of the drug is metabolised via kidney, 50% by liver CYP2D6 (mainly), CYP3A4 and CYP1A2 isoenzymes. About 50% of the drug goes under metabolism. After a single intravenous dose, approximately 40% is excreted as unchanged drug in the urine after 144 hours. Total body clearance of Palonosetron is 160&plusmn;35 ml/h/kg, and renal clearance is 66.5&plusmn;18.2 ml/h/kg in healthy subjects. Palonosetron exhibits a longer half-life (40 hours) and has a greater 5-HT3 receptor binding affinity.</p>', '<p><strong>Usual dosage</strong>: Adult tablet dosage: 0.5 mg daily. Adult IV dosage: A single IV dose of 0.075 mg should be administered over 10 seconds.<br />\r\n<br />\r\n<strong>Chemotherapy-induced nausea and vomiting</strong>: Adult tablet dosage: 0.5 mg administered approximately 1 hour prior to the start of chemotherapy. Adult IV dosage: A single IV dose of 0.25 mg should be administered over 30 seconds approximately 30 minutes before the start of chemotherapy.<br />\r\n<br />\r\n<strong>Radiotherapy-induced nausea and vomiting</strong>: A single IV dose of 0.25 mg should be administered over 30 seconds approximately 30 minutes before each week of radiation fraction.<br />\r\n<br />\r\n<strong>Post-operative nausea and vomiting</strong>: A single IV dose of 0.075 mg should be administered over 10 seconds immediately before induction of anesthesia.<br />\r\n<br />\r\n<strong>Children dosage: (1 month to 17 years)</strong>: A single IV dose at 20 mcg/kg body weight. Which maximum dose is 1.5 mg.</p>', '<p>In controlled clinical trials, Palonosetron injection has been safely administered with corticosteroids, analgesics, antiemetics/antinauseants, antispasmodics and anticholinergic agents. Palonosetron did not inhibit the antitumor activity of cisplatin, cyclophosphamide, cytarabine, doxorubicin and mitomycin C in murine tumor models. Concomitant administration of Palonosetron and metoclopramide has no significant pharmacokinetic interactions. In vitro studies indicated that palonosetron is not inhibitor of CYP1A2, CYP2A6, CYP2B6, CYP2C9, CYP2D6, CYP2E1 &amp; CYP3A4/5 (CYP2C19 was not investigated) nor does it induce the activity of CYP1A2, CYP2D6 or CYP3A4/5. Therefore, the potential for clinically significant drug interactions with Palonosetron appears to be low.</p>', '<p>Palonosetron is contraindicated in patients known to have hypersensitivity to the drug or any of its components.</p>', '<p>The most common adverse reactions are headaches and constipation.</p>', '<p>Pregnancy category &#39;B&#39;. It is not known whether Palonosetron is excreted in breast milk.</p>', NULL, '<p>There is no known antidote to Palonosetron. Overdose should be managed with supportive care.</p>', '<p>Anti-emetic drugs.</p>', '<p>Store in a cool &amp; dry place, protected from light.</p>', '<p><strong>Use in elderly patients</strong>: No dosage adjustment is recommended in elderly patients &gt;65 years of age.<br />\r\n<br />\r\n<strong>Use in Children</strong>: (1 month to 10 years): A single IV dose at 20 mcg/kg body weight. Which maximum dose is 1.5 mg.<br />\r\n<br />\r\n<strong>Use in patients with impaired renal and hepatic function</strong>: No dosage adjustment is recommended in patients with renal and hepatic dysfunction.</p>', '2022-03-14 04:29:53', '2022-03-14 04:29:53'),
(1174, 1174, '<p>Pancreatin is employed for the treatment of patients with</p>\r\n\r\n<ul>\r\n	<li>Chronic pancreatitis</li>\r\n	<li>Cystic fibrosis/Mucoviscidosis</li>\r\n	<li>Following partial or complete pancreatectomy</li>\r\n	<li>Total gastrectomy</li>\r\n	<li>Steatorrhea</li>\r\n	<li>Somatostatinoma</li>\r\n	<li>Celiac disease and</li>\r\n	<li>Other conditions associated with pancreatic insufficiency</li>\r\n</ul>', '<p>Pancreatin is a preparation of Pancreatin, an extract from mammalian pancreas containing enzymes with Amylase, Protease and Lipase activity. It is designed to disintegrate in the alkaline medium of the duodenum where it releases the active enzyme components of Pancreatin (Amylase, Protease and Lipase). Amylase hydrolyzes dietary starch to yield maltose, maltoriose and a-dextrin. Protease cleaves peptide bonds in the center of proteins and polypeptides and forms amino acids and oligopeptides. Lipase hydrolyzes dietary triglycerides forming two molecules of fatty acid and a molecule of beta-monoglyceride. It converts not less than 25 times its weight of starch into soluble carbohydrates and not less than 25 times its weight of casein into proteoses within 5 mins, (equivalent to 150 times in 30 mins).</p>', '<p>2-3 tablets to be swallowed whole with little water immediately after or during meal. Or as directed by the physician.</p>', '<p>Alkaline media will rupture the enteric coating. As such to prevent bursting out of the content in the stomach Pancreatin should not be used concurrently with antacid.</p>', '<p>Pancreatin is contraindicated in patients with known hypersensitivity to the drug.</p>', '<p>The most frequent side effects are gastrointestinal including nausea, vomiting and abdominal discomfort. Buccal and perianal soreness may occur, particularly in infants. Hypersensitivity reactions manifested by sneezing, lacrimation or skin rashes have been reported.</p>', '<p>Pancreatin should be given to a pregnant woman 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 Pancreatin is administered to a nursing mother.</p>', '<p>Patients known to be allergic to animal protein should be treated with caution.</p>', '<p>Excessive dosage may produce a laxative effect. Systemic toxicity does not occur. Very high dosage may cause hyperuricaemia and hyperuricosuria.</p>', '<p>Digestive Enzyme.</p>', '<p>Keep all medicines out of reach of children. Store in a cool and dry place, protected from light.</p>', NULL, '2022-03-14 04:33:12', '2022-03-14 04:33:12'),
(1175, 1175, '<p>Pancuronium&nbsp;is indicated as an adjunct to general anesthesia, to facilitate endotracheal intubation and to provide skeletal muscle relaxation during surgical procedure of medium and long duration.</p>', '<p>Pancuronium is a typical non-depolarising curare-mimetic muscle relaxant. It acts as a competitive acetylcholine antagonist on neuromuscular junctions, displacing acetylcholine (hence competitive) from its post-synaptic nicotinic acetylcholine receptors. It is, unlike suxamethonium, a non-depolarising agent, which means, that it causes no spontaneous depolarisations upon association with the nicotinic receptor in neuromuscular junction, thus producing no muscle fasciculations upon administration. Pancuronium has no hormonal activity. It exerts slight vagolytic activity (i.e. diminishing activity of the vagus nerve) and no ganglioplegic (i.e., blocking ganglions) activity.<br />\r\n<br />\r\nNondepolarizing neuromuscular blocking agents inhibit neuromuscular transmission by competing with acetylcholine for the cholinergic receptors of the motor end plate, thereby reducing the response of the end plate to acetylcholine. This type of neuromuscular block is usually antagonized by anticholinesterase agents.</p>', '<p>Intravenous:</p>\r\n\r\n<p>Facilitate endotracheal intubation, Muscle relaxant in general anaesthesia:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult:</strong>&nbsp;Initially, 50-100 mcg/kg by inj, may reduce to 20-60 mcg/kg if given after suxamethonium. Maintenance: 10-20 mcg/kg.</li>\r\n	<li><strong>Child:</strong>&nbsp;0-30 days Initially, 30-40 mcg/kg. Maintenance: 10-20 mcg/kg; &gt;1 mth Same as adult dose.</li>\r\n</ul>\r\n\r\n<p>Facilitate mechanical ventilation in intensive care:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult:</strong>&nbsp;60 mcg/kg every 1-1.5 hr or less frequently.</li>\r\n</ul>', '<p>Increased effect with inhalational anaesth, other non-depolarising muscle relaxants, antibiotics (polypeptide and aminoglycoside group), diazepam, propranolol, thiamine (high dose), MAOIs, quinidine, Mg sulfate, protamine, nitroglycerin, narcotic analgesics, diuretics, phenytoin, &alpha; and &beta; adrenergic blockers, imidazoles, norepinephrine and epinephrine and prior suxamethonium. Decreased effect with neostigmine, edrophonium, corticosteroids (high dose); KCl, Ca chloride and NaCl; heparin (temporary decrease), azathioprine, theophylline, pyridostigmine, neurolept analgesia and propanidid.</p>', '<p>Pancuronium must not be administered to patients with know hypersensitivity to&nbsp; puncuronium of the bromide ion.</p>', '<p>Tachycardia, HTN, bradycardia, bronchospasm, hypotension, CV collapse, excessive salivation; pain or local skin reactions at inj site. Rarely, hypersensitivity reactions.</p>', '<p><strong>Category C</strong>: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.</p>', '<p>Patient with burn injury, biliary tract disease, pulmonary disease, muscular dystrophies, myasthenia gravis, myasthenic syndrome, electrolyte disturbance, altered pH, dehydration, CV disease, oedema, raised catecholamine concentration and those at risk of HTN. Renal and hepatic impairment. Childn. Pregnancy and lactation.</p>', '<p><strong>Symptoms</strong>: Prolonged apnoea, resp depression and/or muscle weakness. Death may follow acute resp failure.<br />\r\n<br />\r\n<strong>Management:</strong>&nbsp;May administer neostigmine 2.5 mg and atropine 1.2 mg to reverse neuromuscular block while ventilation is continued. When admin of the anticholinesterase agent fails to reverse neuromuscular blockade, continue ventilation until spontaneous breathing is restored.</p>', '<p>Non depolarizing muscle relaxants.</p>', NULL, '<p><strong>Obese patient:</strong>&nbsp;Adjust dose based on ideal body wt.<br />\r\n<strong>Renal Impairment:</strong></p>\r\n\r\n<ul>\r\n	<li>Haemodialysis/peritoneal dialysis patient: Avoid use.</li>\r\n	<li>Continuous renal replacement therapy: 50% of normal dose.</li>\r\n	<li>CrCl (mL/min) &lt;10: Avoid use.</li>\r\n	<li>CrCl (mL/min) 10-50: 50% of normal dose.</li>\r\n</ul>', '2022-03-14 04:35:08', '2022-03-14 04:35:08'),
(1176, 1176, '<p>Pantoprazole is indicated where suppression of acid secretion has therapeutic benefit; i.e&nbsp;</p>\r\n\r\n<ul>\r\n	<li>Peptic ulcer diseases</li>\r\n	<li>Gastroesophageal reflux diseases</li>\r\n	<li>Ulcer induced by non-steroidal anti-inflammatory drugs (NSAIDs)</li>\r\n	<li>Eradication of Helicobacter pylori (in combination with antibiotics)</li>\r\n	<li>Zollinger-Ellison Syndrome</li>\r\n</ul>', '<p>Pantoprazole is a proton pump inhibitor that suppresses the final step in gastric acid production by covalently binding to the H+/K+ATPase enzyme system at the surface of the gastric parietal cell. This effect leads to inhibition of both basal and stimulated gastric acid secretion, irrespective of the stimulus that persists longer than 24 hours.</p>', '<p>Oral:</p>\r\n\r\n<ul>\r\n	<li><strong>Benign gastric ulcer</strong>: 40 mg daily in the morning for 4 weeks, continued for further 4 weeks, if not fully healed.</li>\r\n	<li><strong>Gastro-esophageal reflux disease</strong>: 20-40 mg daily in the morning for 4 weeks, continued for further 4 weeks, if not fully healed; maintenance dose is 20 mg daily, which may be increased to 40 mg daily.</li>\r\n	<li><strong>Duodenal ulcer</strong>: 40 mg daily in the morning for 2 weeks, continued for further 2 weeks if not fully healed.</li>\r\n	<li><strong>Duodenal ulcer associated with Helicobacter pylori</strong>: Pantoprazole is recommended at a dose of 40 mg twice daily in association with antimicrobial agents as detailed below: Amoxycillin 1 g and Clarithromycin 500 mg both twice daily for one week, or Clarithromycin 250 mg and Metronidazole 400 mg both twice daily for one week.</li>\r\n	<li><strong>Prophylaxis of NSAID-associated gastric or duodenal ulcer</strong>: 20 mg daily for those require long-term NSAID treatment.</li>\r\n	<li><strong>Zollinger-Ellison Syndrome</strong>: Initially 80 mg once daily adjusted according to response (elderly max. 40 mg daily); daily doses above 80 mg given in 2 divided doses.</li>\r\n</ul>\r\n\r\n<p><br />\r\nIV Injection:</p>\r\n\r\n<ul>\r\n	<li><strong>Duodenal ulcer and gastric ulcer</strong>:&nbsp;40 mg once daily for 7-10 days</li>\r\n	<li><strong>Gastroesophageal reflux disease associated&nbsp;with a history of erosive esophagitis</strong>:&nbsp;40 mg once daily for 7-10 days</li>\r\n	<li><strong>Prevention of rebleeding in peptic ulcer</strong>:&nbsp;IV 80 mg, followed by 8 mg/hour infusion for 72 hours</li>\r\n	<li><strong>Prophylaxis of acid aspiration</strong>: 80 mg IV every 12 h for 24 h, followed by 40mg every 12 hour</li>\r\n	<li><strong>Long-term management of Zollinger-Ellison Syndrome and other pathological hypersecretory conditions</strong>: 80 mg IV every 12 hours, may increase to 80 mg every 8 hours&nbsp;if needed, may titrate to higher doses depending on acid output.</li>\r\n</ul>', '<p>No significant drug interactions have been observed in clinical studies.</p>', '<p>Pantoprazole is contraindicated in patients with known hypersensitivity to any of the components of the formulation.</p>', '<p>Pantoprazole is well tolerated in both short-term and long-term treatment. Headache and diarrhea are the common side effects and rarely included side effects are abdominal pain, flatulence, rash, insomnia and hyperglycemia.</p>', '<p>US FDA Pregnancy Category of Pantoprazole is B. There are, however, no adequate and well-controlled studies in pregnant woman. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Pantoprazole has been shown to be excreted in human milk. So, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the benefit of the drug to the mother.</p>', '<p>Patients should be cautioned that Pantoprazole tablet should not be split, chewed or crushed. Long-term therapy of Pantoprazole may lead to malabsorption of cyanocobalamin (Vitamin B12) or may increase the risk of osteoporosis related disorders.</p>', '<p>There are no known symptoms of overdosage in humans. Since Pantoprazole is highly protein bound, it is not readily dialyzable. Apart from symptomatic and supportive management, no specific therapy is recommended.</p>', '<p>Proton Pump Inhibitor.</p>', '<p>Keep in a dry place, away from light and heat. Keep out of the reach of children.</p>', NULL, '2022-03-14 04:36:49', '2022-03-14 04:36:49'),
(1177, 1177, '<p>Paracetamol is indicated for fever, common cold and influenza, headache, toothache, earache, bodyache, myalgia, neuralgia, dysmenorrhoea, sprains, colic pain, back pain, post-operative pain, postpartum pain, inflammatory pain and post vaccination pain in children. It is also indicated for rheumatic &amp; osteoarthritic pain and stiffness of joints.</p>', '<p>Paracetamol has analgesic and antipyretic properties with weak anti-inflammatory activity. Paracetamol (Acetaminophen) is thought to act primarily in the CNS, increasing the pain threshold by inhibiting both isoforms of cyclooxygenase, COX-1, COX-2, and COX-3 enzymes involved in prostaglandin (PG) synthesis. Paracetamol is a para aminophenol derivative, has analgesic and antipyretic properties with weak anti-inflammatory activity. Paracetamol is one of the most widely used, safest and fast acting analgesic. It is well tolerated and free from various side effects of aspirin.</p>', '<p>Tablet:</p>\r\n\r\n<ul>\r\n	<li><strong>Adult</strong>: 1-2 tablets every 4 to 6 hours up to a maximum of 4 gm (8 tablets) daily.</li>\r\n	<li><strong>Children (6-12 years)</strong>:&nbsp;&frac12; to 1 tablet 3 to 4 times daily. For long term treatment it is wise not to exceed the dose beyond 2.6 gm/day.</li>\r\n</ul>\r\n\r\n<p>Extended Release Tablet:</p>\r\n\r\n<ul>\r\n	<li><strong>Adults &amp; Children over 12 years</strong>: Two tablets, swallowed whole, every 6 to 8 hours (maximum of 6 tablets in any 24 hours).The tablet must not be crushed.</li>\r\n</ul>\r\n\r\n<p>Syrup/Suspension:</p>\r\n\r\n<ul>\r\n	<li><strong>Children under 3 months</strong>: 10 mg/kg body weight (reduce to 5 mg/kg if jaundiced) 3 to 4 times daily.</li>\r\n	<li><strong>3 months to below 1 yea</strong>r: &frac12; to 1 teaspoonful 3 to 4 times daily.</li>\r\n	<li><strong>1-5 years</strong>: 1 -2 teaspoonful 3 to 4 times daily.</li>\r\n	<li><strong>6-12 years</strong>: 2-A teaspoonful 3 to 4 times daily.</li>\r\n	<li><strong>Adults</strong>: 4-8 teaspoonful 3 to 4 times daily.</li>\r\n</ul>\r\n\r\n<p>Suppository:</p>\r\n\r\n<ul>\r\n	<li><strong>Children 3-12 months</strong>: 60-120 mg,4 times daily.</li>\r\n	<li><strong>Children 1-5 years</strong>: 125-250 mg 4 times daily.</li>\r\n	<li><strong>Children 6-12 years</strong>: 250-500 mg 4 times daily.</li>\r\n	<li><strong>Adults &amp; children over 12 years</strong>: 0.5-1 gm 4 times daily.</li>\r\n</ul>\r\n\r\n<p>Paediatric Drop:</p>\r\n\r\n<ul>\r\n	<li><strong>Children Upto 3 months</strong>: 0.5 ml (40 mg)</li>\r\n	<li><strong>4 to 11 months</strong>: 1.0 ml (80 mg)</li>\r\n	<li><strong>7 to 2 years</strong>: 1.5 ml (120 mg). Do not exceed more than 5 dose daily for a maximum of 5 days.</li>\r\n</ul>\r\n\r\n<p><strong>Paracetamol tablet with actizorb technology</strong>: It dissolves up to five times faster than standard Paracetamol tablets. It is a fast acting and safe analgesic with marked antipyretic property. It is specially suitable for patients who, for any reason, can not tolerate aspirin or other analgesics.</p>\r\n\r\n<ul>\r\n	<li><strong>Adults and children (aged 12 years and over)</strong>: Take 1 to 2 Tablets every four to six hours as needed. Do not take more than 8 caplets in 24 hours.</li>\r\n	<li><strong>Children (7 to 11 years)</strong>: Take &frac12;-1 Tablet every four to six hours as needed. Do not take more than 4 caplets in 24 hours. Not recommended in children under 7 years.</li>\r\n</ul>', '<p>Patients who have taken barbiturates, tricyclic antidepressants and alcohol may show diminished ability to metabolise large doses of Paracetamol. Alcohol can increase the hepatotoxicity of Paracetamol overdosage. Chronic ingestion of anticonvulsants or oral steroid contraceptives induce liver enzymes and may prevent attainment of therapeutic Paracetamol levels by increasing first-pass metabolism or clearance.</p>', '<p>It is contraindicated in known hypersensitivity to Paracetamol.</p>', '<p>Side effects of paracetamol are usually mild, though haematological reactions including thrombocytopenia, leucopenia, pancytopenia, neutropenia, and agranulocytosis have been reported. Pancreatitis, skin rashes, and other allergic reactions occur occasionally.</p>', '<p>Pregnancy category B according to USFDA. This drug should be used during pregnancy only if clearly needed.</p>', '<p>Paracetamol should be given with caution to patients with impaired kidney or liver function. Paracetamol should be given with care to patients taking other drugs that affect the liver.</p>', '<p>Symptoms of Paracetamol overdose in the first 24 hours are pallor, nausea, vomiting, anorexia and abdominal pain. Liver damage may become apparent 12-48 hours after ingestion. Abnormalities of glucose metabolism and metabolic acidosis may occur.</p>', '<p>Non opioid analgesics.</p>', '<p>Keep in a dry place away from light and heat. Keep out of the reach of children.</p>', NULL, '2022-03-14 04:38:48', '2022-03-14 04:38:48'),
(1178, 1178, '<p>Paracetamol IV is indicated for the management of mild to moderate pain, the management of moderate to severe pain with adjunctive opioid analgesics, the reduction of fever.</p>', '<p>Paracetamol exhibits analgesic action by peripheral blockage of pain impulse generation. It produces antipyresis by inhibiting the hypothalamic heat-regulating centre. Its weak anti-inflammatory activity is related to inhibition of prostaglandin synthesis in the CNS.<br />\r\n<br />\r\nParacetamol (Acetaminophen) is thought to act primarily in the CNS, increasing the pain threshold by inhibiting both isoforms of cyclooxygenase, COX-1, COX-2, and COX-3 enzymes involved in prostaglandin (PG) synthesis. Unlike NSAIDs, acetaminophen does not inhibit cyclooxygenase in peripheral tissues and, thus, has no peripheral anti-inflammatory affects. While aspirin acts as an irreversible inhibitor of COX and directly blocks the enzyme&#39;s active site, studies have found that acetaminophen indirectly blocks COX, and that this blockade is ineffective in the presence of peroxides. This might explain why acetaminophen is effective in the central nervous system and in endothelial cells but not in platelets and immune cells which have high levels of peroxides. Studies also report data suggesting that acetaminophen selectively blocks a variant of the COX enzyme that is different from the known variants COX-1 and COX-2. This enzyme is now referred to as COX-3. Its exact mechanism of action is still poorly understood, but future research may provide further insight into how it works. The antipyretic properties of acetaminophen are likely due to direct effects on the heat-regulating centres of the hypothalamus resulting in peripheral vasodilation, sweating and hence heat dissipation.</p>', '<p><strong>Adults and adolescents weighing 50 kg and over</strong>: the recommended dosage of Paracetamol IV is 1000 mg every 6 hours or 650 mg every 4 hours, with a maximum single dose of Paracetamol IV of 1000 mg, a minimum dosing interval of 4 hours, and a maximum daily dose of Paracetamol of 4000 mg per day.<br />\r\n<br />\r\n<strong>Adults and adolescents weighing under 50 kg</strong>: the recommended dosage of Paracetamol IV is 15 mg/kg every 6 hours or 12.5 mg/kg every 4 hours, with a maximum single dose of Paracetamol IV of 15 mg/kg, a minimum dosing interval of 4 hours, and a maximum daily dose of Paracetamol of 75 mg/kg per day.<br />\r\n<br />\r\n<strong>Children &gt;2 to 12 years of age</strong>: the recommended dosage of Paracetamol IV is 15 mg/kg every 6 hours or 12.5 mg/kg every 4 hours, with a maximum single dose of Paracetamol IV of 15 mg/kg, a minimum dosing interval of 4 hours, and a maximum daily dose of Paracetamol of 75 mg/kg per day.</p>', NULL, '<p>Paracetamol is contraindicated in patients with known hypersensitivity to its active ingredient or to any of the excipients in the intravenous formulation. Also contraindicated in patients with severe hepatic impairment or severe active liver disease</p>', '<p>As all paracetamol products, adverse drug reactions are rare (&gt;1/10000, &lt;1/1000) or very rare (&lt;1/10000). Frequent adverse reactions at injection site have been reported during clinical trials (pain and burning sensation). Very rare cases of hypersensitivity reactions ranging from simple skin rash or urticaria to anaphylactic shock have been reported and require discontinuation of treatment. Cases of erythema, flushing, pruritus and tachycardia have been reported.</p>', '<p>Pregnancy Category C. There are no studies of intravenous Paracetamol in pregnant women; however, epidemiological data on oral Paracetamol use in pregnant women show no increased risk of major congenital malformations. Animal reproduction studies have not been conducted with IV Paracetamol and it is not known whether Paracetamol IV can cause fetal harm when administered to a pregnant woman. Paracetamol IV should be given to a pregnant woman only if clearly needed. There are no adequate and well-controlled studies with Paracetamol IV during labor and delivery; therefore, it should be used in such settings only after a careful benefit-risk assessment. While studies with Paracetamol IV have not been conducted, Paracetamol is secreted in human milk in small quantities after oral administration.</p>', '<p>Administration of Paracetamol in doses higher than recommended may result in hepatic injury, including the risk of severe hepatotoxicity and death. Do not exceed the maximum recommended daily dose of Paracetamol. Use caution when administering Paracetamol in patients with the following conditions: hepatic impairment or active hepatic disease, alcoholism, chronic malnutrition, severe hypovolemia (e.g., due to dehydration or blood loss), or severe renal impairment (creatinine clearance &lt; 30 ml/min). There were infrequent reports of life-threatening anaphylaxis requiring emergent medical attention. Discontinue Paracetamol IV immediately if symptoms associated with allergy or hypersensitivity occurs. Do not use Paracetamol IV in patients with Paracetamol allergy.</p>', NULL, NULL, '<p>Store in a cool &amp; dry place &amp; away from children. For single use only. The product should be used within 6 hours after opening. Do not refrigerate or freeze.</p>', '<p><strong>Pediatric Use</strong>: The safety and effectiveness of Paracetamol IV for the treatment of acute pain and fever in pediatric patients ages 2 years and older is supported by evidence from adequate and well-controlled studies of Paracetamol IV in adults.<br />\r\n<br />\r\n<strong>Geriatric use</strong>: No overall differences in safety or effectiveness were observed between these subjects and younger subjects, and other reported clinical experience has not identified differences in responses between the elderly and younger patients.<br />\r\n<br />\r\n<strong>Patients with Hepatic Impairment</strong>: Paracetamol is contraindicated in patients with severe hepatic impairment or severe active liver disease and should be used with caution in patients with hepatic impairment or active liver disease. A reduced total daily dose of Paracetamol may be warranted.<br />\r\n<br />\r\n<strong>Patients with Renal Impairment</strong>: In cases of severe renal impairment (creatinine clearance &lt; 30 ml/min), longer dosing intervals and a reduced total daily dose of Paracetamol may be warranted.</p>', '2022-03-14 04:40:44', '2022-03-14 04:40:44'),
(1179, 1179, '<p>The is indicated in the following condition-</p>\r\n\r\n<ul>\r\n	<li>Headache</li>\r\n	<li>Migraine</li>\r\n	<li>Toothache</li>\r\n	<li>Neuralgia</li>\r\n	<li>Feverishness</li>\r\n	<li>Period pain</li>\r\n	<li>Sore throat</li>\r\n	<li>Backache</li>\r\n	<li>Help to reduce the temperature</li>\r\n	<li>Aches and pain of colds and flu</li>\r\n</ul>', '<p>This is a combination of Paracetamol and Caffeine. Paracetamol has analgesic and antipyretic properties with weak anti-inflammatory activity. Caffeine is an alkaloid which is a theophylline-like xanthine derivative. By intermolecular association with Paracetamol, Caffeine increases the solubility and transmembrane permeation of Paracetamol. In addition, Caffeine increases the pain threshold and tolerance of pain. Caffeine has also an intrinsic power to raise vessel tone in the brain, which provides another benefit to treat migraine and headache.</p>', '<p><strong>Adult dose</strong>: 1-2 tablets every 4-6 hours. Maximum dose: 8 tablets daily.<br />\r\n<strong>Child dose</strong>: Not recommended for children below 12 years.</p>', '<p>May reduce serum levels with anticonvulsants (e.g. phenytoin, barbiturates, carbamazepine). May enhance the anticoagulant effect of warfarin and other coumarins with prolonged use. Accelerated absorption with metoclopramide and domperidone. May increase serum levels with probenecid. May increase serum levels of chloramphenicol. May reduce absorption with colestyramine within 1 hr of admin. May cause severe hypothermia with phenothiazine.</p>', '<p>Paracetamol is contraindicated in patients with severe renal function impairment and hepatic disease (Viral Hepatitis). Known hypersensitivity to paracetamol or caffeine.</p>', '<p>Side effects of paracetamol are usually mild, though haematological reactions including thrombocytopenia, leukopenia, pancytopenia, neutropenia, and agranulocytosis have been reported. Pancreatitis, skin rashes, and other allergic reactions occur occasionally.</p>', '<p>Pregnant mothers should consult with doctors before taking Paracetamol &amp; Caffeine. Paracetamol &amp; Caffeine can be taken whilst breast feeding.</p>', '<p>Paracetamol &amp; Caffeine should be given cautiously in the following cases: In patients with hepatic or renal failure, in patients taking other hepatotoxic medication. Prolonged use of the drug without consulting a physician should be avoided.</p>', '<p>Symptoms of Paracetamol overdose in the first 24 hours are pallor, nausea, vomiting, anorexia and abdominal pain. Liver damage may become apparent 12 to 40 hours after ingestion. Abnormalities of glucose metabolism and metabolic acidosis may occur.</p>', '<p>Non opioid analgesics</p>', '<p>Store in a cool and dry place, protect from light and moisture.Keep all medicines out of the reach of the children.</p>', NULL, '2022-03-14 04:42:26', '2022-03-14 04:42:26'),
(1180, 1180, '<p>This is indicated for the treatment of pain and fever in patients with the risk of liver toxicity.</p>', '<p>Paracetamol (Acetaminophen) is thought to act primarily in the CNS, increasing the pain threshold by inhibiting both isoforms of cyclooxygenase, COX-1, COX-2, and COX-3 enzymes involved in prostaglandin (PG) synthesis. Unlike NSAIDs, acetaminophen does not inhibit cyclooxygenase in peripheral tissues and, thus, has no peripheral anti-inflammatory affects. While aspirin acts as an irreversible inhibitor of COX and directly blocks the enzyme&#39;s active site, studies have found that acetaminophen indirectly blocks COX, and that this blockade is ineffective in the presence of peroxides. This might explain why acetaminophen is effective in the central nervous system and in endothelial cells but not in platelets and immune cells which have high levels of peroxides. Studies also report data suggesting that acetaminophen selectively blocks a variant of the COX enzyme that is different from the known variants COX-1 and COX-2. This enzyme is now referred to as COX-3. Its exact mechanism of action is still poorly understood, but future research may provide further insight into how it works. The antipyretic properties of acetaminophen are likely due to direct effects on the heat-regulating centres of the hypothalamus resulting in peripheral vasodilation, sweating and hence heat dissipation.<br />\r\n<br />\r\nThe mechanism of the possible anti-hepatotoxic activity of L-methionine is not entirely clear. It is thought that metabolism of high doses of acetaminophen in the liver lead to decreased levels of hepatic glutathione and increased oxidative stress. L-methionine is a precursor to L-cysteine. L-cysteine itself may have antioxidant activity. L-cysteine is also a precursor to the antioxidant glutathione. Antioxidant activity of L-methionine and metabolites of L-methionine appear to account for its possible anti-hepatotoxic activity. Recent research suggests that methionine itself has free-radical scavenging activity by virtue of its sulfur, as well as its chelating ability.</p>', '<p><strong>Adult dosage:</strong>&nbsp;2 tablets every 4 hours; max. 8 tablets daily.<br />\r\n<strong>Child Dosage</strong>: Not recommended for children under 12 years of age.</p>', '<p>This should not be used with monoamine-oxidase inhibitor (MAOI), antidepressants (e.g. phenelzine). Prolonged use of paracetamol may enhance the effects of anti-clotting/ blood thinning medicines such as warfarin, leading to an increased risk of bleeding. Methionine may reduce the effect of levodopa. Metoclopramide and domperidone increase the rate of absorption of paracetamol from the gut. The absorption of paracetamol is decreased if cholestyramine is taken at the same time.</p>', '<p>Children under 12 years of age, Known sensitivity or allergy to any ingredient, Liver disease.</p>', '<p>Side effects of recommended doses (up to 8 tablets/capsules a day in adults) are rare, but blood disorders, skin rashes are known to be associated with Napa soft.</p>', '<p>Since this is a fixed dose combination of methionine and paracetamol, it is advised to consult with physician before use during the period of pregnancy and lactation.This should be used with caution during pregnancy, and only if the expected benefit to the mother is greater than any possible risk to the foetus. This&nbsp;should be used with caution by breast feeding mothers, and only if the expected benefit to the mother is greater than any possible risk to the baby.</p>', '<p>This should be used with caution in alcoholism and decreased kidney function. In cases of overdose, immediate advice should be sought from a physician. Alcohol increases the risk of liver damage that can occur if an overdose of paracetamol is taken. The hazards of paracetamol overdose are greater in persistent heavy drinkers and in people with alcoholic liver disease.</p>', NULL, '<p>Non opioid analgesics</p>', '<p>Store at a cool, dry place, away from light. Keep out of reach of children.</p>', NULL, '2022-03-14 04:44:08', '2022-03-14 04:44:08'),
(1181, 1181, '<p>This tablet is indicated for-</p>\r\n\r\n<ul>\r\n	<li>The management of moderate to moderately severe pain in adults.</li>\r\n	<li>The short-term (five days or less) management of acute pain.</li>\r\n</ul>', '<p>Paracetamol has analgesic and antipyretic properties with weak anti-inflammatory activity. Paracetamol (Acetaminophen) is thought to act primarily in the CNS, increasing the pain threshold by inhibiting both isoforms of cyclooxygenase, COX-1, COX-2, and COX-3 enzymes involved in prostaglandin (PG) synthesis. Paracetamol is a para aminophenol derivative, has analgesic and antipyretic properties with weak anti-inflammatory activity. Paracetamol is one of the most widely used, safest and fast acting analgesic. It is well tolerated and free from various side effects of aspirin.<br />\r\n<br />\r\nTramadol is a centrally acting synthetic opioid analgesic. Although its mode of action is not completely understood, from animal tests, at least two complementary mechanisms appear applicable: binding of parent and M1&nbsp;metabolite to &mu;-opioid receptors and weak inhibition of the reuptake of norepinephrine and serotonin. Opioid activity is due to both low affinity binding of the parent compound and higher affinity binding of the O-demethylated metabolite M1&nbsp;to &mu;-opioid receptors. Tramadol has been shown to inhibit reuptake of norepinephrine and serotonin in vitro, as have some other opioid analgesics.These mechanisms may contribute independently to the overall analgesic profile of tramadol.</p>', '<p><strong>For the management of moderate to moderately severe pain</strong>: The recommended dose is 1 or 2 tablets every 4 to 6 hours as needed for pain relief up to a maximum of 8 tablets per day.<br />\r\n<br />\r\n<strong>In case of short-term (five days or less) management of acute pain</strong>: The recommended dose is 2 tablets every 4 to 6 hours as needed for pain relief up to a maximum of 8 tablets per day.<br />\r\n<br />\r\nThis tablet can be administered without regard to food.</p>', NULL, '<p>Tramadol &amp; Paracetamol combination tablets should not be administered to patients who have previously demonstrated hypersensitivity to tramadol, paracetamol, any other component of this product, or opioids. This is contraindicated in any situation where opioids are contraindicated.</p>', '<p>The following adverse reactions may happen to this therapy: asthenia, fatigue, hot flushes, dizziness, headache, tremor, abdominal pain, constipation, diarrhea, dyspepsia, dry mouth, nausea, vomiting, anorexia, anxiety, confusion, euphoria, insomnia, nervousness, somnolence pruritus, rash, increased sweating etc.</p>', '<p>Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. This combination<br />\r\npreparation should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. This combination preparation is not recommended for obstetrical preoperative medication or for post-delivery analgesia in nursing mothers because its safety in infants and newborns has not been studied.</p>', '<ul>\r\n	<li>This combination preparation may impair mental or physical abilities required for the performance of potentially hazardous tasks such as driving a car or operating machinery.</li>\r\n	<li>This combination preparation should not be taken with alcohol containing beverages.</li>\r\n	<li>The patient should be instructed not to take this combination preparation in combination with other tramadol or paracetamol-containing products, including over-the-counter preparations.</li>\r\n	<li>This combination preparation should be used with caution when taking medications such as tranquilizers, hypnotics or other opiate containing analgesics.</li>\r\n</ul>', NULL, '<p>Non-steroidal Anti-inflammatory Drugs (NSAIDs).</p>', '<p>Store in a cool and dry place. Do not freeze. Keep all medicines out of the reach of children.</p>', '<p><strong>pediatric use</strong>: The safety and effectiveness of this combination preparation have not been studied in the pediatric population.<br />\r\n<br />\r\n<strong>Geriatric use</strong>:&nbsp; In general, dose selection for an elderly patient should be cautious, reflecting the greater frequency of decreased hepatic, renal, or cardiac function; of concomitant disease and multiple drug therapy.<br />\r\n<br />\r\n<strong>Use in Renal Disease</strong>: This combination preparation has not been studied in patients with impaired renal<br />\r\nfunction. In patients with creatinine clearances of less than 30 ml/min, it is recommended that the dosing interval of this combination preparation be increased but not to exceed 2 tablets every 12 hours.<br />\r\n<br />\r\n<strong>Use in Hepatic Disease</strong>: This combination preparation has not been studied in patients with impaired hepatic function. The use of this combination preparation in patients with hepatic impairment is not recommended.</p>', '2022-03-14 04:45:53', '2022-03-14 04:45:53'),
(1182, 1182, '<p>For the short-term treatment of postoperative pain in adults. The decision to prescribe a selective cyclooxygenase-2 (COX-2) inhibitor should be based on an assessment of the individual patient&#39;s overall risks.</p>', '<p>Parecoxib is a prodrug of valdecoxib. Valdecoxib is a selective COX-2 inhibitor within the clinical dose range. Cyclooxygenase is responsible for generation of prostaglandins. Two isoforms, COX-1 and COX-2, have been identified. COX-2 is the isoform of the enzyme that has been shown to be induced by pro-inflammatory stimuli and has been postulated to be primarily responsible for the synthesis of prostanoid mediators of pain, inflammation, and fever. COX-2 is also involved in ovulation, implantation and closure of the ductus arteriosus, regulation of renal function, and central nervous system functions (fever induction, pain perception and cognitive function). It may also play a role in ulcer healing. COX-2 has been identified in tissue around gastric ulcers in man but its relevance to ulcer healing has not been established.<br />\r\n<br />\r\nThe difference in antiplatelet activity between some COX-1 inhibiting NSAIDs and COX-2 selective inhibitors may be of clinical significance in patients at risk of thrombo-embolic reactions. COX-2 selective inhibitors reduce the formation of systemic (and therefore possibly endothelial) prostacyclin without affecting platelet thromboxane. The clinical relevance of these observations has not been established.</p>', '<p><strong>Adult</strong>: The recommended dose is 40 mg administered intravenously (IV) or intramuscularly (IM), followed every 6 to 12 hours by 20 mg or 40 mg as required, not to exceed 80 mg/day. As the cardiovascular risk of COX-2 specific inhibitors may increase with dose and duration of exposure, the shortest duration possible and the lowest effective daily dose should be used. There is limited clinical experience with Parecoxib treatment beyond three days.<br />\r\n<br />\r\n<strong>Elderly</strong>: No dose adjustment is generally necessary in elderly patients (&ge;65 years). However, for elderly patients weighing less than 50 kg, treatment should be initiated with half the usual recommended dose of Parecoxib and reduce the maximum daily dose to 40 mg.<br />\r\n<br />\r\n<strong>Children</strong>: The safety and efficacy of parecoxib in children under 18 years old have not been established. No data are available. Therefore, parecoxib is not recommended in these patients.</p>\r\n\r\n<p>&nbsp;</p>\r\n\r\n<p><strong>Administration</strong></p>\r\n\r\n<p>The IV bolus injection may be given rapidly and directly into a vein or into an existing IV line. The IM injection should be given slowly and deeply into the muscle. For instructions on reconstitution of the medicinal product before administration. Precipitation may occur when Parecoxib is combined in solution with other medicinal products and therefore Parecoxib must not be mixed with any other medicinal product, either during reconstitution or injection. In those patients where the same IV line is to be used to inject another medicinal product, the line must be adequately flushed prior to and after Parecoxib injection with a solution of known compatibility.</p>', NULL, '<p>Hypersensitivity to the active substance or to any of the excipients.</p>', '<p>Commonside effects are-</p>\r\n\r\n<ul>\r\n	<li>Change in your blood pressure (up or down)</li>\r\n	<li>You may get back pain</li>\r\n	<li>Ankles, legs and feet may swell (fluid retention)</li>\r\n	<li>You may feel numb- your skin may lose sensitivity to pain and touch</li>\r\n	<li>You may get vomiting, stomach ache, indigestion, constipation, bloating and wind</li>\r\n	<li>Tests may show abnormal kidney function</li>\r\n	<li>You may feel agitated or find it hard to sleep</li>\r\n	<li>Dizziness</li>\r\n	<li>There is a risk of anaemia- changes in red blood cells after an operation that may cause fatigue and breathlessness</li>\r\n	<li>You may get a sore throat or difficulty breathing (shortness of breath)</li>\r\n	<li>Your skin may be itchy</li>\r\n	<li>You may pass less urine than usual.</li>\r\n	<li>Dry socket (inflammation and pain after a tooth extraction)</li>\r\n	<li>Increased sweating</li>\r\n	<li>Low levels of potassium in blood test results.</li>\r\n</ul>', '<p>Parecoxib is suspected to cause serious birth defects when administered during the last trimester of pregnancy because as with other medicinal products known to inhibit prostaglandin, it may cause premature closure of the ductus arteriosus or uterine inertia. NSAID use during the second or third trimester of pregnancy may cause foetal renal dysfunction which may result in reduction of amniotic fluid volume or oligohydramnios in severe cases. Such effects may occur shortly after treatment initiation and are usually reversible. Pregnant women on NSAIDs should be closely monitored for amniotic fluid volume. Parecoxib is contraindicated in the third trimester of pregnancy.<br />\r\n<br />\r\nAdministration of a single dose of parecoxib to lactating women following caesarean section resulted in the transfer of a relatively small amount of parecoxib and its active metabolite valdecoxib into human milk, and this resulted in a low relative dose for the infant (approximately 1% of the weight-adjusted maternal dose). Parecoxib must not be administered to women who breast-feed.</p>', '<p>Parecoxib has been studied in dental, orthopaedic, gynaecologic (principally hysterectomy) and coronary artery bypass graft surgery. There is limited experience in other types of surgery, for example gastrointestinal or urological surgery. Modes of administration other than IV or IM (e.g. intra-articular, intrathecal) have not been studied and should not be used. Because of the possibility for increaed adverse reactions at higher doses of parecoxib, other COX-2 inhibitors and NSAIDs, patients treated with parecoxib should be reviewed following dose increase and, in the absence of an increase in efficacy, other therapeutic options should be considered. There is limited clinical experience with Parecoxib treatment beyond three days. If, during treatment, patients deteriorate in any of the organ system functions described below, appropriate measures should be taken and discontinuation of parecoxib therapy should be considered.</p>', '<p>Reporting of overdose with parecoxib has been associated with adverse reactions which have also been described with recommended doses of parecoxib. In case of overdose, patients should be managed by symptomatic and supportive care. Valdecoxib is not removed by haemodialysis. Diuresis or alkalisation of urine may not be useful due to high protein binding of valdecoxib.</p>', '<p>Non-steroidal Anti-inflammatory Drugs (NSAIDs)</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-14 04:47:55', '2022-03-14 04:47:55');
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
(1183, 1183, '<p><strong>Chronic Kidney Disease Stages 3 And 4</strong>: Paricalcitol capsules are indicated in adults and pediatric patients 10 years of age and older for the prevention and treatment of secondary hyperparathyroidism associated with Chronic Kidney Disease (CKD) Stages 3 and 4.<br />\r\n<br />\r\n<strong>Chronic Kidney Disease Stage 5</strong>: Paricalcitol capsules are indicated in adults and pediatric patients 10 years of age and older for the prevention and treatment of secondary hyperparathyroidism associated with CKD Stage 5 in patients on hemodialysis&nbsp;(HD) or&nbsp;peritoneal dialysis&nbsp;(PD).</p>', '<p>Paricalcitol is a synthetic, biologically active vitamin D analog of calcitriol with modifications to the side chain (D2) and the A (19-nor) ring. Preclinical andin vitro studies have demonstrated that paricalcitol&#39;s biological actions are mediated through binding of the VDR, which results in the selective activation of vitamin D responsive pathways. Vitamin D and paricalcitol have been shown to reduce parathyroid hormone levels by inhibiting PTH synthesis and secretion.</p>', '<p>Usual Adult Dose for Secondary Hyperparathyroidism:</p>\r\n\r\n<p>Initial dose:<br />\r\n<br />\r\n<strong>Stage 3 or 4 Chronic Kidney Disease (CKD)</strong>: Initial dosing is based on baseline intact parathyroid hormone (iPTH):</p>\r\n\r\n<ul>\r\n	<li>500 pg/mL or less: 1 mcg orally daily OR 2 mcg orally 3 times a week</li>\r\n	<li>Over 500 pg/mL: 2 mcg orally daily OR 4 mcg orally 3 times a week</li>\r\n</ul>\r\n\r\n<p><strong>Stage 5 Chronic Kidney Disease (CKD)</strong>:</p>\r\n\r\n<ul>\r\n	<li>Starting dose (micrograms) = baseline iPTH level (pg/mL)/80</li>\r\n	<li>Starting dose is given orally 3 times a week; only start if baseline serum calcium has been adjusted to 9.5 mg/dL or lower.</li>\r\n</ul>\r\n\r\n<p><br />\r\nUsual Pediatric Dose for Secondary Hyperparathyroidism:</p>\r\n\r\n<p>Safety and efficacy have not been established in pediatric patients. The following is dosing used in a very small pediatric trial. No data are available on children under 5 years old.<br />\r\n<br />\r\n<strong>Initial dose, children 5 to 18 years</strong>: 0.04 mcg/kg three times per week if baseline intact parathyroid hormone (iPTH) is less than 500 pg/mL 0.08 mcg/kg three times per week if baseline iPTH is 500 pg/mL or higher. Injected as a bolus dose through a hemodialysis vascular access port at any time during dialysis<br />\r\n<br />\r\nMaximum frequency: Every other day</p>', '<p>Digitalis; ketoconazole &amp; other strong P450 3A inhibitors including atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, voriconazole. May interfere absorption with cholestyramine (cap only). Increased risk of hypercalcemia with prescription-based phosphate or vit D-related medicinal products &amp; Ca-containing prep or thiazide diuretics. Mg- &amp; Al-containing prep (eg, antacids, phosphate-binders).</p>', '<p>Hypersensitivity, Hypercalcemia, hypervitaminosis D.</p>', '<p>Nausea, Vomiting, Edema, Palpitation, Chills, Pneumonia, Lightheadedness, GI bleeding, Flu, Sepsis, Hypokalemia, Hypercalcemia, Increase in blood creatinine.</p>', '<p>This drug should not be used during pregnancy unless the benefit outweighs the risk to the fetus.</p>\r\n\r\n<ul>\r\n	<li>AU TGA pregnancy category: C</li>\r\n	<li>US FDA pregnancy category: C</li>\r\n</ul>\r\n\r\n<p><strong>Lactation</strong>: Not known if distributed into breast milk, use caution</p>', '<p>Excessive administration of vitamin D compounds, including Paricalcitol Capsules, can cause over suppression of PTH, hypercalcemia, hypercalciuria, hyperphosphatemia, and adynamic bone disease.</p>', NULL, '<p>Thyroid drugs &amp; hormone.</p>', NULL, NULL, '2022-03-14 04:49:31', '2022-03-14 04:49:31'),
(1184, 1184, '<p>Paroxetine&nbsp; is indicated in:</p>\r\n\r\n<ul>\r\n	<li>Major Depressive Disorder</li>\r\n	<li>Obsessive Compulsive Disorder</li>\r\n	<li>Panic Disorder</li>\r\n	<li>Social Anxiety Disorder</li>\r\n	<li>Generalized Anxiety Disorder</li>\r\n	<li>Posttraumatic Stress Disorder.</li>\r\n</ul>', '<p>The efficacy of Paroxetine is presumed to be linked to potentiation of serotonergic activity in the central nervous system resulting from inhibition of neuronal reuptake of serotonin (5-hydroxy-tryptamine, 5 HT). Studies at clinically relevant doses in humans have demonstrated that paroxetine blocks the uptake of serotonin into human platelets. In vitro studies in animals also suggest that paroxetine is a potent and highly selective inhibitor of neuronal serotonin reuptake and has only very weak effects on norepinephrine and dopamine neuronal reuptake. In vitro radioligand binding studies indicate that paroxetine has little affinity for muscarinic, alpha1, alpha2, beta adrenergic, dopamine (D2), 5-HT1, 5 HT2 and histamine (H1)-receptors; antagonism of muscarinic, histaminergic and alpha1-adrenergic receptors has been associated with various anticholinergic, sedative and cardiovascular effects for other psychotropic drugs. Because the relative potencies of paroxetine&rsquo;s major metabolites are at most 1/50 of the parent compound, they are essentially inactive.</p>', '<p>Major Depressive Disorder:</p>\r\n\r\n<ul>\r\n	<li><strong>Usual Initial Dosage</strong>: Paroxetine (Paroxetine hydrochloride) should be administered as a single daily dose with or without food, usually in the morning. The recommended initial dose is 20 mg/day. Some patients not responding to a 20 mg dose may benefit from dose increases, in 10 mg/day increments, up to a maximum of 50 mg/day. Dose changes should occur at intervals of at least 1 week.</li>\r\n	<li><strong>Maintenance Therapy</strong>: Systematic evaluation of the efficacy of Paroxetine hydrochloride has shown that efficacy is maintained for periods of up to 1 year with doses that averaged about 30 mg.</li>\r\n</ul>\r\n\r\n<p>Obsessive Compulsive Disorder (OCD):</p>\r\n\r\n<ul>\r\n	<li><strong>Usual Initial Dosage</strong>: Paroxetine (Paroxetine hydrochloride) should be administered as a single daily dose with or without food, usually in the morning. The recommended dose of Paroxetine in the treatment of OCD is 40 mg daily. Patients should be started on 20 mg/day and the dose can be increased in 10 mg/day increments. Dose changes should occur at intervals of at least 1 week.</li>\r\n	<li><strong>Maintenance Therapy</strong>: Dosage adjustments should be made to maintain the patient on the lowest effective dosage, and patients should be periodically reassessed to determine the need for continued treatment.</li>\r\n</ul>\r\n\r\n<p>Panic Disorder:</p>\r\n\r\n<ul>\r\n	<li><strong>Usual Initial Dosage</strong>: Paroxetine should be administered as a single daily dose with or without food, usually in the morning. The target dose of Paroxetine in the treatment of panic disorder is 40 mg/day. Patients should be started on 10 mg/day. Dose changes should occur in 10 mg/day increments and at intervals of at least 1 week. The maximum dosage should not exceed 60 mg/day.</li>\r\n	<li><strong>Maintenance Therapy</strong>: Dosage adjustments should be made to maintain the patient on the lowest effective dosage, and patients should be periodically reassessed to determine the need for continued treatment.</li>\r\n</ul>\r\n\r\n<p>Social Anxiety Disorder (SAD):</p>\r\n\r\n<ul>\r\n	<li><strong>Usual Initial Dosage</strong>: Paroxetine should be administered as a single daily dose with or without food, usually in the morning. The recommended initial dosage is 20 mg/day.</li>\r\n	<li><strong>Maintenance Therapy</strong>: Dosage adjustments should be made to maintain the patient on the lowest effective dosage, and patients should be periodically reassessed to determine the need for continued treatment.</li>\r\n</ul>\r\n\r\n<p>Generalized Anxiety Disorder (GAD):</p>\r\n\r\n<ul>\r\n	<li><strong>Usual Initial Dosage</strong>: Paroxetine should be administered as a single daily dose with or without food, usually in the morning. The recommended starting dosage and the established effective dosage is 20 mg/day.</li>\r\n	<li><strong>Maintenance Therapy</strong>: Dosage adjustments should be made to maintain the patient on the lowest effective dosage, and patients should be periodically reassessed to determine the need for continued treatment.</li>\r\n</ul>\r\n\r\n<p>Posttraumatic Stress Disorder (PTSD):</p>\r\n\r\n<ul>\r\n	<li><strong>Usual Initial Dosage</strong>: Paroxetine should be administered as a single daily dose with or without food, usually in the morning. The recommended starting dosage and the established effective dosage is 20 mg/day. Dose changes, if indicated, should occur in 10 mg/day increments and at intervals of at least 1 week.</li>\r\n	<li><strong>Maintenance Therapy</strong>: Dosage adjustments should be made to maintain the patient on the lowest effective dosage, and patients should be periodically reassessed to determine the need for continued treatment.</li>\r\n</ul>', '<p><strong>Food/antacids</strong>: The absorption and pharmacokinetics of Paroxetine are not affected by food or antacids.<br />\r\n<br />\r\n<strong>Tryptophan</strong>: As with other 5-HT re uptake inhibitors, animal studies indicate that an interaction between Paroxetine and Tryptophan may occur, resulting in a &lsquo;serotonin syndrome&rsquo; suggested by a combination of agitation, restlessness and gastrointestinal symptoms including diarrhoea.&nbsp;<br />\r\n<br />\r\n<strong>Drug metabolizing enzyme inducers /inhibitors</strong>: The metabolism and pharmacokinetics of Paroxetine may be affected by drugs, which induce or inhibit hepatic drug metabolizing enzymes. When Paroxetine is to be coadministered with a known drug metabolizing inhibitor, consideration should be given to using doses at the lower end of the range. No initial dosage adjustment of Paroxetine is considered necessary when it is to be co-administered with known drug metabolizing enzyme inducers. Any subsequent dosage adjustment should be guided by clinical effect (tolerabilityand efficacy).<br />\r\n<br />\r\n<strong>Alcohol</strong>: Although Paroxetine does not increase the impairment of mental and motor skill caused by alcohol, the concomitant use of Paroxetine and alcohol in depressed patients is not advised.<br />\r\n<br />\r\n<strong>Haloperidol/amylobarbitone/oxazepam</strong>: Experience in a limited number of healthy subjects has shown that Paroxetine did not increase the sedation and drowsiness associated with haloperidol, amylobarbitone or oxazepam when given in combination.<br />\r\n<br />\r\n<strong>MAOls</strong>: As with other 5-HT re uptake inhibitors, animal studies indicate that an interaction between Paroxetine and monoamine oxidase (MAO) inhibitors may occur.<br />\r\n<br />\r\n<strong>Lithium</strong>: Since there is little clinical experience, and there have been reports of interaction of lithium with other 5-HT re-uptake inhibitors, the concurrent administration of Paroxetine and lithium should be undertaken with caution.<br />\r\n<br />\r\n<strong>Lithium levels should be monitored.&nbsp;</strong><strong>Phenytoin / anticonvulsants</strong>: Co-administration of Paroxetine and phenytoin is associated with decreased plasma concentrations of Paroxetine and increased adverse experiences. Co-administration of Paroxetine with other anticonvulsants may also be associated with an increased incidence of adverse experiences.<br />\r\n<br />\r\n<strong>Warfarin</strong>: Preliminary data suggest that there may be a pharmacodynamic interaction between Paroxetine and warfarin, which may result in increased bleeding in the presence of unaltered prothrombin times. Paroxetine should therefore be administered with great caution to patients receiving oral anticoagulants.</p>', '<p>Concomitant use in patients taking either monoamine oxidase inhibitors (MAOIs) or thioridazine is contraindicated. This is contraindicated in patients with a hypersensitivity to Paroxetine.</p>', '<p><strong>Major depressive disorder:</strong>&nbsp;Asthenia, sweating, nausea, decreased appetite, somnolence, dizziness, insomnia, tremor, nervousness, ejaculatory disturbance and other male genital disorders.<br />\r\n<br />\r\n<strong>Obsessive compulsive disorder:</strong>&nbsp;Nausea, dry mouth, decreased appetite, constipation, dizziness, somnolence, tremor, sweating, impotence and abnormal ejaculation.<br />\r\n<br />\r\n<strong>Panic disorder:</strong>&nbsp;Asthenia, sweating, decreased appetite, decreased libido , tremor, abnormal ejaculation, female genital disorders and impotence.<br />\r\n<br />\r\n<strong>Social anxiety disorder:</strong>&nbsp;Sweating, nausea, dry mouth, constipation, decreased appetite, somnolence, tremor, decreased libido, yawn, abnormal ejaculation, female genital disorders and impotence.<br />\r\n<br />\r\n<strong>Generalised anxiety disorder:</strong>&nbsp;Asthenia, infection, constipation, decreased appetite, dry mouth, nausea, decreased libido, somnolence, tremor, sweating and abnormal<br />\r\nejaculation.<br />\r\n<br />\r\n<strong>Post-traumatic stress disorder:</strong>&nbsp;Asthenia, sweating nausea, dry mouth, diarrhoea, decreased appetite, somnolence, decreased libido, abnormal ejaculation, female genital disorders and impotence.</p>', '<p>This drug should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.<br />\r\n<br />\r\n<strong>Labor and Delivery</strong>: The effect of Paroxetine on labor and delivery in humans is unknown.<br />\r\n<br />\r\n<strong>Nursing Mothers</strong>: Like many other drugs, Paroxetine is secreted in human milk, and caution should be exercised when Paroxetine hydrochloride is administered to a nursing woman.</p>', '<p><strong>Cardiac conditions</strong>: Paroxetine does not produce clinically significant changes in blood pressure, heart rate and ECG. Nevertheless, as with all psychoactive drugs, caution is advised when treating patients with cardiac conditions.<br />\r\n<br />\r\n<strong>Epilepsy</strong>: As with other antidepressants, Paroxetine should be used with caution in-patients with epilepsy.<br />\r\n<br />\r\n<strong>Seizures</strong>: Overall, the incidence of seizures is &lt; 0.1% in patients treated with Paroxetine. Paroxetine should be discontinued in any patient who develops seizures.<br />\r\n<br />\r\n<strong>ECT</strong>: There is little clinical experience of concurrent administration of Paroxetine with ECT.<br />\r\n<br />\r\n<strong>Ability to drive/use machines</strong>: Clinical experience has shown that therapy with Paroxetine is not associated with impairment of cognitive or psychomotor function. However, as with all psychoactive drugs, patients should be cautioned about their ability to drive a car and operate machinery.<br />\r\n<br />\r\n<strong>Discontinuation of Treatment with Paroxetine</strong>: Recent clinical trials&nbsp;supporting the various approved indications of Paroxetine employed a taper phase regimen, rather than an abrupt discontinuation of treatment. The taper phase regimen used in GAD and PTSD clinical trials involved an incremental decrease in the daily dose by 10 mg/day at weekly intervals. When a daily dose of 20 mg/day was reached, patients were continued on this dose for 1 week before treatment was stopped.</p>', NULL, '<p>SSRIs &amp; related anti-depressant drugs.</p>', '<p>Keep out of the reach of children. Store at a cool and dry place. Protect from light and moisture.</p>', '<p><strong>Dosage for Elderly or Debilitated, and Patients with Severe Renal or Hepatic Impairment</strong>: The recommended initial dose is 10 mg/day for elderly patients, debilitated patients, and/or patients with severe renal or hepatic impairment. Increases may be made if indicated. Dosage should not exceed 40 mg/day.</p>', '2022-03-14 04:51:40', '2022-03-14 04:51:40'),
(1185, 1185, '<p>Pazopanib is indicated for the treatment of patients with advanced renal cell carcinoma (RCC). Pazopanib is indicated for the treatment of patients with advanced soft tissue sarcoma (STS) who have received prior chemotherapy. The efficacy of Pazopanib for the treatment of patients with adipocytic STS or gastrointestinal stromal tumors has not been demonstrated.</p>', '<p>Pazopanib is a multi-tyrosine kinase inhibitor of vascular endothelial growth factor receptor (VEGFR)-1, VEGFR 2, VEGFR-3, platelet-derived growth factor receptor (PDGFR)-&alpha; and -&beta;, fibroblast growth factor receptor (FGFR)-1 and -3, cytokine receptor (Kit), interleukin-2 receptor-inducible T-cell kinase (Itk), lymphocyte-specific protein tyrosine kinase (Lck), and transmembrane glycoprotein receptor tyrosine kinase (c-Fms). In vitro, Pazopanib inhibited ligand-induced autophosphorylation of VEGFR-2, Kit, and PDGFR-&beta; receptors.<br />\r\n<br />\r\n<strong>Absorption</strong>: Pazopanib is absorbed orally with median time to achieve peak concentrations of 2 to 4 hours after the dose. Daily dosing at 800 mg results in geometric mean AUC and C max of 1,037 mcg/mL and 58.1 mcg/mL (equivalent to 132 &micro;M), respectively. There was no consistent increase in AUC or C max at Pazopanib doses above 800 mg.<br />\r\n<br />\r\n<strong>Distribution</strong>: Binding of Pazopanib to human plasma protein in vivo was greater than 99% with no concentration dependence over the range of 10 to 100 mcg/mL. In vitro, studies suggest that Pazopanib is a substrate for P-gp and BCRP.<br />\r\n<br />\r\n<strong>Metabolism</strong>: In vitro studies demonstrated that Pazopanib is metabolized by CYP3A4 with a minor contribution from CYP1A2 and CYP2C8.<br />\r\n<br />\r\n<strong>Elimination</strong>: Pazopanib has a mean half-life of 30.9 hours after administration of the recommended dose of 800 mg. Elimination is primarily via feces with renal elimination accounting for less than 4% of the administered dose.</p>', '<p>The recommended starting dose of Pazopanib is 800 mg orally once daily without food (at least 1 hour before or 2 hours after a meal). The dose of Pazopanib should not exceed 800 mg. Tablets should not be crushed due to the potential for increased rate of absorption which may affect systemic exposure. If a dose is missed, it should not be taken if it is less than 12 hours until the next dose. Or, as directed by the registered physicians.</p>', '<p><strong>Drugs that Inhibit or Induce Cytochrome P450 3A4 Enzymes</strong>: In vitro studies suggested that the oxidative metabolism of Pazopanib in human liver microsomes is mediated primarily by CYP3A4, with minor contributions from CYP1A2 and CYP2C8. Therefore, inhibitors and inducers of CYP3A4 may alter the metabolism of Pazopanib.<br />\r\n<br />\r\n<strong>CYP3A4 Inhibitors</strong>: Coadministration of Pazopanib with strong inhibitors of CYP3A4 (e.g., Ketoconazole, Ritonavir, Clarithromycin) increases Pazopanib concentrations and should be avoided. Consider an alternate concomitant medication with no or minimal potential to inhibit CYP3A4. If coadministration of a strong CYP3A4 inhibitor is warranted, reduce the dose of Pazopanib to 400 mg. Grapefruit or grapefruit juice should be avoided as it inhibits CYP3A4 activity and may also increase plasma concentrations of Pazopanib.<br />\r\n<br />\r\n<strong>CYP3A4 Inducers</strong>: CYP3A4 inducers, such as Rifampin, may decrease plasma Pazopanib concentrations. Consider an alternate concomitant medication with no or minimal enzyme induction potential. Pazopanib should not be used if chronic use of strong CYP3A4 inducers cannot be avoided.<br />\r\n<br />\r\n<strong>Drugs that Inhibit Transporters</strong>: In vitro studies suggested that Pazopanib is a substrate of P-glycoprotein (P-gp) and breast cancer resistance protein (BCRP). Therefore, absorption and subsequent elimination of Pazopanib may be influenced by products that affect P-gp and BCRP. Concomitant treatment with strong inhibitors of P-gp or BCRP should be avoided due to risk of increased exposure to Pazopanib. Selection of alternative concomitant medicinal products with no or minimal potential to inhibit P-gp or BCRP should be considered.<br />\r\n<br />\r\n<strong>Effects of Pazopanib on CYP Substrates</strong>: Results from drug-drug interaction trials conducted in cancer patients suggest that Pazopanib is a weak inhibitor of CYP3A4, CYP2C8, and CYP2D6 in vivo, but had no effect on CYP1A2, CYP2C9, or CYP2C19. Concomitant use of Pazopanib with agents with narrow therapeutic windows that are metabolized by CYP3A4, CYP2D6, or CYP2C8 is not recommended. Coadministration may result in inhibition of the metabolism of these products and create the potential for serious adverse events.<br />\r\n<br />\r\n<strong>Effect of Concomitant Use of Pazopanib and Simvastatin</strong>: Concomitant use of Pazopanib and Simvastatin increases the incidence of ALT elevations. Across monotherapy trials with Pazopanib, ALT greater than 3 x ULN was reported in 126/895 (14%) of patients who did not use statins, compared with 11/41 (27%) of patients who had concomitant use of Simvastatin. If a patient receiving concomitant Simvastatin develops ALT elevations, follow dosing guidelines for Pazopanib or consider alternatives to Pazopanib. Alternatively, consider discontinuing Simvastatin. Insufficient data are available to assess the risk of concomitant administration of alternative statins and Pazopanib.</p>', '<p>It is contraindicated in patients with known hypersensitivity to Pazopanib or any other components of this product.</p>', '<p>Common side effects of Pazopanib include:</p>\r\n\r\n<ul>\r\n	<li>Hepatic Toxicity and Hepatic Impairment</li>\r\n	<li>QT Prolongation and Torsades de Pointes</li>\r\n	<li>Cardiac Dysfunction</li>\r\n	<li>Hemorrhagic Events</li>\r\n	<li>Arterial and Venous Thromboembolic Events</li>\r\n	<li>Thrombotic Microangiopathy</li>\r\n	<li>Gastrointestinal Perforation and Fistula</li>\r\n	<li>Interstitial Lung Disease/Pneumonitis</li>\r\n	<li>Reversible Posterior Leukoencephalopathy Syndrome</li>\r\n	<li>Hypertension</li>\r\n	<li>Hypothyroidism</li>\r\n	<li>Proteinuria</li>\r\n	<li>Tumor Lysis Syndrome</li>\r\n	<li>Infection</li>\r\n	<li>Increased Toxicity with Other Cancer Therapy</li>\r\n</ul>', '<p>Pazopanib can cause fetal harm when administered to a pregnant woman. There are no available data in pregnant women to inform a drug-associated risk. Pregnant women or women should be advised of the childbearing potential of the potential risk to a fetus. There is no information regarding the presence of Pazopanib or its metabolites in human milk, or their effects on the breastfed infant, or on milk production. Because of the potential for serious adverse reactions in breastfed infants from Pazopanib, a lactating woman should be advised not to breastfeed during treatment with Pazopanib and for 2 weeks after the final dose.</p>', '<p><strong>Hepatic Toxicity and Hepatic Impairment</strong>: In clinical trials with Pazopanib, hepatotoxicity, manifested as increases in serum transaminases (alanine transferase [ALT], aspartate aminotransferase [AST]) and bilirubin, was observed. This hepatotoxicity can be severe and fatal. Patients older than 65 years are at greater risk for hepatotoxicity. Transaminase elevations occur early in the course of treatment (92.5% of all transaminase elevations of any grade occurred in the first 18 weeks).<br />\r\n<br />\r\n<strong>QT Prolongation and Torsades De Pointes</strong>: In the RCC trials of Pazopanib, QT prolongation (greater than or equal to 500 msec) was identified on routine electrocardiogram (ECG) monitoring in 2% (11/558) of patients. Torsades de pointes occurred in less than 1% (2/977) of patients who received Pazopanib in the monotherapy trials. Pazopanib should be used with caution in patients with a history of QT interval prolongation, in patients taking antiarrhythmics or other medications that may prolong QT interval, and those with relevant pre-existing cardiac disease. When using Pazopanib, baseline and periodic monitoring of ECGs and maintenance of electrolytes (e.g., calcium, magnesium, potassium) within the normal range should be performed.</p>', '<p>Pazopanib doses up to 2000 mg have been evaluated in clinical trials. Dose-limiting toxicity (Grade 3 fatigue) and Grade 3 hypertension were each observed in 1 of 3 patients dosed at 2000 mg daily and 1000 mg daily, respectively. Treatment of overdose with Pazopanib should consist of general supportive measures. There is no specific antidote for overdosage of Pazopanib. Hemodialysis is not expected to enhance the elimination of Pazopanib because Pazopanib is not significantly renally excreted and is highly bound to plasma proteins.</p>', NULL, '<p>Store below 30&deg; C in a cool and dry place, away from sunlight. Keep out of reach of children.</p>', '<p><strong>Females</strong>: Pazopanib can cause fetal harm when administered to a pregnant woman. Females of reproductive potential should be advised to use effective contraception during treatment and for at least 2 weeks after the last dose of Pazopanib.<br />\r\n<br />\r\n<strong>Males</strong>: To avoid potential drug exposure to pregnant partners and female partners of reproductive potential, male patients (including those who have had vasectomies) with female partners of reproductive potential should be advised to use condoms during treatment with Pazopanib and for at least 2 weeks after the last dose.<br />\r\n<br />\r\n<strong>Pediatric Use</strong>: The safety and effectiveness of Pazopanib&nbsp;in pediatric patients have not been established.</p>', '2022-03-14 04:53:29', '2022-03-14 04:53:29'),
(1186, 1186, '<p>Pefloxacin is indicated in adult for the treatment of single infection or mixed infections caused by two or more susceptible microorganisms. It can also be used for infections caused by organisms resistant to other antibiotics. Pefloxacin&nbsp;is indicated to the following manifestations:</p>\r\n\r\n<ul>\r\n	<li><strong>Gastrointestinal infection</strong>: Enteric fever, acute bacterial diarrhoea &amp; chronic Salmonella carriers.</li>\r\n	<li><strong>Urinary tract infection</strong>: Cystitis, pyelonephritis, prostatitis, epididymitis, uncomplicated and complicated urethritis.</li>\r\n	<li><strong>Respiratory tract infection</strong>: Pneumonia, acute and chronic bronchitis, cystic fibrosis, bronchiectasis, empyema.</li>\r\n	<li><strong>Ear, nose and throat infection</strong>: Otitis media, otitis externa, sinusitis, tonsillitis.</li>\r\n	<li><strong>Bone and joint infection</strong>: Osteomyelitis, arthritis.</li>\r\n	<li><strong>Skin and soft tissue infection</strong>: Infected ulcer, wound infection, abscess, cellulitis, erysipelas and infected burn.</li>\r\n	<li><strong>Pelvic infection</strong>: Salpingitis, endometritis, pelviperitonitis.</li>\r\n	<li><strong>Abdominal and hepatobiliary infection</strong>: Peritonitis, intra abdominal abscess and cholingitis, cholecystitis and empyema of the gall bladder.</li>\r\n	<li>Also used in septicemia, bacteraemia, gonorrhoea, endocarditis, meningitis.</li>\r\n</ul>', '<p>Pefloxcin is a synthetic antibacterial agent, belongs to fluoroquinolone group. It exerts its action by inhibiting the subunit-A of DNA gyrase (Topoisomerase II). Pefloxcin is bactericidal and has a broad spectrum of activity.</p>', '<p><strong>Adult with normal hepatic function</strong>: Pefloxcin 400 mg tablet 12 hourly (morning &amp; evening) with meals to avoid gastrointestinal disturbances. An initial loading dose of 800 mg may be given in order to produce effective blood concentration more rapidly.<br />\r\n<br />\r\n<strong>Adult with hepatic insufficiency</strong>: In patients with severe hepatic insufficiency or reduced blood supply to the liver, the daily doses should be readjusted by increasing the intervals between doses. Dosage need not to be reduced in renal insufficiency.<br />\r\n<br />\r\nDuration of Treatment:</p>\r\n\r\n<ul>\r\n	<li>Usually 5 to 10 days.</li>\r\n	<li>For chronic prostatitis, cystic fibrosis &amp; chronic Salmonella carriers: 14 days.</li>\r\n	<li>For endocarditis: Up to 6 months.</li>\r\n	<li>For chronic osteomyelitis: Up to 1 year.</li>\r\n	<li>For gonorrhoea: 2 tablets single dose.</li>\r\n</ul>', '<p>When taken concomitantly with an Antacid containing Aluminium and/or Magnesium Hydroxide gel, absorption of Pefloxacin is reduced. So, concurrent administration of these agents with Pefloxacin should be avoided.</p>', '<p>Pefloxacin is contraindicated in patients with known hypersensitivity to Quinolone, children under 15 years of age, pregnant and lactating mothers, patient with inborn glucose-6-phosphate dehydrogenase deficiency and patients with history of tendon lesion, tendonitis or tendon rupture.</p>', '<p>Occasionally observed reactions are - Gastrointestinal disturbance: Epigastric pain, nausea, vomiting, diarrhoea, dyspepsia. Central nervous system disturbance: Headache, insomnia. Hypersensitivity reaction: Skin rash, pruritis, photosensitization. Others: Myalgia and/or arthralgia, tendonitis, rupture of achilles tendon.</p>', '<p>Pefloxacin has been assigned to pregnancy category C by the FDA.</p>', '<p>Because of the risk of photosensitivity reaction, exposure to sunlight and ultraviolet radiation should be avoided during Pefloxacin therapy. Dosage readjustment is required in severe hepatic insufficiency. Patients should be informed of the possibility of pain in the achilles tendon.</p>', NULL, '<p>4-Quinolone preparations.</p>', '<p>Keep below 30&deg;C temperature, away from light &amp; moisture. Keep out of the reach of children.</p>', NULL, '2022-03-14 04:55:04', '2022-03-14 04:55:04'),
(1187, 1187, '<p>Pegfilgrastim is a leukocyte growth factor indicated to decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of febrile neutropenia.</p>', '<p>Pegfilgrastim, a Granulocyte Colony-Stimulating Factor (G-CSF) is a pegylated glycoprotein that regulates the production and release of functional neutrophils from bone marrow. Pegfilgrastim is a covalent conjugate of recombinant methionyl human G-CSF (Filgrastim) and monomethoxy polyethylene glycol. Filgrastim is a water soluble 175 amino acid protein with a molecular weight of approximately 19 kilodaltons (kD) and a 20 kD monomethoxy polyethylene glycol molecule is covalently bound to the N-terminal methionyl residue of filgrastim. The average molecular weight of pegfilgrastim is approximately 39 kD.</p>', '<p>The recommended dosage of Pegfilgrastim is a single subcutaneous injection of 6 mg administered once per chemotherapy cycle in adults. Do not administer Pegfilgrastim between 14 days before and 24 hours after administration of cytotoxic chemotherapy. Visually inspect parenteral drug products for particulate matter and discoloration prior to administration, whenever solution and container permit. Do not administer Pegfilgrastim if discoloration or particulates are observed.<br />\r\n<br />\r\nNOTE: The needle cover on the single-use pre-filled syringe contains dry natural rubber (latex); persons with latex allergies should not administer this product.</p>', '<p>No formal drug interaction studies between Pegfilgrastim and other drugs have been performed. Increased hematopoietic activity of the bone marrow in response to growth factor therapy may result in transiently positive bone-imaging changes. Consider these findings when interpreting bone-imaging results. This medicinal product must not be mixed with other medicinal product, particularly sodium chloride solutions.</p>', '<p>Do not administer Pegfilgrastim to patients with a history of serious allergic reactions to pegfilgrastim or filgrastim.</p>', '<p><strong>Splenic Rupture</strong>: Splenic rupture, including fatal cases, can occur following the administration of Pegfilgrastim. Evaluate for an enlarged spleen or splenic rupture in patients who report left upper abdominal or shoulder pain after receiving Pegfilgrastim.<br />\r\n<br />\r\n<strong>Acute Respiratory Distress Syndrome</strong>: Acute Respiratory Distress Syndrome (ARDS) can occur in patients receiving Pegfilgrastim. Evaluate patients who develop fever and lung infiltrates or respiratory distress after receiving Pegfilgrastim for ARDS. Discontinue Pegfilgrastim in patients with ARDS.<br />\r\n<br />\r\n<strong>Serious Allergic Reactions</strong>: Serious allergic reactions, including anaphylaxis can occur in patients receiving Pegfilgrastim. The majority of reported events occurred upon initial exposure. Allergic reactions, including anaphylaxis can recur within days after the discontinuation of initial anti-allergic treatment. Permanently discontinue Pegfilgrastim in patients: with serious allergic reactions. Do not administer Pegfilgrastim to patients with a history of serious allergic reactions to Pegfilgrastim or Filgrastim.<br />\r\n<br />\r\n<strong>Patients with Sickle Cell Disorders</strong>: Severe sickle cell crises can occur in patients with sickle cell disorders receiving Pegfilgrastim. Severe and sometimes fatal sickle cell crises can occur in patients with sickle cell disorders receiving Filgrastim, the parent compound of Pegfilgrastim.</p>', '<p>Pregnancy Category C. There are no adequate and well-controlled studies in pregnant women. Pegfilgrastim was embryotoxic and increased pregnancy loss in pregnant rabbits that received cumulative doses approximately 4 times the recommended human dose (based on body surface area). Signs of maternal toxicity occurred at these doses. Pegfilgrastim should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the fetus.<br />\r\n<br />\r\nNursing Mothers: It is not known whether Pegfilgrastim is secreted in human milk. Other recombinant G-CSF products are poorly secreted in breast milk and G-CSF is not orally absorbed by neonates. Caution should be exercised when administered to a nursing woman.</p>', '<ul>\r\n	<li>Fatal splenic rupture can occur. Evaluate for splenomegaly or splenic rupture in patients with left upper abdominal or shoulder pain.</li>\r\n	<li>Acute Respiratory Distress Syndrome (ARDS) can occur. Evaluate for ARDS in patients who develop fever, lung infiltrates, or respiratory distress. Discontinue Pegfilgrastim in patients with ARDS.</li>\r\n	<li>Serious allergic reactions, including anaphylaxis, can occur. Permanently discontinue Pegfilgrastim in patients with serious allergic reactions.</li>\r\n</ul>', '<p>The maximum amount of Pegfilgrastim that can be safely administered in single or multiple doses has not been determined. Single subcutaneous doses of 300 mcg/kg have been administered to 8 healthy volunteers and 3 patients with non-small cell lung cancer without serious adverse effects. These patients experienced a mean maximum Absolute Neutrophil Count (ANC) of 55x109/L, with a corresponding mean maximum WBC of 67x109/L. The absolute maximum ANC observed was 96x109/L with a corresponding absolute maximum WBC observed of 120x109/L.</p>', '<p>Hematopoietic drug.</p>', '<p>Pegfilgrastim should be stored in a refrigerator at 2-8&deg;C. Do not freeze. Do not shake. Keep away from light.</p>', '<p><strong>Pediatric Use</strong>: Safety and effectiveness of Pegfilgrastim in pediatric patients have not been established.<br />\r\n<br />\r\n<strong>Geriatric Use</strong>: Of the 932 patients with cancer who received Pegfilgrastim in clinical studies, 139 (15%) were age 65 and over, and 18 (2%) were age 75 and over. No overall differences in safety or effectiveness were observed between patients age 65 and older and younger patients.<br />\r\n<br />\r\n<strong>Renal Impairment</strong>: In a study of 30 subjects with varying degrees of renal dysfunction, including end stage renal disease, renal dysfunction had no effect on the pharmacokinetics of Pegfilgrastim. Therefore, Pegfilgrastim dose adjustment in patients with renal dysfunction is not necessary.</p>', '2022-03-14 04:56:55', '2022-03-14 04:56:55'),
(1188, 1188, '<p>Propylthiouracil is indicated:</p>\r\n\r\n<ul>\r\n	<li>in patients with Graves&#39; disease with hyperthyroidism or toxic multinodular goiter who are intolerant of methimazole and for whom surgery or radioactive iodine therapy is not an appropriate treatment option</li>\r\n	<li>to ameliorate symptoms of hyperthyroidism in preparation for thyroidectomy or radioactive iodine therapy in patients who are intolerant of methimazole</li>\r\n</ul>', '<p>Propylthiouracil inhibits the synthesis of thyroid hormones and thus is effective in the treatment of hyperthyroidism. The drug does not inactivate existing thyroxine and triiodothyronine that are stored in the thyroid or circulating in the blood, nor does it interfere with the effectiveness of thyroid hormones given by mouth or by injection. Propylthiouracil inhibits the conversion of thyroxine to triiodothyronine in peripheral tissues and may therefore be an effective treatment for thyroid storm. Propylthiouracil is readily absorbed and is extensively metabolized. Approximately 35% of the drug is excreted in the urine, in intact and conjugated forms, within 24 hours.</p>', '<p><strong>Adults</strong>: The initial dose is 300 mg daily. In patients with severe hyperthyroidism, very large goiters, or both, the initial dose may be increased to 400 mg daily; an occasional patient will require 600 to 900 mg daily initially. The usual maintenance dose is 100 to 150 mg daily.<br />\r\n<br />\r\n<strong>Pediatric Patients</strong>: Propylthiouracil is generally not recommended for use in the pediatric patient population except in rare instances in which other alternative therapies are not appropriate options. Studies evaluating appropriate dosing regimen have not been conducted in the pediatric population although general practice would suggest initiation of therapy in patients 6 years or older at a dosage of 50 mg daily with careful upward titration based on clinical response and evaluation of TSH and free T4 levels. Although cases of severe liver injury have been reported with doses as low as 50 mg/day, most cases were associated with doses of 300 mg/day and higher.</p>', '<p><strong>Anticoagulants (oral)</strong>: Due to the potential inhibition of vitamin K activity by propylthiouracil, the activity of oral anticoagulants (e.g., warfarin) may be increased; additional monitoring of PT/INR should be considered, especially before surgical procedures.<br />\r\n<br />\r\n<strong>Beta-adrenergic blocking agents</strong>: Hyperthyroidism may cause an increased clearance of beta blockers with a high extraction ratio. A reduced dose of beta-adrenergic blockers may be needed when a hyperthyroid patient becomes euthyroid.<br />\r\n<br />\r\n<strong>Digitalis glycosides</strong>: Serum digitalis levels may be increased when hyperthyroid patients on a stable digitalis glycoside regimen become euthyroid; a reduced dose of digitalis glycosides may be needed.<br />\r\n<br />\r\n<strong>Theophylline</strong>: Theophylline clearance may decrease when hyperthyroid patients on a stable theophylline regimen become euthyroid; a reduced dose of theophylline may be needed.</p>', '<p>Propylthiouracil is contraindicated in patients who have demonstrated hypersensitivity to the drug or any of the other product components.</p>', '<p>The most common side effects of Propylthiouracil include:</p>\r\n\r\n<ul>\r\n	<li>nausea</li>\r\n	<li>muscle pain</li>\r\n	<li>vomiting</li>\r\n	<li>headache</li>\r\n	<li>upper stomach pain or tenderness</li>\r\n	<li>sleepiness</li>\r\n	<li>joint pain</li>\r\n	<li>nerve pain</li>\r\n	<li>itching or tingling</li>\r\n	<li>swelling (edema)</li>\r\n	<li>loss or change in taste</li>\r\n	<li>dizziness</li>\r\n	<li>loss of hair</li>\r\n	<li>enlarged salivary glands or enlarged lymph node</li>\r\n</ul>', '<p>Pregnancy Category D. There are cases of liver injury, including liver failure and death, in women treated with propylthiouracil during pregnancy. Two reports of in utero exposure with liver failure and death of a newborn have been reported. If propylthiouracil is used during pregnancy, or if the patient becomes pregnant while taking propylthiouracil, the patient should be warned of the rare potential hazard to the mother and fetus of liver damage. Propylthiouracil crosses the placenta and can cause fetal goiter and cretinism when administered to a pregnant woman. After the first trimester of pregnancy, the use of an alternative antithyroid medication may be advisable.<br />\r\n<br />\r\nNursing Mothers: Propylthiouracil is present in breast milk to a small extent and therefore likely results in clinically insignificant doses to the nursing infant. In one study, nine lactating women were administered 400 mg of propylthiouracil by mouth. The mean amount of propylthiouracil excreted during 4 hours after drug administration was 0.025% of the administered dose.</p>', '<p>Patients should be instructed to report any symptoms of hepatic dysfunction (anorexia, pruritus, jaundice, light colored stools, dark urine, right upper quadrant pain, etc.), particularly in the first six months of therapy. When these symptoms occur, measurement should be made of liver function (bilirubin, alkaline phosphatase) and hepatocellular integrity (ALT/AST levels). Patients who receive propylthiouracil should be under close surveillance and should be counseled regarding the necessity of immediately reporting any evidence of illness, particularly sore throat, skin eruptions, fever, headache, or general malaise. In such cases, white blood cell and differential counts should be obtained to determine whether agranulocytosis has developed. Particular care should be exercised with patients who are receiving concomitant drugs known to be associated with agranulocytosis.</p>', '<p><strong>Symptoms</strong>: Nausea, vomiting, epigastric distress, headache, fever, arthralgia, pruritus, edema, and pancytopenia. Agranulocytosis is the most serious effect. Rarely, exfoliative dermatitis, hepatitis, neuropathies or CNS stimulation or depression may occur. No information is available on the following: LD 50 ; concentration of propylthiouracil in biologic fluids associated with toxicity and/or death; the amount of drug in a single dose usually associated with symptoms of overdosage; or the amount of propylthiouracil in a single dose likely to be life-threatening.<br />\r\n<br />\r\n<strong>Treatment</strong>: To obtain up-to-date information about the treatment of overdose, a good resource is the certified Regional Poison Control Center. In managing overdosage, consider the possibility of multiple drug overdoses, interaction among drugs, and unusual drug kinetics in the patient. In the event of an overdose, appropriate supportive treatment should be initiated as dictated by the patient&rsquo;s medical status.</p>', '<p>Thyroid drugs &amp; hormone.</p>', '<p>Store at controlled room temperature 15&deg;-30&deg;C.</p>', '<p><strong>Pediatric Use</strong>: Postmarketing reports of severe liver injury including hepatic failure requiring liver transplantation or resulting in death have been reported in the pediatric population. No such reports have been observed with methimazole. As such, propylthiouracil is not recommended for use in the pediatric population except in rare instances in which methimazole is not well-tolerated and surgery or radioactive iodine therapy are not appropriate. When used in children, parents and patients should be informed of the risk of liver failure. If patients taking propylthiouracil develop tiredness, nausea, anorexia, fever, pharyngitis, or malaise, propylthiouracil should be discontinued immediately by the patient, a physician should be contacted, and a white blood cell count, liver function tests, and transaminase levels obtained.<br />\r\n<br />\r\n<strong>Geriatric Patients</strong>: Clinical studies of propylthiouracil did not include sufficient numbers of subjects aged 65 or over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.</p>', '2022-03-14 04:59:05', '2022-03-14 04:59:05');
