Drug New

S4 - PRESCRIPTION ONLY MEDICINE S2 - PHARMACY MEDICINE

PARACETAMOL Aniline Analgesics Indications

Pain killer (headache, …) - mild to moderate fever, releave some common cold symptoms (sorethroat, cough, headache, …)

Adverse/ Side Effects

Skin develops rash (rarely) if overdose, urine colour is dark-brown.

Dosages

1

PAIN RELIEVER (ADULT, ORAL) 0.5-1 g q6h. Max 4g/d

2

PAIN RELIEVER (CHILDREN, ORAL) 15 mg/kg q4h or q6h. Max 60 mg/kg/d

3

4

5 Ancillary Labels

13

Do not remove from original packaging until dose required.

19

Contains Paracetamol. Consult your doctor or pharmacist if taking other paracetamol products.

A

SWALLOW WHOLE. Do not chew.

Dose form

* Confirm that the patient is using any other product contains Paracetamol. If so, calculation of required dosage to be intaken per day is essential. Remember max intake of adult is 4 grams a day. * Caution regarding excess of alcohol use. (*APF) * If pain is not relieved in 24 - 48 hours, DO NOT continue to take Paracetamol, seek medical advice. * Pregnancy: A ; Breastfeeding: May be used. * S4 when combined.

















































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S4 - PRESCRIPTION ONLY MEDICINE

GLYCERYL TRINITRATE Nitrate Indications

Acute Angina or Chronic Angina, Heart Failure

Adverse/ Side Effects

Nausea, diarrhoea, palpitations, hypotention, flushing (*APF)

Dosages

1

Acute Angina , Adult (Ref APF) Sublingual Tab: 300 - 900 mcg ; Sublingual Spray: 400 - 800 mcg (1-2 sprays)

2

Prevention of Chronic Angina (Ref APF) Patch: 5 - 15 mg up to 14 hours daily

3

4

5 Ancillary Labels

13

Do not remove from original packaging until dose required.

16

This medicine may cause dizziness especially when you stand up quickly. Ask your doctor or phar

21

Special handling and disposal required - ask your pharmacist.

7b

Discard

days after opening. Date opened

/

/

Dose form

* Ancillary Labels: Patches (Label 13, 21, 16) | Tablets (Label 7b, 16, 13) | Spray: 16 * Change to urinary system: dark-brown colour urine. * Pregnancy: B2; Breastfeeding: Use with caution, monitor side effects of infant. * Use during or before activity expected to have an angina * Spray: prime 5 times before first use, spray under tongue * Tablet: place under tongue, until angina is relieved, spit out, DO NOT swallow to avoid side effects * Store in bottle, protect from moisture, heat and light * Discard 3 months after opening.

















































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S4 - PRESCRIPTION ONLY MEDICINE

AMOXICILLIN Antibiotics & Penicillin Indications

To kill bacteria (antibiotics, anti-infectives), bites or clenched first injuries

Adverse/ Side Effects

Skin rash, nausea, diarrhoea, gastric upset

Dosages

Ault dose ORAL 250 - 500 mg / 8hrs or 1 g twice daily

1

IM/IV 250 mg - 1 g / 6-8hrs

2

Children dose ORAL 7.5-25 mg/kg / 8hrs

3

Acute otitis media (otitis: painful swelling in ears, cause by infection) Children dose 15 mg/kg upto 500 mg / 8 hrs . If compliance, ORAL 30 mg/kg (max 1 g) / 12hrs for 5 days

4

IM/IV 10-25 mg/kg 8 hrs. Max 50 mg/kg / 4hrs

*Compliance: the practice of obeying the rule according to authority

5 Ancillary Labels

D

Add the words 'until all used'.

6

REFRIGERATE. Do not freeze

7a

Discard contents after

/

/

Dose form

* Ancillary Label: For suspension, use label 6, 7a * Space doses as evenly as possible during waking hours. * Pregnancy: A ; Breastfeeding: may be used * Confirm appropriate and antibiotics and dose regime.

















































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S4 - PRESCRIPTION ONLY MEDICINE

SALBUTAMOL Beta2 Agonist, Bronchodilator, Cardiovascular Agent Indications

Asthma, exercise-induced asthma

Adverse/ Side Effects

Tachycardia (excessively rapid heartbeat), tremor, electrolyte disturbances (imbalance of ionized salts in the blood)

Dosages

ADULT DPI 200-400 mg tds or qid / MDI 100-200 mg/tds or qid prn or 5-15 mins before exercise

1

2

3

4

5 Ancillary Labels

ORAL 2-4 mg/tds or qid / NEBULISER 2.5-5 mg/tds or qid prn CHILDREN MDI 100-200 mg/qqh (every 4 hrs) or q6h (every 6 hrs)

NEBULISER < 2yrs, 0.1 mg/kg - 2.5 mg/kg , rpt tds - qid prn , > 2yrs, 2.5-5 mg, rpt tds-qid

ORAL 0.15 mg/kg/dose, rpt q6h prn, max single dose is 4 mg/dose 21

Use only with approved or recommended device.

7b

Discard

days after opening. Date opened

/

/

Dose form

* Ancillary Label: 22 (for capsules and nebules), 7b (for foil wrapping) * Pregnancy: A , Breast-feeding: may be used * Inhalation device is primed before first use, and again if not use for 2 wks * PRESCRIPTION ONLY MEDICINE

















































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S4 - PRESCRIPTION ONLY MEDICINE

OMEPRAZOLE Proton Pump Inhibitor, Anti-ulcer, Gastrointestinal Agent Indications

Omeprazole is used for treatment of: Peptic Ulcer disease, Zollinger-Allison syndrome, H. Pylori eradication

Adverse/ Side Effects

Nausea, severe vomiting, epigastric pain, or diarrhoea with blood-stained stools (APF) >>> See doctor

Dosages

1

ADULT DOSE (APF) 10-40 g/d

2

H. pylori eradication (AMH) Oral, 20 mg bd, with 2 antibacterials

3

Zollinger-Allison syndrome (AMH, APF) Initially, 60 mg ONCE a day, Maintainance: 20-120 mg daily, maximum 80 mg daily

4

CHILDREN DOSE (APF) <10 kg, 5 mg ONCE d /// 10-20 kg, 10 mg daily, max 20 mg d /// >20 kg, 20 mg d, max 40 mg d

5 Ancillary Labels

13

Do not remove from original packaging until dose required.

A

SWALLOW WHOLE. Do not chew.

Dose form

* Precaution if allergic to Omeprazole or Esomeprazole * Pregnancy: B3. May be used when treatment with antacids and H2 antagonists has failed. If a proton pump inhibitor is required, omeprazole is preferred. Breastfeeding: Use with caution, excretions in breast milk is expected. * See doctor instantly if side/adverse effects occur. * Swallow tablet or capsule whole; do not crush or chew. Alternatively, omeprazole tablets (Losec®, Acimax®, Omepral®) may be dispersed in water, orange juice or yoghurt; take within 30 minutes.

















































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S4 - PRESCRIPTION ONLY MEDICINE

SIMVASTATIN Antihyperlipidemic, HMG-COA Reductase Inhibitor Indications

Hypercholesterolemia, Coronary heart disease (Coronary = connected with the heart)

Adverse/ Side Effects

Muscle pain, tenderness, weakness (APF), headache, insomnia, dizziness (AMH)

Dosages

1

ADULT DOSE (To be taken in the evening) 10–80 mg once daily (AMH). Usual dose, 40 mg once daily (AMH)

2

Child 10–17 years (AMH) Initially 10 mg once daily; range 10–40 mg once daily

3

Children 2 - 10 years (APF) 20 mg/d

4

Children > 10 years (APF) 10-80 mg/d

5 Ancillary Labels

16

Avoid eating grapefruit or drinking grapefruit juice while being treated with this medicine.

Dose form

* Take in the evening * Do exercise and control weight, follow low-fat diet regime * Seek medical advice if side effects occur * Pregnancy: D. Breastfeeding: Use contraindicated (If a drug or treatment is contraindicated, there is a medical reason why it should not be used in a particular situation)

















































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S4 - PRESCRIPTION ONLY MEDICINE

FLUTICASONE

Adrenal Glucocorticoid , Anti-Inflammatory , Corticosteroid Indications

Maintenance treatment in persistent asthma, Acute asthma, Allergic Rhinitis

Adverse/ Side Effects

dysphonia (disturbance of vocal function), bruising, facial skin irritation following nebulisation

Dosages

ADULT DOSE MDI / DPI : 100-250 mcg bd. Use up to 1,000 mcg/d in severse asthma

1

2

3

4

Nebules: 2 mg bd CHILDREN DOSE MDI / DPI > 1 yrs, 50-100 mcg bd, severse asthma: 500 mcg/d

Nebules > 4 years: 1 mg bd for up to 7 days

5 Ancillary Labels

14

RINSE MOUTH with water after each use.

Dose form

* THIS MEDICATION IS NOT FOR USE DURING ACUTE ATTACK, but rather a preventive medication intended for continued and regular use even if no symptoms present. * Rinse mouth with water after use to prevent oral thrush (infectious disease in mouth) (Label 14 says so) * Cover eyes during nebulisation because of possible leackage from a mask * May take more than 1 wk to achieve full benefit * Pregnancy: B3, Safe to use. Breasf feeding: safe to use

















































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S4 - PRESCRIPTION ONLY MEDICINE

FRUSEMIDE Cardiovascular Agent & Loop Diuretics Indications

Hypercalcaemia (high Ca level in blood), congestive heart failure, Renal failure (edema), hypertension,

Adverse/ Side Effects

orthrostatic hypotension, dizziness when standing quickly, dehydration, gout…

Dosages

1

***APF***ADULT DOSE ORAL, 20-40 mg once or twice daily. May gradually increase to 400 mg/d

2

Patient with severse renail impairment ~1000 mg daily is required

3

IM / IV 20-40 mg every 1-2 hours

4

CHILDREN DOSE ORAL, 1-2 mg/kg once or twice daily, maximum 6 mg/kg

5

IM / IV 0.5-1 mg/kg every 6-12 hours. Maximum dose 6mg/kg

Ancillary Labels

16

This medicine may cause dizziness especially when you stand up quickly. Ask your doctor or phar

Dose form

* Pregnancy: C (use not recommended). Breast feeding: Use not recommeded. * Care with NSAIDs, digoxin, lithium, thiazide diuretics * Sulfonamide: caution allergies *** This medicine is usually taken once daily in the morning. If you are taking it twice a day, take the first dose in the morning and the second dose before 6 pm. *** You may feel dizzy on standing when taking this medicine. Get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy.

















































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S4 - PRESCRIPTION ONLY MEDICINE

RANITIDINE Anti-ulcer, H2 antogonist Indications

Stress ulcer prophylaxis

Adverse/ Side Effects

nausea, severe vomitting, epigastric pain, black or blood-stained stools

Dosages

ADULT DOSE ORAL, 150-300 mg daily in 1-2 doses

1

2

3

4

IV, 50 mg over 5 mins every 6-8 hours CHILDREN DOSE ORAL, 2-4 mg/kg bd, Max 300 mg/d

IV, 2-4 mg/kg daily in 3-4 divided doses.

5 Ancillary Labels

Dose form

* Pregnancy: B1 (Safe to use), Breast feeding: use with caution, excreted in breast milk and accumulates. * Bradycardia (a slow heartbeat rate, usually less than 60 beats per minute) with rapid IV administration. Rate should not exceed 10 mg/minute. * Renail impairment: dose adjustment may be necessary. * If symptoms do not improve after 2 wks of treatment, seek medical advice.

















































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S2 - PHARMACY MEDICINE

LOPERAMIDE Opioid antidiarrheal Indications

* Diarrhoea, usually short term treatment in adults * Intestinal stoma (to reduce frequency and fluidity of motions)

Adverse/ Side Effects

abdominal pain and bloating, nausea, vomiting, constipation

Dosages

1

ADULT Initially, 4 mg, then 2 mg after each loose bowel action. Maximum daily dose 16 mg

2

CHILDREN 1 month to 1 year: 0.1-0.2 mg/kg twice daily (maximum 2mg/kg daily)

3

4

> 1 year, 0.1-0.2 mg/kg (max 2mg/dose) tdd daily, up to 1.25 mg/kg daily in divided dose

maximum 16 mg daily.

5 Ancillary Labels

Dose form

* Pregnancy: B3, Breast feeding: may be used on short term * If fever or bloody diarrhoea occur, seek medical advice * Do not use loperamide as an antidiarrhoeal in children, except under specialist supervision for chronic diarrhoea, eg short gut syndrome * Seek medical advice if there is no improvement after 48 hours

















































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S2 - PHARMACY MEDICINE

METOCLOPRAMIDE Dopamine antagonist Indications

***Nausea and vomiting*** Gastric stasis (eg after gastric surgery, diabetic gastroparesis); Difficult small intestinal intubation

Adverse/ Side Effects

*APF* involuntary eye, facial or limb movement, *AMH* restlessness, drowsiness, dizziness, headache

Dosages

1

ADULT DOSE Nausea and vomitting: 10 mg three times daily. Maximum 0.5 mg/kg daily

2

CHILDREN DOSE Nausea and vomitting: 15-20 years, 5-10 mg tdd / 5-14 years: 2.5-5 mg tdd

3

4

5 Ancillary Labels

3-5 years, 2 mg 2-3 times daily / 1-3 years: 1 mg 2-3 times daily

< 1 year: 1 mg twice daily Vomitting associated with cancer chemotherapy 1-2 mg/kg four-hourly. Maximum 10 mg/kg daily. 1

This medicine may cause drowsiness and may increase the effects of alcohol. If affected, do not dri

6

REFRIGERATE. Do not freeze

Dose form

* Pregnancy: A (safe to use) / Breast feeding: may be used for short term. * DO NOT take more than the recommended dose. Can cause dystonic reactions * Higher does may be used for nausea due to chemotherapy. * Inquire if any other medicine been lost due to vomitting. * Seek medical advice if side effects occur. * CAUTION: May cause depression. * This medicine may make you feel drowsy or dizzy; do not drive or operate machinery until you know how metoclopramide affects you.

















































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S4 - PRESCRIPTION ONLY MEDICINE

IBUPROFEN Analgesics, Non-selective NSAIDs Indications

Pain (especially caused by inflammation), fever, dysfuntional uterine bleeding, Rheumatoid arthritis and juvenile rheumatoid arthritis, Osteoarthritis

Adverse/ Side Effects

nausea, dyspepsia, GI ulceration or bleeding, raised liver enzymes, diarrhoea, headache, dizziness, salt and fluid retention, hypertension

Dosages

1

ADULT DOSE ***APF*** 200-400 mg 3-4 times daily. Maximum 2,400 mg daily

2

CHILDREN DOSE > 3 months Pain or Fever, 5-10 mg/kg/dose 6-8 hourly as need

3

Anti-inflammatory, Juvenile rheumatoid arthritis, 10 mg/kg/dose 3-4 times a day.

4

Topical >12 years, rub 4–10 cm into the affected area if needed, up to 4 times daily.

5

Combination with codeine Adult, 1–2 tabs (of ibuprofen 200 mg and codeine 12.8 mg) qqh qrn, up to a max of 6 tabs daily.

Ancillary Labels

20

TAKE ONCE WEEKLY ON THE SAME DAY.

6

REFRIGERATE. Do not freeze

B

TAKE WITH OR SOON AFTER FOOD.

Dose form

* Pregnancy: C. Use not recommended during third trimester. Breast feeding: safe to use. * Maximum response should be seen in 1-3 wks. * CHECK use of over-the-counter NSAIDs. * CAUTION with diabetes, hypertension, heart failure, asthm, or peptic ulcer. * CONSIDER stopping 2-3 days before planned surgery, seek medical advice. * Ibuprofen may reduce aspirin’s antiplatelet activity. * If you develop swollen ankles, difficulty in breathing, black stools or dark coffee-coloured vomit, stop taking the medicine and tell your doctor immediately. * Do not take aspirin for pain relief as it will increase the risk of side effects with this medicine.

















































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CELECOXIB Selective-NSAIDs (COX-2-inhibitor) Indications

Rheumatoid arthritis, Osteoarthritis, Ankylosing spondylitis, Period pain

Adverse/ Side Effects

nausea, dyspepsia, GI ulceration or bleeding, raised liver enzymes, diarrhoea, headache, dizziness, salt and fluid retention, hypertension

Dosages

1

ADULT DOSE Osteoarthritis 200 mg daily in 1-2 divided dose

2

Rheumatoid Arthritis 100 mg Twice daily. Maybe increased to 200 mg twice daily (short term).

3

Period Pain 400 mg daily in 1 or 2 doses on the first day, then 200 mg 1-2 times daily qrn; max 5 days treatment.

4

5 Ancillary Labels

10a

Do not take more than one aspirin tablet or capsule each day while being treated with this medicine

12

This medicine may affect mental alertness and/or coordination. If affected, do not drive a motor ve

Dose form

* Risk of cardiovascular adverse events is dose-related; during long term treatment do not use >200 mg daily. * AVOID in patients wih sulfanomide allergy * CAUTION in the presence of diabetes, asthma or a peptic ulcer, hypertension or heart failure. * CAUTION if taking warafin or other anti-coagulants * Maximum response should be seen in 1-3 wks * CONSIDER stopping 2-3 days before planned surgery, seek medical advice * Pregnancy: B3 (Use not recommended), Breast feeding: Use not recommended * If you develop swollen ankles, difficulty in breathing, black stools or dark coffee-coloured vomit, stop taking the medicine and tell your doctor immediately. * Do not take aspirin for pain relief as it will increase the risk of side effects with this medicine.

















































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PRESCRIPTION ONLY MEDICINE

DIGOXIN Cardiac glycoside Indications

heart failure

Adverse/ Side Effects

anorexia, nausea, vomiting, diarrhoea, blurred vision, visual disturbances, confusion, drowsiness, dizziness, nightmares, agitation, depression

Dosages

ADULT DOSE Loading: 250-500 mcg q4h - q6h, max 1.5 mg

1

2

3

4

5 Ancillary Labels

Maintanance: 62.5-250 mcg/d CHILDREN DOSE Loading: give 1/2 of the loading dose initiailly, then 1/4 of the dose at 6-12 hrs, then last 1/4 at 12-18 hrs

Up to 2 years: ORAL / IV: 30-40 mcg/kg ; > 2 years: 30 mcg/kg

Maintanance: ORAL, 5-10 mcg/kg daily in 1 or 2 doses. Maximum 250 mcg/d 17

Ask your doctor or pharmacist before using any other medicine including over-the-counter medicin

Dose form

*Pregnancy, breast feeding: safe to use * Digoxin has serious adverse effects including potential to worsen arrhythmia (proarrhythmic effect) * Digoxin involves in significant drug interaction, be careful * Concomitant administration of antacids may reduce absorption of digoxin. Digoxin concentration may be increased by co-administration of verapamil, nifedipine, spironolactone, quinidine or amiodarone. * Extreme caution with low birth weight infants and in patients with impaired renal function, reduced dosafe and plasma [ ] monitoring should be used. * Therapeutic range is a guide only and toxicity may occur within the manufacturer's recommended range for atrial fibrillation. Anorexia, nausea, vomiting or blurred vision may indicate toxicity.

















































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S4 - PRESCRIPTION ONLY MEDICINE

ENALAPRIL Angiotensin-converting enzyme inhibitor Indications

Hypertension (includes combination with hydrochlorothiazide or lercanidipine), Heart failure, Asymptomatic left ventricular dysfunction

Adverse/ Side Effects

cough (cough can also be a symptom of heart failure), metallic taste or lack of taste, hypotension, hyperkalaemia, headache, dizziness, fatigue, nausea, renal impairment

Dosages

1

ADULT DOSE 2.5 - 40 mg daily in 1-2 doses

2

CHILDREN DOSE 0.1 mg/kg daily in 1-2 doses, increased gradually to maximum of 1 mg/kg daily.

3

***ADULT - Hypertension*** Adult, initially 5 mg daily, increased at intervals of 1–2 weeks up to 10–40 mg daily as 1 or 2 doses.

4

***ADULT - Heart failure*** Adult, initially 2.5 mg daily, increased up to 10–20 mg daily as 1 or 2 doses.

5 Ancillary Labels

11

DO NOT TAKE POTASSIUM while being treated with this medicine unless advised by your doct

12

This medicine may affect mental alertness and/or coordination. If affected, do not drive a motor ve

Dose form

* Pregnancy: D . Breastfeeding: Use with caution * You may feel dizzy when you start taking this medicine. Get up gradually from sitting or lying to minimise this effect; sit or lie down if you become dizzy or light-headed. * Do not take potassium supplements while you are taking this medicine unless your doctor tells you to.

















































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S4 - PRESCRIPTION ONLY MEDICINE

NIFEDIPINE dihydropyridine calcium channel blocker (APF) Indications

Threatened or established preterm labour (<34 weeks gestation) (AMH)

Adverse/ Side Effects

Dosages

1

ADULT DOSE Tabs, 10-40 mg TWICE daily. Controlled release tablets, 20-120 mg daily

2

CHILDREN DOSE Hypertensive crisis: <2 yrs, 2.5 mg; >2 yrs: 5 mg

3

**Check blood pressure after 20 minutes and redose if needed

4

5 Ancillary Labels

9

DO NOT STOP TAKING THIS MEDICINE ABRUPTLY unless otherwise advised by your docto

18

Avoid eating grapefruit or drinking grapefruit juice while being treated with this medicine.

Dose form

* MODE OF ACTION: Relaxes uterine smooth muscle via blockade of calcium channels. * Dihydropyridines can cause peripheral oedema (swollen ankle) * Pregnancy: C.

















































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PSEUDOEPHEDRINE oral sympathomimetic decongestant Indications

Relief of nasal congestion associated with acute and chronic rhinitis

Adverse/ Side Effects

CNS stimulation, nervousness, excitability, dizziness, insomnia, tremor

Dosages

1

ADULT DOSE 60 mg 4-6 hoursly

2

CHILDREN DOSE > 2 years, 1mg/kg 3-4 times daily

3

4

5 Ancillary Labels

Dose form

* Pregnancy: Avoid use, particularly in the first trimester; ADEC category B2. Use not recommended. * Breastfeeding: Use with caution.

















































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PHOLCODINE opioid cough suppressant Indications

Symptom relief in non-productive cough

Adverse/ Side Effects

drowsiness, constipation, nausea, vomiting

Dosages

ADULT DOSE 10–15 mg 3–4 times daily.

1

2

CHILDREN DOSE 2–5 years, 2–2.5 mg 3 times daily. .

3

5–12 years, 2.5–5 mg 3–4 times daily 4

5 Ancillary Labels

1

This medicine may cause drowsiness and may increase the effects of alcohol. If affected, do not dri

Dose form

* Pregnancy: Safe to use; ADEC category A.

















































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CODEINE opioid analgesic, antidiarrhoeal Indications

Mild-to-moderate pain [includes combination with aspirin, ibuprofen and paracetamol]; Cough suppression (see Codeine); Diarrhoea

Adverse/ Side Effects

nausea and vomiting, dyspepsia, drowsiness, dizziness, headache, orthostatic hypotension, itch, dry mouth, miosis, urinary retention, constipation.

Dosages

ADULT PAIN: 30-60 mg q4h, max 240 mg in 24 hrs, COUGH SUPPRESSION: 15–30 mg tds or qid.

1

2

3

4

DIARRHOEA: 30-60 mg tds or qid CHILDREN COUGH SUPPRESSION: 0.25-0.5 mg/kg/dose q6h or q8h

PAIN: oral/IV/IM 0.5-1.0 mg/kg/dose q4h prn

5 Ancillary Labels

1

This medicine may cause drowsiness and may increase the effects of alcohol. If affected, do not dri

16

This medicine may cause dizziness especially when you stand up quickly. Ask your doctor or phar

Dose form

* Label 1 is used when dosage is greater than 20 mg * Be careful when you stand up as this medicine might make you feel dizzy if you stand up too quickly. (AMH) * codeine may be used for moderate pain not controlled by non-opioid analgesics; it is frequently used with paracetamol or aspirin * 6–10% of Caucasians and 1–2% of Asians lack the enzyme CYP2D6 (necessary for metabolism of codeine to morphine); these people are therefore unlikely to obtain analgesia with codeine **** Combinations of codeine 60 mg and paracetamol 1000 mg are more effective for acute pain than paracetamol 1000 mg alone, although the incidence of drowsiness and dizziness is increased. ****RENAL: Use an alternative opioid in renal impairment where possible due to accumulation of active metabolites. Alternatively, a longer interval between usual doses may be required depending on age and clinical status.

















































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S4 - PRESCRIPTION ONLY MEDICINE

MORPHINE Opioid Analgesic Indications

Moderate to severe Acute and Chronic Pain, Acute pulmonary oedema, Relief of severe dyspnoea

Adverse/ Side Effects

Vomit, nausea, dyspepsia, drowsiness, dizziness, headache, orthostatic hypotension, itch, dry mouth, miosis, urinary retention, constipation, Respiratory depression (Michael Jackson's death)

Dosages

1

Adult, ORAL Initially 10-30 mg q4h. Controlled Release 30-60 mg q12h

2

Children, ORAL 0.2-0.5 mg/kg q4h - 16h. Controlled Release 0.3-0.6 mg/kg q12h

3

4

5 Ancillary Labels

1

This medicine may cause drowsiness and may increase the effects of alcohol. If affected, do not dri

A

SWALLOW WHOLE. Do not chew.

16

This medicine may cause dizziness especially when you stand up quickly. Ask your doctor or phar

Dose form

* Controlled release tablets (MS Contin®) must be swallowed whole; do not crush or chew them. * Label 16 (from AMH). Label 1, A is from APF * Do not take Kapanol® capsules with alcohol as it may affect the release of morphine from the capsules and increase the likelihood of side effects. * Naloxone may be used to reverse morphine-induced respiratory depression * Hepatic impairment (severe): Contraindicated * Renal impairment (severe): Reduce Dose * Pregnancy: C. High doses or prolonged use or near term may cause respiratory depression. Breasfeeding: use with caution.

















































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S4 - PRESCRIPTION ONLY MEDICINE

DIAZEPAM Benzodiazepine Indications

Epilepsy, Acute treatment of seizures, including status epilepticus, Muscle spasm

Adverse/ Side Effects

'Morning-after' hangover effect, repiratory disease or sleep apnoea

Dosages

1

Adult, ORAL 5-40 mg d in divided dose

2

Children, ORAL Muscle spasm: 0.05-0.3 mg/kg bds-tds

3

4

Status epilepticus: IV, 0.1-0.3 mg/kg/dose, rpt every 15-30 mins qrn

Rectal, 0.3-0.5 mg/kg/dose

5 Ancillary Labels

Dose form

1a

This preparation is to aid sleep. DROWSINESS MAY CONTINUE THE FOLLOWING DAY. If a

1

This medicine may cause drowsiness and may increase the effects of alcohol. If affected, do not dri

9

DO NOT STOP TAKING THIS MEDICINE ABRUPTLY unless otherwise advised by your docto

Tablet, Injection, Liquid

* Give IV injection slowly at a rate of 2–5 mg/minute. * Beware: sudden discontinuation of long term treatment * Beware of sedation, especially when alcohol is consumed. * Hepatic impairment (severe): Contraindicated * Renal and hepatic impairment (mild-moderate): Dose reduction * Pregnancy: C, Breastfeeding: Use with caution. * Use Label 1 OR 1A

















































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S4 - PRESCRIPTION ONLY MEDICINE

ZOPICLONE Non-benzodiazepine hypnotic agent Indications

Short term treatment of insomnia (condition of being unable to sleep)

Adverse/ Side Effects

diarrhoea, bitter taste

Dosages

Adult 7.5 mg at night for up to 4 wks. Reduce to 3.75 mg if possible

1

2

Elderly patient: 3.75 mg at night (nocte)

3

4

5 Ancillary Labels

Dose form

1

This medicine may cause drowsiness and may increase the effects of alcohol. If affected, do not dri

A

SWALLOW WHOLE. Do not chew.

1A

This preparation is to aid sleep. DROWSINESS MAY CONTINUE THE FOLLOWING DAY. If a

12

This medicine may affect mental alertness and/or coordination. If affected, do not drive a motor ve

Tablet

* Mode of action: Potentiation of inhibitory effects of GABA. * Used for minimum requierd period only. * Hepatic impairment: Starting dose at 5 mg * What is the Trade name of Zopiclone? Ans: Imovane

















































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S4 - PRESCRIPTION ONLY MEDICINE

IMIPRAMINE Tricyclic Antidepressant Indications

Major depression, Nocturnal enuresis (Bed wetting), Panic disorder, Urinary urge incontinence, Second line treatment in ADHD (Attention deficit hyperreactivity disorder)

Adverse/ Side Effects

fast heart rate, blurred vision, urinary difficulty urinating, dry mouth, constipation, weight gain or loss, and low blood pressure when standing.

Dosages

1

Adult 25-75 mg/d, increasing by 25-50 mg every 2-3 days to 75-150 mg/d, max 300 mg/d

2

Children ADHD > 5yrs, 10 mg BD as clinically indicated in increments of 0.5 mg/kg/d . Max 3 mg/kg/d

3

4

Nocturnal enuresis: 7-10 yrs, 10-20 mg 30-60 mins before to bed

> 10 years, 25-50 mg 30-60 mins before to bed

5 Ancillary Labels

Dose form

1

This medicine may cause drowsiness and may increase the effects of alcohol. If affected, do not dri

9

DO NOT STOP TAKING THIS MEDICINE ABRUPTLY unless otherwise advised by your docto

13

Do not remove from original packaging until dose required.

16

This medicine may cause dizziness especially when you stand up quickly. Ask your doctor or phar

Tablet

* Elderly: May respond more slowly. Consider a lower starting dose with a more gradual increase. Avoid using low dose TCAs for sedation as the risks (including falls) outweigh benefit, and sedative effect decreases with time. * Children: A meta-analysis concluded that TCAs were no better than placebo in treating depression in children. If used, obtain a baseline ECG and repeat if the dose approaches 2.5 mg/kg/day. * Cardiovascular: In second or third degree heart block, severe ischaemic heart disease or cardiac instability (eg after MI) adverse effects on conduction (proarrhythmic effects) and heart rate may be significant. *Hepatic impairment: half dose in severe impairment * Pregnancy: C, Breastfeeding: Use with caution * Renal impairment: Caustion. Minitor clinically. * Psychiatric: Overdose carries high risk of fatality; avoid prescribing high strengths (>50 mg) to people with suicidal ideation. * Urinary urge incontinence: strong and sudden need to urinate. *** Imipramine also can cause elevated pressure in the eyes of some patients with glaucoma

















































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S4 - PRESCRIPTION ONLY MEDICINE

FLUOXETINE selective serotonin reuptake inhibitor, antidepressant Indications

Major depression, Obsessive–compulsive disorder, Premenstrual dysphoric disorder, Bulimia nervosa, Panic disorder, Post-traumatic stress disorder

Adverse/ Side Effects

nausea, agitation, insomnia, drowsiness, tremor, dry mouth, diarrhoea, dizziness, headache, sweating, weakness, anxiety, weight gain or loss, sexual dysfunction, rhinitis, myalgia, rash

Dosages

1

Adult 20-80 mg/d. Doses over 20 mg tds, morning and noon

2

Children > 5 years 0.5-1 mg/kg/d as a single morning dose

3

4

5 Ancillary Labels

Dose form

5

Ask your doctor or pharmacist before using any other medicine including over-the-counter medicin

9

DO NOT STOP TAKING THIS MEDICINE ABRUPTLY unless otherwise advised by your docto

12

This medicine may affect mental alertness and/or coordination. If affected, do not drive a motor ve

Tablet, capsule, liquid

* Usually given as a morning dose to activating effects * Dispersible tablets can be used when difficulty swallowing * Full benefit may not be seen for several weeks but adverse effects may occur from start of treatment. * Elderly: Hyponatraemia (is an electrolyte disturbance (disturbance of the salts in the blood) in which the sodium (Natrium in Latin) concentration in the plasma is too low) may occur. * Breastfeeding: use not recommended. * Known Trade Names: Prozac, Lovan

















































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S4 - PRESCRIPTION ONLY MEDICINE

PHENYTOIN Antiepileptic Indications

Epilepsy (dong kinh), including simple partial and complex seizures (meaning sudden attack of illness, especially the brain), and generalised tonic-clonic seizures, Status epilepticus (IV)

Adverse/ Side Effects

dizziness, drowsiness, difficulty focusing (vision), unsteady gate, tiredness, abnormal involuntary movements, nausea, vomiting, constipation, abdominal pain, and loss of appetite

Dosages

1

Adult, ORAL Initially 300 mg/d, increase to 500 mg/d in small dosage increments

2

Adult, IV 15-20 mg/kg when needs and response of patient

3

Children, ORAL 5–8 mg/kg daily in 1 or 2 divided doses.

4

Children IV (Status Epilepticus) 15–20 mg/kg over 20–30 minutes with cardiac monitoring, then 5–10 mg/kg/d in 2–3 divided doses.

5 Ancillary Labels

Dose form

5

Ask your doctor or pharmacist before using any other medicine including over-the-counter medicin

9

DO NOT STOP TAKING THIS MEDICINE ABRUPTLY unless otherwise advised by your docto

13

Do not remove from original packaging until dose required.

Tablet, oral liquid, capsule, injection

* Common Trade Name: DILANTIN Infatabs 50 mg tabs x 200 (chewable) or Dilantin 30 mg Cap x 200 * 100 mg Sodium phenytoin contains 92 mg Phenytoin

















































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S4 - PRESCRIPTION ONLY MEDICINE

WARFARIN Anticoagulant Indications

Prevention and treatment of venous thromboembolism (deep venous thrombosis and, pulmonary embolism), Prevention of thromboembolism in patients with prosthetic heart valves, Primary prevention of stroke in patients with atrial fibrillation associated with mitral, valvulopathy or other risk factors, Secondary prevention of stroke in patients with atrial fibrillation, Prevention of thromboembolism before and after cardioversion, Prevention of stroke in patients with previous myocardial infarction and increased embolic risk

Adverse/ Side Effects

bleeding

Dosages

Adult, ORAL 5 mg/d for 2 days. Maintainance: 1-10 mg/d, taken same time each day

1

2

3

4

5 Ancillary Labels

5

Ask your doctor or pharmacist before using any other medicine including over-the-counter medicin

10b DO NOT TAKE ASPIRIN while being treated with this medicine unless advised by your doctor.

Dose form

Tablet

* Target INR 3.0–4.5 for older model mechanical heart valves. 2.5–3.5 for newer model, less thrombogenic mechanical heart valves. 2.0–3.0 for all other indications. * Aspirin, NSAIDs including COX-2 inhibitors, antiplatelet drugs—increased risk of bleeding due to antiplatelet effect or other unknown mechanism; avoid concurrent use (except in selected patients at high risk for thromboembolism).

















































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S2 - PHARMACY MEDICINE S4 - PRESCRIPTION ONLY MEDICINE

ASPIRIN Analgesic, anti-inflammatory, antiplatelet, antipyretic Indications

Relief of mild to moderate pain such as headache, dysmenorrhoea, myalgias and dental pain -Fever (>18 years of age) -Symptomatic relief of painful tumour metastases in bone -Migraine and tension headache Rheumatoid arthritis, including juvenile rheumatoid arthritis -Osteoarthritis -Rheumatic disorders, including acute rheumatic fever

Adverse/ Side Effects

nausea, dyspepsia, vomiting, GI ulceration or bleeding, asymptomatic blood loss, increased bleeding time, headache, dizziness, tinnitus (common with high doses)

Dosages

Adult, ORAL 1-2 tabs / q4h - q6h prn. Max 8 tabs/d

1

2

(tab, 300 mg (dispersible, white), 96, Solprin (RC), PBS/DPBS)

3

4

5 Ancillary Labels

Dose form

13

Do not remove from original packaging until dose required.

A

SWALLOW WHOLE. Do not chew.

B

TAKE WITH OR SOON AFTER FOOD.

TABLET, RECTAL, SUPPOSITORY

Q: What happens to aspirin is it is exposed to moisture? A: Degrade rapidly in air and water Q: What is the aqueous solubility of aspirin? A: Slightly soluble in water; feely soluble in alcohol; soluble in ether Q: Name two conditions which may be able to be prevented with aspirin. A: -Inhibition of platelet aggregation and Prevent bowel cancer by reducing the number of polyps in the large bowel / Taking doses AFTER FOOD / FORENSICS Cardiprin® tablets are used for the prevention of stroke and other cardiovascular disease. Can they be obtained without a prescription? S2 *the availability of the drug and need for a prescription depends on the other drugs combined with aspirin, if any, and their strength

















































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S4 - PRESCRIPTION ONLY MEDICINE

IRBESARTAN Angiotensin II receptor antagonist Indications

Hypertension, Reduction of renal disease progression in patients with type 2 diabetes, hypertension and microalbuminuria (>30 mg/24 hours) or proteinuria (900 mg/24 hours) Note: Proteinuria= the presence in the urine of abnormally large quantities of protein normally albumin

Adverse/ Side Effects

dizziness, headache, hyperkalaemia

Dosages

Adult, ORAL 75-300 mg/d

1

2

3

4

5 Ancillary Labels

11

DO NOT TAKE POTASSIUM while being treated with this medicine unless advised by your doct

12

This medicine may affect mental alertness and/or coordination. If affected, do not drive a motor ve

16

This medicine may cause dizziness especially when you stand up quickly. Ask your doctor or phar

Dose form

* Renail impairment: Reduce dose * Brand Name: Avapro, Karvea

















































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S4 - PRESCRIPTION ONLY MEDICINE

GLIBENCLAMIDE Sulfonylurea antidiabetic agent Indications

Type 2 diabetes : Increase pancreatic insulin secretion; may decrease insulin resistance.

Adverse/ Side Effects

gastrointestinal disturbances – Nausea, vomiting, epigastric fullness or sensation pressure, anorexia, heartburn, dyspepsia - skin problems, especially those related to light exposure –

Dosages

Adult, ORAL 2.5 – 20 mg / day

1

2

3

4

5 Ancillary Labels

Dose form

10a

Do not take more than one aspirin tablet or capsule each day while being treated with this medicine

b

TAKE WITH OR SOON AFTER FOOD.

oral

* GLIBENCLAMIDE ( Glee-ben-clam-ide) * Glibenclamide is interacting with the folllowing drugs - H2 antagonists (eg cimetidine, ranitidine), sulfonamide antibiotics, ketoconazole, miconazole, MAOIs—may increase hypoglycaemic effect - Cyclosporin—may increase plasma cyclosporin concentration and toxicity and possibly increase hypoglycaemic effect of sulfonylurea - Drugs which may increase blood glucose concentration: danazol, glucocorticoids, thiazide diuretics (high doses), oral contraceptives (high doses), phenothiazines (chlorpromazine), beta2 agonists (IV salbutamol, terbutaline), nicotinic acid, pentamidine, somatropin, atypical antipsychotics (olanzapine, clozapine, quetiapine)

















































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S4 - PRESCRIPTION ONLY MEDICINE

ALLOPURINOL xanthine oxidase inhibitor Indications

Gout – a disease associated with an inborn error if uric acid metabolism that increases production or interferes with excretion of uric acid. Excess uric acid is converted to sodium urate crystals that precipitate form blood and become deposited in joints and other tissues.

Adverse/ Side Effects

Maculopapular or itchy rash

Dosages

1

Adult ORAL 100-300 mg/d. Max 900 mg/d (in divided doses) are used for short periods

2

Children, ORAL 10-20 mg/kg/d in 1-2 divided doses, max 600 mg/d

3

4

5 Ancillary Labels

Dose form

12

This medicine may affect mental alertness and/or coordination. If affected, do not drive a motor ve

b

TAKE WITH OR SOON AFTER FOOD.

oral

* ALLOPURINOL ( Aloe-pure-in-ol) 100–300 mg daily, although doses of up to 900 mg daily (in divided doses) are sometimes used for short time periods * Hepatic impairment: Dosage adjustment necessary. * Renal impairment: Dosage adjustment necessary. * Pregnancy: B2. Use not recommended. Consider symptomatic treatment.

















































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S4 - PRESCRIPTION ONLY MEDICINE

PROPRANOLOL Non-selective Beta blockers Indications

Hypertension, Angina, Tachyarrhythmias, Control of symptoms (tachycardia, tremor) in anxiety and hyperthyroidism, Fallot's tetralogy, Myocardial infarction, Prevention of migraine, Essential tremor, Phaeochromocytoma (with concurrent alpha-blocker)

Adverse/ Side Effects

nausea, diarrhoea, bronchospasm, dyspnoea, cold extremities, exacerbation of Raynaud's syndrome, *bradycardia*, hypotension, postural hypotension (labetalol), heart failure, heart block, fatigue, dizziness, abnormal vision, decreased concentration, hallucinations, insomnia, nightmares, depression, alteration of glucose and lipid metabolism, oedema (carvedilol), Cardiac failure and nightmares

Dosages

1

Adult 20–160 mg/d in divided doses, can increase to 320 mg/day in divided doses.

2

Children, Migraine prophylaxis initial dose, 10 mg daily increasing to 2 mg/kg daily in 2–3 divided doses.

3

4

5 Ancillary Labels

Dose form

9

DO NOT STOP TAKING THIS MEDICINE ABRUPTLY unless otherwise advised by your docto

12

This medicine may affect mental alertness and/or coordination. If affected, do not drive a motor ve

Tablet, IV

* PROPRANOLOL (Pro-pran-o-loll) *Q: Is it advisable for someone who has asthma to take propranolol? Explain. *A: No ---- beta-adrenergic blockade of the smooth muscle of bronchi and bronchioles results in an increased airways resistance

















































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S4 - PRESCRIPTION ONLY MEDICINE

TIMOLOL

Beta-blockers, ophthalmic*** (non-cardioselective beta blocker) Indications

- Glaucoma -- Reduce aqueous humour formation, probably by blockade of the beta receptors on the ciliary epithelium. - Hypertension, Angina Pectoris, Myocardial Infarction, Migraine

Adverse/ Side Effects

stinging on instillation (especially betaxolol solution), bradycardia. Asthma sufferer adverse effects: bronchospasm

Dosages

1

Conventional drops 1 drop of 0.25% once or bds. Max, 1 drop of 0.5% bds

2

Timoptol-XE® 1 drop of 0.25% /d, increase to 1 drop of 0.5% /d if necessary.

3

Gel 0.1%, 1 drop once daily.

4

Infant <12 months 1 drop of 0.25% (of either formulation) once daily.

5

Combination with brimonidine or dorzolamide 1 drop bds

Ancillary Labels

Dose form

9

DO NOT STOP TAKING THIS MEDICINE ABRUPTLY unless otherwise advised by your docto

12

This medicine may affect mental alertness and/or coordination. If affected, do not drive a motor ve

Eye drops, capsules

* non-cardioselective beta blocker: Lack intrinsic sympathomimetic and membrane-stabilising activity * q: Systemic absorption can occur following the use of beta blockers such as timolol in the eye – explain how this can occur. (AMH) * a: Reduces intraocular pressure -- Adding topical beta-blocker when taking a systemic betablocker offers some additional pressure eduction but may increase systemic adverse effects.

















































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CLOTRIMAZOLE Drugs for fungal and yeast infections --- Topical imidazoles Indications

Dermatophytoses, Mucocutaneous candidiasis, including paronychia, Pityriasis versicolor, Seborrhoeic dermatitis, Vaginal candidiasis (see Vaginal candidiasis)

Adverse/ Side Effects

When 1 % bifonazole cream was applied topicaly on a 200 cm2 surface area for 6 hours under, occlusive dressing, between 2% and 4% of the applied dose was absorbed from inflamed skin. And about 1% of the dose was absorbed from healthy intact skin.

Dosages

Ref: AMH Apply a thin layer 2–3 times a day.

1

2

3

4

5 Ancillary Labels

E

Dose form

Cream, liquid

CONTINUE FOR 14 DAYS AFTER SYMPTOMS CEASE

Dermatophytoses, Mucocutaneous candidiasis, including paronychia, Pityriasis versicolor, Seborrhoeic dermatitis, Vaginal candidiasis (see Vaginal candidiasis) Which schedule(s) of the Standard for the Uniform Scheduling of Drugs and Poisons apply to the following clotrimazole preparations? - Clotrimazole 1% skin cream – S2 - Clotrimazole 100 mg vaginal pessaries – S2 - Clotrimazole 2% vaginal cream – S2 Apply a thin layer to the affected skin and surrounding area; pay particular attention to skin folds. For this treatment to be successful you have to use it regularly. Continue using the treatment for 2 weeks after symptoms have gone.

















































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S4 - PRESCRIPTION ONLY MEDICINE

FLUCONAZOLE triazole antifungal agent Indications

Acute or recurrent mucocutaneous candidiasis, Vulvovaginal candidiasis where topical therapy has faile, Candidiasis due to usceptible strains of Candida (not C. krusei or C. glabrata), Treatment and prevention of cryptococcal meningitis if amphotericin is not tolerated, or after initial treatment with amphotericin, Cryptococcosis, Coccidioidomycosis, Histoplasmosis, Primary and secondary prevention of candidal infection in immunocompromised people, Tinea corporis, cruris or pedis resistant to topical therapy, Onychomycosis (if alternatives have failed or are not tolerated)

Adverse/ Side Effects

anorexia, fatigue

Dosages

ADULT Oropharyngeal/Oesophageal: 50 - 200 mg/d , up to 400 mg in HIV patient

1

2

3

4

Onchomycosis: 150–300 mg weekly for 3–12 months. CHILDREN Superficial and oral candidiasis: Oral, 6 mg/kg (max 200 mg) on day one, then 3 mg/kg/d

Systemic infections: IV/oral, 12 mg/kg (max 400 mg) on day one, then 6 mg/kg/d

5 Ancillary Labels

Dose form

5

Ask your doctor or pharmacist before using any other medicine including over-the-counter medicin

D

Add the words 'until all used'.

Oral, IV

* Renal: Reduce dose in renal impairment. * Pregnancy: Repeated high dose contraindicated; although single 150 mg dose appears safe, consider alternative treatment; ADEC category D. * Tell your doctor if you feel unusually tired, nauseous or are not eating, or if you notice dark urine, pale faeces or yellowing of the hites of your eyes or skin.

















































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ONDANSETRON 5HT3 antagonist antiemetic Indications

Nausea and vomiting: * associated with cancer chemotherapy

* postoperative

* radiotherapy-induced

Adverse/ Side Effects

constipation, headache, transient rise in hepatic transaminases

Dosages

1

ADULT Oral, IV, rectal, 4–16 mg; maximum 32 mg/24 hours.

2

CHILD, Post-operative nausea and vomiting > 2 yrs IV, 0.1 mg/kg/dose (up to 4 mg).

3

CHILD, Cancer chemotherapy > 1 yr IV, 5 mg/m2 (maximum 8 mg) every 8–12 hours or oral 4 mg every 8–12 hours.

4

5 Ancillary Labels

Dose form

* Confirm that no other medicine has been lost due to vomiting. * Hepatic impairment (moderate–severe): Caution. Maximum daily dose 8 mg. * Breastfeeding: Use not recommended * more effective for acute than delayed symptoms of cancer chemotherapy-induced nausea and vomiting * Give IV doses of 8 mg or less over at least 5 minutes and doses >8 mg over at least 15 minutes. There have been reports of transient adverse effects with more rapid administration. May be given IM if dose volume is suitable.

















































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OXYMETAZOLINE Nasal sympathomimetic decongestants Indications

Relief of nasal congestion associated with acute and chronic rhinitis, common cold, sinusitis Facilitate intranasal examination

Adverse/ Side Effects

Common: Transient burning, stinging, increased nasal discharge, rebound congestion with prolonged use (4– 5 days) Rare: hypertension, nausea, nervousness, dizziness, drowsiness, insomnia, headache

Dosages

1

Adult, child >5 years Nasal spray/drop 0.05%, 1–2 sprays/drops into each nostril up to 3 times daily.

2

Child 2–5 years Nasal drop 0.025%, 1–2 drops into each nostril up to 3 times daily.

3

4

5 Ancillary Labels

NIL

Dose form

Nasal drop, nasal spray

* Rebound congestion: swelling and congestion of the nasal mucosa that follows the vasodilator effects of decongestant medications /Q: How would you advise patients to minimize the risk of rebound nasal congestion when using a topical nasal decongestant such as oxymetazoline? /A: Keep dose and length of treatment to a minimum (maximum duration of treatment 5 days) to reduce risk of rebound congestion (may take several weeks to reverse)

















































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S3 - PHARMACIST ONLY MEDICINE

DEXCHLORPHENIRAMINE sedating antihistamine Indications

*Allergic upper respiratory conditions, eg rhinitis, Allergic skin conditions, eg urticaria, contact dermatitis, Pruritus (including insect bites)

Adverse/ Side Effects

sedation, dizziness, tinnitus, blurred vision, euphoria, incoordination, anxiety, insomnia, tremor, nausea, vomiting, constipation, diarrhoea, epigastric discomfort, dry mouth, cough

Dosages

1

ADULT, Controlled Release 6 mg BD (label A)

2

ADULT, Conventiional Tab 2 mg QID

3

CHILDREN, 6 - 12 years old 1 mg QID

4

CHILDREN, 2 - 6 years old 0.04 mg/kg/dose TDS

5 Ancillary Labels

Dose form

1

This medicine may cause drowsiness and may increase the effects of alcohol. If affected, do not dri

13

Do not remove from original packaging until dose required.

A

SWALLOW WHOLE. Do not chew.

Tablet, Oral Liquid

/Q: Does dexchlorpheniramine commonly produce sedation/ CNS depression? /A: Yes ( sedation, dizziness, tinnitus, blurred vision, euphoria, incoordination, anxiety, insomnia, tremor, nausea, vomiting, constipation, diarrhoea, epigastric discomfort, dry mouth, cough) * Counselling: This medication may make you sleepy; don’t drive or operate machinery if this happens. Avoid alcohol and other medication which may cause sedation.

















































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S2 - PHARMACY MEDICINE

FEXOFENADINE less-sedating antihistamine Indications

Allergic rhinitis and conjunctivitis Chronic urticaria

Adverse/ Side Effects

drowsiness, fatigue, headache, nausea, dry mouth

Dosages

1

ADULT, Rhinitis 120 mg daily in 1–2 doses or 180 mg once daily.

2

ADULT, Urticaria 180 mg once daily.

3

CHILD, 6–11 years 30 mg twice daily.

4

5 Ancillary Labels

nil

Dose form

* This medication makes some people sleepy; don’t drive or operate machinery if this occurs. * FEXOFENADINE (Fex-o-fen-a-deen) * Chronic urticaria, symptom relief (a pruritic skin eruption characterized by transient wheals of varying shapes and sizes with well-defined erythmatous margins and pale centers— caused by capillary dilation in the dermis that results from the release of vasoactive mediators, including histamine * Renal impairment: Reduce dose

















































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S4 - PRESCRIPTION ONLY MEDICINE

DOXYCYCLINE Tetracycline antibacterial Indications

Acne, Infections caused by M. pneumonia, Community-acquired pneumonia, Exacerbation of chronic bronchitis, Acute bacterial sinusitis, Chlamydial (including lymphogranuloma venereum) and other nongonococcal genital tract infections,PID, Rickettsial infections, Melioidosis (with other agents), Sexually acquired epididymo-orchitis (with ceftriaxone), Chronic prostatitis, Prophylaxis of malaria in areas of widespread mefloquine or chloroquine resistance, or in people in whom mefloquine is not tolerated, Treatment of P. falciparum malaria with quinine

Adverse/ Side Effects

nausea, vomiting, diarrhoea, epigastric burning; tooth discolouration, enamel dysplasia, reduced bone growth (in children <8 years); photosensitivity (depends on tetracycline, dose and degree of sun exposure)

Dosages

1

ADULT, Acute Infection 200 mg as a first dose, thereafter 100 mg daily

2

ADULT, Severe infections 100 mg 12 hourly.

3

ADULT, Acne and bronchiectasis 50–100 mg daily,

4

ADULT, Malaria prophylaxis 100 mg daily, beginning 2 days before and continued for 4 weeks after exposure

5

CHILDREN, Malaria prophylaxis 2 mg/kg up to 100 mg daily, beginning 2 days before and continued for 4 weeks after exposure.

Ancillary Labels

Dose form

4

Do not take dairy products, antacids, iron or calcium supplements within two hours of each dose of

8

Avoid excessive skin exposure to sunlight and sunlamps while being treated with this medicine.

B

TAKE WITH OR SOON AFTER FOOD.

D

Add the words 'until all used'.

Tablets and capsules

* DOXYCYCLINE (Dox-e-sigh-klin) * Renal: Tetracycline and demeclocycline are not recommended in renal impairment; doxycycline and minocycline can be used without dose adjustment. * Hepatic: Hepatotoxicity more likely to occur in hepatic impairment; avoid high doses. * Treatment with hepatotoxic drugs may increase risk of hepatotoxicity. * Children: Contraindicated in children <8 years as tetracyclines discolour teeth and cause enamel dysplasia which increases the risk of dental caries. They are also deposited in bone, causing deformities and inhibiting bone growth. * Pregnancy: Safe if used during the first 18 weeks of pregnancy (16 weeks post-conception); after this they are contraindicated as they may discolour the baby’s teeth; ADEC category D. * Breastfeeding: Courses of 7–10 days are considered safe.

















































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S4 - PRESCRIPTION ONLY MEDICINE

ROXITHROMYCIN Macrolide antibacterial Indications

Upper and lower respiratory tract infections Community-acquired pneumonia Recurrent tonsillitis Skin infections

Adverse/ Side Effects

nausea, vomiting, diarrhoea, abdominal pain and cramps, headache, dyspnoea, cough, candidal infections

Dosages

1

ADULT 150 mg BID, or 300 mg/d. Max 300 mg/d

2

CHILDREN 2.5–4 mg/kg BID

3

Severe hepatic impairment, ADULT 150 mg/d

4

5 Ancillary Labels

Dose form

3B

Take on an EMPTY STOMACH at least half an hour before food or two hours after food.

D

Add the words 'until all used'.

Tablet

* ROXITHROMYCIN (Rox-ith-ro-my-sin) * Severe hepatic impairment: Reduce dose to 150 mg/d * Roxithromycin is absorbed best if you take it at least 15 minutes before a meal. If it makes you feel sick then you can take it with food.

















































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S2 - PHARMACY MEDICINE

NICOTINE <no drug class is found> Indications

Nicotine dependence, aid to stopping smoking

Adverse/ Side Effects

dizziness, headache, nausea, vomiting, hiccups, indigestion, abdominal pain, myalgia, cough (inhaler), vivid dreams (especially 24-hour patch)

Dosages

GUM, High nicotine dependence usually 6–10 pieces of 4 mg gum/d. Avoid >1 piece/hour After 4–8 wks reduce to 2 mg, then stop or taper use over a further 4 wks to zero.

1

2

3

4

5

GUM, Moderate nicotine dependence usually 8–12 pieces of 2 mg gum daily. INHALER, 6–12 cartridges inhaled /d, according to craving or withdrawal symptoms, for 8 wks. Then gradually reduce use over next 4 wks to zero. PATCH, Moderate-to-high nicotine dependence apply 1 patch daily of either 21 mg/24 hours or 15 mg/16 hours. Stop (abruptly or by reducing strength of patches) within 12 weeks.

Ancillary Labels

nil

Dose form

Gum, Inhaler, Lozenge, Patch, Sublingual Tablet

/Q: How do you used the commercially available pharmaceuticals which contains nicotine? What advice would you give to patients? /A: - continue smoking while using Nicabate, may experience increased adverse effects - use of Nicabate beyond 3 months by patients who stop smoking should be discouraged, because the chronic consumption of nicotine by any route can be harmful and addicting

















































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S4 - PRESCRIPTION ONLY MEDICINE

BETAMETHASONE corticosteroid Indications

Inflammatory skin conditions Combination with calcipotriol: Psoriasis vulgaris, chronic stable plaque type

Adverse/ Side Effects

folliculitis, steroid rosacea, perioral dermatitis, skin atrophy, delayed wound healing, striae, purpura, depigmentation, telangiectasia, acneiform eruptions

Dosages

1

ADULT IM, 5.7–11.4 mg.

2

CHILDREN IM, <1 year: 1 mg; 1–5 years: 2 mg; 6–12 years: 4 mg.

3

* Note: Monitor development and growth carefully in children on long-term therapy.

4

5 Ancillary Labels

nil

Dose form

Creams/ Ointments/ Lotion

* BETAMETHASONE (Beta-meth-a-sone) /Q: In Australia, betamethasone is usually used for treatment of skin conditions. List some of the skin conditions which can be treated with topical betamethasone. /A: Rosacea = a chronic inflammatory disease – has two components – erythema (redness) and acneiform papules and pustules Acne vulgaris = acne Allergy to corticosteroids or preservatives in vehicle Ulcerative conditions and/or impaired circulation Uncontrolled infection in area to be treated /Q: Can topically applied corticosteroids such as betamethasone be absorbed in sufficient amounts to produce systemic effects (i.e. effects on the whole body)? /A: Yes – systemic circulation will increase if extensive body surface areas are treated * Changes to Faeces: Pink, red, black faeces may indicate medicine-induced gastrointestinal bleeding. * Trade names: Eleuphrat, prosone

















































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S4 - PRESCRIPTION ONLY MEDICINE

PREDNISOLONE Corticosteroids Indications

••• Where corticosteroids are indicated, eg acute asthma, autoimmune or inflammatory disease, acute transplant rejection, acute gout and croup ••• Autoimmune diseases to suppress an overactive immune system. ••• According to specialist protocol, eg for multiple myeloma, lymphoma, some leukaemias

Adverse/ Side Effects

Nausea (feeling sick), Oedema (swelling), High blood pressure, Abdominal pain, Headache, Dizziness, Muscle weakness, Vomiting, Increased appetite, Blurred vision, Skin rashes

Dosages

1

ADULT, Autoimmune or Inflammatory Disease Initially 5-60 mg/d. Maintenance: 2.5-15 mg/d

2

ADULT, Acute asthma, oral 40-50 mg/d for at least FIVE days.

3

ADULT, Rheumatoid arthritis 5–10 mg/d

4

CHILDREN, Autoimmune or inflammatory disease initially 1–2 mg/kg/d (max 60 mg), reduce dose ip appropriate.

5

CHILDREN, Acute asthma 1–2 mg/kg (maximum 40 mg) once daily for 3–5 days.

Ancillary Labels

Dose form

9

DO NOT STOP TAKING THIS MEDICINE ABRUPTLY unless otherwise advised by your docto

B

TAKE WITH OR SOON AFTER FOOD.

ORAL (tablet & liquid)

••• This medication may affect your mood, eg you may feel more happy or sad than usual. It may also cause problems with sleeping; talk to your doctor if you have any concerns. ••• Tell all doctors, surgeons and dentists treating you that you are taking corticosteroids (or have taken them in the past) because if you become ill or are going to have surgery your dose of medicine may need to be increased. ••• Consider wearing a Medic Alert® bracelet and carrying a card with the details of your treatment. ••• Take in the morning if a once-daily dosing is ordered. ••• May cause reduced wound healing. ••• The general recommended doses are (SOLONE 5 mg, 25 mg) Adult: 10mg to 100mg daily in divided doses Children: 1-5 years: 2.5mg to 10mg twice a day Children: 6-12 years: 5mg to 20mg twice a day

















































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S4 - PRESCRIPTION ONLY MEDICINE

PREDNISONE Corticosteroids Indications

* Prednisone/Prednisolone * Where corticosteroids are indicated, eg acute asthma, autoimmune or inflammatory disease, acute transplant rejection, acute gout and croup * Autoimmune diseases to suppress an overactive immune system. * According to specialist protocol, eg for multiple myeloma, lymphoma, some leukaemias

Adverse/ Side Effects

Nausea (feeling sick), Oedema (swelling), High blood pressure, Abdominal pain, Headache, Dizziness, Muscle weakness, Vomiting, Increased appetite, Blurred vision, Skin rashes

Dosages

ADULT 5-60 mg/d

1

2

3

4

5 Ancillary Labels

Dose form

9

DO NOT STOP TAKING THIS MEDICINE ABRUPTLY unless otherwise advised by your docto

B

TAKE WITH OR SOON AFTER FOOD.

Tablet (ORAL)

••• This medication may affect your mood, eg you may feel more happy or sad than usual. It may also cause problems with sleeping; talk to your doctor if you have any concerns. ••• Tell all doctors, surgeons and dentists treating you that you are taking corticosteroids (or have taken them in the past) because if you become ill or are going to have surgery your dose of medicine may need to be increased. ••• Consider wearing a Medic Alert® bracelet and carrying a card with the details of your treatment. ••• Take in the morning if a once-daily dosing is ordered. ••• May cause reduced wound healing. ••• The general recommended doses are (SOLONE 5 mg, 25 mg) Adult: 10mg to 100mg daily in divided doses Children: 1-5 years: 2.5mg to 10mg twice a day Children: 6-12 years: 5mg to 20mg twice a day

















































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S4 - PRESCRIPTION ONLY MEDICINE

CIPROFLOXACIN Quinolone Antibacterial Indications

Severe Salmonella enteritis, Typhoid, paratyphoid (enteric fever), Shigellosis, Complicated UTIs, Bone or joint infections, Epididymo-orchitis, Meningococcal prophylaxis, P. aeruginosa infections, eg in cystic fibrosis, Prostatitis, Febrile neutropenia (follow-up treatment in low risk patients, with amoxycillin with clavulanic acid), Keratitis or severe bacterial conjunctivitis, Chronic suppurative otitis media.

Adverse/ Side Effects

nausea, vomiting, diarrhea, abdominal pain, rash, headache, and restlessness

Dosages

1

ADULT, Uncomplicated urinary tract infection 250 mg 12-hourly.

2

ADULT, Complicated urinary tract infection 500 mg 12-hourly.

3

ADULT, Respiratory, skin, gastrointestinal and more complicated infections 500–750 mg 12-hourly

4

CHILDREN 5–10 mg/kg 12-hourly.

5

CHILDREN, Cystic fibrosis 15 mg/kg (max 750 mg) 12-hourly.

Ancillary Labels

Dose form

D

Add the words 'until all used'.

3B

Take on an EMPTY STOMACH at least half an hour before food or two hours after food.

4

Do not take dairy products, antacids, iron or calcium supplements within two hours of each dose of

8 12

Avoid excessive skin exposure to sunlight and sunlamps while being treated with this medicine. This medicine may affect mental alertness and/or coordination. If affected, do not drive a motor ve

tablet, oral suspension

* Ciprofloxacin stops the multiplication of bacteria by inhibiting the reproduction and repair of their genetic material (DNA) * Brand Name: Cipro, Cipro XR, Proquin XR * Serious allergic reaction to quinolones, including nalidixic acid (Negram®, a discontinued quinolone) —contraindicated. * History of corticosteroid use—increases risk of tendon damage. * Kidney, heart or lung transplant—increases risk of tendon damage. * Athletes in training—at increased risk of tendon damage. * Pregnancy: Quinolones best avoided due to potential for fetal arthropathy; ADEC category B3. * Breastfeeding: Use alternatives when possible; short courses are acceptable (may cause loose bowel actions in the baby). * Ciprofloxacin is absorbed best if you take it 1 hour before, or 2 hours after, meals; drink plenty of fluids while taking it. * Dairy products, antacids, iron, zinc or calcium supplements may reduce the absorption of ciprofloxacin; do not take them within 2 hours of a ciprofloxacin dose. * It may increase the effects of caffeine in some people; you may need to reduce your caffeine intake. * Avoid sun exposure, wear protective clothing and use sunscreen.

















































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S4 - PRESCRIPTION ONLY MEDICINE

ABACAVIR Nucleoside reverse transcriptase inhibitor Indications

* HIV infection, with other antiretrovirals * Combination with lamivudine: HIV infection, with other antiretrovirals * Combination with lamivudine and zidovudine: HIV infection

Adverse/ Side Effects

headache, nausea, vomiting, anorexia, myalgia, peripheral lipoatrophy, asymptomatic hyperlactataemia, HYPERSENSITIVITY (usually in first 6 weeks. Symptoms include fever, GI symptoms (nausea, vomiting, diarrhoea, abdominal pain), rash, lethargy, malaise, myalgia, arthralgia, respiratory symptoms in about 20% (dyspnoea, sore throat, cough, abnormal chest x-ray), rarely adult respiratory distress syndrome and respiratory failure)

Dosages

1

ADULT 300 mg BID or 600 mg QD (QD = once daily, BID = twice daily)

2

CHILDREN, 3 months - 12 years old 8 mg/kg TWICE daily. Maximum 600 mg daily.

3

4

5 Ancillary Labels

12

This medicine may affect mental alertness and/or coordination. If affected, do not drive a motor ve

Dose form

* IF HYPERSENSITIVITY OCCURS, STOP USING IMMEDIATELY, DO NOT CHALLENGE. * MODE OF ACTION: NRTIs are converted by cellular enzymes to active phosphorylated metabolites that inhibit viral reverse transcriptase and viral DNA synthesis, preventing HIV replication. The specific site of action differs for each drug; these differences are exploited in combination regimens. * Report fever, nausea, vomiting, diarrhoea, rash, tiredness, difficulty in breathing, sore throat or cough. * Should be taken in combination with other antiretrovirals. * Sometimes this medicine can cause lactic acid to build up in your body and cause symptoms. Tell your doctor immediately if you have nausea, vomiting, stomach pain, fatigue or weakness. * Patients with liver disease should be cautious about using abacavir because of the possibility that it can aggravate the condition.

















































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S4 - PRESCRIPTION ONLY MEDICINE

ISOTRETINOIN oral retinoid Indications

* Cystic acne, severe (isotretinoin) * Psoriasis, severe (acitretin) * Keratinisation disorders, severe forms (acitretin) * Brand name: Oratane capsules

Adverse/ Side Effects

Mild acne flare

Dosages

ADULT, CHILD > 12 YRS 0.5–1 mg/kg daily in 1–2 doses. Maximum accumulated dose is 120–150 mg/kg over 4–6 months.

1

2

3

4

5 Ancillary Labels

D

Add the words 'until all used'.

B

TAKE WITH OR SOON AFTER FOOD.

8

Avoid excessive skin exposure to sunlight and sunlamps while being treated with this medicine.

Dose form

* A mild flare of acne commonly occurs after 2–4 weeks of treatment, but improves after 1–2 months of continued treatment; severe flares occur infrequently and require dermatologist review * Avoid using topical anti-acne preparations as local irritation may increase * Most patients remain disease-free after a single course or have long remissions; approximately 10–20% of patients relapse; repeat courses of isotretinoin are recommended if recurrence is severe * Allow at least 2 months after completing a course to see whether further treatment is necessary, as improvement may continue for several months after stopping * Do not donate blood during treatment and for 8 weeks after stopping treatment. * Female patients, it is important that you use adequate contraception before, during and for 1 month after, treatment, because birth defects can occur during this time. * This medicine is absorbed best if taken with food. * This medicine often causes dry lips, mouth and eyes. Use white soft paraffin, eg Vaseline®, to treat dry lips; * Avoid waxing and dermabrasion during, and for 6 months after stopping, treatment as they could cause scarring or irritation of your skin. * Protect skin from sunlight with protective clothing or a broad spectrum sunscreen (preferably 30+, containing a physical barrier, eg titanium dioxide or zinc oxide). Avoid sunlamps and tanning beds. * Avoid waxing and dermabrasion during, and for 6 months after stopping, treatment as they could cause scarring or irritation of your skin.

















































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S4 - PRESCRIPTION ONLY MEDICINE

PHENOBARBITONE barbiturate, antiepileptic Indications

* Epilepsy, including simple and complex partial seizures, generalised tonic-clonic seizures, neonatal and febrile seizures * Status epilepticus unresponsive to benzodiazepines and phenytoin (phenobarbitone)

Adverse/ Side Effects

sedation, confusion, depression, cognitive impairment, altered mood and behaviour, paradoxical insomnia, hyperactivity and aggression (particularly in children), rash IV, hypotension, respiratory depression

Dosages

••••••EPILEPSY•••••• Adult, oral 60–240 mg once daily at bedtime.

1

2

3

4

5 Ancillary Labels

Child, initially, oral 3–4 mg/kg/d; up to 8 mg/kg/d is required to achieve therapeutic plasma [conc] ••••••STATUS EPILEPTICUS•••••• Give at rate <30 mg/minute; may be repeated after 6 hours if necessary.

Adult, IV, 10–20 mg/kg.

Child, IV, 15–20 mg/kg. 1

This medicine may cause drowsiness and may increase the effects of alcohol. If affected, do not dri

5

Ask your doctor or pharmacist before using any other medicine including over-the-counter medicin

9

DO NOT STOP TAKING THIS MEDICINE ABRUPTLY unless otherwise advised by your docto

Dose form

* MODE OF ACTION: Prolong inhibitory postsynaptic potential by increasing the mean chloride channel opening time and hence the duration of GABA-induced cell membrane hyperpolarisation. * This medicine may cause drowsiness and affect your ability to drive or operate machinery; avoid these activities until you know how it affects you. * Avoid taking alcohol as it may worsen the side effects of phenobarbitone/primidone. * This medicine interacts with many other drugs; ask your doctor or pharmacist before using any other medicine including herbal and over-the-counter products. * Do not stop taking this medicine suddenly unless your doctor tells you to. * steady-state plasma concentration may not be achieved for 2–4 weeks * tolerance to sedation develops with continued administration * consider BMD monitoring, and vitamin D and calcium supplements to prevent osteomalacia and osteoporosis, in patients on long term treatment, particularly those at higher risk, eg elderly patients

















































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S4 - PRESCRIPTION ONLY MEDICINE

ZANAMIVIR Neuraminidase inhibitors Indications

Treatment and prevention of influenza A and B (e.g. Swine flu) * Influenza A, the seasonal flu, is the common infection which usually outbreaks in the winter months * Influenza B has a more complicated presence than Influenza A

Adverse/ Side Effects

bronchospasm or worsening respiratory function may occur.

Dosages

1

Adult, child 5 years and over, oral inhalation 10 mg (2 inhalations) BID 5/7

2

Prevention of influenza, Adult, child 5 years and over, oral inhalation 10 mg (2 inhalations) QD for 10 days. This may be extended up to 28 days if necessary.

3

4

5 Ancillary Labels

D

Dose form

Dry Power Inhaler (DPI)

Add the words 'until all used'.

* MOA: Reduce influenza virus replication by inhibiting the viral surface enzyme neuraminidase, preventing release of new virus from cells. * Start treatment as early as possible after symptoms occur, but not >48 hours after onset of initial symptoms of infection. * Treatment, this medicine is intended to shorten the time you have symptoms, such as fever, headache, sore muscles, cough and sore throat. * Otherwise healthy people should treat uncomplicated influenza by resting, drinking plenty of fluids and using paracetamol for symptom relief * Neuraminidase inhibitors have no effect in treating or preventing influenza-like illness

















































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S4 - PRESCRIPTION ONLY MEDICINE

OSELTAMIVIR Neuraminidase inhibitors Indications

Treatment and prevention of influenza A and B

Adverse/ Side Effects

nausea, vomiting, diarrhoea, abdominal pain, headache

Dosages

1

••••••ADULT, CHILD > 13 YRS•••••• 75 mg twice daily for 5 days.

2

••••••CHILD > 1 YEAR•••••• <15 kg, 30 mg twice daily for 5 days.

3

4

5 Ancillary Labels

Dose form

15–23 kg, 45 mg twice daily for 5 days.

23–40 kg, 60 mg twice daily for 5 days.

>40 kg, 75 mg twice daily for 5 days. A

SWALLOW WHOLE. Do not chew.

D

Add the words 'until all used'.

Capsules, Oral Liquid

* Take with food to reduce stomach upset. * Prevention of influenza: Begin treatment within 2 days of exposure (close contact with an infected person). * Treatment, this medicine is intended to shorten the time you have symptoms, such as fever, headache, sore muscles, cough and sore throat. * Otherwise healthy people should treat uncomplicated influenza by resting, drinking plenty of fluids and using paracetamol for symptom relief * Neuraminidase inhibitors have no effect in treating or preventing influenza-like illness * MOA: Reduce influenza virus replication by inhibiting the viral surface enzyme neuraminidase, preventing release of new virus from cells.

















































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S2 - PHARMACY MEDICINE

DOCUSATE Stool softener Indications

–– Constipation (includes combination with senna) –– Prevent straining following rectal surgery and acute perianal disease

Adverse/ Side Effects

Rare: abdominal cramps, diarrhoea, nausea, rash

Dosages

1

ADULT, Oral 100–150 mg QD or BID; max to 480 mg/d in divided doses may be used q.r.n

2

ADULT, Rectal 5 mL when required to relieve constipation.

3

CHILD 6–12 years Oral 50–120 mg daily.

4

CHILD 3–6 years Oral 50 mg daily.

5 Ancillary Labels

NIL

Dose form

* Take tablets with plenty of fluid. * Onset of action is 1–3 days with oral administration and 5–20 minutes following rectal administration * Poloxamer (Coloxyl Drops®) is preferred for children <3 years

















































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S4 - PRESCRIPTION ONLY MEDICINE

VANCOMYCIN Glycopeptide Antibacterial Indications

Treatment of serious infections caused by susceptible organisms resistant to penicillins (MRSA and multi-resistant S. epidermidis, MRSE) or in people with serious allergy to penicillins. Clostridium difficile-associated disease (relapse or unresponsive to metronidazole treatment). Antibacterial prophylaxis for endocarditis before certain procedures in penicillin-hypersensitive people at high risk. Surgical prophylaxis for major procedures involving implantation of prostheses (eg cardiac and vascular procedures) in institutions with a high rate of MRSA or MRSE

Adverse/ Side Effects

Oral vancomycin may cause indigestion, nausea, vomiting, diarrhoea and chills. IV, local pain (may be severe), thrombophlebitis

Dosages

1

ADULT IV, 500 mg six-hourly or 1 g 12-hourly.

2

Pseudomembranous colitis 250–500 mg six-hourly.

3

CHILD IV, 10-15 mg/kg six-hourly.

4

Pseudomembranous colitis oral, 5–10 mg/kg six-hourly

5 Ancillary Labels

D

Add the words 'until all used'.

Dose form

* used with an aminoglycoside for serious systemic enterococcal infections (but increased potential for nephrotoxicity with combination) * reserve oral vancomycin for serious cases of Clostridium difficile-associated disease or relapses unresponsive to metronidazole * stop vancomycin if tinnitus occurs

















































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S4 - PRESCRIPTION ONLY MEDICINE

TRIMEPRAZINE Sedating Antihistamines Indications

• Allergic upper respiratory conditions, eg rhinitis • Allergic skin conditions, eg urticaria, contact dermatitis • Pruritus (including insect bites) • Nausea and vomiting • Sedation, eg premedication

Adverse/ Side Effects

sedation, dizziness, tinnitus, blurred vision, euphoria, incoordination, anxiety, insomnia, tremor, nausea, vomiting, constipation, diarrhoea, epigastric discomfort, dry mouth, cough

Dosages

1

ADULT 10 mg 3–4 times daily; maximum 100 mg daily.

2

CHILD, 3 - 12 YEARS OLD Sedation, 1–2 mg/kg at night; maximum 50 mg.

3

CHILD, 3 - 12 YEARS OLD Allergy, 0.1–0.25 mg/kg 4 times daily; maximum 6.25 mg/dose.

4

5 Ancillary Labels

Dose form

1

This medicine may cause drowsiness and may increase the effects of alcohol. If affected, do not dri

13

Do not remove from original packaging until dose required.

Oral Liquid

* PRECAUTION: Epilepsy—trimeprazine lowers the seizure threshold. Respiratory depression—may worsen.

















































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S4 - PRESCRIPTION ONLY MEDICINE

CITALOPRAM selective serotonin reuptake inhibitor Indications

* Major depression * Anxiety disorders, eg panic disorder, obsessive compulsive disorder (OCD) * Bulimia nervosa * Premenstrual dysphoric disorder

Adverse/ Side Effects

nausea, agitation, insomnia, drowsiness, tremor, dry mouth, diarrhoea, dizziness, headache, sweating, weakness, anxiety, weight gain or loss, sexual dysfunction, rhinitis, myalgia, rash

Dosages

ADULT 20 mg QD, gradually increasing after 2-4 wks if necessary to 60 mg/d

1

2

3

4

5 Ancillary Labels

Dose form

5

Ask your doctor or pharmacist before using any other medicine including over-the-counter medicin

9

DO NOT STOP TAKING THIS MEDICINE ABRUPTLY unless otherwise advised by your docto

12

This medicine may affect mental alertness and/or coordination. If affected, do not drive a motor ve

Oral (tablet)

* Indications other than depression include obsessive compulsive disorder, anxiety, panic and eating disorders. * Full benefit may not be seen for several weeks but adverse effects may occur from start of treatment. * Usually given as a morning dose due to activating effects, although occasionally may cause somnolence and can be taken at night. * The efficacy and safety of citalopram for the treatment of major depressive disorder has not been established in individuals aged less than 18 years.

















































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