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ISBN: 978-969-8295-18-9

PREFACE

The hospital formulary is being published for the first time


by Independent University Hospital in the public interest.
It will be provided free of cost to all of the hospital doctors
regularly for immediate referral and prescribing medicine
which will be available at the hospital pharmacy. It is to
facilitate the patients to get hospital medicine. It includes
the medicines according to PVMS list. It includes generic
names of the medicines. The brand names have been
given for simplicity & better compliance by the hospital
pharmacy and doctors.

It is hoped that it will improve pharmaceutical service of


this hospital. The selection of drugs has been done by a
team after consultation with all the specialists/Professors
of this hospital.

It will be updated on yearly basis. We would keep adding


to the formulary during the year.

The hospital pharmacists will be available to all doctors to


discuss the drug uses, abuses & interactions. Please use
their help in public interest.

We would love to have your views for improvement in this


effort, please don’t hesitate to suggest changes for the
next edition.
Muhammad Shuja Tahir
FRCS(Ed), FCPS(Hon)
Professor of Surgery and Chairman
Independent Foundation Trust
March, 2010
CONTENTS

Sr. No. Description Page No.


01 Analgesics 01
02 Anti Bacterials 09
03 Anti Fungal Drugs 29
04 Anti Helminthics 31
05 Anti Tuberculous Drugs 35
06 Anti Protozoal Drugs 40
07 Gastro Intestinal Drugs 43
08 Cardiovascular Drugs 55
09 Anti Coagulants 66
10 Diuretics 68
11 Respiratory Drugs 71
12 Opthalmological Drugs 79
13 Gynaecological Drugs 85
14 Anti Allergic Drugs 86
15 Intravenous Fluids 90
16 Vitamins and minerals 92
17 Anti Diabetic Drugs 96
18 Vaccines 98
19 ENT Preparations 100
20 Metabolic Agents 102
21 Anti Epileptics 103
22 Anaesthetics 107
1- ANALGESICS 1

ANALGESICS (NON OPIOID)


1.1 PARACETAMOL
Antipyretic inhibits PGE 2 synthesis, no anti-inflammatory proper-
ties.

INDICATIONS
Mild to moderate pain, pyrexia.

CONTRA-INDICATIONS
Hepatic and renal impairment, alcohol dependence.

ADVERSE EFFECTS A
Adverse effects rare, but rashes, blood disorders, and acute N
pancreatitis reported.
Important: liver damage (and less frequently renal damage).
A
L
DOSAGE, FORM & STRENGTH G
Adults;
E
By mouth 500-1000mg every 4-6 hours to a maximum of 4 g
daily: S
I
Children: C
3 months - 1 years: 60-120mg QDS S
1-5 years: 120-250mg
6-12years: 250-500mg

These doses may be repeated every 4-6 hours when necessary


(maximum of 4 doses in 24 hours)

Available as:
Calpol, Disprol, Duragesic, Kanamol, Panadol,
Paracetamol, Provas

Independent University Hospital FORMULARY 2010


2 1.2. ACETYLSALICYLIC ACID
inhibits COX-1 and COX-2. Also anti-platelet action by inhibiting
TXA2

INDICATIONS
Pain , Fever, Anti-inflammatory, IHD and Thromboembolic CVA,
Prophylaxis and acute treatment

CONTRA- INDICATION
Acetylsalicylic acid should not be taken by patients suffering from,
Active peptic ulceration,
Haemophilia
allergic to aspirin
asthma or in the last three months of pregnancy.
A < 16 years old (risk of reye`s syndrome, liver and brain damage).
N
A ADVERSE EFFECT
L Nausea, dyspepsia, heartburn, epigastric discomfort.
G DOSAGE, FORM & STRENGTH
E Adults
S 300-900mg 4 to 6 hourly
I 75mg once a day for prophylaxis
300mg stat for acute MI or CVA
C
S Children:
Not recommended.

Available as:
aspirin, Disprin, Ascard, Loprin, Aspro

1.3. MEFENAMIC ACID


Mild strength NSAID, unselective COX inhibitor

INDICATIONS
Mild to moderate pain in rheumatoid arthritis including juvenile
arthritis, oseoarthrosis, and related conditions; dysmenorrhoea,
menorrhagia.
Independent University Hospital FORMULARY 2010
CONTRA-INDICATIONS 3
Ulcerative lesions of gastro-intestinal tract.
Inflammatory bowel disease.
Renal or hepatic impairment.
Aspirin, anti-inflammatory induced allergy.

ADVERSE EFFECTS
Drowsiness; diarrhoea or rashes.
Thromobocytopenia, hemolytic anaemia.
Convulsions in over dosage.

DOSAGE, FORM & STRENGTH


Adults;
Tabs: 500 mg three times daily.
A
Children 6 months-1 year: N
Susp: 5ml. A
2-4 Years: 1ml.
5-8 Years: 15ml.
L
9-12 Years: 20ml. G
All eight hourly for not more than seven days. E
S
Available as:
Anapen, Forte, Fengesic, Fenstan, Fonstal, Mefgesic, Meflin,
I
Mefnac, Mefnagen, Mefnax, Mefo-250, Meftan, Mepon, C
Minacid, Neomef, Neurontin, Novomic, Ponstan S
1.4 DICLOFENAC SODIUM
Medium strength NSAID

INDICATIONS
Acute back pain, post-operative pain, pain in acute trauma and
fractures, renal colic.

CONTRA- INDICATIONS
Active peptic ulcer.
aspirin/anti-inflammatory induced allergy.
Proctitis.
Independent University Hospital FORMULARY 2010
4 ADVERSE EFFECTS
Transient epigastric pain, G.I. disturbances, headach, oedema.
Rarely blood dysheamopoiesis, peptic ulcer, abnormalities of liver
and renal function, skin reaction, pain at injection site.

DOSAGE
Adults;
oral: 50mg TDS, 75mg BD, 100mg OD
intramuscular: 75mg in Ampule of 3 ml.
Intravenous: 75mg in Ampule of 3 ml in 500ml normal
saline

Children over 1 Year;


1-3 mg/kg body wt daily in divided doses.
A
N Available as:
Athrotec, Artifen, Artinil-K, Beflam Cytopan, Dicloran, Fastaid,
A Fenac, Mobikare, Motaar, Voren, Sofac. Voltral
L
G 1.5 IBUPROFEN
E NSAID, Inseletive COX inhibitor, As well as (mild) anti-
S inflammatory, it also has anti-pyrexial and analgesic properties.
I INDICATIONS
C Musculoskeletal Pain, Fever Rheumatiod arthritis, juvenile rheu-
S matoid arthritis, (JRA), ankylosing spondylitis, osteoarthritis,
spondylitis, osteoarthritis, seronegative arthropathies, periarticular
disorders, soft tissue injuries. Mild to moderate Gynecological
pain.

CONTRA INDICATIONS
Active peptic ulcer, aspirin/anti-inflammatory induce allergy.

ADVERSE EFFECTS
G.I. upset or bleeding, rash.
Rarely thrombocytopenia.
Rarely aseptic meningitis.

Independent University Hospital FORMULARY 2010


DOSAGE 5
Adults;
1200-1800 mg daily in divided dose. Maximum 2400mg daily.

Children;
Usually, 20mg/kg body-wt. Upto 40mg/kg daily. Dose should not
exceed 500mg daily for children weighing less than 30kg.

Available as:
Brufen, Dolofen,Dolofam, Ibuprofen, Profen, Zefen

1.6 INDOMETHACIN
Medium strength NSAID, unselective COX inhibitor

INDICATIONS A
Especially ankylosing spondylitis, RA, Pain and moderate to severe N
inflammation in rheumatic disease and other acute
musculoskeletal disorders; acute gout; dysmenorrhoea; closure of
A
ductus arteriosus. L
G
CONTRA INDICATIONS E
Acute peptic ulcer, history of G.I.T. lesions, aspirine or anti-
inflammatory induced or allergy.
S
Pregnancy and lactation. I
C
ADVERSE EFFECT S
Frequently gastro-intestinal disturbances including diarrhoea,
headache, dizziness and light-headedeness, gastro-intestinal
ulceration and bleeding.
Blurred vision, corneal deposits, peripheral neuropathy.
On rectal administration, prritus, discomfort & bleeding.

DOSAGE, FORM & STRENGTH


oral: 25-50mg QDS
100gm BD (maximum dose 200mg daily).
Rectal suppositories:100 mg at night and in the morning if
required.
Combined oral and rectal treatment: maximum total daily dose

Independent University Hospital FORMULARY 2010


6 150-200mg.

Available as:
Anglocid, Indacin, Indocin, Liometacen, Methacid

1.7 NAPROXEN
NSAID, unselective COX inhibitor

INDICATION:
RA musculoskeletal pain, Post Operative pain, acute gout,
dysmenorrhoea,

ADVERSE EFFECT
G.I upset, G.I bleeding, rash, Thrombocytopenia
A
N DOSAGE, FORM & STRENGTH
250-500mg B.D
A
L Available as:
G Apranax, Dolosyn, Flexin, Naprosyn, Naprox, Proxen, Synflex
E
1.8 PIROXICAM
S INDICATIONS
I Rheumatoid arthritis, osteoarthrosis, ankylosing spondylitis, acute
C musculo-skeletal disorders, acute gout, juvenile chronic arthritis
S (JCA).

CONTRA-INDICATIONS
Aspirin. Anti-inflammatory induced allergy. Active peptic ulcer,
history of recurrent ulceration.

ADVERSE EFFECT
G.I. disturbancees, skin reactions, oedema,CNA effects, malaise,
tinnitus.

DOSAGE, FORM & STRENGTH


Adults;
40-200mg daily as a single dose.

Independent University Hospital FORMULARY 2010


Children over 6 years; 7
JCA only; under 15kg, 5mg; 16-25kg, 10mg; 26-45 kg, 15 mg;
over 46kg, 20mg.

Available as:
Brexin, Feldene, Mobicam, Roxicam, Weldene

ANALGESICS (OPIOID)
1.9 CODIENE PHOSPHATE
INDICATIONS
Mild to Moderate Pain, Diarrhoea, Cough

ADVERSE EFFECTS
Nausea, Vomiting, Constipation, Drowsiness, Respiratory A
Depression, Hypotension N
A
DOSAGE
30-60mg QDS L
G
Available as: E
Codogesic,Napadoc, Paineze, Paracod, Paracodeine, Tocor,
S
Forte
I
1.10 MORPHINE HYDROCHLORIDE OR SULPHATE C
INDICATIONS S
Acute pulmonary oedema: peri-operative analgesia, acute MI.

CONTRA-INDICATIONS
Avoid in raised intra cranial pressure or head injury (in addition to
interfering with respiration, it affects pupillary responses vital for
neurological assessment).

ADVERSE EFFECTS
Nausea and vomiting (particularly in initial stages). Constipation,
and drowsiness; larger doses produce respiratory depression and
hypo tension; other side-effects include difficulty in micturition.
Ureteric or biliary spasm, dry mouth bardycardia, hypo tension,
Independent University Hospital FORMULARY 2010
8 hypothermia, hallucinations, mood changes, utcaria and pruritus.

DOSAGE, FORM & STRENGTH


5-50mg sub cutaneous / intramuscular 4 hourly.
2.5-10mg intravenously 4 hourly.

Adults;
5-50mg sub cutaneous / intramuscular 4 hourly.
2.5-10mg intravenously 4 hourly.
Children upto 1 month;
150 micrograms/kg 1-12 months 200 micrograms/kg.
1-5 Years: 2.5-5mg.
6-12 Years: 5-10mg.
Slow intravenous injection; quarter to half corresponding. intra-
A muscular dose.
N Myocardial infarction, by slow intravenous injection (2mg/minute).
A 10 mg followed by a further 5-10 mg if necessary ;elderly or frail
L patients, reduce dose by half.
Acute pulmonary oedema, by slow intravenous injection
G (2mg/minute). 5 mg.
E Chronic pain, by mouth or by subcutaneous or intramuscular
S injection, 5-20 mg regularly every 4 hours; dose may be increased
I according to needs.
C Oral dose: should be approximately double corresponding
intramuscular dose and triple to quadruple corresponding intra-
S muscular diamorphine dose.
By rectum, as suppositories, 14-30 mg regularly every 4 hours.

Available as:
Magnus, Mr Morphine, Mst Continus

Independent University Hospital FORMULARY 2010


2- ANTI BACTERIALS 9

2.1 BENZYLPENICILLIN
INDICATIONS
Throat infections, otitis media, streptococcal endocarditis,
meningococcal and pneumonia; prophylaxis in limb amputation,
in rheumatic fever, in splenectomy and sickle cell disease.

CONTRA-INDICATIONS
Penicillin hypersensitivity
A
ADVERSE EFFECTS
Hypersensitivity reactions including urticaria, fever, joint pains; N
angioedema; transient leucopenia and thrombocytopenia; T
anaphylactic shock in hypersensitive patients; diarrhoea after I
administration by mouth.

DOSAGE, FORM & STRENGTH


B
Inj: 600mg=(1 million iu)in vial base. A
C
Adults; T
By intramuscular or by slow intravenous injection or by infusion.
1.2 g daily in 4 divided doses, increased if necessary to 2.4g daily
E
or more. R
I
Premature infant and neonate; A
50mg/kg daily in 2 divided doses;
infant 1-4 weeks, 75 mg/kg daily in 3 divided doses.
L
Children 1 month-12 years; S
100mg/kg daily in 4 divided doses.

Available as:
Benzyl, Pencillin, Benzyl Pencillin Polybiotic

Independent University Hospital FORMULARY 2010


10 2.2 AMPICILLIN
(Anhydrous, Thrihydrate, Sodium)
INDICATIONS
Urinary-tract infections, otitis media, sinusitis, chronic bronchitis,
invasive salmonellosis, gonorrhoea.

CONTRA- INDICATIONS
Penicillin hypersensitivity

ADVERSE EFFECTS
Nausea, diarrhoea; rashes (discontinue treatment); rarely, pseudo
A membranous colitis.
N
T DOSAGE, FORM & STRENGTH
Cap or Tab: 250mg; 500mg
I Susp: 125mg/ml, 250mg/ml (base)
Inj: 500mg in vial (base)
B
A Adults;
By mouth, 0.25-1 g every 6 hours, at least 30 minutes
C
T Children under 10 Years;
E Any route, half adult dose.
R Available as:
I Omnipen, Pencit, Ampi-plus, Wilclox
A
L 2.3 AMOXYCILLIN
INDICATIONS
S Respiratory, ENT, UTI and Soft tissue infections. Gonorrhoea.
Dental abscess adjunct to surgical management. Prophylaxis of
bacterial endocarditis.

CONTRA-INDICATIONS
History of previous hypersensitivity reaction to penicillin and /or
cephalosporins.
Do not inject parenteral solutions into or near an artery or nerve.

Independent University Hospital FORMULARY 2010


ADVERSE EFFECTS 11
Anaphylaxis. Glossitis, Stomatitis, gastritis, sore throat, dry mouth,
furry tongue.
Anemia. Hemorrhagic manifestation.
Interstitial nephritis (e.g oligurea, hematuria), Nephrotoxicity.

DOSAGE, FORM & STRENGTH


Cap: 250mg, 500mg
Inj: 250mg, 500mg
Susp: 125mg/5ml, 250 mg/5ml
Caps/Drops/Syp:
A
Adults; N
250-500mg three times daily. T
Children:
125mg 3 times daily I
single 3gm dose one hour before
Prophylaxis of endocarditis:
dental peocedure from which bacteraemia may arise. Repeat 6 B
hours later if necessary. A
Available as:
C
Amoxicillin, Wymox, Amoxil, Ospamox, Supramox T
E
2.4 FLUCLOXACILLIN R
INDICATIONS
Staphy lococcal infections, otitis externa, pheumonia, cellulitis,
I
impetigo, osteomyelitis A
L
CONTRA-INDICATIONS S
history of previous hypersensitivity

ADVERSE EFFECT
Cholestatic jaundice, Anaphylaxis, Glossitis, Stomatitis, gastritis,
sore throat, dry mouth

DOSAGE
250mg-500mg QDS maximum dose 8mg daily

Independent University Hospital FORMULARY 2010


12 Available as:
Bactoxyl, Biflocin, Delflox, F-Clox, Flomoxin, Flucomox

2.5 CO-AMOXICLAV
Mixture of amoxicillin and clavulanic acid.

INDICATIONS
Respiratory tract infections, genito-urinary infections, abdominal
infections cellulitis

CONTRA-INDICATIONS
A H/O Penicillin hypersensitivity
N
ADVERSE EFFECT
T hepatitis, cholestatic jaundice
I
DOSAGE
B less than 40kg; 250mg / 125 TDS
more than 40kg; 500mg / 125 TDS
A
C Available as:
T Augmentin, calamox
E
R 2.6 CEPHALEXIN
First generation cephalosporin
I
A INDICATIONS
L Septicaemia; endocarditis; UTI, respiratory tract, skin and soft
S tissue infections.

CONTRA INDICATIONS
Impaired renal function.

ADVERSE EFFECTS
Hypersenseitivity reactions. G.I. disturbances, convulsions,
eosinophilia, neutropenia, leucopenia, rise in liver enzymes and
blood urea. Positive Coombs test.

Independent University Hospital FORMULARY 2010


DOSAGE FORM & STRENGTH 13
Adults;
250mg 6 hourly or 500mg 8 hourly.
By intramuscular injection or intravenous injection or infusion, 0.5
g every 6-12 hours.

Children;
25-50 mg/kg daily (in divided doses), increased to 100 mg/kg
daily in severe infections.

Available as:
Ceporex, Keflex, Zafalexin A
N
2.7 CEPHRADINE T
First generation cephalosporin
I
INDICATIONS
Infections of respiratory and gastrointestinal tracts and of skin and B
sofl tissues, bones and joints. Septicaemia, endocarditis, prophy- A
laxis in surgery. UTI.
C
CONTRA-INDICATIONS T
Hypersensitivity to cephalosporins or related antibiotics. E
ADVERSE EFFECTS
R
G.I. disturbances (nausea, vomiting, diarrhoea) and hypersensitiv- I
ity pneumonia. Eosinophilia, transient neutropenia. leucopenia, A
thrombocytopenia. L
Elevated SGOT and SGPT. Mild elevation in BUN. S
Headache, dizziness and paraesthesia. Fever and dyspnea.

DOSAGE, FORM & STRENGTH


Cap: 250mg
Susp: 125mg/5ml

Adults;
1 -2gm daily in 2 or 4 divided doses;
(max, 4 gm daily).

Independent University Hospital FORMULARY 2010


14 Children;
25-50 mg/kg daily in 2 or 4 divided doses; (maximum 4 gm daily).

Available as:
Velosef, Infexin, Cephride

2.8 CEFACLOR
Second generation cephalosporin

INDICATIONS
infections due to sensitive gram positive and gram-negative
A bacteria.
N
CONTRA-INDICATIONS
T
cephalosporin hypersensitivity.
I
ADVERSE EFFECT
B diarrhoea, nausea, vomiting, abdominal discomfort, headache,
A Allergic reactions.
C DOSAGE
T 250-500mg 8H
E Maximum 4gm daily.
R Available as:
I Ceclor, Acef, Cefalor
A
L 2.9 CEFUROXIME
S Second generation cephalosporin

INDICATIONS
infections due to sensitive gram positive and gram-negative
especially haemophiles influenzas and neisseria gonorrhoea.

CONTRA-INDICATIONS
cephalosporin hypersensitivity.

ADVERSE EFFECT
diarrhoea, nausea, vomiting, abdominal discomfort, headache,
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Allergic reactions. 15

DOSAGE
oral: 250mg BD
intravenous: 750mg TDS
Prophylaxis: 1.5gm single dose

Available as:
Zinacef, Zinnat, Roxat, Roxime, Cefroxil

2.10 CEFTAZIDIME SODIUM


A
Third generation cephalosporin
N
INDICATIONS T
Infections of the lower respiratory tract, skin and soft tissue. I
Septicaemia. Severe infections in immunocompromised patrients.
UTI and gonorrhoea.
B
CONTRA-INDICATIONS A
Cephalosporin hypersensitivity, prophyria. C
ADVERSE EFFECTS T
Hypersensitivity reactions. E
G.I. disturbances, eosinophilia, neutropenia, leucopenia, R
thrombocytopenia, rise in liver enzymes and blood urea. Positive I
Coombs test.
A
DOSAGE, FORM & STRENGTH L
Inj: 500mg/lg S
Adults;
By deep intramuscular or slow intravenous injection or by intrave-
nous infusion, 1-2 g every 8-10 hour increased in severe infections
up to 8gm daily, in 3 divided doses.

Children over 3 months;


30-60 mg/kg daily in 2-4 divided doses, increased to 100-150
mg/kg daily for sever infections.
Independent University Hospital FORMULARY 2010
16 Available as:
Fortum, Cefcom, Epocef

2.11 CEFTRIAXONE
Third generation cephalosporin

INDICATIONS
Severe respiratory and genitourinary tract, bone and joint, abdom-
inal infections, sepsis, meningitis, Surgical prophylaxis.

CONTRA- INDICATIONS
A Cephalosporin hypersensitivity; porphyria.
N
ADVERSE EFFECTS
T
Diarrhoea and rarely pseudo membranous colitis, nausea and
I vomiting.
Allergic reactions including rashes, pruritus, urticaria, serum
B sickness-like reaction with rashes, fever and arthralgia, and
A anaphylaxis; erythema multiform , toxic epidermal necolysis
C reported; eosinophilic and rarely thrombocytopenia or
neutropenia; disturbances in liver enzymes, transient hepatitis and
T cholestatic jaundice; other side-effects reported include reversible
E interstitial nephritis, hyperactivity,nervousness, sleep disturbances,
R confusion, hypcrtonia, and dizziness.
I
DOSAGE, FORM & STRENGTH
A Inj: 250mgf 500mg, IG
L Adults;
S By intramuscular injection, or by intravenous injection over 2-4
minutes, or by intravenous infusion, 1g daily as a single dose; 2-4
g daily as a single dose in severe infections;
Neonates: 20-50mg / kg daily.
Children: 20-80mg / kg daily.

Surgical prophylaxis, 1 g as a single dose.

Available as:
Rocephin, Norbac, Oxidil, Unitrixone, Fortexone, Trophin
Independent University Hospital FORMULARY 2010
2.12 CEFOTAXIME SODIUM 17
Third generation cephalosporin

INDICATIONS
Infections of the respiratory tract, kidney, urinary tract and repro-
ductive organs, including gonorrhoea, septicaemia, endocarditis,
meningitis.
Infections of bone joint, soft tissues and skin. Abdominal infections
of ear and tliroat. Infected burns and wounds.

CONTRA- INDICATIONS
Hypersensitivity to cephalosporins. A
N
ADVERSE EFFECTS T
Pain at injection site, hypersensitivity reactions. I
G.I. disturbances, candidiasis, thrombocytopcnia, rise in liver
enzymes and blood urea. Positive coomb's test.
B
DOSAGE, FORM & STRENGTH A
Inj: 250mg, 500mg, Ig. C
Adults; T
1 gm intravascular or intramuscular every 12 hours; serious E
infections, 3-6 gm daily in three or four divided doses; (max 12 gm R
daily). Use 2 gm by IV route. I
Neonates: 50mg/kg daily;
Children: 100-150mg/kg daily. A
Both in two to four divided doses; max 200mg/kg daily. L
S
Available as:
Cefotax, Claforan, Zafixime

2.13 CIPROFLOXACIN
INDICATIONS
Gram-negative and Gram-positive infections, enteric fever,
respiratory infection(except pneumococcal), UTI.

Independent University Hospital FORMULARY 2010


18 CONTRA-INDICATIONS
Children and growing adolescents except where benefits exceed
risk. Pregnancy and lactation.

ADVERSE EFFECTS
G.I. disturbances.
Dizziness, headache tremors, confusion, convulsions, sleep
disorders, rashes, photosensitivity, joint pain. Judgement may be
impaired.
Transient increase in serum creatinine level.
Haematological. hepatic and renal disturbances, vasculitis.
A pseudo membranous colitis, haemorrhagic bullae.
N Stevens-Johnson and Lyells syndrome, visual disturbances,
T transient hearing loss, tenosynovitis. Impaired taste, smell and
I tachycardia.

DOSAGE, FORM & STRENGTH


B Tab: 250mg. 500mg.
A Inj: 250mg/100ml.
C
Adults;
T By mouth,
E 250-750 mg twice daily.
R 500mg may be required in resistant cases.
I Most other infections, 500-750mg twice daily.
A By intravenous infusion,
L Prophylaxis of meningitis, (over 30-60 minutes), 200 mg twice
S daily.
Urinary-tract infections, 100mg twice daily.
Gonorrhoea, 100mg as a single dose.

Children;
It is not recommended but where benefit outweighs risk, by mouth,
7.5-15 mg/kg daily in 2 divided doses or by intravenous infusion,
5-10 mg/kg daily in 2 divided doses.

Independent University Hospital FORMULARY 2010


Available as: 19
Ciprocide, Ciproxin, Novidat, Mercip, Hipro

2.14 OFLOXACIN
INDICATIONS
UTI, lower respiratory tract infections, gonorrhoea and non-
gonococcal unethritis cerricitis.

CONTRA-INDICATIONS
Children and growing adolescents except where benefits exceed
risk. Pregnancy and lactation.
A
ADVERSE EFFECT N
transient hypotension anxiety, unsteady gait, neuropathy T
DOSAGE I
200-400mg BD
B
Available as:
Tarivid, Oflox, Oflomed, Tariflox
A
C
2.15 LEVOFLOXACIN T
INDICATIONS E
active against gram-positive and gram-negative organism,
community acquired pneumonia.
R
I
CONTRA-INDICATIONS A
Children and growing adolescents except where benefits exceed L
risk. Pregnancy and lactation.
S
ADVERSE EFFECT
G.I. disturbances.
Dizziness, headache tremors, confusion, convulsions, sleep
disorders, rashes, photosensitivity, joint pain. Judgement may be
impaired.
Transient increase in serum creatinine level.
Haematological. hepatic and renal disturbances, vasculitis.
pseudo membranous colitis, haemorrhagic bullae.
Independent University Hospital FORMULARY 2010
20 Stevens-Johnson and Lyells syndrome, visual disturbances,
transient hearing loss, tenosynovitis. Impaired taste, smell and
tachycardia.

DOSAGE
250-500mg BD

Available as:
Dynaquin, Effiflox, Levofloxa, Qumic, Zevo

2.16 NALIDIXIC ACID


A INDICATIONS
N Urinary tract infections. Gastro-intestinal infections due to Gram-
T Negative orgaisms.
I
CONTRA-INDICATIONS
History of convulsive disorders. Porphyria.
B
A ADVERSE EFFECTS
C G.I., CNS and visual disturbances. Skin rashes, blood dyscrasias,
convulsions, photosensitivity, intracranial hypertension.
T
E DOSAGE, FORM & STRENGTH
R Tab: 500mg - 1000mg 4 times daily.
I Available as:
A Negram, Uridix, Urixin
L
S 2.17 NORFLOXACIN
INDICATIONS
Cystitis, Pyelitis, Cytopyelitis, polynephritis, specially infections
caused by multiple resistant problem organisms.
Typhoid/paratyphoid fever and acute gastroenteritis.

CONTRA-INDICATIONS
Pregnancy, lactation. Prepubertal children and growing adoles-
cents.

Independent University Hospital FORMULARY 2010


ADVERSE EFFECTS 21
Nausea, headache, dizziness, rash, heartburn, abdominal
cramps, diarrhoea, anorexia, sleep disturbances, anxiety, irritabil-
ity, convulsions, hypersensitivity reactions, confusions,
paraesthesia, hemolytic anaemia, pancreatitis, hepatitis,
photosensitivity; avoid excessive sunlight.

DOSAGE, FORM & STRENGTH


Tab: 400mg

Adults;
Urinary tract infections, 1 tab twice daily. A
Typhoid/paratyhoid fever and acute gastroenteritis, N
1 tab thrice daily for 14 days. T
Children;
Not recommended. I
Available as: B
Noroxin, Utinor
A
2.18 DOXYCYCLINE C
INDICATIONS T
PID, Pneumonia; respiratory, gastro- intestinal tract, soft tissue, E
ophthalmic and urinary tract infections. R
CONTRA-INDICATIONS I
Latter half of pregnancy. Lactation. A
L
ADVERSE EFFECTS
Tooth discolouration, enamel hypoplasia, reduced fibula growth S
rate.
Avoid use in children under 8 years, in pregnancy and lactation
unless no alternative.
G.I. disturbances.
Allergic reactions and Superinfections.
DOSAGE, FORM & STRENGTH
Cap or tab: 100mg
Inj: 100mg in vial.

Independent University Hospital FORMULARY 2010


22 Adults;
200mg with food or fluid on the first day, then l00mg daily.
IV 200mg first day in one or two infusion.

Available as:
Vibramycin, Wellcodox, Supramycin-100

2.19 ERYTHROMYCIN
INDICATIONS
Alternative to penicillin in hypersensitive patients; campylobacler
enteritis, pneumonia, legionnaires' disease, syphilis, non-
A gonococcal uretluitis, chronic prostatitis, acne vulgaris; diphtheria
N and whooping cough prophylaxis.
T
CONTRA-INDICATIONS
I Porphyria; contra-indicated in liver disease

B ADVERSE EFFECTS
A Nausea, vomiting, abdominal discomfort, diarrhoea after large
doses.
C Urticaria, rashes and other allergic reactions.
T Reversible hearing loss also reported after large doses; if given for
E more than 14 days may occasionally cause cholestatic jaundice.
R
DOSAGE, FORM & STRENGTH
I Cap or tab: 250mg; 500mg
A Susp: 200mg/5ml.
L
S Adult and Children over 8 years;
By mouth: 250-500mg every 6 hours or 0.5 -1g
every 12 hours; Maximum 4 g daily.

Children upto 2 years; 125 mg every 6 hours,


2-8 years: 250 mg every 6 hours,
By intravenous infusion.
Adult and Children;
Severe infections, 50 mg/kg daily by continuous infusion
or in divided doses every 6 hours;

Independent University Hospital FORMULARY 2010


Available as: 23
Erythrocin, Erybron, Trycin

2.20 GENTAMICIN
INDICATIONS
Septicaemia and neonatal sepsis; meningitis and other CNS
infections, biliary tract infection, acute pyelonephritis or prostatitis,
endocarditis caused by Strep, Viridans or strep. Faecalis (with a
penicillin).

CONTRA-INDICATIONS
Pregnancy, myasthenia gravis A
N
ADVERSE EFFECTS T
Vestibular and auditory damage, nephrotoxicity; rarely, hypomag- I
nesaemia on prolonged therapy, pseudo membranous colitis.

DOSAGE, FORM & STRENGTH B


Inj: 80mg/2ml A
Adults;
By intramuscular or by slow intravenous injection over at least 3
C
minutes or by intravenous infusion, 2-5mg/kg daily (in divided T
doses every 8 hours). E
In renal impairment the interval between successive doses should R
be increased to 12 hours when the creatinine clearance is 30-70 I
ml/minute, 24 hours for 10-30 ml/minute, 48 hours for 5-10
A
ml/minute, and after twice-weekly dialysis for less than 5
ml/minute. L
S
Children up to 2 weeks; 3mg/kg every 12 hours.
2 weeks -12 years; 2mg/kg every 8 hours.

Available as:
Genticyn, Refobacin

Independent University Hospital FORMULARY 2010


24 2.21 LINCOMYCIN
INDICATIONS
Serious Sensitive Infection, Gram positive Cocci, Joint and bone
infections.

CONTRA-INDICATIONS
Clindamycin sensitivity

ADVERSE EFFECTS
Persistent diarrhoea, colitis; discontinue immediately

A DOSAGE, FORM & STRENGTH


N Cap: 600mg
T Inj: 600mg
Syrup:
I
Adults;
B 600mg three or four times daily.
0.6-4.8gm in divided daily dose.
A Children under 1 month;
C Not recommended.
T
Available as:
E Lincocin, Mincomycin, Omicin
R
I 2.22 METRONIDAZOLE
A INDICATIONS
Anaerobic infections, protozoal infections
L
S CONTRA-INDICATIONS
Hepatic encephalopathy, CNS disorders. Pregnancy, lactation.

ADVERSE EFFECTS
Nausea, vomiting, unpleasant taste, and gastro- intestinal distur-
bances; rashes, urticaria and angioedema; rarely drowsiness,
headache, dizziness, ataxia, and darkening, of urine; on pro-
longed or intensive therapy peripheral neuropathy, transient
epileptiform seizures, and leucopenia.

Independent University Hospital FORMULARY 2010


DOSAGE, FORM & STRENGTH 25
Tab: 200mg, 400mg.
Inj: 500mg in 100ml vial

Adult;
Anaerobic infections (usually treated for 7 days), by mouth,
800mg initially then 400mg every 8 hours; by rectum, 1g every 8
hours.
by intravenous infusion, 500mg every 8 hours.

Children;
1-3 Years: 50mg every 8 hours for 3 days. A
3-7 Years: 100mg every 12 hours. N
7-10 years: 100mg every 8 hours. T
I
Acute dental infections, by mouth, 200mg every 8 hours for 3-7
days.
Surgical prophylaxis, by mouth, 4mg every 8 hours started 24 B
hours before surgery, then continued postoperatively by intrave- A
nous infusion, 500mg shortly before surgery then every 8 hours C
untill oral administration can be started. T
7.5mg/kg every 8 hours.
E
Available as: R
Flagyl, Klint, Diazol, Metrozil I
A
2.23 OXYTETRACYCLINE HYDROCHLORIDE
INDICATIONS L
Oxytetracycline sensitive infections, by chlamydia. S
CONTRA-INDICATIONS
Latter half of pregnancy. Avoid use in children under 8 years, in
pregnancy and lactation unless no alternative.

ADVERSE EFFECTS
Tooth discolouration, en hypoplasia, reduced fibula growth rate.
GI disturbances.
Allergic reactions, Superinfections.
Independent University Hospital FORMULARY 2010
26 DOSAGE, FORM & STRENGTH
Cap: 250mg
Susp: 125mg / 5ml

Adults: 250-500mg four times daily.


Children: 25-50mg/kg daily in four divided doses.

Available as:
Terramycin,Oxytetracycline

2.24 CO-TRIMOXAZOLE
A INDICATIONS
N Invasive salmonellosis, Typhoid fever, bone and joint infections due
T to Haemophilus Influenzae, urinary-tract infections, sinusitis,
I exacerbations of chronic bronchitis, gonorrhoea in pencillin-
allergic patients.
B CONTRA-INDICATIONS
A Pregnancy, infants under 6 weeks (risk of kernicterus), renal or
C hepatic failure, jaundice, blood disorders; porphyria.
T ADVERSE EFFECTS
E Nausea, vomiting, diarrhoea.
R Glossitis, rashes, erythema multiforme, epidermal necrolysis,
I eosinophilia, agranulocytosis, granulocytopenia, purpura,
A leucopenia, thrombocytopenia; megaloblastic anaemia due to
trimethoprim; pseudomebranous colitis, jaundiced and hepatic
L necrosis reported.
S
DOSAGE, FORM & STRENGTH
Adults;
By mouth, 480-960mg every 12 hours, Maximum 1.44g.

Children: Every 12 hours.


6 weeks to 5 months: 120mg.
6 months to 5 years: 240mg.
6-12 years: 480mg.
Prophylaxis of recurrent urinary-tract infection;
Independent University Hospital FORMULARY 2010
Adults: 480mg at night. 27
Children: 6-12 mg/kg at night.

Available as:
Septran, Bactrim, Nicotrim, Trimoxin

2.25 CHLORAMPHENICOL
Broad spectrum anti-biotic

INDICATIONS
Typhoid fever, H. Influcnzae meningitis, severe infections when
careful clinical assessment indicates no other antibiotics are A
effective. N
T
CONTRA-INDICATIONS
Pregnancy, I
breast-feeding,
porphyria. B
A
ADVERSE EFFECTS
Blood disorders including irreversible aplastic anaemia (aplastic C
anaemia attributed to chloramphenicol has terminated in leukae- T
mia). E
Peripheral neuritis, optic neuritis. erythema multiforme. R
Nausea, vomiting, diarrhoea and nocturnal haemoglobinuria. I
DOSAGE, FORM & STRENGTH A
Inj: 1g in vial L
Susp: 75mg/5ml S
Adults;
By mouth or by intravenous injection or infusion, 50mg/Kg
daily in 4 divided doses.

Children;
Infants under 2 weeks;
25 mg/kg daily in 4 divided doses.

Independent University Hospital FORMULARY 2010


28 2 weeks-01 year;
50mg/kg daily in 4 divided doses.

Available as:
Chloramphenicol, Methachlor, Dexachlor

A
N
T
I

B
A
C
T
E
R
I
A
L
S

Independent University Hospital FORMULARY 2010


3- ANTI FUNGAL DRUGS 29

3.1 CLOTRIMAZOLE
INDICATIONS
Candidial and mixed candidial / trichomonal vaginal infections.

CONTRA-INDICATIONS
Hypersensitivity to Clotrimazole.

ADVERSE EFFECTS A
Local mild burning or irritation Hypersensitivity reactions. N
DOSAGE, FORM & STRENGTH T
Vaginal cream: 1% Insert contents of the applicator I
intravaginally at night as a single dose.
F
Vaginal tabs: 100mg.
Adult; 100mg inserted nightly for six nights.
U
N
Vaginal tabs: 500mg; G
Adults; 1 inserted as single dose at night. A
Children; Not applicable.
L

Available as: D
Canesten, Clonil Vag, Clomazol, Gynosporin
R
3.2 GRISEOFULVIN U
Dermatophyte infections of skin, nails, scalp where topical therapy G
inappropriate. S
CONTRA-INDICATIONS
Prophyria, severe liver disease.

ADVERSE EFFECTS
Drowsiness, headache, gastric distress. Urticarial reactions,
photosensitivirty and rarely precipitation of SLE.

Independent University Hospital FORMULARY 2010


30 DOSAGE, FORM & STRENGTH
Cap or tab: 125mg, 250mg, 500mg

Adults;
500mg- 1gm daily, preferably in divided doses after meals.

Children;
10mg/kg body-wt. daily in divided doses.

Available as:
A Grifulvin, Griseofulvin
N
T 3.3 NYSTATIN
INDICATIONS
I Oral, esophageal and intestinal candidiasis.

F CONTRA-INDICATIONS
U Tuberculous or viral lesion. Hypersensitivity.
N ADVERSE EFFECTS
G Nausea, vomiting and diarrhoea in high doses.
A
DOSAGE, FORM & STRENGTH
L Tab: 500,000, iu,
Syp: 200mg/5ml.
D Adults; Drops:
R Oral infections, 1ml four times daily.
Intestinal infections, 5ml four times daily,
U Children; 1ml four times daily.
G Tabs:
S Adults: 1-2 tabs, four times daily.

Available as:
Nilstat, Mycitracin, Neomycin Oint, Polymyx

Independent University Hospital FORMULARY 2010


4- ANTI HELMINTHICS 31

4.1 ALBENDAZOLE
INDICATIONS
Adjunct to surgery in hydatid cyts caused by Echinococcous
granulosus or E. Multi-locularies, or primary treatment if surgery is
not possible.

CONTRA-INDICATIONS
Pregnancy. Adequate non-hormonal contraceptive measures must A
be taken during, and for one month after treatment . N
ADVERSE EFFECT
T
Gastro-intestinal disturbances, headache, dizziness, changes in I
liver enzymes; rarely reversible alopecia; rash, fever blood disor-
ders including leucopenia and pancytopenia allergic shock if cyts H
leakage; convulsions and meningism in cerebral disease. E
DOSAGE, FORM & STRENGTH L
Tab: 400mg M
Syp: 40mg/5ml I
N
400mg twice daily for 3 days can be repeated after 3days
T
E. granulosus. H
Adult;
Adjunct in surgical treatment;
I
Over 60 kg, medical treatment, 800mg daily in divided doses for C
28 days; 3 cycles of treatment may be given. S
Available as:
Zentel, Almed , Wormocid

4.1 LEVAMISOLE HCL


INDICATIONS
Intestinal worm infection by A. lumbricoidesn, Americanus, A.
duodenals, E. vermicularis, T. trichiura, S. Stercorarius and T.

Independent University Hospital FORMULARY 2010


32 Colubriformis.

CONTRA-INDICATIONS
Pregnancy and in cases of microfilaraemia.

ADVERSE EFFECTS
Usually mild and transient. Nausea, vomiting, abdominal pain,
giddiness, headache.

DOSAGE, FORM & STRENGTH


A Tab: 40mg
Single dose after meal.
N In severe hookworm infection, second dose after 1 to 7 days is
T suggested .
I
Adults: 120mg.
Children 1-4 years: 40mg.
H 5-15 years: 80mg.
E
L Available as:
M Antiworm, Geomisole, Ketrax, Nilpar
I 4.3 MEBENDAZOLE
N INDICATIONS
T Threadworm, roundworm, whipworm and hookworm infections.
H CONTRA-INDICATIONS
I Pregnancy
C
S ADVERSE EFFECTS
Rarely abdominal pain. Diarrhoea; hypersensetivity reactions
including exantheme, rash uticaria, and angioedma.

DOSAGE, FORM & STRENGTH


Chewable tab: 100mg
Susp: 100mg/5ml
Threadworms.
Adult and Children over 2 years;
100 mg as a single dose;
Independent University Hospital FORMULARY 2010
if reinfection occurs second dose may be needed after 2-3 weeks; 33

Children under 2 years;


Not yet recommended.

Available as:
Vermox, Vermin, Deworm, Wormdox

4.4 PYRANTEL PAMOATE


INDICATIONS
Roundworm, Threadworm, and Hookworm infections. A
CONTRA-INDICATIONS N
Hepatic dysfunction. T
I
ADVERSE EFFECTS
Anorexia, abdominal cramps, nausea, vomiting, diarrhoea;
headache, dizziness, sleep disturbance; rash. H
E
DOSAGE, FORM & STRENGTH L
Tab: 250mg
P9 250/5ml
M
I
Adult and Children over 6 months; N
Ascaris lumbricoides alone, a single dose of 5 mg/kg: T
Mixed infections involving Ascaris lumbricoidess; single dose of 10
mg.kg.
H
I
Available as: C
Combantrin, Pamotrine, Pirental, Pypam, Pyrentrin, Womaq S
4.5 THIABENDAZOLE
INDICATIONS
Strongylodiasis, cutaneous and visceral larva migrans,
dracontiasis, symptoms of trichinosis; secondary treatment for
threadworm infestations; adjunct in hookworm, whipworm, or
roundworm.

Independent University Hospital FORMULARY 2010


34 CONTRA-INDICATIONS
Pregnancy (teratogenesis in animal studies)

ADVERSE EFFECTS
Anorexia, nausea, vomiting, dizziness, diarrhoea, headache,
pruritus, drowsiness; hypersensitivity reactions including fever,
chills, angioedema, rashes, arythema multitus, collapse
parenchymal liver damage.

DOSAGE, FORM & STRENGTH


A Tab: 40mg
N Syp: 40/5ml
25 mg/kg (maximum 1.5g) every 12 hours for 3
T days.
I

H
E
L
M
I
N
T
H
I
C
S

Independent University Hospital FORMULARY 2010


5- ANTI TUBERCULOUS DRUGS 35

5.1 ETHAMBUTOL
INDICATIONS
Prophylaxis and treatment of tuberculosis only in conjunction with
other anti-tuberculosis drugs.
A
CONTRA-INDICATIONS N
Optic neuritis, impaired renal function. T
ADVERSE EFFECTS I
Optic neuritis (related to dose and duration of treatment).
Anaphylactic reactions. T
Anorexia, nausea, vomiting, abdominal distress. U
Fever, malaise headache dizziness.
Elevated serum uric acid level.
B
E
DOSAGE, FORM & STRENGTH R
Tab: 400mg C
Adults; U
15mg/kg daily as a single dose. L
O
Children;
Treatment, 25mg/kg daily as a single dose for 60 days, then
U
15mg/kg daily as a single dose. S
Available as: D
Myambutol, Pulmobutol
R
5.2 ISONIAZID U
INDICATIONS G
Tuberculosis, in combination with other drugs; prophylaxis. S
CONTRA-INDICATIONS
Drug-induced liver disease.

Independent University Hospital FORMULARY 2010


36 ADVERSE EFFECTS
Nausea, vomiting, peripheral neuritis (prophylaxes is done with
high dose pyridoxine). Optic neuritis, convulsions, psychotic
episodes; hyper sensitivity reactions, fever, erythema multiforme,
purpura; agranulocytosis; hepatitis especially over age of 35
years; systemic lupus erythematosus, pellagra hyperglycaemia &
A gynaecomastia.
N DOSAGE, FORM & STRENGTH
T Tab: 100mg.
I By mouth or by injections.
Adult: 300mg daily.
T Children: 5-10mg / kg daily, 300mg maximum
U Available as:
B Aceta INH, Isonex Forte
E
R 5.3 PYRAZINAMIDE
INDICATIONS
C Treatment of tuberculosis only in conjunction with other anti-
U tuberculous drugs.
L
CONTRA INDICATIONS
O Liver disease, pregnancy
U
S ADVERSE EFFECTS
Hepatitis which can be minimized by dosage adjustment,
photosensitivity.
D
R DOSAGE, FORM & STRENGTH
U Tab: 500mg
G Adults;
S 20-30mg/kg daily in divided doses,
maximum 3gm daily.

Children;
Not recommended.

Independent University Hospital FORMULARY 2010


37
Available as:
Pyrazin, Pyrazid, Pyrazinamide

5.4 RIFAMPICIN
INDICATIONS
Tuberculosis A
CONTRA-INDICATIONS N
Jaundice, porphyria T
I
ADVERSE EFFECTS
Gastro-intestinal symptoms including anorexia, nausea, vomiting,
diarrhoea (pseudomebranouscohti sreported). T
Those occurring mainly on intermittent therapy include Influenzae U
like syndrome (with chills, fever, dizziness, bone pain), respiratory B
symptoms (including shortness of breath), collapse and shock. E
Hemolytic anaemia, acute renal failure, thrombocytopenic
purpura; alterations of liver function, jaundice; flushing, urticaria,
R
and rashes. C
Other side-effects reported include oedema, muscular weakness U
and myopathy, leucopenia, eosinophilia, menstrual disturbances. L
Urine, saliva, and other body secretions coloured orange-red.
O
DOSAGE, FORM & STRENGTH U
Cap or Tab: 150mg, 3(M)mg, 450mg, 600mg. S
Syp: 200mg/10ml.
Less than 50kg 450mg
more than 50kg 600mg
D
under 2 years: 10mg per kg R
U
Available as: G
Rifapin, Rifacin
S
5.5 STREPTOMYCIN
INDICATIONS
Broad spectrum antibiotic therapy particularly for mixed infec-
tions.
Independent University Hospital FORMULARY 2010
38 CONTRA-INDICATIONS
In patients who have shown previous hypersensitivity
reactions.

ADVERSE EFFECTS
Proteinuria. Increased SGOT, SGPT. Increased or decreased
A reticulocyte count.
Tinnitus. Confusion, disorientation.
N Purpura. rash, urticaria.
T Numbness, skin tingling. Nausea, vomiting.
I Pulmonary fibrosis.

DOSAGE, FORM & STRENGTH


T Adults: 1gm daily.
U
B Available as:
E Polybiotic Streptomycin
R
C
U
L
O
U
S

D
R
U
G
S

Independent University Hospital FORMULARY 2010


Dosage Guidelines Recommended by WHO 39

For Treating TB Patients.


DOSAGE DOSAGE
DRUGS mg/kg/day
DRUGS mg/kg/day

Rifampicin (R) 10 (8-12) PZA (P) 25 (20-30) A


N
INH (H) 5 (4-6) Streptomxcin (S) 15 (12-18)
T
I

Ethambutol (E) 15 (15-20) Thiaocetazone (T) 2.5 T


U
B
Weight Initial Phase Continuation E
Category Myrin-P Forte Phase Myrin R
C
30-39kg 2 Tablets 2 Tablets
U
L
40-54kg 3 Tablets 3 Tablets O
U
55-70kg 4 Tablets 4 Tablets S

Rifampicin 150mg D
Myrin-P Ethambutol 275mg R
Forte Isoniazid 75mg U
Pyrazinamide 400mg G
Rifampicin 150mg S
Myrin Ethambutol 275mg
Isoniazid 75mg

Independent University Hospital FORMULARY 2010


40 6- ANTI PROTOZOAL DRUGS
6.1 CHLOROQUINE PHOSPHATE
INDICATIONS
Malaria, hepatic, amoebiasis, giardiasis, rheumatoid arthritis.

CONTRA-INDICATIONS
Headache, GI distress. Skin eruptions, depigmentation, hair loss,
A blurred vision, corneal opacities, retinal damage. Blood disorders.
N
DOSAGE, FORM & STRENGTH
T
Tab: 150mg.
I Syp: 50mg / 5ml.
Inj:
P
Adults;
R Initial dose 600mg followed by 300mg after 6 hours, 300mg daily
O for 2days.
T
Children;
O
Malaria suppressive, 5mg/kg as chloroquine base at weekly
Z intervals.
A
L Available as:
Resochin, Nivaquine, Geniquin
D 6.2 PYRIMETHAMINE WITH SULFADOXINE
R INDICATIONS.
U Prevention and treatment of plasmodium falciparum malaria.
G
CONTRA-INDICATIONS
S Suplphonamide sensitivity, severe liver or kidney dysfunction,
blood dyscrasias, neonales. pregnancy and lactation.

ADVERSE EFFECTS
Skin rash, (discontinue immediately), pharyngitis, pruritus, G.I.
disturbance, skin rashes, blood dyscrasisas, erythema multiforme,
Stevens-Johnson syndrome and Lyell's syndrome.
Independent University Hospital FORMULARY 2010
DOSAGE, FORM & STRENGTH 41
Tab: 500mg +25mg
Susp:

SUSPENSION
Adults (Curative dose): 15ml in single dose.
Children (Curative single dose).
Under 4 years; 2.5ml.
4-6 years; 5ml.
7-9 years; 7.5ml.
A
10-14 years; 10ml. N
T
Prophylactic dose; I
Adults;
Non-Immune subjects, 5ml as a single dose once in a week.
Semi-immune subjects, 10-15ml once every four weeks. P
Children; R
Under 4 years: 2.5ml as a single dose.
O
4-8 years: 5ml as a single dose.
9-14 years: 7.5ml as a single doses. T
The mentioned prophylactic dose is once every 2 wks for O
nonimmune subjects while once every 4 weeks for semi-immune Z
subjects. A
TABS.
L
Prophylaxis
Adults; D
Over 14 years; 1 weekly treatment 2-3 as a single dose.
R
Children; U
Under 9-14 years; 3/4 adults dose-Treatment. G
Available as:
S
Fansidar, Amalar, Melofin

6.3 ARTHEMETHER WITH LUMEFANTRINE


INDICATIONS
Treatment of uncomplicated falciparum malaria, treatment of
benign matane.
Independent University Hospital FORMULARY 2010
42 CONTRA-INDICATIONS
Arrhythmia

ADVERSE EFFECT
Abdominal pain, anorexia, diarrhoea, vomiting, nausea, palpita-
tions, cough, headache, dizziness, sleep disturbances, arthralgia
pruritus rash.

A DOSAGE
20mg Tab
N 4 tablets initially followed by 5dose of tables each at
T 8,24,36,48,60 hours.
I
Available as:
Amblum, Co-methe, Exafal, Falcinil, Gen-m
P
R
O
T
O
Z
A
L

D
R
U
G
S

Independent University Hospital FORMULARY 2010


7- GASTRO INTESTINAL DRUGS 43

ANTIULCER DRUGS
7.1 MAGNESIUM TRISILICATE
INDICATIONS G
Dyspepsia A
S
CONTRA-INDICATIONS
Hypophospataemia
T
R
ADVERSE EFFECTS O
Diarrhoea, Belching due to liberated CO2

DOSAGE, FORM & STRENGTH I


Tablet: 2-3 tabs 4-6 times in a day. N
T
Available as:
Gelusil, Gaviscon, Simethicone, Mucaine
E
S
7.2 SUCRALFATE T
INDICATIONS I
Benign gastric and duodenal ulceration; chronic gastritis.
N
CONTRA- INDICATIONS A
Renal impairment. L
ADVERSE EFFECTS
Constipation; diarrhoea, nausea, indigestion, gastric discomfort, D
dry mouth, rash, puritus, back pain, dizziness, insomnia, vertigo R
and drowsiness. U
DOSAGE, FORM & STRENGTH
G
Tab: 1g S
2g twice daily or 1g 4 times daily. 1 hour before meals and at
bedtime, taken for up to 6 weeks or in resistant cases 12 weeks;
maximum 8g daily.

Independent University Hospital FORMULARY 2010


44 Prophylaxis of stress ulceration; suspension 1g 6 times daily
maximum 8g daily.

Available as:
Crafilm, Ulcocid, Ulsanic
G 7.3 CIMETIDINE
A INDICATIONS
S Benign gastric and duodenal ulceration, reflux oesophagitis,
T Zolinger-Ellison's syndrome.
Other conditions where gastric acid reduction is beneficial.
R
O CONTRA-INDICATIONS
Impaired renal function, malignancy, pregnancy lactation.
I ADVERSE EFFECTS
N Altered bowel habits, dizziness, rash, tiredness; reversible
T confusional states, reversible liver damage, headache, decreased
E blood counts, muscle or joint pain, hypersensitivity.
S Bradycardia and AV block; interstitial nephritis and acute pancre-
atitis.
T Gynaecomastia is also an occasional problem with cimetidine but
I usually only in high dosage.
N
A DOSAGE, FORM & STRENGTH
Tab: 400mg
L
Inj: 200mg IM, IV.

D Adults;
R By mouth, 400mg twice daily and at night or 500mg at night.
Benign gastric and duodenal ulceration for at least 4 weeks.
U
6 weeks in gastric ulceration.
G 8 weeks in NSAID -associated ulceration.
S
Children; 20-30mg/kg daily in divided doses.
By slow intravenous injections, 200mg given one at least 2
minutes; may be repeated every 4-6 hours.
By intravenous infusion, 400mg in 100 ml of 0.9% sodium
Independent University Hospital FORMULARY 2010
choloride infused over 30-60 minutes (may be repeated every4-6 45
hour) or by continuous infusion at one average rate of 50-
100mg/hour over 24 hours, maximum 2.4g daily.

Available as:
Cimet, Ulcerax, Tagamet, Ulcedine
G
7.4 RANITIDINE A
INDICATIONS S
Benign gastric and duodenal ulceration, stomah ulcer, reflux T
oesophagitis. Zollinger-Ellison syndrome, other conditions where
reduction of gastric acid is beneficial.
R
O
CONTRA-INDICATIONS
Malignancy, pregnancy & lactation, I
ADVERSE EFFECTS
N
Headache, dizziness. T
Rarely hepatitis, thrombocytopenia, leucopenia, hypersensitivity, E
confusion, breast symptoms. S
DOSAGE, FORM & STRENGTH
T
Tab: 150mg, 300mg I
Inj: 150 mg/ml N
A
Adults;
By mouth, 150mg twice daily morning and night or 300mg at L
night,
Benign gastric and duodenal ulceration for 4 to 8 weeks, 6 weeks D
in NSAID-associated ulceration; in duodenal ulcer 300mg can be R
given twice daily for 4 weeks to achieve a higher healing rate. U
Children; G
Peptic ulcer 2-4 mg/kg twice daily. Maximum 300 mg S
daily.
Maintenance; 150mg at night.

Prophylaxis of NSAID- induced duodenal ulcer, 150mg twice daily.


Independent University Hospital FORMULARY 2010
46 Reflux oesophagitis; 150mg twice daily or 300mg at night for up to
8 weeks.
Zollinger-Ellison syndrome; 150mg 3 times daily increased if
necessary to up to 6g daily to divided doses.
Before introduction of anaesthesia; intravenous injection diluted

G to 20ml and given over at least 2 minutes or by mouth, 150mg 2


hours before induction of anaesthesia, and also when possible on
A the proceeding evening.
S By slow intravenous injection, 50mg diluted to 20ml and given
T over at least 2 minutes; may be repeated every 6-8 hours.
R Prophylaxis of stress ulceration, initial slow intravenous injection
O of 50mg then continuous infusion, 125-250 micrograms/kg per
hour (may be followed by 150mg twice daily by mouth when oral
feeding commences).
I
N Available as:
T Zantac, Nulcer, Ranulcid, Pepticure
E
7.5 OMEPRAZOLE
S Proton pump inhibitors inhibit the secretion of gastric acid by
T blocking the proton pump.
I
N CONTRA-INDICATIONS
pregnancy, liver disease.
A
L ADVERSE EFFECT
nausea, vomiting, flatulence, diarrhoea, headache, dizziness,
D gynaecomastia.
R DOSAGE
U 20mg 00 for 4 weeks (D4)
G 20mg 00 for 8 weeks (G4)
S IV infusion 40mg 1 hours

Available as:
Losec, Omega, Risek, Omezol, Teph 20

Independent University Hospital FORMULARY 2010


7.6 KAOLIN PECTIN 47
INDICATIONS
Diarrhoea, dysentery

CONTRA-INDICATIONS
In acute diarrhea kaolin pectin is not recommended.
G
ADVERSE EFFECTS A
No significant adverse effects are known.
S
DOSAGE, FORM & STRENGTH T
Susp R
Adults; 10-30ml every four hours.
O
Children under 1 year; 5ml.
1-5 years; 10ml. I
Over 5 years; 10-30ml. All every four hours. N
T
Available as:
Streptomagma, Diarhol, Kaltin E
S
7.7 LOPERAMIDE HCL T
INDICATIONS
I
Symptomatic treatment of acute diarrhea.
N
CONTRA-INDICATIONS A
Ulcerative colitis, anti-biotic associated diarrhea. L
ADVERSE EFFECTS
Abdominal cramps, dizziness, drowsiness and skin reaction. D
R
DOSAGE, FORM & STRENGTH
U
4mg initially followed by 2mg after each stool.
G
Available as: S
Imodium, Lomide

Independent University Hospital FORMULARY 2010


48 ANTI-EMETICS

7.8 CYCLIZINE
INDICATIONS
Inj: for prevention and treatment of nausea and vomiting and
G drug-induce vomiting, especially that associated with the adminis-
A tration of narcotic drugs.
CONTRA-INDICATIONS
S Contra-indicated during drive
T
R ADVERSE EFFECTS
O Drowsiness, occasional dry mouth and blurred vision; cyclizine
may aggravate severe heart failure and counteract the
haemodynamic benefits of opioids.
I
N DOSAGE, FORM & STRENGTH
T Tab: 50mg
E Syp: 12.5mg/ml
S Inj: 50mg/ml
T Adults; 1 amp IV/IM upto three times a day.
I
N Children over 12 years; 4 tsp.
A 6-12 years; 2 tsp.
L 2-5 years; 1 tsp. All three times daily.

Adults; 1 tab
D Children over 12 years; 1 tab.
R 6-12 years; ½ tab.
U 2-5 years; 1/4 tab. All three times daily.
G
Available as:
S Marzine, Migril, Tagril

Independent University Hospital FORMULARY 2010


7.9 DIMENHYDRINATE 49
INDICATIONS
Vertigo, Nausea and vomiting . Motion sickness.

CONTRA-INDICATIONS
Comatose or greatly depressed state, hypersensitivity, pressure of
large amounts of CNS depressants, bone marrow depression, G
blood dyscrasias, sub cortical brain damage, Parkinson’s disease, A
liver damage, jaundice, renal insufficiency, cerebral arteriosclero- S
sis, coronary disease, severe hypotension or hypertension, mitral T
insufficiency, pheochromocytoma.
R
ADVERSE EFFECTS O
Sedation, extra pyramidal syndrome, anticholinergic effects and
orthostatic hypertension. I
DOSAGE, FORM & STRENGTH N
Tab: 50mg T
Inj: 50mg/ml E
Syp: 12.5mg/4ml S
Drops/ Tabs
T
Adults; 50-100 two or three times daily. I
N
1-6 years; 12.5-25 mg. A
7-12 years; 25-50 mg; both two or three times daily.
Children under 1 year; Not recommended.
L

Inj: By IM/IV inj (same quantitiy as mentioned above). D


R
Available as:
Gravinate, Devinate U
G
7.10 METOCLOPRAMIDE HYDROCHLORIDE S
INDICATIONS
Nausea and vomiting, particularly in gastro-intestinal disorders
and treatment with cytotoxics or radiotherapy.

Independent University Hospital FORMULARY 2010


50 CONTRA- INDICATIONS
Recent gastro-intestinal surgery, prolactin-dependent breast
carcinoma, phaeochromocytoma.

ADVERSE EFFECTS
Extra pyramidal effects especially in children/young adults,
G hyperprolactinaemia, occasionally dysikinesia on prolonged
A administration, drowsiness, restlessness, diarrhoea and depres-
S sion.
T DOSAGE, FORM & STRENGTH
R Tab: 10mg.
O Syp: 5mg/5ml.
Inj: 5mg/ml.
I Adults;
N By mouth, or by intramuscular injection or by intravenous injection
T over 1-2 minutes, 10mg 5mg.
E
S Young adults 15-19 years under 60 kg; 3 times daily.
Children upto 1 year or upto 10 kg; 1 mg twice daily.
T 1-3 years or 10-14 kg; 1 mg 2-3 times daily.
I 5-9 years or 20-29 kg; 2.5mg 3 times daily.
N 9-14 years or 30 kg and over; 5mg 3 times daily.
A
Available as:
L Metomid, Maxolon, Clopan

D 7.11 ONDANSETRON
R 5HTs antagonist which block 5HT3 receptors in the GIT and CNS
U INDICATIONS
G Vomiting
S
CONTRA-INDICATIONS
Pregnancy, hepatic, impairment

Independent University Hospital FORMULARY 2010


ADVERSE EFFECT 51
constipation headache, flushing, hiccups

DOSAGE
8mg TDS oral IV

Available as: G
Zofran, Ondanles, Ondison, Onset, Setron A
S
7.12 PROCHLORPERAZINE T
INDICATIONS
R
Vomiting, Vertigo, Labyrinthine disorders
O
CONTRA-INDICATIONS
Pregnancy, hepatic, impairment I
N
ADVERSE EFFECT
Sedation, Extra pyramidal effects.
T
E
DOSAGE S
5-20mg 3 times, Maximum 75-100mg T
I
Available as:
Stemetil, Dometil
N
A
ANTI-SPASMODICS L

7.13 ATROPINE SULPHATE D


INDICATIONS
R
Used prior to the administration of general anaesthesia.
Concomitantly with Neostigmine to counteract Muscarinic effects. U
As antidote for oregano-phosphorous insecticide poisoning, G
mushroom poisoning. S
CONTRA-INDICATIONS
Closed angle glaucoma, Patients with narrow angle between the
iris and cornea, gastric or duodenal ulcer causing stenosis and
Independent University Hospital FORMULARY 2010
52 significant gastric retention; urinary retention in prostate hypertro-
phy, paralytic ileus, debilitated patients with esophageal reflux or
oesophagitis.
Since heat loss through sweating is suppressed, caution in high
ambient temperature as hyperpyrexia may result, Particularly in
G infants.
A ADVERSE EFFECTS
S Xerostomia, altered taste perception, nausea, vomiting,
T dysphagia, heartburn, constipation, bloated feeling, paralytic
R ileus, gastrointestinal reflux.
Urinary hesitancy and retention, impotence.
O Blurred vision, mydriasis, photo phobia, cyclophegia, increased
intra ocular pressure. Palpitation, bardycardia following low dose.
I Headache, flushing, nervousness, drowsiness, weakness, dizzi-
N ness, insomnia, fever.
T Suppression of lactation, nasal congestion, severe allergic reac-
tions or drug idiosyncrasies including anaphylaxis and urticaria.
E
S DOSAGE, FORM & STRENGTH
T Inj: 0.5 mg/ml
I Adults; 0.4-0.6mg IV
Children; 0.02mg/kg body weight IV at the time
N of induction or IM
A 30 minutes before induction with a maximum dose of 0.6mg.
L Infants below 5kg; 0.5 to 0.1 mg.

Available as:
D Atrolate, Isopto Atropine, Motilex
R
U 7.14 HYOSCINE
G INDICATIONS
S Smooth muscle spasm

CONTRA-INDICATIONS
Closed angle glaucoma.

Independent University Hospital FORMULARY 2010


ADVERSE EFFECTS 53
Dry mouth with difficulty in swallowing and thirst, dilatation of the
pupils with loss of accommodation and sensitivity to light,
increased intra-ocular pressure, flushing, dry skin, bradycardia
followed by tachycardia, palpitation and constipation; rarely fever,
confusional states and rashes.
G
DOSAGE, FORM & STRENGTH A
Tab/Injection S
Adults; T
1 amp IM or IV R
1 tab tds. O
Available as:
Buscopan, Spasler, Spasmogin I
N
7.15 DOMPERIDONE T
INDICATIONS
E
Nausea, vomiting, dyspepsia, gastroesophegeal reflex.
S
CONTRA-INDICATIONS T
renal impairment pregnancy, breast feeding, prolactinoma, I
hepatic impairment.
N
ADVERSE EFFECT A
GI disturbance, increased prolactin concentration, extapyramidal L
effects and rashes.

DOSAGE
D
Adult R
35kg 10-20mg 3-4 time 80mg max U
85kg 250-500mg/kg 3-4 time G
2.4mg/kg max daily Peridone
S
Available as:
Motilium, Pelton, Domcin, Peridone

Independent University Hospital FORMULARY 2010


54 7.16 MEBEVERINE
INDICATIONS
Adjunct in GI disorders characterized by smooth muscle spasm.

CONTRA-INDICATIONS
paralytic ileus
G
A ADVERSE EFFECT
S Allergic reaction
T DOSAGE
R Adult
O 130-150mg 3 times daily.

Available as:
I Colofac, Zeespa, Mevrin
N
T 7.17 ORAL REHYDRATION SALTS (ORS)
INDICATIONS
E Fluid and electrolyte loss in diarrhoea.
S
T CONTRA-INDICATIONS
Hypertension
I
N ADVERSE EFFECTS
A No significant adverse effects
L
DOSAGE, FORM & STRENGTH
NaCl 3.5%, Trisodium citrate dehydrate 2.0% sachet. According to
D fluid loss, usually 200-400 ml solution after every loose motion.
R
U Infant; 1-1 ½ times usual feed volume
Children; 200ml after every loose, motion
G
S

Independent University Hospital FORMULARY 2010


8- CARDIOVASCULAR DRUGS 55

8.1 ATENOLOL
INDICATIONS
Cardiac dysrhythmias, treatment of myocardial infraction. Early
and late intervention after myocardial infraction.
Management of hypertension, angina pectoris. Cardiac
dysrhythmias. C
Treatment of myocardial infraction. Early and late intervention after A
myocardial infraction. R
CONTRA- INDICATIONS
D
Asthma or history of obstructive airways disease, uncontrolled I
heart failure, sick sinus syndrome, second or third degree heart O
block, cardiogenic shock. V
ADVERSE EFFECTS
A
Brady cardia, heart failure, broncho spasm, peripheral S
vasoconstriction, gastro-intestinal disturbances, fatigue, sleep C
disturbances; U
Rare reports of rashes and dry eyes.
L
DOSAGE, FORM & STRENGTH A
Tab: 50mg,100mg, R
Hypertension: 50 or 100mg once daily. D
Angina; Usually 100mg once daily or 50mg twice
daily. R
Dysrhythmias U
Initial dose. 2.5mg IV inj over 2.5 min. can be repearetd at 5 min G
intervals until response observed max 10mg infusion: 0.15 mg/kg S
over 20 min. Oral maintenance dose 50-100 mg once daily.

Myocardial infraction.
Early intervention within 12 hours; 5-10mg slow IV inj. (1mg/min);
50mg orally 12 hour later; then 100mg once daily commencing
12 hours later.
Independent University Hospital FORMULARY 2010
56 Late Intervention: 100mg daily for long term prophylaxis of
myocardial infraction.

Children;
Not recommended.

Available as:
Tenormin, Cartac, Pule
C
A 8.2 CAPTOPRIL
R INDICATIONS
D Mild to moderate hypertension as adjunct to thiazide diuretics.
Severe hypertension where other measures have failed.
I Adjunct to diuretics and , where appropriate, digitalis in congestive
O cardiac failure.
V
CONTRA- INDICATIONS
A
Neutropenia, agranulocytosis, proteinuria, hypotension, rash, loss
S of taste, cough (rare).
C
U ADVERSE EFFECTS
L Neutropenia, agranulocytosis, proteinuria, hypotension, rash, loss
of taste, cough (rare).
A
R DOSAGE, FORM & STRENGTH
Tab: 25mg
D Hypertension.
R Mild to moderate hypertension. Initially 12.5mg twice daily with a
U thiazide.
G Maintenance;
25-50mg twice daily increasing gradually at 2-4 week intervals.
S
Congestive cardiac failure, initially 6.25mg or 12.5mg.
Maintenance;
25mg three times daily. Maximum 150mg daily.

Available as:
Capoten, Catoper
Independent University Hospital FORMULARY 2010
8.3 DIGOXIN 57
INDICATIONS
Digitalis therapy, particularly congestive heart failure.

CONTRA-INDICATIONS
Ventricular tachycardia. Hypertrophic obstructive cardiomyopathy.
Elective electro-conversion. Hypercalcaemia.

ADVERSE EFFECTS C
Gastrointestinal, visual and conduction disturbances. A
R
DOSAGE, FORM & STRENGTH
Tab: 0.25mg D
Inj: 0.25mg/ml I
O
Adults Maintenance; 250-500mg daily. V
Elderly Maintenance; 125-250 mg daily.
A
Children Maintenance; Usually 10-20mcg/kg daily in
single or divided doses. S
C
Available as: U
Digox, Digoxin, Doxin, Lanoxin
L
8.4 DILTIAZEM A
INDICATIONS R
Angina pectoris

CONTRA- INDICATIONS
D
nd rd
Pregnancy. Sickness syndrome; 2 or 3 degree AV block, ankle R
oedema, nausea, headache, rash. U
G
DOSAGE, FORM & STRENGTH
Tab: 30mg S

Adults;
Usually 60mg three times daily, increasing if necessary to maxi-
mum 480mg daily in divided doses. Initially 60mg twice daily.

Independent University Hospital FORMULARY 2010


58 Children; Not recommended.

Available as:
Herbesser, Tiazem

8.5 DOBUTAMINE HYDROCHLORIDE


INDICATIONS
Inotropic support in infraction, cardiac surgery, cardiomyopathies,
C septic shock, and carcinogenic shock.
A
R CONTRA-INDICATIONS
D Severe hypotension complicating to cardiogenic shock.
I ADVERSE EFFECTS
O Tachycardia and marked increase in systolic blood pressure
V indicate over dosage.
A DOSAGE, FORM & STRENGTH
S Inj 250mg, By intravenous infusion, 2.5-10 micro-
C grams/kg/minute, adjusted according to response.
U
Available as:
L Dobex, Dobuject, Dobutamed
A
R 8.6 DOPAMINE HYDROCHLORIDE
INDICATIONS
Cardiogenic shock ininfraction or cardiac surgery.
D
R CONTRA-INDICATIONS
U Tachyarrhythmia and phaeochromocytoma.
G ADVERSE EFFECTS
S Nausea and vomiting, peripheral vasocontriction, hypotension,
hypertension, tachycardia.

DOSAGE, FORM & STRENGTH


Inj: 200 mg/ml
By intravenous infusion, 2-5 micrograms/kg/ minute initially.

Independent University Hospital FORMULARY 2010


59
Available as:
Dopamine, Intropin, Tropin

8.7 ENALAPRIL MALEATE


INDICATIONS
All grades of essential hypertension; congestive heart fail-
ure(adjunct).
C
CONTRA0INDICATIONS A
Hypersenitivity to ACE inhibitors: known or suspected renovasular R
disease, aortic stenosis or outflow tract obstruction; pregnancy;
porphyria.
D
I
ADVERSE EFFECTS O
Persistent dry cough, throat discomfort, voice changes, dizziness. V
Headache, fatigue, weakness, hypertension, change of taste, sore A
mouth, nausea, diarrhoea, muscle cramps, rash and
angioedema.
S
Rarely pancreatitis, renal impairment; pancreatitis. C
U
DOSAGE, FORM & STRENGTH L
Tab: 5mg, 10mg
Adults;
A
Hypertension, initially 5mg daily; if used in addition to diuretic, in R
elderly patients, or in renal impairment, initially 2.5 mg daily.
Maintenance dose;
D
10-20mg daily; maximum 40mg daily.
Heart failure (adjunct), initially 2.5mg daily Maximum 10-20mg R
daily. U
G
Available as:
S
Renitec, Ramitace, Cardace

8.8 ISOSORBIDE DINTRATE


INDICATIONS
Prophylaxis and treatment of angina; left ventricular failure.

Independent University Hospital FORMULARY 2010


CONTRA-INDICATIONS
60
Marked amaemia, head trauma, cerebralhaemorrhage, closed-
angle glaucoma.

ADVERSE EFFECTS
Throbbing headache, flushing dizziness, postural hypotension,
tacycardia.
C DOSAGE, FORM & STRENGTH
A Tab: 5mg, 10mg
R Sublinually, 5-10mg
By mouth, daily in divided doses, angina 30-120mg, left ventricu-
D
lar failure 40-160mg, up to 240mg if required,
I By intravenous infusion, 2-10mg/hour.
O
V Available as:
A Isoket, Isdin, Isobid, Isocord
S 8.9 GLYCERYL TRINITRATE
C INDICATIONS
U Prophylaxis and treatment of angina; left ventricular failure.
L
CONTRA-INDICATIONS
A Marked anaemia, head trauma, cerebral hemorrhage, closed-
R angle glaucoma.

ADVERSE EFFECTS
D Throbbing headache, flushing, dizziness, postural hypotension,
R tachycardia.
U
G DOSAGE, FORM & STRENGTH
Tablets.
S Injection.
Sublingually, 0.3-1mg. Repeated as required.
By mouth, 2.6-6.4mg as modified-release tablet, 2-3 times daily;
Severe angina, 10mg 3 times daily.
By intravenous infusion, 10-200 micro-grams/minute.

Independent University Hospital FORMULARY 2010


Available as: 61
Angiocard, Angised, Nitronal

8.10 METHYLDOPA
INDICATIONS
Hypertension, in conjuction with diuretic; hypertensive crisis when
immediate effect not necessary.

CONTRA-INDICATIONS C
History of depression, active liver disease, pheochromocytoma; A
porphyria. R
ADVERSE EFFECTS
D
Dry mouth, sedation, depression, drowsiness, diarrhoea, fluid I
retention, failure of ejaculation, liver damage, hemolytic anaemia, O
lupus erythematosus-like syndrome, parkinsonism, rashes, nasal V
stiffness. A
DOSAGE, FORM & STRENGTH
S
Tab: 250mg C
Inj: 250mg U
L
Adults;
By mouth, 250mg 2-3 times daily, gradually increased at intervals A
of 2 or more days; maximum daily dose 3g. R
Elderly;
125 mg twice daily initially, gradually increased; maximum daily
D
dose 2g. R
By intravenous infusion, methyl dopamine hydrochloride 250- U
500mg, repeated after 6 hours if required. G
Available as:
S
Aldomet, Hypergen, Llskomet, Normet

8.11 NIFEDIPINE
INDICATIONS
Prophylaxis and treatment of angina; hypertension; Reynaud’s
phenomenon.
Independent University Hospital FORMULARY 2010
62 CONTRA-INDICATIONS
Cardiogenic shock; advanced aortic stenosis; pregnancy;
porphyria.

ADVERSE EFFECTS
Headache, flushing, dizziness lethargy, also gravitational oedema,
rash, nausea, increased frequency of micturition, eye pain, gum
hyperplasis; depression reported; telangiecasia reported.
C
A DOSAGE, FORM & STRENGTH
R Cap: 10mg
D
Adults & Elderly;
I Angina and Reynaud’s phenomenon, initially 10mg (elderly) 3
O times with or after food.
V
Maintenance;
A 5-20 mg 3 times daily, for immediate effects in angina bite into
S capsule and retain liquid in mouth or swallow.
C
U Available as:
Adalat, Nifed, Nifelat
L
A 8.12 PROPRANOLOL HYDROCHLORIDE
R INDICATIONS
Management of hypertension, angina pectoris. Prophylaxis after
D myocardial infraction, cardiac dysrhymais, migraine. Tremor,
anxiety, prophylaxis of upper gastrointestinal bleeding in patients
R with portal hypertension and oesphageal varices.
U
G CONTRA-INDICATIONS
S Asthma or history of obstructive airways disease, uncontrolled
heart failure, sick sinus syndrome, second or third degree heart
block, cardiogenic shock.

ADVERSE EFFECTS
Bradycardia, heart failure, broncho spasm, peripheral
Independent University Hospital FORMULARY 2010
vasoconstricition, gastrointestinal disturbances, fatigue,sleep 63
disturbances.
Rare reports of rashes and dry eyes (reversible on withdrawal).

DOSAGE, FORM & STRENGTH


Tab: 10mg, 40mg
Inj: 1mg/ml
Adjust dosage according to response. C
Hypertension:
Adults; A
Usually 160-320mg daily. R
Angina pectoris usually 120-240mg daily. D
Anxiety, migraine, essential tremor: Usually 120-240mg daily.
I
Children; O
Migraine: 20mg orally two or three times daily. V
Adults;
A
80-320 mg daily. S
Post myocardial infraction. Begin 5-21 days post infact, 40mg four C
times daily for 2-3 days, then 80mg twice daily or 160mg once U
daily. L
Emergency treatment of dysrhythmias: 1mg given over 1 min. May
be repeated at 2 min intervals to a maximum of 10mg (concious
A
patients) or 5 mg (under anaesthesia). R
Children; D
Dysrhythmias (as a guide):0.025-0.05mg/kg body-wt IV injection
slowly under ECG control, three or four times daily.
R
U
Available as: G
Inderal, Opinol, Oprinol S
8.13 VERAPAMIL HYDROCHLORIDE
INDICATIONS
Treatment and prophylaxis of angina pectoris, supra ventricular
tachycardia of reciprocating type assosiated with wolff Parkinson
white syndrome.
Independent University Hospital FORMULARY 2010
64 Mild to moderate hypertension.

CONTRA-INDICATIONS
Hypotension, bradycardia, second and third-degree AV block, sick
sinus syndrome, cardiogenic shock, sino-atrial block.
History of heart failure or significantly impaired left ventricular
function, even if controlled by therapy.
C Atrialflutter or fibrillation complicating Wolff-Parkinson-White
syndro; porphyria.
A
R ADVERSE EFFECTS
D Constipation; less commonly nausea, vomiting, flushing, head-
I ache, dizziness, fatigue, ankle oedema; rarely
reversibleimpairment of liver function, allergic reactions (ery-
O thema, pruritus).
V Rarely gynaecomastia and gingival hyperplasia after intravenous
A administration, hypotension, bradycardia, heart block, and
S asystole.
C DOSAGE, FORM & STRENGTH
U Tab: 80mg
L
A Adults;
By mouth:
R Supra ventricular arrhythmias, 40-120mg 3 times daily.
Angina, 80-120mg 3 times daily.
D Hypertension, 240-480 daily in 2-3 divided doses. By slow
R intravenous injection over 2 minutes (3 minutes in elderly), 5-
U 10mg (preferably with ECG monitoring);
In paroxysmal
G
S Tachyarrthmia;
A further 5mg after 5-10 minutes if required.

Available as:
Calan, Isocardin
Independent University Hospital FORMULARY 2010
8.14 AMLODIPINE 65
Calcium channel blocker.

INDICATIONS
Hypertension, Prophylaxis of angina.

CONTRA-INDICATIONS
Cardiogenic shock, unstable angina, aortic stenosis.
C
ADVERSE EFFECTS A
Abdominal pain Nausea palpitation, Flushing, Edema, R
Headache, Dizziness, Fatigue, Sleep Disturbance. D
DOSAGE, FORM & STRENGTH I
Adults; By mouth: 5mg once a day 10mg Maximum O
V
Available as:
A
Amodip, Amlodip, Norvasc S
C
U
L
A
R

D
R
U
G
S

Independent University Hospital FORMULARY 2010


66 9- ANTI COAGULANTS
9.1 HEPARIN
INDICATIONS
Deep-vein thrombosis and pulmonary embolism. Unstable
angina, acute peripheral arterial occlusion, myocardial infarction.

CONTRA-INDICATIONS
Haemophilia & other haemorrhagic disorders, thrombocytopenia,
peptic ulcer, cerebral aneurysm, severe hypertension, severe of eye
A or nervous system, hypersensitivity to heparin.
N
DOSAGE, FORM & STRENGTH
T Inj: 5000iu/ml
I
Adults;
Deep-vein thrombosis and pulmonary embolism, by intravenous
C
injection, loading dose of 5000 units followed by continuous
O infusion of 18 units/kg per hours or by subcutaneous injection of
A 15000 units every 24 hours (both adjusted daily by laboratory
G monitoring).
U
Small Adult or Child;
L Lower loading dose then, 15-25 units/kg/hour by intravenous
A infusion, 250 units/kg every 12 hours by subcutaneous injection.
N Unstable angina, acute peripheral arterial occlusion, as intrave-
T nous regimen for deep-vein thrombosis and pulmonary embolism,
S by subcutaneous injection, 5000 units 2 hours before surgery, then
every 8-12 hours for 7 days or until patient is ambulant (monitoring
not needed); during pregnancy (with monitoring), 5000-10000
units every 12 hours.

Available as:
Ecfast, Epsoclar, Mediparine, Multiparin

Independent University Hospital FORMULARY 2010


9.2 TRANEXAMIC ACID 67
INDICATIONS
As an anti-plasm in drug in hemorrhagic disease (purpurea,
aplastic anaemia, cancer, leukemia etc.) and abnormal bleeding.

CONTRA-INDICATIONS
Thromoboembolic disease.

ADVERSE EFFECTS
Nausea, vomiting, diarrhoea; giddiness on rapid intravenous
injection.
A
DOSAGE, FORM & STRENGTH N
Cap: 250mg T
Inj: 250mg/5ml, By mouth, 1-1.5g 2-4 times daily.
I/V injection, 1g 3 times daily.
I

Available as: C
Transamin, Transcam, Tranxic, Traumax O
9.3 CLOPIDROGREL
A
Antiplatelet agent G
U
INDICATIONS L
Prevention of atherosclerotic event, MI, ischemic stroke.
A
CONTRA-INDICATIONS N
Active bleeding, Renal impairment, Pregnancy. T
ADVERSE EFFECTS
S
Dyspepsia, Abdominal pain, Diarrhea, Bleeding disorders.

DOSAGE, FORM & STRENGTH


75mg once a day Acute MI 300mg once than 75mg OD

Available as:
Platex, Ogrel, Clavix

Independent University Hospital FORMULARY 2010


68 10- DIURETICS
10.1 FUROSEMIDE
INDICATIONS
Oedema, oliguria due to renal failure.

CONTRA-INDICATIONS
Precomatose states associated with liver cirrhosis.

ADVERSE EFFECTS
Hyponatraemia, hypokalaemia, hypocholaemicalkalosis,
increased calcium exceryion, hypotension; less commonly nausea,
gastro-intestinal disturbances, hyperuricaemia and gout; hyper-
glycaemia (less common than with thiazides).
D Temporary increased in plasma cholesterol and triglyceride
I concentrations; rarely rashes and bone marrow depression
U (withdraw treatment), pancreatitis (with large parenteral doses),
tinnitus and deafness (usually with large parenteral doses and
R
rapid administration and in renal impiration).
E
T DOSAGE, FORM & STRENGTH
I Tab: 40mg
Inj: 20mg/2ml
C
S Adults;
By mouth, oedema, initially 40mg in the morning.
Maintenance 20mg daily or 40 mg on alternate days, increased in
resistant oedema to 80mg daily.

Children;
1-3mg/kg daily.
intravenous injection or slow intravenous injection (rate not
exceeding 4mg/minute), initially 20-5mg.

Children;
0.5-1.5mg/kg to maximum daily dose of 20mg.

Independent University Hospital FORMULARY 2010


69
Available as:
Fusemid, Lasix

10.2 MANNITOL
INDICATIONS
Cerebral oedema.

CONTRA-INDICATIONS
Congestive cardiac failure, pulmonary oedema.

ADVERSE EFFECTS
Chills, fever.

DOSAGE, FORM & STRENGTH


Inj: 20%, 40% I/V, D
By intravenous infusion, diuresis, 50-200g over 24 hour, I
preceded by a test dose of 200mg/kg slow intravenous injection. U
10.3 SPIRONOLACTONE
R
INDICATIONS E
Oedema and ascites in cirrhosis of the liver, malignant ascites, T
nephrotic syndrome, congestive heart failure; primary I
aldosteronism.
C
CONTRA-INDICATIONS S
Hyperkalaemia, hyponatraemia, severe renal impairment;
pregnancy and bread-feeding; Addison’s disease.

ADVERSE EFFECTS
Gastro-intestinal disturbances, gynaecomastia; hyperkalaemia;
hypotension.

DOSAGE, FORM & STRENGTH


Tab: 25mg, 100mg

Adults; 100-200mg daily, increased to 400mg if


required.

Independent University Hospital FORMULARY 2010


70 Children; Initially 3mg/kg daily in divided doses.

Available as:
Aldactazide, Aldactone, Spidar, Spiromide

10.4 BENDROFLUAZIDE
INDICATIONS
Edema, Hypertension

CONTRA-INDICATIONS
Hypokalaemia, hyponatraemia, severe renal impairment;
Hypercalcemia Addison’s disease.

ADVERSE EFFECTS
Gastro-intestinal disturbances, impotence, hypokalaemia;
D
hypotension, hyponatraemia.
I
U DOSAGE, FORM & STRENGTH
R Edema 5-10mg once daily.
hypertension 2.5mg once daily.
E
T Avialable as:
I Fortzaar, Hyzaar, Co-osar, Aldactazide, Moduretic
C
S

Independent University Hospital FORMULARY 2010


71

11- RESPIRATORY DRUGS


11.1 AMINOPHYLINE
INDICATIONS
Asthma, bronchopenumonia, bronchitis, Cheyne-Stokes respira-
tion, paroxysmal dyspnoea associated with left heart failure.

CONTRA-INDICATIONS
Allergy to theophylline, caffeine, theobromine, ethylendiamine. R
E
ADVERSE EFFECTS
Tachycardia, palpitions, nausea, gastro-intestinal disturbances,
S
headache, insomnia, arrhythmias, and convulsions especially if P
given rapidly by intravenous injection. I
R
DOSAGE, FORM & STRENGTH
Tab: 100mg
A
Inj: 250mg/ml T
O
Adults; Loading dose 6mg/kg. R
Maintenance; 0.5mg/kg/hr IV infusion. Cardiac failure: Y
0.3mg/kg/hr. Liver disease.
0.2 mg/kg/hr. Both cardiac failure and liver disease: 0.1mg/kg/hr.
Children; 5mg/kg six hourly SLOW I.V inj. D
R
Available as: U
Aminolin, Amphyll
G
11.2 EPHEDRINE HYDROCHLORIDE S
INDICATIONS
Reversible airways obstruction.

CONTRA-INDICATIONS
Hyperthyroidism, hypertension, coronary disease, prostatic
hypertrophy, hyperexcitibility, closed angle glaucoma.

Independent University Hospital FORMULARY 2010


72 ADVERSE EFFECTS
Tachycardia, anxiety, restlessness, insomnia common; also mouth,
cold extremities.
DOSAGE, FORM & STRENGTH
Tab / Inj: 50/ml

Adults;
3 times daily; 15-60mg 3 times daily.

R Children upto 1 year; 7.5 mg.


E 1-5 years; 15mg.
S 6-12years; 30mg.
P Available as:
I Abenol Plus, Deltarhinol, Efed, Ephedrine
R 11.3 SALBUTAMOL
A Short acting beta agonist
T
O INDICATIONS
Asthma and other conditions associated with reversible airways
R obstruction; premature labour.
Y
CONTRA0INDICATIONS
D Though Salbutamol inj. are recommended for the prevention of
uncomplicated premature labor associated with toxaemia of
R pregnancy or ante partum haemorrhage from whatever cause is
U contra-indicated.
G Threatened abortion during first or second trimester of pregnancy.
S History of hypersensitivity.
ADVERSE EFFECTS
Fine tremor (usually hands), nervous tension, headache, periph-
eral vasodilation tachycardiac hypokalaemia after high doses
(acsm recommends monitor plasma-potassium in severe asthma;
hypersensitivity reactions including paradoxical broncho spasm,
urticaria, andangioedema reported; slight pain on intramuscular
injection.
Independent University Hospital FORMULARY 2010
DOSAGE, FORM & STRENGTH 73
oral 2mg TDS 8mg Maximum

Children: less then 2 years 100microgram 4 times


daily.
2-6 years: 1-2mg 4 times daily.
6-12 years: 2mg 4 times daily.
subcutaneously: 500microgram 4 hourly.
Intravenous: 5microgram Initially.
Inhalation: 100-200microgram 3-4 times daily. R
Available as:
E
Ventolin, Ventomed, Bretheez-e S
P
11.4 SALMETROL I
Long acting beta agonist R
INDICATIONS A
Asthma and other conditions associated with reversible airways T
obstruction; premature labour. O
CONTRA INDICATIONS
R
Pregnancy and Breast Feeding Y
ADVERSE EFFECTS D
Oropharyegeal Irritation taste disturbance, Rash, insomnia,
Nausea, Pruritus
R
U
DOSAGE, FORM & STRENGTH G
50micrograms twice daily. S
Available as:
Servent

11.5 BECLOMETHSONE
inhaled corticosteroids

Independent University Hospital FORMULARY 2010


74 INDICATIONS
Prophylaxis of asthma.

CONTRA INDICATIONS
Tuberculosis

ADVERSE EFFECTS
Hoarsness, candidiasis

DOSAGE, FORM & STRENGTH


R 50micrograms twice daily.
E
S Available as:
Becotide, Clenil
P
I 11.6 IPRATROPIUM BROMIDE
R Anti-muscarinic bronchodilator
A
INDICATIONS
T
Reversible COPD.
O
R CONTRA INDICATIONS
Y BPH, Glaucoma.

ADVERSE EFFECTS
D Dry month, nausea, constipation, headache.
R
DOSAGE, FORM & STRENGTH
U
20-40 microgram QDS
G
S Available as:
Atrovent

11.7 DEXAMETHASONE
INDICATIONS
Emergency parenteral therapy; intra-articular and soft tissue
conditions.
Rheumatic allergic and inflammatory conditions.

Independent University Hospital FORMULARY 2010


CONTRA-INDICATIONS 75
Hypertension, renal insufficiency etc.

ADVERSE EFFECTS
Hypertension, sodium and water retention and potassium loss.
Cushing;s syndrome with moon face, striae, and acne.
Suppression of growth in children, adrenal atrophy.

DOSAGE, FORM & STRENGTH


Tab: 0.5mg
Inj: 4mg/ml vial of 5ml R
E
Adults; S
By mouth, usual range 0.5-9mg daily. By intramuscular or slow
P
intravenous injection or infusion (as dexamethasone phosphate).
Initial 0.5-20 mg. I
R
Children; A
200-500micrograms/kg daily. T
Cerebal oedema (as dexamethasone phosphate), by intravenous
injection, 10mg initially, then 4mg by intramuscular injection every
O
6 hours as required for 2-10 days. R
Y
11.8 HYDROCORTISONE SODIUM SUCCINATE
INDICATIONS
Adrenal failure; overwhelming infections (with chemotherapy).
D
R
CONTRA-INDICATIONS U
Systemic fungal infections. Known hypersensitivity to components. G
ADVERSE EFFECTS
S
Fluid and electrolyte disturbances, peptic ulceration and hemor-
rhage, impaired wound healing.

DOSAGE, FORM & STRENGTH


Inj: 250mg/2ml

Adults; 100-500mg by slow IV inj.

Independent University Hospital FORMULARY 2010


76 Children; Dose may be reduced according to severity of
condition and response but
should not fail below 25mg daily.

11.9 PREDNISOLONE
INDICATIONS
Suppression of inflammatory and allergic disorders.

CONTRA-INDICATIONS
Peptic ulceration, hypertension, diabetes.
R
E ADVERSE EFFECTS
S Hyperglycemia, osteoporosis, depression, euphoria, peptic
P ulceration, cushingoid changes.
I DOSAGE, FORM & STRENGTH
R Tab: 5mg
A
Adults;
T
By mouth, initially, up to 10-20mg daily (severe disease, up to
O 60mg daily), preferably taken in the morning after breakfast; can
R often be reduced within a few days but may need to be continued
Y for several weeks or months.

Maintenance;
D Usual range, 2.5-15mg daily, but higher doses may be needed;
R cushingoidside- effects increasingly likely with doses above 7.5 mg
U daily.
G By intramuscular injection prednisolone accetate, 25-100mg
S once or twice weekly.

EXPECTORANTS AND COUGH SYRUPS

11.10 SYP. AMINOPHYLINE


32mg

Diphenhydramine 8mg;

Independent University Hospital FORMULARY 2010


Chloride 30mg 77
Menthol 0.98mg
Alcohol 5%
Bottle of 450ml

11.11 SYP. AMMONIUM CHLORIDE 100mg


Sod Chlorpheniramine Maleate 2mg Ephidrine HCL 7 mg.
Menthol 1mg/5ml bottle of 450ml.

R
E
S
P
I
R
A
T
O
R
Y

D
R
U
G
S

Independent University Hospital FORMULARY 2010


Managment of Asthma
78

Step-1 Short acting beta 2 agonist

Step-2 Step-1+ inhaled corticosteroids

R Step-3 Step-1+step-2+ Long acting beta 2 agonist

E
S Step-1+step-2+step-3+
6weeks of
P Step-4 leukotrine receptor antagonist
I oral theophylline
oral beta 2 agonist
R
A Step-5
Step1 + step 2 + step 3 +
oral prednisolone
T
O
Moderate Acute asthma
R
Y 1. Oxygen.
2. Salbutamol/Terbutaline (Nebulise).
3. Oral Prednisolone 40-50mg.
D
R Severe Acute asthma
U 1. Oxygen.
G 2. Salbutamol/Terbutaline (Nebulise).
S 3. Oral Prednisolone 40-50mg or IV hydrocortisone
400mg in 4 divided doses.

Life threatening Acute asthma

1. Oxygen.
2. Salbutamol/Terbutaline (Nebulise).
3. Oral Prednisolone 40-50mg.
4. IV hydrocortisone 400mg in 4 divided doses
5. Ipratropium (Nebulise).

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12- OPTHALMOLOGICAL DRUGS 79

12.1 CHLORAMPHENICOL
INDICATIONS
Bacterial conjunctivitis.

ADVERSE EFFECTS
Aplastic anaemia (rare). O
P
DOSAGE, FORM & STRENGTH T
Eye drops: 0.5% H
Eye ointment: 1%
Adults & Children; A
Ointment 1 application three to four hourly. L
Drops 2 drops three hourly. M
O
12.2 GENTAMICIN
INDICATIONS L
Ocular bacterial infections. O
G
ADVERSE EFFECTS
Transient irritation, Superinfections.
I
C
DOSAGE FORM & STRENGTH A
Eye drops: 0.3% L
Adults; Children;
2-4 drops three times or four times daily and at night. D
R
12.3 SULFACETAMIDE SODIUM U
INDICATIONS
Acute conjunctivitis, superficial cornel ulcer, and other inflamma- G
tory conditions of the eyes. S
ADVERSE EFFECTS
Transient irritation.
Superinfections.

Independent University Hospital FORMULARY 2010


80 DOSAGE, FORM & STRENGTH
Eye ointment : 10%,
Eye drops: 10%, 20%
1 drops two hourly

MIOTICS AND ANTIGLAUCOMA DRUGS


O 12.4 ACETAZOLAMIDE
P INDICATIONS
T Congestive heart failure, oedema and toxaemia of pregnancy,
H pre-menstrual tension. Epilepsy, Glaucoma.
A CONTRA-INDICATIONS
L Chronic closed angle glaucoma. Renal hyperchloraemic acidosis.
M Adrenal insufficiently. Sodium or potassium depletion.
O ADVERSE EFFECTS
L F l u s h i n g, t h i r s t , h e a d a c h e , d r o w s i n e s s , p o l y u r i a ,
O paraesthesia,blood dyscrasias, excitment, rash.
G
DOSAGE, FORM & STRENGTH
I Tab: 250mg
C
A Adults;

L Initially 250-375mg once daily.


Pre-menstrual tension: 125-375mg OD 5-10 days before
menstruation.
D Epilepsy: 250mg-1mg daily in divided doses.
R Children under 2 years;
U 125mg daily; 2-12 years, 125-750mg daily in divided doses
Glaucoma.
G Adults; 1-4 daily in divided doses.
S Children & Infants; ½ tab daily; 1/2-3 tabs daily in divided
doses.

12.5 PILOCARPINE NITRATE


INDICATIONS
Glaucoma
Independent University Hospital FORMULARY 2010
CONTRA-INDICATIONS 81
Acute iritis. Soft contact lenses.

DOSAGE, FORM & STRENGTH


Eye drops: 2%, 4%
Adults & Children: 2 drops thrice daily.

MYDRIATIC / CYCLOPLEGIC DRUGS O


P
12.6 ATROPINE T
INDICATIONS
Long acting mydriatic and cycloplegic for use in uveitis and H
refraction. A
L
CONTRA-INDICATIONS
M
Narrow angle glaucoma. Soft lenses.
O
ADVERSE EFFECTS L
Transient stinging, dry mouth, blurred vision, photo phobia, O
tachycardia, headache. Psychotic reaction, behavioral changes. G
DOSAGE, FORM & STRENGTH I
Eye drops: 1% C
A
Adults and children
Uveitis, 1 drops three times daily.
L
Refraction, 1-2 drops one hour before examination.
D
12.7 HOMATROPINE HYDRO BROMIDE R
INDICATIONS
Mydriatic and cycloplegic with more rapid onset and shorter U
duration than atropine. G
S
CONTRA-INDICATIONS
Narrow angle glaucoma.

DOSAGE, FORM & STRENGTH


Eye drops: 2%

Independent University Hospital FORMULARY 2010


82 Adults & Children; 1 or more drops as required.

12.8 TROPICAMIDE
INDICATIONS
Mydriatic and cyclopegic (with a rapid recovery of accommoda-
tion) for refraction.

O CONTRA- INDICATIONS
P Unknown intra ocular pressure.
T In infants put pressure over Lacrimal sac for 1 minute.
H ADVERSE EFFECTS
A Transient sitngind, dry mouth, blurred vision, photophobia,
L tachycardia, headache, psychotic reactions, behavioral changes.
M DOSAGE, FORM & STRENGTH
O Eye drops: 1%
L
O Adults & Children;
1 or 2 drops of either strength at 1-5 min intervals.
G
I 12.9 CHLORAMPHENICOL+HYDROCORTISONE
C ACETATE
A INDICATIONS
L Ocular infections.

D CONTRA-INDICATIONS
Viral, fungal, tuberculous or purulent infections. Glaucoma.
R
U ADVERSE EFFECTS
G Rise in intra-ocular pressure, corneal thinning, cataract. Aplastic
S anaemia(rare).

DOSAGE, FORM & STRENGTH


Apply once daily to once hourly depending on severity.

Independent University Hospital FORMULARY 2010


12.10 PREDNISOLONE 83
INDICATIONS
Steroid responsive inflammation of the palpebral and bulbat
conjunctiva, cornea and anterior segment of the globe.

CONTRA-INDICATIONS
Viral, fungle tuberculous and other infections of the eye.
O
ADVERSE EFFECTS
P
Rise in intra-ocular pressure, corneal thinning cataract, fungal
infection. T
H
DOSAGE, FORM & STRENGTH A
Eye drops: 1% L
Adults & Children; M
1-2 drops 2-4 times daily. O
During initial 24-48 hours the dosage may safely be increased to 2 L
drops every hour. O
G
ANTIGLAUCOMA DRUGS
I
12.11 BETAXOLOL HYDROCHLORIDE C
INDICATIONS A
Ocular hypertension, chronic open-angle glaucoma. L
CONTRA-INDICATIONS
Sinus bardycardia, cardiogenic shock, uncompensated cardiac D
failure, soft lenses. R
U
ADVERSE EFFECTS
Transient discomfort. Rarely decreased corneal sensitivity.
G
Erythema, corneal punctate staining, keratitis. S
DOSAGE, FORM & STRENGTH
Eye drops: 0.5%

Adults; 1 drops twice daily.


Independent University Hospital FORMULARY 2010
84 Children; Not recommended.

12.12 BETAMETHASONE
INDICATIONS
Non-inflected inflammatory conditions of the eye. In opthalmology
indications include uveitis, marginal keratitis, allergic conjuntivitis,
blepharitis and episcleritis.
O
P CONTRA-INDICATIONS
Viral, fungal, tuberculous or purulent infections. Dendritic ulcer,
T
Glaucoma.
H
A ADVERSE EFFECTS
L Corneal thinning cataract, rise in intra-ocular pressure; avoid
unnecessary use.
M
O DOSAGE, FORM & STRENGTH
L Eye drops: 0.1%
O Adults & Strength: 1 or 2 drops one or two hourly.
G
I DIAGNOSTIC AGENTS
C 12.13 FLUORESCEIN SODIUM
A INDICATIONS
L Detection of lesions foreign bodies.

D
R
U
G
S

Independent University Hospital FORMULARY 2010


13- GYNAECOLOGICAL DRUGS 85

13.1 OXYTOCIN
INDICATIONS
Induction of labour in case of post maturity, premature rupture of
membranes or preeclampsia. Primary and secondary
uterineintertia. Caesarean section. Post partum uterine atomy.
G
CONTRA-INDICATIONS Y
Cephalopelvic disproportion, abnormal presentation.
N
Excessive distension of the uterus (e.g. in multiple pregnancy,
hydramnios), parity greater than 4, elderly multiport, previous. A
Caesarean section or other surgery involving the uterus. Severe E
toxaemia, predisposition to amniotic fluid embolism (foetal death C
in utero, abruption placentae), hypertonic construction, placenta O
praevia. L
ADVERSE EFFECTS O
Very occasionally prolonged or too rapid infusion of syntocinon G
has antidiuretic effects, which may cause transient water intoxica- I
tion, with headaches and nausea. C
DOSAGE, FORM & STRENGTH A
Inj: 5 iu / ml L
Induction or enhancement of labour: IV drip infusion of a 5%
dextrose solution containing 1iu syntocinon per 100 ml. D
The initial infusions rate of 1-4mU/ min=0.1-0.4ml/min )2-8
R
drops/min) may be gradually increased until the desired response
is achieved (maximum 20mU/min = 2ml/min = 40 drops/min) U
provided the foetal heart rate and the frequency and duration of G
contraction are carefully monitored. S
Third stage of labour and purpureum (hemorrhage, subinvolution
of the uterus):5-10iu IM or 5iu slowly IV.

Caesarean Section: 5iu intramurally after delivery of the foetus.

Independent University Hospital FORMULARY 2010


86 14- ANTI ALLERGIC DRUGS
14.1 ADRENALINE
INDICATIONS
Emergency treatment of acute anaphylaxis; cardiopulmonary
resuscitation.

CONTRA-INDICATIONS
A Hyperthyroidism, diabetes mellitus, ischemic heart disease,
N hypertension, elderly patients.
T
ADVERSE EFFECTS
I Anxiety, tremor, tachycardia, arrhythmias, dry mouth, cold extremi-
ties.
A
DOSAGE, FORM & STRENGTH
L
Inj: 1 in 1000/ml
L Acute anaphylaxis, by intramuscular injection, see table below
E Important: intravenous route is for cardiac resuscitation.
R These dose may be repeated every 10 minutes, according to blood
G pressure and pulse, until improvement occurs (may be repeated
several times). Volume of adrenaline injection 1 in 1000 (1mg/ml)
I for intramuscular injection in anaphylactic shock.
C
Age Volume of
D Adrenaline 1 in 1000
R Under 1 Year 0.05 mL
1 Year 0.1 mL
U
2 Years 0.2 mL1
G 3-4 Years 0.3 mL1
S 5 Years 0.4 mL1
6-12 Years 0.5 mL1
Adults 0.5-1 mL1

14.2 CHLOROPHENIRAMINE MALEATE


INDICATIONS
Symptomatic relief of allergy such as hay fever, urticaria; emer-
Independent University Hospital FORMULARY 2010
gency treatment of anaphylactic reactions. 87

CONTRA-INDICATIONS
CNS depression, hypersensitivity to Chlopheniramine Maleate
driving.

ADVERSE EFFECTS
Drowsiness, impaired reactions Dizziness.
A
DOSAGE, FORM & STRENGTH
Tab: 4 mg N
T
Adults; I
By mouth, 4mg every 4-6 hours, maximum 24 mg daily.

Children 1-2 Years; 1 mg twice daily. A


6-12 years; 2mg every 4-6 hours, maximum 12 mg L
daily. L
By slow intravenous injection over 1 minutes, 10-20mg, diluted in E
syring with 5-10 ml blood.
R
Available as: G
Avil, Flueze, Coldene I
C
14.3 PROMETHAZINE HCL
INDICATIONS
Allergic conditions D
R
CONTRA-INDICATIONS
Hypersensitivity to promethazine HCL, driving.
U
G
ADVERSE EFFECTS S
Drowsiness, impaired reactions. Dizziness, disorientation,
photosensitivity, Extra pyramidal reactions, convulsions (high
doses)

DOSAGE, FORM & STRENGTH


Syp: 5mg/5ml

Independent University Hospital FORMULARY 2010


88 Elixir/ Tabs.

Adults; 10-20mg two or three times daily.

Children under 1 years; Not recommended.


1-5 years; 5-15mg.
Over 5 years; 10-25mg. If two doses in 24
hours are required, use lower
A amount stated.
N Adults; 25-50mg by deep IM inj or slow
IV inj after dilution.
T
Children under 5 years; Not recommended.
I Over 5 years; 6.25-12.5mg by deep IM inj.

A Available as:
L Phenergan, Tixylix
L
14.4 CETRIZINE
E INDICATIONS
R Allergic conditions
G
CONTRA-INDICATIONS
I BPH, Glaucoma, Pyloroduodenal obstruction.
C
ADVERSE EFFECTS
D Drowsiness, impaired reactions. Dizziness, disorientation,
photosensitivity, Extra pyramidal reactions, convulsions (high
R doses), Urinary retention, Blurred vision.
U
G DOSAGE, FORM & STRENGTH
S 5-10mg twice daily.

Available as:
Zyrtec, Rigix, Serzine

Independent University Hospital FORMULARY 2010


14.5 LORATIDINE 89
INDICATIONS
Allergic conditions, hay fever, urticaria.

CONTRA-INDICATIONS
BPH, Glaucoma, Pyloroduodenal obstruction.

ADVERSE EFFECTS
Drowsiness, impaired reactions. Dizziness, disorientation, A
photosensitivity, Extra pyramidal reactions, convulsions (high
doses), Urinary retention, Blurred vision. N
T
DOSAGE, FORM & STRENGTH I
5-10mg twice daily.

Available as: A
Antial, Allergat, Xalar, Lorate L
L
14.6 CLEMASTINE E
INDICATIONS
Allergic conditions, hay fever, urticaria.
R
G
CONTRA-INDICATIONS I
BPH, Glaucoma, Pyloroduodenal obstruction. C
ADVERSE EFFECTS
Drowsiness, impaired reactions. Dizziness, disorientation, D
photosensitivity, Extra pyramidal reactions, convulsions (high R
doses), Urinary retention, Blurred vision. U
DOSAGE, FORM & STRENGTH
G
1mg twice daily (Maximum 6mg daily) S
Available as:
Alereas, Tandegyl

Independent University Hospital FORMULARY 2010


90 15- INTRAVENOUS FLUIDS
Electrolytes (mEq/Liter) Dextrose
BRAND NAME GENERIC NAME (as monohydrate)
Na +
K
+
Ca Mg++ ++
Cr Lactate (gms/L)

Located Ringer`s
Ringolact 130 4 2.7 – 108.7 28 –
Injection
5% Dextrose and 108.7
Ringolact-D 130 4 2.7 – 28 50
electrolytes injection
I 5% Dextrose and 60
Ringolact-M 60 20 3 – 23 55
N Electrolytes Injection

T Pladex-5
5% Dextrose
– – – –

– 55
Intravenous Infusion
R 0.9% Sodium Chloride
150
A Plasaline Intravenous Infusion
(Normal Saline)
150 – – – – –

V 10% Dextrose –
Pladex-10 – – – – – 110
E Injection Infusion

N 25% Dextrose injection


25% Dextrose
– – – –

– 275
Injection
O 5% Dextrose and
Pladexsal 154
U 0.45% Sodium
Chloride Injection
154 – – – – 50

S Pladexsal 1/2
5% Dextrose and
77
0.45% Sodium 77 – – – – 50
Chloride Injection
3.3% Dextrose and
F Pladexsal 1/3 0.3 Sodium 51 – – – 51 – 33
Chloride Injection
L 0.18% Sodium Choride
Pladexsal 1/5 30 – – – 30 – 47
U and 4.3% Dextrose
Intravenous Infustion
I Nisf Normal Saline
0.45% Sodium
77
Choride Injection 77 – – – — –
D
Composed Sodium
S Ringer`s Solution
Chloride Injection 147 4 4.4 – 156 – –

20% Mannitol
Osmotol – – – – – – –
Intravenous Infusion

Lactated Potassic
Darrow`s Solution 121 35 - – 103 53 –
Saline Injection
Peritoneal Dialysis
Peri Solution 140 -- 4 1.5 102 43.5 16
Solution

Independent University Hospital FORMULARY 2010


15.1 POLYGELLINE 91
INDICATIONS
Blood loss, plasma loss, dehydration, hypovlaemic shock, volume
losses during and after surgery, extra corporeal circulation,
hematolysis, dehydration circulation states, for use in heart-lung-
machines, for perfusion of isolated organs, plasma exchange,
intra operative hemodilution.
Carrier for low dose insulin infusion.

CONTRA-INDICATIONS I
No absolute contra-indications is known. N
In presence of relative contra-indications (e.g cardiac insufficiency, T
fixed hypertension, cardiogenic shock) infusion should be per- R
formed under proper supervision.
A
ADVERSE EFFECTS V
Wheal, transitory urticaria, skin reactions, temporary hypotension, E
raised temperature and or shivering may occur. N
DOSAGE, FORM & STRENGTH O
Inj 35mg with electrolytes bag of 500ml with set. U
As per doctor’s advise. 50ml to be infused in one hour. In emer- S
gency cases where immediate volume replacement is needed
polygeline can be infused rapidly.
F
L
U
I
D
S

Independent University Hospital FORMULARY 2010


92 16- VITAMINS AND MINERALS
16.1 ASCORBIC ACID
INDICATIONS
Vitamin C deficiency, prevention and treatment of scurvy.

DOSAGE, FORM & STRENGTH


V
Tab: 50mg
I
T Prophylactic;
A 25-75 mg daily.
M Therapeutic;
I Not less than 250mg daily individed doses.
N
S 16.2 CALCIUM GLUCONATE.
INDICATIONS
Calcium deficiency, pregnancy and lactation.
A
N CONTRA-INDICATIONS
Conditions associated with Hypercalcaemiaandypercalciuria.
D
ADVERSE EFFECTS
M Mild gastro- intestinal disturbances; bradycardia, arrhythmias,
I and irritation after intravenous injection.
N DOSAGE, FORM & STRENGTH
E Tab: 100mg
R
Adults;
A By mouth, daily in divided doses, as calcium gluconate or latate.
L By deep intramuscular injection or by slow intravenous injection.
S Acute.
Hpocalcaemia.
Calcium gluconate 1-2g.
Children;
Obtain paediatric advice; intramuscular route not recommended.

Independent University Hospital FORMULARY 2010


16.3 CALCIUM LACTATE 93
INDICATIONS
Calcium deficiency, pregnancy and lactation.

CONTRA-INDICATIONS
Conditions associated with hypercalcaemiaandhypercalciuria.

ADVERSE EFFECTS V
Mild Gastro-intestinal disturbances; bradycardia, arrhythmias, I
and irritation after intravenous injection.
T
DOSAGE, FORM & STRENGTH A
Tab: 300mg M
Adults;
I
By mouth, daily in divided doses, as calcium gluconate or lactate. N
By deep intramuscular injection or by slow intravenous injection, S
acute hypocalcaemia, calcium gluconate 1-2g.

Children;
A
Obtain paediatric advice; intramuscular route not recommended. N
D
16.4 VITAMIN COMPLEX
INDICATIONS
Neuralgia and neuritis of toxic and non-toxic origin.
M
I
DOSAGE, FORM & STRENGTH N
Tab/Inj
E
Adults; R
1 inj daily or no alternate days. 3 tabs daily. A
L
VITAMINS AND HEMATINICS S
16.5 FERROUS GLUCONATE
INDICATIONS
Iron deficiency anaemia.

Independent University Hospital FORMULARY 2010


94 DOSAGE, FORM & STRENGTH
Syp: 300mg/5ml

Prophylactic;
2 tabs daily before food.

Therapeutic;
V 4-6 tabs daily in divided doses before food.

I Children6-12 years;
T Prophylactic and therapeutic, 1-3 tabs daily.
A
M 16.6 FERROUS SULPHATE
INDICATIONS
I Iron deficiency anaemia.
N
S DOSAGE, FORM & STRENGTH
Tab: 150mg
Ferrus iron.
A
N Therapeutic;
D 120-180 daily in divided doses.

Prophylactic;
M 69mg daily.
I
Children;
N Therapeutic, daily in divided doses.
E
R Upto 1 year; 36mg.
A 1-5 years; 72mg.
L Under 1 year; 6-12mg.
S 16.7 FOLIC ACID
INDICATIONS
Megaloblastic anaemia due to folic acid deficiency.

CONTRA-INDICATIONS
Megaloblastic anaemia due to vitamin B12 deficiency.
Independent University Hospital FORMULARY 2010
ADVERSE EFFECTS 95
Nausea, constipation.

DOSAGE, FROM & STRENGTH


Tab: 5mg

Adults;
Initially 10-20mg daily for 14 days then 5-10mg daily. V
16.8 B COMPLEX
I
INDICATIONS T
Multi-vitamin supplement for infants. A
M
DOSAGE, FORM & STRENGTH
Syp: vit B1 3mg, Vit B2 3mg, pyridoxine 2mg I
nicotinamide 23mg/5ml. N
S
Adults; 1-2 tsp daily.
Children; 1tsp daily.
A
N
D

M
I
N
E
R
A
L
S

Independent University Hospital FORMULARY 2010


96 17- ANTI DIABETIC DRUGS
17.1 GLIBENCLAMIDE
INDICATIONS
Diabetes mellitus

CONTRA-INDICATIONS
Juvenile diabetes with ketosis; impairment of renal function; stress;
A pregnancy’ diabetic coma.
N
T ADVERSE EFFECTS
Nausea and sensation of fullness are exceptional. Changes in
I haemopoietic systemic are rare.

D DOSAGE, FORM & STRENGTH


Tablet,
I Initially 5mg daily (elderly patients 2.5mg), adjusted according to
A response; maximum 15mg daily; taken with breakfast.
B
E 17.2 GLICLAZIDE
INDICATIONS
T Diabetes mellitus.
I
C CONTRA-INDICATIONS
Juvenile diabetes with ketosis; impairment of renal function; stress;
pregnancy; diabetic coma.
D
R ADVERSE EFFECTS
I Nausea and sensation of fullness are exceptional. Change in
G haemopoietic system are rare.
S DOSAGE, FORM & STRENGTH
Tablet,
Initially, 40-80mg daily, adjusted according to response; up to
160mg as a single dose, with breakfast; higher doses divided;
maximum 320mg daily.

Independent University Hospital FORMULARY 2010


17.3 METFORMIN 97
HYDROCHLORIDE
INDICATIONS
Diabetes mellitus.

CONTRA-INDICATIONS
Hepatic or renal impairment (withdraw if renal impairment sus-
pected), predisposition to lactic acidosis, heart failure, severe
infection or trauma, dehydration, alcohol dependence; preg- A
nancy, breast-feeding. N
ADVERSE EFFECTS T
Anorexia, nausea, vomiting, diarrhoea (usually transient), lactic I
acidosis (withdraw treatment), decreased vitamin B12 absorption.

DOSAGE, FORM & STRENGTH


D
Tablet, I
500 mg every 8 hours or 850 mg every 12 hours with or after food; A
maximum 3g daily in divided doses though most physicians limit B
this to 2 g daily.
E
T
I
C

D
R
I
G
S

Independent University Hospital FORMULARY 2010


98 18- VACCINES
18.1 TETANUS TOXOID
INDICATIONS
Tetanus vaccines stimulate the production of the protective anti-
toxin.

DOSAGE, FORM & STRENGTH


Inj: 0.5 ml
0.5 mL or as stated on the label, by intramuscular or deep subcuta-
neous injection followed after 4 weeks by a second dose and after
a further 4 weeks by a third dose.

18.2 HEPATITIS B VACCINE


INDICATIONS
V Active immunization against hepatitis B virus.
A
C CONTRA-INDICATIONS
C Severe febrile infections.
I ADVERSE EFFECTS
N Mild transient local soreness, erythema and induration at inj site,
E low grade fever, malaise, nausea, dizziness.
S DOSAGE, FORM & STRENGTH
Inj: 0.5mg/1 ml

Adults & Children;


1 dose by IM inj, into the deltoid muscle, repeated 1 month and 6
month later.

18.3 RABIES VACCINES


INDICATIONS
Prophylaxis and therapy to rabies.

DOSAGE, FORM & STRENGTH


Inj: 50mg in vial, By SC or IM route.

Independent University Hospital FORMULARY 2010


Prophylaxis; 99
Day-1 1st dose.
Day 7 2nd dose.
Day 28 3rd dose.
Booster after one year then every three years.

Therapeutic;
In non-vaccinated subjects.
Day-1 1st dose.
Day 3 2nd dose.
Day 14 3rd dose.
Day 28 4th dose.
Day 30 5th dose.
Day 90 6th dose.
(Optional) V
A
18.4 ANTI SNAKE VENOM
INDICATIONS
C
The snake bite may cause local systemic effects. Local effects C
include pain, swelling, bruising and tender enlargement of I
regional lymph nodes. Systemic effects include early transient N
hypotension with syncope, angioedema, abdominal colic,
E
diarrhoea, and vomiting with later persistent or recurrent
hypotension. ECG abnormalities, spontaneous systemic bleeding, S
coagulopathy, adult respiratory distress syndrome, and acute renal
failure.

DOSAGE, FORM &B STRENGTH


Inj: 10ml in vial.
The anti snake venum diluted with 2-3 volumes of sodium chloride
intravenous infusions 0.9% and given by slow intravenous injection
(not more than 2ml of diluted anti venom per minute) or by intrave-
nous infusion. The same dose should be used for adults and
children. The dose can be repeated in 1-2 hours if there is no
clinical improvement. Adrenaline injection must be kept for
treatment of anaphylactic anti venum injection.

Independent University Hospital FORMULARY 2010


100 19- ENT PREPARATIONS
19.1 POLYMYXIN B SULPHATE
INDICATIONS
For the treatment of inflammatory otitis externa due to, or compli-
cated by, bacterial infection.

DOSAGE, FORM & STRENGTH


10,000 u/ml

E Adults;
3 drops 3 or 4 times daily into affected ear.
N
T Children;
1 or 2 drops 3 or 4 times daily into affected ear.
P
19.2 POLYMYXIN B SULPHATE + LIGNOCAINE HCL
R INDICATIONS
E For the symptomatic relief and treatment of otitis extrena.
P
DOSAGE, FORM & STRENGTH
R 10,00 u + 50mg/ml
A
T Adults;
I 3 drops 3 or 4 times daily into affected ear.
O Children;
N 1 or 2 drops 3 or 4 times daily into affected ear.
S
19.3 SODA GLYCERIN
DOSAGE, FORM & STRENGTH
Drops 2-5%

19.4 POLYMYXIN B SULPHATE + HYDROCORTISONE


ACETATE + NEOMYCIN SULPHATE
INDICATIONS
For the treatment of inflammatory otitis externa due to, or compli-
cated by, bacterial infection.
Independent University Hospital FORMULARY 2010
DOSAGE, FORM & STRENGTH 101
5mg/ml + 10mg/ml + 5mg/ml

Adults; 3 drops 3 or 4 times daily into affected ear.


Children; 1 or 2 drops 3 or 4 times daily into
affected ear.

E
N
T

P
R
E
P
R
A
T
I
O
N
S

Independent University Hospital FORMULARY 2010


102 20- METABOLIC AGENTS
20.1 ALLOPURINOL
ZYLORIC 100mg, 300mg
INDICATIONS
Allopurinol is indicated for reducing urate. Uric acid formation in
conditions where urate/uric acid deposition has already occurred
(e.g. gouty arthritis, skin tophi, nephrolithiasis) or in a predictable
clinical risk (e.g. treatment of malignancy potentially leading to
M zinc acid nephropathy).
E
CONTRA- INDICATION
T
Not a treatment for acute gout but continue if attack develops
A when already receiving allopurinol, and treat attack separately.
B
O ADVERSE- EFFECT
L Rashes (withdraw therapy; if rash mild, re-introduce cautiously but
discontinue immediately if recurrence occurs).
I
Skin reactions associated with exfoliation, fever, lymphadenopthy,
C arthralgia, and or eosinophilia, resembling Stevens-Johnson or
Lyell’s Syndrome, occur rarely.
A Gastro-intestinal disorders.
G Rarely malaise, headache, vertigo, drowsiness, taste disturbances,
E hypertension, symptomless xanthine deposits in muscle, alopecia,
hepatotoxicity, paraesthesia and neuropathy.
N
T DOSAGE, FROM & STRENGTH
S Tab: 100mg, 300mg

Children;
In neoplastic conditions, enzyme disorders 10-20 mg/kg daily.

Independent University Hospital FORMULARY 2010


21- ANTI-EPILEPTICS 103

21.1 CARBAMAZEPINE
INDICATIONS
Anti-Epileptics, Mood Stabilizer, Analgesic, Prophylaxis of maniac
depressive psychosis unresponsive to lithium. Generalized tonic
clonic and partial seizures, diabetic neuropathy. Trigeminal
neuralgia.

CONTRA-INDICATIONS
A-V conduction abnormalities unless paced. Lactation. A
ADVERSE EFFECTS
N
Vertigo, Ataxia, Gastric upset, diplopia, dry mouth, drowsiness & T
dizziness. I
Oedema & rarely hyponatraemia.
Blood dyscrasias, rashes, toxic epidermal necrolysis, hair loss. E
Acute renal failure.
Lymph-node enlargement, cardiac conduction disturbances,
P
hepatitis, and cholestatic jaundice. I
L
DOSAGE, FORM & STRENGTH E
Adults & Children;
100-200mg O.D / B.D P
Maximum Dose 2000mg Daily T
Children I
upto 1 Year: 100-200mg. C
1-5 Year: 200-400mg.
5-10 Year: 400-600mg.
S
10-15 Year: 600mg-1gm.
All daily in divided doses.

Available as:
Epilex, Seizunil, Tegral, Epitab Xr, Carbanil

21.2 DIAZEPAM
Benzodiazepene long acting

Independent University Hospital FORMULARY 2010


104 INDICATIONS
Short-term use in anxiety or insomnia, adjunct in acute alcohol with
drawl; status epileptics, muscle spasm, peri-operative.

CONTRA-INDICATIONS
Respiratory depression; acute pulmonary insufficiency: not for
phobic or obsessional states, chronic psychosis; porphyria.

ADVERSE EFFECT
Drowsiness and lightheadedness the next day; confusion and
atexia (especially in the elderly); amnesia may occur; dependence.
A Occasionally; headache, vertigo, hypotension, salivation
N changes, gastro-intestinal disturbances, rashes , visual distur-
T bances, changes in libido urinary retention.
I Blood disorders and jaundice reported.
On intravenous injection: pain, thromobophlebitis, and rarely
apnoea or hypotension.
E
P DOSAGE, FORM & STRENGTH
Adults;
I
By mouth: Anxiety 2mg - 3 times daily, increased if necessary, to
L 15-30 mg daily in divided dose.
E
P Elderly or debilitated;
T Half adult dose, Insomnia associated with anxiety, 5-15mg at
bedtime.
I
C Children;
S Night terrors and somnambulism, 1-2 mg at bedtime.By intramus-
cular injection or slow intravenous injection (into a large vein, at a
rate of not more than 5 mg/minute), for severe anxiety, control of
acute panic attacks, and acute alcohol withdrawal, 10mg,
repeated if necessary after 4 hours.
By rectum: as rectal solution, for acute anxiety and agitation.

Adult and children over 3 Years;


10 mg(elderly 5 mg), repeated; after 5 minutes if necessary.

Independent University Hospital FORMULARY 2010


Children 1-3 Year; 5mg. 105

Available as:
Valium, Cerelium, Diazepam, Relax, Relaxipam

21.3 PHENYTOIN SODIUM


INDICATIONS
Status epilepticus; seizures in neuro-surgery; arrhythmias.

CONTRA-INDICATION
Sinus bardycardia, sino-atrial block, and second third degree
heart block; stokes-adams sydrome; prophyria. A
N
ADVERSE EFFECTS
T
Gum atrophy, Blood disorders, Intravenous injection may cause
cardiovascular and CNS depression (particularly if injection too I
rapid) with arrhythmias, hypo tension, and cardiovascular col-
lapse; alterations, in respiratory function (including respiratory E
arrest.) P
DOSAGE, FORM & STRENGTH
I
150-500mg / Day in 1-2 doses orally. L
15mg / kg intravenous at 50mcg / min. E
P
Adults;
By slow intravenous injection (with blood pressure and ECG
T
monitoring), status epileptic us, 15mg/kg at a rate not exceeding I
50mg per minute, as a loading dose. C
Maintenance doses of about 100mg should be given thereafter at S
intervals of every 6 hours, monitored by measurement of plasma
concentration; rate and dose reduced according to weight.
Instramuscular injection not recommended.

Available as:
Dihydan, Dilantin, Epitoin, Fentin, Phenton-s

Independent University Hospital FORMULARY 2010


106 21.4 SODIUM VALPROATE
INDICATIONS
Anti-epileptics, Mood stabilizer

CONTRA-INDICATIONS
Hepatic dysfunction, Porphyrias

ADVERSE EFFECT
Sedation, Weight gain, hair loss, oedema, pancreatitis, hepatic
failure, hyperammonaemia, thrombocytopenia, neurological
effects.
A
N DOSAGE, FORM & STRENGTH
Adults;
T 300mg B.D orally.
I Usual maintenance, 1-2 gm daily. Maximum 2.5 gm daily.

Available as:
E
Dapakan, Epilim, Epival, Malprate, Orifral, Valep, Valpro,
P Valprox
I
L
E
P
T
I
C
S

Independent University Hospital FORMULARY 2010


22- ANAESTHETICS 107

INHALATIONAL ANAESTHETICS

22.1 ENFLURANE
Enflurane is a volatile anaesthetic similar to halothane, but is less
potent, about twice the concentration being necessary for induc-
tion and maintenance

INDICATIONS
Enflurane is usually given to supplement nitrous oxide-oxygen
mixtures and may be given in preference to halothane when A
repeated anaesthesia is required. N
CONTRA-INDICATIONS A
Avoid in porphyria E
S
ADVERSE EFFECTS
Enflurance is a powerful cardio respiratory depressant. Shallow
T
respiration is likely to result in a rise of arterial carbon dioxide H
tension, but ventricular arrhythmias are uncommon. It is probably E
safe to use adrenaline infiltrations. Myocardial depression may T
result in fall in cardiac output and in arterial hypotension. I
DOSAGE, FORM & STRENGTH
C
Inhalation fluid: Using a specifically calibrated vaporizer, induc- S
tion, increased gradually from 0.4% to maximum of 4.5% in air,
oxygen, or nitrous oxide-oxygen, according to response.

22.2 ISOFLURANE
Isoflurane is an isomer of enflurane. It has a potency intermediate
between that of halothane and enflurene.
Heart rhythm is gradually stable during rate may rise, particularly in
younger patients. Systemic arterial pressure may fall, due to
decreases in systemic vascular and with less decrease in cardiac
output than occurs with halothane.
Independent University Hospital FORMULARY 2010
108 Respiration is depressed. Muscle relaxation is produced and
muscle relaxant drugs potentiated.

INDICATIONS
Isoflurane is used for induction and maintenance of anaesthesia.

CONTRA-INDICATIONS
Contra-indicated in patients, hypersensitivity to Isoflurane.

ADVERSE EFFECTS
Cardio-respiratory depression, bradycardia, ventricular arrhyth-
mia.
A DOSAGE, FORM & STRENGTH
N Inhalation: Using a specficially calibrated vaporizer, induction,
A increased gradually from 0.5% to 3% in oxygen or nitrous oxide-
E oxygen ; an additional 0.5-1% may be required when given with
oxygen alone; caesarean section, 0.5-0.7% in nitrous oxide-
S oxygen.
T
H Children; 1.5-2%
E Maintenance; 0.5-2%.
T
INTRAVENOUS ANAESTHETICS
I
C 22.3 KETAMINE
S INDICATIONS
Induction & maintenance of anaesthesia. It is mainly used for
paediatric anaesthesia. Particularly when repeated administrations
are required.

CONTRA-INDICATIONS
Ketamine is contraindicated in patients with hypertentsion and is
best avoided in those prone to hallucinations.

ADVERSE EFFECTS
There is cardiovascular stimulation and arterial pressure may rise
with tachycardia.
Independent University Hospital FORMULARY 2010
High incidence of hallucinations. 109
Recovery is relatively slow.

DOSAGE, FORM & STRENGTH


Inj: 50mg/ml in 10 ml vial (base)
Intramuscular injection: short procedures, initially 6.5-13 mg/kg
(10mg/kg usually produces12-25minutes of surgical anaesthe-
sia). Diagnostic maneuvers and procedure not involving intense
pain, initially 4 mg/kg.
Intravenous injection: over at least 60 seconds. Short procedures,
initially 1-4.5 mg/kg usually produces 5-10 minutes of surgical
anaesthesia.
Intravenous infusion: of a solution containing 1 mg/ml. Longer A
procedures & induction. Total drip infusion 10-45 micro- N
grams/kg/minute, rate adjusted according to response.
A
22.4 THIOPENTAL SODIUM E
Thiopental sodium is an ultrashort-acting depressant of the central S
nervous system which induces hypnosis and anaesthesia, but T
notanalgesia. It produces hypnosis within 30-40 seconds of H
intravenous injection. Recovery after a small dose is rapid, with E
after a small dose is rapid. With some somnolence and retrograde
amnesia.
T
I
INDICATIONS C
Thiopental sodium is indicated S
As the sole anesthetic for brief(15 minutes) procedure,
For induction of anesthesia prior to administration of other anes-
thetic agents.
To supplement regional anesthesia.

To provide hypnosis during balanced anesthesia with other agents


for analgesia or muscle relaxation.
For the control of convulsive states during or following inhalation
anesthesia, local anesthesia, or other cause.
In neurosurgical patients with increased intra cranial pressure, if

Independent University Hospital FORMULARY 2010


110 adequate ventilation is provided, and For narcoanalysis and
narcosynthesis in psychiatric disorders.

CONTRA-INDICATIONS
Absolute contra-indications are;
Absence of suitable veins for intravenous administration.
Hypersensitivity (allergy) to barbiturates.
Status asthmaticus.
Latent or manifest porphyria.

Relative contra-indications are;


Severe cardiovascular diseases. Hypotension or shock
A Conditions in which the hypnotic effect may be prolonged or
N potentiated, excessive premeditation, Addison’s diseases, hepatic
or renal dysfunction , myxedema, increased blood urea, severe
A
anemia, asthma and myasthenia gravis.
E
S ADVERSE EFFECTS
T Care should be taken in administering the drug to patients with
H advanced cardiac disease, increased intra cranial pressure.
Asthma.
E Mythenia gravis.
T Endocrine insufficiently (pituitary, thyroid. Adrenal, pancreas).
I Respiratory depression which may result from either unusual
C responsiveness to thiopental.
S Laryngospasm may occur with light thiopental sodium.
Narcosis at intubation, or in the absence of intubation, if foreign
matter of secretions in the respiratory tract create irritation.
Myocardial depression may occur with thiopental sodium.

DOSAGE, FORM & STRENGTH


Inj: 500mg.
Intravenous injection: in fitand pre-medicated adults, initially
100- 150 mg (4-6 ml of 2.5% solution)over 10-15 seconds,
repeated if necessary according to response after 20-30 seconds;
or up to 4 mg/kg

Independent University Hospital FORMULARY 2010


Children; Induction 2-7 mg/kg. 111

Available as:
Pentathal

22.5 PROPOFOL
Short acting anaesthetic

INDICATIONS
Intravenous anaesthesia

ADVERSE EFFECT
Flushing, Transient apnoea, Thrombosis, Phlebitis
A
CONTRA INDICATION N
Pregnancy, Breast Feeding A
E
Dose;
1.5-2.5mg/kg @ of 20-40mg every 10 seconds S
T
Available as: H
Diprivan, Fresofol, Pofol, Propofol, Recofol E
T
LOCAL ANAESTHETICS
I
22.6 LIDOCAINE HYDROCHLORIDE C
Short acting and quick onset S
INDICATIONS
Topical anaesthesia, infilteration anaesthesia, intravenous
regional anaesthesia

CONTRA INDICATIONS
Hypovolaemia.
Complete heart block.
Avoid in porphyria.
Do not use solutions containing adrenaline for anaesthesia in

Independent University Hospital FORMULARY 2010


112 appendages.

ADVERSE EFFECTS
Hypotension.
Bradycardia.
Cardiac arrest.
CNS effects include agitation, euphoria, respiratory depression,
convulsions.

DOSAGE, FORM & STRENGTH


Inj: 1%, 2% in vial, Inj.
1%, 2% + Epinephrine,
A 1:100,000,1:200,000 in vial.
2-4% Dental cartridge 2% +Epinephrine 1:80,000 Gel 5%.
N
A Infiltration Anaesthesia:
E 0.25 -0.5% with adrenaline 1 in 200000, using 2-50 ml of a 0.5%
S solution in minor surgery and up to 60ml for extensive surgery.
T Nerve Blocks:
H With adrenaline 1 in 200000, 1% to a maximum of 50 ml,2% to a
E maximum of 25 ml.
T Epidural and Caudal block,
With adrenaline 1 in 200000, 1% to a maximum of 50 ml, 2% to a
I
maximum of 25 ml.
C
S Surface Anaesthesia,
Usual strengths 2-4%. Mouth throat , and upper gastro-intestinal
tract, maximum 200 mg.

22.7 BUPIVICAINE
Long acting and slow onset

INDICATIONS
Topical anaesthesia, infilteration anaesthesia, intravenous
regional anaesthesia, Spinal anaesthesia, epidural anaesthesia

Independent University Hospital FORMULARY 2010


CONTRA INDICATIONS 113
Hypovolaemia.
Complete heart block.
Avoid in porphyria.
Do not use solutions containing adrenaline for anaesthesia in
appendages.

ADVERSE EFFECTS
Hypotension.
Bradycardia.
Cardiac arrest.
CNS effects include agitation, euphoria, respiratory depression,
convulsions. A
DOSAGE, FORM & STRENGTH
N
0.5% 20ml, 5mg/ml for spinal anaesthesia. A
E
How to calculate safe dose of local anaesthestics S
T
Drug concentration is expressed as percentage
H
Percentage is measured as per 100ml
E
T
Lignocaine 1% 10mg/ml I
Lignocaine 2% 20mg/ml C
S
Bupivicaine 0.25% 2.5mg/ml

Drug Maximum Dose Maximum Dose


without adrenaline with adrenaline

Lignocaine 300mg 500mg

Bupivicaine 150mg 300mg

Independent University Hospital FORMULARY 2010


114 ANTICHOLINERGICS
22.8 NEOSTIGMINE METHYLSULPHATE
INDICATIONS
Neostigmine is useful in the therapy of pathological muscle
weakness caused by myasthenia gravis, hemiplegia and
monoplegia. Atonic constipation especially postoperative intesti-
nal atony and urinary retention, paroxysmal tachycardia.
Neostigmine antagonizes effects of synthetic curare like drugs.

CONTRA-INDICATIONS
Mechanical, intestinal or urinary obstructions.
A History of sensitivity to the drug.
N ADVERSE EFFECTS
A Side effects are most commonly related to over dosage.
E Muscarinic effects: nausea, vomiting, diarrhea, increased saliva-
S tion, abdominal cramps, fasciculation, weakness.
T DOSAGE, FORM & STRENGTH
H Inj: 05mg or 2.5mg/ml in amp. of 1 ml.
E Myasthenia gravis: 1.0-3.0 mg S/C or I/M daily.
T Postoperative intestinal atony or urinary retention: 0.25 mg
S/C
I or I/M prophylactically immediately after operation, repeatedly
after 4 t0 6 hours.
C Paroxysmal tachycardia: 0.5-1.0 mg S/C or I/M.
S
Hemiplegia , Monoplegia: 0.5-1.0 mg S/C or I/M followed by a
glycerine suppository or saline enema.
Flatulence of pregnancy: 0.5 mg S/C or I/M every 5 to 10 days.

NEUROMUSCULAR BLOCKING AGENTS


22.9 ATRACURIUM BESYLATE
INDICATIONS
A muscle relaxation for a wide range of procedures and to facilitate
controlled ventilation. For endo-tracheal intubation where subse-

Independent University Hospital FORMULARY 2010


quent muscle relaxation is required. 115

CONTRA-INDICATIONS
Hypersensitivity to atracurium besylate.

ADVERSE EFFECTS
Tracrium should be administrated only with adequate general
anaesthesia and under the close supervision of an experienced
anaesthetist and with adequate facilities for endotracheat
intubation and artificial ventilation.

DOSAGE, FORM & STRENGTH


Inj: 10mg/ml.
Over one minute, 0.3-0.6 mg/kg depending on the duration of full
A
block required. This dosage provides relaxation for15-35 minutes. N
Full block can be prolonged with supplementary doses of 0.1-0.2 A
mg/kg as required. E
S
Endotracheal intubation can usually be accomplished within 90
sec, from the IV inj. Of 0.5-0.6 mg/kg.
T
As an infusion: After initial bolus dose of 0.3-0.6 mg/kg. H
Neuromuscular block can be maintained by administration as a E
continuos infusion at rates so 0.3-0.6 mg/kg hour. T
I
22.10 PANCURONIUM BROMIDE
INDICATIONS C
As an adjuvant in adult/child surgical anaesthesia to obtain S
surgical relaxation so that operative manipulations are facilitated.

CONTRAINDICATIONS
Moderate rise of mean arterial pressure may occur.
Pancuronium decreases intra ocular pressure and induces meiosis.
A few cases of reactions at the site of injection have been reported.

DOSAGE, FORM & STRENGTH


Inj: 2mg/kg,
Intravenous injection: Initially
for intubation 50-100 micro-
grams/kg then 10-20 micrograms/kg as required.
Independent University Hospital FORMULARY 2010
116 Children;
Initially 60-100 micrograms/kg, then 10-20 micrograms/kg.
Neonate;
30-40 micrograms/kg initially then 10-20 micrograms/kg.
Intensive care, by intravenous injection, 60 micrograms/kg every
60-90 minutes.

22.11 SUXAMETHONIUM CHLORIDE


INDICATIONS
Endotracheal intubation.
Short surgical interventions, especially in the abdomen, setting of
fractures and dislocations, bronchoscopy, cytoscopy, etc .),
A gynaecological examination and interventions in obstetrics &
electroconvulsive therapy. Intravenous drip for prolonged muscle
N relaxation in abdominal surgery.
A
E CONTRA INDICATIONS
S Severe hepatic functional disorders.
Pulmonary oedema.
T
H ADVERSE EFFECTS
E Prolonged muscle paralysis may occur in patients with low or a
T typical plasma pseudocholinesterase enzymes.
Prolonged paralysis also occur in dural block, which occur after
I repeated doses of suxamethonium and is caused by developing of
C a non-depolarizing block following the primary depolarizing
S block.
DOSAGE, FORM & STRENGTH
Inj: 50mg/kg.
Administration preferably by I/V inj; in special circumstances also
I/M inj.
Drip infusion for continuous muscle relaxation.
Combination with all the usual anaesthesia agents is possible.
Dosage according to desired degree of muscle relaxation. Dose of
0.1-0.2 mg/kg body wt usually produce muscle relaxation for 1-3
minutes without interfering with respiration.

Independent University Hospital FORMULARY 2010


116
23- INDEX
BENDROFLUAZIDE 73
A BENZYLPENICILIN 10
ACETAZOLAMIDE 83 BETAXOLOL HCL 86
ADRENALINE 89 BUPIVICAINE 118
ALBENDAZOLE 33
ALLOPURINOL 107
AMINOPHYLINE 74 C
AMLODIPINE 68
CALCIUM GLUCONATE 96
AMOXICILLIN 11
CALCIUM LACTATE 97
AMPICILLIN 11
CAPTOPRIL 59
AMINOPHYLINE SYP 80
CARBAMAZEPINE 108
AMMONIUM CHLORIDE SYP 80
CARDIOVASCULAR DRUGS 58
I ANAESTHETICS 112
CEFACLOR 15
ANALGESIC (OPIOID) 7
N ANALGESICS (NON OPIOID) 1
CEFOTAXIME SODIUM 18
CEFTAZIDIME SODIUM 16
D ANTI ALLERGIC DRUGS 89
CEFTRIAXONE 17
ANTI BACTERIALS 10
E ANTI COAGULANTS 69
CEFUROXIME 16
CEPHALEXIN 13
X ANTI DIABETIC DRUGS 100
CEPHRADINE 14
ANTI EMETICS 50
CETRIZINE 91
ANTI EPILEPTICS 108
CHLORAMPHENICOL+HYD-
ANTI FUNGAL DRUGS 31
ROCORTISONE ACETATE 85
ANTI HELMINTHICS 33
CHLORAMPHENICOL 29
ANTI PROTOZAL DRUGS 42
CHLORAMPHENICOL 82
ANTI SNAKE VENOM 103
CHLOROPHENIRAMINE
ANTI SPASMODICS 54
MALEATE 90
ANTI TUBERCULOUS DRUGS 37
CHLOROQUINE PHOSPHATE 42
ANTICHOLINERGICS 119
CIMETIDINE 46
ANTIGLAUCOMA DRUGS
CIPROFLOXACIN 19
ANTIULCER DRUGS 45
CLEMASTINE 92
ARTHEMETHER WITH
CLOPIDROGREL 70
LUMEFANTRINE 44
CLOTRIMAZOLEX 31
ASCORBIC ACID 96
CO-AMOXICLAV 13
ATENOLOL 58
CODIENE PHOSPHATE 7
ATRACURIUM BESYLATE 120
CO-TRIMOXAZOLE 28
ATROPINE SULPHATE 54, 84
CYCLIZINE 50

B D
DEXAMETHASONE 78
B COMPLEX 99
DIAGNOSTIC AGENTS
BECLOMETHSONE 77
Independent University Hospital FORMULARY 2010
DIAZEPAM
DICLOFENAC SODIUM
109
3 H 116

DIGOXIN 60 HEMATINICS 98
DILTIAZEM 60 HEPARIN 69
DIMENHYDRINATEX 51 HOMATROPINE HYDRO
DIURETICS 71 BROMIDE 84
DOBUTAMINE HCL 61 HYDROCORTISONE SODIUM
DOMPERIDONE 55 SUCCINATE 78
DOPAMINE HCL 61 HYOSCINE 55
DOXYCYCLINE

I
E IBUPROFFEN 4
ENALAPRIL MALEATE 62 INDOMETHACIN 5
ENFLURANE 112 INTRAVENOUS I
ENT DRUGS 105 ANAESTHETICS 113 N
EPHEDRINE HCL 74 INTRAVENOUS FLUIDS 94
ERYTHOMYCIN 23 IPRATROPIUM 77 D
ETHAMBUTOL 37 ISOFLURANE 112 E
EXPECTORANTS AND ISONIAZID 37
COUGH SYRUPS 80 ISOSORBIDE DINTRATE 63 X

F K
FERROUS GLUCONATE 98 KAOLIN PECTIN 49
FERROUS SULPHATE 98 KETAMINE 113
FLUCLOXACILLIN 12
FLUORESCEIN SODIUM
FOLIC ACID
87
99 L
FUROSEMIDE 71 LEVAMISOLE HCL 33
LEVOFLOXACIN 21
LIDOCAINE HCL 116
LINCOMYCIN 25
G LOCAL ANAESTHETICS 116
GASTRO INTESTINAL DURGS 45 LOPERAMIDE HCL 49
GENTAMICIN 24 LORATIDINE 92
GENTAMICIN 82
GLIBENCLAMIDE
GLICLAZIDE
100
100 M
GLYCERYL TRINITRATEX 63 MAGNESIUM TRISILICATE 45
GRISEOFULVIN 31 MANNITOL 72
GYNAECOLOGICAL DRUGS 88 MEBENDAZOLE 34
MEBEVERINE 56
Independent University Hospital FORMULARY 2010
116 MEFENAMIC ACID 2 PILOCARPINE NITRATE 84
METABOLIC AGENTS 107 PIROXICAM 6
METFORMIN 101 POLYGELLINE 95
METHYDOPA 64 POLYMYXIN B SULPHATE +
METROCLOPRAMIDE HCL 52 HYDROCORTISONE ACETATE +
METRONIDAZOLE 26 NEOMYCIN SULPHATE 106
MIOTICS 83 POLYMYXIN B SULPHATE +
MORPHINE SULPHATE 8 LIGNOCAINE HCL 105
MYDRIATIC DRUGS 84 POLYMYXIN B SULPHATE 105
MYRIN P 41 PREDNISOLONE 79
MYRIN 41 PROCHLORPERAZINE 53
PROMETHAZINE HCL 90
PROPOFOL 116

N PROPRANOLOL HCL
PYRANTEL PAMOATE
66
35
I NALIDIXIC ACID 21 PYRAZINAMIDE 38
N NAPROXEN 6 PYRIMETHAMINE WITH
NEOSTIGMINE SULFADOXINE 42
D METHYLSULPHATE 119
E NEUROMUSCULAR BLOCKING

R
AGENTS 120
X NIFEDIPINE 65
NORFLOXACIN 22 RABIES VACCINES 102
NYSTATIN 32 RANITIDINE 47
RESPIRATORY DRUGS 74
RIFAMPICIN 39

O
S
ORS 56
OFLOXACIN 20
OMEPRAZOLE 48 SALBUTAMOL 75
ONDANSETRON 53 SALMETROL 76
OPHTHALMOLOGICAL SODA GLYCERIN 105
DRUGS XX 82 SODIUM VALPROATE 111
OXYTETRACYCLINE SPIRONOLACTONE 72
HYDROCHLORIDE 27 STREPTOMYCIN 40
OXYTOCIN 88 SUCRALFATE 45
SULFACETAMIDE SODIUM 82
SUXAMETHONIUM
CHLORIDE 121

P
PANCURONIUM BROMIDE 121
PARACETAMOL 1
PHENYTOIN SODIUM 110
Independent University Hospital FORMULARY 2010
116
T V
TETANUS TOXOID 102 VACCINE 102
THIABENDAZOLE 35 VERAPAMIL H C L 67
THIOPENTALSODIUM 114 VITAMIN COMPLEX 97
TRANEXAMIC ACID 70 VITAMINE AND MINERALS 96

I
N
D
E
X

Independent University Hospital FORMULARY 2010