Phenobarbital Brand Name: Barbilixir (CAN), Barbita (CAN), Bellatal, Solfoton, phenobarbital sodium, Parenteral: Luminal Sodium Pregnancy

Category D, C-IV controlled substance Drug classes: Barbiturate (long acting), Sedative, Hypnotic, Anticonvulsant, Antiepileptic agent Therapeutic actions General CNS depressant; barbiturates inhibit impulse conduction in the ascending RAS, depress the cerebral cortex, alter cerebellar function, depress motor output, and can produce excitation, sedation, hypnosis, anesthesia, and deep coma; at subhypnotic doses, has anticonvulsant activity, making it suitable for long-term use as an antiepileptic. Indications Sedative (oral or parenteral) Hypnotic, short-term (up to 2 wk) treatment of insomnia (oral or parenteral) Long-term treatment of generalized tonic-clonic and cortical focal seizures (oral) Emergency control of certain acute convulsive episodes (eg, those associated with status epilepticus, eclampsia, meningitis, tetanus, and toxic reactions to strychnine or local anesthetics; parenteral) Preanesthetic (parenteral) Anticonvulsant treatment of generalized tonic-clonic and cortical focal seizures (parenteral) Emergency control of acute convulsions (tetanus, eclampsia, epilepticus; parenteral) Contraindications Contraindicated with hypersensitivity to barbiturates, manifest or latent porphyria; marked liver impairment; nephritis; severe respiratory distress; previous addiction to sedative-hypnotic drugs (may be ineffective and may contribute to further addiction); pregnancy (fetal damage, neonatal withdrawal syndrome); lactation. . Adverse effects Somnolence, agitation, confusion, hyperkinesia, ataxia, vertigo, CNS depression, nightmares, lethargy, residual sedation (hangover), paradoxical excitement, nervousness, psychiatric disturbance, hallucinations, insomnia, anxiety, dizziness, thinking abnormality Bradycardia, hypotension, syncope Nausea, vomiting, constipation, diarrhea, epigastric pain Rashes, angioneurotic edema, serum sickness, morbiliform rash, urticaria; rarely, exfoliative dermatitis,

Stevens-Johnson syndrome Pain, tissue necrosis at injection site, gangrene; arterial spasm with inadvertent intra-arterial injection; thrombophlebitis; permanent neurologic deficit if injected near a nerve Hypoventilation, apnea, respiratory depression, laryngospasm, bronchospasm, circulatory collapse Tolerance, psychological and physical dependence, withdrawal syndrome Drug Interactions: Increased serum levels and therapeutic and toxic effects with valproic acid Increased CNS depression with alcohol Increased risk of nephrotoxicity with methoxyflurane Increased risk of neuromuscular excitation and hypotension with barbiturate anesthetics Decreased effects of the following drugs: theophyllines, oral anticoagulants, beta-blockers, doxycycline, griseofulvin, corticosteroids, hormonal contraceptives and estrogens, metronidazole, phenylbutazones, quinidine Nursing considerations Monitor patient responses, blood levels (as appropriate) if any of the above interacting drugs are given with phenobarbital; suggest alternative means of contraception to women using hormonal contraceptives. Do not administer intra-arterially; may produce arteriospasm, thrombosis, gangrene. Administer IV doses slowly. Administer IM doses deep in a large muscle mass (gluteus maximus, vastus lateralis) or other areas where there is little risk of encountering a nerve trunk or major artery. Monitor injection sites carefully for irritation, extravasation (IV use). Solutions are alkaline and very irritating to the tissues. Monitor P, BP, respiration carefully during IV administration. Arrange for periodic laboratory tests of hematopoietic, renal, and hepatic systems during long-term therapy. Taper dosage gradually after repeated use, especially in epileptic patients. When changing from one antiepileptic drug to another, taper dosage of the drug being discontinued while increasing the dosage of the replacement drug.

Indications
Phenobarbital is indicated in the treatment of all types of seizures except absence seizures.[4][15] Phenobarbital is no less effective at seizure control than more modern drugs such as phenytoin and carbamazepine. It is, however, significantly less well tolerated.[16][17] The first line drugs for treatment of status epilepticus are fast acting benzodiazepines such as diazepam or lorazepam. If these fail then phenytoin may be used, with phenobarbital being an alternative in the

U.S. but used only third line in the UK.[18] Failing that, the only treatment is anaesthesia in intensive care.[15][19] Phenobarbital is the first line choice for the treatment of neonatal seizures.[5][20][21] Concerns that neonatal seizures in themselves could be harmful make most physicians treat them aggressively. There is, however, no reliable evidence to support this approach.[22] Phenobarbital is sometimes indicated for alcohol and benzodiazepine detoxification for its sedative and anticonvulsant properties. The benzodiazepines chlordiazepoxide (Librium) and oxazepam (Serax) have largely replaced phenobarbital for detoxification.[23]

[edit] Other uses

Phenobarbital is often used for the treatment of acute withdrawal from benzodiazepines.[citation needed] Phenobarbital properties can effectively reduce tremors and seizures associated with abrupt withdrawal from benzodiazepines. Phenobarbital is a cytochrome P450 inducer. Its used to reduce the toxicity of some drugs. Phenobarbital is occasionally prescribed in low doses to aid in the conjugation of bilirubin in patients suffering from Gilbert's Syndrome. In infants suspected of neonatal biliary atresia, phenobarbital is used in preparation for a 99mTc-IDA hepatobiliary study that differentiates atresia from hepatitis or chondrostasis.

rug Name: CALTRATE PLUS CALTRATE PLUS DESCRIPTION: CALCIUM SUPPLEMENT WITH VITAMIN D - ORAL COMMON CALTRATE PLUS BRAND NAME(S): Citracal + D, Os-Cal, Oyster Shell + D CALTRATE PLUS SIDE EFFECTS: CALTRATE PLUS is generally well tolerated. Constipation may occur. Notify your doctor if you experience nausea, vomiting, stomach cramps, dry mouth, increased thirst or increased urination while taking CALTRATE PLUS. If you notice other effects not listed above, contact your doctor or pharmacist. HOW TO USE CALTRATE PLUS: CALTRATE PLUS: Take CALTRATE PLUS orally as directed. It is best taken with or just after a meal to improve absorption. Take each dose with a full glass of water. CALTRATE PLUS USES: Calcium plays a critical role in the body. It is essential for normal functioning of nerves, cells, muscle and bone. Vitamin D improves the absorption of calcium into the body. Calcium supplements are used to treat or prevent low blood calcium levels. Calcium may be prescribed for treatment of osteoporosis (bone loss), osteomalacia (brittle bones), rickets, tetany, parathyroid disease. Calcium supplements are often used to ensure an adequate dietary intake in conditions such as pregnancy, nursing, kidney disease, pancreatitis or during therapy with anti-seizure medications. CALTRATE PLUS PRECAUTIONS: Tell your doctor if you have any pre-existing heart disease or kidney stones. CALTRATE PLUS should

be used as directed during pregnancy or while breast-feeding. CALTRATE PLUS DRUG INTERACTIONS: Tell your doctor of any over-the-counter or prescription medication you may take especially digoxin and tetracycline antibiotic. Avoid taking any tetracycline antibiotic within 1 to 2 hours of taking calcium since calcium may interfere with the absorption of tetracycline. Do not start or stop any medicine without doctor or pharmacist approval. CALTRATE PLUS OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. Symptoms of overdose may include nausea and vomiting, severe drowsiness, dry mouth, loss of appetite, metallic taste, stomach cramps, unconsciousness, diarrhea, weakness, headache, constipation, dizziness, or irritability. CALTRATE PLUS NOTES: Calcium supplements are available in different forms which vary in the amount of calcium they contain. Ask your doctor or pharmacist to help select the best product for you. Follow any dietary guidelines recommended. MISSED CALTRATE PLUS DOSE: If you miss a dose, take it as soon as remembered; if it is near the time for the next dose, take both the missed dose and the regular scheduled dose then resume your usual dosing schedule. CALTRATE PLUS STORAGE: Store tablets and capsules at room temperature between 59 and 86 degrees F (15 to 30 degrees C) away from heat and light. Do not store in the bathroom

NATRANOX INDICATIONS: ~ Upper respiratory tract infections (including ENT) - sinusitis, otitis media, recurrent tonsillitis. These infections are often caused by Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Streptococcus pyogenes. ~Lower respiratory tract infections-acute exacerbations of chronic bronchitis, bronchopneumonia, urinary-tract infections often caused by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. ~Genito-urinary tract and abdominal infections in particular cystitis (especially when recurrent or complicated, but not prostatitis) septic abortion, pelvic or puerperal sepsis, and intra-abdominal sepsis. These infections are often caused by Enterobacteriaceae (mainly Escherichia coli), Staphylococcus saprophyticus, Enterococcus species. Skin and soft tissues infections in particular, cellulites, animal bites, and severe dental abscess with spreading cellulites caused by Staphyloccocus aureus, Streptococcus pyogenes and Bacteriodes species.

ANTIMICROBIAL ACTIONS: Co-amoxiclav is an antibacterial combination consisting of amoxicillin (as sodium) and the betalactamase inhibitor, clavulanic acid (as potassium clavulanate). Amoxicillin is the 4-hydroxy analogue of ampicillin. Amoxicillin hinders the cell wall synthesis of sensitive bacteria and is bactericidal against many Gram-positive and Gram-negative bacteria. It is active against all penicillin-sensitive bacteria: streptococci, and most strains of pneumococci, gonococci and meningococci are sensitive. Bacteria that produce beta-lactamase (e.g. most of the staphylococci) are resistant. Amoxicillin is also active against strains of haemophilus influenza that do not produce beta-lactamase. Clavulanic acid has a beta-lactam structure resembling that of penicillin nucleus, except that the fused thiazolidine ring of the penicillins is replaced by an oxazolidine ring. In general, clavulanic acid has only weak antibacterial activity. It is potent progressive inhibitor of plasmid-mediated and some chromosomal beta-lactamases produced by Gram-negative bacteria including Haemophilus ducreyi, H.influenzae, Neisseria gonorrhoeae, Moraxella catarrhalis (Branhamella catarrhalis), Bacteroides fragilis and some Enterobacteriacese. It is also an inhibitor of the beta-lactamases produced by Staphylococcus aureus. Clavulanic acid can permeate bacterial cell walls and can therefore inactivate both extracellular enzymes and those that are bound to the cell. Its mode of action depends on the particular enzyme inhibited, but it generally acts as a competitive, and often, irreversible, inhibitor. Clavulanic acid consequently enhances the activity of penicillin and cephalosporin antibacterials against many resistant strains of bacteria. However, it is generally less effective against chromosomally medicated type 1 beta-lactamases: therefore, many Citrobacter, Enterobacter, Morganells and Serratia spp. and Pseudomonas aeruginosa remain resistant. Some plasmid-mediated extended release spectrum beta lactamases in Klebsiella pneumoniae, some other Enterobactriaceae, and Ps. aeruginosa are also not inhibited by beta-lactamases inhibitors. Co-amoxiclav is bactericidal to a wide range of organisms including: Gram-positive: Aerobes: Enterococcus faecalis, Enterococcus faecium, Streptococcus pneumoniae, Streptococcus pyogenes, Streptococcus viridans, Staphylococcus aureus, Coagulase negative staphylococci (including Staphylococcus epidermidis), Corynebacterium species, bacillus anthracis, Listeria monocytogenes. Anaerobes: Clostridium species, Peptococcus species, Peptostreptococcus. Gram-negative: Aerobes: Haemophilus influenzae, Moraxella catarrhalis, (Branhamella catarrhalis) Escherichia coli, Proteus mirabilis, Proteus vulgaris, Klebsiella species, Salmonella species, Neisseria gonorrhoeae, Neisseria meningitidis, Vibrio cholerae, Pasteurella multocida Anaerobes: Bacteroides species, including B.fragilis DRUG INTERACTIONS Probenicid decreases the renal tubular secretion of amoxicillin but does not affect clavulanic acid excretion. Concurrent use with co-amoxiclav may result in increased and prolonged blood levels of amoxicillin but not of clavulanic acid.

Co-amoxiclav may reduce the efficacy of oral contraceptives and patients should be warned accordingly. Penicillins such as co-amoxiclav may decrease the removal of methotrexate from the body increasing the risk of toxicity. Antibiotics such as co-amoxiclav may alter the effect of anticoagulants such as warfarin. Intravenous administration can cause local irritation, induration and phlebitis at the injection site. CONTRAINDICATIONS Co-amoxiclav is contraindicated in patients with a history of allergic reactions to any penicillin. It is also contraindicated in patients with a previous history of amoxicillin-potassium clavulanate-associated cholestatic jaundice/ hepatic dysfunction. SPECIAL WARNING AND SPECIAL PRECAUTIONS FOR USE Changes in liver function tests have been observed in some patients receiving co-amoxiclav. The clinical significance of these changes is uncertain but co-amoxiclav should be used with caution in patients with evidence of hepatic dysfunction. Cholestatic jaundice, which may be severe, but is usually reversible, has been reported rarely. Signs and symptoms may not become apparent for several weeks after treatment has ceased. In patients with renal impairment, dosage should be adjusted according to the degree of impairment. If the parenteral administration of high dosage is necessary, the sodium content must be taken into account in patients on a sodium restricted diet. In patients with reduced urine output crystalluria has been observed very rarely, predominantly with parenteral therapy. During administration of high doses of amoxicillin it is advisable to maintain adequate fluid intake and urinary output in order to reduce the possibility of amoxicillin crystalluria. Amoxicillin has been reported to precipitate in bladder catheters after intravenous administration of large doses. A regular check of potency should be maintained. Serious and occasionally fatal hypersensitivity (anaphylactoid) reactions have been reported in patients on penicillin therapy. These reactions are more likely to occur in individuals with a history of penicillin hypersensitivity. Erythematous rashes have been associated with glandular fever in patients receiving amoxicillin. Prolonged use may also occasionally result in overgrowth of non-susceptible organisms.

PREGNANCY AND LACTATION Reproduction studies in animals (mice and rats) with orally and parenterally administered co-amoxiclav have shown no teratogenic effects. In a single study in women with preterm, premature rupture of the foetal membrane (pPROM), it was reported that prophylactic treatment with co-amoxiclav may be associated with an increased risk of necrotising enterocolitis in neonates. As with all medicines, use

should be avoided in pregnancy especially during the first trimester, unless considered essential by the physician. Co-amoxiclav may be administered during the period of lactation. With the exception of the risk of sensitisation, associated with the excretion of trace quantities in breast milk, there are no known detrimental effects for the breast-fed infant. ADVERSE REACTIONS Adverse reactions are uncommon and mainly of a mild and transitory nature. Gastrointestinal reactions: Diarrhea, indigestion, nausea, vomiting, and mucocutaneous candidiasis have been reported. Antibiotic-associated colitis (including pseudomembranous colitis and haemorrhagic colitis) has been reported rarely. Nausea, although uncommon, is more often associated with higher oral dosages. If gastrointestinal side effects occur with oral therapy they may be reduced by taking Co-amoxiclav at the start of meals. Superficial tooth discolouration has been reported rarely, mostly with the suspension. It can usually be removed by brushing. Renal and urinary tract disorders: Crystalluria has been reported very rarely. Genito-urinary effects: Vaginal itching, soreness and discharge may occur. Hepatic effects: Moderate and asymptomatic rises in AST and/ or ALT and alkaline phosphatases have been reported occasionally. Hepatitis and cholestatic jaundice have been reported rarely. These hepatic reactions have been reported more commonly with Co-amoxiclav than with other penicillins. After Co-amoxiclav hepatic reactions have been reported more frequently in males and elderly patients, particularly those over 65 years. The risk increases with duration of treatment longer than 14days. These reactions have been very rarely reported in children. Signs and symptoms usually occur during or shortly after treatment but in some cases may not occur until several weeks after treatment has ended. Hepatic reactions are usually reversible but they may be severe, and, very rarely, deaths have been reported. Hypersensitivity reactions: Urticarial and erythematous skin rashes sometimes occur. Rarely, erythema multiforme, StevensJohnson syndrome, toxic epidermal necrolysis, bullous exfoliative dermatitis, acute generalized exanthematous pustulosis (AGEP), serum sickness-like syndrome and hypersensitivity vasculitis have been reported. Treatment should be discontinued if one of these disorders occurs. In common with other Beta-lactams antibiotics angioedema and anaphylaxis have been reported. Interstitial nephritis can occur rarely. Haematological effects: As with other Beta-lactams transient leucopenia (including neutropenia and agranulocytosis),

thrombocytopenia and haemolytic anaemia have been reported rarely. Prolongation of bleeding time and prothrombin time has also been reported rarely. CNS effects: CNS effects have been seen very rarely. These include reversible hyperactivity, dizziness, headache and convulsions. Convulsions may occur with impaired renal function or in those receiving high doses.

Local: Thrombophlebitis at the site of the injection has been reported occasionally. OVERDOSAGE: Gastrointestinal symptoms and disturbance of the fluid and electrolyte balances may be evident. They may be treated symptomatically with attention to the water electrolyte balance. Co-amoxiclav may be removed from the circulation by haemodialysis. Amoxicillin crystalluria, in some cases leading to renal failure, has been observed. INCOMPATIBILITIES: Co-amoxiclav injection should NOT be mixed or reconstituted with dextrose solution, sodium bicarbonate solution for injection, protein hydrolysates and other proteinaceous fluids, blood or plasma or withintravenous lipid emulsions. If co-amoxiclav is prescribed concurrently with an aminoglycoside, the antibiotics should not be mixed in the syringe, intravenous fluid container or giving set because loss of activity of the aminoglycoside can occur under these conditions. CAUTION: Foods, Drugs, Devices and Cosmetics Act prohibits dispensing without prescription. DOSAGES FOR TREATMENT OF INFECTIONS: Direction for reconstitution: Co-amoxiclav (Natravox) 500mg/ 100mg IV: Dissolve the powder in 10mL water for injection Co-amoxiclav (Natravox) 1000mg/ 200mg IV: Dissolve the powder in 2mL water for injection For intravenous infusion: the reconstituted vial should be further diluted with the desired volume of a suitable infusion liquid. Co-amoxiclav (Natravox) IV is less stable in infusions containing glucose, dextran or bicarbonate. Reconstituted solution should, therefore, not be added to such infusions but may be injected into the drip tubing over a period of three to four minutes. Note: Co-amoxiclav (Natravox) IV vials are not suitable for intramuscular or subcutaneous administration. Co-amoxiclav (Natravox) IV vials should be given by slow intravenous injection over a period of three to four minutes. It may be injected directly into a vein or via a drip tube.

anufacturer Natrapharm Distributor Natrapharm Contents Per 375 mg tab Amoxicillin 250 mg, clavulanic acid 125 mg. Per 625 mg tab Amoxicillin 500 mg, clavulanic acid 125 mg. Per 156.25 mg/5 mL susp Amoxicillin trihydrate 125 mg, clavulanic acid 31.25 mg. Per 312.5 mg/5 mL susp Amoxicillin trihydrate 250 mg, clavulanic acid 62.5 mg. Per 457 mg/mL Amoxicillin trihydrate 400 mg, clavulanic acid 57 mg. Per 500 mg/100 mg vial Amoxicillin Na 500 mg, K clavulanate 100 mg. Per 1 g/200 mg vial Amoxycillin Na 1 g, K clavulanate 200 mg Indications Resp tract, GUT, abdominal, skin & soft tissue infections. Click to view Natravox detailed prescribing infomation Dosage Tab Adult & childn >12 yr Mild to moderate infection 250 mg/125 mg tid or 500 mg/125 mg bid. Severe infection 500 mg/125 mg tid. Dental infection 250 mg/125 mg tid or 500 mg/125 mg bid for 5 days. Susp Childn 25 mg/kg/day. Serious infections Up to 50 mg/kg/day. To be taken in divided doses 8 hrly. Inj Treatment of infection Adult & childn >12 yr 1.2 g 8 hrly. IV 3-4 min. IV Infusion 30 min. If serious increase frequency 6 hr intervals. Surgical prophylaxis 1-2 g given at the induction of anesth. Click to view Natravox detailed prescribing infomation Overdosage View Natravox overdosage for action to be taken in the event of an overdose. Administration May be taken with or without food (May be given w/o regard to meals. Best taken at the start of meals for better absorption & to reduce GI discomfort.). Contraindications Hypersensitivity to penicillin. History of amoxicillin-K clavulanateassociated cholestatic jaundice/hepatic dysfunction. Click to view Natravox detailed prescribing infomation Special Precautions Monitor renal function. Pregnancy & lactation. Click to view Natravox detailed prescribing infomation Adverse Drug Reactions Transient hepatitis & cholestatic jaundice; skin rash, urticaria, angioedema, anaphylaxis; pseudomembranous colitis; Stevens-Johnson syndrome; maculopapular rash; diarrhea, nausea & vomiting. View ADR Monitoring Website Side Effects View Natravox side effects Drug Interactions Probenecid, OCs. View more drug interactions with Natravox Caution For Usage For caution against possible variation of physical aspect of medicine... click to view Natravox detailed prescribing infomation Storage View Natravox storage conditions for details to ensure optimal shelf-life. Description View Natravox description for details of the chemical structure and excipients (inactive components). Mechanism of Action View Natravox mechanism of action for pharmacodynamics and pharmacokinetics details. MIMS Class Penicillins ATC Classification J01CR02 - amoxicillin and enzyme inhibitor ; Belongs to the class of penicillin combinations, including beta-lactamase inhibitors. Used in the systemic treatment of infections.

DAKTARIN cream
SCHEDULING STATUS: Schedule 2 PROPRIETARY NAME (and dosage form):

DAKTARIN cream
COMPOSITION: Miconazole nitrate 20 mg/g.

Preservative: benzoic acid 0,2% m/m. PHARMACOLOGICAL CLASSIFICATION: A 13.9.2 Dermatological preparations: fungicides. PHARMACOLOGICAL ACTION: Miconazole nitrate is a synthetic 1-phenethylimidazole derivative. In vitro, low concentrations of miconazole nitrate are fungistatic against all Phycomycetes, Ascomycetes and Adelomycetes tested (e.g. Saprolegnia, Candida, Cryptococcus, Aspergillus, Dermatophytes, Phialophora, Sporotrichum), and fungicidal against Trichophyton mentagrophytes, Trichophyton rubrum, Epidermophyton floccosum. Trichophyton interdigitale and Microsporum canis. Thus DAKTARIN cream is a broad-spectrum anti-fungal agent. As yet there is no evidence of drug resistance developing to miconazole nitrate. Miconazole nitrate also possesses some anti-bacterial activity against Gram-positive organisms. In addition DAKTARIN cream has a very rapid alleviating effect on the pruritis which frequently accompanies infection. INDICATIONS: Dermatomycoses, e.g.: Tinea pedis (Athlete's foot) Tinea corporis (Tinea circinata) Tinea manuum Tinea cruris due to: Trichophyton mentagrophytes Trichophyton rubrum Microsporum audouinii Epidermophyton floccosumCandidial infections: Infections of the skin (e.g. intertrigo) Perianal infections Stomatitis angularis (cheilitis, perlche) Balanoposthitis CONTRA-INDICATIONS: DAKTARIN cream is contra-indicated in those patients who have shown hypersensitivity to miconazole. DOSAGE AND DIRECTIONS FOR USE: For external use only. DAKTARIN cream should be applied to the lesions twice daily and thoroughly rubbed into the skin. When all lesions have disappeared (usually after 2 to 5 weeks), treatment should be continued for a further 10 to 14 days to prevent relapse. SIDE-EFFECTS AND SPECIAL PRECAUTIONS: DAKTARIN cream is excellently tolerated and leaves no stain on skin or clothes. Minimal absorption of the active ingredient takes place through the skin and systemic side-effects are therefore most unlikely to arise. Local irritation and sensitivity reactions may occur with DAKTARIN cream. Drug interaction Systemic absorption of miconazole, although low after topical administration, may potentiate the activity of warfarin. KNOWN SYMPTOMS OF OVERDOSAGE AND PARTICULARS OF ITS TREATMENT: Poisoning or overdosage is unlikely to occur owing to the limited extent to which miconazole nitrate is absorbed. If it does occur treatment should be along conventional lines. IDENTIFICATION: A smooth white cream, miscible with water. PRESENTATION: DAKTARIN cream is supplied in a tube containing 30 g of cream. STORAGE INSTRUCTIONS: Store below 25C. Keep out of reach of children.