Gabapentin Indications Doses Precautions Interactions and Adverse Effects

Indications:

Gabapentin has been effective as add-on therapy in patients with drug-resistant partial seizures in patients over 3 years of age; limited studies also suggest efficacy of the drug in generalized seizures; comparisons of gabapentin with standard antiepileptic agents are required to determine its ultimate place in therapy.

Doses & Administrations:
DOSE: ADULT: Initially a dose of 300mg TID should be used, this should be titrated to acheive response and a usual dose of 400mg TID, dose may be titrated according to the response to a maximum dose of 2400-3600mg/day PEDIATRIC: FOR 01 MONTH - 05 YEARS: 40MG/KG/DAY in three divided doses FOR 5 YEARS TO 12 YEARS: 30MG/KG/DAY in three divided doses FOR OVER 12 YEARS: 300MG TID

Contra Indications:
Hypersensitivity to GABAPENTIN Pancreatitis

Precautions:
Renal insufficiency Abrupt discontinuation may precipitate status epilepticus.

Pregnancy Status:
CATEGORY: 'C' (contraversial)

Renal Failure Doses:
IF creatinine clearance is 30 to 60 milliliters/minute, the recommended GABAPENTIN dose is 300 milligrams twice a day. creatinine clearance 15 to 30 milliliters/minute, the GABAPENTIN dose is 300 milligrams daily. For creatinine clearance less than 15 ml/minutes, the recommended dose is 300 milligrams every other day

Lactation Status:
BREASTFEEDING: Unknown.

Interactions:
ANTACID-GABAPENTIN: ANTACID MAY DECREASE THE BIOAVAILABILITY OF GABAPENTIN TO 20%, THEREFORE, GABAPENTIN SHOULD BE AVOIDED WITH ANTACIDS PHENYTOIN-GABAPENTIN: GABAPENTIN MAY INCREASES THE PHENYTOIN LEVELS IN SERUM, THEREFORE, CARE SHOULD BE TAKEN WHEN BOTH ARE USED SIMULTANEOUSLY OR WHEN ONE OF THEM IS ADDED OR REMOVE FROM THE REGIMEN.

Adverse Effects:
The most frequent adverse effects of gabapentin in studies to date have been somnolence, fatigue, dizziness, blood pressure changes, ataxia, and nystagmus; other adverse effects include abnormal coordination, weight gain, edema, skin rash, purpura, nausea, vomiting, blurred vision, diplopia, mood changes, headache, seizures, tremor, and slurred speech.

Read More »

Unknown Adverse Effects, Gabapentin, Interactions, Intrerations, Precautions

Amlodipine Side Effects Interactions and Dosage

Amlodipine is indicated for the first line treatment of hypertension and can be used "as the sole agent to control blood pressure in the majority of patient.

Amlodipine besylate (Norvasc) is a drug that belongs to the drug class of calcium channel blockers (CCBs), and is prescribed for the treatment and prevention of angina (heart or chest pain) that results from coronary spasm and from exertion.

HOW TO USE: Take this medication by mouth, usually once daily with or without food or as directed by your doctor.

Amlodipine is also used to prevent certain types of chest pain (angina). It may help to increase your ability to exercise and decrease the frequency of angina attacks.


Amlodipine side effects

• feeling like you might pass out;
  swelling in your hands, ankles, or feet;
  pounding heartbeats or fluttering in your chest; or
  chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling.
  headache
  dizziness drowsiness
  tired feeling
  stomach pain or
  flushing (warmth, redness, or tingly feeling).

Interactions of Amlodipine besylate

Amlodipine besylate interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.


Usual Adult Amlodipine Dose for Hypertension:

Initial dose: 5 mg orally once a day
Maintenance dose: 5 to 10 mg orally once a day

Small or fragile patients may be started on 2.5 mg orally once a day.

Usual Adult Amlodipine Dose for Angina Pectoris:

Chronic stable or vasospastic angina, or angiographically documented coronary artery disease in patients without heart failure or an ejection fraction less than 40%: 5 to 10 mg orally once a day

Most patients with chronic stable or vasospastic angina require 10 mg for adequate effect. In clinical studies, most patients with coronary artery disease required 10 mg.

Usual Adult Amlodipine Dose for Coronary Artery Disease:

Chronic stable or vasospastic angina, or angiographically documented coronary artery disease in patients without heart failure or an ejection fraction less than 40%: 5 to 10 mg orally once a day

Most patients with chronic stable or vasospastic angina require 10 mg for adequate effect. In clinical studies, most patients with coronary artery disease required 10 mg.

Usual Geriatric Amlodipine Dose for Hypertension:

Initial dose: 2.5 mg orally once a day
Maintenance dose: 2.5 to 10 mg orally once a day

Usual Geriatric Dose for Angina Pectoris:

Chronic stable or vasospastic angina: 5 to 10 mg orally once a day
The lower dose is recommended in the elderly; however, most patients require 10 mg for adequate effect.

Usual Pediatric Dose for Hypertension:

6 to 17 years: 2.5 mg to 5 mg orally once a day
Doses in excess of 5 mg daily have not been studied in pediatric patients.

Read More »

Unknown Amlodipine, Interactions, Side Effects

Bronchodilators and Antiasthma Drugs Contraindicationa Precautions and Intreractions

Bronchodilators and Antiasthma Drugs:
Within the past few years a number of new drugs have been introduced to treat respiratory disorders, such as
bronchial asthma and disorders that produce chronic airway obstruction.  bronchodilators, drugs that have been around for a long time but are still effective in specific instances, and the newer antiasthma drugs that have proven to be highly effective in the prophylaxis (prevention) of breathing difficulty.
Asthma is a reversible obstructive disease of the lower airway. With asthma there is increasing airway
obstruction caused by bronchospasm and bronchoconstriction, inflammation and edema of the lining of the bronchioles,and the production of thick mucus that can plug the airway .

There are three types of asthma:
1. Extrinsic (also referred to as allergic asthma and caused in response to an allergen such as pollen, dust, and animal dander)
2. Intrinsic asthma (also called nonallergic asthma and caused by chronic or recurrent respiratory infections, emotional upset, and exercise)
3. Mixed asthma (caused by both intrinsic and extrinsic factors)

Extrinsic or allergic asthma causes the IgE inflammatory response. With exposure, the IgE antibodies
are produced and attach to mast cells in the lung. Reexposure to the antigen causes them to bind to the IgE
antibody, releasing histamine and other mast cell products. The release of these products causes bronchospasm, mucous membrane swelling, and excessive mucous production. Gas exchange is impaired,
causing carbon dioxide to be trapped in the alveoli so that oxygen is unable to enter.identifies the
asthmatic pathway from both intrinsic and extrinsic stimulus.
Other disorders of the lower respiratory tract include emphysema (lung disorder in which the terminal bronchioles or alveoli become enlarged and plugged with mucus) and chronic bronchitis (chronic
inflammation and possibly infection of the bronchi).
Chronic obstructive pulmonary disease (COPD) is the name given collectively to emphysema and chronic
bronchitis because the obstruction to the airflow is present most of the time. Asthma that is persistent and
present for most of the time may also be referred to as COPD.

BRONCHODILATORS

A  bronchodilator is a drug used to relieve bronchospasm associated with respiratory disorders, such as
bronchial asthma, chronic bronchitis, and emphysema.These conditions are progressive disorders characterized by a decrease in the inspiratory and expiratory capacity of the lung. Collectively, they are often referred to as COPD.
The patient with COPD experiences dyspnea (difficulty breathing) with physical exertion, has difficulty inhaling
and exhaling, and may exhibit a chronic cough.The two major types of bronchodilators are the sympathomimetics and the xanthine derivatives. The anti-cholinergic drug ipratropium bromide (Atrovent) is
used for bronchospasm associated with COPD, chronic bronchitis, and emphysema.

Bronchodilators: Sympathomimetic
Examples of sympathomimetic bronchodilators include albuterol (Ventolin), epinephrine (Adrenalin), salmeterol (Serevent), and terbutaline (Brethine). Many of the sympathomimetics used as bronchodilators have the subclassification of beta-2 (2) receptor agonists (eg,albuterol, salmeterol, and terbutaline). Additional information concerning the various sympathomimetic

ACTIONS
When bronchospasm occurs, there is a decrease in the lumen (or inside diameter) of the bronchi, which
decreases the amount of air taken into the lungs with each breath. A decrease in the amount of air taken into
the lungs results in respiratory distress. Use of a bronchodilating drug opens the bronchi and allows more air
to enter the lungs, which in turn, completely or partially relieves respiratory distress.

USES
Sympathomimetics  (drugs that mimic the sympathetic nervous system) are used primarily to treat reversible airway obstruction caused by bronchospasm associated with acute and chronic bronchial asthma,exercise induced bronchospasm, bronchitis, emphysema, bronchiectasis (abnormal condition of the bronchial tree), or other obstructive pulmonary diseases.

ADVERSE REACTIONS
Administration of a sympathomimetic bronchodilator may result in restlessness, anxiety, increase in blood
pressure, palpitations, cardiac arrhythmias, and insomnia. When these drugs are used by inhalation, excessive
use (eg, over the recommended times) may result in paradoxical bronchospasm.

CONTRAINDICATIONS, PRECAUTIONS,
AND INTERACTIONS
The sympathomimetic bronchodilators are contraindicated in patients with known hypersensitivity to the
drug, cardiac arrhythmias associated with tachycardia, organic brain damage, cerebral arteriosclerosis, and narrow angle glaucoma. Salmeterol is contraindicated during acute bronchospasm. The sympathomimetics are used cautiously in patients with hypertension, cardiac dysfunction, hyperthyroidism, glaucoma, diabetes, prostatic hypertrophy, or a history of seizures. The sympathomimetic drugs are used cautiously during pregnancy (all are Pregnancy Category C, except terbutaline, which is Pregnancy Category B), and lactation.
When the sympathomimetics are used concurrently with other sympathomimetic drugs , additive adrenergic effects can occur. When used with the monoamine oxidase inhibitors, the patient is at increased risk for a hypertensive crisis.
When the sympathomimetics are administered with a adrenergic blocker, the drugs may inhibit the cardiac,
bronchodilating, and vasodilating effects of the sympathomimetic. When a  blocker such as propranolol is
administered with a sympathomimetic such as epinephrine, an initial hypertensive episode may occur followed
by bradycardia. Concurrent use of the sympathomimetics with oxytocic drugs may result in severe hypotension. When the sympathomimetics are administered with theophylline there is an increased risk for cardiotoxicity. When epinephrine is administered with insulin or oral hypoglycemic drugs, the patient may require an increased dose of the hypoglycemic drug.

Bronchodilators: Xanthine Derivatives
Examples of the  xanthine derivatives (drugs that stimulate the central nervous system [CNS] resulting in
bronchodilation, also called methylxanthines) are theophylline and aminophylline. 

ACTIONS 
The xanthine derivatives, although a different class of drugs, also have bronchodilating activity by means of their direct relaxation of the smooth muscles of the bronchi.

USES
The xanthine derivatives are used for symptomatic relief or prevention of bronchial asthma and reversible
bronchospasm associated with chronic bronchitis and emphysema.


ADVERSE REACTIONS
Adverse reactions associated with administration of the xanthine derivatives include nausea, vomiting, restlessness, nervousness, tachycardia, tremors, headache, palpitations, increased respirations, fever, hyperglycemia,and electrocardiographic changes.


CONTRAINDICATIONS, PRECAUTIONS,
AND INTERACTIONS

The xanthine derivatives are contraindicated in those with known hypersensitivity, peptic ulcers, seizure disorders (unless well controlled with appropriate anticonvulsant medication), serious uncontrolled rrhythmias,
and hyperthyroidism.
The xanthine derivatives are used cautiously in patients older than 60 years, those with cardiac disease,
hypoxemia, hypertension, congestive heart failure, or liver disease. Aminophylline, dyphylline, oxtriphylline,
and theophylline are Pregnancy Category C drugs and are used cautiously during pregnancy and lactation.
When xanthine bronchodilators are administered with sympathomimetic drugs, additive
CNS and cardiovascular effects may occur. If a patient eats large amounts of charcoal-broiled foods while taking the xanthines, a decrease in the therapeutic effect of the xanthines may occur. Certain foods contain xan
thine (eg, coffee, colas, or chocolate) and may increase the risk of cardiac and CNS adverse reactions.Cigarettes, nicotine gum and patches, barbiturates,phenytoin, loop diuretics, isoniazid, and rifampin may decrease the effectiveness of the xanthines. There is an increased risk of xanthine toxicity when the drugs are administered with influenza vaccination, oral contraceptives, glucocorticoids, -adrenergic blockers, cimetidine, macrolides, thyroid hormones, or allopurinol.

Read More »

Unknown Bronchodilators and Antiasthma Drugs, Contraindications, Interactions, Precautions