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    For over 50 years, MIMS has provided trusted and relevant clinical information for over two million healthcare professionals in Asia. Designed for busy. - Free ebook download as PDF File .pdf), Text File .txt) or a drugs part 1 - Dr John CIMS India Drugs Reference. Download CIMS India and enjoy it on your iPhone, iPad and iPod touch. Designed for busy individuals on the go, the MIMS app is a one-stop medical.

    This link opens in a new window Therapeutic recommendations designed to assist in the management of patients with specific health conditions. Recommendations are based on the latest international literature and have been interpreted by leading Australian medical experts. The guidelines are written principally for prescribers to provide clear, practical, succinct and up-to-date therapeutic information. The information is independent, unbiased and summarises current evidence and opinion. Provides up-to-date information on pharmacology, including critical areas such as molecular biology, new drugs, and clinical studies. Please log out immediately after use. Comprehensive, uniform guide to the uses, properties, and safety of pharmaceutical excipients. Essential reference source for the development, production, control, or regulation of pharmaceutical preparations. Includes more than fully-referenced monographs.

    Choose high-quality, pre-appraised sources first and make sure they are current. Select the information that is most relevant to the needs of your particular patient.

    Take the time to become familiar with the features of the resources you use. Keywords: complementary medicines, drug information, drug interaction Introduction Using reliable information resources informs safe and consistent practice. There is so much information available on medicines that it can be hard to identify accurate, current, unbiased and evidence-based resources.

    Questions to consider when selecting an information source Not all information sources are reliable, so it is useful to ask yourself some simple questions to help you appraise them.

    Is it evidence-based? Se- min Pediatr Surg. Curr Colorectal Ad- Cancer Rep. J Clin Oncol. Support Care 1;35 25 Manage- al. Ann Oncol. Ceftriaxone plus once daily aminogly- 20;35 3 Postop- vs. Chemo- erative adjuvant chemoradiotherapy in therapy.

    D2-dissected gastric cancer: is radiothera- Current trends py necessary after D2-dissection? World J in the management of anaemia in solid Gastroenterol. Curr Opin Support Palliat Care. Jun;10 2 International Melanoma Meta-Analysis Blood meta-analysis.

    Eur J Cancer. Eur J Surg On- col. Support Care Cancer. Adjuvant endocrine therapy for early ommendations: controlling nausea and vomiting with chemotherapy of low or mini- mal emetic potential. Support Care Can- cer. Chemotherapy: Target Therapy and Immunotherapy 15 Erratum Support Care Chemotherapy-associated peripheral neu- ropathy in patients with early-stage breast Crit Rev Oncol in advanced cancer patients.

    Arch Toxicol. Miltenburg NC, Boogerd W. Chemothera- breakthrough nausea and vomiting. Sup- py-induced neuropathy: a comprehensive port Care Cancer.

    Cancer Treat Rev. Aprepitant and fosaprepitant: a year Persistent neuropathy after treatment Apr;20 4 Acta Oncol. New frontiers in the pathobiology and B akogeorgos M, Georgoulias V. Risk-re- treatment of cancer regimen-related mu- duction and treatment of chemotherapy- cosal injury. Front Pharmacol. Expert 8; Rev Anticancer Ther. Impact of chemotherapy on cancer-related fatigue C heson BD. Etiology and management of and cytokines in patients: a systemat- tumor lysis syndrome in patients with chron- ic review of quantitative studies.

    Urine as hydroxymetabolites ; 4 hr elimination half-life. Used in the treatment of inflammation and rheumatism. Note that there are some more drugs interacting with aceclofenac aceclofenac aceclofenac brands available in India Always prescribe with Generic Name: CIMS Class: Each tablet contains aceclofenac mg and paracetamol mg: Overdosage Empty stomach promptly by gastric lavage or induction of emesis.

    Administer standard supportive measures. Contraindications Hypersensitivity. Moderate to severe renal or hepatic impairment; severe heart failure; pregnancy third trimester. Special GI disease; renal or hepatic impairment; alcohol-dependent Precautions patients; asthma or allergic disorders; haemorrhagic disorders; hypertension; cardiac impairment.

    Caution when driving or operating machinery. Monitor renal and hepatic function and blood counts during long term treatment. Persistently elevated hepatic enzyme levels may require drug withdrawal.

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    Adverse Drug Paracetamol: Nausea, allergic reactions, skin rashes, acute Reactions renal tubular necrosis. Diarrhoea, headache, vertigo, dizzies, nervousness, tinnitus, depression, drowsiness, insomnia; fever, angioedema, bronchospasm, rashes; blood dyscrasias.

    Very rare, blood dyscrasias eg, thrombocytopaenia, leucopaenia, neutropaenia, agranulocytosis ; liver damage. Severe GI bleeding; nephrotoxicity. Drug Interactions Paracetamol: Reduced absorption of cholestyramine within 1 hr of administration. Accelerated absorption with metoclopramide. M0ay increase the plasma concentrations of lithium and digoxin. Increased nephrotoxicity with diuretics. Serum-potassium should be monitored when used with potassium-sparing diuretics.

    May increase plasma methotrexate levels leading to toxicity if administered within hr of methotrexate admin. Risk of convulsions with quinolones. Increased risk of liver damage in chronic alcoholics. Increased risk of toxicity with high doses or long term admin of barbiturates, carbamazepine, hydantoins, isoniazid, rifampin and sulfinpyrazone. Lab Interference Aceclofenac interferes with thyroid function tests.

    Mechanism of Aceclofenac is a phenylacetic acid derivative that inhibits Action synthesis of the inflammatory cytokines interleukin-1b and tumour necrosis factor, and inhibits prostaglandin E2 production. It increases glycosaminoglycans GAG synthesis, the principal macromolecule of the extracellular matrix, which aids in repair and regeneration of articular cartilage.

    Paracetamol has analgesic and antipyretic action with weak anti-inflammatory activity. It produces analgesia by increasing pain threshold and antipyresis by acting on the hypothalamic heat-regulating centre. Distributes throughout most fluids of the body.

    Probably metabolised by CYP2C9; average plasma elimination half-life: Mainly metabolised hepatically; plasma elimination half-life: About two-thirds of the administered dose is removed in the urine, mainly as conjugated hydroxymetabolites. Most metabolites are removed in the urine within 24 hr. Used to relieve pain and fever. Contraindications Active haemorrhage or risk of serious haemorrhage; severe hypertension; pregnancy.

    Special Bleeding disorders; peptic ulcers; severe wounds; Precautions cerebrovascular disorders, bacterial endocarditis; renal or hepatic impairment; lactation. Avoid alcohol. Adverse Drug Alopecia; fever, nausea, vomiting, diarrhoea; skin rash; Reactions cholestatic liver damage.

    Drug Interactions Potentiates hypoglycaemic agents. Bismuth carbonate and Mg reduce absorption. Cimetidine, allopurinol, diuretics and other oral anticoagulants enhance effect. Potentiated by NSAIDs, amiodarone, antibacterial agents eg, co-trimoxazole, cephalosporins, erythromycin, quinolone antibiotics, chloramphenicol, doxycycline, INH and neomycin. Rifampicin, barbiturates and griseofulvin diminish effect.

    Food Interaction Renal excretion of metabolites is decreased when administered with grapefruit juice. Readily absorbed from the GI tract. Extensively bound to plasma proteins. Largely in the urine mainly as metabolites. Used in the treatment of thrombosis. Note that there are some more drugs interacting with acenocoumarol acenocoumarol acenocoumarol brands available in India Always prescribe with Generic Name: Diuretics , Anticonvulsants , Antiglaucoma Preparations acetazolamide.

    Intermittent treatment is needed for continued efficacy. Oral Preoperative management of angle-closure glaucoma Adult: Oral Adjunct in open-angle glaucoma Adult: Oral Epilepsy Adult: Either alone or with other antiepileptics: Neonates and up to 12 yr: Initially, 2.

    Oral Prophylaxis of high-altitude disorders Adult: Prompt descent is still advised if severe symptoms such as cerebral or pulmonary oedema occur. Intravenous Chronic open-angle glaucoma Adult: As an adjunct, 0. Adjust dose according to symptomatology and ocular tension. Intravenous Acute closed angle glaucoma Adult: Intravenous Epilepsy Adult: Optimum dose: When used with other anticonvulsants, initiate at mg once daily in addition to existing medications and adjust accordingly.

    Admixture incompatibility: Overdosage Symptoms may include electrolyte imbalance, acidotic state and central nervous effects. Monitor serum electrolyte levels particularly potassium and blood pH levels. Supportive measures are required to restore electrolyte and pH balance. Acidotic state can usually be corrected by the admin of bicarbonate.

    Contraindications Hypersensitivity to sulphonamides; sodium or potassium depletion, hepatic insufficiency; hepatic cirrhosis; hyperchloraemic acidosis; severe renal impairment; severe pulmonary obstruction; chronic noncongestive angle-closure glaucoma; adrenocortical insufficiency.

    Special Potassium supplements may be required. Impaired hepatic Precautions or renal function; diabetes. Monitor plasma electrolytes and blood count regularly. IM route is not recommended. Adverse Drug Drowsiness, paraesthesia, ataxia, dizziness, thirst, anorexia, Reactions headache; confusion, malaise, depression; GI distress, metabolic acidosis, polyuria, hyperuricaemia, renal calculi, nephrotoxicity, hepatic dysfunction.

    Rarely, skin reactions or blood dyscrasias.

    Drug Interactions Aids penetration of weakly acidic substances like sulphonamides across blood and CSF barrier. May inhibit renal excretion of basic drugs e. May increase salicylate toxicity acidosis. Hypokalaemia with corticosteroids and potassium-wasting diuretics. May increase excretion of lithium and primidone. May cause osteomalacia with anticonvulsants.

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    May potentiate effect of folic acid antagonists, oral hypoglycaemic agents, oral anticoagulants and severe reactions to sulphonamides. Lab Interference May cause false positive results for urinary protein. Interferes with HPLC theophylline assay and serum uric acid levels. Either studies in animals have revealed adverse effects on the foetus teratogenic or embryocidal or other and there are no controlled studies in women or studies in women and animals are not available.

    Storage Intravenous: Mechanism of Acetazolamide specifically inhibits the enzyme carbonic Action anhydrase which catalyses the reversible reaction involving the hydration of CO2 and dehydration of carbonic acid.

    Carbonic anhydrase is also inhibited in the CNS to retard abnormal and excessive discharge from neurons. Moderately rapid absorption from the GI tract; peak plasma concentrations after 2 hr oral. Concentrates in the red blood cells and renal cortex; enters the breast milk. Urine as unchanged drug ; hr elimination half-life.

    Note that there are some more drugs interacting with acetazolamide acetazolamide acetazolamide brands available in India Always prescribe with Generic Name: P - Caution when used during pregnancy L - Caution when used during lactation. Oral Paracetamol poisoning Adult: Repeat dose if the patient vomits within 1 hr of admin. Continue therapy until paracetamol levels are not detectable and there is no evidence of hepatotoxicity. Intravenous Paracetamol poisoning Adult: Doses as per adult dose but adjust volume of based on child age and wt to avoid fluid overload.

    Inhalation Mucolytic Adult: Endotracheal Mucolytic Adult: Ophthalmic Dry eye associated with abnormal mucus production Adult: Incompatible with metals e. A change in colour of solution to light purple may be observed and does not indicate significant change in safety or efficacy. Special Asthmatic patients, history of bronchospasm, peptic ulceration. Precautions Pregnancy, lactation. Adverse Drug Flushing, fever, stomatitis, nausea, vomiting, rhinorrhoea, Reactions bronchospasm, anaphylactoid reactions, rashes.

    Rarely, blurred vision, bradycardia, syncope, thrombocytopenia, convulsions. Rarely, respiratory or cardiac arrest. Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect other than a decrease in fertility that was not confirmed in controlled studies in women in the 1st trimester and there is no evidence of a risk in later trimesters.

    Storage Endotracheal: Undiluted solution may be kept refrigerated for 96 hr. Diluted solution to be used within 1 hr. Mechanism of Acetylcysteine may decrease the viscosity of secretions by Action splitting of disulphide bonds in mucoproteins. It also promotes the detoxification of an intermediate paracetamol metabolite which is used in the management of paracetamol overdosage.

    Rapidly absorbed from the GI tract oral ; peak plasma concentrations after 0. Extensively hepatic. Urine; elimination half-life: Classification Used in the treatment of wet cough. S01XA08 - acetylcysteine; Belongs to the class of other agents used as ophthalmologicals.

    V03AB23 - acetylcysteine; Belongs to the class of antidotes. Used to neutralize paracetamol overdose. Note that there are some more drugs interacting with acetylcysteine acetylcysteine acetylcysteine brands available in India Always prescribe with Generic Name: Oral Suppression of recurrent herpes simplex Adult: May reduce to mg daily if necessary.

    Reassess the condition every mth. For mild or infrequent recurrences: Episodic treatment may be used: Oral Prophylaxis of herpes simplex in immunocompromised patients Adult: Oral Herpes zoster shingles Adult: Intravenous Mucocutaneous herpes simplex in immunocompromised patients Adult: Dose to be given as IV infusion over 1 hr. Peritoneal dialysis: Half the usual dose once daily. Half the usual dose every 24 hr and an additional half-dose after haemodialysis.

    Intravenous Herpes simplex encephalitis Adult: Intravenous Genital herpes Adult: Intravenous Neonatal herpes simplex virus infections Child: Birth - 3 mth: Intravenous Herpes zoster in immunocompromised patients Adult: Ophthalmic Herpes simplex keratitis Adult: Remove the calculated dose and add it to any appropriate IV solution at a volume selected for admin during each 1-hr infusion.

    Recommended infusion concentrations: Higher concentrations e. Standard, commercially available electrolyte and glucose solutions are suitable for IV admin; biologic or colloidal fluids e.

    Y-site incompatibility: Syringe incompatibility: Pantoprazole, caffeine citrate. Dobutamine, dopamine. Special Renal impairment. Neurological Precautions abnormalities with significant hypoxia, serious hepatic or electrolyte abnormalities. Maintain adequate hydration. Adverse Drug Nausea, vomiting, headache, diarrhoea, rash, haematological Reactions changes occasional , increase in liver enzymes, burning, itching or erythema topical use.

    Eye application may produce stinging, superficial punctate keratopathy, blepharitis or conjunctivitis. IV administration: Local reaction, pain, inflammation, phlebitis, extravasation leads to ulceration. Rarely, renal failure.

    Occasionally neurotoxicity after IV use: Lethargy, confusion, agitation, tremors, seizures, coma. Drug Interactions Probenecid decreases urinary excretion and increases half-life. Risk of renal impairment increased by other nephrotoxic drugs. Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect other than a decrease in fertility that was not confirmed in controlled studies in women in the 1 st trimester and there is no evidence of a risk in later trimesters.

    Once diluted for admininstration, solution should be used within 24 hr. J05AB01 - aciclovir; Belongs to the class of nucleosides and nucleotides excluding reverse transcriptase inhibitors. S01AD03 - aciclovir; Belongs to the class of antiinfectives, antivirals.

    Used in the treatment of eye infections. Note that there are some more drugs interacting with aciclovir aciclovir further details are available in official CIMS India aciclovir aciclovir brands available in India Always prescribe with Generic Name: Initially, 10 mg daily for wk. Max dose: Oral Congenital icthyosis Adult: Initially, mg daily for wk before dose adjustments are done.

    Usual range: Oral Severe lichen planus Adult: Oral Severe psoriasis Adult: Overdosage Symptoms are identical to acute hypervitaminosis A, ie, headache and vertigo. Hepatic and renal impairment. Special Female patients to avoid alcohol during and 2 mth after Precautions treatment.

    Avoid blood donation during therapy or at least yr after stopping therapy. Radiographic treatment for prolonged therapy. Monitor plasma lipid and glucose levels especially diabetics regularly. Monitor LFTs. Adverse Drug Dryness of mucous membranes and skin; conjunctivitis, dry Reactions sore mouth; ophth disturbances; raised lipid level, pancreatitis; sticky skin, dermatitis.

    Severe headache; GI disturbances; dermatologic reactions, oedema, paronychia, granulomatous lesions, bullous eruptions; reversible hair thinning and alopoecia; CNS disturbances; sweating; taste disturbance, gingivitis; benign intracranial hypertension; photosensitivity; skeletal hyperostosis; extraosseous calcification; premature epiphyseal closure in child.

    Phototoxicity, jaundice, hepatitis and hepatotoxity. Drug Interactions Concomitant use with keratolytics or high dose vitamin A. Reduces anticoagulant effect of coumarins e. Concomitant use of microdised progestin oral contraceptives. Concomitant use of methotrexate can potentiate hepatotoxicty. Concomitant use with tetracycline. Food Interaction Co-administration with food may increase oral bioavailability.

    Lab Interference Elevation of liver enzymes, lipids, triglycerides and cholesterol level in blood. Studies in animals or human beings have demonstrated foetal abnormalities or there is evidence of foetal risk based on human experience or both, and the risk of the use of the drug in pregnant women clearly outweighs any possible benefit.

    The drug is contraindicated in women who are or may become pregnant. Mechanism of Acitretin is an active metabolite of etretinate but its Action mechanism of action is unknown. Note that there are some more drugs interacting with acitretin acitretin acitretin brands available in India Always prescribe with Generic Name: Contraindications Pregnancy, lactation; CV disease.

    Special Myocardial irradiation and use of radiotherapy. Hepatic or Precautions renal impairment. Adverse Drug Nausea, vomiting, mucositis, irritant to tissue, sore mouth, Reactions bone-marrow suppression, hyperuricaemia.

    Alopoecia rare. Cardiotoxicity rare , myelosuppression in patients who received mitomycin or a nitrosourea, leucopenia. Drug Interactions Other cardiotoxic drugs e.

    Lab Interference Elevated bilirubin level. Mechanism of Aclarubicin is an anthracycline, a cytotoxic antibiotic, and Action inhibits RNA synthesis through intercalation.

    Rapidly distributed into tissues after IV admin. Extensively metabolised. Triphasic clearance. Terminal elimination half-life: About 3 hr.

    Excreted in urine mainly as metabolites. Used in the treatment of cancer. Apply thinly onto affected areas once daily at night after cleansing. Special Patients with sunburn, eczema. Avoid Precautions excessive exposure to sunlight or UV irradiation. Keep away from the eyes, lips, nostrils and mucous membranes. Do not apply to cuts, abrasions, scaly or flaky skin, or patches of sunburned skin.

    Use with caution with preparations containing sulfur, resorcinol, or salicylic acid. Adverse Drug Mild skin irritation, scaling, erythema, cutaneous dryness, Reactions sensations of stinging and burning, pruritus.

    Drug Interactions Increased irritation may occur with medicated or abrasive soaps, products with a pronounced drying effect and those containing alcohol or astringents.

    Mechanism of Adapalene binds to specific retinoic acid nuclear receptors Action which normalises the differentiation of follicular epithelial cells resulting in decreased microcomedone formation. Adapalene binds to specific retinoic acid nuclear receptors which normalises the differentiation of follicular epithelial cells resulting in decreased microcomedone formation. Minimal topical. Haemodialysis patients: Overdosage Monitor for signs of toxicity, apply supportive treatment when necessary.

    Contraindications Lactation. Special Pregnancy; elderly; child; renal or hepatic impairment. HIV Precautions antibody testing to be performed before initiation due to possible resistance development in untreated HIV infection. Increased risk of hepatotoxicity in females, obese patients and with prolonged treatment. Monitor renal function every 3 mth; hepatitis B biochemical, viral and serological markers every 6 mth and LFTs. Discontinue therapy if liver function worsens, severe hepatomegaly, steatosis or unexplained metabolic or lactic acidosis.

    Monitor hepatic function for several mth in patients whose antihepatitis therapy is discontinued as acute exacerbations of hepatitis may occur. Adverse Drug Nausea, dyspepsia, abdominal pain, flatulence, diarrhoea, Reactions asthenia, headache.

    Pruritus, skin rashes, and respiratory effects e. Lactic acidosis, severe hepatomegaly with steatosis, hepatotoxicity, nephrotoxicity. Drug Interactions Increased risk of nephrotoxicity with nephrotoxic drugs e. Ibuprofenincreases bioavailability of adefovir.

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    Food Interaction Increased risk of hepatotoxicty with alcohol in hepatitis B infection. Mechanism of Adefovir dipivoxil is an acyclic nucleoside reverse transciptase Action inhibitor. The diester function is hydrolyzed and subsequently phosphorylated to the active adefovir diphosphate.

    It can be used in patients with lamivudine-resistant hepatitis B. Rapidly converted to adefovir after oral admin. Plasma concentration peaks after 0. Widely distributed to body tissues. Protein binding: Note that there are some more drugs interacting with adefovir dipivoxil adefovir dipivoxil adefovir dipivoxil brands available in India Always prescribe with Generic Name: Initially, 3 mg by rapid IV inj into a central or large peripheral vein over 2 sec with cardiac monitoring; 6 mg may be given after minutes if necessary, then 12 mg after a further minutes.

    Avoid increments if high level AV block occurs at any particular dose. Max Dosage: Intravenous Paroxysmal supraventricular tachycardia Adult: Intravenous Myocardial imaging Adult: Inject radionuclide 3 minute after infusion. Contraindications 2nd or 3rd degree AV block and sick sinus syndrome unless pacemaker fitted , asthma, hypersensitivity. Special Pregnancy; heart transplant patients; patients on Precautions dipyridamole lower initial dose of adenosine 0.

    Adverse Drug Facial flushing, palpitations, chest pain, bradycardia, Reactions sweating, hypotension, dyspnoea, choking sensation, headache, lightheadedness, tingling, numbness, neck and back pain, nausea, metallic taste. ECG changes suggestive of rhythm disturbances. Drug Interactions Adenosine effects antagonised by methylxanthines like caffeine, theophylline, etc.

    Concomitant carbamazepine may increase the risk of heart block. Adenosine effects are potentiated by dipyridamole. Mechanism of Adenosine acts rapidly to slow down conduction through the Action AV node via the A1 receptors.

    It also mediates peripheral and coronary vasodilatation by stimulating the A2 receptors. Rapidly taken up into the erythrocytes and vascular endothelial cells. Metabolised to adenosine monophosphate and inosine. Plasma half-life: Note that there are some more drugs interacting with adenosine adenosine adenosine brands available in India Always prescribe with Generic Name: For cystic echinococcosis, up to 3 treatment cycles of 28 days each may be given with 14 treatment-free days in between cycles.

    For alveolar echinococcosis, treatment cycles of 28 days each with 14 treatment-free days in between. Treatment cycles may need to be continued for mth or yr until complete eradication of parasites. Oral Neurocysticercosis Adult: Oral Ascariasis Adult: Oral Hookworm infections Adult: Oral Enterobiasis Adult: Enterobiasis Adult: Oral Strongyloidiasis Adult: Oral Giardiasis Adult: Overdosage Symptomatic and supportive measures are advised.

    Contraindications Pregnancy and lactation. Hypersensitivity, liver impairment. Special Monitor blood counts and liver function. Administer within 7 Precautions days of start of normal menstruation in women of childbearing age. Adequate nonhormonal contraceptive measures must be taken during and for 1 mth after therapy.

    Perform liver function tests and blood counts before and every 2 wk during high dose therapy of hydatid disease. Adverse Drug GI discomfort, headache, nausea, dizziness, allergic Reactions reactions, pruritus, raised liver enzymes, alopecia and dry mouth.

    Bone marrow depression. Drug Interactions Cimetidine increases albendazole metabolism. Serum levels are increased if taken with dexamethasone and praziquantel agent. Mechanism of Albendazole exhibits a broad-spectrum anthelmintic activity Action showing vermicidal, ovicidal and larvicidal actions. It inhibits tubulin polymerization in the parasite and blocks glucose uptake; energy levels are reduced resulting to death of the parasite.

    Susceptible parasites include hookworm, roundworm, threadworm, whipworm, tapeworm, strongyloides, opisthorchis and hydatid disease Echinococcus.

    Poorly absorbed from the GI tract oral. Widely distributed; bile, CSF. Extensive hepatic first-pass metabolism; converted to albendazole sulfoxide.

    Via bile; via urine small amounts. Note that there are some more drugs interacting with albendazole albendazole further details are available in official CIMS India albendazole albendazole brands available in India Always prescribe with Generic Name: Oral Paget's disease of bone Adult: Oral Prophylaxis of postmenopausal osteoporosis Adult: Oral Corticosteroid-induced osteoporosis Adult: Treatment and prevention: Administration Should be taken on an empty stomach.

    Overdosage Symptoms may include hypocalcaemia, hypophosphataemia and upper GI adverse events, such as upset stomach, heartburn, esophagitis, gastritis or ulcer. Milk or antacids should be given to bind alendronate. Should not induce vomiting due to the risk of oesophageal irritation.

    Patient should remain fully upright. Dialysis would not be beneficial. Correct vitamin D and calcium deficiency before starting therapy. To be taken half an hr before breakfast and remain upright for at least 30 minutes after admin. Adverse Drug Oesophagitis, oesophageal ulcers and erosions, dysphagia, Reactions heartburn, retrosternal pain, abdominal pain, distension, diarrhoea, constipation, flatulence, headache, rash, erythema, musculoskeletal pain, transient decreases in serum phosphate.

    Drug Interactions Concomitant iron, calcium supplements and antacids hinder alendronate absorption. Food Interaction Food, mineral water, coffee, tea and juice interfere with absorption of alendronate. Mechanism of Alendronic acid reduces bone resorption by inhibiting the Action action of osteoclasts.

    Poorly absorbed from the GIT oral ; reduced by food. Used in the treatment of bone diseases. Initially, 1 mcg daily. Premature infants and neonates: Overdosage Symptoms may include anorexia, lassitude, nausea and vomiting, constipation or diarrhoea, polyuria, nocturia, sweating, headache, thirst, somnolence and vertigo and hypercalcaemia. Stop admin of alfacalcidol. Treatment is symptomatic and supportive. Ensure patient is well hydrated by i.

    Monitor electrolytes, calcium levels, renal function, ECG especially in patients on digitalis. Consider treatment with glucocorticosteroids, loop diuretics, bisphosphonates, calcitonin and haemodialysis with low calcium content. Contraindications Hypercalcaemia, metastatic calcification, hyperphosphataemia except when occurring with hypoparathyroidism , hypermagnesaemia. Special Pregnancy, lactation, renal impairment, infants, elderly. Monitor Precautions serum levels of calcium in patients with renal failure.

    Caution in hypercalciuria esp in those with history of renal calculi. Avoid in patients with hypersensitivity to inj.

    Adverse Drug Anorexia, nausea, vomiting, diarrhoea, lassitude, polyuria, Reactions sweating, headache, thirst, vertigo, pruritus, rash, urticaria. Hypercalcaemia, hypercalciuria and ectopic calcification.

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