© Okereke P. 2007
+2348055318800
1st print 2003
2nd print 2007 with amendments
No part of this publication may be reproduced in any for, electronic, mechanical, photocopying, recording or otherwise without the written permission of the publishers.
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Therefore the purpose of this book is not to make suggestions, create additional or separate list of essential drugs apart from the already existing list of the essential drugs of World Health Organization/Nigeria. Rather it is aimed at giving essential information (indication, mode of action, side effects, contraindications, route of administration, dosage schedule, safety precautions and examples of popular brand products that contains the required generic preparations) on rational used of drugs.
Finally all doses recommended in this book are for adults except where otherwise stated.
---Author
Narcotic 10
Non narcotic 12
NSAIDs 13
Antihistamines 18
Antianaphylactic 21
Specific 24
Nonspecific 24
Antihelmintics 32
Antifilariais 34
Antischistosomal 36
Antibacterial 37
Anti TBL 60
Antifungal 63
Antiviral 67
Antigiardiasis and antiamoebic 71
Anti malaria 72
Corticosteroids 80
Androgen 82
Oestrogen 83
Progestogens 84
Contraceptives 85
Pituitary drugs 87
Anti diabetics 90
Antianaemia 94
Plasma substitute 97
Anti coagulants 97
Anti anginal 100
Anti arrhythmic 102
Anti hypertensive 103
Cardiac glycosides 108
Antiinfective 109
Anti-inflammatory and antipruritic 110
Fungicides 112
Scabicides and pediculicides 114
Antiifective 116
Anti-inflammatory/antiallergic 118
Antacids/antiulcer drugs 126
Anti emetic 129
Antispasmodic/smooth muscle relaxant 133
Purgative 134
Anti diarrhea 137
Antihaemorrhoid 138
Sera and immunoglobulins 140
Vaccine 142
Myasthenia gravis 146
Hypnotics and sedatives 150
Anti psychotic 153
Anti asthmatic 158
Antitussive and expectorants 159
Antiifective 172
Anti-inflammatory 173
Nose 174
Mouth and throat 176
2. ANALGESICS, ANTIPYRETICS AND NSAIDS
Analgesics (Painkillers) are a class of drugs used to relieve pain. The pain relief induced by analgesics occurs either by blocking pain signals going to the brain or by interfering with the brain's interpretation of the signals, without producing anaesthesia or loss of consciousness. There are basically two kinds of analgesics: non-narcotics and narcotics.
Non-narcotics - Non narcotic analgesics are effective in relieving mild to moderate pains and are further classified into two: i. anti pyretic and ii. Non steroidal anti-inflammatory agents
Narcotics - Narcotic analgesic alleviates severe pains and is capable of producing sedation even at moderate doses.
It is not fully understood how painkillers work. Damaged or inflamed body tissues produce various chemicals which send signals through the nervous system to the brain. The brain produces the sensation of pain. Different painkillers act at different points in this process. For example, NSAIDS may act at the point of injury, whereas others act on the nerves or brain.
30 mg (tartrate)/tab; 500 mg/ml amp.
A less potent narcotic analgesic used to relieve moderately severe pain; normal dose is 30 to 60 mg every six hours is for adults. This medication may cause dependence, especially if it has been used regularly for an extended time or if it has been used in high doses. In such cases, withdrawal reactions (e.g., runny nose, watery eyes, and restlessness) may occur if you suddenly stop this drug. To prevent withdrawal reactions when stopping extended, regular treatment with this drug, gradually reduce the dosage
Synonym: DF 118
10 mg, 15 mg (sulphate or hydrochloride)/ amp, and 10mg (sulphate)/tab.
Is a powerful opiate derivative and is mostly suitable for severe continuous pain of visceral or soft tissue origin especially where other narcotic analgesic have failed. It is better to start therapy with oral dose of 2.5 to 5 mg every four hours. Dose may be titrated by 50 to 100% to control pain for full 24 hours. Morphine causes respiratory depression but does not alter blood pressure just like other opiate analgesic. Constipation with morphine is severe therefore it may be administered together with laxatives and antiemetic if vomiting occur. Contraindications include respiratory depression, obstructive airway disease, 24 hours pre and post operation, pregnancy, head injury, lactation and coma. S/E: tolerance, dependence, constipation, nausea, vomiting, drowsiness, urticaria. Morphine may be given in a dose of 10 to 20 mg either by s.c, i.m, or i.v injection.
50 mg/tab; 50 mg/ml (HCl)
Pethidine hydrochloride is an effective analgesic that can be used in place of morphine for the relieve of most severe types of pain. The analgesic action of pethidine hydrochloride is sometimes accompanied by euphoria; its duration of action may last for 2-5 hours. The dose varies with the purpose, age and route of administration. For relieve of pain in most medical and surgical condition, a dose of 100 mg i.m, orally or slow i.v injection. In severe pain, a dose of 150 mg may be required; up to 50 mg may be given as a single slow intravenous dose. Pethidine reduces the severity of labour pain, but does not alter contraction. A dose of 100 mg intramuscular is used for this purpose. S/P: Pethidine may cause respiratory depression
Inj., pethidine 50mg (HCl) plus Levallorphan
0.625mg (tatrate) in 1 or 2ml ampoule
A nice combination of pethidine hydrochloride and levallorphan tartrate. The actions of pethidine are as enumerated above. Levallorphan prevents respiratory depression due to pethidine and other narcotic analgesic. Therefore pethilorfan exhibit all the analgesic actions of pethidine but does not cause respiratory depression in healthy patient as do ordinary pethidine. It is a good substitute for pethidine for safety reasons. Pethilorphan does not relieve respiratory depression caused by other medical condition.
300 mg/tab; 500 mg/cap
Acetylsalicylic acid has analgesic, anti-pyretic and anti-inflammatory action. It is one of the essential drugs because of its low toxicity, cheapness and ready availability. It is indicated in less severe pains like headache, neuralgia, gout, neuritis, rheumatic joint pains, myalgias, cold, toothache and feverish conditions. Acetylsalicylic acid acts on the hypothalamus and inhibits prostaglandin that is responsible for production of inflammation, fever and pains. Dose: 0.3-1g in divided doses for analgesic and antipyretic, 0.5-1g every 4 hours in chronic rheumatism. All by oral administration. It is contraindicated in gastric lesion, and asthma. Side effects include dyspepsia, haematemesis and melaena.
Brand name: Aspirin
500 mg, 125 mg/tab. or cap. 125 mg/5 ml syrup or susp.
Paracetamol has analgesic action, but no anti-inflammatory effect. It is a good substitute to patients sensitive to acetylsalicylic acid. Its hepatotoxic effect is irreversible. This effect is always due to overdose. Paracetamol is used to relieve pain in conditions like Toothache, Pain During Periods, Pain associated with Arthritis, Backache, Muscle Pain, Fever, Pain, Head Pain. Migraine Headache, rheumatism and neuralgia. Do not take this medication for fever for more than 3 days. For adults, do not take this product for pain for more than 10 days (5 days in children) Pain medications work best if they are used as the first signs of pain occur. If you wait until the symptoms have worsened, the medication may not work as well. . Paracetamol causes less gastric irritation than acetylsalicylic acid and is more preferred in elderly patient. The adult dose is 0.5 to 1g every three or four hour. Children aged 3-7: 250 mg, 7-12 years: 500 mg
Popular brand name: panadol,
(NSAIDs) and drugs used for gout
25 mg/cap
This is a non-steroidal anti-inflammatory drug. It has analgesic, antipyretic and anti-inflammatory effect and is therefore used in the treatment of musculoskeletal disorders such as osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, gout, dysmenorrhoea and lumbago. A dose of 25-50 mg b.i.d or t.i.d is advised with meals. Higher doses can produce such effects like headache, nausea, vomiting, epigastric discomfort and gastric lesion. Indomethacin is contraindicated in patient with history peptic ulcer disease and asthma.
Brand name: Indocid
250 mg/tab
Diflunisal has about 8 to 12 hours duration of action without antipyretic effect but anti inflammatory and analgesic effect. Its major area of action is inflammatory conditions and pains like osteoarthritis, rheumatoid arthritis and pains and associated symptoms of dysmenorrhoea. The usual therapeutic dose in patients with osteo or rheumatoid arthritis is between 500 mg to 1g daily in one or two divided doses. In painful conditions like dysmenorrhoea, initial dose of 1g followed by 500 mg b.i.d is recommended. It is contraindicated in asthmatic attack, patients allergic to salicylates or other NSAIDs, gastric intestinal ulcer. Adverse effects are gastrointestinal pains, dyspepsia, nausea, tinnitus. S/P: ulcerative patients, patients receiving anticoagulant, liver diseases. Diflunisal is mostly available in tablets and should not be administered together with indomethacin.
Brand name: Dolobid
25 mg and 100 mg per tab.
Inflammatory and degenerative form of rheumatism, acute musculoskeletal disorders, acute gout, post traumatic and post operative inflammation and pain; painful conditions of the ear, nose and throat; renal and biliary colic, dysmenorrhoea and inflammatory infections. Adult dose of 75 to 150mg daily is recommended orally or intramuscularly with food. It is contraindicated in peptic ulcer disease, asthma and pregnancy. Side effects involved are nausea, vomiting, dyspepsia, rashes, gastrointestinal pain, headache, dizziness.
Brand name: Voltaren
200 and 400 mg per tab/cap
A non-steroidal anti-inflammatory agent indicated in the treatment of muscular and soft tissue pains, rheumatoid arthritis, osteoarthritis, analgesic and anti-inflammatory conditions. Initial dose of 1.2g daily in divided doses and maintenance dose of 600 mg daily also in divided doses. Toxic effects: gastrointestinal upset or haemorrhage skin rash. Contraindications: history of or active peptic ulcer.
Synonym: Brufen, Motrin
500, 100 and 200 mg per cap; 100 mg/2ml amp.
Ketoprofen controls symptoms for a period of 24 hours with a central analgesic activity for a powerful pain relief. Its main area of action is rheumatological disorders, ankylosing spodylitis, acute gout, acute painful musculoskeletal conditions, cervical spondylitis, acute gout and postoperative pains. 100-200 mg daily single daily dose with food. Route of administration could either be by mouth or deep intramuscular injection. Contraindications: pregnancy, patients allergic to NSAIDs, bronchial asthma, active peptic ulcer, dyspepsia and renal dysfunction.
Synonyms: Orudis, Oruvil
250 mg, 500 mg per tab.
Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, acute gout, acute musculoskeletal disorders, dysmenorrhoea, and other painful and inflammatory conditions. 500-1000 mg daily in two divided doses at twelve hourly intervals or as a single daily dose depending on clinical reasons. S/E: skin rash, GI intolerance, headache tinnitus and vertigo. S/P: elderly, history or active gastrointestinal lesions, renal or hepatic impairment, and heart failure. C/I: NSAIDs induced allergy, active peptic ulcer, pregnancy, lactation and children.
10 and 20 mg/tab and cap. 10 mg/ml amp.
A non steroid anti-inflammatory agent for the management of osteoarthritis, rheumatoid arthritis ankylosing spondylitis, gout, muscle and skeletal disorders, dysmenorrhoea, post traumatic and post operative pains and inflammatory conditions. A standard dose of 20 mg daily as single dose for three days is advised. In acute state give 40 mg daily for 2 days then 20 mg daily for 5-12 days. In the case of gout, initial dose of 40 mg as a single dose then 40 mg daily in single or divided doses for next 4 to 6 days. Children below 15 kg: 5 mg/kg; 16-25kg: 10 mg/kg; 26-45 kg: 15 mg/kg; over 46 kg: as for adult, all as single daily dose. It is contraindicated in history of or active peptic ulcer, patient sensitive to NSAIDs, pregnancy, lactation and asthma. S/E: GI disturbance, oedema, injection site reactions, tinnitus.
Synonym: Feldene
100 mg/tab
Inhibit xanthine oxidase enzyme that produces uric acid. For this reason, it is useful in the treatment of gout. Initiation of therapy may be accompanied by an increase of acute gout attacks, therefore colchicines or an anti-inflammatory drug should be given concurrently when initiating therapy. Allopurinol reduces the production of uric acid by inhibiting xanthine oxidase. So allopurinol prevents the production and deposition of uric acid as sodium urate crystal in the joint, tendon sheets, and organs which in turn causes gout. It is also used in the management of calcium oxalate renal stones when fluid and dietary measures have failed. However allopurinol should only be used in chronic gout. It is on record that allopurinol should not be used in acute gout as it exacerbate and prolong symptoms. Adult dose is 100-200mg daily in mild conditions. Larger doses should be administered in divided doses of not more than 300mg/day in divided doses. C/I: aspirin, acute gout; S/P: pregnancy elderly, renal or hepatic dysfunction; S/E: Nausea and acute gout, Skin reactions (withdraw if occur). NOTE: NSAIDs should be used in the treatment of acute gout Brand name: Zyloric
1 comment:
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