Antiinflammatory/ Antirheumatics/ Gout Preparations

 

6.1 Steroidal Antiinflammatory Agents

6.2 Antirheumatics

6.3 Antigout

6.4 Non-Steroidal Antiinflammatory Agents

6.5 Antiinflammatory Enzymes

6.1 Steroidal Antiinflammatory Agents

DEXAMETHASONE PHOSPHATE

Dosage Form: Injection 4 mg/2 ml (as phosphate) (II)

 

Recommended Dose: By IM/IV injection or infusion: Initially 0.5-20 mg. Children: 200-500 mcg/kg daily. Shock: by IV injection or infusion 2-6 mg/kg repeated if necessary after 2-6 hours. Cerebral oedema: IV injection 10 mg initially then 4 mg IM every 6 hours as required for 2-10 days.

 

Indications: Adjunctive treatment of severe shock of haemorrhage, traumatic, surgical of septic origin, cerebral oedema.

 

Contra-Indications: In systemic viral and fungal infections; peptic ulcer, psychosis, congestive heart failure, chronic renal failure.

 

Special Precautions: In hypertension, epilepsy, elderly person. Long term treatment should not be abruptly discontinued. Rapid, large doses of IV injection may cause cardiovascular collapse.

 

HYDROCORTISONE

XE "HYDROCORTISONE"

Dosage Form: Tablet 10 mg (II)

 

Recommended Dose: NAME="I17640"The initial dosage varies from 20 to 240 mg/day depending on the disease being treated.

 

Indication: Replacement therapy in chronic adrenocortical insufficiency, salt-losing forms of congenital adrenal hyperplasia syndromes, antiinflammatory agent.

 

Contra-Indications: See Dexamethasone

 

Special Precautions: See Dexamethasone

 

METHYLPREDNISOLONE SODIUM SUCCINATE

XE "METHYLPREDNISOLONE SODIUM SUCCINATE"

Dosage Form: Injection 0.5 gm/vial, 1 gm/vial (I)

 

Recommended Dose: By IM/slow IV injection or infusion: 10-40 mg repeated as required. For IV injection, dissolve in approriate volume of dextrose, or/and in NaCl injection. Children: Not less than 500 mcg/kg daily. BY deep IM injeection: 40-120 mg repeated every 2-3 week if required.

 

Indications: Suppression of inflammatory and allergic disorders; cerebral oedema associated with malignancy, rheumatic disease, skin.

 

Contra-Indications: See Dexamethasone.

 

Special Precautions: See Dexamethasone.

METHYLPREDNISOLONE ACETATE

Dosage Form: Injection 0.2 gm/5 ml (I)

 

Recommended Dose: See Methyl Prednisolone Sodium Succinate.

 

Indications: See Methyl Prednisolone Sodium Succinate.

 

Contra-Indications: See Dexamethasone.

 

Special Precautions: See Dexamethasone.

PREDNISOLONE

Dosage Form: Tablet 5 mg; Syrup 2.5 mg/5 ml, 3 mg/5 ml (II)

 

Recommended Dose: Initially 20-40 mg daily or up to 60-80 mg if necessary for 4-5 days. Maintenance dose: 5-20 mg daily. Children: Initially 2 mg/kg daily then gradually reduced.

 

Indications: Severe bronchial asthma and status asthmaticus, allergic and inflammatory disorders, acute leukaemia, nephrotic syndrome and either corticosteroid indicated conditions.

 

Contra-Indications: See Dexamethasone.

 

Special Precautions: See Dexamethasone.

6.2 Antirheumatics

D-PENICILLAMINE

Dosage Form: Capsule 250 mg (I)

 

Recommended Dose: Initially 125-250 mg daily. Increase at interval of 1-3 months to maximum 1.5g/day. Maintenance: 500-750 mg daily. Children: Under 20 kg; 25 mg bd up to 150 mg tds. Over 20 kg; 50 mg bd uo to 200 mg tds, increased slowly over several weeks.

 

Indications: Severe rheumatoid arthritis not responsive to other anti-inflammatory agents.

 

Contra-Indications: In patients receiving gold therapy, antimalarial drugs, or other drugs capable of causing blood disorders.

 

Special Precautions: In renal and hepatic impairment.

HYDROXYCHLOROQUINE SULPHATE

Dosage Form: Tablet, 200 mg (I*)

 

Criteria of use: 1. Restricted for Skin Clinic and Medical Specialist Clinic 2. For Systemic Lupus Erythematosus (SLE) cases only

 

Recommended Dose: Administered on expert advice, initially 400 mg daily in divided doses; maintenance 200-400 mg daily; max. 6.5 mg/kg daily (but not exceeding 400 mg daily), CHILD, the minimum effective doses should be employed and should not exceed 6.5 mg/kg daily (max. 400 mg daily).

 

Indications: Active rheumatoid arthritis (including juvenile idiopathic arthritis), systemic and discoid lupus erythematosus; dermatological conditions caused or aggravated by sunlight.

 

Contra-Indications: Patients with preexisting maculopathy. Patients sensitive to 4-aminoquinoline compounds.

 

Special Precautions: Used with caution in hepatic impairment and in renal impairment. All patients should have an ophthalmological examination before treatment with hydroxychloroquine is initiated. Thereafter, ophthalmological examination must be repeated at least every 6 months. Used with caution in neurological disorders (especially in those with a history of epilepsy), in severe gastro-intestinal disorders, in G6PD deficiency, in porphyria, and in the elderly.

6.3 Antigout

ALLOPURINOL

Dosage Form: Tablet 100 mg (II)

 

Recommended Dose: Initially 100 mg daily. Maintenance: 200-600 mg daily in divided doses. Maximum of 800 mg daily. Children: 8mg/kg/day up to 20 mg/kg/day. Take with food.

 

Indications: Treatment of chronic gout, hyperuricaemia, uric acid nephropathy and recurrent uric acid stone formation.

 

Contra-Indications: Acute gout attack. Nursing mothers.

 

Special Precautions: Reduce dose in renal and hepatic impairment. Pregnancy. Increase fluid intake.

6.4 Non-Steroidal Antiinflammatory Agents

ACETYLSALICYLIC ACID

Dosage Form: Tablet 300 mg (II)

 

Recommended Dose: 0.31 g every 4 hours after food; max. in acute conditions 8 g daily; child, juvenile arthritis, up to 80 mg/kg daily in 56 divided doses after food, increased in acute exacerbations to 130 mg/kg

 

Indications: Rheumatoid arthritis, plaelet aggregration (Transient ischaemic attacks, secondary prevention of MI, prophylaxis against stroke, vascular occlusion & deep vein thrombosis), myocardial infarction, mild to moderate pain, pyrexia.

 

Contra-Indications: Gastro-intestinal ulceration, haemophilia, concurretn anti-coagulants therapy. Asthmatic patients.

 

Special Precautions: In impaired renal and hepatic function dehydration, pregnancy, allergic disease, G6PD deficiency.

 

CELECOXIB

XE "CELECOXIB"

Dosage Form: Capsule 200 mg, 400 mg

 

Recommended Dose: Osteoarthritis: 200 mg per day administered as a single dose or as 100 mg twice daily. Rheumatoid arthritis: 100 to 200 mg twice daily. Familial adenomatous polyposis (FAP): 400 mg twice daily.

 

Indications: Relief of signs and symptoms of osteoarthritis; relief of signs and symptoms of rheumatoid arthritisin adults; reduce the number of adenomatous colorectal polyps in familial adenomatous polyposis as adjunct to usual care.

 

Contra-Indications: Hypersensitivity to celecoxib or any component, sulfonamides, aspirin, or other nonsteroidal anti-inflammatory drugs (NSAIDs)

 

Special Precautions: Gastrointestinal irritation, ulceration, bleeding, and perforation may occur with NSAIDs. Patient with history of GI disease (bleeding or ulcers), decreased renal function, hepatic disease, congestive heart failure, hypertension or asthma.

DICLOFENAC SODIUM

Dosage Form: Injection 75 mg/3 ml ampoule (II)

 

Recommended Dose: By deep IM injection: 75 mg daily.

 

Indications: Rheumatoid arthritis and other rheumatoid disorder, acute gout.

 

Contra-Indications: Peptic ulcer, asthma or other allergic reaction induced by NSAIDs.

 

Special Precautions: GI symptoms, severe hepatic or renal damage, pregnancy, bleeding

 

ETORICOXIB

XE "ETORICOXIB"

Dosage Form: Tab 90 mg, 120 mg (I)

 

Criteria of use: Follow the Chronic Pain Management Protocol

 

Recommended Dose: Osteoarthritis, adult and adolescent over 16 years, 60 mg once daily

 

Rheumatoid arthritis, adult and adolescent over 16 years, 90 mg once daily; Acute gout, adult and adolescent over 16 years, 120 mg once daily

 

Indications: pain and inflammation in osteoarthritis and in rheumatoid arthritis; acute gout

 

Contra-Indications: inflammatory bowel disease; uncontrolled hypertension

 

Special Precautions: monitor blood pressure; breast-feeding

IBUPROFEN

Recommended Dose: 200-400 mg tds with food up to 2.4g daily. Children: 20mg/kg daily in divided doses. Maximum: 500 mg for those weighing less than 30 kg.

 

Indications: Rheumatoid arthritis, osteoarthritis, acute gout and musculoskeletal disorders. Dysmenorrhoea.

 

Contra-Indications: Pregnancy, children under 14 years, syndromes of nasal polyps, angioedema, bronchospasm induced by aspirin or other NSAIDs.

 

Special Precautions: Patients with bleeding disorders, peptic ulceration and those receiving coumarin and anti-coagulants and cardiovascular disease.

INDOMETHACIN

Dosage Form: Capsule 25 mg (II)

 

Recommended Dose: 25-50 mg bd or tds with food, up to 200 mg daily.

 

Indications: Treatment of rehumatoid arthritis, ankylosing spondylitis, osteoarthritis and gout.

 

Contra-Indications: Peptic ulceration, salicylate hypersensitivity, pregnancy, lactation and children under 14 years old.

MEFENAMIC ACID

Dosage Form: Capsule 250 mg (II)

 

Recommended Dose: 500 mg tds after food. Children: Over 6 months; 6.5 mg/kg tds-qid for maximum of 7 days.

 

Indications: Relief of pain in rheumatoid arthritis, Still;s disease and osteoarthritis.

 

Contra-Indications: Patients with ulceration or inflammation of gastro-intestinal tract.

 

Special Precautions: In impaired renal and hepatic function; epilepsy, bronchial asthma; may enhance effects of coumarin anti-coagulants.

MELOXICAM

Dosage Form: Tablet 7.5 mg (I)

 

Criteria of use: Follow the Chronic Pain Management Protocol

 

Recommended Dose: Osteoathritis, 7.5 mg daily with food, increased if necessary to max.15 mg once daily. Rheumatoid athritis and ankylosing spondylitis 15 mg once daily with food. (7.5 mg daily in elderly)

 

Indications: Pain and inflamation in rheumatic disease; exacerbation of osteoathritis (short-term); ankylosing spondylitis.

 

Contra-Indications: Treatment of peri-operative pain in setting of coronary artery bypass graft (CABG) surgery , hypersensitivity to meloxicam , patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other nonsteroidal anti-inflammatory agents; severe, even fatal, anaphylactic-like reactions have been reported.

 

Special Precautions:

   Increased risk of serious cardiovascular thrombotic events, myocardial infarction, and stroke; risk may increase with duration of use and in patients at risk for cardiovascular disease

   Increased risk of serious gastrointestinal adverse events (bleeding, ulceration, perforation of stomach or intestines) that can occur at any time and without warning; higher risk in elderly or debilitated patients

   Asthma

   Avoid in late pregnancy; may cause premature closure of the ductus arteriosus

   Dehydration

   Elderly

   History of coagulation defects

   History of GI ulceration, bleeding or perforation

   History of liver dysfunction

   History of renal disease

   Hypertension, fluid retention, or CHF

   Preexisting anemia

NAPROXEN

Dosage Form: Tablet 250 mg (II)

 

Recommended Dose: Rheumatoid disorders: Initially 250 mg bd adjusted to 500 mg-1 g daily in 2 divided doses. Acute gout: Initially 750 mg followed by 250 mg every 8 hours. Children: Over 5 years; 10 mg/kg/day in 2 divided doses.

 

Indications: Treatment of rehumatoid arthritis, osteoarthritis and acute gout.

 

Contra-Indications: Syndromes of nasal polyps, angiodema, bronchospasm induced by aspirin or other NSAIDs, pregnancy.

 

Special Precautions: Pre-existing ulcer disease or history of GI bleeding.

 

PARECOXIB XE "PARECOXIB"

 

Dosage Form: Injection 40 mg (I* - Anaesthesiologist)

 

Criteria of use: Restricted for ICU/ HDU and OT only

 

Recommended Dose: By deep intramuscular injection or by intravenous injection, initially 40 mg, then 2040 mg every 612 hours when required; max. 80 mg daily; elderly weighing less than 50 kg, initially 20 mg, then max. 40 mg daily; child and adolescent under 18 years, not recommended

 

Indications: short-term management of acute postoperative pain

 

Contra-Indications: history of allergic drug reactions including sulphonamide hypersensitivity; inflammatory bowel disease

 Special Precautions: dehydration; following coronary artery bypass graft surgery.

PIROXICAM

Dosage Form: Tablet 10 mg (II)

 

Recommended Dose: 10-30 mg daily in single or in divided doses. Acute gout: Initially 40 mg then 40 mg daily for 4-6 days. Acute musculoskeletal disorder: 40 mg daily for 2 days then 20 mg daily for 7-14 days. Children: Over 6 years: <15 : 5 mg daily. 16-25 kg: 10 mg daily. 26-45 kg: 15 mg daily. >46 kg : 20 mg daily.

 

Indications: Rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, acute gout and acute musculoskeletal disorders.

 

Special Precautions: Patietns with history of gastrointestinal haemorrhage or ulcers or aspirin sensitivity.

6.5 Antiinflammatory Enzymes

HYALURONIDASE XE "HYALURONIDASE"

 

Dosage Form: Injection 1,500 units amp (I)

 

Recommended Dose: Adult: Parenteral Adjunct in hypodermoclysis 1,500 u for every 500-1,000 mL of fluid for SC administration. Facilitate SC/IM inj 1,500 u added directly into the inj. Aid in dispersal of extravasated fluids or blood 1,500 u into the affected area. Aid in diffusion of local anesth in ophthalmology 15 u/mL of local anesth soln.

 

Indications: Enhance permeation of subcutaneous or intramuscular injection, local anaesthetics and subcutaneous infusion; promote resorption of excess fluids and blood.

 

Contra-Indications: Hypersensitivity, malignancy. Direct application to the cornea, reduction of swelling of bites or stings. Inj into or around infected area. IV admin; unexplained premature labour.

 

Special Precautions: Impaired renal function. Infants, elderly. Patients with infections. Pregnancy, lactation.

 

 

PAPAIN

Dosage Form: Tablet 150,000 units (II)

 

Recommended Dose: Suck or chew 2 tablets qid for the first day then 1 tablet qid for 5 days.

 

Indications: In conjunction w/ other physical or chemotherapeutic measures for treatment of oedema & inflammation.

 

Contra-Indications: Blood clotting disease, generalised or systemic infections. Concomitant therapy w/ anticoagulant.

 

Special Precautions: Pregnancy. Renal or hepatic disease.

PROLASE

Dosage Form: Tablet 10,000 units (II)

 

Recommended Dose: 2 tablets sucked or chewed every 4 hours for 1st day, then 1 tablet every 4 hours for at least 5 days.

 

Indications: Treatment / prevention of oedema, inflammatory disorders and induced trauma, in conjunction with other physical/chemothrapeutic measureas.

 

Contra-Indications: Concomitant use with anti-coagulants, blood clotting disorders.

 

Special Precautions: In pregnancy.

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