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Antiinflammatory/ Antirheumatics/
Gout Preparations |
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6.1 Steroidal Antiinflammatory Agents 6.4 Non-Steroidal Antiinflammatory
Agents 6.1
Steroidal Antiinflammatory
Agents 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: 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 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 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 Dosage Form: Tablet 300 mg (II) Recommended
Dose:
0.3–1 g every 4 hours after food; max. in acute conditions
8 g daily; child,
juvenile arthritis, up to 80 mg/kg daily in 5–6 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. 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 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
20–40 mg every 6–12 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 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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