Книга_5230_Библиотеки_им_академика_М_И_Перельмана

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Amiodarone; arrhythmias $ Class III antiarrhythmic. Dose Oral

200mg/ 8h PO for wk, then 200mg/ 2h PO for wk, then 200mg/

24h PO as maintenance dose;

IV loading Initially 5mg/ kg over 20– 20min

IVI (with ECG monitoring) then further infusion if necessary of up to .2g over 24h IVI rillation and utter, VF (see above) thyroid dysfunction, iodine sensitivity roid disease, hypokalaemia, heart failure, elderly, bradycardia

Indication SVT, nodal and ventricular tachycardias, atrial b-

CI Bradycardia, sinoatrial heart block,

CautionPregnancy, breastfeeding, thy-

SEN+V, taste

disturbance, raised transaminases, jaundice, bradycardia, hypotension, pulmonary toxicity, corneal deposits, skin discolouration

InfoMonitor LFTs and

TFTs every6mth.

AmlodipineSee calcium- channel blockers. Amoxicillin $ Beta- lactam. Dose 500mg– g PO/ IV 8h Indication

Infection ALL/ CLL

CI Penicillin allergy Caution Glandular fever, CMV infection,

SEN+V, diarrhoea,rash.

Ampicillin $ Beta- lactam. Dose 500mg– g PO/ IV 6h Indication

Infection ALL/ CLL

CI Penicillin allergy Caution Glandular fever, CMV infection,

SEN+V, diarrhoea,rash.

Antacids/ alginates Dose See Table 5.3 Indications Acid reux

disease

Caution Hepatic and renal impairment; if symptoms are severe

or persist seek expert opinion Table5.3

Info The sodium load in these preparations can be signicant

SEDepends upon preparation used, see

and they should be used with caution in patients with hepatic impairment. The alginates increase the viscosity of the stomach contents and can protect the oesophageal mucosa from acid attack; the raft- forming alginates oat on the surface of the stomach contents and may further reduce the symptoms of reux.

Table5.3 Antacids and alginates

Classication

Aluminium hydroxide eg Alu- Cap®

Magnesium carbonate

Magnesium trisilicate

Alginate raft- forming suspensions

Other alginate preparations

Dose  capsule 4 times daily and at bedtime CI Hypophosphataemia, neonates SE Constipation

Dose 0mL 3 times daily in water CI Hypophosphataemia SE Diarrhoea, belching (due to CO

Dose Depends upon preparation, see BNF CI and SE See magnesium carbonate

eg Peptac

Dose 0– 20mL after meals and at bedtime SE Usually none

eg Gastrocote

Dose 5– 5mL 4 times daily (after meals and at bedtime) SE Usually none

liberation)

183PHARMACOPOEIA

184 CHAPTER 5 Pharmacopoeia

Antiemetics Dose See Table5.4Indications N+V, see Table5.5; not

all antiemetics are eective for all causes of N+V Table5.4

InfoIt is important to establish the cause ofN+V.

Caution and SE See

Table5.4 Antiemetic classication

Antihistamines Cinnarizine, cyclizine, promethazine

Cyclizine

Phenothiazines Chlorpromazine, droperidol, perphenazine,

Prochlorperazine

Dopamine antagonists

Metoclopramide Dose 0mg/ 8h PO/ IV/ IM

5HT3 antagonists Granisetron, ondansetron

Ondansetron

Miscellaneous Dexamethasone, benzodiazepines, hyoscine

Dose 50mg/ 8h PO/ IV/ IM CI Heart failure SE Drowsiness, pain on injection, urinary retention, dry

mouth, blurred vision

prochlorperazine, triuoperazine

Dose Consult BNF; 0mg/ 8h PO, 2.5mg/ 24h IM,

3– 6mg/ 2h buccal

CI Parkinson’s, epilepsy SE Extrapyramidal eects, hypotension, drowsiness, agitation

Domperidone, metoclopramide

CI Avoid in patients <2yr (especially ♀) and in bowel

obstruction

SE Extrapyramidal eects

Dose 4– 8mg/ 8h PO/ IV/ IM CI QT prolongation SE Constipation, headache, ushing, bradycardia, hypotension

hydrobromide, nabilone, neurokinin receptor antagonists

Table5.5 Causes ofN+V and suggested antiemetic

Likely cause Suggested antiemetics

Pregnancy Promethazine, prochlorperazine, metoclopramide,

Postoperative In no particular order:5HT

Bowel obstruction

Motion sickness Hyoscine hydrobromide, promethazine, cyclizine

Vestibular disorders

Cytotoxic chemotherapy

Palliative care Depends upon cause,

ondansetron

antagonists, antihistamines (eg cyclizine), dexamethasone, phenothiazines (eg prochlorperazine), metoclopramide

Treat the cause. Avoid metoclopramide

Betahistine (see BNF), antihistamine (eg cinnarizine, see BNF), phenothiazine (eg prochlorperazine)

Pre and post treatment with domperidone or metoclopramide; add in dexamethasone, 5HT antagonists. See BNF

E p. 245

185PHARMACOPOEIA

Antihistamines $ H

Indications Symptomatic relief of allergy (eg hayfever, allergic rhinitis,

urticaria)

Caution Avoid if possible in pregnancy and breastfeeding;

- receptor antagonists. Dose See Table 5.6



consult BNF if renal or hepatic impairment; all antihistamines have the potential to cause sedation, some more so than others (Table5.6); the sedating antihistamines also possess signicant antimuscarinic activity and should be used with caution in prostatic hypertrophy, urinary retention, and in patients with angle- closure glaucoma headache, antimuscarinic eects antagonists at H ists at H

ranitidine).

receptors; cimetidine and ranitidine are antagon-



receptors, and are useful for gastric acid suppression (see

Info The drugs in this section are all

SEDrowsiness,

Table5.6 Antihistamines

Non- sedating antihistamines Acrivastine, cetirizine, desloratadine, fexofenadine,

levocetirizine, loratadine, mizolastine, rupatadine

Cetirizine

Desloratadine

Loratadine

Sedating antihistamines Alimemazine, chlorphenamine, clemastine,

cyproheptadine, hydroxyzine, ketotifen, promethazine

Chlorphenamine

Dose 0mg/ 24h PO Caution Halve dose if eGFR <30mL/ min

Dose 5mg/ 24h PO

Dose 0mg/ 24h PO

Dose 4mg/ 4– 6h PO (max 24mg/ 24h); 0mg/ 8h IV/ IM

(over min if given IV)

Apixaban $ Direct inhibitor of factor Xa. Indication and dose VTE

prophylaxis afterhip/ knee replacement

35d for hips (start 2– 24h after surgery); 0mg/ 2h for 7d, then 5mg/ 2h for 6mth;

PE/ DVTContinue with 2.5mg/ 2h; Prophylaxis ofstroke and systemic em- bolism innon- valvular atrial brillation and one risk factor(Such as previous

2.5mg / 2h PO for 4d for knees,

Treatment ofDVT/ PE Initially

Prophylaxis of recurrent

stroke or TIA, symptomatic heart failure, DM, HTN, or >75yr) 5mg/ 2h (reduce dose to 2.5mg/ 2h if 2 of:>80yr, <6kg, or serum creatinine >33mmol/ L)

Caution Avoid in patients with signicant bleeding

risk. Wait 30h after last dose before removing epidural catheter and wait 5h until next dose

SE Anaemia; bruising; haemorrhage; nausea

Info No routine anticoagulant monitoring required (INR tests are

unreliable).

Arthrotec

Asacol

$ NSAID. See diclofenac.

$ Aminosalicylate. See mesalazine.

Aspirin; antiplatelet $ NSAID. Dose Antiplatelet 75mg/ 24h PO;

ACS/ MI300mg/ STATPO; Non- haemorrhagic stroke300mg/ 24h PO for 4d

then 75mg/ 24hPO brovascular and cardiovascular events 6 (Reye’s syndrome) ulceration, concomitant use of other anticoagulants

IndicationSecondary prevention of thrombotic cere-

CI Active bleeding, children under

Caution Pregnancy, breastfeeding, asthma, peptic

SE Bronchospasm,

GI irritation/ haemorrhage.

186 CHAPTER 5 Pharmacopoeia

Aspirin; analgesic/ antipyretic $ NSAID. Dose 300– 900mg/ 4–

6h PO; max 4g/ 24h; pyrexia, acute migraine ‘Aspirin; antiplatelet’

Acute migraine 900mg for  dose  Indication Pain,

CI As for ‘Aspirin; antiplatelet’ Caution As for

SE As for ‘Aspirin; antiplatelet’.

AT II receptor antagonists DoseSee Table5.7; commence therapy

in the same way as starting an ACEi (E p. 80)

IndicationsPatients in-

tolerant of ACEi; heart failure, hypertension, diabetic nephropathy, prophylaxis of cardiovascular events

Caution Pregnancy and breast-

feeding, renal artery stenosis/ renal impairment, aortic stenosis, hyperkalaemia, known allergy to ACEi. May not be eective in AfricanCaribbean patients

SE Postural hypotension, renal impairment and

hyperkalaemia, taste disturbance, urticaria and angioneurotic oedema; cough can occur but is less common than withACEi.

Table5.7 AT II receptor antagonists

Candesartan Dose Initially 4– 8mg/ 24h PO up to max 32mg/ 24h PO

Irbesartan Dose Initially 75– 50mg/ 24h PO up to max 300mg/ 24h PO

Losartan Dose Initially 25– 50mg/ 24h PO up to max 00mg/ 24h PO

Valsartan Dose Initially 80mg/ 24h PO up to max 320mg/ 24h PO

AtenololSee beta- blockers. Atorvastatin $ HMG CoA reductase inhibitor. See statins. Atropine; bradycardia $ Anticholinergic. Dose 500micrograms/

STAT IV every 3– 5min; max 3mg/ 24h

IndicationBradycardia CI Glaucoma,

myasthenia gravis, pyloric stenosis, prostatic enlargement Down’s syndrome, GORD

SE Transient bradycardia, antimuscarinic ef-

fects (constipation, urinary urgency and retention, pupil dilatation/ loss of accommodation, dry mouth).

Bactroban

$ Antibacterial. See mupirocin.

Beclometasone $ Corticosteroid. Dose 200– 400micrograms/ 2h

INH

IndicationChronic asthma (step 2 BTS guidelines)Caution TBSEOral

candidiasis, hoarse voice, paradoxical bronchospasm (rare) preparations/ devices are not interchangeable and should be prescribed by brandname.

Bendroumethiazide $ Thiazide diuretic. Dose Oedema 5– 0mg/

alternate days PO; hypertension trolyte imbalance (especially dK

Hypertension 2.5mg/ 24h PO Indication Oedema,

CautionDM, gout, SLE SEDehydration, hypotension, elec-

)Interaction ilithium levels and NSAIDs

decrease eect.

Caution

InfoDierent

Benzylpenicillin (penicillin G) $ Beta- lactam. Dose 0.6– .2g/

6h IV (max 4.8g/ 24h in divided doses) throat, endocarditis lergy

SEDiarrhoeaInteractionDecrease eects of oral contraceptive pill,

CI Penicillin allergy Caution History of al-

Indication Infection; skin,

allopurinol increases risk ofrash.

Beta- blockers Dose See Table5.8 Indications Generic indications in-

clude: hypertension, angina, myocardial infarction, arrhythmias, heart failure, thyrotoxicosis, anxiety, migraine prophylaxis, benign essential tremor; topically for glaucoma

Caution Pregnancy, breastfeeding,

avoid abrupt withdrawal especially in patients with IHD (risk of rebound iHR/ iBP), st- degree AV block, DM (may mask symptoms dglucose), COPD

CI Asthma, uncontrolled heart failure, marked

bradycardia, dBP, 2nd/ 3rd- degree AV block, severe peripheral arterial disease

SE Bradycardia, hypotension (especially postural), heart failure,

bronchospasm, conduction disorders, peripheral vasoconstriction, headache, fatigue, sleep disturbance (often nightmares, insomnia), impotence

Info The cardioselective β- blockers (Table5.8) have less eect

on β

receptors but are not cardiospecic and bronchoconstriction can

still occur in susceptible patients. Water- soluble β- blockers (atenolol, nadolol, sotalol) are excreted by the kidneys and a dose reduction is often necessary in renal impairment; these are also less likely to cause sleep disturbance and nightmares.

Table5.8 β- blockers. Doses show initial dose range fortreatment ofhypertension, doses vary withindication; consultBNF

Cardioselective

Atenolol

Bisoprolol

Metoprolol

Non- cardioselective

Carvedilol

Labetalol

Propranolol

Sotalol Used onl y to treat arrhythmias. Only commence after seeking

Timolol Used predominantly as eye drops for the treatment of

Dose 25– 50mg/ 24h PO (00mg/ 24h max); also available IV

Dose 5– 0mg/ 24h PO (20mg/ 24h max)

Dose 50– 00mg/ 24h PO (400mg/ 24h max); also available IV

Dose 2.5mg/ 24h PO (max 50mg/ 24h in divided doses)

Dose 00mg/ 2h PO (max 2.4g/ 24h in divided doses); also

available IV

Dose 40– 80mg/ 2h PO, increase weekly (max 320mg/ 24h in

divided doses)

expertadvice

Dose 40mg/ 2h PO (usual maintenance dose 80– 60mg/ 2h

PO); also available IV

glaucoma; case reports exist of this resulting in systemic eects

187PHARMACOPOEIA

188 CHAPTER 5 Pharmacopoeia

Betamethasone creamSee topical corticosteroid. Bezabrate $ Fibrate. Dose 200mg/ 8h PO; modied- release pre-

parations available, check BNF to diet and other measures

Indication Hyperlipidaemias unresponsive

CI Hypoalbuminaemia, primary biliary cir-

rhosis, gall bladder disease, nephrotic syndrome, pregnancy and breastfeeding

Caution Renal impairment (see BNF for reduced dosing), hepatic

impairment, hypothyroidism

SEGI disturbance, anorexia, cholestasis.

BisoprololSee beta- blockers.

Bowel cleansing preparations (eg Klean-Prep®, MoviPrep®, Picolax®, etc) $ Laxative. Dose Consult BNF or local guideline

Indications Prior to surgery, colonoscopy, or radiological examination CI Bowel obstruction, toxic megacolon Caution Elderly, children, dehy-

dration

SEN+V, abdominal pain and distension, dehydration, electrolyte

disturbance

Info These agents should not be used in the treatment of

constipation (see also laxatives).

Bricanyl

Buccastem

$ β2 agonist. See terbutaline.

See antiemetics (phenothiazine).

Budesonide $ Corticosteroid. Dose 00– 800micrograms/ 2h INH;

– 2mg/ 2h NEB TB

SEOral candidiasis, hoarse voice, paradoxical bronchospasm (rare).

IndicationChronic asthma (step 2 BTS guidelines) Caution

Bumetanide $ Loop diuretic. Dose Typically 500micrograms–

2mg /24h dK Hypotension (dK betes 

Indication Oedema (LVF, pulmonary oedema) CI Severe

and dNa+, hypovolaemia, acute renal impairment Caution

SE GI disturbance, hypotension, electrolyte disturbances

, dNa+, dMg2+, metabolic alkalosis), can exacerbate gout and dia-

InteractionIncreases toxicity of gentamicin, digoxin, NSAIDsInfo As

for all loop diuretics, high doses can cause tinnitus and deafness. Higher doses may be needed in chronic renal impairment.

Bupropion $ Treatment of nicotine dependence. Dose Commence

– 2wk before target smoking cessation date, initially 50mg/ 24h PO for 6d, then 50mg/ 2h PO (max single dose 50mg; max total daily dose 300mg)

Indication Smoking cessation CI Acute alcohol or benzo-

diazepine withdrawal, severe hepatic cirrhosis, CNS tumour, history of seizures

Caution Hepatic impairment, renal impairment, pregnancy and

breastfeeding

SE Dry mouth, GI disturbances, taste disturbance, agita-

tion, anxiety.

Buscopan

Calcichew®/ Calcichew® D Calcium carbonate $ Calcium salt. Dose See BNF Indication

Osteoporosis, dCa History of renal stones, sarcoid, renal impairment

$ Antimuscarinic. See hyoscine butylbromide.

$ Calcium salt. See calcium carbonate.

CI iCa

(urine/ serum), eg malignancy Caution

SE GI disturbance,

dHR, arrhythmias.

Calcium- channel blockers $ Dihydropyridines. Dose See

Table 5.9

Indications iBP, prophylaxis of angina CI Unstable an-

gina, cardiogenic shock, signicant aortic stenosis, acute porphyria

Caution Pregnancy, breastfeeding, heart failure SE Abdominal

pain, N+V, ushing, palpitations, dBP, oedema, headache, sleep disturbance, fatigue

Info The dihydropyridines relax smooth muscle and

dilate both coronary and peripheral arteries. Nimodipine preferentially acts upon cerebral vascular smooth muscle and is used in the prevention and treatment of ischaemic neurological decits following aneurysmal subarachnoid haemorrhage.

Table5.9 Calcium- channel blockers (dihydropyridines)

Amlodipine Dose Initially 5mg/ 24h PO up to max 0mg/ 24h PO

Felodipine Dose Initially 5mg/ 24h PO up to max 0– 20mg/ 24h PO

Nifedipine Dose Depends upon preparation. Always specify specic brand

Nimodipine Dose 60mg/ 4h PO starting within 4d of subarachnoid

for modied- release (MR) preparations; consult BNF

haemorrhage and continue for 2d; IV preparation available, consult BNF

Calcium- channel blockers $ Verapamil, diltiazem. Dose See

Table 5.0 used in the management of tachyarrhythmias

Indications iBP, prophylaxis of angina; verapamil is also

CI Left ventricular

failure, bradycardia, 2nd- or 3rd- degree AV dissociation, sick sinus syndrome

Caution Pregnancy, patients taking β- blockers or other nega-

tively chronotropic drugs, st- degree AV dissociation, acute phase of MI

SE Bradycardia, dBP, heart block, dizziness, ushing, headache, oe-

dema, GI disturbance

Interactions Unlike the dihydropyridines, diltiazem

and verapamil are negatively chronotropic and inotropic and should not generally be used in conjunction with β- blockers or other negatively chronotropicdrugs.

Table5.0 Calcium- channel blockers (verapamil, diltiazem)

Diltiazem Dose Depends upon preparation; consult. Always specify specic

Verapamil Dose Typically 40– 20mg/ 8h PO for SVT; 80– 20mg/ 8h PO for

brand for MR preparations; consult BNF

angina prophylaxis; 80– 60mg/ 8h PO for iBP; 5– 0mg over 5min IV with ECG monitoring for treatment of acute SVT (seek senior help before giving IV inotropes/ chronotropes)

189PHARMACOPOEIA

190 CHAPTER 5 Pharmacopoeia

Calcium chloride $ Calciumsalt. Dose0mL of 0%; give mL/ min

IV

Indication Emergency management of dCa2+CI iCa2+Caution History

of renal stones, sarcoid, renal impairment

SE Peripheral vasodilatation,

dBP, injection- site reactions; more irritant than calcium gluconate.

Calcium gluconate $ Calciumsalt. Dose 10mL of 10% for dCa2

30mL of 10% for iK agement of dCa coid, renal impairment

; give over 3min IV Indication Emergency man-

, iK+ CI iCa

Caution History of renal stones, sar-

SE Peripheral vasodilatation, dBP, injection- site

reactions.

Calcium Resonium

parations also available (see BNF)

$ Calcium salt. Dose 5g/ 6– 8h PO; PR pre-

Indication iK

(mild to moderate)

CautionPregnancy, breastfeedingSEGI disturbanceInfoMonitorK

Calpol

$ Simple analgesic. See paracetamol.

CanagliozinSeeSGLT2 inhibitors.

CandesartanSee AT II antagonists.

Canesten

$ Imidazole antifungal. See clotrimazole.

CaptoprilSeeACEi. Carbamazepine $ Antiepileptic. Dose Initially 00mg/ 2h PO;

Increase To max 2g/ 24h in divided doses; PR preparations available

(see BNF) pain, eg trigeminal neuralgia (see BNF for dosing)

Indication Antiepileptic; generalized tonic– clonic, chronic

CI AV conduc-

tion abnormalities, history of bone marrow depression, acute porphyria

Caution Pregnancy, breastfeeding, cardiac disease, Hong Kong

Chinese/ Thai origin, history of skin conditions

SEN+V, dizziness, drow-

siness, headache, ataxia, visual disturbance, cytopenias, hepatic dysfunction, skin disorders

Monitoring carbamazepine

Interaction Enzyme inducer.

Random sample 20– 50micromol/ L (4– 2mg/ L)

Toxic >50micromol/ L (>2mg/ L)

Carbimazole $ Antithyroid. Dose Initially 5– 40mg/ 24h PO; Once

5– 5mg/ 24h PO as maintenance dose usually given for 2–

euthyroid

8mth

Indication Hyperthyroidism CI Severe blood disorders Caution

Pregnancy, breastfeeding, hepatic impairment

SE N+V, pruritus, rash,

agranulocytosis.

CarvedilolSee beta- blockers.

CefaclorSee cephalosporin.

CefalexinSee cephalosporin.

CefotaximeSee cephalosporin.

CefradineSee cephalosporin.

CeftazidimeSee cephalosporin.

CeftriaxoneSee cephalosporin.

CefuroximeSee cephalosporin.

Celecoxib $ NSAID/ COX2 inhibitor. Dose 00– 200mg/ 2h PO (max

400mg/ 24h in divided doses) rheumatoid arthritis, and ankylosing spondylitis NSAID

Caution Pregnancy, breastfeeding, hepatic impairment, renal impair-

ment

SEGI disturbance/ bleeding, headache, dizzinessInteractionDecreases

IndicationPain and inammation; osteoarthritis,

CIIHD, CVD, HF, allergy to any

eects of antihypertensives, increases toxicity of methotrexate, increased risk of renal impairment with ACEi, AT II antagonists, or ciclosporin.

Cephalosporin DoseSee Table5.Indications Infections (with known

or suspected antimicrobial sensitivity—consult local guidelines), surgical prophylaxis, other prophylaxis

Caution Not known to be harmful

in pregnancy, present in breast milk in low concentration; 0.5– 6.5% of patients who are penicillin- allergic will display allergy to cephalosporins as cephalosporins contain a beta- lactam ring as do the penicillins and carbapenems dominal discomfort, headache, allergic reactions

SEDiarrhoea (rarely antibiotic- associated colitis), N+V, ab-

Info Cephalosporins are

among the antibiotics which are most likely to result in Clostridium dicile diarrhoea, the others being quinolones and clindamycin. As with all antibiotics, it is important to consult local guidelines as infectious agents have dierent susceptibilities depending upon geographical location.

Cetirizine $ H

antagonist. See antihistamine.



Table5. Cephalosporins (consult local guidelines)

First generation

Cefalexin Dose 500mg (250– 500mg) 8h PO Indications UTIs, respiratory tract

Cefradine

Second generation

Cefuroxime

Third generation

Cefotaxime

Ceftriaxone

Ceftazidime

infections, otitis media, sinusitis, skin and soft tissue infections

Dose 500mg (250– 500mg) 6h PO Indications surgical prophylaxis

but generally not used widely now

Dose 750mg (750– 500mg) 8h IV, 500mg (250– 500mg) 2h PO; Indications Gram- positive and Gram- negative bacteria; surgical

prophylaxis

Dose g (– 2g) 2h IV Indications better Gram- negative activity,

but poorer coverage against Gram- positive bacteria than cefuroxime; penetrates the CSF

Dose g (– 4g) 24h IV Indications better Gram- negative activity,

but poorer coverage against Gram- positive bacteria than cefuroxime; penetrates the CSF

Dose g (– 2g) 8h IV or 2g/ 2h IV; Indications better Gram-

negative activity, but poorer coverage against Gram- positive bacteria than cefuroxime; good activity against Pseudomonas

191PHARMACOPOEIA

Chloramphenicol; eye drops $ Antibiotic. Dose drop 0.5%/ 2h

TOP; reduce frequency as infection is controlled. Continue for 48h after symptoms resolve surgery

SE Transient stinging.

Indication Conjunctivitis, corneal abrasions, post eye

192 CHAPTER 5 Pharmacopoeia

Chlordiazepoxide $ Benzodiazepine.

alcohol withdrawal treatment/ prophylaxis

Dose

See Table5.2

Caution

Indications

Acute

Pregnancy, breastfeeding, liver disease, renal impairment, respiratory disease (sleep apnoea, respiratory failure), reduce dose in the elderly, avoid abrupt withdrawal depression, drowsiness, confusion, ataxia, amnesia, dependence

Respiratory

Info

Symptoms of acute alcohol withdrawal tend to occur 2– 48h after the last alcoholic drink and usually subside 5– 7d after the last drink. A reducing dose of chlordiazepoxide acts as a surrogate CNS depressant (which is the eect alcohol has upon the CNS) and it is uncommon for physical symptoms of withdrawal to present if patients are treated with this sort of regimen; always consider vitamin supplementation in these patients (E p. 98); consult local guidelines.

Table5.2 Chlordiazepoxide regimen foralcohol withdrawal (local guidelines may dier fromthis suggested regimen)

Day  20mg/ 6h PO Day 4 0mg/ 8h PO Day 7 5mg/ 2h PO

Day 2 20mg/ 8h PO Day 5 5mg/ 6h PO Day 8 STOP

Day 3 0mg/ 6h PO Day 6 5mg/ 8h PO

Chlorhexidine $ Antiseptic. IndicationSkin preparation prior to sur-

gery or other invasive procedures (eg vascular access, spinal/ epidural anaesthesia), surgical hand scrub, oral hygiene, antiseptic lubricant (eg

Hibitane other body cavities

Chlorphenamine $ H Cimetidine $ Antihistamine (H

)CI Avoid contact with eyes, brain, meninges, middle ear and

SESensitivity, mucosal irritation.

antagonist See antihistamine.



antagonist). See ranitidine.

Ciprooxacin $ Quinolone. Dose500– 750mg/ 2h PO; 400mg/ 2h IV

Indication Infections: GI, respiratory, urinary CI Pregnancy, breastfeeding,

allergy to quinolones threshold), adolescents/ children, renal impairment tendonitis (including tendon rupture)

CautionMyasthenia gravis, seizures (reduced seizure

SE N+V, diarrhoea,

Interaction NSAIDs increase risk

of seizure, increase levels of theophyllines, increase nephrotoxicity of ciclosporin, increase eect of warfarin.

Citalopram $ Selective serotonin re- uptake inhibitor. Dose 20mg/

24h PO (max 40mg/ 24h) mania, QT interval prolongation disease, DM

InteractionMAOI within2wk.

SE GI disturbance, anorexia, weight loss, dNa

IndicationDepression, panic disorderCI Active

Caution Pregnancy, epilepsy, cardiac

, agitation

Clarithromycin $ Macrolide antibiotic. Dose 250– 500mg/ 2h PO/

IV

Indication Atypical pneumonias, Helicobacterpylori CI AllergyCautionPregn

ancy, breastfeeding, hepatic or renal impairment, concomitant use with statins

SEGI upset, irritant toveins.

Clindamycin $ Antibiotic. Dose50– 450mg/ 6h PO; up to 4.8g/ 24h

IV in 2– 4 doses for life- threatening infections (consult BNF)

Indication

Gram- positive cocci and anaerobes; osteomyelitis, intra- abdominal infections, MRSA phyria

SE GI disturbance, antibiotic- associated colitis (namely C.di ),

CI Diarrhoea Caution Breastfeeding, acute por-

hepatotoxicity, arthralgia; discontinue drug if patient develops new onset diarrhoea

InteractionIncreases neuromuscular blockade.

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