Summary of Product Characteristics
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Consumer Medicine Information
New Zealand Datasheet Name of Medicine DOZILE Doxylamine Succinate 25 mg Capsules Presentation Liquid filled soft gel capsules, purple, containing 25 mg doxylamine succinate. Uses Actions Doxylamine succinate is a white or creamy white powder with a characteristic odour and has solubilities of approximately 1 g/mL in water and 500 mg/mL in alcohol at 25°C. It has a pKa of 5.8 and 9.3. A 1% aqueous solution has a pH of 4.8 - 5.2. Doxylamine succinate is an ethanolamine derivative antihistamine. Because of its sedative effect, it is used for the temporary relief of sleeplessness. The drug is also used in combination with antitussives and decongestants for the temporary relief of cold and cough symptoms. It is not structurally related to the cyclic antidepressants. It is an antihistamine with hypnotic, anticholinergic, antimuscarinic and local anaesthetic effects. Duration of action is 6-8 hours. Pharmacokinetics Following oral administration of a single 25 mg dose of doxylamine succinate in healthy adults, mean peak plasma concentrations of about 100 ng/mL occur within 2- 3 hours after administration. The drug has an elimination half-life of about 10 hours in healthy adults. Absorption It is easily absorbed from the gastrointestinal tract. Following an oral dose of 25 mg the mean peak plasma level is 99 ng/mL 2.4 hours after ingestion. This level declines to 28 ng/mL at 24 hours and 10 ng/mL at 36 hours. Distribution The apparent volume of distribution is 2.5 L/kg. Metabolism The major metabolic pathways are N-demethylation, N-oxidation, hydroxylation, N- acetylation, N-desalkylation and ether cleavage. -
Appendix A: Potentially Inappropriate Prescriptions (Pips) for Older People (Modified from ‘STOPP/START 2’ O’Mahony Et Al 2014)
Appendix A: Potentially Inappropriate Prescriptions (PIPs) for older people (modified from ‘STOPP/START 2’ O’Mahony et al 2014) Consider holding (or deprescribing - consult with patient): 1. Any drug prescribed without an evidence-based clinical indication 2. Any drug prescribed beyond the recommended duration, where well-defined 3. Any duplicate drug class (optimise monotherapy) Avoid hazardous combinations e.g.: 1. The Triple Whammy: NSAID + ACE/ARB + diuretic in all ≥ 65 year olds (NHS Scotland 2015) 2. Sick Day Rules drugs: Metformin or ACEi/ARB or a diuretic or NSAID in ≥ 65 year olds presenting with dehydration and/or acute kidney injury (AKI) (NHS Scotland 2015) 3. Anticholinergic Burden (ACB): Any additional medicine with anticholinergic properties when already on an Anticholinergic/antimuscarinic (listed overleaf) in > 65 year olds (risk of falls, increased anticholinergic toxicity: confusion, agitation, acute glaucoma, urinary retention, constipation). The following are known to contribute to the ACB: Amantadine Antidepressants, tricyclic: Amitriptyline, Clomipramine, Dosulepin, Doxepin, Imipramine, Nortriptyline, Trimipramine and SSRIs: Fluoxetine, Paroxetine Antihistamines, first generation (sedating): Clemastine, Chlorphenamine, Cyproheptadine, Diphenhydramine/-hydrinate, Hydroxyzine, Promethazine; also Cetirizine, Loratidine Antipsychotics: especially Clozapine, Fluphenazine, Haloperidol, Olanzepine, and phenothiazines e.g. Prochlorperazine, Trifluoperazine Baclofen Carbamazepine Disopyramide Loperamide Oxcarbazepine Pethidine -
Pain Management 101
PAIN MANAGEMENT 101 By: Vicki McCulloch RN, NP & DeAnna Looper RN, CHPN, CHPCA Expect more from us. We do. Objectives • Identify a step-wise approach to pain management. • Identify the WHO Pain Ladder. • Identify non-pharmacological pain control measures. • Identify adjuvant treatment measures. • Identify common myths and truths • Identify common side effects and treatment options. Expect more from us. We do. Pain Management Principles • Use Multi-Treatment and Multi-Discipline Approach • Combine opioids with non-opioid medications • Non-pharmaceutical approaches • Include family and caregiver in planning • Include the patient! • Coordinate with facility • Coordinate with all providers- • Primary Care Provider • Nursing Home Physician • Hospice IDG Members Expect more from us. We do. Utilize the WHO Ladder World Health Organization • (WHO) “analgesic ladder” • Follow the steps as indicated. • Determine if adjuvants are necessary. Expect more from us. We do. WHO Pain Ladder STEP 3 “Strong” opioid for severe pain +/- non-opioid +/- adjuvant STEP 2 “Mild” opioid for mild- moderate pain +/- non- opioid +/- adjuvant STEP 1 Non-opioid + / - adjuvant Expect more from us. We do. Step 1-Mild Pain NON-OPIOID MEDICATION OPTIONS • Acetaminophen (Tylenol)-(Paracetamol)-(Panadol) • Non-steroidal anti-inflammatory drugs (NSAIDs) Traditional NSAIDS Ibuprofen-(Motrin) Aspirin-(Bayer) Naproxen- (Aleve) Nabumetone-(Relafen) Cox-2 Inhibitors Celecoxib-(Celebrex) Rofecoxib-(Vioxx) Valdecoxib-(Bextra) Expect more from us. We do. Adjuvants • Antidepressants -
Potentially Harmful Drugs in the Elderly: Beers List
−This Clinical Resource gives subscribers additional insight related to the Recommendations published in− March 2019 ~ Resource #350301 Potentially Harmful Drugs in the Elderly: Beers List In 1991, Dr. Mark Beers and colleagues published a methods paper describing the development of a consensus list of medicines considered to be inappropriate for long-term care facility residents.12 The “Beers list” is now in its sixth permutation.1 It is intended for use by clinicians in outpatient as well as inpatient settings (but not hospice or palliative care) to improve the care of patients 65 years of age and older.1 It includes medications that should generally be avoided in all elderly, used with caution, or used with caution or avoided in certain elderly.1 There is also a list of potentially harmful drug-drug interactions in seniors, as well as a list of medications that may need to be avoided or have their dosage reduced based on renal function.1 This information is not comprehensive; medications and interactions were chosen for inclusion based on potential harm in relation to benefit in the elderly, and availability of alternatives with a more favorable risk/benefit ratio.1 The criteria no longer address drugs to avoid in patients with seizures or insomnia because these concerns are not unique to the elderly.1 Another notable deletion is H2 blockers as a concern in dementia; evidence of cognitive impairment is weak, and long-term PPIs pose risks.1 Glimepiride has been added as a drug to avoid. Some drugs have been added with cautions (dextromethorphan/quinidine, trimethoprim/sulfamethoxazole), and some have had cautions added (rivaroxaban, tramadol, SNRIs). -
PRESCRIBING INFORMATION (Dicyclomine Hydrochloride USP
PRESCRIBING INFORMATION BENTYLOL® (dicyclomine hydrochloride USP) Tablets 10 mg and 20 mg Syrup 10 mg/5 mL Antispasmodic APTALIS PHARMA CANADA INC. Date of Revision: 597 Laurier Blvd. July 16, 2012 Mont-St-Hilaire, Quebec J3H 6C4 Control number: 156699 BENTYLOL® (dicyclomine hydrochloride, USP) Prescribing Information Tablets & Syrup PRESCRIBING INFORMATION BENTYLOL® (dicyclomine hydrochloride USP) 10 mg and 20 mg Tablets Syrup, 10 mg/5 mL Antispasmodic ACTION AND CLINICAL PHARMACOLOGY Bentylol (dicyclomine) relieves smooth muscle spasm of the gastrointestinal tract. Animal studies indicate that this action is achieved via a dual mechanism: (1) a specific anticholinergic effect (antimuscarinic) at the acetylcholine (ACh)-receptor sites with approximately 1/8 the milligram potency of atropine (in vitro guinea pig ileum); and (2) a direct effect upon smooth muscle (musculotropic) as evidenced by dicyclomine's antagonism of bradykinin- and histamine-induced spasms of the isolated guinea pig ileum. Atropine did not affect responses to these two agonists. Animal studies showed dicyclomine to be equally potent against ACh - or barium chloride (BaCl2) - induced intestinal spasm while atropine was at least 200 times more potent against the effects of ACh than against BaCl2. Tests for mydriatic effects in mice showed that dicyclomine was approximately 1/500 as potent as atropine; antisialagogue tests in rabbits showed dicyclomine to be 1/300 as potent as atropine. After a single oral 20 mg dose of dicyclomine in volunteers, peak plasma concentration reached a mean value of 58 ng/mL in 1 to 1.5 hours. The principal route of elimination is via the urine. __________________________________________________________________________________ Aptalis Pharma Canada Inc. -
Drugs to Avoid in Patients with Dementia
Detail-Document #240510 -This Detail-Document accompanies the related article published in- PHARMACIST’S LETTER / PRESCRIBER’S LETTER May 2008 ~ Volume 24 ~ Number 240510 Drugs To Avoid in Patients with Dementia Elderly people with dementia often tolerate drugs less favorably than healthy older adults. Reasons include increased sensitivity to certain side effects, difficulty with adhering to drug regimens, and decreased ability to recognize and report adverse events. Elderly adults with dementia are also more prone than healthy older persons to develop drug-induced cognitive impairment.1 Medications with strong anticholinergic (AC) side effects, such as sedating antihistamines, are well- known for causing acute cognitive impairment in people with dementia.1-3 Anticholinergic-like effects, such as urinary retention and dry mouth, have also been identified in drugs not typically associated with major AC side effects (e.g., narcotics, benzodiazepines).3 These drugs are also important causes of acute confusional states. Factors that may determine whether a patient will develop cognitive impairment when exposed to ACs include: 1) total AC load (determined by number of AC drugs and dose of agents utilized), 2) baseline cognitive function, and 3) individual patient pharmacodynamic and pharmacokinetic features (e.g., renal/hepatic function).1 Evidence suggests that impairment of cholinergic transmission plays a key role in the development of Alzheimer’s dementia. Thus, the development of the cholinesterase inhibitors (CIs). When used appropriately, the CIs (donepezil [Aricept], rivastigmine [Exelon], and galantamine [Razadyne, Reminyl in Canada]) may slow the decline of cognitive and functional impairment in people with dementia. In order to achieve maximum therapeutic effect, they ideally should not be used in combination with ACs, agents known to have an opposing mechanism of action.1,2 Roe et al studied AC use in 836 elderly patients.1 Use of ACs was found to be greater in patients with probable dementia than healthy older adults (33% vs. -
Diphenhydramine Hydrochloride Oral Solution USP Rx ONLY
DIPHENHYDRAMINE HYDROCHLORIDE- diphenhydramine hydrochloride solution Pharmaceutical Associates, Inc. ---------- Diphenhydramine Hydrochloride Oral Solution USP Rx ONLY DESCRIPTION Diphenhydramine hydrochloride is an antihistamine drug having the chemical name 2- (diphenylmethoxy)-N,N -dimethylethylamine hydrochloride and has the molecular formula C 17H 21NO•HCI (molecular weight 291.82). It occurs as a white odorless, crystalline powder and is freely soluble in water and alcohol. The structural formula is as follows: Each 5 mL contains 12.5 mg of diphenhydramine hydrochloride and alcohol 14% for oral administration. Inactive Ingredients: Citric acid, D&C Red No. 33, FD&C Red No. 40, flavoring, purified water, sodium citrate, and sucrose. CLINICAL PHARMACOLOGY Diphenhydramine hydrochloride is an antihistamine with anticholinergic (drying) and sedative effects. Antihistamines appear to compete with histamine for cell receptor sites on effector cells. A single oral dose of diphenhydramine hydrochloride is quickly absorbed with maximum activity occurring in approximately one hour. The duration of activity following an average dose of diphenhydramine hydrochloride is from four to six hours. Diphenhydramine is widely distributed throughout the body, including the CNS. Little, if any, is excreted unchanged in the urine; most appears as the degradation products of metabolic transformation in the liver, which are almost completely excreted within 24 hours. INDICATIONS AND USAGE Diphenhydramine hydrochloride in the oral form is effective for the following indications: Antihistaminic For allergic conjunctivitis due to foods; mild, uncomplicated allergic skin manifestations of urticaria and angioedema; amelioration of allergic reactions to blood or plasma; dermatographism; as therapy for anaphylactic reactions adjunctive to epinephrine and other standard measures after the acute manifestations have been controlled. -
The Anticholinergic Toxidrome
Poison HOTLINE Partnership between Iowa Health System and University of Iowa Hospitals and Clinics July 2011 The Anticholinergic Toxidrome A toxidrome is a group of symptoms associated with poisoning by a particular class of agents. One example is the opiate toxidrome, the triad of CNS depression, respiratory depression, and pinpoint pupils, and which usually responds to naloxone. The anticholinergic toxidrome is most frequently associated with overdoses of diphenhydramine, a very common OTC medication. However, many drugs and plants can produce the anticholinergic toxidrome. A partial list includes: tricyclic antidepressants (amitriptyline), older antihistamines (chlorpheniramine), Did you know …… phenothiazines (promethazine) and plants containing the anticholinergic alkaloids atropine, hyoscyamine and scopolamine (Jimson Weed). Each summer, the ISPCC receives approximately 10-20 The mnemonic used to help remember the symptoms and signs of this snake bite calls, some being toxidrome are derived from the Alice in Wonderland story: from poisonous snakes (both Blind as a Bat (mydriasis and inability to focus on near objects) local and exotic). Red as a Beet (flushed skin color) Four poisonous snakes can be Hot as Hades (elevated temperature) found in Iowa: the prairie These patients can sometimes die of agitation-induced hyperthermia. rattlesnake, the massasauga, Dry as a Bone (dry mouth and dry skin) the copperhead, and the Mad as a Hatter (hallucinations and delirium) timber rattlesnake. Each Bowel and bladder lose their tone (urinary retention and constipation) snake has specific territories Heart races on alone (tachycardia) within the state. ISPCC A patient who has ingested only an anticholinergic substance and is not specialists have access to tachycardic argues against a serious anticholinergic overdose. -
Department of Health
DEPARTMENT OF HEALTH National Drug Policy - Pharmaceutical Management Unit 50 National Formulary Committee Philippine National Drug Formulary EssentialEssential MedicinesMedicines ListList Volume I, 7th Edition ( 2008 ) Published by: The National Formulary Committee National Drug Policy ‐ Pharmaceutical Management Unit 50 DEPARTMENT OF HEALTH Manila, Philippines All rights reserved 2008 The National Formulary Committee National Drug Policy‐Pharmaceutical Management Unit 50 (NDP‐PMU 50) Department of Health San Lazaro Cmpd., Rizal Ave., Sta. Cruz, Manila, Philippines 1003 ISBN 978‐971‐91620‐7‐0 Any part or the whole book may be reproduced or transmitted without any alteration, in any form or by any means, with permission from DOH provided it is not sold commercially. ii PHILIPPINE NATIONAL DRUG FORMULARY Volume I, 7th Edition 2 0 0 8 Francisco T. Duque III, MD, MSc Secretary of Health Alexander A. Padilla Undersecretary of Health, Office for External Affairs Robert Louie P. So, MD Program Manager, NDP-PMU 50 Dennis S. Quiambao, MD Proj. Mgmt. Operating Officer & Coordinator (PMOOC) NDP-PMU 50 NATIONAL FORMULARY COMMITTEE Estrella B. Paje-Villar, MD, DTM & H Chairperson Jose M. Acuin, MD, MSc Alma L. Jimenez, MD Alejandro C. Baroque II, MD Marieta B. de Luna, MD Bu C. Castro, MD Nelia P. Cortes-Maramba, MD Dina V. Diaz, MD Yolanda R. Robles, PhD Pharm Mario R. Festin, MD, MS, MHPEd Isidro C. Sia, MD BFAD Representative SECRETARIAT Luzviminda O. Marquez, RPh, RMT Mary Love C. Victoria, RPh Michael D. Junsay, RPh Ermalyn M. Magturo iii Republic of the Philippines DEPARTMENT OF HEALTH OFFICE OF THE SECRETARY 2/F Bldg. 1, San Lazaro Cmpd., Rizal Avenue, Sta. -
Pcf5 Palliative Care Formulary
PCF5 PALLIATIVE CARE FORMULARY Published by palliativedrugs.com Ltd. Palliativedrugs.com Ltd Hayward House Study Centre Nottingham University Hospitals NHS Trust, City Campus Nottingham NG5 1PB United Kingdom www.palliativedrugs.com # palliativedrugs.com Ltd 2014 The moral rights of the editors have been asserted. PCF4þ ePDF 2013 PCF4þ ePDF 2012 PCF4 2011, reprinted 2012 (twice), 2013 PCF3 2007, reprinted 2008, 2009 PCF2 2002, reprinted 2003 PCF1 1998 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior permission in writing of palliativedrugs.com Ltd or as expressly permitted by law, or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to [email protected] or by ordinary mail to the above address. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. ISBN 978-0-9552547-9-6 Typeset by OKS Prepress Services Private Ltd, Chennai, India Printed by Halstan Printing Group, Amersham, UK DISCLAIMER Every effort has been made to ensure the accuracy of this text, and that the best information available has been used. However, palliativedrugs.com Ltd neither represents nor guarantees that the practices described herein will, if followed, ensure safe and effective patient care. The recommendations contained in this book reflect the editors’ judgement regarding the state of general knowledge and practice in the field as of the date of publication. Information in a book of this type can never be all-inclusive, and therefore will not cover every eventuality. -
Composition Colicon ® Tablet: Each Tablet Contains Dicycloverine Hydrochloride BP 10 Mg
Composition Colicon ® Tablet: Each tablet contains Dicycloverine Hydrochloride BP 10 mg. Colicon ® Syrup: Each 5 ml syrup contains Dicycloverine Hydrochloride BP 10 mg. Colicon ® Injection: Each 2 ml ampoule contains Dicycloverine Hydrochloride BP 20 mg. Description Colicon ® (Dicycloverine Hydrochloride) is an antispasmodic and anticholinergic (antimuscarinic) agent. Colicon ® relieves smooth muscle spasm of the gastrointestinal tract, urinary bladder & ureter. It works at specific receptors, called cholinergic (or muscarinic) receptors, located on the involuntary muscle in the walls of the gut. As antispasmodic drug Colicon ® causes the gut muscle to relax, relieving the pain of colic produced by gut muscle contraction and spasm. Also it has direct musculotropic action. Indication and usage Irritable bowel syndrome (Diarrhea Predominant) Infantile colic GIT spasm Diverticulitis Abdominal colic Diarrhea Dysentery Dosage and administration Adults : 10 to 20 mg three to four times a day. Maximum recommended oral dose is 160 mg daily in divided dose. Children : Children over 6 months of age- 5 to 10 mg three times a day. IM injection: Usual recommended injectable dose is 80 mg daily by IM route in 4 divided dose. Side-Effects Insomnia, headache, weakness, confusion, increased ocular tension, urinary hesitancy, palpitations etc. Precaution Use with caution in patients with autonomic neuropathy, hepatic or renal disease, ulcerative colitis, coronary heart disease, congestive heart failure, cardiac tachyarrhythmia, known or suspected prostatic hypertrophy. Contraindication Obstructive uropathy Obstruction disorder in GIT Severe ulcerative colitis Unstable cardiovascular status in acute hemorrhage Glucoma Myasthenia gravis Patients with hypersensitivity to dicycloverine hydrochloride Infants less than 6 months of age Use in Pregnancy and Lactation Pregnancy Category B. -
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Hallucinogens And Dissociative Drug Use And Addiction Introduction Hallucinogens are a diverse group of drugs that cause alterations in perception, thought, or mood. This heterogeneous group has compounds with different chemical structures, different mechanisms of action, and different adverse effects. Despite their description, most hallucinogens do not consistently cause hallucinations. The drugs are more likely to cause changes in mood or in thought than actual hallucinations. Hallucinogenic substances that form naturally have been used worldwide for millennia to induce altered states for religious or spiritual purposes. While these practices still exist, the more common use of hallucinogens today involves the recreational use of synthetic hallucinogens. Hallucinogen And Dissociative Drug Toxicity Hallucinogens comprise a collection of compounds that are used to induce hallucinations or alterations of consciousness. Hallucinogens are drugs that cause alteration of visual, auditory, or tactile perceptions; they are also referred to as a class of drugs that cause alteration of thought and emotion. Hallucinogens disrupt a person’s ability to think and communicate effectively. Hallucinations are defined as false sensations that have no basis in reality: The sensory experience is not actually there. The term “hallucinogen” is slightly misleading because hallucinogens do not consistently cause hallucinations. 1 ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com ce4less.com How hallucinogens cause alterations in a person’s sensory experience is not entirely understood. Hallucinogens work, at least in part, by disrupting communication between neurotransmitter systems throughout the body including those that regulate sleep, hunger, sexual behavior and muscle control. Patients under the influence of hallucinogens may show a wide range of unusual and often sudden, volatile behaviors with the potential to rapidly fluctuate from a relaxed, euphoric state to one of extreme agitation and aggression.