Pain Killer drugs
Protocols
Diclofenac Sodium:
Brand name: Clofenac(square),voltaline(Novartis)
Preparation: 12.5 /25/50 mg suppository, 25& 50 tab
1% gel
Oral
Rheumatoid Arthritis, Osteoarthritis
Diclofenac sodium: 50 mg PO q8hr
Extended release: 100 mg PO once daily;
Rheumatoid Arthritis, Osteoarthritis
Diclofenac sodium: 50 mg PO q8hr
Extended release: 100 mg PO once daily;
may be increased to 100 mg PO q12hr
Ankylosing Spondylitis
Diclofenac sodium: 25 mg PO 4 or 5 times daily
Mild-to-Moderate Acute Pain, Dysmenorrhea
100 mg PO once, then 50 mg PO q8hr PRN
Intravenous
Postoperative pain
Adult: As diclofenac Na: 75 mg infusion in glucose
Ankylosing Spondylitis
Diclofenac sodium: 25 mg PO 4 or 5 times daily
Mild-to-Moderate Acute Pain, Dysmenorrhea
100 mg PO once, then 50 mg PO q8hr PRN
Intravenous
Postoperative pain
Adult: As diclofenac Na: 75 mg infusion in glucose
5% or NaCl 0.9% (previously buffered w/ Na bicarbonate)
given over 30-120 min or as bolus inj, may repeat
after 4-6 hr if necessary. Max period: 2 days.
Intramuscular
Rheumatoid arthritis; Sprains ; Strains; Tendinitis;
Intramuscular
Rheumatoid arthritis; Sprains ; Strains; Tendinitis;
Pain and inflammation associated with musculoskeletal
and joint disorders ; Bursitis; Acute gout; Dysmenorrhoea
Adult: As diclofenac Na: 75 mg once daily, injected into the
Adult: As diclofenac Na: 75 mg once daily, injected into the
gluteal muscle, may increase to 75 mg bid in severe conditions.
Max period: 2 days.
Hepatic impairment: Dose adjustment may be needed.
Hepatic impairment: Dose adjustment may be needed.
Should be taken with food. Take immediately after meals.
Rheumatoid arthritis, Osteoarthritis, Ankylosing spondylitis,
Pain, Migraine, Dysmenorrhea, Muscle aches, Acute gout,
Inflammation, Renal colic,Tendinitis, Backaches, Dental pain,
Menstrual cramps, Bursitis
It is contra-indicated for those patients who are hypersensitive
to Diclofenac. In patients with active or suspected peptic ulcer
or gastrointestinal bleeding, or for those patients in whom
attacks of asthma, urticaria or acute rhinitis are precipitated
by aspirin or other NSAIDs possessing prostaglandin
synthetase inhibitinig activity, it is also contraindicated.
Because of the presence of Lidocaine, it is also
Because of the presence of Lidocaine, it is also
contraindicated for those patients who are hypersensitive
to local anaesthetics of the amide type, although the
incidence is very rare.
Side-effects of Diclofenac is usually mild and transient.
It is generally well tolerated. At the starting of the treatment,
however, patients may sometimes complain of gastrointestinal
discomfort, epigastria pain, eructation, nausea and Diarrhoea,
headache and bleeding sometime may occur. Occasionally skin
rash, peripheral oedema and abnormalities of serum
transaminase have been reported.Very rarely reported
side effects include activation of peptic ulcer, haematemesis
or melena, blood dyscrasia (extensive usage). There have been
isolated reports of anaphylactoid reactions.
Drugs used for Rheumatoid Arthritis
Category: Not Classified
pregnancy_description
pregnancy_description
Diclofenac, a phenylacetic acid derivative is a prototypical NSAID.
It has potent anti-inflammatory, analgesic and antipyretic actions.
It reversibly inhibits the enzyme, cyclooxygenase, thus resulting in
reduced synthesis of prostaglandin precursors.
May increase serum levels of methotrexate. Concomitant use w/
other NSAIDs or anticoagulants (e.g. warfarin) is associated w/
higher risk of GI bleeding. Increased risk of nephrotoxicity w/
ciclosporin or triamterene. May increase the risk of developing
corneal complications in patients w/ significant pre-existing
corneal inflammation when use concomitantly w/ ophth
preparation containing corticosteroids. Colestyramine and
colestipol reduce the bioavailability of diclofenac. Decreased
plasma concentration when administered after sucralfate.
Ophth application of diclofenac may reduce the efficacy of
ophth acetylcholine and carbachol. May increase serum
levels of lithium and digoxin.
Per Unit Price: Tk. 12.05
Package: 10's pack
Package: 10's pack
Paracetamol:
Brand name: Napa(beximco),Ace(square)
Tamen(skf)
Preparation:
Suppository: 60/125/250/500mg
syp: 120mg/5ml
Tablet: 250mg/500mg /1gm
I/V infution:10mg/ml
paediatric drop: 80 mg/ml
Oral
Mild to moderate pain and fever
Tablet
Adult: 1 - 2 tablets every 4 to 6 hours up
Mild to moderate pain and fever
Tablet
Adult: 1 - 2 tablets every 4 to 6 hours up
to a maximum of 4 g (8 tablets) daily
Extended Release (XR) Tablet
Adults: 2 tablets, swallowed whole, every
Extended Release (XR) Tablet
Adults: 2 tablets, swallowed whole, every
6 to 8 hours (maximum of
6 tablets in any 24 hours).
Syrup/Suspension:
Adults: 4-8 Measuring spoonful 3-4 times daily;
Rectal
Suppository
Adults: 500 mg-1 g every 4-6 hours to a
Syrup/Suspension:
Adults: 4-8 Measuring spoonful 3-4 times daily;
Rectal
Suppository
Adults: 500 mg-1 g every 4-6 hours to a
maximum of 4 g daily.
Oral
Mild to moderate pain and fever
Tablet
Children (6 - 12 years) : 1/2 to 1 tablet
Mild to moderate pain and fever
Tablet
Children (6 - 12 years) : 1/2 to 1 tablet
3 to 4 times daily
Extended Release (XR) Tablet
Children over 12 years: 2 tablets, swallowed whole,
Extended Release (XR) Tablet
Children over 12 years: 2 tablets, swallowed whole,
every 6 to 8 hours (maximum of 6 tablets in any 24 hours).
Syrup
Mild to moderate pain and fever
Children:
3 months - <1 year : 60 - 120 mg (1/2 - 1 measuring spoonful),
1 - 5 years : 1 - 2 measuring spoonful
6 - 12 years : 2 - 4 measuring spoonful
Children: 2 months: 60 mg (1/2 measuring spoonful) for
Syrup
Mild to moderate pain and fever
Children:
3 months - <1 year : 60 - 120 mg (1/2 - 1 measuring spoonful),
1 - 5 years : 1 - 2 measuring spoonful
6 - 12 years : 2 - 4 measuring spoonful
Children: 2 months: 60 mg (1/2 measuring spoonful) for
post immunization pyrexia;
Paediatric Drops
Mild to moderate pain and fever
Children Up to 3 months: 0.5 ml (40 mg)
4 to 11 months: 1.0 ml (80 mg)
1 to <2 years: 1.5 ml (120 mg)
2 to 3 years: 2 ml (160mg)
4 to 5 years: 3 ml (240 mg)
Dose can be repeated, every 4 hours.
Rectal
Mild to moderate pain and fever
Suppository
Children: 3 months-<1 year: 60-125 mg
1-<5 years: 125-250 mg
5-12 years: 250-500 mg
These doses may be repeated every 4-6 hours
Paediatric Drops
Mild to moderate pain and fever
Children Up to 3 months: 0.5 ml (40 mg)
4 to 11 months: 1.0 ml (80 mg)
1 to <2 years: 1.5 ml (120 mg)
2 to 3 years: 2 ml (160mg)
4 to 5 years: 3 ml (240 mg)
Dose can be repeated, every 4 hours.
Rectal
Mild to moderate pain and fever
Suppository
Children: 3 months-<1 year: 60-125 mg
1-<5 years: 125-250 mg
5-12 years: 250-500 mg
These doses may be repeated every 4-6 hours
as necessary (maximum 4 doses in 24 hours).
Children over 12 years: 500 mg-1 g every 4-6
Children over 12 years: 500 mg-1 g every 4-6
hours to a maximum of 4 g daily.
Post-immunisation pyrexia
Child: 2-3 mth 60 mg. If necessary, a 2nd dose
Post-immunisation pyrexia
Child: 2-3 mth 60 mg. If necessary, a 2nd dose
may be given after 4-6 hr.
May be taken with or without food.
Fever, Mild to moderate pain, osteoarthritis,
rheumatoid arthritis, chronic low back pain,
Renal stone pain, neuropathic pain, toothache,
migraine, postoperative mild to moderate pain.
Hypersensitivity.
Thrombocytopenia, leucopenia, pancytopenia,
neutropenia, agranulocytosis, pain and burning
sensation at inj site. Rarely, hypotension and tachycardia.
Potentially Fatal: Stevens-Johnson syndrome, toxic
Potentially Fatal: Stevens-Johnson syndrome, toxic
epidermal necrolysis, acute generalised exanthematous
pustulosis, acute renal tubular necrosis and hepatotoxicity.
Non-Opioid Analgesics
Category: B
pregnancy_description
pregnancy_description
Paracetamol exhibits analgesic action by peripheral blockage of
pain impulse generation. It produces antipyresis by inhibiting
the hypothalamic heat-regulating centre. Its weak anti-inflammatory
activity is related to inhibition of prostaglandin synthesis in the CNS.
May reduce serum levels w/ anticonvulsants (e.g. phenytoin,
barbiturates, carbamazepine). May enhance the anticoagulant
effect of warfarin and other coumarins w/ prolonged use.
Accelerated absorption w/ metoclopramide and domperidone.
May increase serum levels w/ probenecid. May increase serum
levels of chloramphenicol. May reduce absorption w/
colestyramine w/in 1 hr of admin. May cause severe
hypothermia w/ phenothiazine.
Per Unit Price: Tk. 18.29,20.70,31.87
Package: 50ml,60ml,100ml bot
Package: 50ml,60ml,100ml bot
Ketorolac Tromethamine:
Brand name:Rolac(renata),Torax(square),roket(glove)
Preparation;
tablet: 10mg
injection: 10mg/ml , 30 mg/ml ,60mg/ml
Oral
Adult
Moderately Severe Acute Pain
Short-term (<5 days) management of moderately
Adult
Moderately Severe Acute Pain
Short-term (<5 days) management of moderately
severe acute pain that requires analgesia at opioid
level; not indicated for minor or chronic painful conditions
IV: 30 mg as single dose or 30 mg q6hr; not to exceed 120 mg/day
IM: 60 mg as single dose or 30 mg q6hr; not to exceed 120 mg/day
PO: 20 mg once after IV or IM therapy, THEN 10 mg q4-6hr;
IV: 30 mg as single dose or 30 mg q6hr; not to exceed 120 mg/day
IM: 60 mg as single dose or 30 mg q6hr; not to exceed 120 mg/day
PO: 20 mg once after IV or IM therapy, THEN 10 mg q4-6hr;
not to exceed 40 mg/day
Elderly
IV: 15 mg as single dose or 15 mg q6hr; not to exceed 60 mg/day
IM: 30 mg as single dose or 15 mg q6hr; not to exceed 60 mg/day
PO: 10 mg once after IV or IM therapy, THEN 10 mg q4-6hr; not to
Elderly
IV: 15 mg as single dose or 15 mg q6hr; not to exceed 60 mg/day
IM: 30 mg as single dose or 15 mg q6hr; not to exceed 60 mg/day
PO: 10 mg once after IV or IM therapy, THEN 10 mg q4-6hr; not to
exceed 40 mg/day
Dosing Considerations
Always begin with parenteral therapy; oral administration
Dosing Considerations
Always begin with parenteral therapy; oral administration
indicated only as continuation of IV/IM dosing, if necessary
Duration of therapy should not exceed 5 days
Duration of therapy should not exceed 5 days
<2 years
Safety and efficacy not established
2-16 years
Single dose: 0.5 mg/kg IV/IM once; not to exceed 15 mg
Multiple dose: 0.5 mg/kg IV/IM q6hr; not to exceed 5 days
Safety and efficacy not established
2-16 years
Single dose: 0.5 mg/kg IV/IM once; not to exceed 15 mg
Multiple dose: 0.5 mg/kg IV/IM q6hr; not to exceed 5 days
Renal impairment
Severe: Contraindicated
Moderate (moderately elevated serum creatinine): Use 50% of
Severe: Contraindicated
Moderate (moderately elevated serum creatinine): Use 50% of
recommended dosage; not to exceed 60 mg/day IM/IV
Moderate to severe pain
Hypersensitivity to aspirin or other NSAIDs, asthma.
Hypovolaemia or dehydration. Do not give postoperatively
to patients with high risk of haemorrhage. History of peptic ulcer
or coagulation disorders. Nasal polyps, angioedema, bronchospasm.
Labour. Moderate to severe renal impairment. GI bleeding,
cerebrovascular bleeding. As prophylactic analgesic before
surgery. Pregnancy, lactation.
>10%
Headache (17%),Somnolence (3-14%),Dyspepsia (12-13%),
Headache (17%),Somnolence (3-14%),Dyspepsia (12-13%),
GI pain (12-13%),Nausea (12-13%)
1-10%
Diarrhea (3-9%),Dizziness (3-9%),Pruritus (3-9%),Edema (1-3%),
1-10%
Diarrhea (3-9%),Dizziness (3-9%),Pruritus (3-9%),Edema (1-3%),
Increased blood urea nitrogen (BUN) (3%),Constipation (<3%),
Purpura (<3%),Increased serum creatinine (2%),Drowsiness
(6%),Hypertension (4%)
<1%
Abnormal thinking,Anaphylaxis,Blurred vision,Bronchospasm,
<1%
Abnormal thinking,Anaphylaxis,Blurred vision,Bronchospasm,
Cholestatic jaundice,Depression,Difficulty in concentration
,Dysgeusia,Euphoria,Hemolytic-uremic syndrome,Hepatitis
,Hyperkalemia,Hyponatremia,Hypotension,Increased liver
function test values,Insomnia,Laryngeal/lingual edema,
Liver failure,Melena,Nervousness,Oliguria,Pallor,Peptic
ulcer,Rash,Rectal bleeding,Stomatitis,Urinary frequency,
Urinary retention,Vasodilation
Potentially Fatal: Anaphylaxis. Severe skin reactions.
Potentially Fatal: Anaphylaxis. Severe skin reactions.
MI, stroke, GI bleeding.
Non-Opioid Analgesics
Category: C
pregnancy_description
pregnancy_description
Ketorolac inhibits prostaglandin synthesis by
decreasing the activity of the cyclooxygenase enzyme.
May reduce effects of antihypertensives eg ACE inhibitors
or angiotensin II receptor antagonists (AIIA). Increased risk
of renal toxicity with ACE inhibitors, diuretics. Increased
adverse effects with aspirin or other NSAIDs. Hallucinations
may occur when used with fluoxetine, thiothixene, alprazolam.
Potentially Fatal: Increased risk of GI bleeding with warfarin.
May increase toxicity of methotrexate (MTX) and lithium.
Increased plasma concentrations with probenecid.
Per Unit Price: Tk. 10.04
Package: 40's pack
Package: 40's pack
Tiemonium Methylsulphate:
Brand name: Algin(renata),Viset(healthcare)
Norvis(square)
Preparation:
Tablet: 50mg
injection: 5mg/2 ml
Syrup: 10 mg/5ml
Oral
Adult
Tablet: The usual dosages are 2 to 6 tablets
Adult
Tablet: The usual dosages are 2 to 6 tablets
(100-300 mg) daily in divided doses as required.
Parenteral
Injection: 1 ampoule by slow IV/IM injection 3
Parenteral
Injection: 1 ampoule by slow IV/IM injection 3
times daily.
Dysentery, Diarrhoea, Gastroenteritis, Biliary colic,
Enterocolitis, Cholecystitis, Colonopathies, Mild
cystitis and spasmodic dysmenorrhoea, Visceral
muscle spasm
This drug must not be used in glaucoma (acute pain
in the eyeball with disorders of vision), difficulties in
urinating (disorders of the prostate or bladder).
Tiemonium Methylsulfate INN may have some
undesirable effects in certain individuals like risk of
hypotension and tachycardia especially in case of injection.
Anticholinergics(others)
Category: Not Classified
pregnancy_description
pregnancy_description
Tiemonium Methylsulfate) is a synthetic anticholinergic-antispasmodic
drug. Tiemonium are quaternary ammonium antimuscarinic agent
with peripheral effect similar to those of atropine. Tiemonium strengthens
calcium bonding with phospho lipids and proteins thus stabilizing the cell
membrane of the GI tract.
Per Unit Price: Tk. 90
Package: 100ml bot
Package: 100ml bot
Paracetamol + Tramadol Hydrochloride:
Brand name: Napadol(Beximco)
Oral
Moderate to severe pain
Adult: 1-2 tab 6 hrly.
Max: 8 tab/day. Max duration: 5 days.
Hepatic impairment: Moderate: Increase
Moderate to severe pain
Adult: 1-2 tab 6 hrly.
Max: 8 tab/day. Max duration: 5 days.
Hepatic impairment: Moderate: Increase
dosing interval. Severe: Contraindicated.
Not recommended in child under 18 years of age.
Renal impairment:
CrCl (ml/min) Dosage Recommendation
10-30 Increase dosing interva to 12 hr.ly
<10 Not recommended.
CrCl (ml/min) Dosage Recommendation
10-30 Increase dosing interva to 12 hr.ly
<10 Not recommended.
May with or without food.
Moderate to severe pain
Hypersensitivity to tramadol, paracetamol or opioids.
Situations where opioid use may be contra-indicated
(e.g. acute intoxication with alcohol, hypnotic drugs,
centrally-acting analgesics, opioids or psychotropic drugs).
Severe hepatic impairment, uncontrolled epilepsy.
Concurrent use or within 2 wk of discontinuation from MAOIs.
Postural hypotension, resp depression, hepatotoxicity,
Stevens-Johnson syndrome, toxic epidermal necrolysis,
bradycardia, collapse, allergic reactions w/ resp symptoms
(e.g. dyspnoea, bronchospasm, wheezing, angioneurotic oedema),
changes in appetite, motor weakness, changes in mood, activity,
cognitive and sensorial capacity; exacerbation of asthma,
withdrawal symptoms (e.g. agitation, anxiety), skin rash,
blood dyscrasias, hypoprothrombinemia.
Potentially Fatal: Severe anaphylactic reactions.
Potentially Fatal: Severe anaphylactic reactions.
Combined analgesics
Category: Not Classified
pregnancy_description
pregnancy_description
Tramadol is a centrally acting opioid analgesic which binds
to mu-opioid receptors and weakly inhibits the reuptake of
norepinephrine and serotonin. Paracetamol, a para-aminophenol
derivative, has analgesic, antipyretic and weak anti-inflammatory
activity. Together, tramadol and paracetamol has faster onset of
action compared to tramadol alone and longer duration of action
compared to paracetamol alone.
Increased risk of seizures and serotonin syndrome w/ SSRIs, SNRIs,
TCAs, and 5-HT agonists (e.g. sumatriptan). Increased CNS depression
w/ barbiturates, benzodiazepines, other anxiolytics, hypnotics, sedative
antidepressants, sedative antihistamines, neuroleptics, centrally-acting
antihypertensive drugs, thalidomide and baclofen. Decreased analgesic
efficacy w/ ondansetron. Increased INR w/ warfarin. Potentially Fatal:
Increased risk of seizure and serotonin sydrome w/ MAOIs.
Per Unit Price: Tk. 8
Package: 30's pack
Package: 30's pack
Tramadol Hydrochloride:
Brand name: Anadol(square),Ultramal(unimed)
Preparation:
Tablet: 50mg
Capsule: 50mg & 100mg
Injection:100mg/2ml
Suppository:100mg/2ml
Oral
Moderate to severe pain
Moderate to severe pain
Adult:
Immediate release
Chronic pain: 25 mg PO every morning initially;
increased by 25-50 mg/day every 3 days up to
50-100 mg PO q4-6hr PRN; not to
exceed 400 mg/day
Acute pain: 50-100 mg PO q4-6hr PRN;
Acute pain: 50-100 mg PO q4-6hr PRN;
not to exceed 400 mg/day
Extended release
100 mg PO once daily initially; increased by
Extended release
100 mg PO once daily initially; increased by
100 mg/day every 5 days; not to exceed 300 mg/day
Parenteral
Moderate to severe pain
Adult: IM/IV: 50-100 mg 4-6 hrly over 2-3 min.
Postoperative pain
Adult: Initially, 100 mg followed by 50 mg every 10-20 min
Parenteral
Moderate to severe pain
Adult: IM/IV: 50-100 mg 4-6 hrly over 2-3 min.
Postoperative pain
Adult: Initially, 100 mg followed by 50 mg every 10-20 min
if necessary, to a total of 250 mg in the 1st hr including initial
dose. Thereafter, 50-100 mg 4-6 hrly up to a total daily dose of 600 mg.
Elderly: >75 yr Increase dosing interval.
Hepatic impairment: Severe: Immediate release,
Elderly: >75 yr Increase dosing interval.
Hepatic impairment: Severe: Immediate release,
50 mg PO q12hr; extended release not recommended
Moderate-to-Severe Pain
Immediate release
<17 years: Safety and efficacy not established
>17 years (acute): 50-100 mg PO q4-6hr PRN; not to
Immediate release
<17 years: Safety and efficacy not established
>17 years (acute): 50-100 mg PO q4-6hr PRN; not to
exceed 400 mg/day
>17 years (chronic): 25 mg PO every morning initially;
>17 years (chronic): 25 mg PO every morning initially;
increased by 25-50 mg/day every 3 days as separate doses
up to 50-100 mg PO q4-6hr PRN; not to exceed 400 mg/day
Extended release
<18 years: Safety and efficacy not established
Extended release
<18 years: Safety and efficacy not established
Renal impairment:
CrCl (ml/min) Dosage Recommendation
10-30 Increase dosing interval to 12 hrly.
<10 Contraindicated.
CrCl (ml/min) Dosage Recommendation
10-30 Increase dosing interval to 12 hrly.
<10 Contraindicated.
May be taken with or without food.
Moderate to severe pain, Postoperative pain
Suicidal patients, acute alcoholism; head injuries; raised
intracranial pressure; severe renal impairment; lactation.
>10%
Constipation (24-46%),Nausea (24-40%),Dizziness (10-33%),
Constipation (24-46%),Nausea (24-40%),Dizziness (10-33%),
Vertigo (26-33%),Headache (18-32%),Somnolence (7-25%),
Vomiting (9-17%),Agitation (7-14%),Anxiety (7-14%),Emotional
lability (7-14%),Euphoria (7-14%),Hallucinations (7-14%),
Nervousness (7-14%),Spasticity (7-14%),Dyspepsia (5-13%)
,Asthenia (6-12%),Pruritus (8-11%)
1-10%
Diarrhea (5-10%),Dry mouth (5-10%),Sweating (6-9%),Hypertonia
1-10%
Diarrhea (5-10%),Dry mouth (5-10%),Sweating (6-9%),Hypertonia
(1-5%),Malaise (1-5%),Menopausal symptoms (1-5%),Rash (1-5%),
Urinary frequency (1-5%),Urinary retention (1-5%),Vasodilation (1-5%),
Visual disturbance (1-5%)
<1%
Abnormal gait,Amnesia,Cognitive dysfunction,Depression,Difficulty in
<1%
Abnormal gait,Amnesia,Cognitive dysfunction,Depression,Difficulty in
concentration,Dysphoria,Dysuria,Fatigue,Hallucinations,Menstrual
disorder,Motor system weakness,Orthostatic hypotension,Paresthesia
,Seizures,Suicidal tendencies,Syncope,Tachycardia,Tremor
Frequency Not Defined
Abnormal electrocardiogram (ECG),Angioedema,Bronchospasm,Flushing
Frequency Not Defined
Abnormal electrocardiogram (ECG),Angioedema,Bronchospasm,Flushing
,Hypertension,Hypotension,Myocardial ischemia,Palpitation,Urticaria,
Withdrawal syndrome
Potentially Fatal: Respiratory depression.
Potentially Fatal: Respiratory depression.
Opioid analgesics
Category: Not Classified
pregnancy_description
pregnancy_description
Tramadol inhibits reuptake of norepinephrine, serotonin and enhances
serotonin release. It alters perception and response to pain by binding
to mu-opiate receptors in the CNS.
Increased risk of convulsions or serotonin syndrome w/ SSRI,
serotonin-norepinephrine reuptake inhibitors (SNRI), TCA and other
seizure threshold lowering drugs (e.g. bupropion, mirtazapine,
tetrahydrocannabinol). Decreased serum concentrations w/ carbamazepine.
May potentiate the anti-depressant effect of norepinephrine, 5-HT agonists
or lithium. Increased INR and ecchymoses w/ coumarin derivatives (e.g. warfarin).
Potentially Fatal: Increased risk of seizure and serotonin syndrome w/ MAOIs.
Per Unit Price: Tk. 15
Package: 20's pack
Package: 20's pack
Aceclofenac:
Brand name: Flexi(sqaure),Reservix(incepta)
Movex(opsonin)
Preparation:
Tablet; 100mg,200mg SR
Adult: PO Ankylosing spondylitis;
Osteoarthritis; Rheumatoid arthritis
100 mg twice daily.
SR Tablet : The recommended dose
100 mg twice daily.
SR Tablet : The recommended dose
is 200 mg, once daily.
Elderly: The pharmacokinetics of aceclofenac
Elderly: The pharmacokinetics of aceclofenac
are not altered in elderly patients, therefore it is
not considered necessary to modify the dose
and dose frequency.
Hepatic Impairment Reduce initial dose to 100 mg daily .
Hepatic Impairment Reduce initial dose to 100 mg daily .
Safety & Efficacy not established.
No dose adjustment needed.
Should be taken with food. Take w/ or immediately after meals.
Indicated for the relief of pain and inflammation in both acute
and chronic pain like, osteoarthritis, rheumatoid arthritis,
ankylosing spondylitis, dental pain, post-traumatic pain,
low back pain, gynaecological pain.
Hypersensitivity to aspirin or NSAIDs; moderate to
severe renal impairment; pregnancy (3rd trimester);
history of peptic ulceration or GI bleed; patients with
infections.
Gastrointestinal disorders (dyspepsia, abdominal pain,
nausea and diarrhoea) and occasional occurance of
dizziness. Dermatological side effects including pruritus
and rash. Abnormal hepatic enzyme levels and raised
serum creatinine have occasionally been reported.
Potentially Fatal: Severe GI bleeding; nephrotoxicity;
Potentially Fatal: Severe GI bleeding; nephrotoxicity;
blood dyscrasias.
Drugs used for Rheumatoid Arthritis
Category: Not Classified
pregnancy_description
pregnancy_description
Aceclofenac, a phenylacetic acid derivative, has
antiinflammatory and analgesic properties. It is a
potent inhibitor of cyclo-oxygenase which is
involved in the production of prostaglandins.
May increase plasma concentrations of lithium
and digoxin. Increased nephrotoxicity when used
with diuretics or ciclosporin. Monitor serum potassium
when used with potassium-sparing diuretics and ACE
inhibitors. May enhance activity of anticoagulants. May
increase risk of methotrexate toxicity when administered
within 24 hr of methotrexate admin. Increased risk of GI
bleed with other NSAIDs. Increased risk of
convulsion with quinolones.
Per Unit Price: Tk. 4.02
Package: 100's pack
Package: 100's pack
Naproxen:
Brand name:Sonap(square),Naprox(SKF)
Naprosyn(radiant),Napryn(Healthcare),Napro-A(ACME)
preparation:
Tablet: 250mg & 500mg
Gel : 10% gel
Adults
Oral:
Pain
500 mg PO initially, then 250 mg PO q6-8hr or
500 mg PO q12hr PRN; not to exceed 1250 mg/day
Oral:
Pain
500 mg PO initially, then 250 mg PO q6-8hr or
500 mg PO q12hr PRN; not to exceed 1250 mg/day
naproxen base on day 1; subsequent daily doses
should not exceed 1000 mg naproxen base
Extended release: 750-1000 mg PO qDay; may
Extended release: 750-1000 mg PO qDay; may
temporarily increase to 1500 mg/day if tolerated
well and clinically indicated
Rheumatoid Arthritis, Osteoarthritis,
Rheumatoid Arthritis, Osteoarthritis,
Ankylosing Spondylitis
500-1000 mg/day PO divided q12hr; may
500-1000 mg/day PO divided q12hr; may
increase to 1500 mg/day if tolerated well
for limited time
Extended release: 750-1000 mg PO qDay;
Extended release: 750-1000 mg PO qDay;
may temporarily increase to 1500 mg/day
if tolerated well and clinically indicated
Dysmenorrhea
500 mg PO initially, then 250 mg PO q6-8hr or
Dysmenorrhea
500 mg PO initially, then 250 mg PO q6-8hr or
500 mg PO q12hr (long-acting formula); not to
exceed 1250 mg/day on first day; subsequent
doses should not exceed 1000 mg/day naproxen base
Gout, Acute
750 mg PO initially, followed by 250 mg q8hr until
Gout, Acute
750 mg PO initially, followed by 250 mg q8hr until
attack subsides
Extended release: 1000-1500 mg qDay, followed by
Extended release: 1000-1500 mg qDay, followed by
1000 mg qDay until attack subsides
Pain
>12 years
500 mg PO initially, then 250 mg PO q6-8hr or 500 mg PO
>12 years
500 mg PO initially, then 250 mg PO q6-8hr or 500 mg PO
q12hr PRN; not to exceed 1250 mg/day naproxen base on
day 1; subsequent daily doses should not exceed 1000 mg
naproxen base
Extended release: 750-1000 mg PO qDay; may temporarily
Extended release: 750-1000 mg PO qDay; may temporarily
increase to 1500 mg/day if tolerated well and clinically indicated
Juvenile Idiopathic Arthritis
>2 years: 10 mg/kg/day oral suspension PO divided q12hr;
Juvenile Idiopathic Arthritis
>2 years: 10 mg/kg/day oral suspension PO divided q12hr;
not to exceed 15 mg/kg/day
Renal impairment: CrCl <30 mL/min: Use not recommended
Severe: Contraindicated.
Severe: Contraindicated.
Should be taken with food.
Rheumatoid arthritis, Ankylosing spondylitis, Post-operative pain,
Dysmenorrhea, Acute gout, Acute migraine attacks, Renal colic,
Mild to moderate pain, Tendonitis, Osteoarthritis (degenerative arthritis),
Acute musculoskeletal disorders, Bursitis
Hypersensitivity. Aspirin or NSAID allergy. Perioperative pain in the
setting of CABG surgery. Pregnancy (3rd trimester).
1-10%
Abdominal pain (3-9%),Constipation (3-9%),Dizziness (3-9%),
Abdominal pain (3-9%),Constipation (3-9%),Dizziness (3-9%),
Drowsiness (3-9%),Headache (3-9%),Heartburn (3-9%),Nausea
(3-9%),Edema (3-9%),GI bleeding (1-4%),GI perforation (1-4%),
Lightneadedness (<3%),GI ulcers (1-4%),Fluid retention (3-9%),
Diarrhea (1-3%),Stomatitis (<3%),Diverticulitis (1-3%),Dyspnea
(3-9%),Hearing disturbances (<3%)
<1%
Meaningful (3 × upper limit of normal) elevation of serum alanine
<1%
Meaningful (3 × upper limit of normal) elevation of serum alanine
aminotransferase or aspartate aminotransferase
Drugs used for Rheumatoid Arthritis
Category: Not Classified
pregnancy_description
pregnancy_description
Naproxen, a propionic acid derivative, is a prototypical NSAID.
It reversibly inhibits the cyclooxygenase-1 and -2 (COX-1 and -2)
enzymes, thus resulting in reduced synthesis of prostaglandin
precursors. It can inhibit platelet aggregation, has anti-inflammatory,
analgesic and antipyretic actions.
May enhance methotrexate toxicity. Reduced BP response to ACE
inhibitors or angiotensin II receptor antagonists. Increased risk of
serious GI events (e.g. ulcer) w/ aspirin. Increased risk of GI
bleeding w/ warfarin. May reduce the natriuretic effects of
furosemide or thiazide diuretics. May increase serum lithium
concentrations and reduce renal lithium clearance. Delaye
absorption w/ antacids, colestyramine or sucralfate.
May interfere w/ the antihypertensive effects of beta-blockers
(e.g. propranolol). May increase serum levels w/ probenecid.
Per Unit Price: Tk. 4.03
Package: 100's pack
Package: 100's pack
Pethidine Hydrochloride:
Brand name: G-pathedine(gono)
Preparation: 100mg/2ml
Parenteral
Moderate to severe acute pain
Adult: 25-100 mg IM/SC inj or 25-50 mg by slow
Moderate to severe acute pain
Adult: 25-100 mg IM/SC inj or 25-50 mg by slow
IV inj repeated after 4 hr.
Obstetric analgesia
Adult: 50-100 mg by IM/SC inj as soon as contractions
Obstetric analgesia
Adult: 50-100 mg by IM/SC inj as soon as contractions
occur at regular intervals; repeat after 1-3 hr if needed.
Max: 400 mg in 24 hr.
As a preoperative medication
Adult: 25-100 mg IM/SC given 1 hr before surgery.
Postoperative pain
Adult: 25-100 mg IM/SC inj every 2-3 hr if necessary.
Intravenous
Adjunct to anaesthesia
Adult: 10-25 mg by slow IV inj.
Hepatic impairment: Dose reductions may be necessary.
Max: 400 mg in 24 hr.
As a preoperative medication
Adult: 25-100 mg IM/SC given 1 hr before surgery.
Postoperative pain
Adult: 25-100 mg IM/SC inj every 2-3 hr if necessary.
Intravenous
Adjunct to anaesthesia
Adult: 10-25 mg by slow IV inj.
Hepatic impairment: Dose reductions may be necessary.
Parenteral
Moderate to severe acute pain
Child:
SC/IM:
2 mth to 12 yr: 0.5-2 mg/kg;
12-18 yr: 20-100 mg. Repeat dose every 4-6 hr if needed.
IV inj: Neonates and children >12 yr: 0.5-1 mg/kg IV inj
Moderate to severe acute pain
Child:
SC/IM:
2 mth to 12 yr: 0.5-2 mg/kg;
12-18 yr: 20-100 mg. Repeat dose every 4-6 hr if needed.
IV inj: Neonates and children >12 yr: 0.5-1 mg/kg IV inj
every 10-12 hr if needed in those up to 2 mth and
every 4-6 hr if needed in older children.
12-18 yr: 25-50 mg every 4-6 hr if needed.
Alternatively, >1 mth: Loading dose: 1 mg/kg by IV
12-18 yr: 25-50 mg every 4-6 hr if needed.
Alternatively, >1 mth: Loading dose: 1 mg/kg by IV
inj followed by 100-400 mcg/kg/hr via continuous IV
infusion adjusted according to response.
As a preoperative medication
Child: 1-2 mg/kg given IM 1 hr before surgery.
Postoperative pain
Child: 0.5-2 mg/kg IM every 2-3 hr if necessary.
As a preoperative medication
Child: 1-2 mg/kg given IM 1 hr before surgery.
Postoperative pain
Child: 0.5-2 mg/kg IM every 2-3 hr if necessary.
Renal impairment: Dose reductions may be necessary.
Reconstitution: Dilute with water for inj to a
concentration of 5-10 mg/ml.
Anaesthesia, Postoperative pain, Moderate to
severe acute pain, Obstetric analgesia
Hypersensitivity.
Hypotension; fatigue, drowsiness, dizziness, nervousness,
headache, restlessness, malaise, confusion, depression,
hallucinations, tremors, muscle twitches, increased intracranial
pressure, seizure, serotonin syndrome; rash, urticaria; nausea,
vomiting, constipation, anorexia, stomach cramps, xerostomia,
biliary spasm, paralytic ileus, sphincter of Oddi spasm; ureteral
spasms, decreased urination; pain at inj site; weakness; dyspnoea;
histamine release, physical and psychological dependence.
Opioid Analgesics
Category: B
pregnancy_description
pregnancy_description
Pethidine is a phenylpiperidine derivative opioid analgesic.
It acts mainly as mu-receptor agonist. Like most, opioid analgesics,
it mimics endogenous opioids by activating opioid receptors in the
central and peripheral nervous system. It reduces the release of
neurotransmitter substances and also reduces the activity of
postsynaptic neurons in the spinal cord thus preventing transmission
of pain impulse.
Increased pethidine metabolite levels with aciclovir, cimetidine, ritonavir.
Reduced analgesic effects with phenytoin, barbiturates. Additive sedative
and/or respiratory depressive effects with alcohol, barbiturates,
benzodiazepines, phenothiazines, TCAs, other CNS depressants.
Potentially Fatal: Increased risk of serotonin syndrome with MAOIs
(not be given concurrently or within 14 days of their discontinuation),
serotonin agonists, serotonin reuptake inhibitors, sibutramine, TCAs.
Per Unit Price: Tk. 99.45
Package: 2ml amp x 5's pack
Package: 2ml amp x 5's pack
Nalbuphine Hydrochloride:
Brand name: Nalbun-1/2(incepta)
Preparation: 10mg/ml ,20mg/ml
Parenteral
Moderate to severe pain
Adult: IM/IV/SC: 10-20 mg 3-6 hrly as required.
Non-opioid-tolerant patients:
Moderate to severe pain
Adult: IM/IV/SC: 10-20 mg 3-6 hrly as required.
Non-opioid-tolerant patients:
Max single dose: 20 mg. Max daily dose: 160 mg.
Intravenous
Adjunct in balanced anaesthesia
Adult: Induction: 0.3-3 mg/kg over 10-15 min.
Maintenance: 0.25-0.5 mg/kg as single admin
Intravenous
Adjunct in balanced anaesthesia
Adult: Induction: 0.3-3 mg/kg over 10-15 min.
Maintenance: 0.25-0.5 mg/kg as single admin
if required.
Hepatic impairment: Caution; dose reduction
Hepatic impairment: Caution; dose reduction
may be necessary; monitor
Pain
<1 year: Safety and efficacy not established
>1 year: 0.1-0.2 mg/kg IV/IM/SC q3-4hr PRN; individual
<1 year: Safety and efficacy not established
>1 year: 0.1-0.2 mg/kg IV/IM/SC q3-4hr PRN; individual
dose not to exceed 20 mg; not to exceed 160 mg/day
Renal impairment: Caution; dose reduction may be
necessary; monitor
IV Administration
Administer each 10 mg by IV push over 3-5 minutes
Administer each 10 mg by IV push over 3-5 minutes
Moderate to severe pain, Pain associated with MI, Balanced
anaesthesia
Hypersensitivity. Absolute: Diarrhea associated with toxins,
pseudomembranous colitis, respiratory depression (<12 beats/min)
Acute asthma, bradycardia, inflammatory bowel disease,
Acute asthma, bradycardia, inflammatory bowel disease,
respiratory impairment
>10%
Sedation (36%)
1-10%
Clamminess (9%),Nausea and vomiting (6%),Dizziness (5%),
Sedation (36%)
1-10%
Clamminess (9%),Nausea and vomiting (6%),Dizziness (5%),
Xerostomia (4%),Headache (3%)
<1%
Asthma,Bradycardia,Burning,Dyspnea,Hypertension,Hypotension,
<1%
Asthma,Bradycardia,Burning,Dyspnea,Hypertension,Hypotension,
Itching,Miosis,Pulmonary edema,Respiratory depression,
Tachycardia,Urticaria,Vertigo
Potentially Fatal: Anaphylactic or anaphylactoid and other
Potentially Fatal: Anaphylactic or anaphylactoid and other
serious hypersensitivity reactions e.g. shock, respiratory distress,
respiratory arrest, bradycardia, cardiac arrest, hypotension,
laryngeal oedema.
Opioid analgesics
Category: Not Classified
pregnancy_description
pregnancy_description
Nalbuphine is a phenanthrene derivative opioid analgesic
with mixed opioid agonist and antagonist activity. It inhibits
the ascending pain pathways, altering the perception of and
response to pain by binding to opiate receptors in the CNS.
It also produces generalised CNS depression.
Additive CNS depressant effects may occur with other CNS
depressants e.g. alcohol, anaesthetics, anxiolytics,
hypnotics, TCAs and antipsychotics.
Per Unit Price: Tk. 60
Package: 5 's pack
Package: 5 's pack
Aspirin:
Brand name:Carva(square),Ecospirin(ACME)
Solrin(opsonin)
PO
Prophylaxis of myocardial infarction
Adult: 75-300 mg once daily. Lower
Prophylaxis of myocardial infarction
Adult: 75-300 mg once daily. Lower
doses should be used in patients
receiving ACE inhibitors.
Stent implantation
Adult: 300 mg 2 hr before procedure
Stent implantation
Adult: 300 mg 2 hr before procedure
followed by 150-300 mg/day thereafter.
Mild to moderate pain and fever
Adult: 150-300 mg repeated every 4-6 hr
Mild to moderate pain and fever
Adult: 150-300 mg repeated every 4-6 hr
according to response. Max: 4 g/day.
Pain and inflammation associated with
Pain and inflammation associated with
musculoskeletal and joint disorders
Adult: Initial: 2.4-3.6 g/day in divided doses.
Adult: Initial: 2.4-3.6 g/day in divided doses.
Usual maintenance: 3.6-5.4 g/day. Monitor
serum concentrations.
Hepatic impairment: Severe liver disease:
Hepatic impairment: Severe liver disease:
Not recommended
PO
Juvenile rheumatoid arthritis
Child: <25 kg: 60-100 mg/kg/day PO divided q6-8hr
Juvenile rheumatoid arthritis
Child: <25 kg: 60-100 mg/kg/day PO divided q6-8hr
(maintain serum salicylate at 150-300 mcg/mL)
>25 kg: 2.4-3.6 g/day
Pain & Fever
<12 years
10-15 mg/kg PO q4hr, up to 60-80 mg/kg/day
>25 kg: 2.4-3.6 g/day
Pain & Fever
<12 years
10-15 mg/kg PO q4hr, up to 60-80 mg/kg/day
Renal impairment
CrCl >10 mL/min: Dose adjustment not necessary
CrCl <10 mL/min: Not recommended
CrCl >10 mL/min: Dose adjustment not necessary
CrCl <10 mL/min: Not recommended
Should be taken with food.
Fever, Headache, Pain/inflammation, Acute coronary
syndrome, TIA, MI, Stroke
Hypersensitivity (attacks of asthma, angioedema, urticaria
or rhinitis), active peptic ulceration; pregnancy (3rd trimester),
children <12 yr, patients with haemophilia or haemorrhagic
disorders, gout, severe renal or hepatic impairment, lactation.
GI disturbances; prolonged bleeding time, rhinitis, urticaria and
epigastric discomfort; angioedema, salicylism, tinnitus; bronchospasm.
Potentially Fatal: Gastric erosion, ulceration and bleeding; severe,
Potentially Fatal: Gastric erosion, ulceration and bleeding; severe,
occasionally fatal exacerbation of airway obstruction in asthma;
Reye's syndrome (children <12 yr). Hepatotoxicity; CNS depression
which may lead to coma; CV collapse and resp failure; paroxysmal
bronchospasm and dyspnoea.
Anti-platelet drugs
Category: Not Classified
pregnancy_description
pregnancy_description
Aspirin is an analgesic, anti-inflammatory and antipyretic. It inhibits
cyclooxygenase, which is responsible for the synthesis of prostaglandin
and thromboxane. It also inhibits platelet aggregation.
Alcohol, corticosteroids, analgin, phenylbutazone and oxyphenbutazone
may increase risk of GI ulceration. Aspirin increases phenytoin levels.
May antagonize actions of uricosurics and spironolactone. Potentially
Fatal: May potentiate effects of anticoagulants, methotrexate and oral
hypoglycaemics.
Per Unit Price: Tk. 0.5
Package: 100's pack
Package: 100's pack
Etoricoxib:
Brand name: Etorix(SKF),Tory(square)Danilo(healthcare)
Preparation: 60mg/90mg/120mg
Oral
Osteoarthritis
Adult: 30 mg once daily, increased to 60 mg
Osteoarthritis
Adult: 30 mg once daily, increased to 60 mg
once daily if needed.
Ankylosing spondylitis; Rheumatoid arthritis
Adult: 90 mg once daily.
Acute gout
Adult: 120 mg once daily. Max duration: 8 days.
Hepatic impairment: Mild (Child-Pugh score of 5-6):
Ankylosing spondylitis; Rheumatoid arthritis
Adult: 90 mg once daily.
Acute gout
Adult: 120 mg once daily. Max duration: 8 days.
Hepatic impairment: Mild (Child-Pugh score of 5-6):
60 mg once daily.
Moderate (Child-Pugh 7-9): Max 60 mg every other
Moderate (Child-Pugh 7-9): Max 60 mg every other
day or 30 mg once daily.
Severe (Child-Pugh >10): Avoid.
Severe (Child-Pugh >10): Avoid.
Child: <16 yr Contraindicated.
May be taken with or without food.
Rheumatoid arthritis, Osteoarthritis, Gout
Inflammatory bowel disease, severe congestive
heart failure, active peptic ulceration, cerebrovascular
disease, CrCL <30 ml/min; lactation. Children and
adolescent < 16 yr.
GI disorders; ischemic cardiac events; hypersensitivity reactions,
headache, dizziness, nervousness, depression, drowsiness,
insomnia, vertigo, tinnitus, photosensitivity; blood disorders,
fluid retention, hypertension; dry mouth, taste disturbance,
mouth ulcers; appetite and wt changes; chest pain, fatigue,
paraesthesia, influenza-like syndrome, myalgia. Renal toxicity.
Non-steroidal Anti-inflammatory Drugs (NSAIDs)
Category: Not Classified
pregnancy_description
pregnancy_description
Etoricoxib is a selective cyclooxygenase-2 (COX-2) inhibitor primarily
responsible to reduce mediators of pain and inflammation. Its action is
due to inhibition of prostaglandin synthesis via inhibition of COX-2.
May increase INR w/ oral anticoagulants. May decrease effects of
ACE inhibitors, angiotensin II antagonist and diuretics. May increase
lithium plasma concentrations. May reduce plasma levels w/ rifampicin.
Increased serum concentrations of ethinylestradiol.
Per Unit Price: Tk. 14
Package: 30's pack
Package: 30's pack
Ibuprofen;
Brand name: Inflam(synovia),Flamex(ACI),
Preparation: 200 & 400 mg
Pain/Fever/Dysmenorrhea
200-400 mg PO q4-6hr; not to exceed 1.2 g
200-400 mg PO q4-6hr; not to exceed 1.2 g
unless directed by physician
Inflammatory Disease
400-800 mg PO q6-8hr; not to exceed 3.2 g/day
Osteoarthritis, Rheumatoid Arthritis
300 mg, 400 mg, 600 mg, or 800 mg PO q6-8hr;
Inflammatory Disease
400-800 mg PO q6-8hr; not to exceed 3.2 g/day
Osteoarthritis, Rheumatoid Arthritis
300 mg, 400 mg, 600 mg, or 800 mg PO q6-8hr;
not to exceed 3.2 g/day
Severe hepatic impairment: Avoid use
Severe hepatic impairment: Avoid use
Fever
6 months to 12 years
5-10 mg/kg/dose PO q6-8hr; not to
6 months to 12 years
5-10 mg/kg/dose PO q6-8hr; not to
exceed 40 mg/kg/day
Pain
4-10 mg/kg/dose PO q6-8hr; not to
Pain
4-10 mg/kg/dose PO q6-8hr; not to
exceed 40 mg/kg/day
Juvenile Idiopathic Arthritis
30-50 mg/kg/24hr PO divided q8hr;
Juvenile Idiopathic Arthritis
30-50 mg/kg/24hr PO divided q8hr;
not to exceed 2.4 g/day
Significantly impaired renal function:
Monitor closely; consider reduced dosage if warranted
Should be taken with food.
Rheumatoid arthritis, Osteoarthritis, Pain,
Fever, Pericarditis, Dysmenorrhea, Patent
ductus arteriosus, Inflammation, Musculoskeletal
and joint disorders
Active peptic ulcer; hypersensitivity. Neonates with
congenital heart disease, suspected necrotising
enterocolitis and active bleeding (parenteral).
1-10%
Dizziness (3-9%),Epigastric pain (3-9%),Heartburn (3-9%),
Dizziness (3-9%),Epigastric pain (3-9%),Heartburn (3-9%),
Constipation (1-3%),Nausea (3-9%),Rash (3-9%),Tinnitus
(3-9%),Edema (1-3%),Fluid retention (1-3%),Headache
(1-3%),Vomiting (1-3%)
<1%
Acute renal failure (sometimes with acute tubular necrosis or
<1%
Acute renal failure (sometimes with acute tubular necrosis or
hyperkalemia, polyuria, azotemia, cystitis, hematuria,
decreased creatinine clearance, elevations in blood urea
nitrogen (BUN) or creatinine without other manifestations
of renal failure)
Agranulocytosis,Aplastic anemia,Erythema multiforme,
Agranulocytosis,Aplastic anemia,Erythema multiforme,
Erythematous macular rashes,Exfoliative dermatitis,
Hemolytic anemia (with or without positive direct antiglobulin
test results),Neutropenia,Thrombocytopenia (with or without
purpura),Toxic epidermal necrolysis (Lyell syndrome) and
photosensitivity reactions
Potentially Fatal: Severe CV thrombotic events. Severe
Potentially Fatal: Severe CV thrombotic events. Severe
GI bleeding, ulceration and perforation.
Drugs used for Rheumatoid Arthritis
Category: Not Classified
pregnancy_description
pregnancy_description
Ibuprofen inhibits synthesis of prostaglandins in body
tissues by inhibiting cyclooxygenase-1 and 2. It has
anti-inflammatory, analgesic and antipyretic properties.
Increased risk of GI bleeding w/ warfarin, corticosteroids,
SSRIs and aspirin. May reduce the natriuretic effects of
diuretics. Reduced antihypertensive effect of ACE inhibitors
and angiotensin II receptor antagonists. May increase toxicity
of lithium and methotrexate. Increased nephrotoxicity w/
ciclosporin and tacrolimus.
Per Unit Price: Tk. 1.43
Package: 50's pack
Package: 50's pack
Indomethacin:
Brand name: Indomet(opsonin),Imet(pacific)
Preparation:
Capsule: 75mg ,25 mg
Suppository: 100mg
Oral
Inflammatory/Rheumatoid Disorders
Immediate release: 25-50 mg PO q8-12hr;
Inflammatory/Rheumatoid Disorders
Immediate release: 25-50 mg PO q8-12hr;
not to exceed 200 mg/day
Extended release: 75-150 mg/day PO in single
Extended release: 75-150 mg/day PO in single
daily dose or divided q12hr; not to
exceed 150 mg/day
Bursitis/Tendinitis
Immediate-release: 75-150 mg/day
Bursitis/Tendinitis
Immediate-release: 75-150 mg/day
PO divided q6-8hr
Extended-release: 75-150 mg/day PO in
Extended-release: 75-150 mg/day PO in
single daily dose or divided q12hr
Acute Gouty Arthritis
50 mg PO q8hr for 3-5 days; reduced once
Acute Gouty Arthritis
50 mg PO q8hr for 3-5 days; reduced once
pain is under control
Rectal
Pain and inflammation associated with
Rectal
Pain and inflammation associated with
musculoskeletal and joint disorders
Adult: As supp: 100 mg to be inserted at
Adult: As supp: 100 mg to be inserted at
night and repeated in the morning if necessary.
Inflammatory/Rheumatoid Disorders
<2 years: Safety and efficacy not established
2-14 years: 1-2 mg/kg/day PO divided q6-12hr;
<2 years: Safety and efficacy not established
2-14 years: 1-2 mg/kg/day PO divided q6-12hr;
not to exceed 4 mg/kg/day or 150-200 mg/day
>14 years: 25-50 mg IR PO q8-12hr; not to
>14 years: 25-50 mg IR PO q8-12hr; not to
exceed 200 mg/day;
75-150 mg/day ER PO in single daily dose or
75-150 mg/day ER PO in single daily dose or
divided q12hr; not to exceed 150 mg/day
Take with food to avoid gastrointestinal (GI) effects
Rheumatoid arthritis, ankylosing spondylitis, and
osteoarthritis (degenerative joint disease), gout,
acute non-articular rheumatism
(bursitis, synovitis, tendinitis).
Indomethacin is contraindicated in patients
with ulcer, gastritis, active ulcerative colitis, and
should be used with caution in patients with a
history of these disorders. It is also contraindicated
in previously hypersensitive patient.
>10%
Transient renal insufficiency (40%),Jaundice (<15%),
Transient renal insufficiency (40%),Jaundice (<15%),
Elevated liver function test values (≤15%),Headache (12%)
1-10%
Dizziness (3-9%),Dyspepsia (3-9%),Epigastric
1-10%
Dizziness (3-9%),Dyspepsia (3-9%),Epigastric
pain (3-9%),Indigestion (3-9%),Nausea (3-9%)
Symptomatic upper GI ulcers, gross bleeding/perforation
Symptomatic upper GI ulcers, gross bleeding/perforation
(4% of patients treated for 1 year; 1% of
patients treated for 3-6 months).
Abnormal pain/cramps/distress (<3%),Constipation
Abnormal pain/cramps/distress (<3%),Constipation
(1-3%),Depression (1-3%),Diarrhea (1-3%),Fatigue
(1-3%),Somnolence (1-3%),Tinnitus (1-3%),Vertigo (1-3%)
<1%
Acute interstitial nephritis with hematuria/proteinuria,
<1%
Acute interstitial nephritis with hematuria/proteinuria,
Acute respiratory distress,Agranulocytosis,Angioedema,
Aplastic anemia,Asthma,Bone marrow depression,
Congestive heart failure (CHF),Hemolytic anemia,
Leukopenia,Macular and morbilliform eruptions,Pulmonary
edema,Thrombocytopenia,Thrombocytopenic purpura,
Ulcerative stomatitis,Urticaria
Drugs used for Rheumatoid Arthritis
Category: C
pregnancy_description
pregnancy_description
Indometacin, an indole acetic acid derivative has anti-inflammatory,
analgesic and antipyretic actions. It reversibly inhibits
cyclooxygenase-1 and -2 (COX-1 and -2) enzymes, thus
resulting in reduced synthesis of prostaglandin precursors.
May increase plasma levels of methotrexate. Increased risk
of GI bleeding w/ warfarin. May reduce hypotensive effects of
hydralazine, furosemide, ?-blockers (e.g. atenolol, propranolol,
oxprenolol), or thiazide diuretics. Increased risk of hyperkalaemia
w/ K-sparing diuretics, ACE inhibitors, K supplements. May
increase nephrotoxic effects of ciclosporin or triamterene.
Increase plasma concentration w/ probenecid. May increase
plasma levels of aminoglycoside (e.g. amikacin, gentamicin) in
premature neonates. May enhance antipsychotic effect (e.g.
severe drowsiness and confusion) of haloperidol. Al- or
Mg-containing antacids may reduce GI disorders of indometacin.
Potentially Fatal: Diflunisal decreases renal clearance and
increases plasma concentrations of indometacin which leads
to fatal GI haemorrhage.
Per Unit Price: Tk. 0.5
Package: 100's pack
Package: 100's pack
Mefenamic Acid:
Brand name:Dysmen(Renata),Myfocin(incepta)
Fenamic(beximco)
Preparation:
Tablet: 250 mg ,500mg
Syrup: 50mg/5ml
Oral
Rheumatoid arthritis; Mild to moderate pain; Dental pain;
Rheumatoid arthritis; Mild to moderate pain; Dental pain;
Postoperative pain; Dysmenorrhoea; Osteoarthritis; Menorrhagia
Adult: 250-500 mg upto 3 times daily for 3-7 days. Max. 1.5 gm total.
Adult: 250-500 mg upto 3 times daily for 3-7 days. Max. 1.5 gm total.
Oral
Rheumatoid arthritis; Mild to moderate pain; Dental pain; Postoperative
Rheumatoid arthritis; Mild to moderate pain; Dental pain; Postoperative
pain; Dysmenorrhoea; Osteoarthritis; Menorrhagia
Child: >6 mth 25 mg/kg daily in divided doses for up to 7 days.
Child: >6 mth 25 mg/kg daily in divided doses for up to 7 days.
Should be taken with food.
Rheumatoid arthritis, Osteoarthritis, Dysmenorrhoea, Menorrhagia, Dental pain,
Pain and inflammation, Mild to moderate pain, Postoperative pain
Hypersensitivity to mefenamic acid, aspirin or other NSAIDs. Patient w/
inflammatory bowel disease, active ulceration or chronic inflammation of
the upper or lower GI tract, renal failure. History of asthma, urticaria,
allergic-type reactions. Treatment of perioperative pain in the setting of
CABG surgery, pregnancy (3rd trimester), lactation. Coronary artery
bypass graft surgery, severe renal impairment, severe heart failure.
>10%
Borderline elevations of one or more LFTs (<15%)
1-10%
Abdominal pain,Anorexia,Diarrhea,Nausea,Pyrosis,Gastritis,Flatulence,
Borderline elevations of one or more LFTs (<15%)
1-10%
Abdominal pain,Anorexia,Diarrhea,Nausea,Pyrosis,Gastritis,Flatulence,
Constipation,Steatorrhea,Upper GI ulcers, gross bleeding/perforation
(1% of patients treated for 3-6 mth and 2-4% of those treated for 1 yo)
<1%
Leukopenia,Eosinophilia,Thrombocytopenic purpura,Agranulocytosis,
<1%
Leukopenia,Eosinophilia,Thrombocytopenic purpura,Agranulocytosis,
Pancytopenia,Bone marrow hypoplasia,Renal failure (including papillary
necrosis & acute interstitial nephritis),Acute interstitial nephritis has been
associated with hematuria, proteinuria, & nephrotic syndrome
Potentially Fatal: Autoimmune haemolytic anaemia; convulsions (overdosage).
Potentially Fatal: Autoimmune haemolytic anaemia; convulsions (overdosage).
Drugs used for Rheumatoid Arthritis
Category: Not Classified
pregnancy_description
pregnancy_description
Mefenamic acid, an anthranilic acid derivative, is a prototypical NSAID.
It reversibly inhibits the cyclooxygenase-1 and -2 (COX-1 and -2) enzymes,
thus resulting in reduced synthesis of prostaglandin precursors.
It has analgesic and antipyretic properties w/ minor anti-inflammatory activity.
Concomitant use w/ CYP2C9 isoenzyme inhibitors may alter safety and efficacy
of mefenamic acid. May enhance methotrexate toxicity. Reduced BP response
to ACE inhibitors or angiotensin II receptor antagonists. Increased risk of serious
GI events w/ aspirin. May reduce the natriuretic effects of furosemide or thiazide
diuretics. Reduced renal lithium clearance and elevated plasma lithium levels.
May enhance anticoagulant effect of warfarin.
Per Unit Price: Tk. 2.8
Package: 100's pack
Package: 100's pack
Sulindac:
Brand name:sudac(drug int),Lindac(popular)
Preparation: 100mg/200mg
Oral
Ankylosing spondylitis; Osteoarthritis;
Ankylosing spondylitis; Osteoarthritis;
Rheumatoid arthritis
Adult: For symptomatic treatment:
Adult: For symptomatic treatment:
150 mg bid; may adjust subsequent
doses based on response. Max: 400 mg/day.
Acute painful shoulder
Adult: For symptomatic treatment: 200 mg bid;
Acute painful shoulder
Adult: For symptomatic treatment: 200 mg bid;
may reduce dose after satisfactory response achieved.
Max: 400 mg/day. Treatment duration: 7-14 days is
usually adequate.
Acute gouty arthritis
Adult: For symptomatic treatment: 200 mg bid; may
Acute gouty arthritis
Adult: For symptomatic treatment: 200 mg bid; may
reduce dose after satisfactory response achieved.
Max: 400 mg/day. Treatment duration: 7 days is
usually adequate.
Hepatic impairment: Acute and chronic hepatic disease:
Hepatic impairment: Acute and chronic hepatic disease:
May need dosage reduction.
Safety & efficacy not established
Renal impairment: May need dosage reduction. Not
recommended in severe renal impairment.
Should be taken with food.
Rheumatoid arthritis, Osteoarthritis, Acute gouty arthritis,
Ankylosing spondylitis, Acute painful shoulder
Hypersensitivity. Pregnancy (3rd trimester), treatment of
peri-operative pain in CABG surgery .
1-10%
GI pain (10%),Constipation (3-9%),Diarrhea (3-9%),Dizziness
GI pain (10%),Constipation (3-9%),Diarrhea (3-9%),Dizziness
(3-9%),Dyspepsia (3-9%),Headache (3-9%),Nausea (3-9%),
Rash (3-9%),Abdominal cramps (1-3%),Anorexia (1-3%),Edema
(1-3%),Nervousness (1-3%),Pruritus (1-3%),
Tinnitus (1-3%),Vomiting (1-3%)
<1%
Hypersensitivity reactions,Thrombocytopenia,Ecchymosis,
<1%
Hypersensitivity reactions,Thrombocytopenia,Ecchymosis,
Purpura,Leukopenia,Agranulocytosis,Neutropenia,Bone
marrow depression,CHF (<1%),Hematuria (<1%),Renal
impairment (including renal failure),Interstitial nephritis,
Nephrotic syndrome
Potentially Fatal: Anaphylaxis reactions; cross-sensitivity
Potentially Fatal: Anaphylaxis reactions; cross-sensitivity
reactions in patients with known aspirin triad reactions;
Steven-Johnson Syndrome and toxic epidermal necrolysis.
Drugs used in Gout
Category: C
pregnancy_description
pregnancy_description
Sulindac is a prodrug which undergoes reversible reduction to
its active sulfide metabolites. It inhibits prostaglandin synthesis
by decreasing cyclooxygenase activity.
Concomittent use with dimethyl sulfoxide may result in peripheral
neuropathy. Increased nephrotoxicity with ciclosporin; increased risk
of methotrexate toxicity; increased risk of bleeding with other NSAIDs,
warfarin and thrombolytic agents. Antagonises effect of antihypertensives.
Unpredictable interactions with lithium.
Per Unit Price: Tk. 5
Package: 50's pack
Package: 50's pack
Tolfenamic Acid:
Brand name: Tufnil 200mg(SKF),Anilic(drug int)
Preparation: 200mg tablet
Oral
Acute migraine attacks
Adult: 200 mg when 1st symptoms appear,
Acute migraine attacks
Adult: 200 mg when 1st symptoms appear,
may be repeated after 1-2 hr, if necessary.
Mild to moderate pain
Adult: 100-200 mg tid.
Hepatic impairment: Severe: Avoid.
Mild to moderate pain
Adult: 100-200 mg tid.
Hepatic impairment: Severe: Avoid.
Renal impairment: Severe: Avoid.
Should be taken with food. Take w/ or immediately
after meals.
Mild to moderate pain, Acute migraine attacks
Hypersensitivity to aspirin or other NSAID. Active or history
of GI bleeding or ulceration, severe heart failure, history of
GI bleeding or perforation related to previous NSAID therapy.
Severe renal and hepatic impairment. Pregnancy (3rd trimester).
Dysuria esp in males; tremor, euphoria, fatigue, pulmonary infiltration,
nausea, vomiting, diarrhoea, flatulence, constipation, dyspepsia,
abdominal pain, melaena, haematemesis, ulcerative stomatitis,
exacerbation of Crohn's disease and colitis, gastritis, pancreatitis;
oedema, HTN, cardiac failure; nephritis, hepatitis, jaundice,
abnormal liver function; visual disturbances, optic neuritis,
headache, paraesthesia, depression, confusion, hallucinations,
tinnitus, vertigo, tremor, dizziness, malaise, drowsiness;
thrombocytopenia, neutropenia, agranulocytosis, anaemia.
Potentially Fatal: Exfoliative dermatitis, Stevens-Johnson syndrome,
Potentially Fatal: Exfoliative dermatitis, Stevens-Johnson syndrome,
toxic epidermal necrolysis; GI bleeding, ulceration or perforation.
Other drugs for migraine
Category: Not Classified
pregnancy_description
pregnancy_description
Tolfenamic acid, an anthranilic acid derivative, is an NSAID.
It has anti-inflammatory, analgesic and antipyretic effects.
Increased rate of absorption of tolfenamic acid with metoclopramide and
magnesium hydroxide. Decreased rate of absorption of tolfenamic acid
with aluminium hydroxide. Increased risk of bleeding with anticoagulants
and other NSAIDs. Decreased antihypertensive response to loop diuretics,
?-blockers and ACE inhibitors. Coadmin increased plasma concentrations
of lithium, methotrexate and cardiac glycosides. Increased risk of nephrotoxicity
with ACE inhibitors, ciclosporin, tacrolimus or diuretics.
Per Unit Price: Tk. 10
Package: 40's pack
Package: 40's pack