GABA-B receptor agonist. Its beneficial effects in spasticity result from actions at spinal and supraspinal sites. Blocks mono-and-polysynaptic reflexes by acting as an inhibitory neurotransmitter, blocking the release of excitatory transmitters.
Spasticity: Start 5 mg orally three times daily, increase every 3 days to 20 mg orally three times daily. Max dose: 20 mg orally four times daily (80mg/day).
Hiccups (unlabeled use): 10-20 mg 2-3 times/day.
Injection (soln) intrathecal [preservative free] (Lioresal®):
50 mcg/mL (1 mL)
500 mcg/mL (20 mL)
2000 mcg/mL (5 mL).
Tablet: 10 mg, 20 mg
- Test dose: 50-100 mcg, doses >50 mcg should be given in 25 mcg increments, separated by 24 hours.
- A screening dose of 25 mcg may be considered in very small patients.
- Patients not responding to screening dose of 100 mcg should not be considered for chronic infusion/implanted pump.
- Maintenance: After positive response to test dose, a maintenance intrathecal infusion can be administered via an implanted intrathecal pump. Initial dose via pump: Infusion at a 24-hourly rate dosed at twice the test dose. Avoid abrupt discontinuation.
Bendroflumethiazide is a thiazide diuretic. These act mainly on the early segment of the distal tubule by inhibiting Na+ and Cl– reabsorption. This leads to increased Na+ and Cl– excretion and therefore increased water secretion.
- Oedema caused by cardiac failure
- Oedema caused by diabetes insipidus
- 5mg and 5mg tablets.
- For oedema
- Initially 5-10mg once daily or on alternative days, dose to be taken in the morning, then maintenance 5-10mg 1-3 times a week.
- For hypertension
- 5 mg daily, dose to be taken in the morning, higher doses are rarely necessary
WARNINGS AND PRECAUTIONS
- Hypersensitivity to Bendroflumethiazide or other sulphonamides
- Hypokalaemia can occur with both thiazide and loop diuretics. The risk of hypokalaemia depends is greater with thiazides than with an equipotent dose of a loop diuretic
- Cirrhosis (risk of development of hepatic encephalopathy)
- Thiazides and related diuretics can exacerbate diabetes, gout, and systemic lupus erythematosus.
- Lower initial doses of diuretics should be used in the elderly because they are particularly susceptible to the side-effects.
- Agranulocytosis, blood disorders, impotence, leucopenia, thrombocytopenia
Penicillins contain a b-lactam ring fused with a thiazolidine ring. Penicillins are bactericidal antibiotics that inhibit cell wall synthesis. When gram-positive bacteria are exposed to b-lactams, growth continues but with reduced cross-linkage of peptidoglycan resulting in weakening of the cell wall and lysis.
- Gram +ve cocci
- Meningococcal infections
- Mild-moderate susceptible infections
- Throat infections
- Otitis Media
- Anthrax (in combination with other antimicrobials)
- Intrapartum prophylaxis against group B streptococcal infection
- 600mg and 1.2g powder for solution for injection vials. Dissolve in at least 8mL of water for injection
By IM, or by slow IV injection, or by intravenous infusion. 0.6–1.2 g every 6 hours, dose may be increased if necessary in more serious infections, single doses over 1.2 g to be given by intravenous route only.
By slow IV injection, or by intravenous infusion. 1.2g every 4 hours, increased if necessary to 2.4g every 4 hours, dose may be increased in infections such as enterococcal endocarditis.
By slow IV injection, or by intravenous infusion. 2.4g every 4 hours.
WARNINGS AND PRECAUTIONS
- Hypersensitivity to Penicillins
- Accumulation of sodium from injection can occur with high doses
- Anaphylaxis, angioedema, diarrhoea, fever, hypersensitivity reactions, joint pains, rashes, serum sickness-like reaction, urticaria
- Cerebral irritation, CNS toxicity (including convulsions), coagulation disorders, encephalopathy, haemolytic anaemia, interstitial nephritis, leucopenia, thrombocytopenia
Bisoprolol is a cardioselective β1-adrenergic blocking agent used for secondary prevention of myocardial infarction (MI), heart failure, angina pectoris and mild to moderate hypertension. Bisoprolol competitively blocks the β1-adrenoceptor thus blocking the activation of the signalling cascade which is normally activated by adrenaline and noradrenaline stimulation. This decreases the adrenergic tone of the heart and pacemaker cell activity.
- Myocardial infarction
- Heart failure
- 25mg, 2.5mg, 3.75mg, 5mg, 7.5mg and 10mg tablet
- 5–10 mg once daily; maximum 20 mg per day.
For adjunct in heart failure
- By Initially 1.25 mg once daily for 1 week, dose to be taken in the morning, then increased if tolerated to 2.5 mg once daily for 1 week, then increased if tolerated to 3.75 mg once daily for 1 week, then increased if tolerated to 5 mg once daily for 4 weeks, then increased if tolerated to 7.5 mg once daily for 4 weeks, then increased if tolerated to 10 mg once daily; maximum 10 mg per day.
WARNINGS AND PRECAUTIONS
- Hypersensitivity to Bisoprolol
- Contraindicated in patients who suffer from bronchospasm
- Contraindicated in: Asthma, cardiogenic shock, hypotension, marked bradycardia, metabolic acidosis, phaeochromocytoma (apart from specific use with alpha-blockers), Prinzmetal’s angina, second-degree AV block, severe peripheral arterial disease, sick sinus syndrome, third-degree AV block, uncontrolled heart failure
- Acute or decompensated heart failure requiring intravenous inotropes, sino-atrial block
- Cramp, depression, muscle weakness
- Dry eyes, hypertriglyceridaemia, hearing impairment, syncope
Section Editor: Dr Paul Efthymiou