Medgyl

Manufacturer	Medhaus
Distributor	Medhaus
Contents	Metronidazole
Indications	Treatment of susceptible protozoal infections eg amoebiasis, balantidiasis, Blastocystis hominis infections, giardiasis & trichomoniasis. It has also been tried in leishmaniasis & microsporidiosis.
Dosage	Adult 400-800 mg tid for 5-10 days. Childn 7-10 yr 35-50 mg/kg body wt/day in divided doses, 3 yr 1/3 adult dose, 1-3 yr ¼ adult dose.
Administration	susp:Should be taken on an empty stomach (Take at least 1 hr before meals.); tab:Should be taken with food.
Contraindications	Lactation.
Special Precautions	Patients w/ blood dyscrasias or w/ active disease of the CNS, severe liver disease. Avoid prolonged use. Discontinue treatment if peripheral neuropathy or CNS toxicity occur. Pregnancy, esp 1st trimester.
Adverse Drug Reactions	GI disturbances, headache, anorexia, vomiting, diarrhea, dry mouth, furred tongue, glossitis & stomatitis. Weakness, dizziness, ataxia, drowsiness, insomnia & mood changes, depression or confusion. Temporary moderate leukopenia, urethral discomfort, darkening of urine.
Pregnancy Category (US FDA)	Category B: Either animal-reproduction studies have not demonstrated a foetal risk but there are no controlled studies in pregnant women or animal-reproduction studies have shown an adverse effect (other than a decrease in fertility) that was not confirmed in controlled studies in women in the 1st trimester (and there is no evidence of a risk in later trimesters). http://www.mims.com/Philippines/drug/info/Medgyl/?q=Other%20Antiprotozoal%20Agents&type=brief

pentamidine isetionate

Indication & Dosage	Parenteral African trypanosomiasis Adult: For early stage infection due to Trypanosomabrucei gambiense: 4 mg/kg daily or on alternate days by IM inj or IV infusion for a total of 7-10 doses. Not effective for trypanosomiasis involving CNS but 2 doses may be given in late-stage infection prior to starting treatment with eflornithine or melarsoprol. Child: 1 mth- 18 yr: 4 mg/kg daily or on alternate days by IM inj or IV infusion; total of 7-10 doses. Renal impairment: Dose adjustment may be needed. Intramuscular Leishmaniasis Adult: For visceral leishmaniasis or mucocutaneous leishmaniasis due to Leishmanis braziliensis or L. aethiopica: 4 mg/kg 3 times wkly for 5-25 wk or longer. Alternative treatment: for visceral leishmaniasis: 3-4 mg/kg on alternate days up to a max of 10 inj, may repeat course; for cutaneous leishmaniasis due to L. aethiopica or L. guyanensis: 3-4 mg/kg 1-2 times wkly until resolution of the condition; for diffuse cutaneous leishmaniasis due to L. aethiopica: 3-4 mg/kg wkly, continue for at least 4 mth after parasites are no longer detectable on skin smears. Child: 1 mth-18 yr: For visceral leishmaniasis: 3-4 mg/kg on alternate days; max: 10 inj; may repeat course if necessary. Dose to be given via deep IM inj. For cutaneous leishmaniasis: 3-4 mg/kg 1-2 times wkly until condition resolves. Renal impairment: Dose adjustment may be needed. Parenteral Pneumocystis (carinii) jiroveci pneumonia Adult: 4 mg/kg once daily for 14 days or longer, by IM inj or preferably slow IV infusion. Child: 1 mth-18 yr: 4 mg/kg once daily for at least 14 days. CrCl (ml/min) Dosage Recommendation 10-50 Administer dose every 24-36 hr. <10 Administer dose every 48 hr. Inhalation Prophylaxis of Pneumocystis(carinii) jiroveci pneumonia Adult: In HIV-positive patients: 300 mg once every 4 wk. For patients who cannot tolerate this dose: 150 mg every 2 wk. Child: 1 mth- 18 yr: 300 mg every 4 wk or 150 mg every 2 wk via suitable nebuliser. CrCl (ml/min) Dosage Recommendation 10-50 Administer dose every 24-36 hr. <10 Administer dose every 48 hr. Inhalation Mild to moderate P. (carinii) jirovecii infection Adult: 600 mg daily for 3 wk via nebulisation. Child: 1 mth-18 yr: 600 mg once daily for 3 wk. For secondary prevention: 300 mg every 4 wk or 150 mg every 2 wk. Renal impairment: Dose adjustment may be needed. Reconstitution: Reconstitute: 600mg in 6 ml of water. Incompatibility: Reconstituted solutions must not be mixed with anything apart from water for inj, 5% glucose or 0.9% sodium chloride. Should not be mixed with other drugs or be administered with a bronchodilator in the same nebuliser.
Overdosage	Symptoms: cardiac rhythm disorders, including torsades de pointes. Treatment: symptomatic.
Special Precautions	History of asthma, smoking, hypokalaemia, hypomagnesaemia, coronary heart disease, bradycardia, history of ventricular arrhythmias, concomitant use with other drugs which prolong QT interval (if QTc interval >550 msec: consider alternative therapy), hypertension or hypotension, hyperglycaemia or hypoglycaemia, leucopenia, thrombocytopenia, anaemia, hepatic and renal impairment. Patients at risk of pneumothorax with nebulised therapy. Pregnancy and lactation. Patients should remain supine during admin due to risk of severe hypotension following admin. Monitor: BP, hepatic and renal function, blood-glucose and serum-calcium concentrations, blood counts and ECG. Direct IV inj should be avoided where possible and given slowly (at least 60-120 min); IM inj should be deep and administered in the buttocks.
Adverse Drug Reactions	Impaired renal function, acute renal failure, raised liver enzymes and haematological disturbances eg, leucopenia, anaemia, thrombocytopenia. Hypoglycaemia followed by hyperglycaemia and type 1 DM; acute pancreatitis. IM/IV: Sudden hypotension. IV (rapid injection): Dizziness, headache, vomiting, breathlessness, tachycardia and fainting. IM: Pain, swelling, rhabdomyolysis, sterile abscess formation and tissue necrosis at site of inj. Inhalation: Cough and bronchoconstriction; bitter taste. Hypocalcaemia, hyperkalaemia, skin rashes, fever, flushing, convulsions, hallucinations, GI effects e.g., nausea, vomiting, taste disturbances, abdominal pain and anorexia. Potentially Fatal: Cardiac arrhythmias, sudden hypotension; hypoglycaemia; pancreatitis; Stevens-Johnson syndrome, nephrotoxicity (in up to 25% of patients with pneumocystis pneumonia receiving parenteral treatment).
Drug Interactions	Increases risk of ventricular arrhythmias with amiodarone or levacetylmethadol. Increases risk of hypocalcaemia with foscarnet. Nephrotoxic drugs e.g. amphotericin B; increased risk of CNS depression and hypoglycaemic aggravation with alcohol; aminoglutethimide, carbamazepine, phenytoin, rifampicin may decrease levels of pentamidine; omeprazole, delavirdine, fluconazole, fluvoxamine, gemfibrozil, isoniazid, ticlopidine may increase levels of pentamidine. Potentially Fatal: Increased risk of QT interval prolongation with phenothiazines, TCAs, terfenadine, astemizole, IV erythromycin, halofantrine and quinolone antibiotics.
Storage	Intramuscular: Before reconstitution: protect from light and keep at room temperature (do not refrigerate as crystals may form); once reconstituted: store at 2-8 °C and use within 24 hr. Parenteral: Before reconstitution: protect from light and keep at room temperature (do not refrigerate as crystals may form); once reconstituted: store at 2-8 °C and use within 24 hr.
Mechanism of Action	Pentamidine isetionate inhibits oxidative phosphorylation and interferes with nucleotides and nucleic acid incorporation into the DNA/RNA, thus interfering with DNA/RNA, phospholipids and protein synthesis of susceptible protozoa. Absorption: IM: Absorbed well; inhalation: Limited systemic absorption. Distribution: IV: rapid (except to lung). Volume of distribution greater after IM administration. Excretion: Elimination half life: IV: 6 hr; IM: 9 hr (may be prolonged in renal impairment; excretion via urine (33-66% as unchanged drug). http://www.mims.com/Philippines/drug/info/pentamidine%20isetionate/?type=full&mtype=generic#Dosage

paromomycin

Indication & Dosage	Oral Tapeworm infections Adult: 1 g every 15 minutes for 4 doses. For cestodiasis caused by Hymenolepis nana: 45 mg/kg daily, given as a single dose for 5-7 days. Child: For infections caused by D. latum, D. caninum, T. saginata or T. solium: 11 mg/kg every 15 min for 4 doses. For infections caused by H. nana: 45 mg/kg/day, given as a single dose for 5-7 days. Oral Cryptosporidiosis Adult: In AIDS patients: 1.5-2.25 g/day in 3-6 divided doses for 10-14 days (courses up to 4-8 wk may be needed). Oral Giardiasis Adult: 25-35 mg/kg/day in 3 divided doses for 7 days. Child: 25-35 mg/kg/day tid for 7 days. Oral Dientamoeba fragilis infections Adult: 25-35 mg/kg/day in 3 divided doses for 7 days. Child: 25-35 mg/kg/day tid for 7 days. Oral Hepatic encephalopathy Adult: Adjunct in the management of hepatic coma: 4 g daily in divided doses for 5-6 days. Oral Amoebiasis Adult: Caused by Entamoeba histolytica: 25-35 mg/kg/day in 3 divided doses for 5-10 days. Child: 25-35 mg/kg/day tid for 5-10 days. Intramuscular Visceral leishmaniasis Adult: 11-20 mg/kg/day for 10-21 days. Topical/Cutaneous Cutaneous leishmaniasis Adult: Paromomycin sulfate 15% and methylbenzethonium chloride 12% in white petrolatum: Apply bid for 10-20 days.
Administration	Should be taken with food. (Take during meals.)
Overdosage	Nausea, vomiting, diarrhoea. Care is supportive and symptomatic.
Contraindications	Intestinal obstruction.
Special Precautions	Renal impairment; ulcerative lesions of the bowel to avoid renal toxicity through inadvertent absorption. Prolonged use may result in fungal or bacterial superinfection. Pregnancy. Do not use alone in the treatment of extraintestinal amoebiasis.
Adverse Drug Reactions	Diarrhoea, abdominal cramps, nausea, vomiting, heartburn. Rarely: Headache, vertigo, exanthema, rash, pruritus, steatorrhoea, secondary enterocolitis, eosinophilia, ototoxicity.
Drug Interactions	Decreased effect of digoxin, vitamin A, and methotrexate; increased effect of oral anticoagulants, neuromuscular blockers, and polypeptide antibiotics.
Food Interaction	Malabsorption of xylose, sucrose, and fats.
Pregnancy Category (US FDA)	Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.
Storage	Intramuscular: Store at 15-30°C. Protect from moisture. Oral: Store at 15-30°C. Protect from moisture. Topical/Cutaneous: Store at 15-30°C. Protect from moisture.
Mechanism of Action	Paromomycin is an aminoglycoside antibiotic with antibacterial and antiprotozoal activity. It is a luminal or contact amoebicide since it acts primarily in the intestinal lumen. It is direct-acting, and is effective either in the presence or absence of bacteria. Paromomycin is bactericidal and inhibits protein synthesis in susceptible bacteria at the 30S ribosomal unit. Absorption: Poorly from the GI tract. Rapidly following IM inj; peak plasma concentrations achieved within 1 hr. Excretion: Via faeces (100% as unchanged drug); any absorbed drug via urine.http://www.mims.com/Philippines/drug/info/paromomycin/?type=full&mtype=generic#Dosage

miltefosine

Indication & Dosage	Oral Visceral leishmaniasis Adult: 100-150 mg daily for 28 days. Topical/Cutaneous Mycosis fungoides Adult: 6% solution applied 1-2 times daily. Topical/Cutaneous Skin metastases of breast cancer Adult: 6% solution applied 1-2 times daily.
Contraindications	Pregnancy, lactation, concurrent radiation therapy.
Special Precautions	Metastases grown over breast implants.
Adverse Drug Reactions	Oral: leukocytosis; thrombocytosis; GI irritation, nausea, vomiting, diarrhoea, constipation; ocular, hepatic, renal toxicity. Topical: pruritis; erythema; scaling; xerosis; tightness of the skin; dermatitis; pain; ulceration; necrosis.
Mechanism of Action	Miltefosine is a phospholipid derivative thought to work by disrupting cell-membrane function.

Anti-Infectives (Systemic)

furazolidone

Indication & Dosage

Oral Giardiasis, Cholera Adult: 100 mg 4 times daily. Usual duration: 2-5 days, up to 7 days in some patients or 10 days for giardiasis. Child: 1.25 mg/kg 4 times daily, usually given for 2-5 days or up to 10 days for giardiasis.

Administration

Should be taken with food. (Avoid food & beverage containing tyramine or tryptophan, eg alcohol, beer (incl alcohol-free beer), cheese, yoghurt. See lit for complete list.)

Contraindications

Hypersensitivity, infants <1 mth. Alcohol.

Special Precautions

Pregnancy, lactation, G6PD deficiency.

Adverse Drug Reactions

Hypersensitivity, hypoglycaemia, orthostatic hypotension, dizziness, drowsiness, headache, malaise, nausea, vomiting, rash, fever, arthralgia, brown urine, haemolytic anaemia. Potentially Fatal: Agranulocytosis. Hypertensive crisis with MAOIs.

Drug Interactions

Disulfiram-like reaction with alcohol. Potential hypertensive crisis with sympathomimetics, tyramine-containing foods, levodopa. Potentially Fatal: Potentiation of MAOIs. Toxic psychosis with amitriptyline.

Food Interaction

Reaction with foods rich in tyramine.

Pregnancy Category (US FDA)

Category C: Either studies in animals have revealed adverse effects on the foetus (teratogenic or embryocidal or other) and there are no controlled studies in women or studies in women and animals are not available. Drugs should be given only if the potential benefit justifies the potential risk to the foetus.

Mechanism of Action

Furazolidone has a broad antibacterial spectrum which is active against susceptible organisms including E. coli, staphylococci, Giardia sp. and against salmonella, shigella, proteus, and V. cholerae. Its bactericidal action is by interfering with bacterial enzyme systems. Absorption: Poor (oral). Excretion: Urine (as active drug and metabolites).http://www.mims.com/Philippines/drug/info/furazolidone/?type=full&mtype=generic#Dosage