M Tadalafil

Indications pulmonary arterial hypertension erectile dysfunction (section 7.4.5) Cautions hypotension (avoid if systolic blood pressure below 90 mmHg) aortic and mitral valve disease pericardial constriction congestive cardiomyopathy left ventricular dysfunction life-threatening arrhythmias coronary artery disease uncontrolled hypertension pulmonary veno-occlusive disease predisposition to priapism anatomical deformation of the penis hereditary degenerative retinal disorders interactions...

M Oxprenolol Hydrochloride

Indications see under Dose Cautions see under Propranolol Hydrochloride Contra-indications see under Propranolol Hydro-chloride Hepatic impairment reduce dose Pregnancy see notes above Breast-feeding see notes above Side-effects see under Propranolol Hydrochloride Dose Hypertension, 80-160 mg daily in 2-3 divided doses, increased as required max. 320 mg daily Angina, 80-160 mg daily in 2-3 divided doses max. 320mg daily Arrhythmias, 40-240 mg daily in 2-3 divided doses max. 240 mg daily Anxiety...

Drugs affecting biliary composition and flow

The use of laparoscopic cholecystectomy and of endoscopic biliary techniques has limited the place of the bile acid ursodeoxycholic acid in gallstone disease. Ursodeoxycholic acid is suitable for patients with unimpaired gall bladder function, small or medium-sized radiolu-cent stones, and whose mild symptoms are not amenable to other treatment it should be used cautiously in those with liver disease (but see below). Patients should be given dietary advice (including avoidance of excessive...

Recommended regimens for Helicobacter pylori eradication in adults

400 mg twice daily 400 mg twice daily and either amoxicillin or metronidazole can be used. However, if a patient has been treated with metronid-azole for other infections, a regimen containing a proton pump inhibitor, amoxicillin and clarithromycin is preferred for initial therapy. If a patient has been treated with a macrolide for other infections, a regimen containing a proton pump inhibitor, amoxicillin and metronid-azole is preferred for initial therapy. These regimens eradicate H. pylori...

Doxazosin

Indications hypertension (see notes above) benign prostatic hyperplasia (section 7.4.1) Cautions care with initial dose (postural hypotension) pulmonary oedema due to aortic or mitral stenosis cataract surgery (risk of intra-operative floppy iris syndrome) heart failure interactions Appendix 1 (alpha-blockers) Driving May affect performance of skilled tasks e.g. driving Contra-indications history of hypotension mono- therapy in overflow bladder or anuria Hepatic impairment use with caution...

Minoxidil

Indications severe hypertension, in addition to a diuretic and a beta-blocker Cautions see notes above angina after myocardial infarction (until stabilised) lower doses in dialysis patients acute porphyria (section 9.8.2) interactions Appendix 1 (vasodilator antihypertensives) Contra-indications phaeochromocytoma Renal impairment use with caution in significant impairment Pregnancy avoid possible toxicity including reduced placental perfusion neonatal hirsutism reported Breast-feeding present...

Macrogols

Indications see preparations below Cautions discontinue if symptoms of fluid and electrolyte disturbance see also preparations below Contra-indications intestinal perforation or obstruction, paralytic ileus, severe inflammatory conditions of the intestinal tract (such as Crohn's disease, ulcer-ative colitis, and toxic megacolon), see also preparations below Pregnancy manufacturers advice use only if essential no information available Breast-feeding manufacturers advice use only if essential no...

Laxatives

1.6.5 Bowel cleansing preparations 1.6.6 Peripheral opioid-receptor antagonists Before prescribing laxatives it is important to be sure that the patient is constipated and that the constipation is not secondary to an underlying undiagnosed complaint. It is also important for those who complain of constipation to understand that bowel habit can vary considerably in frequency without doing harm. Some people tend to consider themselves constipated if they do not have a bowel movement each day. A...

Statins

The statins (atorvastatin, fluvastatin, pravastatin, rosuvastatin, and simvastatin) competitively inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase, an enzyme involved in cholesterol synthesis, especially in the liver. Statins are more effective than other lipid-regulating drugs at lowering LDL-cholesterol concentration but they are less effective than the fibrates in reducing triglyceride concentration. However, statins reduce cardiovascular disease events and total mortality...

Calciumchannel blockers

Calcium-channel blockers (less correctly called 'calcium-antagonists') interfere with the inward displacement of calcium ions through the slow channels of active cell membranes. They influence the myocardial cells, the cells within the specialised conducting system of the heart, and the cells of vascular smooth muscle. Thus, myocardial contractility may be reduced, the formation and propagation of electrical impulses within the heart may be depressed, and coronary or systemic vascular tone may...

Nizatidine

Indications see under Dose Cautions see notes above also avoid rapid intravenous injection (risk of arrhythmias and postural hypotension) interactions Appendix 1 (histamine H2-antagonists) and notes above Hepatic impairment manufacturer advises caution Renal impairment use half normal dose if eGFR 20-50mL minute 1.73m2 use one-quarter normal dose if eGFR less than 20mL minute 1.73m2 Pregnancy manufacturer advises avoid unless essential Breast-feeding amount too small to be harmful Side-effects...

M Labetalol Hydrochloride

Indications hypertension (including hypertension in pregnancy, hypertension with angina, and hypertension following acute myocardial infarction) hypertensive crises (see section 2.5) controlled hypotension in anaesthesia Cautions see under Propranolol Hydrochloride interferes with laboratory tests for catecholamines liver damage (see below) Liver damage Severe hepatocellular damage reported after both short-term and long-term treatment. Appropriate laboratory testing needed at first symptom of...

Heart failure

Drug treatment of heart failure associated with a reduced left ventricular ejection fraction (left ventricular systolic dysfunction) is covered below optimal management of heart failure with a preserved left ventricular ejection fraction has not been established The treatment of chronic heart failure aims to relieve symptoms, improve exercise tolerance, reduce the incidence of acute exacerbations, and reduce mortality. An ACE inhibitor, titrated to a 'target dose' (or the maximum tolerated dose...

Mebeverine Hydrochloride

Indications adjunct in gastro-intestinal disorders characterised by smooth muscle spasm Cautions avoid in acute porphyria (section 9.8.2.) Contra-indications paralytic ileus Pregnancy not known to be harmful manufacturers advise caution Side-effects allergic reactions (including rash, urticaria, angioedema) reported ADULT and CHILD over 10 years 135-150mg 3 times daily preferably 20 minutes before meals CHILD under 10 years see BNF for Children 1Mebeverine Hydrochloride (Non-proprietary) A...

M Aspirin antiplatelet

Indications secondary prevention of thrombotic cerebrovascular or cardiovascular disease, and following by-pass surgery (see also section 2.10.1 and notes above) Cautions asthma uncontrolled hypertension previous peptic ulceration (but manufacturers may advise avoidance of low-dose aspirin in history of peptic ulceration) concomitant use of drugs that increase risk of bleeding G6PD deficiency (section 9.1.5) interactions Appendix 1 (aspirin) Contra-indications use other than as an antiplatelet...

Lactulose

Indications constipation (may take up to 48 hours to act), hepatic encephalopathy (portal systemic encephalopathy) Cautions lactose intolerance interactions Appendix 1 (lactulose) Contra-indications galactosaemia, intestinal obstruction Pregnancy not known to be harmful see also Pregnancy, p. 67 Side-effects nausea (can be reduced by administration with water, fruit juice or with meals), vomiting, flatulence, cramps, and abdominal discomfort Dose Lactulose (Non-proprietary) Solution, lactulose...

M Omega3acid Ethyl Esters

Indications adjunct to diet and statin in type IIb or III hypertriglyceridaemia adjunct to diet in type IV hypertriglyceridaemia adjunct in secondary prevention in those who have had a myocardial infarction in the preceding 3 months Cautions haemorrhagic disorders, anticoagulant treatment (bleeding time increased) Hepatic impairment monitor liver function Pregnancy manufacturer advises use only if potential benefit outweighs risk no information available Breast-feeding manufacturer advises...

Adverse reactions

Adverse reactions often present in the elderly in a vague and non-specific fashion. Confusion is often the presenting symptom (caused by almost any of the commonly used drugs). Other common manifestations are constipation (with antimuscarinics and many tranquillisers) and postural hypotension and falls (with diuretics and many psychotropics). Hypnotics Many hypnotics with long half-lives have serious hangover effects, including drowsiness, unsteady gait, slurred speech, and confusion. Hypnotics...

Antacids and simeticone

Antacids (usually containing aluminium or magnesium compounds) can often relieve symptoms in ulcer dyspepsia and in non-erosive gastro-oesophageal reflux (see also section 1.1) they are also sometimes used in functional (non-ulcer) dyspepsia but the evidence of benefit is uncertain. Antacids are best given when symptoms occur or are expected, usually between meals and at bedtime, 4 or more times daily additional doses may be required up to once an hour. Conventional doses e.g. 10 mL 3 or 4...

Isosorbide Mononitrate

Indications prophylaxis of angina adjunct in congestive heart failure Cautions see under Glyceryl Trinitrate Contra-indications see under Glyceryl Trinitrate Hepatic impairment see under Glyceryl Trinitrate Renal impairment see under Glyceryl Trinitrate Pregnancy manufacturers advise avoid unless potential benefit outweighs risk Breast-feeding see under Glyceryl Trinitrate Side-effects see under Glyceryl Trinitrate Dose Initially 20 mg 2-3 times daily or 40 mg twice daily (10 mg twice daily in...

Docusate Sodium

Indications constipation, adjunct in abdominal radiological procedures Cautions see notes above do not give with liquid paraffin rectal preparations not indicated if haemorrhoids or anal fissure Contra-indications see notes above Pregnancy not known to be harmful manufacturer advises caution Breast-feeding present in milk following oral administration manufacturer advises caution rectal administration not known to be harmful Side-effects see notes above Dose By mouth, chronic constipation, up...

Compound haemorrhoidal preparations with corticosteroids

Corticosteroids are often combined with local anaesthetics and soothing agents in preparations for haemorrhoids. They are suitable for occasional short-term use after exclusion of infections, such as herpes simplex prolonged use can cause atrophy of the anal skin. See section 13.4 for general comments on topical corticos-teroids and section 1.7.1 for comment on local anaesthetics. Children Haemorrhoids in children are rare. Treatment is usually symptomatic and the use of a locally applied cream...

Stoma care

Prescribing for patients with stoma calls for special care. The following is a brief account of some of the main points to be borne in mind. Enteric-coated and modified-release preparations are unsuitable, particularly in patients with an ileostomy, as there may not be sufficient release of the active ingredient. Laxatives Enemas and washouts should not be prescribed for patients with an ileostomy as they may cause rapid and severe loss of water and electrolytes. Colostomy patients may suffer...

Heparin

Indications see under Dose Cautions see notes above also elderly concomitant use of drugs that increase risk of bleeding interactions Appendix 1 (heparin) Heparin-induced thrombocytopenia Clinically important heparin-induced thrombocytopenia is immune-mediated and does not usually develop until after 5-10 days it can be complicated by thrombosis. Platelet counts should be measured just before treatment with unfractionated or low molecular weight heparin, and regular monitoring of platelet...

M Glyceryl Trinitrate

Indications anal fissure (section 1.7.4) extravasation (section 10.3) Sublingual prophylaxis and treatment of angina Buccal prophylaxis and treatment of angina adjunct in unstable angina acute and congestive heart failure Injection control of hypertension and myocardial ischaemia during and after cardiac surgery induction of controlled hypotension during surgery congestive heart failure unstable angina Transdermal see under preparations below Cautions hypothyroidism malnutrition hypothermia...

M Bisacodyl

Indications see under Dose Cautions see notes above Contra-indications see notes above, acute surgical abdominal conditions, acute inflammatory bowel disease, severe dehydration Pregnancy see Pregnancy, p. 67 Side-effects see notes above nausea and vomiting colitis also reported suppositories, local irritation Dose Constipation, by mouth, 5-10 mg at night, increased if necessary to max. 20 mg at night CHILD (but see section 1.6) 4-18 years 5-20mg once daily, adjusted according to response By...

Fistulating Crohns disease Treatment may not be

Necessary for simple, asymptomatic perianal fistulas. Metronidazole section 5.1.11 or ciprofloxacin section 5.1.12 can improve symptoms of fistulating Crohn's disease but complete healing occurs rarely unlicensed indication . Metronidazole by mouth is used at a dose of 10-20 mg kg daily in divided doses usual dose 400-500 mg 3 times daily it is usually given for 1 month but no longer than 3 months because of concerns about peripheral neuropathy. Ciprofloxacin by mouth is given at a dose of 500...