Supply:500mg/100ml/Bot(MEDAZOLER), 250mg/Tab(METRODINR)
Use:It has bactericidal, amebicidal and trichomonacidal action, active against most obligately anaerobic bacteria, trichomonas vaginalis, Entamoeba histolytic, Giardia lamblia.
Contraindication:Pregnancy, hypersensitivity, patients with blood dyscrasia, severe hepatic impairement.
Adverse effect:GI discomforts , headache, anorexia, dry mouth, dizziness. vertigo, peripheral neuropathy, reversible leukopenia, skin rash
Usual dosage:For trichomoniasis: PO 2g as a single dose or 250mg TID for 7 days. For amebiasis: adults: PO 750mg TID for 5-10 days; Child: PO 35-50mg/kg/day in 3 divided dose for 5-10 days, maximum dose 2.4g/day. For giardiasis: adults: 250mg TID for 5-7 days, child: 15mg/kg/day in 3 divided dose for 5 days. For anaerobic infection: PO or IV, initial dose 15mg/kg, followed by maintenance dose 7.5mg/kg/Q6H, maximum dose 4g/day.
TINIDAZOLE
Supply:500mg/100ml/Bot(FLUGENR)
Use:Prophylaxis & treatment of post-op anaerobic infection
Contraindication:Blood dyscrasias. Active CNS disease
Adverse effect:Thrombophlebitis; nausea, fatigue, vomiting
Usual dosage:800mg/day by IV infusion
Anthelmintics
MEBENDAZOLE C
Supply:100mg/Tab(VERMOXR)
Use:It is an anthelmintic agent, effect agaisnt threadworm (pinworm) (Enterobius), roundworm(Ascaris), whipworm (Trichuris), hookworms (Ancylostoma and Necator).
Contraindication:Hypersensitivity, and pregnancy.
Adverse effect:Nausea,vomiting, abdominal pain and diarrhea.
Usual dosage:Threadworm: 100mg in a single dose, repeated in 2-3 weeks. Hookworm, whipworm: 100mg BID for 3 days, maximum dose: 200mg/kg/day
ANTINEOPLASTIC AGENTS
CYCLOPHOSPHAMIDE D
Supply:500mg/Vial(SYKLOFOSFAMIDR), 50mg/Tab(ENDOXAN-ASTAR)
Use:Acute leukemia, lymphomas, Hodgkin's disease, endometrial carcinoma, breast cancer, sarcomas.
Contraindication:Hemorrhagic cystitis, diabetes mellitus, renal and hepatic failure.
Adverse effect:Leukopenia, thrombocytopenia, alopecia, cystitis, nausea, vomiting, pulmonary fibrosis, cardiotoxicity, skin rash.
Usual dosage:Initial: IV 2.5mg/kg/day; maintenance: 2.5mg/kg twice week, oral 2.5mg/kg/day.
Stability: Cyclophosphamide 100mg/L or 3.1g/L in D5W, 1.5% or less cyclophosphamide decomposition in 8 hours at 24 to 27 ? or 6 days at 5 ?. Cyclophosphamide 4g/L in Sodium Chloride 0.9%, 3.5% cyclophosphamide decomposition in 24 hours at room temperature and 1% decomposition in 4 weeks under refrigeration.
Special precautions:Patients of reproductive age should use contraceptives throughout therapy & for not <6 mth afterwards.Diabetes melliyus; elderly & debilitated patients; renal & hepatic failure
CISPLATIN D
Supply:0.5mg/ml 10mg/vial(PLATINOLR)
Use:Ovarian carcinoma, squamous cell carcinoma of head and neck, lymphoma.
Contraindication:Patients with renal and hearing impairment.
Adverse effect:Severe nausea, vomiting, renal failure, peripheral neuropathy, ototoxicity, hypomagnesaemia.
Usual dosage:100mg/m2 IV infusion over 12 hours, alternative schedule 20mg/m2/day for 5 days every 3 week for 3 courses, in combination with bleomycin & vinblastine.
Special precautions:Perform audiometric testing & neurologic exam. Momitor peripheral blood counts & liver function
Stability: D5W with cisplatin 50mg/L, reconstituted in sterile water for injection, stated to have a utility time of 8 hours at 25? or 24 hours at 4? in a glass container under fluorescent light. NS with cisplatin 1.25mg/mL is stable for 48 hours in polyvinylchloride containers.
DACARBAZINE C
Supply:200mg/Vial(DTIC-DOMER)
Use:Malignant melanoma, Hodgkin's disease, combine of other antineoplastic agents.
Contraindication:Hypersensitivity to dacarbazine.
Adverse effect:Hemopoietic toxicity, hepatotoxicity, anaphylactic reactions, alopecia, anorexia, nausea, vomiting.
Usual dosage:
1. Recommended Dosage: 2-4.5mg/kg/day IV for 10 days, repeated at 4-week intervals.
2. Alternate recommended Dosage: 250mg/m2/day IV for 5 days, repeated every 3 weeks.
Special precautions:Local pain, burning sensation & irritation at the site of inj may be relieved by locally applied hot packs
Stability: Dacarbazine, reconstituted, may be diluted in D5W (or NS) and may be stored for 72 hours at 4 ? or for 8 hours at 25? and under normal light.
EPIRUBICIN
Supply:10mg/Vial(PHARMORUBICINR)
Use:Breast carcinoma, malignant lymphomas, soft tissue sarcomas, gastric and ovarian carcinomas.
Contraindication:Myelodepression, severe heart disease, previous treatments with maximal cumulative doses of adriamycin or daunoblastin.
Adverse effect:Cardiac toxicity, alopecia, mucositis, gastro-intestinal disorders, hematologic toxicity.
Usual dosage:The recommemded dose for single agent in adult is 75-90mg/m2 body surface, as 3-5 minutes IV injections 3 weekly when compatible with extent bone marrow function.
Special precautions:Liver impairment. Previous extensive radiotherapy. Bone infiltration by tumor
FLUORO-URACIL C
Supply:250mg/5ml/Vial(FLUORO-URACILR)
Use:Antifungal agent, inhibits Cryptococcus neoformans and Candida spp, Phialophora pedrosoi, Phialophora verrucosa, Cladosporium carrionii and Torulopsis glabrata.
Contraindication:Patients with renal or hepatic impairment or blood disorders.
Adverse effect:Bone marrow depression, agranulocytosis, aplastic anemia.
Usual dosage:150 mg/kg/day in 4 divided doses.
Dosage adjustment: according to CrCl (ml/min)
CrCl Dosage Interval
20-40
12.5-37.5 mg/kg
Q12H
10-20
12.5-37.5 mg/kg
Q24H
<10
12.5-37.5 mg/kg
Q24-48H
Special precautions:GI ulceration, bleeding or hemorrhage. DPD deficiency.
FLUTAMIDE D
Supply:250mg/Tab(FUGERELR)
Use:Flutamide is a nonsteroidal nonhormonal antiandrogenic.
Place in therapy: In treating prostate cancer, flutamide compares favorably to DES and leuprolide monotherapy. Flutamide represents a less toxic alternative to DES or surgical orchiectomy and provides additional benefit when used in combination with leuprolide in patients with carcinoma of the prostate and as such will be a useful formulary addition.
Contraindication:Hypersensitivity to flutamide; severe hepatic impairment
Adverse effect:Gynecomastia and galactorrhea are the most frequently reported adverse effects. Other adverse effects include diarrhea, which has resulted in non-compliance, nausea, vomiting and transient serum transaminase elevations.
Usual dosage:250 mg PO TID; Doses of 1.5 g/day have also been effective, without increased toxicity.
Special precautions:Periodic liver function test & sperm count determinations may be considered in patients on long-term treatment
GEMCITABINE HCL D
Supply:200mg/Vial(GEMZARR)
Use:Gemcitabine is a cytotoxic agent structurally related to cytarabine. It can be used in advanced breast cancer, non-small-cell lung cancer, pancreatic carcinoma, and ovarian carcinoma.
Place in therapy: A greater intracellular accumulation of active metabolites is achieved with gemcitabine relative to cytarabine, and it may process superior antitumor activity than cytarabin.
Contraindication:Hypersensitivity to gemcitabine; use carefully in patient with hepatic dysfunction, myelosuppression, pregnancy, renal impairment, and avoid infusion times longer than 60 minutes. Monitor CBC prior to each dose.
Adverse effect:The adverse effects include: myelosuppression (dose limiting), flu-like symptoms (occasionally dose-limiting), fatigue, fever, peripheral edema, proteinuria, cutaneous reactions, and gastrointestinal effects.
Usual dosage:Pancreatic cancer: 1000 mg/m2 IV once weekly for 7 consecutive doses non-small-cell lung cancer: 1000 mg/m2 IV for 3 consecutive doses per cycle
Infusion time more than 30 min may induce further adverse effects. Dosage adjustment according to the mornitoring of the platelet, WBC and agranulocytosis:
Dosage adjustment according to the mornitoring of the platelet, WBC and agranulocytosis
Agranulaocyte (x 106/L)
Platelet count (x 106/L)
% of Total Dose
>1000
And >100000
100
500-1000
Or 50000-100000
75
<500
Or <50000
Hold
Special precautions:Monitor platelet, leukocyte & granulocyte counts. Pregnancy, lactation, child, Impaired renal function or hepatic insufficiency. May impair ability ability to drive or operate machinery
Stability: The reconstituted solution is prepared with 5 ml NS. The maximum concentration of reconstituted solution is 40 mg/ml. The further diluted solution is stable for 24 hours at 15-30?.
IRINOTECAN
Supply:100mg/5ml/Vial(CAMPTOR)
Use:2nd -line treatment for metastatic colorectal cancer in patients failing an established 5-fluorouracil containing treatment regimen
Contraindication:Chronic inflammatory bowel disease &/or bowel obstruction; pregnancy or lactation; bilirubin > 1.5 times the ULN of normal range; severe bone marrow failure; WHO performance status> 2
Adverse effect:Delayed diarrhea, neutropenia; nausea, vomiting; acute cholinergic syndrome; dyspnea, muscle cramp, paresthesia, asthenia; alopecia, constipation, anorexia, abdominal pain, mucositis, cutaneous reactions; allergy, infusion site reaction
Usual dosage:350 mg/m2 , IV over a 30-90 mins period every 3 week.
METHOTREXATE X
Supply:50mg/Vial(METHOTREXATER)
Use:Low dose therapy: choriocarcinoma, lymphotic leukemia, breast carcinoma. High dose therapy: malignant melanoma, osteogenic sarcoma, epidermoid carcinoma of neck and head, small cell carcinoma of lung.
Contraindication:Psoriatic patients with severe renal or hepatic disorder, blood dyscrasia, pregnant women.
Adverse effect:Nausea, vomiting, leukopenia, thrombocytopenia, stomatitis, diarrhoea, hepatic and lung fibrosis.
Usual dosage:2.5-5mg/day or 15-50mg/m2 every 1-2 weeks, IM, IT, PO; 12mg/m2 twice weekly, IT.
Stability: D5W with methotrexate 50mg/L is compatible for 24 hours in glass or polyolefin containers; conditions not specified. Methotrexate 50mg/mL in Sodium Chloride 0.9%, chemically is stable for at least 1 week at 22 to 25?.
MITOMYCIN-C
Supply:2mg/Vial(MITOMYCIN-CR)
Use:Adenocarcinoma of stomach, pancrease, colon and breast; head and neck cancers, advanced biliary ovarian, lung and cervical, squamous cell carcinomas, transitional cell carcinoma of the urinary bladder.
Contraindication:Thrombocytopenia, coagulation disorders.
Adverse effect:Nausea, vomiting, thrombocytopenia, leukopenia, stomatitis, alopecia.
Usual dosage:10mg/m2 IV, every 3-4 weeks.
Special precautions:Monitor patient frequently with lab tests. Infectious disease, bleeding tendency.
Stability: D5W with mitomycin 20 to 40mg/L is stable for 3 hours at room temperature. Mitomycin 40mg/L in NS is reported less than 10% mitomycin loss reported in 24 hours at 25?.
PACLITAXEL D
Supply:30mg/5ml/Vial(TAXOLR)
Use:It can be used in refractory ovarian and breast cancer; activity has also been demonstrated in acute leukemia, lung cancer, malignant melanoma, and a variety of other malignancies.
Place in therapy: Besides overay carcinoma, paclitaxel also has activity against other malignancies, including malignant melanoma and acute leukemia.
Contraindication:1.Previous hypersensitivity to paclitaxel or cremophor EL (polyoxyethylated castor oil). 2.Patients with baseline neutropenia of less than 1500 cells/mm3.
Adverse effect:The major adverse effect is neutropenia. Other adverse effects include hypersensitivity reactions, mucositis, alopecia, neuropathies, myalgias, arthralgias, gastrointestinal disturbances, and arrhythmias.
Usual dosage:Refractory ovarian cancer: 135 mg/m2 over 24 hours repeated every 3 weeks; diluted with D5W, NS to a final concentration of 0.3-1.2 mg/ml before injection. A prophylactic antiallergic regimen of dexamethasone, diphenhydramine, and cimetidine or ranitidine may be used previous injection of praclitaxol.
Stability: Concentrations of 0.3 to 1.2 milligrams/milliliter is stable for 27 hours at 25? in D5W or NS. No Polyvinyl chloride (PVC) container or tubing should be used for a leaching of diethylhexyl phthalate (DEHP) from bags may occur.
Special precautions:Cardiac conduction abnormalities
TAMOXIFEN D
Supply:10mg/Tab(TADEXR)
Use:Advanced breast cancer.
Contraindication:Hypersensitivity to tamoxifen, patients with leukopenia or thrombocytopenia , pregnancy.
Adverse effect:Peripheral edema, reduced hemoglobulin, gynecological problems (vaginal bleeding, menstrual irre-gularities).
Usual dosage:10-20mg BID.
Special precautions:May be given to premenopausal women only after through exam has excluded the possibility of pregnancy.
TOREMIFENE CITRATE D
Supply:60mg/Tab(FARESTONR)
Use:Metastatic breast cancer in postmenopausal patients
Contraindication:Pre-exisiting endometrial hyperplasia, severe hepatic failure.
Adverse effect:Hot flush, sweating, nausea, leucorrhea, dizziness, oedema, pain, vomiting, vag bleeding, fatigue, skin discoloration, insomnia, dyspnea, pruritus, anorexia, reversible cornea, verticillata, asthenia. Thromboembolic events, endometrial hypertrophy
Usual dosage:60 mg daily
Special precautions:Non-compensated cardiac insufficiency, severe angina pectoris, hypercalcaemia, severe thromboembolic disease, hepatic impairment
VINBLASTINE SULFATE D
Supply:10mg /Vial(VINBLASTINER)
Use:Generalized Hodgkin's disease, lymphocytic lymphoma, histocytic lymphoma, mycosis fungoides, advanced carcinoma of the testis, Kaposi's sarcoma, choriocarcinoma, Letterer-Siwe disease, carcinoma of breast.
Contraindication:Patients with leukopenia of bacterial infection, should not be used during the first trimester of pregnancy.
Adverse effect:Nausea, vomiting, constipation, vesiculations of the mouth, ileus, diarrhea, anorexia, abdominal pain, rectal bleeding, pharyngitis, hemorrhagic enterocolitis bleeding, numbness, parethesias, peripheral neuritis, mental depressions, loss of deep tendon reflexes, headache, convulsions, malaise, weakness, dizziness, pain tumor site, vesiculation of skin.
Usual dosage:Adults: IV initially 0.1mg/kg/week, increased by 0.05 mg/kg/week, until falls WBC to 3000/mm3, the tumor regresses or maximal dose of 0.5mg/kg is reached (usually 0.15-0.2mg/kg). Child: IV, 0.1-0.2mg/kg/week or 3-6mg/m2/week.
Stability: D5W or NS with vinblastine 20mg/L is less than 5% vinblastine decomposition in 3 weeks at 4 or 25? in the dark.
Special precautions:Toxicity may be enhanced in the presence of hepatic insufficiency
GYNEOLOGICAL PREPARATIONS
POLICRESULEN
Supply:90mg/Vag.Supp.(ALBOTHYLR)
Use:Local treatment of inflammation or infection and tissus damage of vaginal and cervix (e.g. dischage due to bacterial, trichomonal and fungal infections; pressure sares from pessaries), condylomata acuminata etc.
Contraindication:Concomitant use of other topical agents in treating the affected areas
Adverse effect:Occasionally, mild local discomfort at beginning of treatment which disappears on discontinuation
Usual dosage:1 to be inserted on alternate days
Special precautions:1st trimester of pregnancy. Avoid deep intracervical application of the concentrate
CLOTRIMAZOLE B
Supply:200mg/Vag.Tab(FASTINR)
Use:Clotrimazole is effective against a broad spectrum of fungi. Vaginal clotrimazole 500 mg as a single dose is considered a treatment of choice in uncomplicated vulvovaginal candidiasis
Place in therapy: Due to the elimination of a compliance problem, single-dose clotrimazole vaginal tablets may be a treatment of choice in uncomplicated and possibly recurrent vulvovaginal candidiasis.
Contraindication:Hypersensitivity to clotrimazole; If clotrimazole vaginal treatment fails, appropriate microbiological studies should be done to confirm the diagnosis and rule out other pathogens
Adverse effect:Local irritation and contact dermatitis may occur with topical administration of clotrimazole.
Usual dosage:a single 500-mg intravaginal dose.
CONJUGATDED ESTROGENS
Supply:42.5gm/Vag.Crem(PREMARINR)
Use:Atrophic vaginitis. Post-menopausal atrophic urethritis.
Contraindication:Known or suspected breast cancer, estrogen-dependent neoplasia, active thromboembolic disease, undiagnosed abnormal genital bieeding. Known or suspected pregnancy
Adverse effect:Rarely nausea, vomiting. Breakthrough bleeding, spotting, change in menstrual flow, amenorrhea. Breast tenderness, enlargement, secretion. GI effects, cholestatic jaundice. Chloasma or melasma. Steepening of the cormeal curvature; intolerance to contact lenses. Headache, migraine, dizziness; chorea. Weight changes; edema; changes in libido.
Usual dosage:Intravaginally or topically, 0.5-2 g daily depending on severity of condition. Max: 4g/day. Cyclic administration (3 wk on &1 wk off) should be used
Special precautions:Systemic absorption may occur. Warning & precautions associated with oral Premarin should be considered
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